Chart of the Day: The Wild East is counterfeit central

Economist story:  global seizures of fake drugs way up, and Asia leads the way--by a ways.

No great surprise with LATAM not far behind.

The recently settled frontier economies are naturally environments where counterfeiters shine--the proverbial snake-oil salesman of the American Wild West.

The Economist's warning:  fake drugs have always bedeviled developing countries, but now, because of the new and expanding connectivity between Old and New Core (my terminology), such vulnerabilities are being exported to our neck of the woods.

I will readily admit to this vulnerability:  when we buy Xyzal through a Canadian online pharmacy, sometimes it comes from Britain, sometimes from Mumbai, sometimes from South Africa or Brazil.

As for those drugs made here in America?  A safe bet is that half the ingredients likewise come from New Core economies.

Chart of the Day (4): Trimming the real fat in the U.S. economy

FT full-pager analysis.

The tale of the tape.

We're not way out of proportion (pun intended), but why should we lead on this one?

The weird factoids:  Rich men are more likely to be fat than poor men, but poor women are significantly more likely to be fat than rich women.

So the classic rich couple is the heavy-set man with the thin wife and the classic poor couple is the skinny guy with the chunky wife.

The second chart seems to explain the epidemic:  we've just changed our diet considerably since the 1960s, because when I was growing up, being overweight was really fairly uncommon.  Now, you walk around and its the skinny people who stick out--really a stunning turn in just a couple of generations (1970-2010).  

Gotta believe it can be reversed if it happened that fast.

I recently dropped 20 pounds and it feels great.  The biggest driver for me? I'm just getting bored with food, especially when I travel because so much of it is so tasteless that you just start wondering, "Why bother?"

Stealing from Africa: China's aggressive pursuit of Global Fund health grants

Foreign Policy piece, by way of WPR's Media Roundup, that rightfully accuses China of stealing from Peter (Africa) to pay Paul (it's own interior rural poor) in its aggressive pursuit and winning of "Global Fund to fight AIDS, tuberculosis and  malaria" health grants to the tune of $1B.

Chow points out that China has donated only $16m to the fund over 8 years, compared to $5.5B by the U.S. 

Particularly egregious:  $149m in health grants to battle malaria, when last year China suffered 38 deaths from that disease.

Meanwhile, a lot of African countries with far worse health burdens are getting crumbs compared to China, which ranks #4 in the world for Global Fund grants.

No one says China still doesn't have issues, but with $2.5T in money from the West already in terms of trade-surplus-generated reserve currency holdings, it's hard to argue that China should still be shoving aside more worthy African recipients.

Policing the web: brain burnout for the cops

Interesting NYT story on the mental health toll suffered by people who work for screening companies and monitor the web for depraved content.

Reminds me of that old University of Wisconsin study that my brother participated in when he was a student:  shown loads of graphic and nasty stuff over a lengthy period, he increasingly expressed more ambivalence about it—the toll deadening his normal sense of revulsion.

That profound desensitizing exacts its pound of mental flesh.  In one company, 50 workers review 20m photos a week!  The effect is compared to battle fatigue.

Chinese in the Rear View Mirror May Appear Larger than They Are

FT story on how the West’s diet industry “drools over China’s desire to lose weight.”

Fat Chinese?  Yup.  A stunningly fast outcome of the one-child policy is the supersizing of the “little emperors,” who are supposed to fight over insufficient number of Chinese women WRT marriage AND take care of their parents and grandparents in their old age AND (according to whack-job Western demographers) somehow be willing to join the military and fight overseas wars because of their “surplus” status AND (according to this story) will have to do all these things while fighting their own personal battles of the bulge.

These poor fellows.

Better read Paul French’s book, already out:  “Fat China:  How Expanding Waistlines are Changing a Nation.”

Remember such trends when you scan all these “China will rule the world” tomes and fend off the litany of expert predictions of why we must go to war with China over developing region resources.  China isn’t merely moving up the production scale with speed, it’s likewise moving up the Western scale of social problems with equal speed.

I mean, how many “literate peasants” do you expect will be willing to lay down their lives in overseas adventures for these chubby little emperors back home?  Given China’s loooong history of military adventurism distant from its shores (hmm, where did I put that volume?)?

