Complicated Chemicals Seek Some Corporate Lovin'

Thanks to my first post on organ donations and executions, the stories generated by my news algorithm have taken on a capital-punishment-y nature. Thus I was first alerted to the problem with Sodium thiopental, one of the three drugs used in executions (the other two are Pancuronium bromide and Potassium chloride). Hospira was apparently the only company in America that produced the drug and when they stopped production in 2009, various states turned to a London based company.

Apparently the drugs produced by that company, Dream Pharma, are of  questionable quality and legality, prompting the DEA to size various states' sodium thiopental supplies and delaying executions across the country. My home state, Georgia, was first to be investigated, followed by Tennessee and Kentucky because they apparently bought from Georgia's supply. Other states are either giving up their supply to the DEA or switching their drug cocktail (which can cause its own problems).

Depending on your views on capital punishment, you may think this shortage is a good thing. But it's indicative of a larger, troubling trend of drug shortages because cost of production exceeds profits. If you live in Alabama, Arizona, Louisiana, Texas, or any of the other states that the coral snake is found in, be extra careful. The last vial of anti-venom expired in October of 2010 with no signs of a replacement source appearing anytime soon. Occasionally, the problem is with a shaky supply chain. For instance, Arizona ran out of scorpion anti-venom because only Marilyn Bloom was producing it and she retired. But by far, the most common culprit is economics. There are maybe 100 coral snake bites a year that require the anti-venom, so the cure was never destined to be a big money maker. But now that Wyeth has stopped production completely, any company looking to be the new source has to pay and pass the multi-million dollar hurdles involved with getting a drug past the FDA approval process. But why would any company do that if it has been clearly proven that this product has no chance of ever being profitable?

This begs the question: Who should be responsible for producing things that are not profitable, yet are still necessary? The first thought that springs to mind is that the government should subsidize it, like they do for mass transit, parks, museums, and other infrastructure and amenities. However, if the government did pay to manufacture anti-venom or other unprofitable but necessary drugs, it would cross a line that would be difficult to re-draw. Would the government limit itself to just production of already known drugs or would it also take on the extremely expensive task of searching for new ones? Would it only produce drugs with expired patents or would it be allowed to ignore patents completely if there isn't a profit to be had and essentially become rogue generic manufacturer? Why would drug companies, the so called "Big Pharma," continue to chase after those ever increasingly more expensive cures if there is some other source that can constantly afford a loss? Except (currently policies notwithstanding) the government can't operate at a loss indefinitely and eventually the whole structure will come crashing down.

So. We need to come up with a solution. Ideas? For now the most effective thing I can think of is avoiding anything that might be venomous and rare. If that fails, kill it with fire. Long term outlooks on this strategy are not so good, so other suggesting are eagerly welcome.

One last note on sodium thiopental. The shortage is occurring because Hospira and many other companies that manufacture the drug are facing boycotts from European governments that belong to the EU. As the EU is opposed to execution, member countries refuse to buy from those companies unless the company can ensure that none of its drugs will be used in lethal injections. However, states have mostly side-stepped this issue by using other barbiturates, and sodium thiopental has other uses. In fact, it is listed in the WHO's list of essential medicines, meaning that it is needed for a basic health care system. I hope that no one has been adversely affected because of this shortage.

NOTE: This post DOES NOT mean that I am for or against capital punishment. It merely means that I am interested in the economics of drug design. 

The Trouble with Internships

A couple of days ago, a friend of mine was updating me on his summer job search. One posting, he said, was from a guy who wanted people to come sit at his kitchen table and work eight hours a day on building his website. Unpaid.

"Like an internship?" I asked in disgust.

"Exactly. Only it wouldn't be worth it because this guy and his site aren't known. So it's really more like free labor." We both immediately started on about how stupid the whole thing was and the unfairness of the internships but in the end we both just laughed it off. My friend is interviewing for a much better gig that actually pays and he already has a basic summertime job lined up plus supportive parents so he'll be okay should either plan fall through. But that got me thinking about kids who don't have supportive parents and/or flexible jobs.

Internships are temporary jobs with well-known corporations, non-profits, or the government that are intended to offer experience and networking opportunities. I never applied for an internship but I have applied for some shadowing/volunteering gigs so I assuming the two are pretty similar. You fill out an extensive application, beg the only teachers that might remember you your favorite teachers for a recommendation, and possibly face an interview or three in the hopes of being allowed to make coffee and charts for six to twelve weeks of the summer. I get the sense that for certain majors like business, journalism, or political science, internships are unofficially required in the way that shadowing and volunteering are unofficially required for pre-med and pre-vet students.  But the hidden sacrifice of internships is that the majority of them are unpaid. So really your parents you have to be able to afford to underwrite a whole summer of free work.

