ramanujan

You are insane. No charity will accept an amount of 500 uBTC. They're probably batching the donations and then sending them in bulk.

Very interesting and highly creative. A few thoughts.

1) If a graphical plot turns data into something visual, an audio "plot" turns data into something audible. Your output is an audio file rather than an image or video file. The typical applications of this are to turn a boolean flag into a chime (e.g. text message received). Your important insight is that this can be extended to longer-form audio outputs.

2) When is audio more advantageous than image or video?

  - When you cannot look at a screen (driving, working out)
  - When there are too many screens (control room)
  - In a very dark environment where visibility is impeded
  - If you are blind or vision-impaired

Perhaps the most interesting application would be in a car, which is where people spend a great deal of time and have their ears and brains (but not their eyes) free. Some ideas:

a) Could you generate different sounds based on the importance of a text message (doing something like Gmail's importance filtering) signaling that you don't really need to respond to this particular message right now while driving?

b) Could you have audio feedback for important things along the road? For example, the problem with the Trapster app (trapster.com) is that I need to look at the phone to see where the speedtraps are. You can imagine an integrated audio feed that could give information like this and also tell you your constantly updated ETA (via Google Maps API call). Or you could listen to the pulse of your company on the road to do something semi-useful, and drill down into notable events via voice.

c) The really interesting thing is if you could pair this with a set of defined voice control commands. As motivation: an audible plot can't be backtracked like a visual plot. With a visual plot your eyes can just scan back to the left. To scan back and re-heard the sound you just heard requires rewinding and replaying. But it could be interesting to set up a small set of voice commands that allow not just rewinding, but rewinding and zooming. So you hear an important "BEEP" and you want to say something like "STOP. ZOOM" and set up the heuristics such that this identifies the right BEEP and then gives an audio drill-down of exactly what that BEEP represented.

d) Done right, you might be able to turn a subset of webservices into a sort of voice-controlled data radio for the road. People spend thousands of hours in their cars so it's a real opportunity.

I believe the rule of thumb is that there are 15 that reach $100M revenue. We could square the figure of 200 at $100M valuation with this rule of thumb if we assume valuation is say 10X revenue, so 200 reach ~$10M revenue. Thus maybe 1/15 or so of the companies that reach $10M in revenue hit the next level of scale and get to $100M revenue.

This is amazing work. Could you explain why you decided to go with many individual stills rather than filling in the gaps in a video codec? It's a really counterintuitive approach.

Genomics is now in the clinic in a big way, albeit for diagnostics rather than cures. Two recent links you might find informative:

http://techcrunch.com/2013/04/23/counsyl http://techcrunch.com/2013/04/25/sv-angel-health-informatics

Datastax, Datastax. Must have appeared 20 times in the piece. I'm sure they are a great company but Oracle's real problem is Postgres (and, to a lesser extent, SQLite and the various MySQL forks). Oracle might want to consider paying $1B to the Postgres devs to sidetrack development for a few years like they did with MySQL.

Can you put an email in your profile? We've got some people independently interested in the Bitcoin-for-Cyprus thing.

It looks like this possibility was known and broadcasted to merchants during the maintenance window two days ago. It's kind of like the Rails mass assignment or security bug: merchants are just going to have to stay on top of Bitcoin issues.

http://www.reddit.com/r/Bitcoin/comments/1a51xx/now_that_its...

  [Submitted March 12]

  It's DanielTaylor again and I wanted to create a simple yet 
  intuitive post to explain the folks out there what happened  
  a couple of hours ago. This might also be useful for 
  bloggers or journalists who might be going to write about 
  it in the following hours.

  TL;DR

  The programs that read the blockchain, the bitcoin ledger, 
  disagree.

  Due to a bug in 0.7, it says that HIS is the correct 
  version of this ledger and 0.8 says that HIS is the correct 
  version.

  Miners (the people who add pages to the blockchain) are 
  told to switch to the 0.7 program so that this version 
  gains more support and the other one is discarded. 
  (orphaned).

  Regular users are not affected. Their transactions are 
  included in both ledgers and don't need to change any 
  programs.

  During that time, though, there is a slight chance of a 
  double-spend ocurring. That is why people recommended 
  merchants and exchanges to wait until there is one single 
  blockchain again before processing purchases and 
  merchandise.

  ...

  What's a double-spend?

  This is the reason why some merchants and exchanges stopped   
  processing incoming bitcoins for a couple of hours.

  The bitcoin network prevents people from spending the same 
  coins by mantaining this unique ledger, the blockchain. But 
  now that there were two of them, it was theoretically 
  possible to broadcast two different transactions with the 
  same coins and still get some confirmations.

  With some luck, someone could sneakily sneakily* buy a 
  television to a merchant who was reading the 0.8 ledger and 
  have the transaction confirmed. At the same time he could 
  have sent the same coins back to himself and, with some 
  luck, have the transaction confirmed on the 0.7 ledger.

  What happens is that, in the end when 0.7 wins, the thief 
  will have the television and his bitcoins. Remember that 
  there were two different versions of the same coins!

  This is not something easy to do and requires a lot of luck 
  because the blocks mined (the pages added to the ledger)  
  must be mined precisely in the correct order. But still, in 
  this situation it was easier to pull off and so it was 
  recommended for merchants and exchanges to temporarily stop 
  processing incoming transactions.

  Now the situation has resolved and the blockchain keeps 
  growing happily, page by page, block y block.

Strongly agree. If he names names, something good might come of this now that it has HN's attention for the day. And if he was going to journalists, he had a willingness to name names at some point in the past. I understand that these guys are organized crime, but without names no action can be taken. With the right push, Anonymous can/will dox the hell out of these guys given enough details. OP has to judge for himself whether (a) these are really bad guys and (b) he has the courage to call down the Internet upon them.

(To preempt: yes, Anonymous is not always good. No, I don't believe that Internet justice is always bad, or that it would be bad in this case, especially as all formal avenues appear to have been exhausted and the perpetrator is scot free.)

  People can inject just about anything they want into 
  themselves

http://www.leagle.com/xmlResult.aspx?page=4&xmldoc=19981...