Many-fat destiny beckons . . . 

Getting hospitals ready for a WMD event

pic here

Bernadine Healy piece in Newsweek catches my eye because of Enterra’s emerging/ongoing work with major hospitals in the NYC area (and now in TX) regarding this very same issue:  how to maximize and coordinate cooperation among major hospitals in the event of WMD terrorism.

Healy cites a Thomas Tallman, head of emergency services at the fabled Cleveland Clinic on 4 key points:

First, hospitals must be ready to respond to any large-scale terrorist attack via robust contingency plans for patient flow (something Enterra works on a lot).

Second, all healthcare workers are trained up on WMD drills and can rely on plans posted throughout the facility.

Third, and most importantly in our minds, “networks of local and regional hospitals have been created to work closely with public authorities so resources can be shared.”  This is what the exercises are for, making everyone aware of and conversant in the network established.

Fourth, the chain of command is clear and practiced ahead of time—another key aspect of exercises, in my experience.

All really basic stuff but hard to achieve in facilities that operate—as a rule—as close to 100% capacity all the time in order to save money.

Healy’s point:  even if you do all four, no plan will survive contact with an actual WMD event, due to the immense complexity.

That’s where Enterra comes in with its focus on rules smart enough to rule themselves and change in response to altered conditions (altered as far as the plans are concerned). 

Bottom line:  your plans have to be reconfigurable on the fly.

India's pharma industry grows up

NYT story on how India's pharma industry is both moving up the ranks and consolidating its position as a low-cost manufacturer. The development recalls Andy Grove's arguments about losing manufacturing and thereby losing the long-term innovation edge. This piece gives you the sense of how hard--if not impossible--it will be to stem such losses in existing mature industries, which says we do best to follow his advice in new industries.

The gist of the piece:

India’s drug industry — on track to grow about 13 percent this year, to just over $24 billion — was once notorious for making cheap knockoffs of Western medicines and selling them in developing countries. But India, seasoned in the basics of medicine making, is now starting to take on a more mainstream role in the global drug industry, as a result of recent strengthening of patent law here and cost pressures on name-brand drug makers in the West.

And while the Indian industry has had quality-control problems, it nonetheless benefits from growing wariness about the reliability of ingredients from that other historically low-cost drug provider — China. The United States is India’s top export customer for drugs.

India is becoming a “base for manufacturing for the global market,” said Ajay G. Piramal, the chairman of Piramal Healthcare, a drug maker based in Mumbai. Eventually, in Mr. Piramal’s perhaps overly optimistic forecast, only the very first and very last steps of the business — molecular drug discovery and marketing — will be run by the West’s global drug giants.

Those companies “don’t create much value” in the steps in between, he said.

It is not only Indian executives, though, who are bullish about the pharmaceuticalsindustry here. Analysts, research groups and consultants have been making similar predictions in recent months.

Big pharmaceutical companies have come calling, too. This year, Mr. Piramal sold his generic drug business to Abbott Laboratories for $3.7 billion, the latest in a string of takeovers and joint ventures here.

Like China, India seeks to move up production chains as rapidly as possible:

The shift to pharmaceuticals is part of a subtle, broader shift in the Indian economy. Moving beyond less sophisticated, outsourced services like telephone call centers, India has been advancing up the business value chain, particularly in law and medical diagnostics. Now it is showing a flair for manufacturing, particularly in goods demanding high-skill production and superlow prices.

Which says we have no alternative but to do the same.

Chart of the day: China shoots up ranks of pharma markets

From FT story on how Japanese pharma Eisai has penetrated China's growing market well before its national competitors.

Reason why is that China is rapidly moving up the ranks from 10th place in 2004 to third, after Japan and the US, by 2014.

Usual bottom-of-the-pyramid reality:

Emerging markets, particularly China, are becoming increasingly important for drugmakers, which have to deal with slowing growth at home.

The big driver in China?  The gov's $125B overhaul of the country's weak health system.

Would you want to know your potential for longevity?

WSJ story on scientists claiming to be able to calculate longevity potential on the basis of studying very old people and discovering "a genetic signature of longevity."

Despite the great complexity of causality here, the lead researcher says "we can compute your specific predisposition to exceptional longevity."  The academic researchers (Boston U) say they have no plans to profit from or patent the technology, and that a test will be made available on the Internet sometime in late July.

