Showing posts with label FDA. Show all posts
Showing posts with label FDA. Show all posts

Jun 19, 2010

The End of Men

Earlier this year, women became the majority of the workforce for the first time in U.S. history. Most managers are now women too. And for every two men who get a college degree this year, three women will do the same. For years, women’s progress has been cast as a struggle for equality. But what if equality isn’t the end point? What if modern, postindustrial society is simply better suited to women? A report on the unprecedented role reversal now under way— and its vast cultural consequences

By Hanna Rosin

Image credit: John Ritter

In the 1970s the biologist Ronald Ericsson came up with a way to separate sperm carrying the male-producing Y chromosome from those carrying the X. He sent the two kinds of sperm swimming down a glass tube through ever-thicker albumin barriers. The sperm with the X chromosome had a larger head and a longer tail, and so, he figured, they would get bogged down in the viscous liquid. The sperm with the Y chromosome were leaner and faster and could swim down to the bottom of the tube more efficiently. Ericsson had grown up on a ranch in South Dakota, where he’d developed an Old West, cowboy swagger. The process, he said, was like “cutting out cattle at the gate.” The cattle left flailing behind the gate were of course the X’s, which seemed to please him. He would sometimes demonstrate the process using cartilage from a bull’s penis as a pointer.

In the late 1970s, Ericsson leased the method to clinics around the U.S., calling it the first scientifically proven method for choosing the sex of a child. Instead of a lab coat, he wore cowboy boots and a cowboy hat, and doled out his version of cowboy poetry. (People magazine once suggested a TV miniseries based on his life called Cowboy in the Lab.) The right prescription for life, he would say, was “breakfast at five-thirty, on the saddle by six, no room for Mr. Limp Wrist.” In 1979, he loaned out his ranch as the backdrop for the iconic “Marlboro Country” ads because he believed in the campaign’s central image—“a guy riding on his horse along the river, no bureaucrats, no lawyers,” he recalled when I spoke to him this spring. “He’s the boss.” (The photographers took some 6,500 pictures, a pictorial record of the frontier that Ericsson still takes great pride in.)



Video: In this family feud, Hanna Rosin and her daughter, Noa, debate the superiority of women with Rosin’s son, Jacob, and husband, Slate editor David Plotz


Feminists of the era did not take kindly to Ericsson and his Marlboro Man veneer. To them, the lab cowboy and his sperminator portended a dystopia of mass-produced boys. “You have to be concerned about the future of all women,” Roberta Steinbacher, a nun-turned-social-psychologist, said in a 1984 People profile of Ericsson. “There’s no question that there exists a universal preference for sons.” Steinbacher went on to complain about women becoming locked in as “second-class citizens” while men continued to dominate positions of control and influence. “I think women have to ask themselves, ‘Where does this stop?’” she said. “A lot of us wouldn’t be here right now if these practices had been in effect years ago.”

Ericsson, now 74, laughed when I read him these quotes from his old antagonist. Seldom has it been so easy to prove a dire prediction wrong. In the ’90s, when Ericsson looked into the numbers for the two dozen or so clinics that use his process, he discovered, to his surprise, that couples were requesting more girls than boys, a gap that has persisted, even though Ericsson advertises the method as more effective for producing boys. In some clinics, Ericsson has said, the ratio is now as high as 2 to 1. Polling data on American sex preference is sparse, and does not show a clear preference for girls. But the picture from the doctor’s office unambiguously does. A newer method for sperm selection, called MicroSort, is currently completing Food and Drug Administration clinical trials. The girl requests for that method run at about 75 percent.

Even more unsettling for Ericsson, it has become clear that in choosing the sex of the next generation, he is no longer the boss. “It’s the women who are driving all the decisions,” he says—a change the MicroSort spokespeople I met with also mentioned. At first, Ericsson says, women who called his clinics would apologize and shyly explain that they already had two boys. “Now they just call and [say] outright, ‘I want a girl.’ These mothers look at their lives and think their daughters will have a bright future their mother and grandmother didn’t have, brighter than their sons, even, so why wouldn’t you choose a girl?”

Why wouldn’t you choose a girl? That such a statement should be so casually uttered by an old cowboy like Ericsson—or by anyone, for that matter—is monumental. For nearly as long as civilization has existed, patriarchy—enforced through the rights of the firstborn son—has been the organizing principle, with few exceptions. Men in ancient Greece tied off their left testicle in an effort to produce male heirs; women have killed themselves (or been killed) for failing to bear sons. In her iconic 1949 book, TheSecond Sex, the French feminist Simone de Beauvoir suggested that women so detested their own “feminine condition” that they regarded their newborn daughters with irritation and disgust. Now the centuries-old preference for sons is eroding—or even reversing. “Women of our generation want daughters precisely because we like who we are,” breezes one woman in Cookie magazine. Even Ericsson, the stubborn old goat, can sigh and mark the passing of an era. “Did male dominance exist? Of course it existed. But it seems to be gone now. And the era of the firstborn son is totally gone.”

Ericsson’s extended family is as good an illustration of the rapidly shifting landscape as any other. His 26-year-old granddaughter—“tall, slender, brighter than hell, with a take-no-prisoners personality”—is a biochemist and works on genetic sequencing. His niece studied civil engineering at the University of Southern California. His grandsons, he says, are bright and handsome, but in school “their eyes glaze over. I have to tell ’em: ‘Just don’t screw up and crash your pickup truck and get some girl pregnant and ruin your life.’” Recently Ericsson joked with the old boys at his elementary-school reunion that he was going to have a sex-change operation. “Women live longer than men. They do better in this economy. More of ’em graduate from college. They go into space and do everything men do, and sometimes they do it a whole lot better. I mean, hell, get out of the way—these females are going to leave us males in the dust.”

Man has been the dominant sex since, well, the dawn of mankind. But for the first time in human history, that is changing—and with shocking speed. Cultural and economic changes always reinforce each other. And the global economy is evolving in a way that is eroding the historical preference for male children, worldwide. Over several centuries, South Korea, for instance, constructed one of the most rigid patriarchal societies in the world. Many wives who failed to produce male heirs were abused and treated as domestic servants; some families prayed to spirits to kill off girl children. Then, in the 1970s and ’80s, the government embraced an industrial revolution and encouraged women to enter the labor force. Women moved to the city and went to college. They advanced rapidly, from industrial jobs to clerical jobs to professional work. The traditional order began to crumble soon after. In 1990, the country’s laws were revised so that women could keep custody of their children after a divorce and inherit property. In 2005, the court ruled that women could register children under their own names. As recently as 1985, about half of all women in a national survey said they “must have a son.” That percentage fell slowly until 1991 and then plummeted to just over 15 percent by 2003. Male preference in South Korea “is over,” says Monica Das Gupta, a demographer and Asia expert at the World Bank. “It happened so fast. It’s hard to believe it, but it is.” The same shift is now beginning in other rapidly industrializing countries such as India and China.

