All posts by Rian

A unanimous triumph of common sense

Pharmacy, ,

Two posts ago:

Arthur Firstenberg says he is highly sensitive to certain types of electric fields, including wireless Internet and cell phones.

“I get chest pain and it doesn’t go away right away,” he said.

Firstenberg and dozens of other electro-sensitive people in Santa Fe claim that putting up Wi-Fi in public places is a violation of the Americans with Disabilities Act.

Result:

The City Council has unanimously approved a plan to provide wireless Internet service in libraries and other city buildings, over the objections of those who say they are electrically sensitive.

That doesn’t mean the legal wrangling is over, however.

Julie Tambourine, an advocate for the disabled and homeless, said after Wednesday’s meeting that the legal analysis was flawed, because it didn’t take into account those with diabetes, seizure disorders, respiratory ailments and other conditions that can be adversely affected by microwave radiation.

These idiots need to read up on the electromagnetic spectrum. Unless they’re going to sit in a lead box all day long with no visible light on a carefully controlled diet, they’re going to be exposed to all kinds of EM radiation, including gamma rays throughout their lifetimes. And even inside that theoretical lead box, there’s no guarantee of being radiation-free.

For further comic value, these people’s minds would explode if they had any idea of how many radio waves pass through their bodies each second. Theoretically, for physiologic purposes, 802.11b+g wi-fi signals (0.124-0.121m wavelength depending on channel) are no different than FM radio signals (~3m wavelength). Common sense would tell you that that’s pretty insignificant.

But since common sense is often wrong, we look to the actual evidence. And the evidence in favor of wifi radiation sensitivity just isn’t there.

Hillary’s superficial plan to “fix” gas prices

Economics, Politics, , , , , ,

It seems that Hillary Clinton wants to tax big oil, but only on their record profits. She would do this to make up the revenue lost while putting the federal gas tax on hold for a while. While I’m sure this is more of a ploy to pander to voters due to her faltering campaign, the whole thing is incredibly superficial for a couple of reasons.

The first is that taxing big oil is only going to shift the cost to consumers. While you might see a temporary drop in prices at the pump, businesses typically shift such burdens on to the consumers. Doing this only makes sense for their bottom line. Beyond this, it will cause an increase in demand, causing prices to rise naturally. But then, Hillary apparently doesn’t care what economists think.

Secondly, there’s the temporary nature of the repeal. Reinstating the tax after it’s been rolled back for a while will be unpopular on an epic scale, but I suppose Hillary is mostly going for a short-term boost to get her through to the November elections. Naturally, I’ve heard nothing about rolling back the tax on big oil’s profits once the federal gas tax would go back into effect. That means that the consumer is going to be doubly hurt in the end anyway.

This leaves big oil’s profits right where they’re at now. Taxing big oil’s profits isn’t the answer — and neither is breaking up the oil monopolies. (Though the latter might not be a bad first step.)

The real problem is that demand has exceeded supply. This is a result of the American way of life. We depend on oil for literally everything: we are a spread out nation of roads where a child’s first thought of freedom = getting their drivers’ license, and whose development has, for generations, been driven by cheap oil. Every aspect of our lives is controlled by the road: everything from our food to our consumer goods arrives via truck. Auto companies have been complicit as well, and in some cases actively undermined attempts to create efficient mass transit systems that were a direct threat to their business model.

This isn’t a problem that can be fixed overnight, nor is it a problem that will be cheap or easy to fix. Comparisons to European nations and Japan with their comprehensive mass transit systems are inherently flawed because of the US’s relatively low population density and sheer size of our country. While effective, efficient mass transit is certainly the answer in urban and larger suburban areas, those systems do not scale well in more rural areas.

In that respect, we will always be a nation of cars — or other personal transport devices[1]. The mantra that we need freedom from foreign oil is trite, and it misses part of the point: we need freedom from petroleum in general, inasmuch as that is economically and techonologically possible. We will always be somewhat dependent on combustible fuels so long as the internal combustion engine is our primary mode of getting from Point A to Point B. (And really, aside from bicycles and our feet, there’s nothing out there that’s as efficient from top to bottom as a modern internal combustion engine.)

So in that respect, even if Hillary’s plan had a prayer of a chance of long-term success, and if she had any ability to get it passed — which she doesn’t because it’s an idea for this summer, not after January — it would be like prescribing a pain med instead of removing the thorn from one’s foot.