  In Court, Plaintiff argued that he should have the right to 
  take whatever treatment he wishes due to his terminal 
  condition regardless of whether the FDA approves the 
  treatment as effective or safe, and that to prohibit him 
  from taking the treatment he wishes violates his rights 
  under the United States Constitution.4 The United States 
  Supreme Court previously addressed and rejected this  
  argument in Rutherford. In Rutherford, cancer patients 
  requested the right to use Laetrile, arguing, as does 
  Plaintiff, that for terminally ill patients the 
  effectiveness or safety of the proposed treatment is 
  irrelevant since such treatment is a last chance effort. 
  However, as identified by the Supreme Court in Rutherford, 
  to permit terminally ill patients to seek any type of 
  treatment regardless of the effectiveness of such treatment 
  would create a cottage industry existing solely to provide 
  potential panaceas to highly vulnerable patients. The 
  language of the Supreme Court in rejecting the Laetrile 
  argument is equally applicable here.

  "If history is any guide, this new market would not be long 
  overlooked. Since the turn of the century, resourceful 
  entrepreneurs have advertised a wide variety of purportedly 
  simple and painless cures for cancer, including liniments    
  of turpentine, mustard, oil, eggs, and ammonia; peat moss; 
  arrangements of colored floodlamps; pastes made from   
  glycerin and limburger cheese; mineral tablets; and 
  `Fountain of Youth' mixtures of spices, oil, and suet. In 
  citing these examples, we do not, of course, intend to 
  deprecate the sincerity of Laetrile's current proponents, 
  or to imply any opinion on whether that drug may ultimately 
  prove safe and effective for cancer treatment. But this 
  historical experience does suggest why Congress could 
  reasonably have determined to protect the terminally ill, 
  no less than other patients, from the vast range of self-
  styled panaceas that inventive minds can devise."

The absolute worst case scenario is that they lose some money and die a little sooner. The best case scenario is that they live!

To say that someone else can or should have the power to constrain another human in this way, to keep them from a chance at living, in the name of "protecting" them from doctors or companies...well, we are likely at a fundamental philosophical impasse. Which is why I return to my original point. Feel free to stay in the United States with the FDA. Those with a different cast of mind need a jurisdiction where we can take conscious risks, where we aren't "protected" from medical innovation.

Three points.

First, many (most?) medical advances seem crazy and kooky because they haven't been tried before. So it's not usually as obvious as "this is a proven scam" vs. "this really works". It's much more frequently "this is unproven". And like Barry Marshall's famous self-experiment with H. pylori, someone has to be first for it to ever get proven.

Second, when the government gets it wrong, it gets it catastrophically wrong. The USDA Food Pyramid recommending "6-11 servings of grain" is still being slavishly followed, and in the fullness of time we might well find it partially responsible for the epidemic of obesity and type II diabetes. The FDA is still doing Phase I/II/III clinical trials despite all the evidence in favor of adaptive trials. And tens of millions of people were irradiated by TSA x-ray scanners fast-tracked through the FDA approval process, scanners criticized by UCSF scientists, scanners which have now (finally) been withdrawn. These errors are magnified in impact because no one can opt-out, because a .gov has a bully pulpit, and because strong political incentives exist to silence criticisms.

Third, if people have the right to euthanasia, or the right to walk near bridges, I do believe they have the right to try what treatments they want. Frankly I don't consider someone else's medical affairs my business, anymore than I'd ask why they had an abortion. You can argue that vaccinations present a public health issue, and I might agree with you there. But otherwise this strikes me as a right to privacy and right to bodily integrity issue.

You might be interested in these studies. The second link is to a discussion of Andy Grove's editorial in Science calling for the FDA to only certify safety (rather than safety + efficacy + comparative effectiveness). But it's the third that gets at your question:

http://www.cato.org/pubs/regulation/regv27n2/v27n2-8.pdf

http://marginalrevolution.com/marginalrevolution/2011/10/and...

http://fdareview.org/harm.shtml

  The delay and large reduction in the total number of new 
  drugs has had terrible consequences. It is difficult to 
  estimate how many lives the post-1962 FDA controls have 
  cost, but the number is likely to be substantial; 
  Gieringer (1985) estimates the loss of life from delay 
  alone to be in the hundreds of thousands (not to mention 
  millions of patients who endured unnecessary morbidity). ... 

  If the U.S. system resulted in appreciably safer drugs, we 
  would expect to see far fewer postmarket safety 
  withdrawals in the United States than in other countries. 
  Bakke et al. (1995) compared safety withdrawals in the 
  United States with those in Great Britain and Spain, each 
  of which approved more drugs than the United States during 
  the same time period. Yet, approximately 3 percent of all 
  drug approvals were withdrawn for safety reasons in the 
  United States, approximately 3 percent in Spain, and 
  approximately 4 percent in Great Britain. There is no 
  evidence that the U.S. drug lag brings greater safety.

The only way to prove this definitively is a side-by-side experiment with a new jurisdiction in which patients and entrepreneurs alike are free to choose and the FDA has no power.

The issue is not really whether these treatments work or not. Every new treatment is by necessity unproven and more risky than an established one. Some people are early adopters or terminal patients with high risk-tolerances; others would rather suffer for a while than chance a drug that might make things worse.

Both of those are fine as preferences. The trouble arises because every US citizen is forced to have the global minimum of risk-tolerances across the population. It would be as if you could not try a development version till it became user-friendly enough for your grandparents. Specifically, in the US, you can't be an early adopter: the FDA does not allow citizens to opt-out unless they leave the borders of the USA. Indeed, in Cowan vs. US (1998) it successfully sued in federal court to prevent a dying AIDS patient from trying an experimental drug:

http://www.leagle.com/xmlResult.aspx?page=4&xmldoc=19981...

  Plaintiff requests that Dr. Davis be authorized to inject 
  Plaintiff with the with the experimental goat neutralizing 
  antibody drug [1] and that the FDA be enjoined from 
  interfering with Dr. Davis' treatment of Plaintiff. ...

  The Court is sympathetic to Plaintiff's situation. 
  However, the law is very clear, and under the current 
  statutes and regulations, Plaintiff's physician may not 
  administer the goat neutralizing antibody drug absent 
  prior approval of the FDA. In Court, Plaintiff argued that 
  he should have the right to take whatever treatment he 
  wishes due to his terminal condition regardless of whether 
  the FDA approves the treatment as effective or safe, and 
  that to prohibit him from taking the treatment he wishes 
  violates his rights under the US Constitution. ...

  This Court is in no way criticizing the intentions of 
  Plaintiff and his physician or the potential effectiveness 
  of the proposed treatment. Plaintiff's physician should 
  pursue approval of his Investigational New Drug 
  application as quickly as possible. Plaintiff's doctor 
  must obtain appropriate approval through the proper 
  regulatory authorities. As much as this Court may 
  empathize with Plaintiff, the authority to provide some 
  type of exemptions for individuals such as Plaintiff rests 
  with Congress and not with this Court.

http://blogs.wsj.com/health/2008/10/17/lance-armstrong-and-b...

