Getting Drug Companies to Release Clinical Trial Data

There’s a tension in our society between openness and confidentiality. On the one hand, we celebrate openness and full disclosure. Men like Julian Assange and Edward Snowden who allegedly break laws and release confidential or classified information are lauded as anti-establishment heroes. The media doesn't allow politicians, celebrities, and other people in the public eye any privacy. On the other hand, laws like HIPAA restrict our ability to acquire health care information about other people. I recently blogged about the inability of parents to find out about their children’s mental health treatment.

A change has been occurring regarding public access to pharmaceutical clinical trial data. A recent New York Times article talks about the efforts of researchers to push drug companies to release unpublished clinical trial data.

The article profiles Peter Doshi, a M.I.T.-educated researcher, and Dr. Tom Jefferson, a British epidemiologist. They collaborated to determine if the anti-flu drug Tamiflu was effective. Jefferson had earlier concluded that Tamiflu reduced the complications of flu. His review was based on a study that pooled the results of 10 clinical trials. Only 2 out of these 10 trials had been published in medical journals, however. Taking another look at the data, Jefferson approached Roche, the manufacturer of Tamiflu, for the results of the 8 missing trials. Roche declined to cooperate, citing Jefferson’s refusal to sign a confidentiality agreement.

Due to the missing data, Jefferson’s team published an article in the British Medical Journal that concluded that Tamiflu was only moderately effective against influenza-like symptoms, and cannot be shown to reduce complications of influenza (e.g. pneumonia and hospitalization). The journal also did its own investigation, concluding that Roche had hired ghost writers to author some of the articles involving Tamiflu, pressuring the writers to highlight positive aspects of the drug.

After the British Medical Journal articles appeared, Roche turned over partial copies of study reports. The European Medicines Agency also turned over documents from 19 trial reports to Jefferson and colleagues. These documents allowed researchers to discover the importance of clinical study reports, which are thousands of pages long, and contain details such as descriptions of trial protocol and design, and ingredients of placebo pills. This April, Roche further relented, agreeing to make available clinical study reports for all Roche-sponsored trials of Tamiflu.

“All these years later, and we still don’t know if Tamiflu is effective,” said Dr. Harlan Krumholz, a Yale cardiologist. “It’s perplexing to have a billion-dollar drug, and you’re not willing to share everything you’ve got to know whether this thing is effective and safe.”

Prodding from Doshi and others led the pharmaceutical company GlaxoSmithKline to announce that it will share detailed data from all company-sponsored trials dating to 2000. This would amount to more than 1000 trials involving more than 90 drugs. Due to past misdeeds, Glaxo needed an image rehabilitation. Last year, it pleaded guilty to criminal charges and agreed to pay $3 billion in fines. It had been accused by the U.S. Justice Department of failing to report safety data about its diabetes drug Avandia, and publishing misleading information about the antidepressant Paxil. The settlement, which also involved civil penalties over marketing of other drugs, was the largest ever involving a pharmaceutical company.

Publication bias of studies involving antidepressant drugs is a topic in Irving Kirsh’s book The Emperor's New Drugs (which I review here). Kirsh had used the Freedom of Information Act to obtain unpublished clinical trial studies of antidepressants from the FDA.

Not everyone in the pharmaceutical industry is happy with the new openness. The Pharmaceutical Research and Manufacturers of America (PhRMA), a major industry group, and other drug companies oppose releasing clinical trial data. John J. Castellani, chief executive of PhRMA, said that “[i]f you dump onto the sidewalk all the data and you include commercially protected information, then you’re essentially giving to competitors what we invested billions of dollars in.” U.S. federal law restricts what information can be released, especially data that can reveal personal or commercially confidential information.

My view is that the public has a right to know all the results of studies of a particular drug, both positive and negative. It’s the pharmaceutical company’s obligation to provide this data. They certainly have a right to withhold commercially protected information, and private research participant data, but they don’t have the right to only publish positive studies, and hide negative studies. I applaud Doshi, Jefferson, Kirsh and others who have helped push drug companies to release clinical trial data.