The proposal is just astonishingly dumb on every conceivable level.

I do have some related thoughts about the next ten years…

1) We’ll see a small resurgence of the railroad industry. Rail travel is more efficient than air travel, and solves some of the mass transport problems presented by our spread-out nation. This will resemble the current hub-and-spoke airline system in the short term. Business travelers won’t mind taking the train as much due to the ubiquity of wireless internet access and the fact that you can use cellphones while on a train. Trains don’t have to be slow, either. So while you won’t be taking the train from NYC to LA for a one-day affair, you might well take it from Boston to Washington DC for the same.

2) More effective car-pooling systems. Thanks to the Internet, it’s easier to more effectively carpool with folks headed in your direction. This could be supplemented by mass transit systems — buses in the beginning, and trains later on — where people gather at smaller, de-centralized staging areas for a trip into the city. Many suburban areas already have these systems, but there are many, many larger cities that don’t.

3) More and better research into biofuels as a replacement for traditional petroleum. This goes beyond corn-based ethanol which was a failure of epic proportions, as it resulted in increased food prices and is energy-intensive to produce. The graphic below (click for larger) demonstrates some of the more promising alternatives, particularly algae and switch grass.

biofuels comparison chart
(Preserved against link-rot from this article.)

I think America is getting to the point where they’re ready to think about letting go of their precious four-wheeled transportation. Drive by a used car dealership, and you’re likely to see quite a few gas guzzlers sitting on the lot. This alone is anecdotal evidence that the PED of gasoline isn’t zero. A more formal study finds that when the price of fuel goes up and stays up by 10%, the process of adjustment is dynamic and far reaching:

  • The volume of traffic will go down by roundly 1% within about a year, building up to a reduction of about 3% in the longer run (about five years or so).
  • The volume of fuel consumed will go down by about 2.5% within a year, building up to a reduction of over 6% in the longer run.

The reason why fuel consumed goes down by more than the volume of traffic, is probably because price increases trigger more efficient use of fuel (by a combination of technical improvements to vehicles, more fuel conserving driving styles, and driving in easier traffic conditions). So further consequences of the same price increase are:

  • Efficiency of use of fuel goes up by about 1.5% within a year, and around 4% in the longer run.
  • The total number of vehicles owned goes down by less than 1% in the short run, and 2.5% in the longer run.

Prices have certainly gone up by more than 10% in the last 12 months, and the snowballing effect of this phenomenon is that many people of my generation have gotten rid of their cars where and whenever possible, and instead opt for healthier, less expensive modes of transportation: walking or biking. When they need to travel a longer distance, they rent a Zipcar.

I certainly would if it were realistic.

[1] I could see motorbikes becoming more popular, as they are in the UK, as gasoline prices continue to rise. For Americans who have not been to the UK, it is not uncommon to see motorcycles and scooters out and about, even in the rain.

Allergic to WiFi (so let’s sue the city)

Pharmacy, ,

America: where’s it’s your God-given right to sue anyone or anything for whatever the hell you want, no matter how absurd it is.

God bless the tinfoil hat brigade:

Arthur Firstenberg says he is highly sensitive to certain types of electric fields, including wireless Internet and cell phones.

“I get chest pain and it doesn’t go away right away,” he said.

Firstenberg and dozens of other electro-sensitive people in Santa Fe claim that putting up Wi-Fi in public places is a violation of the Americans with Disabilities Act.

Psst, Arthur, this is what we call a somatization disorder.

Sante Fe, the rest of the country is laughing at you.

Quietly influential

Business, Science & Technology, , ,

I chuckle every now and again when I see the MSM reporting on blogs. The usual suspects almost always turn up: TechCrunch, the HuffPo, GigaOM, BuzzMachine — as well as a smattering of the hot blogs du jour. This time it was Steve Rubel’s MicroPersuasion and Passive Aggressive Notes.

I must confess some incredulity, because I have never seen Ars Technica mentioned in a story that focuses specifically on blogs. This despite being relegated to merely a “blog” (albeit acknowledged as an influential one) most of the time by the mainstream media when they reference a story that Ars breaks.

Now, the HuffPo is a huge website. Probably a little bigger than Ars with 5.7M unique readers per month. TechCrunch is markedly smaller, and GigaOM is smaller still (1.37M pageviews/month or so).