People want predictability in all things except the length of their life, where the vast majority prefer ignorance that allows maximum anticipation of possibilities.

There is a distinct difference between those who will die on the low end of the longevity spectrum and the "wellderly" who make it safely to old age and then face the prospect of 2-3 decades more life.

One expert claimed that life insurance policies would be forever altered by such testing capacity, but for now, it requires a several-thousand-dollar layout to have your entire genome profiled.  I guess insurance companies would need to posit their savings to justify the costs either picked up by them and made mandatory for granted coverage or forced upon consumers similarly.

What intrigues me more is the potential for genetic manipulation to "fix" what is missing.  For example:

While a healthy lifestyle is paramount, such genetic factors appear to become more important the longer we live. Indeed, a variation in a single key gene called FOX03A can triple the chances a person may live past 100, researchers at the Pacific Health Research Institute in Hawaii recently reported.

How much would the average person be willing to pay to have FOX03A boosted?

Chart of the day: biotech best Moore's law

From The Economist.

Hard not to expect a serious revolution out of that trend. Economic revolutions follow those in science, and those in science follow those in measurement.

From the article:

The telescope revolutionized astronomy; the microscope, biology; and the spectroscope, chemistry.  The genomic revolution depends on two technological changes.  One, in computing power, is generic--though computer-makers are slavering at the amount of data biology 2.0 will need to process, and the amount of kit that will be needed to do the processing.  This torrent of data, however, is the result of the second technological change that is driving genomics, in the power of DNA sequencing.

The East has fewer qualms about messing with nature

WAPO story on how loose and fast--by our standards--China explores the world of biotechnology.

Centuries after it led the world in technological prowess -- think gunpowder, irrigation and the printed word -- China has barged back into the ranks of the great powers in science. With the brashness of a teenager, in some cases literally, China's scientists and inventors are driving a resurgence in potentially world-changing research.

Unburdened by social and legal constraints common in the West, China's trailblazing scientists are also pushing the limits of ethics and principle as they create a new -- and to many, worrisome -- Wild West in the Far East.

I can't remember if it was captured in PNM or "Blueprint," but I explored this theme years ago in the brief when I'd tell the story of how a genetic therapy for cancer was invented in the U.S. but couldn't get tested for legal reasons. It was thereupon pursued in China, with its looser rule set on such things, and once it was proven out, the Chinese company came to the US to get a patent. That was an eye-opener for me.

Part of it is the difference in philosophy and religion: we have this one-life view of reality but the East is a lot fuzzier on that concept (Buddhism), so it's naturally more relaxed on the subject.

Another reality:  when you're on your way up, you have little regard for the environmental consequences.  In that sense, I've always delighted in Futurama's character of Leo Wong, whose attitude toward the environment is emblematic of a lot of Chinese industrialists right now.  Another good reference:  Daniel Day-Lewis's portrayal of Daniel Plainview in "There will be blood."  Talk about a plain view!

China, with its hundreds of impoverished rural folk, will remain in this "conquering nature at all costs" mindset for a while--or until it gets too expensive. Yes, we'll hear about and see all sorts of efforts to go "green," but even there, you will see corner-cutting bravado that will frighten to no end. 

The rule-set clash heats up on medical pot

 

NYT story on the growing complexity of new rules regarding medical marijuana, with Colorado as ground zero for experimentation.

Opening bit:  don't assume you can get rich quick selling medical pot, because the restrictions are dazzlingly complex.

“You’d never see a law that says, ‘If you want to sell Nike shoes in San Francisco, the shoes have to be made in San Francisco,’ ” says Ms. Respeto, sitting in a tiny office on the second floor of the Farmacy. “But in this industry you get stuff like that all the time.”

As usual, the economics races ahead of the politics, but the politics is struggling to catch up.

One of the odder experiments in the recent history of American capitalism is unfolding here in the Rockies: the country’s first attempt at fully regulating, licensing and taxing a for-profit marijuana trade. In California, medical marijuana dispensary owners work in nonprofit collectives, but the cannabis pioneers of Colorado are free to pocket as much as they can — as long as they stay within the rules.

