What's a Blit?

It was many years ago today that Dr. McElhone came to say a new word (to me, anyway): blit. What's a blit, you might ask? Well, I'll tell you: five pounds of shit in a four pound sack. Being from Texas and Nevada, it was sack and not bag. Kind of the same vein as, "Girl, you're as dumb as a sack of hair!" So, what's up with blit and hair? The death spiral of capitalism.

"Robert, you're out of your bleeing mind!"

Could be. But follow along with me. More than once, these pages have described the problem of heavily capitalized production, namely the strait jacket of amortization and the need for stable, if not growing, demand. As more cost is claimed by capital, the more difficult it is to manage average cost, and thus price (modulo customer discrimination). Ya gotta pay the vig. In the Olde Days, as demand softened you just fired employees. Average cost dropped to more closely match market clearing price. Capital heavy production makes that anywhere from difficult to impossible, since they ain't no bodies to fire.

"But Robert, that never actually happens!" Thanks to all the news that's fit to print, we get a case study.
The Headline:

For Cancer Centers, Proton Therapy's Promise Is Undercut by Lagging Demand

Can't get more on point than that. Proton therapy is a five pound cost in a four pound sack of demand. The shit drips over the top. Yuck.

But about 30 years after the Food and Drug Administration first approved proton therapy for limited uses, doctors often hesitate to prescribe it and insurers often will not cover it.

That means there simply may not be enough business to go around.

Or, as has been argued in these pages more than once: if only the 1% have healthcare, even they won't be able to afford it. Another bone oft picked here: Say's Law, aka supply creates it's own demand. Laffer being the modern zealot of that knucklehead idea. Were it true, we'd never have recessions, much less panics and depressions.

At Indiana, he added, "we began to see that simply having a proton center didn't mean people would come."

What's even worse is that such machines seem to be no better than regular treatment.

But its pinpoint precision has not been shown to be more effective against breast, prostate and other common cancers. One recent study of lung-cancer patients found no significant difference in outcomes between people receiving proton therapy and those getting a focused kind of traditional radiation, which is much less expensive.

Remember 2005, when all the smart people in the room told us that skyrocketing house prices were the new normal and that there had never been, and could never be, a nationwide stall in home sales? Remember?

We Save Lives

The constant refrain from the most profitable industry (not counting the FIRE parasites), "we need sky-high prices because we save lives", is, once again, belied. Here's the story.

Those who received pumps (785) survived a median of 67 months, compared with 44 months for patients who did not get them (1,583). The result was especially striking, Dr. D'Angelica said, because patients who got pumps were sicker to begin with.

May be there'll be enough backlash to throw the critters out of the swamp.

Skew You

A recurring theme in these endeavors: data analysis is helpful only when there's a stable underlying data generation process. Among other things, this makes stat as a tool for macroeconomic policy analysis fraught with danger. The members of that branch of study have been arguing over the structure of analysis. The quants against the historicals. On the whole, historicals have been right. On the other hand, there's the old saw, "economists have accurately predicted 10 of the last 5 recessions!" As an example, here's an interesting post. I'll leave it to the reader to decide whether the effort is Type III error.

An even more egregious error happens when median/mean is relied on. It's also worth noting that one of the few shorts was explicit: they didn't believe an MoA existed. Ouch.

This time around, Celldex had comparison data that strongly suggested its lead candidate, glemba, could provide a survival benefit over chemo for patients with a difficult-to-treat form of breast cancer. Unfortunately, the data came from a subgroup contained within an otherwise failed trial. In retrospect, it looks like several outliers resulted in a lot of wasted resources.
[my bold]

Outliers, on one side of the median/mean, will skew you dead. Not to mention: subgroup post-hoc "analysis" is the Very Big Red Flag biostats. On often wonders why a legit math stat would get within a barge pole's length of such companies. But they do. I guess the money's not bad.