It makes me wonder why these particular blogs are chosen. Is it because the stories about blogs are by their nature more noise than substance? Indeed these stories are often widely hyped when they hit and will make their way around the ‘sphere several times before disappearing like yesterday’s newspaper. (The blogosphere echochamber at its finest.) Ars seems to be anti-hype most of the time. It’s been known to take a somewhat dim and sometimes even contrarian view to what’s hot in the blogosphere this week — “The Cloud!“, death by blogging! — if indeed what the blogosphere is focusing on this week is even worth talking about at all. (Usually it’s not.)

So here are some sites that Business Week may want to think about including, because these sites are the real movers and shakers in the Internet publishing world. This list is by no means comprehensive, and I make no comments about their content or quality of the sites, only their size. This list isn’t sorted in any meaningful way:

For comparison, TechCrunch sits at ~7.5M pageviews per month, and Ars Technica sits at ~30M.

Gardasil: DTC advertising via your college bookstore

Pharmacy, , ,

Merck is advertising Gardasil directly to college students that utilize Barnes and Noble’s bkstore.com. For those unfamiliar, bkstore.com has a plugin structure where students log on to their college’s bookstore, choose their class number (e.g. PHRM 328), and their books are loaded up, and you can either pick them up or have them shipped to you. No going to stand in lines or trying to figure out what books you need. One click shopping at it’s most convenient.

So these are college bookstores inadvertently advertising prescription drugs to the entire college population. Well, more accurately, to the population that chooses to have their books shipped to their home, anyway. I don’t know if the bundles that can be picked up have similar advertising info.

Merck’s going about it in a strange way, though. They’re sticking the prescribing information into these boxes. No fancy brochures, just the PI packet, which I find rather bizarre.

I can’t say it doesn’t make sense, or that it’s a terrible idea — I think it’s better than advertising Ambien on television — but it does make me wonder what’s next… Cephalon advertising Provigil to high school and college kids? Med students? Pharmacy students?

Hey, why not?

(No discounts for having advertising in your box of books, either. ;) )

On the Condé Nast Ars Technica acquisition

Business, Science & Technology, , ,

So the hot news in the blogosphere this week has been the acquisition of Ars Technica by Condé Nast. TechCrunch broke the story on Friday, but there was no official word from Ars until yesterday due to an embargo. Anyway, in that time, there has been quite a lot of discussion on the valuation of “blogs” — or the overvaluation thereof, as the thinking in the blogosphere seems to be.

Silicon Valley Insider:

Ars’ 8-person news operation will be folded into Wired Digital, which is run by CondéNet.

This is almost, but not quite, correct. Ars will remain its own brand, and will retain its own staffing. Ars will not be “folded” into Wired, though they will continue to exist under the Wired Digital umbrella (which is turn is owned by CN). In a very real sense, they will be friendly competitors. This is not unlike two newspapers owned by a larger parent company competing with one another in overlapping geographic territories. (A common practice in traditional print media.)

I guess I’m a little bit stuck on calling Ars a “blog”, however. Ars is a news site with real, investigative reporting and thoughtful analysis, longer, multi-page in-depth investigative and explanatory pieces and guides, and has been around since before people had even heard the word “blog”. If anything Ars is a news site and a focused blog network all rolled into a single brand. (As opposed to the old Weblogs, Inc. model where each blog was separate and had its own flavor.) The journals section of the site combines six different journals under one umbrella — each of which has a large enough audience on their own to be considered very successful. Particularly Infinite Loop and Opposable Thumbs.

On the $25 million

There was a collective gasp in the blogosphere over the price commanded by Ars. Frankly, I’m not really sure why. When I first heard the number, I thought it was low, given the amount of traffic that Ars gets, which is different than the traffic that sources that measure such things think.

The usual suspects like Comscore and Alexa are referenced as though they’re absolutes. The truth is that Alexa is horribly inaccurate, as anyone who runs a website with a tech-savvy audience will tell you. (Who do you know that uses the Alexa toolbar?) Nonetheless, these same sites will turn around and quote the stats as though they’re somehow magically more meaningful for another web property. It doesn’t really make a lot of sense if you stop and think about it.

Maroon Ventures:

Some key stats:

  • Purchase Price $25,000,000
  • Monthly Unique Visitors: 1,500,000
  • Monthly Pageviews: 4,000,000

Okay, let’s have some fun. Let’s assume that this acquisition helps set the market price for the internet blog pure play. What it this acquisition telling us?