The catch is that there are a ton of rules, and more are coming in the next few months. The authorities here were initially caught off guard when dispensary mania began last year, after President Obama announced that federal law enforcement officials wouldn’t trouble users and suppliers as long as they complied with state law. In Colorado, where a constitutional amendment legalizing medical marijuana was passed in 2000, hundreds of dispensaries popped up and a startling number of residents turned out to be in “severe pain,” the most popular of eight conditions that can be treated legally with the once-demonized weed.

More than 80,000 people here now have medical marijuana certificates, which are essentially prescriptions, and for months new enrollees have signed up at a rate of roughly 1,000 a day.

As supply met demand, politicians decided that a body of regulations was overdue. The state’s Department of Revenue has spent months conceiving rules for this new industry, ending the reefer-madness phase here in favor of buzz-killing specifics about cultivation, distribution, storage and every other part of the business.

Whether and how this works will be carefully watched far beyond Colorado. The rules here could be a blueprint for the 13 states, as well as the District of Columbia, that have medical marijuana laws.

The rule-set reset unfolds . . .

Today the rat's lung, tomorrow yours

WSJ story on latest in a series of “groundbreaking experiments in the burgeoning field of regenerative medicine,” involving the creation in a lab of lungs for a rat (and I mean a real rat and not some Wall Street banker!).

Described as a “small but tantalizing step,” you have to think that doing this for a rat can’t be all that different than for a human—scale yes, but complexity not so much.  When transplanted into the rates, the lungs exchanged oxygen for CO2 just like they’re supposed to do.

Impressive.

Other labs have already done livers and hearts, to varying degrees of success.

Right now over 100k Americans are on waiting lists for organ transplants (kidneys #1, then livers, then lungs). 

To me, this is the most crucial part of life-extending technologies—not so much the super-extension of a few but the rescuing of a lot of people cut down in the primes and thus allowed to live far longer lives than they otherwise would have been able to.

Finally, some common sense on residents' hours in hospitals

WSJ story on new plan from Accreditation Council for Graduate Medical Education to place limits on the hours worked by residents in hospitals.

Finally!

A 2004 report found that first-year residents working all-night shifts were responsible for half of preventable “adverse events.”

In 2003, the council limited resident work weeks to no more than 80 hours, down from the previous unbelievable norm of 120.  The new guidelines say the youngest residents shouldn’t work more than 16-hour shifts while the more experienced ones can go 24.  The current limit for all is 30 hours.

After the experiences we had with Emily’s long cancer fight in the mid-1990s, I learned to ask any doctor I met on a hospital floor or in an ER how long they had been on the shift, and if anybody said more than 20 hours, then you treated them with kid gloves, because extreme fatigue impairs thinking much like alcohol—you just get stupider with each hour just like with each drink.

Long overdue new rule set.

Rwanda: healthcare on the cheap

NYT story on near-universal healthcare in poor Rwanda.  $2 a year buys it.

Nothing fancy, and yet impact:

Since the insurance, known as health mutuals, rolled out, average life expectancy has risen to 52 from 48, despite a continuing AIDS epidemic, according to Dr. Agnes Binagwaho, permanent secretary of Rwanda’s Ministry of Health. Deaths in childbirth and from malaria are down sharply, she added.

Shows the utility, no matter the level of development.

Doesn't work without some outside money help, and it's hard to get locals to pay in advance, but the larger point is, if it costs something, even if it's not much, people take it a lot more seriously--and use it.

Ella . . . enchanted but protected

WAPO story on the next-generation morning-after contraceptive that's been available in Europe for a while and now looks to hit the street in America as a extending capability to the Plan B product we've already got.  FDA just approved, safety-wise.

Plan B, which works for up to 72 hours after sex, was eventually approved for sale without a prescription, although a doctor's order is required for girls younger than 17. The new drug promises to extend that period to at least 120 hours. Approved in Europe last year, ella is available as an emergency contraceptive in at least 22 countries.

This is a powerful and empowering product for women.  It would be a different world if this were available throughout the Gap, but at least we'll have it here--after the usual fight.

"Cable" comes to the cancer ward

WSJ story describing recent claims by researchers of notable advances in treating cancer, the focus being on targeted therapies that employ advanced genetic-based technologies.

Naturally, all of this is expensive.

