From June 19, 1909
From November 21, 1908
From February 2, 1902
Comments, observations and thoughts from two bloggers on applied statistics, higher education and epidemiology. Joseph is an associate professor. Mark is a professional statistician and former math teacher.
Very little, if anything, is known about the origin of the game. But it is known that medieval writers attributed it to Pythagoras, although no trace of it has been discovered in Greek literature, and the earliest mention of it is from the time of Hermannus Contractus (1013–1054).
The name, which appears in a variety of forms, points to a Greek origin, the more so because Greek was little known at the time when the game first appeared in literature. Based upon the Greek theory of numbers, and having a Greek name, it is still speculated by some that the origin of the game is to be sought in the Greek civilization, and perhaps in the later schools of Byzantium or Alexandria.
The first written evidence of Rithmomachia dates back to around 1030, when a monk, named Asilo, created a game that illustrated the number theory of Boëthius' De institutione arithmetica, for the students of monastery schools. The rules of the game were improved shortly thereafter by the respected monk, Hermannus Contractus, from Reichenau, and in the school of Liège. In the following centuries, Rithmomachia spread quickly through schools and monasteries in the southern parts of Germany and France. It was used mainly as a teaching aid, but, gradually, intellectuals started to play it for pleasure. In the 13th century Rithmomachia came to England, where famous mathematician Thomas Bradwardine wrote a text about it. Even Roger Bacon recommended Rithmomachia to his students, while Sir Thomas More let the inhabitants of the fictitious Utopia play it for recreation.
The game was well enough known as to justify printed treatises in Latin, French, Italian, and German, in the sixteenth century, and to have public advertisements of the sale of the board and pieces under the shadow of the old Sorbonne.
Arthur [Sackler] helped pay his medical-school tuition by taking a copywriting job at William Douglas McAdams, a small ad agency that specialized in the medical field. He proved so adept at this work that he eventually bought the agency—and revolutionized the industry. Until then, pharmaceutical companies had not availed themselves of Madison Avenue pizzazz and trickery. As both a doctor and an adman, Arthur displayed a Don Draper-style intuition for the alchemy of marketing. He recognized that selling new drugs requires a seduction of not just the patient but the doctor who writes the prescription.
Sackler saw doctors as unimpeachable stewards of public health. “I would rather place myself and my family at the judgment and mercy of a fellow-physician than that of the state,” he liked to say. So in selling new drugs he devised campaigns that appealed directly to clinicians, placing splashy ads in medical journals and distributing literature to doctors’ offices. Seeing that physicians were most heavily influenced by their own peers, he enlisted prominent ones to endorse his products, and cited scientific studies (which were often underwritten by the pharmaceutical companies themselves). John Kallir, who worked under Sackler for ten years at McAdams, recalled, “Sackler’s ads had a very serious, clinical look—a physician talking to a physician. But it was advertising.” In 1997, Arthur was posthumously inducted into the Medical Advertising Hall of Fame, and a citation praised his achievement in “bringing the full power of advertising and promotion to pharmaceutical marketing.” Allen Frances put it differently: “Most of the questionable practices that propelled the pharmaceutical industry into the scourge it is today can be attributed to Arthur Sackler.”
Advertising has always entailed some degree of persuasive license, and Arthur’s techniques were sometimes blatantly deceptive. In the nineteen-fifties, he produced an ad for a new Pfizer antibiotic, Sigmamycin: an array of doctors’ business cards, alongside the words “More and more physicians find Sigmamycin the antibiotic therapy of choice.” It was the medical equivalent of putting Mickey Mantle on a box of Wheaties. In 1959, an investigative reporter for The Saturday Review tried to contact some of the doctors whose names were on the cards. They did not exist.