It is all too common for small bios to go all in, given that they have, in general, small pipelines. If I had a nickel for every one of these that generated traffic like, "but there's one guy still alive after 5 years taking WhizzBang250", I'd be sipping tequila on a Caribbean island. ImmunoOncology is one of the bigger deals these days, but there're even spontaneous remissions in cancer and always have been.

With PhARMA constantly braying that it costs $X billion to get "a drug to market" so drugs have to be really expensive to pay for all that, it's worth pondering whether the moolah is funnelled into R&D or mgt. pockets?

The Asymptote of Progress - part the ninth

Yesterday morning was going to be a Carnac day, in which a missive stating the prediction that FAA/NTSB would demand stepped up inspection of high-cycle engines was to be offered. Never got around to it and, naturally, such was reported later in the day. Which brings us to today's reporting where we get some fruitful quotes about jet engines.

Like the engine on the Southwest jet, two others — one used on the Boeing 787 Dreamliner and another on some Boeing 767s — developed cracks. On Tuesday, the same day as the engine failure on the Southwest plane, the Federal Aviation Administration said Boeing 787 Dreamliners powered by Rolls-Royce engines could no longer be flown on ultralong, over-water flights.

The engines are produced by three different manufacturers, but the fact that all three have developed safety issues is prompting questions about the engines' design, operation and their inspection procedures.

The worry is that the flaws are part of a trend as manufacturers push to develop ever more powerful and complex machines.

"We've gotten smarter," said Richard Giannotti, an aerospace engineer. "We can design things to a very low margin with a lot of reliability data to back it up. But when we get to the ragged edge, it doesn't take much for things to go wrong."

Sound like turbofans have reached the wall? Along with Li-ion batteries?

The Asymptote of Progress - part the eighth

This hot off the presses (7:56):

VALE Vale S.A. reports Iron ore production reached 82.0 Mt in 1Q18, 4.2 Mt and 11.4 Mt lower than in 1Q17 and 4Q17, respectively (13.12 )
Iron ore production reached 82.0 Mt in 1Q18, 4.2 Mt and 11.4 Mt lower than in 1Q17 and 4Q17, respectively, mainly due to management's decision in 2Q17 to reduce production of lower grade ore, reinforcing the positioning of Vale as a premium producer and resulting in higher price realization and better margins since 1Q17. The more intense rain season also affected production in 1Q18.

So, let's make America Great Again with imported iron ore, since we haven't enough in the ground worth digging for. Such a Wonderful Idea.

The Deplorables - part the second

Yet another series, with unknown length, impelled by the Trumpistas. I'm going to guess that Bevin hasn't the faintest idea that he's indicting his state's redneck deplorables. And he's implicitly demanding that public school teachers be domestic violence cops, in addition to gun-totin', rootin-tootin eraser cleaners. Hillary is lookin righter by the day.

I guarantee you somewhere in Kentucky today a child was sexually assaulted that was left at home because there was nobody there to watch them. I guarantee you somewhere today a child was physically harmed or ingested poison because they were home alone because a single parent didn't have any money to take care of them.

The Case for Public Goods

Since Orange Julius Caesar is the illegitimate love child of Ayn Rand and Benito Mussolini, we've seen (I'm talkin Pruitt, Ryan, et al) the rise of Social Darwinism to never attained heights. Which brings us to this "study".

When curing a disease with gene therapy is bad business

The answer, naturally, is that such science has no business being a business. Especially in the cited cases where the "cures" are for truly rare diseases, and not the faux types which Pharma is jumping into with both feet.

So, where's the moolah going to come from?

Novartis's projections that the treatment could bring in several billion a year in revenue also suggest that the company might charge unheard-of prices, perhaps $2.25 million according to Wall Street bankers.

Society as a whole, through whatever damn gummint insurance exists and "taxing" the privately insured, should shift mountains of money for some basic science?? Time to wake up and smell the coffee. There are public goods, and there's no benefit to piling on gobs of empty profit to the price. The science will out, no matter.