26 December 2010

One Pill, Two Pill, Red Pill, Blue PIll

Some people (check google) would have you believe that the red pill/blue pill question is Important and Insightful. They are wrong. On the off chance you are lucky enough to have never seen the Matrix here is The Offer:
Morpheus : This is your last chance. After this, there is no turning back. You take the blue pill, the story ends. You wake up and believe... whatever you want to believe. You take the red pill... you stay in wonderland... and I show you just how deep the rabbit hole goes.
On first glance this is a simple offer: Do you want to know unpleasant truths or continue living a lie. However, if you think about it for longer than a second it’s much more complex. There is a very crucial aspect of The Matrix that is of paramount importance and often glossed over: The illusion is perfect. That is to say, you cannot know your world is not real. Thus, for the time between the offer and your decision there are two realities that simultaneously exist: your epistemic one, and the objective one. In this way, Morpheus' offer is the choice between remaining in your epistemic one (and forgetting entirely the existence of the objective one) and accepting the objective one and knowing that your heretofore epistemic reality was a lie.

Which do you choose? You’re probably still thinking that you’ll choose the red pill, "After all," you tell yourself, "I want to know what is real." Let me reiterate: Realness has no place in this argument. In The Matrix the veil of ignorance is perfect, aside from Morpheus, there is nothing to pierce it.

12 December 2010

Why you want to be a key opinion leader

Why does anyone do any one particular thing? Start where detectives do: greed, ambition, revenge, envy, conviction, and insanity. Set insanity aside, you're not on trial (yet). Set conviction aside as well since a prerequirement to being an opinion leader is the ability to convince yourself as well as your audience.

Detective, what next? "It's always money, unless it's a woman or drugs." Couldn't be; doctors make lots of money (though they wholeheartedly deny this). Here's a secret: the utility of money, after a certain point, no longer matters. It becomes a way of keeping score. Why do the assholes on Wall Street keep paying themselves hundreds of millions of dollars year after year? It isn't because their bank account doesn't have enough zeros, it's because it doesn't have enough zeros compared to someone else.

How to invent a new drug

Generic prilosec is a drug called omeprazole that is often taken for acid reflux. Omeprazole is sold as a racemic mixture. While this would matter for many drugs (one enantiomer might be active, the other inactive [in rare cases the different enantiomers can have different effects with disastrous consequences; see: thalidomide]), for omeprazole it doesn’t matter, since as soon as you put it into an acidic enviroment (the stomach!) the stereocenter (a sulfoxide) is protonated, some rearrangements occur, and presto, both the R and S enantiomers are converted into precisely the same bio-active drug.

Now, back in the day when AstraZenica was deriving a significant amount of revenue from Prilosec (prior to generics and OTC status) one of their chemists realized this. So one of their business folk decided, “Hey, when we lose those protections, we’ll just re-submit the drug to the FDA as a specific enantiomer (the S in the case of Nexium [hence the name esomeprazole) and get a “new” drug, and then we can keep charging $200 for a 30 day supply!”

Then one of their sales reps probably pointed out, “Hey, we’ll have to get some studies to show that Nexium is better than the much cheaper Prilosec, otherwise doctors will never prescribe it.”

So one of the medicinal chemists said, “Hey, this drug is totally safe, so we’ll just double the dosage [compared to the 10 and 20 mg available strengths for Prilosec] and the studies will show increased efficacy!” (Which is why Nexium comes in 20 and 40 mg doses.)

Thus a new drug (Nexium) was born. Even though taking 20 mg of Nexium is exactly the same (as far as your body is concerned) as Prilosec, you have to pay much more for the former. This way AstraZenica gets to make beaucoup bucks for another 10-15 years and do absolutely no scientific discovery.