Philip Morris' $300 million verdict

Big Tobacco's high dividend payout strategy might not be working.

A Florida Circuit Court last week awarded a former smoker, 61-year old Lucinda Naugle, $300 million in her lawsuit against Philip Morris (NYSE:PM), finding wheelchair-bound Naugle, who now has emphysema after smoking from age 20 to 45, 10% guilty and the cigarette manufacturer 90% guilty for compensatory damages. Philip Morris shares dropped 1.2% $18.98 on Friday at the news and haven't been doing too well since.

This was actually a case that came out of the so-called "Engle Progeny lawsuits", when in 2006 the Florida Supreme Court vacated a 2000 verdict in a class action lawsuit (Engle v. R.J. Reynolds Tobacco Co). And while the $156 billion verdict was overturned (this lawsuit involved 700,000 smokers) the court allowed plaintiffs to file individual claims and use the liability findings from the trial.

So Naugle's verdict was the 10th Engle verdict this year and 8 out of 10 of these verdicts were against Big Tobacco, although Naugle's was the largest of all of them. And Philip Morris isn't done yet-there are about 8,000 more waiting for their day in court.

Obviously Philip Morris is crying foul, saying the decision is unconstitutional since it allowed the jury to look at previous jury findings and evidence unrelated to Naugles.

You might wonder how this sort of thing comes about. After all, I thought the MacDonald-made-me-fat lawsuits were far and wide decried as pointless. Haven't we had these cases before?

Actually we have: just in 2007 in Philip Morris v. Williams, the Supreme Court overturned an Oregon jury’s award of $79.5 million in punitive damages. This wasn't because the smoker should've known about the harmful effects of smoking though. Rather the Court ruled 5-4 that "the Constitution's Due Process Clause forbids a State to use a punitive damages award to punish a defendant for injury that it inflicts upon nonparties."

This meant that it's unfair for Philip Morris to be held responsible for harm to strangers since the charges would be limitless as well as arbitrary. Which would explain the Engles decision.

If Philip Morris loses the appeal, it'll obviously be a bad sign for Big Tobacco, even if $300 million could be considered small fries when you think about the $206 billion the seven largest tobacco companies agreed to pay in a 1998 nation-wide settlement.

Sex Change Limits in Thailand

In 2007 a willowy, gorgeous 21-year old student Thanyarasmi Siraphatphakorn won the Miss Tiffany Universe pageant—for being the most beautiful transvestite in Thailand.

There are no official numbers for how many transsexuals exist in Thailand. By some estimates it could be around 10,000, with one doctor saying he does procedures three times a week (half of them foreigners), and others say as many as 20% of schoolboys call themselves a transsexual even without a sex change operation, causing one school to install transsexual bathrooms, with a logicial bathroom sign:


I've always wondered about transsexual prevalence, when it seems Asians (at least in the states) are much more conservative than Westerners. Transsexual rights campaigner Suttirat Simsiriwong says, "Thai society and culture tend to be very sweet, very soft, and the men can be really feminine, if we tend to be gay, many of us tend to be transgender" and that the number of transsexuals in Thailand are no more than transsexuals elsewhere. According to the American Psychological Association 1 in 11,900 men and 1 in 30,400 women are uncomfortable being in the body they were born in and wish they were of a different sex.

Maybe transsexuality in Thailand is like bisexuality in Manhattan. And with prices like $1,000 to $6,000 to become a woman (a three-hour procedure), it's no wonder there are so many so-called "katoeys" in Thailand.

So today, the Thai Department of Health issued rules to limit sex change surgeries and make candidates think more carefully about their decisions, which are irreversible:

1. Candidates must be at least 18 (this rule was always in place)
2. Candidates must cross-dress for one year after informing a doctor of the initial decision and undergo hormone therapy
3. Candidates must undergo a mental evaluation before the surgery, obtain approvals from two psychiatrists, and attend follow-up visits with a psychiatrist after the surgery.

There are absolutely no numbers I could find about how much Thais have spend on sexual reassignment surgeries, and not even how many undergo SRS. While I am pretty sure any of those looking to do this are very certain of their decision, and an SRS isn't exactly the same as getting a tattoo, these rules should eliminate any of those "I'm drunk so let's do it" type of decisions.