  “We did a safety review, consulted with experts on PML, 
  and worked closely with FDA to come up with a risk 
  management program that allowed us to bring it back on the 
  market in a way that limited its use,” a Biogen 
  spokeswoman told the Law Blog. The plan prohibits giving 
  Tysabri for unapproved uses.

  Biogen Idec is running an early-stage trial of the drug in 
  multiple myeloma, but Baron doesn’t meet the criteria to 
  participate.

  Baron’s a prominent donor to the Democratic party, and 
  many of his powerful friends, including Lance Armstrong 
  and Bill Clinton, made appeals on his behalf. And the 
  family agreed not to sue if anything goes wrong.

  Ultimately, his doctors at the Mayo Clinic worked directly 
  with the FDA to find a “legal basis” for giving Baron 
  Tysabri. The deal was announced on Baron’s son’s blog late 
  yesterday.

But this is not really optimal. If you are an academic, you accept the concept of QC/quality checking, but you aren't stuck with just one journal to submit to. You can revise and resubmit somewhere else. And if you are an end-user, you don't have to take a reviewer's opinion into account when choosing between movies, books, bikes, or virtually any other physical good with star ratings on Amazon.com. Except for drugs. Then you, as the end-user, cannot opt-out and take the FDA's opinions with a grain of salt. In part this is because the FDA will sue you directly. In part it is because companies that even think of trying this route will get slapped by the FDA for trying to game the system, and subsequently find their approvals slowed or (nowadays) outright denied.

We need to carve out a jurisdiction where patients and entrepreneurs alike are free to take informed risks, recognizing up front that sick people do die in medicine, and also recognizing that society already allows people to take incredible risks in other contexts (joining the military, bungee jumping, walking tightropes). Whether that new jurisdiction is Singapore, or Estonia, or a seastead, or a medical cruise ship, or something else is to be determined. But that has to be the goal.

[1] In case a "goat antibody" sounds weird to you, it's a common thing in molecular biology. Google it, or see for example Thermo's web page: http://www.pierce-antibodies.com/custom-antibodies/goat-anti...

  I remember reading an academic article that showed how the 
  real cost was almost always 1/20 of that

The best response to Light and Warburton is that if it really took only $43 million to ship a drug, then they should raise the capital and start a drug company. It would be by far the most capital-efficient and successful drug company of the last 50 years. If they have really figured out how to cut all the fat, they would be hailed throughout the industry.

But I hope to persuade you that when someone outside the industry is off by two orders of magnitude ($43M vs. $4B), it is likely that they are the ones who have missed something important. I encourage you to read Derek Lowe's more detailed critique here:

http://pipeline.corante.com/archives/2011/03/07/the_costs_of...

http://pipeline.corante.com/archives/2011/03/08/that_43_mill...

First off, I am happy that we both seem to agree on a qualitative fact: there is indeed a tradeoff between what statisticians call type I and type II errors. At one extreme, you can let everything through, advance technology rapidly, and suffer some side effects (type I bias). Or you can block everything, stop technology, and suffer no side effects (type II bias). If we agree on this qualitative point, the key is whether we are currently at a Pareto optimum. Is our current system optimizing the type I vs. type II tradeoff? I have a numerical scenario below which you can critique, but first to your points.

  It's faster to run experiments on animals than people. 

  I think you are vastly overestimating what society has to 
  gain by deregulating medicine. You'll get a one-time gain 
  of 10 years of progress at the cost of an unknown number of 
  lives.

In scenario I, we do it status quo and safe, with no deaths. Very generously, let us grant that a cure appears in 10 years. This is generous because a regulated market may never iterate upon the cure if it is radical/different (e.g. Barry Marshall and H. pylori).

In scenario II, we accelerate the cure in a deregulated market. The R&D phase takes 1 year and costs us 100 deaths from test pilots / early adopters; the scaling phase takes 2 years and costs us another 900 deaths from volunteers. These numbers are vastly in excess of any reasonable safety testing paradigm in a deregulated space (no one died in Banting & Best's experiments) and I cite them as extremely conservative upper bounds.

Ok. Then in scenario I, the status quo, you had

  - 0 die from testing
  - cure appears at end of 10 years
  - 10 million people die over those 10 years
  - 10 million deaths

  - 1000 die from testing over 3 years
  - 3 million die from disease over those yeers
  - cure appears in year 3
  - no further deaths
  - 3 million + 1000 total deaths

So, regarding efficacy testing, I think the costs/benefits have to be assessed in full context. If you go back to the time before the FDA, it was a time of incredible wonder drugs and useless patent medicines. Kind of like the Internet: the price of being able to put up a domain name in 10 minutes with no centralized check for accuracy means information proliferates and the web/market/search sorts it out.

And we kind of know what a safe-but-not-necessarily-effective market for drugs will look like: the supplement industry. Supplements are cheap, they vary in effectiveness on a per person basis, and they have undoubtedly produced some really great things (creatine, omega 3). Take a look at this awesome graphic:

http://www.informationisbeautiful.net/play/snake-oil-supplem...

The thing is, with centralized regulation for efficacy two things happen. First, many of the bubbles on that graph never appear in the first place. Second, because they never appear, they never accumulate enough evidence/market size to rise up the list. We are choking the channel if centralized regulators require our minimum viable products to be not just safe, but highly efficacious.

The best way to see this is that centralized regulation kills iteration. Talk to anyone in the drug space: they'd love to be able to change their dosing methodology (altering dosage amount, frequency, formulation) or otherwise take advantage of serendipitous post-market findings. Viagra, famously, was initially intended to medicate blood pressure[1].

But right now they can't even change the labels on their drugs without the FDA's approval, which is why the average layman gets a folded-up chemistry textbook[2] rather than a user-friendly instruction manual, let alone a website which totes up other people's experiences with the drug. To get a sense of how much that could contribute to the patient user experience, see Help Remedies[3], which can get away with better UI/UX because they're dealing in generics.

Anyway, on net, I think something like a pharmacogenomic erowid.org [4,5] is the best way to establish efficacy. That would be distributed and the data would be public and constantly updated, with sample sizes far in excess of the current FDA process. Patients would get accounts and link their genomic information with the site after buying any new drug, and input their own survey data in order to see other people's (aggregated, anonymized) experiences. This would mean that you can launch safe drugs of unproven efficacy, and then collect efficacy data at a far larger scale than we do today. But this kind of innovation will only be possible in a jurisdiction outside the FDA's thumb.