Parents Denied Information on Their Children's Mental Health Care

Imagine being a parent of a child with serious mental illness. You’re anxious about your child’s well-being. You’re concerned about his future. You feel stressed out having to cope with his mood swings, meltdowns, tantrums, antisocial or violent behavior, etc. You’re disappointed that your child’s future isn't as bright as you once imagined. On top of these sources of anguish, what you don’t need is a mental health system that denies you information on your child’s treatment. This is what many American parents of mentally ill people are faced with, according to a recent Wall Street Journal article.

The article describes several parents of violent mentally ill men. Suzanne Lankford's adult son allegedly knocked her out with a blow to a head, participated in an armed robbery of a mall, and assaulted a nurse and law enforcement officer. He has exhibited paranoid symptoms, phoning in reports of people stalking him, and barricading himself inside a room to ward off imaginary assassins. Ms. Lankford is unable to get any information on her son’s treatment, due to privacy concerns.

Pat Milan's adult son, diagnosed with paranoid schizophrenia, had cut his throat and dug his own grave in his backyard. His son was admitted to a treatment facility in 2011, but released eight days later despite protests from his father. Professionals at the treatment facility noted homicidal and suicidal ideation, and that he had a suicide plan. Pat Milan was denied access to these treatment records. After being brought home, Mr. Milan’s son attached a shotgun shell to a steel pipe, put the combination in his mouth, and exploded the shell via a fuse (the article didn't say if he died).

Being denied access to treatment information isn't only a problem for parents of adult children. Pennsylvania has a law that allows a child as young as 14 to prevent his parents from receiving information about his care. Quoting Rep. Tim Murphy (R, Pa.), "So you have a seventh- or eighth-grader making decisions on their mental illness. I wouldn't let a 14-year-old decide much of anything."

What is the reasoning behind this denial of access to information about immediate family members? Ira Burnim of the David L. Bazelon Center for Mental Health Law, a Washington, D.C., advocacy group, says that confidentiality is vital to ensure that patients seek treatment. According to Burnim, "the current system discourages patients" from seeking care because of the stigma of mental illness. HIPAA is the legal framework that restricts access to protected mental health care information.

The article also talks about the obstacles to involuntary commit mentally ill individuals to treatment. Five states don’t allow involuntary mental health treatment at all, Nevada has a bill pending that would allow it in some circumstances, and the other 44 states have stringent requirements for involuntary treatment.

E. Fuller Torrey, founder of the Treatment Advocacy Center, estimates that 216,000 of the homeless population, or about 1/3, are adults with severe untreated mental illness. He also estimates that there are 400,000 untreated mentally ill adults in jails and prisons.

I think that immediate family members should by default have access to health information. Parents should be given access to their adult children’s mental health treatment records. This access should only be taken away if the child specifically requests it. There’s no reason to deny parents information. In most cases, parents are trying to do their best for their children. They need to be informed to either make decisions on behalf of their children, or assist their children in making the correct decision. Mental illness impairs judgment and rational decision making. People with mental illness need all the help they can get from their family.

I have a personal example to relate about this. When I was a freshman in college, I had some serious mental health issues. I saw someone at the student health center, who referred me to an outside therapist. To pay for this therapy I would have had to tell my parents about it, since I needed their financial assistance. I didn't want them to know about my problems, so I decided not to pursue treatment. I have no idea whether or not therapy would have been helpful at the time. But the rational decision would have been to try treatment, even if it meant that my parents would know that I was having problems. The problems eventually got worse, and my parents found out about them anyway.

Involuntary treatment is another issue. The article combines mental health information and involuntary treatment, but I see them as separate. I used to be in favor of involuntary treatment for the mentally ill. That was when I believed that drug treatment was effective and safe. I don’t believe that any more, after reading Anatomy of an Epidemic (which I review here). Drug treatment has never been proven to be long-term effective for psychiatric disorders. Depending on the drug, side effects can be severe and debilitating. Antipsychotics have some of the worst side effect profiles, with the older ones causing movement disorders like tardive dyskinesia, and the newer ones causing metabolic disorders like weight gain and type-2 diabetes. The people most likely to be involuntary committed are those with schizophrenia and other psychotic disorders. They are almost guaranteed to be prescribed antipsychotic drugs. I don’t think that people should be coerced to take drugs that have never been shown to improve their long-term functioning, and which have such serious side effects.