Anyway I'm guessing waking up the next morning and wishing you hadn't castrated yourself is probably kind of devastating. In any case, I think these rules are a great call.

Healthcare Bill & Botax (cont.)

So the Democrats pushed their healthcare bill through last night and it is one step closer to law, after it's approved by the Senate, then reconciled with the House bill and finally President Obama.

But some people are saying this could be good for the industry, citing brothels and tobacco as examples:

1. Nevada brothels actually wanted to give tax revenues to the state: Anytime you’re going to take tax money, the state’s not going to view you as a relic and put you out of business,” said a lobbyist for the Nevada Brothel Association. Legislators were unwilling to accept.

2. Because of the vast amount of taxes the US government has been taking from Big Tobacco, it actually gives Big Tobacco considerable political clout. They even did a study on this in Korea, where they found the more a local government derived revenues from tobacco companies, the less likely it was to participate in anti-smoking campaigns.

While in these two cases it makes sense that the cost of taxing your industry is worth the benefit of political influence, I don't know if the plastic surgery industry is comparable. First, plastic surgery doesn't cause cancer (at least we don't think it does yet) and it's also not exactly like prostitution either.

Well I emailed the big companies (Allergan, Johnson & Johnson, Medicis, etc) asking them about their views. They haven't gotten back to me yet but I think the plastic surgery industry's complaints about this tax answers this question about political influence.

Healthcare Bill & Botax

So the Democrats unveiled their healthcare bill today. It all looks great -the Congressional Budget Office calculates that the legislation, which will expand coverage to 31 million more Americans by 2019, also will reduce $138 billion in deficits over the same period.

One interesting provision though, hasn't escaped critics, even though it was buried somewhere in the bill's 2,074 pages: there's a 5% federal tax for cosmetic procedures (not including surgeries to correct deformities or injuries). Estimated to raise $6 billion the next decade after it begins in January, the tax along with cuts to the federal Medicare system would help Reid’s $848 billion healthcare bill meet two benchmarks set by President Obama—keep the ten-year cost under $900 billion and ensure it doesn’t exacerbate federal budget deficits.

This kind of tax isn't new. New Jersey did it in 2004 but after it only raised $7.5 billion of the estimated $24 billion, they repealed it, then Gov. Corzine vetoed the repeal, and it still only raised $11 million in 2007.


So plastic surgery supporters have been up in arms about this, with several complaints:

1. It's sexist: 86% of patients are female

2. It really doesn't target the rich: According to the American Society for Plastic Surgeons, 30 percent of patients have an annual income of $30,000 or less and 41 percent make between $30,000 and $60,000. Only 13 percent earn at least $90,000.

3. People who get plastic surgeries also don't burden the healthcare system, contribute to ballooning costs of Medicare nor are these procedures covered by insurance. It's far from being a sin tax at all.

Reid’s tax proposal nonetheless put pressure on an industry already concerned about the economic downturn. According to ASAPS, cosmetic procedures plunged 12 percent last year to 10.2 million, compared to a two percent growth the year before.

On Thursday after the proposal was announced, shares of Botox and breast-implant maker Allergan Inc. (AGN) declined 2.3 percent to $58.56 and shares of competitor Medicis Pharmaceutical Corp. (MRX) fell 2% to $23.46.

Flibanserin: Women's Viagra, Finally

In another instance that differentiates men from women, we now are one step closer to a female Viagra, more than ten years after sildenafil citrate in the form of Viagra came onto the market in 1998 from Pfizer Inc.

This new women's drug is called flibanserin, developed by a private Germany-based pharma company called Boehringer Ingleheim. This is the same company that brought us Flomax, used to treat enlarged prostates which can block the flow of urine (luckily for Boehringer the U.S. patent for Flomax actually expired last month).

The reason why it took this long to develop a drug to treat Hypoactive Sexual Desire Disorder (HSDD) in women is because, as many of us-men and women-will have learned by now, women's sex drive is usually controlled by the brain whereas men's are more physical. So sildenafil worked by increasing blood flow to that crucial male appendage whereas a drug to work on something as complex as the human female brain is much harder to develop.