Up to a point, the reasons behind this shift are obvious. As thinking and communicating have come to eclipse physical strength and stamina as the keys to economic success, those societies that take advantage of the talents of all their adults, not just half of them, have pulled away from the rest. And because geopolitics and global culture are, ultimately, Darwinian, other societies either follow suit or end up marginalized. In 2006, the Organization for Economic Cooperation and Development devised the Gender, Institutions and Development Database, which measures the economic and political power of women in 162 countries. With few exceptions, the greater the power of women, the greater the country’s economic success. Aid agencies have started to recognize this relationship and have pushed to institute political quotas in about 100 countries, essentially forcing women into power in an effort to improve those countries’ fortunes. In some war-torn states, women are stepping in as a sort of maternal rescue team. Liberia’s president, Ellen Johnson Sirleaf, portrayed her country as a sick child in need of her care during her campaign five years ago. Postgenocide Rwanda elected to heal itself by becoming the first country with a majority of women in parliament.

In feminist circles, these social, political, and economic changes are always cast as a slow, arduous form of catch-up in a continuing struggle for female equality. But in the U.S., the world’s most advanced economy, something much more remarkable seems to be happening. American parents are beginning to choose to have girls over boys. As they imagine the pride of watching a child grow and develop and succeed as an adult, it is more often a girl that they see in their mind’s eye.

What if the modern, postindustrial economy is simply more congenial to women than to men? For a long time, evolutionary psychologists have claimed that we are all imprinted with adaptive imperatives from a distant past: men are faster and stronger and hardwired to fight for scarce resources, and that shows up now as a drive to win on Wall Street; women are programmed to find good providers and to care for their offspring, and that is manifested in more- nurturing and more-flexible behavior, ordaining them to domesticity. This kind of thinking frames our sense of the natural order. But what if men and women were fulfilling not biological imperatives but social roles, based on what was more efficient throughout a long era of human history? What if that era has now come to an end? More to the point, what if the economics of the new era are better suited to women?

Once you open your eyes to this possibility, the evidence is all around you. It can be found, most immediately, in the wreckage of the Great Recession, in which three-quarters of the 8 million jobs lost were lost by men. The worst-hit industries were overwhelmingly male and deeply identified with macho: construction, manufacturing, high finance. Some of these jobs will come back, but the overall pattern of dislocation is neither temporary nor random. The recession merely revealed—and accelerated—a profound economic shift that has been going on for at least 30 years, and in some respects even longer.

Earlier this year, for the first time in American history, the balance of the workforce tipped toward women, who now hold a majority of the nation’s jobs. The working class, which has long defined our notions of masculinity, is slowly turning into a matriarchy, with men increasingly absent from the home and women making all the decisions. Women dominate today’s colleges and professional schools—for every two men who will receive a B.A. this year, three women will do the same. Of the 15 job categories projected to grow the most in the next decade in the U.S., all but two are occupied primarily by women. Indeed, the U.S. economy is in some ways becoming a kind of traveling sisterhood: upper-class women leave home and enter the workforce, creating domestic jobs for other women to fill.

The postindustrial economy is indifferent to men’s size and strength. The attributes that are most valuable today—social intelligence, open communication, the ability to sit still and focus—are, at a minimum, not predominantly male. In fact, the opposite may be true. Women in poor parts of India are learning English faster than men to meet the demands of new global call centers. Women own more than 40 percent of private businesses in China, where a red Ferrari is the new status symbol for female entrepreneurs. Last year, Iceland elected Prime Minister Johanna Sigurdardottir, the world’s first openly lesbian head of state, who campaigned explicitly against the male elite she claimed had destroyed the nation’s banking system, and who vowed to end the “age of testosterone.”

Yes, the U.S. still has a wage gap, one that can be convincingly explained—at least in part—by discrimination. Yes, women still do most of the child care. And yes, the upper reaches of society are still dominated by men. But given the power of the forces pushing at the economy, this setup feels like the last gasp of a dying age rather than the permanent establishment. Dozens of college women I interviewed for this story assumed that they very well might be the ones working while their husbands stayed at home, either looking for work or minding the children. Guys, one senior remarked to me, “are the new ball and chain.” It may be happening slowly and unevenly, but it’s unmistakably happening: in the long view, the modern economy is becoming a place where women hold the cards.

In his final book, The Bachelors’ Ball, published in 2007, the sociologist Pierre Bourdieu describes the changing gender dynamics of Béarn, the region in southwestern France where he grew up. The eldest sons once held the privileges of patrimonial loyalty and filial inheritance in Béarn. But over the decades, changing economic forces turned those privileges into curses. Although the land no longer produced the impressive income it once had, the men felt obligated to tend it. Meanwhile, modern women shunned farm life, lured away by jobs and adventure in the city. They occasionally returned for the traditional balls, but the men who awaited them had lost their prestige and become unmarriageable. This is the image that keeps recurring to me, one that Bourdieu describes in his book: at the bachelors’ ball, the men, self-conscious about their diminished status, stand stiffly, their hands by their sides, as the women twirl away.

The role reversal that’s under way between American men and women shows up most obviously and painfully in the working class. In recent years, male support groups have sprung up throughout the Rust Belt and in other places where the postindustrial economy has turned traditional family roles upside down. Some groups help men cope with unemployment, and others help them reconnect with their alienated families. Mustafaa El-Scari, a teacher and social worker, leads some of these groups in Kansas City. El-Scari has studied the sociology of men and boys set adrift, and he considers it his special gift to get them to open up and reflect on their new condition. The day I visited one of his classes, earlier this year, he was facing a particularly resistant crowd.

None of the 30 or so men sitting in a classroom at a downtown Kansas City school have come for voluntary adult enrichment. Having failed to pay their child support, they were given the choice by a judge to go to jail or attend a weekly class on fathering, which to them seemed the better deal. This week’s lesson, from a workbook called Quenching the Father Thirst, was supposed to involve writing a letter to a hypothetical estranged 14-year-old daughter named Crystal, whose father left her when she was a baby. But El-Scari has his own idea about how to get through to this barely awake, skeptical crew, and letters to Crystal have nothing to do with it.