In conclusion, let’s allow parents to be informed about their adult children’s mental health treatment, but let’s not allow parents to involuntarily commit their children to forced drugging and hospitalization.

Bipartisan Push for Better Mental Health Care Won’t Be Helpful

In the aftermath of the shootings at Sandy Hook Elementary School, with memories of the Aurora movie theater shooting, the Gabby Giffords shooting, and the Virginia Tech shootings still in mind, people demanded that the U.S. Congress do something. These shootings, along with many others, were perpetrated by mentally ill individuals. Liberals wanted more gun control. Conservatives wanted more armed guards and armed civilians to take down the shooters. The divided congress was unable to pass a gun control measure. But apparently liberals and conservatives were able to agree on one thing, according to a recent New York Times article: better care for the mentally ill. According to the article, “[t]he emerging legislation would, among other things, finance the construction of more community mental health centers, provide grants to train teachers to spot early signs of mental illness and make more Medicaid dollars available for mental health care.” There would also be support for children who faced trauma, and suicide prevention initiatives. Approximately 1.5 million additional people with mental illness would be treated each year.

This is a good, thing, right? What’s there to complain about more mental health treatment? There’s nothing to complain about, if one believes in the current drug-based model of care. Treatment in this context will be primarily psychoactive drugs. The community mental health center will recruit and encourage people to see a doctor and get a prescription for a psychotropic medication. Teachers will spot early signs of ADHD, depression, and bipolar disorder in children, and put the children on the road to chronic stimulant, antidepressant, and antipsychotic drug treatment. Medicaid is notorious for drugging up the children who rely on it for health care. Suicide will be prevented by prescribing antidepressant drugs. The vast majority of the 1.5 million additional treated people will be prescribed drugs.

After reading Anatomy of an Epidemic (which I review here), I stopped believing that psychotropic drugs are an effective long-term solution for most mental disorders. The evidence is just not there. Some drugs, such as antipsychotics and benzodiazepines, are effective short-term solutions to psychotic or anxious symptoms. The problem is that they don’t help the patient function better over the long term. While the evidence isn’t clear that drugs caused the explosion of debilitating mental illness in recent years, they certainly haven’t helped prevent it. Drugging of children in particular (for ADHD or bipolar disorder) has likely led to poor long-term outcomes, including mental (psychotic disorders, increased suicide rate, rapidly-cycling bipolar) and physical (extreme weight gain and type 2 diabetes for children taking atypical antipsychotics).

I would have preferred to see congress pass a gun control measure. The mentally ill and guns go together like North Korea and nuclear weapons. People with mental illness should not be allowed to purchase firearms. They should not have access to them in their homes. Adam Lanza’s mother was tragically irresponsible for having guns in her home. Her son used these guns to kill her in her home, then 26 people at Sandy Hook Elementary, including 20 children.

I have lived with serious mental illness for some 30 years. Mine has been under better control than many people. I have never been hospitalized for mental illness. I have never had to quit or leave a job due to mental illness. But I would never trust myself with owning or having possession of a gun. The reason is that there are times when my emotions become extreme or difficult to control. In those times, I don’t want access to a gun. It only takes one mistake for a personal or public tragedy to occur.

Gun sales and ownership should be banned for anyone who has been treated for a psychiatric disorder—I mean anyone treated at any time in their life. This would be a major change from current American law, and would require confidential records being unsealed, but it is for the greater good. Anyone living with someone who has been treated for mental illness should be required, if they own a gun, to keep it locked and inaccessible. The NRA will be furious and scream that we are becoming Nazi Germany, but tough. The NRA’s refusal to consider any type of gun control legislation, and their control of most Republican legislators, have allowed these preventable tragedies to happen.