In fact flibanserin was discovered much as sildenafil was-an usually large number of trial patients would keep the drug even though it didn't work too well as an antidepressant, or what it was initially developed for. So Boehringer started to look into its usefulness in promoting female sexual desire, and presented positive findings today.

Competition's pretty close though: There's another drug still in safety testing called LibiGel, developed by Illinois-based BioSante Pharmaceuticals, which BioSante expects will be submitted for approval and launched sometime in 2011. The thing is LibiGel is an actual topical gel you apply on your arm once a day to deliver testosterone into the blood stream, since testosterone deficiency has been found to decrease female sex drives. Concerning Boehringer's progress with flibanserin, BioSante CEO Stephen M. Simes said it is "important and exciting medical news" for women.

If men are any indication, the quarter after Viagra came out, Pfizer's profits rose almost 40%, and the patent is still in effect (this hasn't discouraged China, although China's not exactly famous for patent protection anyway).

Plus we women are lucky enough to get menopause at some point (this development actually comes at an interesting time when cultural references of cougars have really been proliferating), and even with as many as a quarter of pre-menopausal American women suffering from HSDD according to a study last year, this sort of drug should be very well received.

Glue in You: Kryptonite & Heart-Surgery

Doctors can now use glue to aid bone healing in open-heart surgery after a pilot study of 20 patients in Canada today. Now if you get heart surgery, they won't have to stitch wires into your breastplate (according to this guy ScienceDaily talked to, it can be pretty terrible when the wire breaks - squeezing toothpaste and breathing was understandably torture). Now while I couldn't find any information on how often the wire breaks, this glue is great anyway since it helps you heal faster.

The study was also supported by the company that created the glue - Doctor's Research Group, founded by Richard Deslauriers (degrees in mechanical engineering and medicine) in 1997, based in Connecticut, who started the company in an old stamping factory with a couple engineers. Now they've got 600+ people on just the sales team, according to this venture summary. The glue, called Kryptonite, was developed in 2005 and has been approved in 31 countries including Canada, the USA and Europe. This should be good news for us when heart disease is still the leading cause of death (although it might hand that title over to cancer - "malignant neoplasms" - someday), according to the CDC:


Bone glue isn't a new thing, but apparently Kryptonite's 18 times stronger than one brand of bone glue on the market, PMMA (which gets hot when used). There's also Plexur P Biocomposite (cleared by FDA in 2007) and Stryker Simplex P Bone Cement (used in orthopedics since 1973).

It's not clear why Kryptonite was the first to be used for heart surgery but the glues do differ in little ways: For example Plexur's been used more for bone graft extending and bone filling, made from phosphate, calcium and proteins, whereas Kryptonite's made from fatty acids and calcium carbonate, the same compound that pearls and eggshells are made of. Plus applications of these things are done step by step (ie Plexur was used for bone grafts, then ankle surgeries, and then applied to the spine last year), so maybe DRG beat everyone else to the chase.

DRG says sales for Krytonite have been 1 million in Europe but they're private, so there's not much data available. Plus they don't even have a website up. But according to an interview back in 1999, they've got some other patents for a mishmash of products with similarly interesting names:

• Echoplus digital signal processing stethoscope allows doctors to record heartbeats and preserve them for comparisons during future patient visits. Physicians can also slow or speed recordings to better observe patterns.

• The only combination bone screw and suture anchor system, Sherlock, which reduces time in the operating room.

• The Piranha self-drilling bone screw.

• The Lockjaw 15-minute intermaxillary fixation system, a flexible direct bonding arch bar, for use in open-mouth surgery, which reduces operating-room time and reduces exposure to infection.

• The Hummer combination reflex hammer and tuning fork

It should be interesting to see where else we can apply bone glue, but for right now I'm glad it's out there as one more thing in the doctor's toolbox when they're splitting you open.

H1N1 Roots of Paranoia

I found it strange that despite all the evidence to the contrary, people are so paranoid about the H1N1 vaccine. But it seems a lot of this nervousness stemmed from a 1976 vaccine fiasco, where the government initiated a national vaccination program against a pandemic, by the same H1N1 strain we're seeing today, which never materialized (one person was killed by the strain and 13 were hospitalized).