  • Value of the Monthly Unique User: $16.65/unique
  • Value of the Monthly Pageview: $6.25/pageview

Unfortunately, these numbers aren’t correct, no matter what TechCrunch would have you believe, but to be fair to Chris, Ken hadn’t posted the official word until yesterday. As far as TechCrunch is concerned, more diligent reporting would have led to Federated Media’s information page on Ars for potential advertisers — so they should know better.

Here’s the official word on the acquisition, straight from the horse’s mouth:

We have an amazing community, both in terms of its size (5+ million readers, as tracked privately by Quantcast) and in terms of its contributions (12 million posts, thousands upon thousands of news tips, recommendations, and corrections). Our community is unparalleled, in my not so humble opinion, and it’s a big reason why this year we’re serving more than 30 million page views each month. (I’ve seen lots of folks citing Comscore numbers… they’re horribly, horribly wrong).

Now you might think that the $25 million isn’t so unreasonable. Taking a look at the old Federated Media advertising numbers[1], you can see that Ars commands about $38 per thousand pageviews.

30,000,000 / 1,000 * $38 * 3 ads on each page = $3,420,000

That’s $3.42M per month in advertising revenue that Ars is generating. Yes, FM takes a cut of that, but Ars has other, smaller revenue sources, such as affiliate referal dollars and Ars-branded merchandise for sale, so we’ll call the difference a wash.

Now that’s revenue, not profit. There’re 8 full-time employees, as well as webhosting for the main site, the cost of the CDN (they’ve been using CacheFly to serve all static content), the cost of the discussion forums (currently a hosted solution: groupee’s eve product) as well as several ICs that do web development, CMS development and other technical work for them.

A typical business acquisition is 3-5x annual profit[2], so that means the four main founders (Ken, Jon, Ben Rota, and Panders) were taking in an annual profit of ~$6.25M per year split however they were splitting it.

Final thoughts

I often wonder why such blatantly incorrect numbers are often bandied about when the truth is usually freely available if you look for it. It’s no secret just how many pageviews Ars has been doing: they’re posted on Federated Media’s website for anyone who wants to advertise there. And you can bet your shiny metal ass that they’re accurate — and more likely (*gasp*) conservative. When millions of dollars are changing hands on a monthly basis, there are very accurate accounting measures going to be built in so buyers can have faith that they’re getting what they pay for.

And for those wondering whether Ars is or is not going to jump the shark, I have two thoughts for you:

First, this isn’t the first time Ars Technica has been part of an online network. Early readers of Ars may recall that Ars was once part of the now-defunct Maximum PC network. Then, as now, the larger and more focused you are, the more you command in CPM rates.

Second, having known Jon and Ken since 2000, I can say with a great deal of personal conviction that Ars isn’t going anywhere, and that thing most certainly will change, but they will change because that’s what the guys steering the ship (Ken, Jon, and possibly Eric) want — not because it’s what Condé Nast wants. So if you see something change in the future, you can feel free to continue pointing the finger at the founders, not at Condé Nast. ;)

Footnotes:
[1]I’ve linked to a screenshot because the original FM link will inevitably disappear in the near future as Ars Technica will no longer be outsourcing their advertising to Federated Media.

[2]This will obviously change depending on your industry.

On panic disorder and benzodiazepine use

Pharmacy

I’m taking a class just for fun right now — psychopharmacology — and the discussions that crop up are quite excellent. Many of the students are prescribers in my area, and I fill their scripts on a regular basis. It makes for an interesting, voyeuristic look into their thought processes given some of the case studies. That is, I know who they are, but they don’t know who I am…

This week’s topic is panic disorder and relapse in patients with and without a history of substance abuse. Fun topic, really, and one close to my heart.

Case study:

[You are] working with a 32 year old man who comes to you for an evaluation of panic in August in Lowell. He meets the diagnostic criteria for panic disorder and has been experiencing untriggered episodes for the last 2 months. Name three factors that would guide your selection of medication and then discuss your pharmacologic plan for this unfortunate man.

One of the responses — by a prescriber in my area — was to encourage deep breathing, progressive relaxation, identifying triggers and avoiding the situation, CBT, and starting an SSRI. If panic continues, start a benzo.