If the government wants to spend money, what should it spend it on, if not treating mental illness? What about research? The problem with research is that the biochemical / drug paradigm still dominates psychiatric research, decades after it’s been clear that the chemical imbalances that drugs supposedly treat don’t exist. The drugs themselves cause chemical imbalances, but after millions of dollars and decades of research, no one has been able to show that any psychiatric disorder is caused by a chemical imbalance. Any government research money will be wasted on new drugs, new brain imaging, new tests, and other things that won’t do anything to improve the lives of the mentally ill. Research on alternative treatments would be more promising, but only a tiny fraction of any allocated funds would go into this type of research.

I’d like to see the government spend its money on providing a solution to the homeless problem. Current policy is to leave the homeless to their own resources. If they want to live on the street, or in a public park, fine. Short-term treatment with medication is useless, since they go off the medication as soon as they leave the hospital or treatment center. Many homeless are afflicted with mental illness and substance abuse. The fact that they are living on the streets is an indictment of the entire drug-based psychiatric paradigm. Deinstitutionalization began in the 1960’s, a half-century ago. Drugs were supposed to provide the severely mentally ill the stability and mental resources to live outside the hospital. But, as I've said above, drugs are not an effective long-term solution for most mental disorders. Thus many deinstitutionalized patients were not able to control their problems, and live independently on their own. Those without financial or family resources to fall back on ended up on the streets. They are the government’s responsibility, and the fact that they are still on the streets decades after deinstitutionalization began is a sign of abject public policy failure.

I have a recent personal experience with the homeless problem in Salt Lake City. On a rainy night, I stopped in at the city library. The Salt Lake City Library is an architectural masterpiece. Here are some pictures of it:

The city library may be a masterpiece of modern architecture, but it’s a leaky masterpiece. There were many containers filled with leaking water that rainy night. This indicates that beautiful and practical architecture are not equivalent. More relevant for the current discussion is that on every floor of this spectacular library there were homeless people. They were sitting on the chairs, using the Internet, and using the bathrooms. One of the homeless guys camped out in the handicapped stall, prompting a man in a wheelchair to complain. The city library is basically a homeless shelter. This is an insult to the taxpayers who support it, to the patrons who want to enjoy its resources, and to the homeless themselves. They should have a permanent home, and the government should provide it.

During most of my lifetime, American homelessness was largely a problem of mentally ill and substance abusing people. Recent years has seen more short-term economic homelessness. What we need to do is to separate out those who are capable of being employed, and those who aren't. Programs for the short-term economic homeless should focus on getting them a temporary residence, and preparing them to get a job. Even better, prevent them from being homeless in the first place by having available state-supported short-term housing for them if they become evicted from their homes. The long-term homeless, those who are too physically or mentally disabled to work, should have permanent state-subsidized housing. This housing must provide care for their disabilities. They should not have the option to be homeless. If they don’t like the state-subsidized housing, let them show that they can independently live in regular housing, or can live with friends or relatives.

Commitment laws need to be changed. This doesn't mean that mentally ill people should be committed to short-term hospitalization, to undergo forced drugging. It means that homeless mentally ill people should be committed to long-term housing. In some cases, those who are most impaired, this will mean state hospitalization.

This change to our homeless policy will be expensive. It can be paid for with reduced entitlement spending (Medicare and Social Security), reduced defense spending, and increased taxes. The benefits will be enormous—we can reclaim our public spaces, our libraries, parks, and streets, and the homeless will no longer be homeless. It would be a much better use of state funds than expanding mental health drug treatment.

Antipsychotics the New Weapon of Choice for American Soldiers

Prescriptions for antipsychotic drugs to American active-duty soldiers increased 1,083% from 2005 to 2011, according to a recent New York Times article. For the statistics-impaired, this is an almost 12-times increase. This increase occurred despite a steady reduction in combat troop levels since 2008. As a comparison, prescriptions for antipsychotic drugs to civilians increased 22% during this time period. The military attempts to screen out recruits with psychiatric disorders, so what’s the reason for this massive increase in antipsychotic drug prescriptions?

The article’s author speculates that antipsychotics are being prescribed off-label for use as sedatives. Prescriptions for other sedating drugs, such as benzodiazepines and anticonvulsants, also showed a large increase in this time period. There is weak evidence that antipsychotics are effective for PTSD. The evidence is stronger for SSRI antidepressants being effective for PTSD, but antidepressant prescriptions declined by almost 50% between 2006 and 2009. The author speculates that the military favors the quick-acting drugs versus the longer-acting antidepressants.