But in the 48 million Americans (or 24% of the population) who were vaccinated that year, 532 developed Guillain-Barré syndrome, where a person's own immune system attacks the nerve system which can lead to paralysis. Most recovered but 25 died with some suffering lasting damage. This fiasco is what Glenn Beck bases his skepticism of the H1N1 vaccine on (October 8th, 2009 in his radio program), which Politifact then disproves and takes apart nicely.

There's only been findings of a causal relationship between the 1976 vaccine and GBS, with no one knowing how it happened (scientists don't even know how GBS is caused, in general). Vaccines, however, have come a long way in the last 30 years, and there's been millions of Americans since who have been vaccinated every year with no link to GBS. Not to mention you're more likely to get GBS from the flu itself than from its vaccine, according to a study this January, and your best chance of avoiding GBS is to get vaccinated, according to another study in 2007. Note that this is also a published study, unlike the unpublished studies naysayers dig up.

So NewScientist sums up the odds this way:

"The risk of getting Guillain-Barré from a flu vaccine is almost certainly less than 1 in a million; the risk of getting it from flu itself is more than 40 in a million. Swine flu is estimated to have killed 800 people in the US already, or more than 2 in every million so far. And during the first wave of swine flu this summer, 1 out of every 20,000 children aged 4 or under in the US ended up in hospital."

But obviously doubts linger from this, as the 1976 fiasco sparked over $100 million in lawsuits against the federal government, since to quicken the vaccination process the government granted immunity to vaccine manufacturers while shifting the burden liabilities on itself. Still, litigation worries decimated vaccine manufacturers: in the 1970s there were 25 vaccine manufacturers in the US but by 2004 there were only five.

But while the manufacturers in 1976 didn't take shortcuts, the US government has really stayed in the safe side, sticking with tried-and-true methods when it comes to vaccine. So I'm referring to those vaccine skeptics who keep repeating about the dangers of adjuvants (which makes vaccines more potent) and thimerosal (a preservative).

The US has sacrificed quantity for adjuvant-free vaccines (while Europe allows adjuvants) and evidence of the danger of thimerosal in vaccines is lacking. Not to mention there are H1N1 vaccines that are thimerosal-free anyway for those who are still concerned. SciAm has an interesting piece about how anecdotal evidence can undermine scientific results.

This isn't to say concern about H1N1 isn't warranted. H1N1 is truly a strain to be reckoned with. It really does hit the younger population more than the elderly - harking back to the 1918 flu where young people died violently by the masses - where 79 percent of US cases are younger than 30, and 2 percent are older than 65. Pregnant women are also in that high risk group with 6 percent of US cases being pregnant women while pregnant women make up about 1 or 2 percent of the population, although strangely there's no data on how hard pregnant women are hit with seasonal flu. And it turns out H1N1's a new strain which binds deeper in the lungs than ordinary flu.

But what's interesting is that this "younger people" phenomenon might be attributed to the 1976 vaccine as well as the 1918 flu. According to a study last month (published by the New England Journal of Medicine) by several researchers, a senior author being CDC Influenza division member Jacqueline Katz, those who were around to be exposed to the 1918 as well as the 1976 strains (both in the H1N1 family) "have some level of cross-reactive antibody" to the current 2009 strain, finding that folks older than 60 are more resistant to this year's H1N1 virus, and those who had the 1976 vaccination are even more resistant. Funny how those skeptics missed all this, hm?

H1N1 Paranoia

It seems like this can't be ignored anymore. I tried to avoid it so as to not beat the dead cat since it's been crazily publicized since April, but it's a topic this health blog can't ignore anymore: H1N1.


I initially thought H1N1's overly-publicized nature would mean there's nothing new to be added to the conversation. But there's actually a lot of misunderstanding concerning H1N1, especially its vaccine. This on the left by Jessica Hagy about sums it up.

Concerns about this vaccine has just become unwarranted paranoia. 47 percent of Americans say they would take it, and amazingly 47 percent say they wouldn't, according to Pew Research Center.

Where's this coming from??