[1] http://www.mc.vanderbilt.edu/lens/article/?id=116

[2] http://dailymed.nlm.nih.gov/

[3] http://www.helpineedhelp.com

[4] http://www.pharmgkb.org/

[5] http://www.erowid.org/

So, a few points (I didn't downvote you).

1) First, FDA fast-tracks many bad things. Hundreds of millions of people were irradiated by scanners that FDA waved on through because a fellow .gov agency (TSA) sponsored them. So: even the risk-averse can't trust a single centralized regulator to be "risk-averse" rather than "pro-government". We need multiple regulators (see my posts elsewhere in the thread), where you can use things approved by the slower/expensive/safest one while I can use items approved by the faster/cheaper/riskier ones.

http://arstechnica.com/science/2010/11/fda-sidesteps-safety-...

  Dr. Holdren passed the letter on to the Food and Drug 
  Administration for review. But, in the FDA's response, the 
  agency gave the issues little more than a data-driven brush 
  off. They cite five studies in response to the professors' 
  request for independent verification of the safety of these 
  X-rays; however, three are more than a decade old, and none 
  of them deal specifically with the low-energy X-rays the 
  professors are concerned about. The letter also doesn't 
  mention the FDA's own classification of X-rays as 
  carcinogens in 2005.

http://www.myraqa.com/blog/how_long_is_90_days

  By law, FDA must respond to your 510(k) within 90 days, and 
  typically they do. The thing you have to understand is that 
  FDA measures 90 days about the same way the NFL measures 
  the 60 minutes in a football game. It's not unusual for the 
  clock to spend more time stopped than running.

Thalidomide in particular is to the FDA what 9/11 is to the TSA, it's the justification for everything they do. If you get into the history books you'll see that Frances Kelsey never actually suspected teratogenic effects; she suspected neurological issues. Moreover, thalidomide was actually a very efficacious drug for morning sickness, it was just unsafe. Yet the 1962 revision to the FD&C act added efficacy testing on top of safety testing.

That's weird. The thing is, toxicological/safety testing, even aggressive safety testing is "only" in the tens of millions, not billions. It's efficacy testing (and then comparative effectiveness) that really piles on the dollars. If the lesson of thalidomide was that we should do aggressive safety testing, then no one got the message, because Kefauver & Harris' 1962 amendments to FD&C meant we ended up spending several hundred billion dollars on efficacy instead.

Perhaps then the lesson from thalidomide might be that pregnant mothers should be much more risk-averse in what drugs they take. It's not really a lesson that says "we need to delay all drugs more", because due to pharmacogenomics some side effects are only going to be apparent when you introduce them into humans on a large scale anyway.

Moreover, risk can't be eliminated, and different people will have different risk profiles. What if a 70 year old man with terminal cancer wants to take an experimental, non-FDA approved drug? Do you sue like the FDA did in Cowan vs. US to prevent him from doing so?

For that matter, what if a 25 year old pregnant woman wants to take a new drug? Do we prevent her from doing so? Maybe we should, but we currently don't stop pregnant women from drinking alcohol or smoking cigarettes.

One has to think very carefully about whether every tragedy means one must ban or mandate something with a federal law.

Lot of important points to engage there, and generally agree with the spirit of the comments. I think many biotech startups would instantly take a deal that gave them and their patients the ability to opt-out of FDA, in exchange for some demonstration that they aren't using public funds (e.g. committing to not use some fraction of the research literature, ineligibility for all govt grants, etc.).

Regarding patents, they are a form of artificial scarcity on the sales end. Regulation is a form of artificial scarcity on the R&D end. That's why regulatory affairs and IP are the two most important departments in any pharma company.

It's useful to think about what the pharma industry would look like with no FDA and no IP protection. It'd look a lot like food, energy drinks, or supplement manufacturers, making commodity products with marketing as the primary source of margin. Generic drug manufacturers are a good first step towards this; we'll see more of this in the near future with the pharma cliff and end of many major drug patents.

Incidentally, the intersection between regulation and IP produces some extremely bizarre behavior:

http://www.fda.gov/downloads/Drugs/.../Guidances/ucm079342.p...

  This guidance is intended to provide industry with 
  information on how the Food and Drug Administration (FDA) 
  is applying the 180-day generic drug exclusivity provisions 
  of the Federal Food, Drug, and Cosmetic Act (the Act) in 
  light of recent court decisions. The guidance
  addresses the issue of the elimination of the "successful 
  defense" requirement, which required an abbreviated new 
  application (ANDA) applicant to be sued for patent 
  infringement and to prevail in the litigation to receive 
  the 180-day period of marketing exclusivity.

I can get into the duct-tape upon duct-tape that led to this bizarre state of affairs, but think about how perverse it is that the FDA was telling companies to break patent law (or at least risk a civil lawsuit) as a matter of policy. That's the kind of thing you uncover when you actually look at how regulations are implemented.

Finally, regarding funding, yes, NIH spends about $31B per year, which is a lot. However, drug companies spend $4B per drug approved[1], which is an incredible amount of money when multiplied across all drugs. I'm not sure exactly how one could stop drug companies from profiting from public domain research as you propose. Are you saying that NIH should get into the business of drug development and/or not allow its funded academics to publish papers or start drug companies?

If you are saying the former, I actually happen to agree that NIH would be reasonably good at drug development, as Francis Collins has proposed, because as a fellow .gov it would be able to play hardball with the FDA in a way that no normal company could. Among other things, it wouldn't fear going out of business, and would be able to appeal to the HHS secretary if FDA retaliated against it. On the other hand, this new NIH-to-FDA pipeline would lose a lot of checks and balances; it'd sort of be like HHS as the large drug co with NIH as the scientists and FDA as the regulatory affairs, without any real check by the market other than the nationalized drug companies of other countries.

Think about how the FDA fast tracked [2] things like TSA body scanners and you'll get a sense for what its actual commitment to safety is when it's a fellow .gov that is sponsoring a drug/device.

As a final point, if you meant instead that NIH should be abolished and academics should stop publishing papers, I think we will actually see the implosion of the US higher ed research establishment over the next 5-10 years due to MOOCs and budget cuts, so that may come to pass as well.

[1] http://www.forbes.com/sites/matthewherper/2012/02/10/the-tru...