Have soldiers become more psychologically disturbed in recent years, which would explain the massive increase in prescriptions for sedating medications? It’s difficult to understand why. Iraq and Afghanistan have a unique set of challenges for soldiers’ mental health. Unlike past wars, where there was a dangerous front line and relatively safe zones everywhere else, the front line in Iraq and Afghanistan is everywhere. There is always the danger of encountering an IED, or being ambushed. But this was the case in 2005, so why did it increase so much between 2005 and 2011?

Along with the fear of death and injury, soldiers serving overseas experience additional stresses of being separated long distances from family and friends, and being in an unfamiliar and hostile environment. Those who are geomagnetically sensitive also suffer from being in a vastly different geomagnetic environment from which they grew up. But this was a problem in other foreign wars, when soldiers weren't as drugged as much as they are now.

The main purpose of using psychoactive drugs is for soldiers to escape from reality. This is the case for the legal prescribed drugs along with the illegal drugs. The different classes of drugs allow for soldiers to escape from reality in different ways. For example, psychedelic drugs like LSD or PCP create hallucinatory experiences. Opiates like morphine and heroin relieve physical and psychological pain. Benzodiazepenes like Valium and Xanax relieve anxiety. Alcohol has been used for thousands of years as a means for soldiers to escape reality. These drugs also impair soldiers in different ways, and some of them are highly addictive, so it’s important for the military leadership to keep drug use under control.

Based on the 12-fold increase in antipsychotic prescriptions to soldiers, the military leadership has apparently decided that these drugs are a safe and effective way for the soldiers to escape the horrors of their situation. Antipsychotics allow the user to escape from reality by blunting emotions and desires (antidepressants have a similar psychological effect, but are less effective than antipsychotics, and have less dangerous side effects). An irony is that although antipsychotics were designed to combat the delusions of schizophrenics, it’s a mass delusion among psychiatrists and other doctors who prescribe them that they are safe and effective in the long term. Antipsychotics have some of the worst side-effect profiles of any psychoactive drug (nicotine and alcohol are worse). One side effect of the older antipsychotic drugs (and to a lesser extent the newer ones) is a debilitating permanent condition known as “tardive dyskinesia”, i.e. involuntary body movements such as lip smacking, grimacing, and upper or lower limb movements. The newer ones are associated with serious metabolic disorders, including weight gain and type-2 diabetes. Their long-term effectiveness in treating schizophrenia, the condition they were originally designed and approved to treat, is questionable. Their long-term effectiveness in treating PTSD and other conditions afflicting soldiers is even more questionable. The fact that they cause a major reduction in emotion and motivation is not helpful for a soldier’s performance at his job.

One reason military doctors are gung ho about prescribing antipsychotics is that they are not addictive. But not addictive is not the same thing as safe or effective. They aren’t addictive because most people find the absence of emotions or desires unpleasant. This is the reason that people go off these drugs so frequently. This is the reason why they aren’t a viable long-term solution to psychotic disorders. Prescribing them off-label to soldiers as a sedative is bad medicine, and should be banned.

19% of American High School Boys Diagnosed with ADHD

A recent New York Times article reported the disturbing fact that 19% of American high school boys have received an ADHD diagnosis. 11% of school-age children overall have received the diagnosis. There has been a 16% increase in children between ages 4 and 17 being diagnosed with ADHD since 2007, and a 41% increase in the last decade. The increased diagnosis correlates with increased prescriptions to stimulant medications like Ritalin and Adderall. These medications, while offering short-term increased concentration abilities in children with true ADHD, also have risks of side-effects, including addiction, anxiety, and occasional psychosis. Evidence that stimulants improve long-term outcomes in children with ADHD is lacking.