Like them, he explains, he grew up watching Bill Cosby living behind his metaphorical “white picket fence”—one man, one woman, and a bunch of happy kids. “Well, that check bounced a long time ago,” he says. “Let’s see,” he continues, reading from a worksheet. What are the four kinds of paternal authority? Moral, emotional, social, and physical. “But you ain’t none of those in that house. All you are is a paycheck, and now you ain’t even that. And if you try to exercise your authority, she’ll call 911. How does that make you feel? You’re supposed to be the authority, and she says, ‘Get out of the house, bitch.’ She’s calling you ‘bitch’!”

The men are black and white, their ages ranging from about 20 to 40. A couple look like they might have spent a night or two on the streets, but the rest look like they work, or used to. Now they have put down their sodas, and El-Scari has their attention, so he gets a little more philosophical. “Who’s doing what?” he asks them. “What is our role? Everyone’s telling us we’re supposed to be the head of a nuclear family, so you feel like you got robbed. It’s toxic, and poisonous, and it’s setting us up for failure.” He writes on the board: $85,000. “This is her salary.” Then: $12,000. “This is your salary. Who’s the damn man? Who’s the man now?” A murmur rises. “That’s right. She’s the man.”

Judging by the men I spoke with afterward, El-Scari seemed to have pegged his audience perfectly. Darren Henderson was making $33 an hour laying sheet metal, until the real-estate crisis hit and he lost his job. Then he lost his duplex—“there’s my little piece of the American dream”—then his car. And then he fell behind on his child-support payments. “They make it like I’m just sitting around,” he said, “but I’m not.” As proof of his efforts, he took out a new commercial driver’s permit and a bartending license, and then threw them down on the ground like jokers, for all the use they’d been. His daughter’s mother had a $50,000-a-year job and was getting her master’s degree in social work. He’d just signed up for food stamps, which is just about the only social-welfare program a man can easily access. Recently she’d seen him waiting at the bus stop. “Looked me in the eye,” he recalled, “and just drove on by.”

The men in that room, almost without exception, were casualties of the end of the manufacturing era. Most of them had continued to work with their hands even as demand for manual labor was declining. Since 2000, manufacturing has lost almost 6 million jobs, more than a third of its total workforce, and has taken in few young workers. The housing bubble masked this new reality for a while, creating work in construction and related industries. Many of the men I spoke with had worked as electricians or builders; one had been a successful real-estate agent. Now those jobs are gone too. Henderson spent his days shuttling between unemployment offices and job interviews, wondering what his daughter might be doing at any given moment. In 1950, roughly one in 20 men of prime working age, like Henderson, was not working; today that ratio is about one in five, the highest ever recorded.

Men dominate just two of the 15 job categories projected to grow the most over the next decade: janitor and computer engineer. Women have everything else—nursing, home health assistance, child care, food preparation. Many of the new jobs, says Heather Boushey of the Center for American Progress, “replace the things that women used to do in the home for free.” None is especially high-paying. But the steady accumulation of these jobs adds up to an economy that, for the working class, has become more amenable to women than to men.

The list of growing jobs is heavy on nurturing professions, in which women, ironically, seem to benefit from old stereotypes and habits. Theoretically, there is no reason men should not be qualified. But they have proved remarkably unable to adapt. Over the course of the past century, feminism has pushed women to do things once considered against their nature—first enter the workforce as singles, then continue to work while married, then work even with small children at home. Many professions that started out as the province of men are now filled mostly with women—secretary and teacher come to mind. Yet I’m not aware of any that have gone the opposite way. Nursing schools have tried hard to recruit men in the past few years, with minimal success. Teaching schools, eager to recruit male role models, are having a similarly hard time. The range of acceptable masculine roles has changed comparatively little, and has perhaps even narrowed as men have shied away from some careers women have entered. As Jessica Grose wrote in Slate, men seem “fixed in cultural aspic.” And with each passing day, they lag further behind.

As we recover from the Great Recession, some traditionally male jobs will return—men are almost always harder-hit than women in economic downturns because construction and manufacturing are more cyclical than service industries—but that won’t change the long-term trend. When we look back on this period, argues Jamie Ladge, a business professor at Northeastern University, we will see it as a “turning point for women in the workforce.”

The economic and cultural power shift from men to women would be hugely significant even if it never extended beyond working-class America. But women are also starting to dominate middle management, and a surprising number of professional careers as well. According to the Bureau of Labor Statistics, women now hold 51.4 percent of managerial and professional jobs—up from 26.1 percent in 1980. They make up 54 percent of all accountants and hold about half of all banking and insurance jobs. About a third of America’s physicians are now women, as are 45 percent of associates in law firms—and both those percentages are rising fast. A white-collar economy values raw intellectual horsepower, which men and women have in equal amounts. It also requires communication skills and social intelligence, areas in which women, according to many studies, have a slight edge. Perhaps most important—for better or worse—it increasingly requires formal education credentials, which women are more prone to acquire, particularly early in adulthood. Just about the only professions in which women still make up a relatively small minority of newly minted workers are engineering and those calling on a hard-science background, and even in those areas, women have made strong gains since the 1970s.

Office work has been steadily adapting to women—and in turn being reshaped by them—for 30 years or more. Joel Garreau picks up on this phenomenon in his 1991 book, Edge City, which explores the rise of suburbs that are home to giant swaths of office space along with the usual houses and malls. Companies began moving out of the city in search not only of lower rent but also of the “best educated, most conscientious, most stable workers.” They found their brightest prospects among “underemployed females living in middle-class communities on the fringe of the old urban areas.” As Garreau chronicles the rise of suburban office parks, he places special emphasis on 1978, the peak year for women entering the workforce. When brawn was off the list of job requirements, women often measured up better than men. They were smart, dutiful, and, as long as employers could make the jobs more convenient for them, more reliable. The 1999 movie Office Space was maybe the first to capture how alien and dispiriting the office park can be for men. Disgusted by their jobs and their boss, Peter and his two friends embezzle money and start sleeping through their alarm clocks. At the movie’s end, a male co-worker burns down the office park, and Peter abandons desk work for a job in construction.

Near the top of the jobs pyramid, of course, the upward march of women stalls. Prominent female CEOs, past and present, are so rare that they count as minor celebrities, and most of us can tick off their names just from occasionally reading the business pages: Meg Whitman at eBay, Carly Fiorina at Hewlett-Packard, Anne Mulcahy and Ursula Burns at Xerox, Indra Nooyi at PepsiCo; the accomplishment is considered so extraordinary that Whitman and Fiorina are using it as the basis for political campaigns. Only 3 percent of Fortune 500 CEOs are women, and the number has never risen much above that.