During the sixties, Arthur got rich marketing the tranquillizers Librium and Valium. One Librium ad depicted a young woman carrying an armload of books, and suggested that even the quotidian anxiety a college freshman feels upon leaving home might be best handled with tranquillizers. Such students “may be afflicted by a sense of lost identity,” the copy read, adding that university life presented “a whole new world . . . of anxiety.” The ad ran in a medical journal. Sackler promoted Valium for such a wide range of uses that, in 1965, a physician writing in the journal Psychosomatics asked, “When do we not use this drug?” One campaign encouraged doctors to prescribe Valium to people with no psychiatric symptoms whatsoever: “For this kind of patient—with no demonstrable pathology—consider the usefulness of Valium.” Roche, the maker of Valium, had conducted no studies of its addictive potential. Win Gerson, who worked with Sackler at the agency, told the journalist Sam Quinones years later that the Valium campaign was a great success, in part because the drug was so effective. “It kind of made junkies of people, but that drug worked,” Gerson said. By 1973, American doctors were writing more than a hundred million tranquillizer prescriptions a year, and countless patients became hooked. The Senate held hearings on what Edward Kennedy called “a nightmare of dependence and addiction.”
A 1995 memo sent to the launch team emphasized that the company did “not want to niche” OxyContin just for cancer pain. A primary objective in Purdue’s 2002 budget plan was to “broaden” the use of OxyContin for pain management. As May put it, “What Purdue did really well was target physicians, like general practitioners, who were not pain specialists.” In its internal literature, Purdue similarly spoke of reaching patients who were “opioid naïve.” Because OxyContin was so powerful and potentially addictive, David Kessler told me, from a public-health standpoint “the goal should have been to sell the least dose of the drug to the smallest number of patients.” But this approach was at odds with the competitive imperatives of a pharmaceutical company, he continued. So Purdue set out to do exactly the opposite.
Sales reps, May told me, received training in “overcoming objections” from clinicians. If a doctor inquired about addiction, May had a talking point ready. “ ‘The delivery system is believed to reduce the abuse liability of the drug,’ ” he recited to me, with a rueful laugh. “Those were the specific words. I can still remember, all these years later.” He went on, “I found out pretty fast that it wasn’t true.” In 2002, a sales manager from the company, William Gergely, told a state investigator in Florida that Purdue executives “told us to say things like it is ‘virtually’ non-addicting.”
May didn’t ask doctors simply to take his word on OxyContin; he presented them with studies and literature provided by other physicians. Purdue had a speakers’ bureau, and it paid several thousand clinicians to attend medical conferences and deliver presentations about the merits of the drug. Doctors were offered all-expenses-paid trips to pain-management seminars in places like Boca Raton. Such spending was worth the investment: internal Purdue records indicate that doctors who attended these seminars in 1996 wrote OxyContin prescriptions more than twice as often as those who didn’t. The company advertised in medical journals, sponsored Web sites about chronic pain, and distributed a dizzying variety of OxyContin swag: fishing hats, plush toys, luggage tags. Purdue also produced promotional videos featuring satisfied patients—like a construction worker who talked about how OxyContin had eased his chronic back pain, allowing him to return to work. The videos, which also included testimonials from pain specialists, were sent to tens of thousands of doctors. The marketing of OxyContin relied on an empirical circularity: the company convinced doctors of the drug’s safety with literature that had been produced by doctors who were paid, or funded, by the company.
Constituents requesting that Rep. Jimmy Duncan Jr. (R-TN) hold a town hall on repealing the Affordable Care Act aren't being met with a polite brushoff from staffers anymore. Instead, Duncan's office has started sending out a form letter telling them point-blank that he has no intention to hold any town hall meetings.Admittedly, it is a long time until midterms, but possibly not long enough to repair this kind of damage.
“I am not going to hold town hall meetings in this atmosphere, because they would very quickly turn into shouting opportunities for extremists, kooks and radicals,” the letter read, according to a copy obtained by the Maryville Daily Times. “Also, I do not intend to give more publicity to those on the far left who have so much hatred, anger and frustration in them.”