This strikes me as fairly typical approach for a primary care provider in dealing with someone who presents during an acute panic attack, but I think that it’s doing the patient a disservice. Perhaps it’s also a typical response for a psychiatrist who is afraid to use benzodiazepines.

I’ll post my response here, verbatim, because I think there’s a deep (and common) misunderstanding of what panic is, and what having a panic attack is like.

It seems like you’re thinking of panic as something that can be gotten out of, as though it’s a normal fight-or-flight type response where removal from a stressful stimulus means no more panic.

This is dangerous thinking, and forgive me if I’ve read you wrong.

It can be harder than perhaps some practitioners think to identify a trigger. While triggers can often be identified, I think it’s important to note that when a patient first presents, and you make a diagnosis of panic disorder, discovering these triggers will be more complex than simply avoiding a stressful situation, or simplifying and eliminating stressors from one’s life. (Which is a very time-consuming process.)

You can’t turn the ship on a dime.

Please don’t fall victim to the idea that because you’ve been scared out of your wits a few times and your heartrate went up and your BP went through the roof that that is a panic attack. It’s not. Panic attacks usually appear in a completely idiopathic manner, particularly the first time they hit. It’s not an “Oh Gee, you scared me,” type of thing, it’s more of a “DEAR GOD I’M DYING, SOMEONE PLEASE DIAL 911” type of thing.* (The caps are appropriate there. ;) )

Panic attacks can, and do hit without any warning in an otherwise comfortable, relaxed setting. Watching a movie in your living room, for example.

It’s not like [situation] -> panic attack a few minutes or an hour later with a clear antagonist. It can come days after the stressors. It can also take a few weeks and lots of practice to build up an arsenal of effective coping mechanisms to return oneself to a calming state in the middle of an active attack.

Re: Deep breathing. This can also be problematic as at the point where one’s lungs are fully inflated one can experience a PVC or PAC, which is VERY disconcerting to someone who’s already acutely aware of what their heart is doing. I can actually trigger PVCs in myself by doing this.

—

I don’t mean to lecture. I’m not the professor, and perhaps I’ve read too much between the lines of what you’ve written. As someone who didn’t get out of bed for 3 weeks the first time I had a panic attack, I feel very strongly about the issue, and combatting it aggressively rather than taking a more laid back, it’ll-fix-itself approach. Particularly this: “deep breathing, progressive relaxation, identifying triggers and avoiding the situation, CBT, [etc.]”

Those are all great long-term approaches, but the short-term is what someone with panic disorder in an active phase cares about most. Long term stuff can come after, just get me through right now.

And I am keenly aware that my personal experience should never cloud my clinical judgement inasmuch as that is humanly possible.

* I tried to dial 911 my first time, in the middle of a biochemistry lecture, no less. But I couldn’t see well enough to dial the number. In retrospect, knowing what I know now, I’m glad I couldn’t because that would have been a misuse of medical resources. :p

Early in panic, people are usually not capable of accessing the skills to use behavioral coping mechanisms. You usually need to halt the panic quickly and this is where BZDs are needed. Panic is such an uncomfortable and painful experience, the BZD’s are in a way like pain medications in the early stages of treatment.

The more you talk, the less I believe you

Pharmacy

Something I’ve noticed for years: the more a patient talks at you, the more likely they are to be lying. They talk and talk and talk, and nothing of substance comes out. It’s a smokescreen for something else they want. They tell you their life story, and then ask for an early fill on their Vicodin as though the two are somehow related.

Do they think I’m stupid? I can’t count the number of times I’ve put the phone down with the person still talking at me (without having said more than “May I help you?”) done something, and then come back with them still blowing hot air.

The more words someone uses, the greater the chances are that they’re full of shit.

This is in contrast to someone with a legitimate issue who will tell you their story in as few words as possible, and then ask what they need to do. Even people who typically blow smoke talk less when they’re actually telling the truth and they have, for instance, a police report to back it up.

Every retail pharmacist in the world knows exactly what I’m talking about, and I’m sure most ED types do too. Remarkable that the bottom-feeders on the planet haven’t figured out that if they just kept their mouths shut, I’d be 2-3x more likely to believe them. I would have thought such a skill would be accidentally uncovered and remembered. But perhaps idle chatter is the verbal form of a nervous twitch, and many of these folks are halfway decent candidates for the Darwin Awards anyway, so I shouldn’t be surprised that they haven’t learned from past successes.

In any event, they’d all be shitty poker players.