But even the way this issue is now framed reveals that men’s hold on power in elite circles may be loosening. In business circles, the lack of women at the top is described as a “brain drain” and a crisis of “talent retention.” And while female CEOs may be rare in America’s largest companies, they are highly prized: last year, they outearned their male counterparts by 43 percent, on average, and received bigger raises.

Even around the delicate question of working mothers, the terms of the conversation are shifting. Last year, in a story about breast-feeding, I complained about how the early years of child rearing keep women out of power positions. But the term mommy track is slowly morphing into the gender-neutral flex time, reflecting changes in the workforce. For recent college graduates of both sexes, flexible arrangements are at the top of the list of workplace demands, according to a study published last year in the Harvard Business Review. And companies eager to attract and retain talented workers and managers are responding. The consulting firm Deloitte, for instance, started what’s now considered the model program, called Mass Career Customization, which allows employees to adjust their hours depending on their life stage. The program, Deloitte’s Web site explains, solves “a complex issue—one that can no longer be classified as a woman’s issue.”

“Women are knocking on the door of leadership at the very moment when their talents are especially well matched with the requirements of the day,” writes David Gergen in the introduction to Enlightened Power: How Women Are Transforming the Practice of Leadership. What are these talents? Once it was thought that leaders should be aggressive and competitive, and that men are naturally more of both. But psychological research has complicated this picture. In lab studies that simulate negotiations, men and women are just about equally assertive and competitive, with slight variations. Men tend to assert themselves in a controlling manner, while women tend to take into account the rights of others, but both styles are equally effective, write the psychologists Alice Eagly and Linda Carli, in their 2007 book, Through the Labyrinth.

Over the years, researchers have sometimes exaggerated these differences and described the particular talents of women in crude gender stereotypes: women as more empathetic, as better consensus-seekers and better lateral thinkers; women as bringing a superior moral sensibility to bear on a cutthroat business world. In the ’90s, this field of feminist business theory seemed to be forcing the point. But after the latest financial crisis, these ideas have more resonance. Researchers have started looking into the relationship between testosterone and excessive risk, and wondering if groups of men, in some basic hormonal way, spur each other to make reckless decisions. The picture emerging is a mirror image of the traditional gender map: men and markets on the side of the irrational and overemotional, and women on the side of the cool and levelheaded.

We don’t yet know with certainty whether testosterone strongly influences business decision-making. But the perception of the ideal business leader is starting to shift. The old model of command and control, with one leader holding all the decision-making power, is considered hidebound. The new model is sometimes called “post-heroic,” or “transformational” in the words of the historian and leadership expert James MacGregor Burns. The aim is to behave like a good coach, and channel your charisma to motivate others to be hardworking and creative. The model is not explicitly defined as feminist, but it echoes literature about male-female differences. A program at Columbia Business School, for example, teaches sensitive leadership and social intelligence, including better reading of facial expressions and body language. “We never explicitly say, ‘Develop your feminine side,’ but it’s clear that’s what we’re advocating,” says Jamie Ladge.

A 2008 study attempted to quantify the effect of this more-feminine management style. Researchers at Columbia Business School and the University of Maryland analyzed data on the top 1,500 U.S. companies from 1992 to 2006 to determine the relationship between firm performance and female participation in senior management. Firms that had women in top positions performed better, and this was especially true if the firm pursued what the researchers called an “innovation intensive strategy,” in which, they argued, “creativity and collaboration may be especially important”—an apt description of the future economy.

It could be that women boost corporate performance, or it could be that better-performing firms have the luxury of recruiting and keeping high-potential women. But the association is clear: innovative, successful firms are the ones that promote women. The same Columbia-Maryland study ranked America’s industries by the proportion of firms that employed female executives, and the bottom of the list reads like the ghosts of the economy past: shipbuilding, real estate, coal, steelworks, machinery.

If you really want to see where the world is headed, of course, looking at the current workforce can get you only so far. To see the future—of the workforce, the economy, and the culture—you need to spend some time at America’s colleges and professional schools, where a quiet revolution is under way. More than ever, college is the gateway to economic success, a necessary precondition for moving into the upper-middle class—and increasingly even the middle class. It’s this broad, striving middle class that defines our society. And demographically, we can see with absolute clarity that in the coming decades the middle class will be dominated by women.

We’ve all heard about the collegiate gender gap. But the implications of that gap have not yet been fully digested. Women now earn 60 percent of master’s degrees, about half of all law and medical degrees, and 42 percent of all M.B.A.s. Most important, women earn almost 60 percent of all bachelor’s degrees—the minimum requirement, in most cases, for an affluent life. In a stark reversal since the 1970s, men are now more likely than women to hold only a high-school diploma. “One would think that if men were acting in a rational way, they would be getting the education they need to get along out there,” says Tom Mortenson, a senior scholar at the Pell Institute for the Study of Opportunity in Higher Education. “But they are just failing to adapt.”

This spring, I visited a few schools around Kansas City to get a feel for the gender dynamics of higher education. I started at the downtown campus of Metropolitan Community College. Metropolitan is the kind of place where people go to learn practical job skills and keep current with the changing economy, and as in most community colleges these days, men were conspicuously absent. One afternoon, in the basement cafeteria of a nearly windowless brick building, several women were trying to keep their eyes on their biology textbook and ignore the text messages from their babysitters. Another crew was outside the ladies’ room, braiding each other’s hair. One woman, still in her medical-assistant scrubs, looked like she was about to fall asleep in the elevator between the first and fourth floors.

When Bernard Franklin took over as campus president in 2005, he looked around and told his staff early on that their new priority was to “recruit more boys.” He set up mentoring programs and men-only study groups and student associations. He made a special effort to bond with male students, who liked to call him “Suit.” “It upset some of my feminists,” he recalls. Yet, a few years later, the tidal wave of women continues to wash through the school—they now make up about 70 percent of its students. They come to train to be nurses and teachers—African American women, usually a few years older than traditional college students, and lately, working-class white women from the suburbs seeking a cheap way to earn a credential. As for the men? Well, little has changed. “I recall one guy who was really smart,” one of the school’s counselors told me. “But he was reading at a sixth-grade level and felt embarrassed in front of the women. He had to hide his books from his friends, who would tease him when he studied. Then came the excuses. ‘It’s spring, gotta play ball.’ ‘It’s winter, too cold.’ He didn’t make it.”