[2] http://arstechnica.com/science/2010/11/fda-sidesteps-safety-...

  approved treatments in humans often lag 10 years or so 
  behind what's known to work in animal models

http://www.nobelprize.org/educational/medicine/insulin/disco...

  Early in 1921, Banting took his idea to Professor John    
  Macleod at the University of Toronto, who was a leading 
  figure in the study of diabetes in Canada. 

  Banting and Best began their experiments by removing the 
  pancreas from a dog. ... By giving the diabetic dog a few 
  injections a day, Banting and Best could keep it healthy 
  and free of symptoms.

  The team was eager to start testing on humans. But on whom 
  should they test? Banting and Best began by injecting 
  themselves with the extract. They felt weak and dizzy, but 
  they were not harmed.

  In January 1922 in Toronto, Canada, a 14-year-old boy, 
  Leonard Thompson, was chosen as the first person with 
  diabetes to receive insulin. The test was a success. 
  Leonard, who before the insulin shots was near death, 
  rapidly regained his strength and appetite. The team now 
  expanded their testing to other volunteer diabetics, who 
  reacted just as positively as Leonard to the insulin 
  extract.

  The news of the successful treatment of diabetes with 
  insulin rapidly spread outside of Toronto, and in 1923 the 
  Nobel Committee decided to award Banting and Macleod the 
  Nobel Prize in Physiology or Medicine.

What if we tried that today?

You mean, just rely on the judgment of the experts involved and the verbal consent of the patients?

You mean, just allow the doctors to come up with whatever dose they felt warranted and patients to take whatever dose they feel comfortable with?

You mean, resist having some kind of ostensibly judicious central authority approve all such decisions, and rely on the distributed judgments of all consenting participants involved?

Yes. The typical response is that this is a recipe for anarchy. But history shows that it is a recipe for Nobel Prizes, and it is not like 1920s America was much like Somalia.

Would there be risk? Sure. Some people will not be helped and others might even harmed by new and unproven treatments. That's the price if we're serious about rapid progress, or really any progress. There must always be a first human trial; why not as soon as possible if people really are dying?

Needless to say, this kind of boldness won't fly in the modern US. Outside of the internet, the country has become just too risk averse, too wealthy to pay the price of progress. Our task as hackers then is to create at least one spot on this earth where patients can take whatever treatments they want, where entrepreneurs/technologists can invent whatever drugs/devices they want, and where no regulator has the power to intercede between these two consenting parties. And where we can go from idea to human trials as fast as the patient pleases.

Let's go point by point.

1) Regarding diabetes and the FDA:

  I don't think removing the FDA is going to find a cure for 
  diabetes.

http://www.nobelprize.org/educational/medicine/insulin/disco...

  Early in 1921, Banting took his idea to Professor John 
  Macleod at the University of Toronto, who was a leading 
  figure in the study of diabetes in Canada. Macleod didn't 
  think much of Banting's theories. Despite this, Banting 
  managed to convince him that his idea was worth trying.

  In January 1922 in Toronto, Canada, a 14-year-old boy, 
  Leonard Thompson, was chosen as the first person with 
  diabetes to receive insulin. The test was a success. 
  Leonard, who before the insulin shots was near death, 
  rapidly regained his strength and appetite. The team now 
  expanded their testing to other volunteer diabetics, who 
  reacted just as positively as Leonard to the insulin 
  extract.

  The news of the successful treatment of diabetes with 
  insulin rapidly spread outside of Toronto, and in 1923 the 
  Nobel Committee decided to award Banting and Macleod the 
  Nobel Prize in Physiology or Medicine.
  

2) Regarding type I vs. type II errors:

  We need the FDA to regulate drugs and medical devices.   
  There's too much potential for quackery. 

http://www.nobelprize.org/nobel_prizes/medicine/laureates/20...

  The extreme skepticism of my colleagues led me to believe   
  that I might never be funded to perform the crucial trial 
  of antibiotics...  I realized then that the medical 
  understanding of ulcer disease was akin to a religion. No 
  amount of logical reasoning could budge what people knew in 
  their hearts to be true. Ulcers were caused by stress, bad 
  diet, smoking, alcohol and susceptible genes. A bacterial 
  cause was preposterous.

  We should be paying medical researchers similar incomes to 
  engineers at Silicon Valley tech firms.

4) Concerning stem cells:

  California taxes are funding one of the biggest research 
  efforts into stem cells.

http://blogs.nature.com/news/2012/10/texas-stem-cell-provide...

  Last September, Nature predicted a stem cell showdown in 
  Texas, between the FDA and a company providing unproven 
  stem cell treatments, and that seems to be happening. In a 
  severe “warning letter” posted on the agency’s website this 
  week (but dated September 24, 2012), the FDA told 
  Sugarland, Texas-based Celltex Therapeutics Corporation 
  that its stem cell products fall under FDA regulation and 
  need to be approved before use in patients.

  The letter is a challenge to new regulations that the Texas 
  Medical Board put in place in April, which had made FDA 
  approval an option, not a requirement. Those regulations 
  state that doctors injecting stem cells into patients need 
  FDA approval or the approval of a local institutional 
  review board (IRB). The warning letter makes clear that the 
  FDA expects its approval to be mandatory—effectively 
  replacing the “or” with an “and”.

  In recent court filings, the Food and Drug Administration 
  has asserted that stem cells—you know, the ones our bodies 
  produce naturally—are in fact drugs and subject to its 
  regulatory oversight. So does that make me a controlled 
  substance? The bizarre controversy revolves around the 
  FDA's attempt to regulate the Centeno-Schultz Clinic in 
  Colorado that performs a nonsurgical stem-cell therapy 
  called Regenexx-C.

  We need the FDA

Why is it in Roche's interest to lobby for a stronger FDA? Because FDA alumni are hired by large manufacturers to lobby the FDA and increase barriers to entry for startups. When you get into the details of how regulations are actually enforced, it is all about relationships/politics/press coverage and has very little to do with technical merit.

I could go on in this vein...among other things, you might be interested in the fraction of pre-1938 drugs and pre-1976 devices that are routinely prescribed from an ostensible age of quackery.

However, the fundamental idea is not really to convince people who want the FDA that it should continue to exist, but to get a critical mass of people who don't want the FDA to create a place where it does not have power. Then you and those who agree with you can reside in the US, where the FDA has sole authority. And we can opt-out of the FDA, as both patients and entrepreneurs.

