293 (30 November 2016)

Welcome to week 293!  The articles below caught my attention this week.  Please note that what are intended to be relatively objective “briefs” are preceded by dashes (——–), whereas additional material or relatively subjective comments are preceded by asterisks (********).  The links to articles preceded by [SR] require a subscription to be read in their entirety, although complete articles may frequently be found by an Internet title search.

(16 November 2016): “For one condition, the drugs came before the disorder” (http://www.jsonline.com/story/news/investigations/2016/11/16/one-condition-drugs-came-before-disorder/93823042/)

********This article, on the treatment of premenstrual dysphoric disorder (PMDD), appeared in the Asheville Citizen-Times on 24 November 2016.  It is one of a series on “Illness Inflation” developed by the Milwaukee Journal-Sentinel and MedPage Today.  An overview of the way that “New and expanded medical definitions create more patients—and a lucrative market for drug firms” can be found at: http://archive.jsonline.com/watchdog/watchdogreports/new-and-expanded-medical-definitions-create-more-patients–and-a-lucrative-market-for-drug-firms–379981751.html.

********A complete list of the conditions examined in the “Inflation” series can be found at: http://projects.jsonline.com/topics/illness-inflation/index.html.  They include: Adult ADHD, Binge-eating disorder, Female sexual interest/arousal disorder, Intermittent explosive disorder, Low testosterone, Overactive bladder, Pre-diabetes, and PMDD.  The conditions are categorized as psychiatric and medical.  For me what stands out in the PMDD article is the role that pharmaceutical companies and regulators play in defining a market for a drug.  As the link in this paragraph notes, “New definitions or lowered thresholds mean millions more people—overnight—fit the criterial of having treatable disorders.”

********MedPage Today seems to be a source worth remembering.  You can learn more about it at: http://www.medpagetoday.com/.  Coincidentally, when I went to its page, I found an article dealing with surgeon Tom Price, a member of the House of Representatives who has been nominated to be the next Health and Human Services Secretary.  You can learn more about Price’s views in the article “10 Questions: Rep. Tom Price, MD (R-Ga)” (http://www.medpagetoday.com/Surgery/Orthopedics/44217).

(25 November 2016): “Small Businesses Lament There Are Too Few Mexicans in U.S., Not Too Many” [SR](http://www.wsj.com/articles/small-businesses-lament-there-are-too-few-mexicans-in-u-s-not-too-many-1480005020)

——–In Dallas, San Francisco, and the state of Florida, employers are losing revenue because of labor shortages.  “As hiring accelerates and the labor market tightens thanks to a steady U.S. recovery, employers who need low-skilled workers are increasingly struggling to fill vacancies.  One big reason: Mexican workers, who form the backbone of industries like hospitality, construction and agriculture, are in short supply.”  According to senior economist Pia Orrenius at the Federal Reserve Bank of Dallas, “Mass migration from Mexico is over . . . Low-skilled labor will never be as plentiful again.”  One reason is smaller families.  “For the last 20 years, Mexican families have averaged just over two children, compared with nearly seven in the late 1960s.”  In addition, “some Mexican states have launched campaigns to discourage youngsters from making the perilous journey north.”  Likewise, “smugglers are commanding higher prices to get migrants through territory often controlled by drug gangs and across a far more secure border than ever before.”

********The situation described above would seem to be a boon for low-skilled American workers but, as mentioned in the article, “Employers say U.S.-born workers don’t want those jobs.”  As I read through the article, twice, I found it interesting that in 1986 then-President Ronald Reagan “granted amnesty to six million undocumented immigrants.”  The article is accompanied by a four-minute video and a small number of charts and photos that add a lot.  Then there are the more than 900 comments provided by readers.  One especially telling graph shows the number of Mexicans apprehended by the U.S. Border patrol from 1960 to 2014.  Apprehensions have fallen from a seeming peak in 2000 of about 1.6 million to a modern low of 250,000 in 2014.  One explanation is that enforcement has declined but the explanation more consistent with the drift of the article is that the U.S. has become relatively less attractive (Mexico relatively more attractive).  What policy has failed to do, it seems, economic and cultural conditions have done.

********The topics of immigration and smuggling give me a chance to say a word or two about the book I am currently reading, Smuggler Nation: How Illicit Trade Made America (https://www.amazon.com/Smuggler-Nation-Illicit-Trade-America/dp/0199360987), by Peter Andreas.  The book is a sustained effort to discuss the various ways that smuggling and related illegal activities have affected the development of the U.S.  It is chronologically developed and has a good deal to say about illegal immigration.  At the end of chapter 8, which deals with the slave trade, Andreas notes:

The illicit slave trade was not the only (or the numerically most significant) episode of smuggled human cargo in American history . . . As we will see later in our story, millions of foreign workers clandestinely came to America through the back door, but in violation of U.S. immigration laws rather than antislave-trade laws.  As cheap immigrant workers came to replace slaves as America’s most exploitable labor force in the late nineteenth century, the federal government became far more involved in immigration control than it had ever been in policing the slave trade.