It makes some economic sense that women attend community colleges—and in fact, all colleges—in greater numbers than men. Women ages 25 to 34 with only a high-school diploma currently have a median income of $25,474, while men in the same position earn $32,469. But it makes sense only up to a point. The well-paid lifetime union job has been disappearing for at least 30 years. Kansas City, for example, has shifted from steel manufacturing to pharmaceuticals and information technologies. “The economy isn’t as friendly to men as it once was,” says Jacqueline King, of the American Council on Education. “You would think men and women would go to these colleges at the same rate.” But they don’t.

In 2005, King’s group conducted a survey of lower-income adults in college. Men, it turned out, had a harder time committing to school, even when they desperately needed to retool. They tended to start out behind academically, and many felt intimidated by the schoolwork. They reported feeling isolated and were much worse at seeking out fellow students, study groups, or counselors to help them adjust. Mothers going back to school described themselves as good role models for their children. Fathers worried that they were abrogating their responsibilities as breadwinner.

The student gender gap started to feel like a crisis to some people in higher-education circles in the mid-2000s, when it began showing up not just in community and liberal-arts colleges but in the flagship public universities—the UCs and the SUNYs and the UNCs. Like many of those schools, the University of Missouri at Kansas City, a full research university with more than 13,000 students, is now tipping toward 60 percent women, a level many admissions officers worry could permanently shift the atmosphere and reputation of a school. In February, I visited with Ashley Burress, UMKC’s student-body president. (The other three student-government officers this school year were also women.) Burress, a cute, short, African American 24-year-old grad student who is getting a doctor-of-pharmacy degree, had many of the same complaints I heard from other young women. Guys high-five each other when they get a C, while girls beat themselves up over a B-minus. Guys play video games in each other’s rooms, while girls crowd the study hall. Girls get their degrees with no drama, while guys seem always in danger of drifting away. “In 2012, I will be Dr. Burress,” she said. “Will I have to deal with guys who don’t even have a bachelor’s degree? I would like to date, but I’m putting myself in a really small pool.”

UMKC is a working- and middle-class school—the kind of place where traditional sex roles might not be anathema. Yet as I talked to students this spring, I realized how much the basic expectations for men and women had shifted. Many of the women’s mothers had established their careers later in life, sometimes after a divorce, and they had urged their daughters to get to their own careers more quickly. They would be a campus of Tracy Flicks, except that they seemed neither especially brittle nor secretly falling apart.

Victoria, Michelle, and Erin are sorority sisters. Victoria’s mom is a part-time bartender at a hotel. Victoria is a biology major and wants to be a surgeon; soon she’ll apply to a bunch of medical schools. She doesn’t want kids for a while, because she knows she’ll “be at the hospital, like, 100 hours a week,” and when she does have kids, well, she’ll “be the hotshot surgeon, and he”—a nameless he—“will be at home playing with the kiddies.”

Michelle, a self-described “perfectionist,” also has her life mapped out. She’s a psychology major and wants to be a family therapist. After college, she will apply to grad school and look for internships. She is well aware of the career-counseling resources on campus. And her fiancé?

Michelle: He’s changed majors, like, 16 times. Last week he wanted to be a dentist. This week it’s environmental science.

Erin: Did he switch again this week? When you guys have kids, he’ll definitely stay home. Seriously, what does he want to do?

Michelle: It depends on the day of the week. Remember last year? It was bio. It really is a joke. But it’s not. It’s funny, but it’s not.

Among traditional college students from the highest-income families, the gender gap pretty much disappears. But the story is not so simple. Wealthier students tend to go to elite private schools, and elite private schools live by their own rules. Quietly, they’ve been opening up a new frontier in affirmative action, with boys playing the role of the underprivileged applicants needing an extra boost. In 2003, a study by the economists Sandy Baum and Eban Goodstein found that among selective liberal-arts schools, being male raises the chance of college acceptance by 6.5 to 9 percentage points. Now the U.S. Commission on Civil Rights has voted to investigate what some academics have described as the “open secret” that private schools “are discriminating in admissions in order to maintain what they regard as an appropriate gender balance.”

Jennifer Delahunty, the dean of admissions and financial aid at Kenyon College, in Ohio, let this secret out in a 2006 New York Times op-ed. Gender balance, she wrote back then, is the elephant in the room. And today, she told me, the problem hasn’t gone away. A typical female applicant, she said, manages the process herself—lines up the interviews, sets up a campus visit, requests a visit with faculty members. But the college has seen more than one male applicant “sit back on the couch, sometimes with their eyes closed, while their mom tells them where to go and what to do. Sometimes we say, ‘What a nice essay his mom wrote,’” she said, in that funny-but-not vein.

To avoid crossing the dreaded 60 percent threshold, admissions officers have created a language to explain away the boys’ deficits: “Brain hasn’t kicked in yet.” “Slow to cook.” “Hasn’t quite peaked.” “Holistic picture.” At times Delahunty has become so worried about “overeducated females” and “undereducated males” that she jokes she is getting conspiratorial. She once called her sister, a pediatrician, to vet her latest theory: “Maybe these boys are genetically like canaries in a coal mine, absorbing so many toxins and bad things in the environment that their DNA is shifting. Maybe they’re like those frogs—they’re more vulnerable or something, so they’ve gotten deformed.”

Clearly, some percentage of boys are just temperamentally unsuited to college, at least at age 18 or 20, but without it, they have a harder time finding their place these days. “Forty years ago, 30 years ago, if you were one of the fairly constant fraction of boys who wasn’t ready to learn in high school, there were ways for you to enter the mainstream economy,” says Henry Farber, an economist at Princeton. “When you woke up, there were jobs. There were good industrial jobs, so you could have a good industrial, blue-collar career. Now those jobs are gone.”

Since the 1980s, as women have flooded colleges, male enrollment has grown far more slowly. And the disparities start before college. Throughout the ’90s, various authors and researchers agonized over why boys seemed to be failing at every level of education, from elementary school on up, and identified various culprits: a misguided feminism that treated normal boys as incipient harassers (Christina Hoff Sommers); different brain chemistry (Michael Gurian); a demanding, verbally focused curriculum that ignored boys’ interests (Richard Whitmire). But again, it’s not all that clear that boys have become more dysfunctional—or have changed in any way. What’s clear is that schools, like the economy, now value the self-control, focus, and verbal aptitude that seem to come more easily to young girls.

Researchers have suggested any number of solutions. A movement is growing for more all-boys schools and classes, and for respecting the individual learning styles of boys. Some people think that boys should be able to walk around in class, or take more time on tests, or have tests and books that cater to their interests. In their desperation to reach out to boys, some colleges have formed football teams and started engineering programs. Most of these special accommodations sound very much like the kind of affirmative action proposed for women over the years—which in itself is an alarming flip.