Okay, so let's say that you've found an internship and you're reasonable sure that you can cover all summer expenses without a steady paycheck. That's not an unreasonable assumption for a large number of middle class undergraduates (myself included). But if you receive any form of financial aid from your school, there might be more complications to consider. I found at least one college that requires any recipient of a financial aid package to earn at least $2,000 over the summer and I'm willing to bet there are similar stipulations at other institutions of higher learning. So students are forced to give up something that is important and valuable to their future in order to take on something immediate but irrelevant, like cleaning pools or flipping burgers. It seems to me like those places are making it even harder for disadvantaged students to succeed after college.

To make things even more ethically icky, a quiet but bustling business of internship placement has sprung up in the last few years. For a "modest" fee, these companies do everything from mass distributing an applicant's resume to arranging interviews or producing and releasing personalized press packages. Those fees I mentioned can range from $5,000 to $9,500, or an actual percentage of your paycheck if you're lucky enough to net a paid internship (the only type that particular company offers to its customers). For their defense, these companies claim that most of their customers are middle-class students whose parents "dig-deep" and that they offer a greater range of opportunities and experiences than the average students could find on their own. One company has even started scholarships or their own financial aid for low-class prospective customers, though when I type the company's name into Google, auto-fill wants to add "scam" or "worth it" to the entry. I can't  understand is why a company would want to even consider a candidate who needs a company like this.

But if you feel like using a placement company to give your application an edge is still to risky, you could just outright buy an internship. Apparently the economic downturn has prompted various charities to get very creative with their fundraising techniques, including auctions that offer insanely competitive internship positions with Rolling Stone, Elle, and Atlantic Records. Again, why would you want to pick an intern like this?

"I feel like the government should regulate internships somehow. But then, when is the government good at regulating anything?" I told my friend at the end our conversation. But it turns out that the government already loosely regulates internships.

The U.S. Department of Labor's Wage and Hour Division allows an employer not to pay a trainee if all of the following are true:

1. The training, even though it includes actual operation of the facilities of the employer, is similar to what would be given in a vocational school or academic educational instruction;
2. The training is for the benefit of the trainees;
3. The trainees do not displace regular employees, but work under their close observation;
4. The employer that provides the training derives no immediate advantage from the activities of the trainees, and on occasion the employer’s operations may actually be impeded;
5. The trainees are not necessarily entitled to a job at the conclusion of the training period; and
6. The employer and the trainees understand that the trainees are not entitled to wages for the time spent in training.

An exception is allowed for individuals who volunteer their time, freely and without anticipation of compensation for religious, charitable, civic, or humanitarian purposes to non-profit organizations. An exception is also allowed for work performed for a state or local government agency. Some states have their own laws on the subject. Laws in the state of California, for example, require an employer to pay its interns working in California unless the intern receives college credit for the labor[1].

A gross oversimplification over the above text for all of you who thought TL:DR. 

 Source

Loopholes exist with any law, however, and there are reports of businesses forcing students to accept college credit for their internships just so that they do not have to pay them. This also limits the internships a student may take if their school does not accept the college credit. But I take bigger issue with #3: The trainees do no displace regular employees, but work under their close observation. We all know the stereotypes for internships - you spend the day assembling charts, copying reports, and making coffee. Sounds an awful lot like what an entry-level secretary could be  doing, doesn't it? In fact, both the Justice Department and the Department of Labor have opened investigations to see if, in these days of strained budgets, corporations have been cutting costs by unlawfully using interns.

When I started doing research for this post, I tried typing "the trouble with internships" into Google. It probably won't be a surprise to anyone actually employed, but the five results or so were all about the trouble with interns. Employers love to tell story on how lazy, irresponsible, and just plain stupid their worst interns rather than celebrating or helping the good ones. Granted, I scroll down a little further and it's all people complaining about how awful their internships are or how difficult it is to get one (more on that later). But it sounds like the system isn't really doing anyone any sort of good.

Ugh. I'll just leave you with this suitably adequate XKCD knockoff. Remember that feedback and comments are better than day shadowing doctors at Emory.