This is going to require thinking outside the confines of the United States and US politics, but the payoff will be nothing short of a revolution in the pace of biomedical innovation.

Right, but if there were a private system similar to the one in which Underwriters Laboratories operates, that'd be preferable. I'm not sure how to get there from here, which is why I said "I'm not sure how you'd pull this off".

For example, it might be feasible to get Cedars-Sinai to partner with (say) Singapore's HSA and do some kind of fast track approval process intended to compete with FDA's slow approval. Here Singapore's name brand would be enough for the Asian market while Cedars' brand would establish to American medical tourists that the product/device/service had been vetted.

Good question. Broadly speaking, the whole regulatory space (not just FDA, but all other agencies) is indeed a massive business opportunity. There are basically two ways to operate here:

  Option 1: reduce costs of complying with FDA. 
  Option 2: reduce the power of FDA.

So then there is Option 2: reduce FDA power. I've come to believe that the second strategy is much more effective in the long run. So what does that entail?

1) Regulator review sites. Something that might be surprisingly effective would be a site that named and shamed individual regulators, kind of like TheFunded.com for regulators. With some good SEO this might be the single most effective thing one can do. It would be incredibly popular and could branch out into SEC, EPA, and other agencies.

2) Regulatory review sites. Relatedly, with all other domains (movies, music, books, etc.) there is a thriving system of competitive, third party reviews and star ratings. Yelp, Amazon, Metacritic, Rotten Tomatoes, even Google PageRank are all review methodologies that are intentionally robust to the decisions of a single regulator. Figure out how to get 2000 cardiologists worldwide to do public internet reviews of heart drug/devices rather than a hand-picked FDA panel of 15, and you can show under very conservative assumptions that the resulting rank-ordering of products will be far more accurate.

3) Filing in other countries first. For example, within medical device companies, it's well known now that you get your CE Mark in Europe first[1,2,3], and then think about the US. You can get some revenue and the CE Mark process is far more consistent than the US.

4) Otherwise enhancing regulatory competition. Imagine if Harvard, the Mayo Clinic, and Cedars-Sinai could suddenly clear drugs and devices like the FDA. The FDA already contracts with scientists from there to run their expert panels, as they don't have the expertise in house. The CE Mark strategy above is this in embryo, but it's only two jurisdictions (EU and US). I'm not sure how you'd pull this off, but the basic idea is to use other "name brands" in medicine to help set up regulatory competition.

5) Software-based regulatory arbitrage. With modern information technology, it may be possible to locate software-based components of a device/drug overseas in fast market access countries[4] like Singapore, Hong Kong, or Israel.

6) Medical tourism and/or medical cruise ships. Figuring out ways to do internet marketing of offshore medical tourism to Americans, with transparent prices and treatments proven in other countries (even if not FDA approved) will be a big deal over the next 10-20 years as the US medical system enters crisis from all the aging seniors. All you need is a relatively small but high profile group of people voting with their dollars to seek treatment or move operations overseas to start provoking real change. Nothing within the system will do that now.

These are the sorts of ideas, many informational, that I think will have a much bigger impact than methods to streamline compliance.

[1] http://thehill.com/blogs/healthwatch/medical-devices-and-pre...

[2] http://www.nytimes.com/2011/02/10/business/10device.html?pag...

[3] http://www.medicaldevices.org/system/files/FDA%20impact%20US...

[4] www.emergogroup.com/files/fast-access-markets-slides.pdf

  2. There are regulatory obstacles for businesses.

Moreover, it is just more stressful to deal with a regulatory climate where any error is assumed to have happened because you were an evil corner-cutting capitalist who didn't allocate enough for safety. This kind of Monday morning quarterbacking is unfortunately usually done by people who've never shipped a drug or device in their lives, like most politicians, journalists, or federal regulators. Twitter, unlike Genzyme[2], is not fined millions of dollars by the FDA when its site is down.

Finally, you have to guess what the law is. There is so much "discretion" [3,4] afforded to regulatory agencies that the threat of fines and seizures over bizarre interpretations of the law by a Carmen Ortiz-style ambitious regulator is never far from your mind. Example [5]:

  [Newsweek:] What exactly would constitute a “medical   
  claim?” Would pointing people to medical research papers 
  [qualify]?

  [FDA]: It depends. There are rules as to how one can do   
  that … Those rules are actually worked out pretty well, 
  and they just would need to make sure they’re staying 
  within the rules.

  [Newsweek:] Are those rules on the Web?

  [FDA]: I don’t know where the policy is. I would have to 
  get it for you. It’s an agencywide policy. I would have to 
  find it for you. And it won’t be that easy for people to 
  follow it…

  The agency has urged hospitals to allow vendors to guide 
  them on security of sophisticated devices. But the vendors 
  sometimes tell hospitals that they cannot update FDA-
  approved systems, leaving those systems open to potential 
  attacks. In fact, the agency encourages such updates.

  “A lot of people are very confused about FDA’s position on 
  this,” said John Murray Jr., a software compliance expert 
  at the agency.

  In United States v. Park, the Supreme Court held that a 
  responsible corporate official can be convicted of a 
  misdemeanor based on his or her position of responsibility 
  and authority to prevent and correct violations of the 
  Food Drug and Cosmetic Act (FDCA). Thus, evidence that an 
  individual participated in the alleged violations or even 
  had knowledge of them is not necessary.  

For just a taste of how all this plays out, look at the FDA's ongoing attempt to regulate[8] mobile health apps. Who knows what the rules will be, what they will cost, or what the fines are? Look at the FDA's attempt to deny[5] people access to their genome without a prescription. Look at the fact that they issued a record 10000+ 483s in 2011[9], which threaten a business with civil or criminal penalties. Look at the fact that they used these 483s to shut down Teva and Sandoz and Hospira and Bedford at the same time[10], causing a massive shortage of injectables which they blamed on industry profit seeking and used to gain[11] yet more regulation, more power, more budget.

Look, finally, how they claim in an official court filing against family farms producing raw milk that you have "No Generalized Right to Bodily and Physical Health" [12], where they approvingly cite the case of Cowan vs. US, where a terminal cancer patient was denied access to experimental medication, denied the right to opt-out of the FDA:

  There is No Generalized Right to Bodily and Physical   
  Health.