Whether boys have changed or not, we are well past the time to start trying some experiments. It is fabulous to see girls and young women poised for success in the coming years. But allowing generations of boys to grow up feeling rootless and obsolete is not a recipe for a peaceful future. Men have few natural support groups and little access to social welfare; the men’s-rights groups that do exist in the U.S. are taking on an angry, antiwoman edge. Marriages fall apart or never happen at all, and children are raised with no fathers. Far from being celebrated, women’s rising power is perceived as a threat.

What would a society in which women are on top look like? We already have an inkling. This is the first time that the cohort of Americans ages 30 to 44 has more college-educated women than college-educated men, and the effects are upsetting the traditional Cleaver-family dynamics. In 1970, women contributed 2 to 6 percent of the family income. Now the typical working wife brings home 42.2 percent, and four in 10 mothers—many of them single mothers—are the primary breadwinners in their families. The whole question of whether mothers should work is moot, argues Heather Boushey of the Center for American Progress, “because they just do. This idealized family—he works, she stays home—hardly exists anymore.”

The terms of marriage have changed radically since 1970. Typically, women’s income has been the main factor in determining whether a family moves up the class ladder or stays stagnant. And increasing numbers of women—unable to find men with a similar income and education—are forgoing marriage altogether. In 1970, 84 percent of women ages 30 to 44 were married; now 60 percent are. In 2007, among American women without a high-school diploma, 43 percent were married. And yet, for all the hand-wringing over the lonely spinster, the real loser in society—the only one to have made just slight financial gains since the 1970s—is the single man, whether poor or rich, college-educated or not. Hens rejoice; it’s the bachelor party that’s over.

The sociologist Kathryn Edin spent five years talking with low-income mothers in the inner suburbs of Philadelphia. Many of these neighborhoods, she found, had turned into matriarchies, with women making all the decisions and dictating what the men should and should not do. “I think something feminists have missed,” Edin told me, “is how much power women have” when they’re not bound by marriage. The women, she explained, “make every important decision”—whether to have a baby, how to raise it, where to live. “It’s definitely ‘my way or the highway,’” she said. “Thirty years ago, cultural norms were such that the fathers might have said, ‘Great, catch me if you can.’ Now they are desperate to father, but they are pessimistic about whether they can meet her expectations.” The women don’t want them as husbands, and they have no steady income to provide. So what do they have?

“Nothing,” Edin says. “They have nothing. The men were just annihilated in the recession of the ’90s, and things never got better. Now it’s just awful.”

The situation today is not, as Edin likes to say, a “feminist nirvana.” The phenomenon of children being born to unmarried parents “has spread to barrios and trailer parks and rural areas and small towns,” Edin says, and it is creeping up the class ladder. After staying steady for a while, the portion of American children born to unmarried parents jumped to 40 percent in the past few years. Many of their mothers are struggling financially; the most successful are working and going to school and hustling to feed the children, and then falling asleep in the elevator of the community college.

Still, they are in charge. “The family changes over the past four decades have been bad for men and bad for kids, but it’s not clear they are bad for women,” says W. Bradford Wilcox, the head of the University of Virginia’s National Marriage Project.

Over the years, researchers have proposed different theories to explain the erosion of marriage in the lower classes: the rise of welfare, or the disappearance of work and thus of marriageable men. But Edin thinks the most compelling theory is that marriage has disappeared because women are setting the terms—and setting them too high for the men around them to reach. “I want that white-picket-fence dream,” one woman told Edin, and the men she knew just didn’t measure up, so she had become her own one-woman mother/father/nurturer/provider. The whole country’s future could look much as the present does for many lower-class African Americans: the mothers pull themselves up, but the men don’t follow. First-generation college-educated white women may join their black counterparts in a new kind of middle class, where marriage is increasingly rare.

As the traditional order has been upended, signs of the profound disruption have popped up in odd places. Japan is in a national panic over the rise of the “herbivores,” the cohort of young men who are rejecting the hard-drinking salaryman life of their fathers and are instead gardening, organizing dessert parties, acting cartoonishly feminine, and declining to have sex. The generational young-women counterparts are known in Japan as the “carnivores,” or sometimes the “hunters.”

American pop culture keeps producing endless variations on the omega male, who ranks even below the beta in the wolf pack. This often-unemployed, romantically challenged loser can show up as a perpetual adolescent (in Judd Apatow’s Knocked Up or The 40-Year-Old Virgin), or a charmless misanthrope (in Noah Baumbach’s Greenberg), or a happy couch potato (in a Bud Light commercial). He can be sweet, bitter, nostalgic, or cynical, but he cannot figure out how to be a man. “We call each other ‘man,’” says Ben Stiller’s character in Greenberg, “but it’s a joke. It’s like imitating other people.” The American male novelist, meanwhile, has lost his mojo and entirely given up on sex as a way for his characters to assert macho dominance, Katie Roiphe explains in her essay “The Naked and the Conflicted.” Instead, she writes, “the current sexual style is more childlike; innocence is more fashionable than virility, the cuddle preferable to sex.”

At the same time, a new kind of alpha female has appeared, stirring up anxiety and, occasionally, fear. The cougar trope started out as a joke about desperate older women. Now it’s gone mainstream, even in Hollywood, home to the 50-something producer with a starlet on his arm. Susan Sarandon and Demi Moore have boy toys, and Aaron Johnson, the 19-year-old star of Kick-Ass, is a proud boy toy for a woman 24 years his senior. The New York Times columnist Gail Collins recently wrote that the cougar phenomenon is beginning to look like it’s not about desperate women at all but about “desperate young American men who are latching on to an older woman who’s a good earner.” Up in the Air, a movie set against the backdrop of recession-era layoffs, hammers home its point about the shattered ego of the American man. A character played by George Clooney is called too old to be attractive by his younger female colleague and is later rejected by an older woman whom he falls in love with after she sleeps with him—and who turns out to be married. George Clooney! If the sexiest man alive can get twice rejected (and sexually played) in a movie, what hope is there for anyone else? The message to American men is summarized by the title of a recent offering from the romantic-comedy mill: She’s Out of My League.

In fact, the more women dominate, the more they behave, fittingly, like the dominant sex. Rates of violence committed by middle-aged women have skyrocketed since the 1980s, and no one knows why. High-profile female killers have been showing up regularly in the news: Amy Bishop, the homicidal Alabama professor; Jihad Jane and her sidekick, Jihad Jamie; the latest generation of Black Widows, responsible for suicide bombings in Russia. In Roman Polanski’s The Ghost Writer, the traditional political wife is rewritten as a cold-blooded killer at the heart of an evil conspiracy. In her recent video Telephone, Lady Gaga, with her infallible radar for the cultural edge, rewrites Thelma and Louise as a story not about elusive female empowerment but about sheer, ruthless power. Instead of killing themselves, she and her girlfriend (played by Beyoncé) kill a bad boyfriend and random others in a homicidal spree and then escape in their yellow pickup truck, Gaga bragging, “We did it, Honey B.”

