John McCarthy died today at the age of 84. He coined the term Artificial Intelligence and invented LISP: the programming language that every computer scientist interested in A.I. considers to be his first love (as far as programming languages go).
He authored many seminal papers in the field and was the source of much of the enthusiasm (and gentle skepticism) about the possibility of intelligent machines throughout the last half century.
Artificial Intelligence is a young field, and as McCarthy suggested, I believe the 21st century will be its time to shine with intelligent systems in medicine, communication, warfare (for good and for bad), and much more. It’s sad to see one of the field’s visionaries pass away. But I’m excited at the prospect of his work and the work of those he inspired transforming our future in the decades to come.
I stopped by Rite Aid yesterday and observed the simple fact that Advil was 2.5 times more expensive than Ibuprofen (its generic counterpart).
I always get the generic brand. Well not always, almost always… Do not laugh, but when I hurt my ankle a year ago at a judo tournament, I bought the brand name Advil. Yes, I paid extra just for the placebo effect. However, for some god forsaken reason, it immediately felt good when I took it. It felt like it was “working better”, whatever that means in the case of a mild anti-inflammatory. Why?
I looked into this question online, and it seems that all legitimate government and scientific reports show no difference between generics and brand name drugs. Here is a simple representative article from the FDA: Facts and Myths about Generic Drugs.
So what is the difference? And if there is no difference, how the hell does our semi-capitalist system allow a product to cost 2.5 times more than another one that does the same exact thing and still survive as a product. What is at work here? Are we just paying for the power of the name? Is the placebo effect of a medicine for which you had to pay more that significant?
Tuberculosis (TB) is an infectious disease. It spreads through the air, attacks the lungs, and is present in about one third of the world’s population. About 10% of those cases progress from latent to active TB, which has a 50% chance of killing you if left untreated.
Why am interested in this topic? It’s hard to explain, but I can simply say that I’m horrified by it, and the amount of people it kills in developing countries. Mountains Beyond Mountains first introduced me to the impact of this disease (and other infectious diseases) in the poverty-stricken nation of Haiti. One of the big “problems” is that people in rich countries are not dying from TB, and therefore, the amount of money invested in TB research and aid is minimal relative to other diseases such as AIDS and cancer. The result is that most drugs available for treating TB are expensive, with few “market forces” or R&D progress driving down the prices.
Multi-Drug-Resistant Tuberculosis (MDR-TB) is particularly troubling in this regard. TB is remarkably good at evolving in your body to the point where it gains resistance to the first line of drugs: isoniazid and rifampicin. How do you treat it then? Well, you need:
- An MDR-TB specialist, with careful attention to your unique “species” of MDR-TB.
- A soup of very expensive “second-line” drugs that carry with them terrible side-effects.
- A realization that even if you have unlimited funds, you’re probably still going to die.
The troubling question for medicine is what to do about MDR-TB in Haiti where people cannot afford to eat, let alone pay anything for any kind of drugs to help them. Treating an MDR-TB patient is 10 to 100 times more expensive than a TB patient that responds positively to the first-line drugs. So what do you do? Do you just let them die? And because TB is highly contagious, do you force MDR-TB patients into isolation, while not providing any medical assistance with any real hope for treatment?
These are questions Mountains Beyond Mountains asks, and as I sit here typing these words, I am having trouble not losing myself in the hopelessness of such moral questions about death and dying.
The “Great Epi Divide” is a term coined by doctor Paul Farmer (who is the subject of the book Mountains Beyond Mountains) to describe two groups of people in the world based on what makes them sick and what kills them. The first group are the people that tend to die in their seventies from illnesses that are loosely-speaking “inevitable accompaniments to the aging of bodies”. The second group of people dies 10 to 40 years earlier than that from violence, hunger, infectious diseases that medical science knows how to prevent and to treat (if not cure).
The second group is defined by absolute poverty, lacking nearly every necessity: clean water, shoes, medicine, food.
What Mountains Beyond Mountains reveals (as many other sources do) that the people in the first group have very little real awareness of the conditions of life in the second group. More importantly, we can’t handle thinking of them as fellow human beings. The problem is overwhelming. Early on in the book, Farmer describes other doctors working in Haiti that couldn’t wait to get back to America. They thought of themselves as “American first”, and human second, longing for the comfort of their life in the States over the brutal reality of their moral calling in Haiti.