These numbers are making some academic psychiatrists concerned. James Swanson is a professor of psychiatry at Florida International University, and one of the primary ADHD researchers in the last 20 years. According to Swanson, “There’s no way that one in five high-school boys has A.D.H.D. If we start treating children who do not have the disorder with stimulants, a certain percentage are going to have problems that are predictable — some of them are going to end up with abuse and dependence. And with all those pills around, how much of that actually goes to friends? Some studies have said it’s about 30 percent.”

Think about this—30% of stimulant medication is going to children who don’t have any disorder. They are using it to focus, to stay awake, and to improve their grades. Parents, doctors, and pharmacists are essentially giving normal children access to speed. Maybe these children will do better at school in the short term. But they are risking a life of drug abuse and dependence. Sure, grades are important, but are they really that important?

Dr. Ned Hallowell, a child psychiatrist and author of best-selling books on the disorder, is another psychiatrist who has changed his viewpoint on ADHD. For years Dr. Hallowell would reassure skeptical parents by telling them that Adderall and other stimulants were “safer than aspirin.” He now says, “I regret the analogy” and “won’t be saying that again.” Halloway still thinks that many children with ADHD continue to go unrecognized and untreated, but wants more rigorous diagnostic procedures. “I think now’s the time to call attention to the dangers that can be associated with making the diagnosis in a slipshod fashion,” he said. “That we have kids out there getting these drugs to use them as mental steroids — that’s dangerous, and I hate to think I have a hand in creating that problem.”

Regarding rigorous diagnostic procedures: proposed changes to the DSM, to be released soon in the DSM-V, allow for more adolescents and adults to qualify for the disorder. Some of the proposed changes include increasing the age of first symptoms from 7 to 12; examples, such as repeatedly losing one’s cell phone, that are applicable to teenagers; and a change in the requirement that symptoms cause “impairment” to symptoms simply “impacting” daily activities.

Pharmaceutical companies predictably use their marketing power to persuade parents and doctors to get more children an ADHD diagnosis and prescription for stimulant medication. An example of this is a pamphlet for Vyvanse from its manufacturer, Shire. In the pamphlet, a parent looks at her son and says, “I want to do all I can to help him succeed.”

The stimulant drugging of our youth is a national crisis that needs to be addressed. It is unlikely that psychiatrists and pharmaceutical companies will reform themselves without outside pressure. Left alone, the corrupt pharmaceutical-psychiatric establishment will diagnose and drug more children, as evidenced by the numbers mentioned above, and proposed changes in the DSM-V. The government needs to be involved in the solution. Some needed changes include the outlawing of off-label prescribing to children, tightening the diagnostic standards of ADHD, restricting the prescribing of stimulant medications to children, encouragement of using non-drug alternative solutions to ADHD, encouraging  research in alternative treatments for ADHD, outlawing drug company advertising to the public, outlawing drug companies’ bribes to doctors, and expelling from school any children found with stimulant medication that is not prescribed to them, or any children sharing their medication with other children. There also need to be more long-term studies done of the effects of stimulant medications on children with or without ADHD.

The Tesla Electric Car: Not Ready for Prime Time

The electric car is advanced by many as a clean, environmentally-friendly solution to our energy needs. Before reading a New York Times article describing a test drive of the Tesla Model S electric car, I believed that it was a viable, serious alternative to the ubiquitous, ancient internal combustion engine. This article, and the blog response by Elon Musk, the CEO of Tesla, has changed my mind. Now I think the car is a joke and is part of our energy problem, not a solution.

The New York Times article by John Broder describes a harrowing experience, in what should have been a routine winter drive from Washington, DC to Connecticut, and ending in New York City. He started out with a full charge in suburban Washington. He recharged at a 480-volt Supercharger station in Newark, Delaware, waiting 49 minutes for a full charge, which should have given him 242 miles of driving. This is more than enough miles to the Supercharger station in Milford, CT, which was his next charging stop. As he drove through New Jersey, however, the estimated range fell faster than the miles he drove. Broder slowed his car to below the speed limit, and kept the cabin cold, but he still lost miles. As he became worried that he wouldn't make it to the Milford Supercharging station, he called Tesla, and got various pieces of battery-saving advice from different officials. Some of this advice, such as turning off the cruise control, was wrong.