This will be a constant theme of the bio-gen revolution that unfolds over coming decades:  the tech will be there, but the question will be one of who gets access.  I expect that access to such medical technologies, especially those involving the significant extension of life, will become the primary human rights struggle of the century.

But what caught my eye here was the following bit:

"Cancer is like cable television," says George Sledge, a breast-cancer expert at Indiana University and newly elected president of the American Society of Clinical Oncology, which hosted the cancer meeting. "Thirty years ago you had three channels. Now you have 500."

The guy's point:  the more we learn and the better we target, the more target-complex becomes the battlespace.  Cancer, over time, will be revealed to be almost as complex and varied as the human experience. Since it is primarily a disease of aging, the longer we extend life, the more we will view it as our primary medical challenge.  For most of us who will enjoy this life-lengthening age, cancer will be less the dead-end and more the accepted right of passage.

But yeah, who plays gatekeeper will be crucial.

Chart of the day: under-five global deaths since 1970

Economist article on public health citing what one Aussie expert calls "undoubtedly the biggest advance in mortality measurement in four decades!"  

This guy, Alan Lopez of Queensland U, presented a study on infant death trends in Washington in late May (later published by Lancet), and the Economist readily excused his hyperbole, because it's a stunning trend.

As the Economist chart showed, everybody was tracking the incredible decline over the past four decades.  What Lopez's work showed was that they were all underestimating the drop.

Setting aside methodological controversies that naturally ensue, along with the fear of charities that such revisions rob them of donations, the real point of this chart is the overwhelming agreement on the curve, with only minor disagreements (to the layman, that is) regarding degrees of steepness.  

You want to sell me that crap that says globalization is bad for the weakest and the poorest on this planet?  Well, infant mortality is a great measure, and there seems to be an amazing correlation between globalization's explosive spread since the early 1970s (when this globalized world was truly born) and the cutting in half--in absolute terms--of infant mortality globally--EVEN AS THE WORLD POPULATION ALMOST DOUBLED FROM 3.6B TO 6.6B!

So factoring in the population growth, babies today are really roughly four times more likely to make to five than those born in 1970.

Put that in your pipe and smoke it.

China, the true heavyweight

artwork here

Bloomberg BusinessWeek snapshot article.

The most immediately visual evidence of China’s one-child policy is the chubby male kid tended to by multiple adults (those two parents and six grandparents) as he waddles down the street. 

When I was in China for the first time (our adoption trip), I almost felt like I was part of some magical character parade in a Miyazaki film (you know, those floating fat spirit characters from “Spirited Away”) because, compared to the Chinese, we Americans were huge.   Most of the guys weighed over 250lbs and most of the women were over 150.  The disparity was stunning.

Until you spotted that overweight “little emperor” be tended to so gently by the doting grandparents.  Thirty percent of Chinese adults are now overweight, and their numbers lean toward the younger ones—the initial products of the one-child policy going back to the early 1980s.  Just six years ago the share was 25%.  The share will keep rising:  40% of Beijing boys are overweight.

In America, roughly 2/3rds of adults are considered overweight.

The story starts with a suitable poster child:  26-yeard-old Shanghai man, 5-9 and 220 lbs.  He remembers being “plied with dumplings, ice cream, and Kentucky Fried Chicken by his parents and grandparents.”  Now he fears an early heart attack.

This is a tricky issue in a country that has as many uninsured people as we’ve got people (300m), thus the gov is spending $125 to get everyone covered by 2020.  Type 2 diabetes numbers now approach 100m and are sure to rocket far higher.

Bottom line:  anybody who does healthcare, weight control, and fitness has a future in China—a very BEEEG future!

This thing is toking off!

WSJ story on pot store boom across Montana, of all places, replete with an uptick in violence surrounding the stores (fire bombs tossed in windows).  One town saw a rise in ER patients using.

DC and 15 states have passed med marijuana bills, but the cities have been left to deal with them, leading to a lot of confusion.

Montana cop on new pot store:  "Before the doors even open, the parking lot has 300 kids throwing Frisbees and playing Hacky-Sack."

Been there and done that.

There are people who really need and absolutely benefit, and then there's the groundswell anticipating decriminalization.

This will not go smoothly, but it is coming.