For starters you've got people from Nation of Islam leader Minister Louis Farrakhan saying things like "the Earth can't take 6.5 billion people. We just can't feed that many. So what are you going to do? Kill as many as you can. We have to develop a science that kills them and makes it look as though they died from some disease" to Bill Maher twittering (Sept. 26) to his 60 thousand followers, "If u get a swine flu shot ur an idiot."

Then you've got the crazies at watchdog group VacTruth alleging that the entire thing is a government cover-up (with unsaid motivation), citing an unpublished study in Canada saying getting the seasonal flu vaccine doubles your chances of getting H1N1 flu. Of course the CDC refutes the study and there's also an Australian study which did not find such a link. Confusion about where the vaccine was developed is also pretty clear when "who developed H1N1 vaccine" pops up as a google search suggestion as you type it.

But there isnt' a whole lot of any evidence showing the H1N1 vaccine is any more dangerous than your usual flu vaccines, especially compared to evidence showing the contrary. The only thing I could find is skeptics repeatedly accusing the H1N1 vaccine for being "fast-tracked" and being made by shortcuts, without proof, sometimes saying the vaccine was developed by dubious manufacturers, again with absolutely no evidence for it.

On the other side, the CDC, WHO, FDA and manufacturers all say the vaccine has been developed no differently from usual seasonal vaccines. The only reason why there's a separate H1N1 vaccine is seasonality: it takes 6-9 months to create a flu vaccine and H1N1 came onto the scene obviously when no one predicted it. If it had emerged onto the scene a few months earlier, there would've just been one flu vaccine instead of the two we see now (here's a great H1N1 timeline which explains it nicely).

The vaccine manufacturers are also are usual manufacturers (Sanofi, Novartis, CSL, MedImmune, with a full list of all vaccines approved in the US here), and H1N1 vaccine ingredients are listed on the FDA website. And it's not like the government's using these big companies as a front for shadier manufacturers - they are really the ones making the stuff with auditors and financial statements showing profit windfalls (especially Sanofi and Novartis) for Big Pharma because of H1N1 vaccine production.


CBS even took a tour at the Sanofi plant (the only vaccine plant in the US) showing that these vaccines aren't just made in someone's backyard or some shady undeveloped country, if you go to the right place (ie steer clear of website scams and don't depend on what the FDA calls "fraudulent H1N1 products" like tea and vitamins to cure you or help much. Plus you know what I think about vitamins and flu) to get vaccinated. On top of that, there's a ton of monitoring to ensure the safety of vaccines.

As for the alleged "fast-tracking," Dr Margaret Chan, WHO Director-General, stressed back in September, "We want to do our job as quickly as possible. When we say that we fast-track things, it means that we streamline the bureaucratic process; there is no question that we would compromise on the quality and safety of vaccines.” And for those who think pandemic vaccines are more dangerous than seasonal vaccines because they're less tested and took shortcuts to develop, the only difference is actually just who pays for it - pandemic vaccines are paid for by the government, whereas conventional vaccines are paid for by ordinary health services.

If you're still wary, Ben Sherwood's got a great piece at HuffPo about unwarranted paranoia which definitely rings true:

"Yes, life is risky. Often, we choose to overlook scary facts every day and go about our lives. And even when there are simple, easy ways to minimize dangers, we frequently don't bother

Read more at: http://www.huffingtonpost.com/ben-sherwood/swine-flu-vaccine-why-you_b_344316.html&cp".

."

Well, last year right after I got tonsillitis (not a pretty illness, got it in China and went to four different hospitals) I became VERY susceptible to the flu, getting it about three times in four months last spring. So let me tell you as a person very acquainted with the flu, you don't want to get it. Please do bother getting the vaccine, if not for yourself then for herd immunity. (Actually this herd immunity study found that people who were vaccinated were more likely to get measles, and it turned out to be because of herd immunity..which just might be the reason for the Canadian study?)

Barefoot running

Just this weekend a friend of mine made his goal of finishing the 26-mile New York City Marathon in under four hours. Looks like staying in on Halloween was worth it.