After an hour of charging at the Milford Superstation, the car told him that he had 185 miles remaining, which should have been enough for him to return to the station the next morning to recharge. He spent the night in Groton. When he parked the car, it told him he had 90 miles of range, twice the 46 miles he planned to travel back to Milford the next morning. After a cold, subfreezing night, the car told him he only had 25 miles left. 72% of the battery energy disappeared overnight. He didn't have enough charge to reach Milford. A Tesla official told him to “condition” the battery by sitting in the car for 30 minutes with low heat. This bad advice further reduced the miles remaining to 19 miles. Tesla found a charging facility in Norwich, only 11 miles away. Broder made it to Norwich, and after an hour of charging was cleared by Tesla to head to Milford.

Broder never made it to Milford. The car ran out of charge before he got there. Tesla dispatched a tow truck for him. The towing experience was anything but routine—the car had an electrically actuated parking brake that would not release without battery power, and had no manual override. It took 45 minutes to drag his car to the flatbed of the tow truck.

Five hours after leaving Groton on a trip that should have taken less than an hour, Broder pulled into the Milford Supercharging station. After 80 minute of recharging in Milford, Broder was able to reach his final destination, the Tesla dealership in Manhattan.

Tesla’s CEO Elon Musk, instead of apologizing for the car’s shortcomings and offering to improve it, instead made bizarre accusations that Broder deliberately sabotaged the test drive and lied about the results. Both Broder and Rebecca Greenfield from the Atlantic Wire questioned Musk's accusations. Whether or not Musk was correct about Broder traveling faster than he claimed (Musk said that at times Broder actually went above the speed limit of 65 mph!), and that he set the cabin temperature to a comfortable setting for most of the trip, and that he didn't wait long enough to recharge (read the charge times above, and compare to the times you usually spend gassing up a car), Broder's account of his test drive are incredibly damaging and essentially not refuted.

I’m blogging about this because I see in these reports and accusations not only issues with a particular car, but important fundamental problems in our society. Let me list the crucial problems with the car as exposed by Broder, and I’ll dig deeper in my analysis to criticize society:

1. A car whose battery drains charge when the weather is cold is not a solution to our energy problems. At least when I fill up my car on a cold winter night, I expect to have a full tank of gas the next morning. Broder claimed that the battery lost about 70% of its charge when he spent the night in Groton. It also lost charge when he was driving to Connecticut. The Tesla car battery drains charge like a house drains heat on a cold night when a window is wide open. This is not energy efficient. The lost charge must be replenished from electrical power. This means that we must generate more power to fuel these cars than we otherwise would have had to.
   
   I’m puzzled by the lack of concern over what the impact of the electric car will be on our electrical power infrastructure. Since the Tesla electric car and other ones are now just expensive novelties, and since Tesla doesn’t charge customers to fill up at their Supercharger stations, there’s nothing to worry about. But what about if these electric cars become mass produced? What happens if electric cars become, for example, 20% of all cars on the road?
   
   I’ll run some numbers to find out exactly how 20% of automobiles being Tesla electric cars will impact our electrical power grid. There are approximately 250 million registered vehicles in the U.S., about half of them (125 million) being automobiles. That would mean about 25 million Tesla electric cars. With a fully-charged 85 kwh battery, the EPA rates the car should do 265 miles. Considering Broder’s experience described above, this is very generous to Tesla, but let’s go with these numbers. Assume that a car averages 12k miles / year. That means that one Tesla car consumes 3849 kwh / year. Multiplied by 25 million Tesla cars, this comes out to 96 billion kwh of electrical energy consumed by Tesla cars per year. The total U.S. electrical consumption  in 2011 is 3856 billion kwh, according to the U.S. Energy Information Administration. The 25 million Tesla cars will add about 2.5% to our energy consumption. This doesn’t sound like much, but we will have to expand generating capacity to handle this.
   
   What will the electric car do to the environment? Currently about 2/3 of the U.S.’s power generation is driven by fossil fuels. Unless some major breakthrough happens, we will need to use more fossil fuels to generate more electricity that these electric cars will consume. I also must remind people that the basic technology of fossil fuels heating up water, producing steam, which drives turbines, which generates electricity, dates from the late 19th century, about the same time as the internal combustion engine. The Telsa electric car is a high-tech wonder whose motive power comes from very old technology.
   