  Plaintiffs’ assertion of a “fundamental right to their own 
  bodily and physical health, which includes what foods they 
  do and do not choose to consume for themselves and their 
  families” is similarly unavailing because plaintiffs do 
  not have a fundamental right to obtain any food they wish. 
  In addition, courts have consistently refused to 
  extrapolate a generalized right to “bodily and physical 
  health” from the Supreme Court’s narrow substantive due 
  process precedents regarding abortion, intimate relations, 
  and the refusal of lifesaving medical treatment. 

  See Glucksberg, 521 U.S. at 721 (warning that the fact 
  “[t]hat many of the rights and liberties protected by the 
  Due Process Clause sound in personal autonomy does not 
  warrant the sweeping conclusion that any and all 
  important, intimate, and personal decisions are so 
  protected”); see also Cowan v. United States, 5 F. Supp. 
  2d 1235, 1242 (N.D. Okla. 1998) (rejecting a claim that 
  the plaintiff had the fundamental “right to take whatever 
  treatment he wishes due to his terminal condition 
  regardless of whether the FDA approves the treatment”).

The only solution here is for hackers to carve out a jurisdiction in which the FDA has no say, where patients are free to be early adopters and startups are free to push the technological envelope. Patients in this zone will need to be mature and understand that these are version 1.0s, and may not help or even actually harm them. But every drug or device or surgery needs someone to be first, and a few brave risk takers could both benefit their own health and push humanity forward. After all, we have thousands of people dying for futile risks in various foreign wars.

So, the limiting reagent is not money, or expertise, or motivation, or smarts. raganwald, you and most of HN are plenty smart enough. It's about the freedom for companies to innovate, for patients to take risks. We need a jurisdiction (a seastead? Singapore? Estonia?) that enables us to push the technological frontier. Everything else will fall into place once we can't be punished for innovating.

[1] http://jnci.oxfordjournals.org/content/104/18/1347.extract#

[2] http://www.fiercepharma.com/story/genzyme-submits-175m-fine-...

[3] http://www.ivdtechnology.com/article/letters-labcorp-show-fd...

[4] http://www.fdalawblog.net/fda_law_blog_hyman_phelps/2011/03/...

[5] http://www.thedailybeast.com/newsweek/blogs/the-human-condit...

[6] http://articles.washingtonpost.com/2012-12-25/news/36015727_...

[7] http://www.gatewayfda.com/fda-regulations/under-park-doctrin...

[8] http://m.spectrum.ieee.org/biomedical/devices/the-fda-takes-...

[9] http://blog.fdazilla.com/2011/11/fda-issues-483-every-50-min...

[10] http://www.forbes.com/sites/aroy/2012/06/15/how-margaret-ham...

[11] http://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm050796....

[12] http://www.organicpastures.com/pdfs/FDA%20dismissal%20docume...

One thing worthy of notice are the "combo" nature of these penalties. For example, he says Computer Fraud is pretty much the same as Wire Fraud. Yet that's a separate count, with more years/fines/numbers, which gives the prosecution a larger Sword of Damocles to hold over someone's head. Why have a separate crime if you are always going to charge both?

Kerr is probably right on the narrow point that if you decided to throw the book at someone you'd hit them with a combo like this (and they later expanded it into a 13-hit combo), and might even be right that this combo is "nothing unusual". We should wait for part two, but the multiplication of an infinite number of federal statutes in combination with prosecutorial discretion looks like the real problem here. We need to trim the sails of these prosecutors in a big way, or at least provide an external check.

For example: they're against jury trials? They want to deny people the right to a jury by depleting their cash? Well, what about a virtual jury? Have a site with all public court documents and filings, like the grand jury indictment. Look at how many years they are pursuing and include bios/faces of the accused, defense, and the prosecutors. Then have people vote up/down as to whether or not they think the punishment fits the crime. Completely non-binding of course, and conceptually separate from the question of innocence/guilt. Include lots of analytics/stats on past convictions and the like. Make money via Amazon affiliate links to books on crime, TV shows, etc. And do SEO so that people found innocent are very clearly marked as such in search result snippets.

Many crimes are salacious so with reasonable graphic design you'd have no problem getting visitors (like the Smoking Gun). The resulting scrutiny of prosecutorial decisions by thousands of people would indeed change the profession, putting a second and more scalable check on them comparable to the press.

He had no money left, was already bankrupt after defending himself to this point...Besides, this is the wrong question - on what earth should it even be possible for a prosecutor to threaten thirty five years and a felony conviction for this sort of thing? That kind of sentence is for attempted murder, it is a few years short of life in prison. This was wrong, this was not right. Prosecutions like these mean that we lose our humanity.

Well, you might be interested in the technical guts of that GSK fine. It is related to the idea that no one knows what is legal anymore, and in this case too federal prosecutors drove a man (Peter Gleason) to suicide.

Very briefly, once you spend four billion[1] to get a drug approved by FDA for purpose A, a doctor can choose to prescribe it for purposes B, C, and D -- and can publish papers on said applications -- but you as the manufacturer are prohibited from discussing these "off label" applications with other doctors through your salesforce. Even handing out papers is a gray area. So a pharma rep in an office with a doctor concerned about condition B and a patient who suffers from condition B is prohibited, under this FDA theory, from remarking on the utility of his company's drug for condition B. Since ~40% of prescriptions [2] are for off-label uses of drugs, this is a very big deal.

The reason for this ban on "off-label marketing" is that the FDA wants you to spend another few billion to take the new application through the entire New Drug Application process; relying on distributed doctors rather than centralized FDA for drug evaluation means FDA loses user fees and review authority. Note that the drug has already been proved safe as dosages in off-label applications are very similar; FDA however does not want doctors to judge on their own whether the drug is efficiacious (these are terms of art in the drug industry). Since FDA cannot regulate doctors directly due to the AMA's clout, they go after drug companies who are under their purview and block them from mentioning anything other than purpose A.

With that background, now to the GSK fine: http://www.justice.gov/usao/ma/news/2012/July/GSKsettlement....

  Global health care giant GlaxoSmithKline LLC (GSK) agreed 
  to plead guilty and to pay $3 billion to resolve its 
  criminal and civil liability arising from the company’s 
  unlawful promotion of certain prescription drugs

  Under the provisions of the Food, Drug and Cosmetic Act, 
  a company in its application to the FDA must specify each 
  intended use of a drug.  After the FDA approves the 
  product as safe and effective for a specified use, a 
  company’s promotional activities must be limited to the   
  intended uses that FDA approved.  In fact, promotion by 
  the manufacturer for other uses – known as “off-label 
  uses” – renders the product “misbranded.” 