I'm not a runner. Well to be accurate, not even an exerciser. It's terrible, I know. Even just running a couple miles today would probably make my heart explode. But back in London as an undergrad classes were pretty easy, so to alleviate the crushing boredom and to work off those daily, insanely delicious scones with clotted cream, I started running. Of course I'd just get lost and end up jogging around greater London for 3 hours (there was no one to ask - out of hatred of crowds and fear of heat stroke I'd jog at 11pm despite a friend trying to arm me with pepper spray and a tracking anklet).

My heart adjusted but that wasn't even a problem compared to my feet and calves. I had never endured soreness like that from my lost-jogging. And my friend RAN 26-miles. Which is why I became so interested in barefoot shoes when I read this story in NYMag last spring.

Adam Sternbergh lists several pieces of evidence that modern footwear is bad for our feet, making us run in a way that completely contrary to what nature intended, including this 2007 study which found that before we started wearing these shoes (not the 1700s but our caveman days) we had healthier feet and this 1991 study which found you're more prone to injuries with expensive shoes (meaning more padding and obstructions to your natural gait) than cheap ones. Apparently padded shoes interfere with our natural gait and rolling of the foot from the heel to the arch to toes pushing off from the ground, making us spend 5% more energy walking with shoes and increasing the pressure on our feet and knees.

But wandering around barefoot in NYC is asking for trouble, so now there are shoes as mainstream as the Nike Free (introduced in 2005) to more fringe-ier types like the Vibram Five Fingers (introduced in the US in 2006), from an Italian company that at first wanted to design shoes for boaters and kayakers. Then it won the 2007 Time award for best inventions.
They're not exactly Louboutins but I've been intrigued to try them for a while now, (even though they're $85) if I were still a lost-jogger.

Is barefoot running truly good for you? There's actually a lot of debate, with a study even admitting there's not enough evidence to know for sure, despite previous studies. Even the guy that barefooters hold up as the prime example, Ethiopian Abebe Bikila who won the first of his consecutive Olympic gold medals barefoot in 1960, donned a pair of Asics in the Tokyo Olympics and set another record. And barefoot running has recently gained a cult following, with people like Ken Saxton leading the way. There are even blogs about the barefoot experience like Ted's.

What people are saying now is that you should ease into barefoot running, and it seems everything should be in moderation, especially when some people are just biomechanically imperfect, which is really just stating the obvious.

But the barefoot business is booming. According to the NYT, barefoot shoemaker Terra Plana expects to sell 70,000 shoes this year, double from last year, and Vibram says its FiveFingers shoes have tripled every year since it was introduced here in 2006, expecting this year's US sales to be $10 million. That might be small fries in a $17 billion athletic shoe industry but given the growth, its a clear trend to watch.

Gravity and Insemination

This past Thursday researchers in Amsterdam published in the British Medical Journal that 15 minutes of lying down after artificial insemination could be very helpful.

Artificial insemination has been around for a long time, ever since Arabs used it for horses in the 14th century and Dr. John Hunter in England performed a successful human procedure in 1790 via syringe. By 1941 over 10,000 women became pregnant through the procedure, and by 1955, it was 50,000.

This new discovery about helping insemination along reminds me about this Friends episode, where one of the quirkier characters, Phoebe, lies upside down on a couch in hopes of increasing chances of pregnancy. Back then (1998), we laughed.

I think before we became used to the idea of artificial insemination and started thinking about it, couples would usually stay prostate post-natural insemination. So we never thought about gravity and insemination. Maybe it was just something nature intended all along, and it wasn't until we humans came up with test tube babies that we needed to rediscover things that came so naturally.

But I have wondered about long-term consequences of frozen eggs and sperm, of growing embryoes in a petri-dish a couple days before planting it into a person. How could something so unnatural turn out okay? Well so far it seems the world's first test tube baby, Louise Brown, is alright, having just had her own baby, naturally, three years ago. But scientists have observed in 2004 (yes, almost half a century later we started doing this stuff) that birth defects happen 1.4 to 2 times more often in what they call births through "assisted reproductive technology."

I suppose a cleft lip doesn't do much to discourage a couple desperate to be parents. We've got plastic surgery. And maybe cerebral palsy isn't so discouraging either. We've got private nurses and drugs. And spontaneous abortions? Maybe we'll come up with more drugs to get rid of those too someday.