   The basic societal problem here is short-term thinking. The people who can afford the $60k to $100k for a Tesla car might believe they are helping the environment, since their car produces zero emissions. But where does the energy that drives these cars come from? As I said above, the electrical energy that drives the batteries come mainly from fossil fuels, using old technology. People don’t think about the long-term consequences of the switch to electric cars.



2. The lack of a manual override for the parking brake represents engineering incompetence. Didn't the engineers involved in the brake’s design ever think that the brake might need to be disengaged was when the car was being towed? And one of the reasons for towing an electrical car is that it’s run out of charge? If there’s no charge in the battery, and there’s no manual override for the brake, then there is no way to disengage the parking brake. Moving a car to the tow truck becomes a much more complicated and lengthy process.
   
   Incompetence is nothing new, but it seems to be increasing in recent years. The Bush Administration was a case study in incompetence. There’s less excuse for this post-Great Recession, because with the high unemployment rate companies have been able to choose the crème de la crème for any professional or management job. Couldn't Telsa have chosen, among the hundreds who apply, an engineer with the brains to figure out that a manual parking brake override would be necessary?



3. Broder mentions frequent calls to Tesla, with many leading to poor advice. This brings me to another societal problem, poor customer service. I just personally encountered poor customer service from Express Scripts, a pharmacy insurance provider. I was furious after several calls that were poorly handled and didn’t lead to any solution. I’m sure that everyone reading this has encountered examples of poor customer service, especially from call centers. This has become a societal problem because of outsourcing, layoffs, high turnover, and lack of initiative, responsibility, and intelligence among low-paid people that companies, in their zeal to cut costs, put in customer service positions.
   
   If I were CEO of Tesla, and I had advance notice of a New York Times reporter test driving one of my cars, I would have given Broder the cell phone number of my best engineer, and made sure that the engineer was available at all times to take Broder’s calls. According to Broder, it was Tesla who set up the test drive and arranged the date. So ignorance among Tesla executives is no excuse. Since Tesla left Broder basically on his own, even though they knew that he would report on the car in the New York Times, one can only imagine the customer service that regular consumers get.



4. Finally, Elon Musk's blog response demonstrated extremism and lack of taking responsibility, which are both major societal problems. Musk claimed that Broder was dishonest, and deliberately sabotaged the test drive. Musk admitted to no faults, no problems, and no feedback from Broder at all that deserved any apology. He took no responsibility for any of the car’s failures or shortcomings. According to Musk, all the alleged problems with the car were the machinations of a deceptive reporter.
   
   Extremism such as Musk’s is prevalent today, especially in politics. Republicans can find nothing of value in what Democrats advocate, and vice versa. “It’s my way or the highway” has become a mantra in politics. This is not a constructive point of view, one that will lead to solving problems. Extremism is also connected to lack of taking responsibility. If you’re completely right, and the other side is completely wrong, then you have no responsibility for any of the problems we face. It’s all the other side’s fault. This is what I get from Musk’s response. He’s completely right, Broder’s completely wrong, and there is nothing for Musk to take responsibility for. If the Tesla car has no problems, then Musk has no reason to improve it at all. Fortunately the marketplace will punish Musk if he maintains this attitude (or his board will fire him). In politics, the extremist idiots just keep getting elected.

Rare Genetic Mutations Are Linked to Common Diseases

A recent New York Times article indicates that common human diseases such as cancer and psychiatric disorders are caused by a combination of rare genetic mutations. This is different from the "common disease, common variant" viewpoint that has guided previous research. It is easier to look for common genetic mutations than rare ones. This has proved to be a fruitless search. "Common variants have turned out to explain only a fraction of the genetic risk of common disease." The challenge for future research is that rare mutations are difficult to find, and require large sample sizes. Also, different races of people (e.g. Africans versus Europeans) will likely have different mutations. The bottom line is that we're a long way from understanding the genetic causes of psychiatric disorders such as depression, autism, or schizophrenia.