The Marlboro Man, meanwhile, master of wild beast and wild country, seems too far-fetched and preposterous even for advertising. His modern equivalents are the stunted men in the Dodge Charger ad that ran during this year’s Super Bowl in February. Of all the days in the year, one might think, Super Bowl Sunday should be the one most dedicated to the cinematic celebration of macho. The men in Super Bowl ads should be throwing balls and racing motorcycles and doing whatever it is men imagine they could do all day if only women were not around to restrain them.

Instead, four men stare into the camera, unsmiling, not moving except for tiny blinks and sways. They look like they’ve been tranquilized, like they can barely hold themselves up against the breeze. Their lips do not move, but a voice-over explains their predicament—how they’ve been beaten silent by the demands of tedious employers and enviro-fascists and women. Especially women. “I will put the seat down, I will separate the recycling, I will carry your lip balm.” This last one—lip balm—is expressed with the mildest spit of emotion, the only hint of the suppressed rage against the dominatrix. Then the commercial abruptly cuts to the fantasy, a Dodge Charger vrooming toward the camera punctuated by bold all caps: MAN’S LAST STAND. But the motto is unconvincing. After that display of muteness and passivity, you can only imagine a woman—one with shiny lips—steering the beast.

This article available online at:

http://www.theatlantic.com/magazine/archive/2010/07/the-end-of-men/8135/

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No Refills - Big Pharma in the US

In 2009, only 25 new drugs were approved—less than half the number in the mid-’90s. Why are new pharmaceuticals so hard to bring to market? Overcautious regulators and profit-hungry conglomerates make easy scapegoats, but they’re only partly to blame. While we’re waiting for both sides to reinvent themselves, even little things like better monitoring of side effects can lead to big new discoveries.

By Megan McArdle

Image credit: Edel Rodriguez

The golden age of drug discovery.” That’s how Martin Mackay, Pfizer’s president of pharmatherapeutics research and development, recently described the state of his industry. That surprised a lot of drug researchers, many of whom feel more like the Indians than the conquistadors. Although Mackay said the Pfizer pipeline was “replete” with new drugs, nothing on the horizon seems capable of replacing the revenue his firm will lose when Lipitor, the best-selling patented drug of all time, goes off patent at the end of next year. Pfizer is not the only company whose pipeline is tapping out. What most people think of when they imagine “drug discovery” is what the Food and Drug Administration calls “new molecular entities” (NMEs)—entirely new compounds. And the number of these being approved as drugs has declined.

In 1996—arguably the peak of pharmaceutical productivity in the past two decades—the FDA approved 53 NMEs. These days, breaking the 20 mark is rare; last year 19 were approved, plus six “biologics,” substances such as vaccines and antibodies that are based on proteins made by living cells. Most analysts seem to think that U.S. companies just aren’t turning out as many valuable new drugs as they used to.

How can this be happening now, just when we’ve decoded the human genome, developed new techniques for synthesizing drug compounds, and built powerful computer models of how compounds interact with their targets? Why aren’t the pipelines overflowing with new blockbusters? That’s a good question. “Blame the FDA,” say conservatives and drug companies. “Blame the companies,” respond liberal activists and good-government types. But as viscerally satisfying as such finger-pointing may be, it offers half-truths at best. For a variety of reasons, we may be entering an age when a miracle cure is just that.

Ask a conservative—or a chemist whose compound is in the advanced stage of clinical trials—about drug development and you’ll get an earful about the FDA. Over time, critics say, high-profile disasters like Fen-Phen and Vioxx, which killed or seriously harmed some of the people who took them, have encouraged ever-more-stringent review. The number of clinical trials required to support a new-drug application has more than doubled since 1980, while the number of patients needed in each trial has almost tripled. As a result of these and many other factors, the clinical-trial stage now costs more than four times as much, even after adjusting for inflation.

Making drug trials more expensive can have a big effect on development. Once they’re developed, most drugs are nearly pure profit (a topic of much complaint among consumer activists). The cost is all in the R&D—somewhere between hundreds of millions and nearly $2 billion per drug, depending on which estimate you use. And the single biggest portion of that cost is the very, very expensive clinical trials, in which pharmaceutical companies try to show the FDA that their compound is safe and effective.

This means that clinical trials have unwanted side effects. Because of their astronomical expense, one drug with a huge market is more commercially desirable than 25 drugs that each treat a less common disease, because only one set of trials is necessary. If you’re targeting a disease that affects relatively few people, one of two things will happen: the drug will be very expensive, or the drug will be shelved because it’s unlikely to earn back its R&D investment.

Tougher safety and efficacy standards may also be keeping good drugs out of the public’s hands. Most people agree that today’s FDA would not have approved aspirin; even penicillin, the miracle drug that helped dramatically extend the human lifespan when introduced in the early 1940s, is questionable. Allergic reactions to penicillin kill a higher percentage of its takers than Vioxx ever did, while the gastrointestinal bleeding produced by aspirin means it probably would have flunked while still in animal testing.

But there’s another side to the story. For starters, the stodgy FDA may be changing. Roger Longman, a former managing partner at Windhover, a health-care-analysis firm, says that while “the rank and file is sort of resistant” to streamlining its clinical-testing system, “there’s an interesting split at the FDA. At the top of the FDA, they’re not getting more conservative—in fact, I think that they’re going the other way.”

Besides, as Pedro Cuatrecasas, a biochemist and professor of pharmacology at the University of California at San Diego, points out, attrition rates—the percentage of compounds that fail in clinical trials—haven’t actually increased. That makes it hard to blame overfussy regulators for the decline in new drugs—though Derek Lowe, a pharmaceutical researcher who also writes about the industry, notes that firms do take the agency’s newer and stiffer requirements into account when deciding whether to take a drug candidate into trials. However, Lowe adds, some of these safety requirements are less a reflection of increasing FDA risk aversion than of our ability to test for more things. Even without the FDA breathing down their necks, lawsuit-shy companies have plenty of disincentives to pour millions into a drug that causes gastrointestinal bleeding.

