Posts by Thomas Lumley
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There's two reasons the value of a statistical life doesn't enter directly into Pharmac's calculations. The first is that VSL is really for immediate life/death decisions like road deaths -- it doesn't allow for quality of life or for shortened lifespan. More importantly, though, Pharmac doesn't have the option to spend more money to save more lives -- their drug subsidy budget is set by Parliament, and they can only trade off one drug against another. At $80,000 per person, treating 50,000 people would take five years of Pharmac's entire $800 million/year drug budget.
I just looked up the PTAC minutes (PDF)from last year where Hep C was discussed. They liked the new drugs, but said:
3.16. The Committee noted that the supplier’s submission proposed funding for all chronic hepatitis C patients in New Zealand. Members considered that the pricing proposed in the application would have a very significant fiscal impact and that the supplier had made no attempt to address this fiscal risk.
That's pretty clear.
I hope that with competing products becoming available, the suppliers will negotiate a bit more. Gilead has licensed generic manufacture of the active ingredient of Solvaldi (sofosbuvir) in India for sale to developing countries, which suggests they may be willing to settle for charging what people will actually pay.
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Access: Zika and microcephaly: things to…, in reply to George Darroch,
It's true that Ae. aegypti is relatively unlikely to establish in NZ at the moment. Ae. albopictus probably could but so far hasn't (and would face a major biosecurity response if it tried)
There are other Aedes species that do live in NZ, and it's conceivable that they could transmit Zika -- there's no direct evidence that they can, but there wouldn't be at this stage. Given that we've never had a confirmed outbreak of dengue or similar viruses in NZ I think it's reasonable to behave as if the local mosquitoes are safe, but it's not certain.
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Access: Zika and microcephaly: things to…, in reply to Russell Brown,
Very informative.
My understanding was that the primary mosquito responsible ( Aedes aegyptii ) could survive in Northland but has been kept out by biosecurity. The WHO says that Aedes albopictus, which could live in Auckland if it got here, can also spread Zika.
That is, if NZ is safe from direct transmission, it's thanks to biosecurity as well as climate and distance.
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There’s also a story about medicinal chemistry in the improvement of preventive treatments. Corticosteroids will suppress the immune system as much as you want, but in addition to suppressing the whole body’s immune response (not just the airways) they also mess with a huge range of other things from glucose:insulin balance to stomach acid to bone density.
The chemical success was in designing steroids that could be inhaled to suppress immune responses in the airways, but where neither the inhaled portion nor the (inevitable) swallowed portion of the dose would end up in the bloodstream.
The safety improvement was so dramatic that inhaled corticosteroids are not just prescribed for asthma, fluticasone is now available over the counter for hayfever!
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The new Onehunga beach/foreshore on Christmas Day, late afternoon.
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Up Front: Reading Murder Books, in reply to kw,
I'm glad to hear the Murray Whelan books travel well, though a bit surprised. I'm from Melbourne and to me, they seem to fit their time and place so well.
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Another vote for Kerry Greenwood. I'd also add Donna Leon (cynical but not callous Venetians with good food), Janet Neel, and Laurie King (I prefer her modern series to her Holmes one).
Darker, but still very good: Batya Gur's police procedurals set in Jerusalem.
And for people who read Young Adult fantasy, the mystery series Point of Hopes, Point of Dreams, Point of Knives, Fair's Point by Melissa Scott and Lisa Barnett. These are set in a fantasy world apparently inspired by Bruges in its Golden Age, and feature a sweet gay romance.
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Thanks for posting this. I wrote about it on StatsChat, and other statisticians I've talked to today have agreed it's outrageous both specifically that Jarrod Gilbert should be denied at data access, and more generally that the data should come with discretionary veto over publication.
Because earlier comments have been mentioning pharmaceutical companies, I'd like to quote this from the 'Uniform Requirements' of the International Committee of Medical Journal Editors
Authors should avoid entering in to agreements with study sponsors, both for-profit and non-profit, that interfere with authors’ access to all of the study’s data or that interfere with their ability to analyze and interpret the data and to prepare and publish manuscripts independently when and where they choose.
Veto power isn't standard practice, particularly in medical research, because we know it gets misused.
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Hard News: The Police Ten 7 State, in reply to Idiot Savant,
In my experience, it is not standard boilerplate. Having the right to see the reports in advance is reasonably standard, though not uncontroversial. Veto power over publication is not.
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@Rich: The US equivalent has been studied: it works better than polls a long way out from the election. I don't know what's known about the smaller markets here.
There big issue is still the haziness of the crystal ball, even if we assume the markets are well calibrated. At the moment, the market thinks there's almost a 20% chance of National staying where it is or improving, and thinks the election result is massively unclear. But that's what I'd expect: two years out, people shouldn't rationally be confident of the outcome. We don't know what the economy will be doing and we don't know who will be the Labour and National party leaders.
For comparison to the 58% implied chance of National winning the 2017 election, iPredict only has a 62% implied chance of the 2016 Presidential election going to a Democrat. That doesn't mean either election will be a cliffhanger -- it's quite likely in both cases that the winner will be clear six months out.