In the first weeks of the 115th Congress, elected officials dropping by their home districts were surprised to find town halls packed to the rafters with concerned constituents. Caught off guard and on camera, lawmakers were asked to defend President Donald Trump’s immigration policies and provide a timeline on repealing and replacing the Affordable Care Act.
Now, many of them are skipping out on these events entirely. Some have said large meetings are an ineffective format for addressing individual concerns. Many others have, like the President himself, dismissed those questioning their agenda as “paid protesters” or radical activists who could pose a physical threat.
Voters turning out to town halls are pushing back hard on this characterization, arguing that they represent varied ideological backgrounds and have diverse issues to raise. Constituents unable to meet with their elected officials over the weekend told TPM that they’re not attending town hall events to make trouble. Instead, they say they want accountability from the people they pay to represent them.
Kim Mattoch, a mother of three and event planner, told TPM that she tried to go to a Saturday town hall in Roseville, California with GOP Rep. Tom McClintock but couldn’t make it in. The 200-seat theater hosting the event was quickly filled to capacity, leaving hundreds waiting outside.
“I’m a constituent of McClintock and a registered Republican in a very Republican district—though I don’t really align very well these days with the Republican Party,” Mattoch said in a Monday phone call. “So I wanted to go to the town hall because I legitimately had questions for the congressman.”
Mattoch said the protesters waiting outside had a wide range of “legitimate concerns.” She personally hoped to ask her representative about how the GOP was progressing on repealing and replacing the ACA and why House Republicans last week voted to kill a ruling aimed at preventing coal mining debris from ending up in waterways.
Yet McClintock told the Los Angeles Times that he thought an “anarchist element” was present in the crowd outside his event, and said he was escorted to his car by police because he’d been told the atmosphere was “deteriorating.”
Ramon Fliek, who attended the McClintock event with his wife, told TPM on Monday that police “were kind enough to block the whole road” to make space for the overflow crowd, and that he overheard protesters thanking law enforcement for “doing their jobs.”
“If you look at the videos from the event, you can’t get any notion that it was aggressive,” he said. “There was an older woman with a poodle that ran after him and it’s like, okay, the older lady with the poodle is not going to threaten you. I understand that he might want to give that impression, but it was very pleasant.”
For budget deficits are going to soar thanks to Republican legislation — probably by even more than the official scorekeepers say, because the legislation creates so many new loopholes. And offsetting those deficits will require going after the true big-ticket programs, namely Medicare and Social Security.
Oh, they’ll find euphemisms to describe what they’re doing, talking solemnly about the need for “entitlement reform” as an act of fiscal responsibility — while their huge budget-busting tax cut for the rich gets shoved down the memory hole. But whatever words they use to cloak the reality of the situation, Republicans have given their donors what they wanted — and now they’re coming for your benefits.I am actually a big opponent of "deficits don't matter", even when spouted by the left. I totally understand the need to invest and that low interest rates that right now is a fine time to run deficits if there is a good reason. But, in the long run, deficits either need to be paid or are going to act in an inflationary way. What is saving us, for now, is that the rich are so rich that there are a shortage of secure investment opportunities so rates are low.
Driverless cars and trucks rule the road, while robots “man” the factories. Super-smartphones hail Uber helicopters or even planes to fly their owners across mushrooming urban areas. Machines use algorithms to teach themselves cognitive tasks that once required human intelligence, wiping out millions of managerial, as well as industrial, jobs.
These are visions of a world remade — for the most part, in the next five to 10 years — by technological advances that form a fourth industrial revolution. You catch glimpses of the same visions today not only in Silicon Valley but also in Paris think tanks, Chinese electric-car factories or even here at the edge of the Sahara.
Technological disruption in the 21st century is different. Societies had years to adapt to change driven by the steam engine, electricity and the computer. Today, change is instant and ubiquitous. It arrives digitally across the globe all at once.