You can find a time series (1850-2015) of number of immigrants and immigrants as a percentage of the population at: http://www.migrationpolicy.org/programs/data-hub/charts/immigrant-population-over-time.

(26 November 2016): “Brewers Bet Beer Drinkers Seek More Sober Suds” [SR](http://www.wsj.com/articles/brewers-bet-beer-drinkers-seek-more-sober-suds-1479810603)

——–“After years of trying and failing to jump-start sales of alcohol-free beer, the world’s largest brewers are expanding their nonalcoholic offerings with renewed zeal.  Each of the new global Big Three in brewing—Anheuser-Busch InBev NV, Heineken NV and Carlsberg A/S—is investing in new technology, marketing and distribution for nonalcoholic beers like Budweiser Prohibition Brew, 0.0% MAXX and Nordic.  They are betting stricter alcohol regulations and a shift toward healthier consumption will lift sales.”  Although the sales of these beers are currently low, “Nonalcoholic beer is growing three times faster than the overall beer market,” according to Carlsberg CEO Cees’t Hart.  In addition, “Brewers earn fatter profit margins from nonalcoholic beer given the absence of excise tax and the fact that such beers often sell at a premium to regular beer.”  Increases in beverage sales will have to solve a basic problem: “many everyday drinkers aren’t convinced nonalcoholic beers make sense.  As noted a former intern who studied the market, “It’s kind of like nonbeneficial exercise—why would people use this if the main benefit doesn’t exist?”

********As a consumer of “NABs” and having read recently about prohibition, this subject is of interest.  According to the article, alcohol-free beer can be made “either by halting the conversion of sugars to alcohol early or removing the alcohol after brewing is complete.”  Only this second method seems to have been discussed in a recent “Answer Man” column in our local paper: http://www.citizen-times.com/story/news/local/2016/11/07/answer-man-non-alcoholic-craft-beer-mia-mhu-asbestos/93418962/.  I suspect that craft brewers will find it difficult to produce at a scale that is profitable given the narrowness of the market but the situation may well be different for the global Big Three.

********The cigarette industry, of course, really knows how to target customers and develop products and advertising in its pursuit.  This is again made apparent in “Marlboro Black Lures Millennials Who Shunned Cowboy Image” [SR](http://www.wsj.com/articles/marlboro-black-lures-millennials-who-shunned-cowboy-image-1480329006).  In contrast to the tradition Marlboro Red, the lower-priced Black “offers what the company calls a ‘bold, modern take’ on Marlboro—think tattoos, black jeans and motorcycles instead of Stetsons, bluejeans and horses.  It is marketed to young adults with direct mail that looks more like a VIP party invitation—black, rimmed with white—than junk mail.  In the five years since Marlboro Black was introduced, it has done a lot to help Philip Morris USA with its millennial problem.”  This is probably a good time to again draw attention to The Cigarette Century (https://www.amazon.com/Cigarette-Century-Persistence-Product-Defined/dp/0465070485/), by Allan Brandt.

********While we are on the subject of cigarettes, The Atlantic had a very interesting article in its December issue: “How Casinos Enable Gambling Addicts” (http://www.theatlantic.com/magazine/archive/2016/12/losing-it-all/505814/).  The story is built around the sad case of Scott Stevens, a gambling addict who eventually committed suicide.  The article notes that “one in five gambling addicts attempts suicide—the highest rate among addicts of any kind.”  The article is very informative, going into some detail on the various strategies embodied in electronic gaming machines (EGMs) intended to encourage players to gamble longer.  Regarding the connection to cigarettes, “Public-policy advocates compare slot machines to cigarettes.  Both, they claim, are products specifically and deliberately engineered to have addictive properties that are known to hook users.”  The article cites a few books from which one could learn more.  Two that caught my attention are Addiction by Design: Machine Gambling in Las Vegas (https://www.amazon.com/Addiction-Design-Machine-Gambling-Vegas/dp/0691160880/), by Natasha Dow Schüll, and Gambling in America: Costs and Benefits (https://www.amazon.com/Gambling-America-Benefits-Earl-Grinols/dp/0521830133/), by Earl L. Grinois.  One thing I saw reinforced by the article is how difficult it is to rid a state of a product once it has been taxed, as the government will lose tax revenue once the product disappears.  Of course, this has also been a selling point of gambling in North Carolina and other states.  Legalize gambling, tax it, and then use tax revenues to support, for example, education.  Sometimes it is hard to keep your principles when a pile of money is placed before you.

May you have a good week!

Bruce

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