Hence the left’s counterclaim to conservative complaints about the FDA: that companies, not regulators, are the ones who are too risk-averse. Pharmaceutical companies are blamed for focusing on marketing at the expense of innovation: they allegedly kill promising compounds because of fears of small markets, then concentrate on “me too” drugs that aren’t really any better than their competition’s. Or they tweak existing drugs in ways that don’t necessarily make the drugs any more effective, but do give companies a new patented drug for which they can charge the Earth. (Remember how we got Clarinex around the time Claritin was going off patent?) Then, when pharma companies have exhausted these strategies, they shore up their finances by merging with other companies and downsizing their research staff.

The complaints about mergers hold some truth. Even without the customary lab closings and shelved projects, mergers can trigger uncertainty and personnel turnover, causing good projects to languish. And yes, pharmaceutical firms do bring out a fair number of tweaks to existing drugs, or old drugs approved for new disease indications.

But those who want to chalk up empty pipelines entirely to mismanagement may be confusing cause with effect. Firms don’t merge because it’s fun; they merge because a big hole in their pipeline can lead to financial troubles. Mergers spread the risk. Companies naturally start obsessing about costs and marketing when their products become less profitable.

Besides, if companies have really stopped caring about R&D, why is it that according to Joseph DiMasi, an economist at Tufts who specializes in the pharmaceutical industry, spending on R&D is 11 times what it was 30 years ago? (To be sure, R&D spending has dropped in the past year, but it is not clear whether that change represents a new trend or a reaction to the financial crisis.) And why are firms having so many dramatic failures in Phase III, when the compound is tested on a large number of patients and failure is most costly? If they were really so conservative, wouldn’t they be killing those projects a lot earlier?

In fact, while some companies are diversifying into generics and animal medicines, Longman thinks that overall the industry is spending not too little but too much on massive internal research teams hunting for the next blockbuster drugs. He believes the major pharmaceutical companies should make investments in lots of promising compounds at biotech firms—sort of like taking an option on a drug.

No firm has yet taken Longman’s advice and dramatically shrunk its internal research operations. But some companies, notably GlaxoSmithKline and AstraZeneca, are using external partnerships with smaller firms to replenish their pipelines. So far, however, this approach hasn’t been enough to stop the slide. Which raises the worrying question: What if creating new drugs is just getting harder and harder?

In many ways, the task facing researchers is simply more difficult than it was 20 or 30 years ago. Back then, chemists had big fat targets like angiotensin, a protein that causes blood vessels to constrict. Scientists knew it caused high blood pressure, and better yet, they were pretty sure they could develop a small molecule (that is, one that can easily enter the bloodstream) that would hit what they were aiming at. Best of all, hypertension provided an enormous market. Driven by similar finds in other areas, an age of blockbusters dawned: the Lipitors and Prilosecs and Allegras.

These days the targets seem smaller, fewer, and farther away. The best-understood diseases already have a lot of good drugs treating them. New treatments need to prove that they have better efficacy, fewer side effects, or something like a longer-lasting dose that makes them superior to the pills already on the market. Longman likens this process to chasing an Olympic sprinter—who has a head start.

In other words, complaints about me-too drugs are overblown, since they’re actually harder to get approved than something with a novel target. Because clinical trials are the most expensive part of development, such projects are still pretty risky. When you’re up against nothing, it’s relatively easy to show that you’re more effective than the alternative. But when you’re up against already-state-of-the-art treatments, you’re looking for small improvements. That means you need huge numbers of patients to generate a statistically significant result. And since good treatments already exist, the safety hurdles are also higher—the FDA is less likely to approve a statin that causes internal bleeding than a pancreatic-cancer drug that does the same.

Meanwhile, in the areas where we don’t have good drugs, we don’t have so many easy targets, either. The great hopes for finding drug prospects by decoding the human genome have largely faltered; so far, reading our DNA seems mostly to have taught us how little we still understand about our own biology. So researchers are left with complex problems like cancer, which is really not one disease at all, but several thousand different ways that a human cell can go wrong. Or Alzheimer’s: after decades, researchers are still trying to decide whether the disease’s signature beta-amyloid plaques in the brain are a cause of dementia, or a side effect.

Of course it is true that advances in genetic science have yielded some relatively simple targets to shoot for: diseases like Gaucher’s, which is caused by a hereditary deficiency in a single enzyme, and which can be treated with a synthetic version of the missing substance. But it is almost axiomatically true that simple genetic defects with debilitating or fatal consequences tend to be relatively rare. The more-prevalent conditions that we’d really like to find blockbusters to cure are, increasingly, complex metabolic processes like obesity, which may be caused by many things going wrong at once.

Drugs are still being developed for those simpler, rarer conditions—Genzyme, among other companies, has made a good living developing compounds for diseases like Gaucher’s. But the task is harder, and more expensive. A year’s worth of Gaucher’s treatment can cost $200,000.

As Longman suggests, it’s hard for big pharmaceutical companies to target such little markets. Genzyme’s $4.5 billion in annual revenue is less than Pfizer takes in just on Lipitor. Big Pharma isn’t set up for micro-research.

Then there are the customers. Drug-plan managers like Medco and Caremark have gotten more aggressive. Drugs that 10 years ago would have been blockbusters—like the anti-platelet drug Effient, Eli Lilly’s answer to Plavix—now face tough scrutiny. In fact, Medco is funding research that it hopes will make the medical case for the continued use of Plavix (which is cheaper) by most patients, while identifying the subset of patients who would benefit from the new drug. That would be great news for health-care costs, but terrible news for Eli Lilly.

The fact is, no single pipeline theory works well on its own; they all interact. A stodgier FDA can mean stuffier decisions inside companies. Smaller pipelines make for bigger mergers. Bigger companies, in turn, may mean smaller pipelines.

But the way that all these things are intertwined might actually make it easier, rather than harder, to boost our research output: any change has ripple effects. If Big Pharma can look outside its own walls more, and if the FDA can reinvent itself, the whole landscape may well alter. And though we might not quite understand our genome now, give us another decade, and it may start yielding some interesting drug targets for the diseases that we’d still very much like to cure.

Even the smaller targets we’ve already identified may yield more drugs if we can hold down the cost of clinical trials. Strategies like outsourcing our drug trials to countries with lower costs have already helped. And Vijay Vaitheeswaran, the health-care correspondent for The Economist, believes that we will soon be employing electronic reminder systems to ensure that patients take their pills, and monitoring systems that can better track side effects. These two changes alone could make smaller clinical trials more viable and effective; other innovations may follow.

None of this may work—Panacea, after all, was just a Greek goddess. But even if nothing works, look on the bright side: at least we won’t have to pay for so many pricey new drugs.

This article available online at:

http://www.theatlantic.com/magazine/archive/2010/07/no-refills/8133/

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