  A federal appeals-court panel on Monday overturned the 
  conviction of a pharmaceutical salesman for so-called off-
  label drug marketing, saying he was protected by free-
  speech rights.

  The decision could threaten Food and Drug Administration 
  rules that prohibit the marketing of drugs for off-label 
  uses, or those that aren't specifically approved by the 
  FDA.

  Indictment of Doctor Tests Drug Marketing Rules

  At first, Dr. Peter Gleason thought his arrest was a joke.

  In the early afternoon of Monday, March 6, half a dozen 
  men in suits surrounded Dr. Gleason, a Maryland 
  psychiatrist, at a train station on Long Island and 
  handcuffed him.

  “I said, ‘Well, this is a gag,’ ” Dr. Gleason recalled in 
  a recent interview. “They said, ‘No, this isn’t.’ ”

  Dr. Gleason, 53, was taken aback because he was arrested, 
  and later charged, for doing something that has become 
  common among doctors: promoting a drug for purposes other 
  than those approved by the federal government.

  However, the state failed to note one important detail – 
  Gleason died this past February. The 57-year-old physician 
  recently saw his medical licenses suspended in 
  Pennsylvania and California, and the accumulated weight of 
  the events apparently led him to commit suicide, according 
  to his sister. We left messages with the Florida 
  Department of Health about the filing, but not have 
  received a reply (read the complaint here).

[1] http://www.forbes.com/sites/matthewherper/2012/02/10/the-tru...

[2] http://papers.ssrn.com/sol3/Delivery.cfm/SSRN_ID568402_code3...

Unfortunately, a lot of lobbying these days is done in self-defense. This is a good article on how the politicians corrupted Microsoft and turned it into a lobbying machine. Congress will threaten you with banning your business or passing laws that favor competitors unless you grease their pockets.

http://washingtonexaminer.com/carney-how-hatch-forced-micros...

  "If you want to get involved in business," Sen. Orrin Hatch 
  warned technology companies at a conference in 2000, "you 
  should get involved in politics."

  Hatch was referring to the shortcomings of then-software 
  king Microsoft, which he had spent most of the previous 
  decade harassing from his perch as Judiciary Committee 
  chairman. The message was clear: If you become successful, 
  you must hire lobbyists, you must start a political action 
  committee, and you must donate to politicians. Otherwise 
  Washington will make your life very difficult.

  Hatch's crusade against Microsoft was a formative moment in 
  the cozy relationship between K Street and Capitol Hill. 
  That coziness has become a prime target of the Tea Party in 
  recent years -- and so has Orrin Hatch, who faces a primary 
  Tuesday against conservative challenger Dan Liljenquist.
 
  Here's the Hatch-Microsoft story:

  The Clinton administration brought antitrust charges 
  against Microsoft after the Windows 95 operating system 
  came preloaded with Microsoft's browser, Internet Explorer. 
  Though the case was in the hands of the Federal Trade 
  Commission and the courts, Hatch brought Microsoft CEO Bill 
  Gates before his Senate Judiciary Committee in 1998, and 
  gave him a good dressing down, ostensibly for being a 
  monopolist.

  But it grated on Hatch and other senators that Gates didn't 
  want to want to play the Washington game. Former Microsoft 
  employee Michael Kinsley, a liberal, wrote of Gates: "He 
  didn't want anything special from the government, except 
  the freedom to build and sell software. If the government 
  would leave him alone, he would leave the government 
  alone."

  This was a mistake. One lobbyist fumed about Gates to 
  author Gary Rivlin: "You look at a guy like Gates, who's 
  been arrogant and cheap and incredibly naive about 
  politics. He genuinely believed that because he was 
  creating jobs or whatever, that'd be enough."

  Gates was "cheap" because Microsoft spent only $2 million 
  on lobbying in 1997, and its PAC contributed less than 
  $50,000 during the 1996 election cycle.

  "You can't say, 'We're better than that,' " a Microsoft 
  lobbyist told me on Friday. "At some point, you get too 
  big, and you can't just ignore Washington."

  "You can sit there and say, 'We despise Washington and we 
  don't want to have anything to do with them,' " the 
  lobbyist said. "But guess what? We're going to have 
  hearings about the [stuff] you do."

  It's no shocker that lobbyists think companies should hire 
  lobbyists. But so does Capitol Hill -- Orrin Hatch 
  included.

  In a 2000 speech to technology companies, Hatch called 
  Microsoft "knuckle-headed and hard-nosed," according to 
  Wired magazine. "I have given [Microsoft] advice, and they 
  don't pay any attention to it." In that same speech, Hatch 
  warned: "If you want to get involved in business, you 
  should get involved in politics."

  "The industry had an attitude that government should do 
  what it needs to do but leave us alone," one Hill 
  technology staffer complained to Business Week at the time. 
  "Their hands-off approach to Washington will come back to 
  haunt them."

When, in your opinion, was the golden age of human history?

The reason I ask is that something like 80% of the world today has mobile phones. Or, as another example, this source says about one in seven people don't have clean water: http://water.org/water-crisis/one-billion-affected

So that means ~85.7% of people do have access to clean water. Do you think that fraction has ever been higher in human history?

The dead white guy was responsible for 100 million people dead, most of them non-European. If you want to feel guilty for something, feel guilty for denying that. His great idea was to abolish private property, such that you didn't own the very toothbrush in your hand, the clothes on your back, the house you built with your own hands - or your farm.

Why is it that rejecting the ideas of Marx led China (and Vietnam, and Singapore, and Taiwan) to unprecedented wealth? Why is Chile rich and Cuba poor? Why is North Korea dark while South Korea is alight? Why was Eastern Europe impoverished while Western Europe was wealthy? Why was the Comintern established, why did the Soviet Union foment revolution all around the world, why did Pol Pot stack up a million skulls?

And, most importantly, what exactly "colonized" Eastern Europe and China and North Korea within the span of 10 years to drive them so far behind Western Europe, Taiwan, and South Korea respectively?

It's all Marx. Every time. You want to atone for something, atone for that. That is your sin: converting millions of indigenous people to an alien, white, Western ideology that promised heaven and yielded hell.

jacquesm: As a "third world person", I don't think the West owes anything to us. It's actually a very Euro-centric and arguably racist model of the world to believe that only whites have agency and that everything hinges on what whites did or did not do.

Nonwhite people are perfectly capable of killing themselves (and whites!) in huge numbers. Genghis Khan, Shaka Zulu, the Aztecs, and the Arabs conquered lands and put many cities to the sword. Islam radiated out from the Middle East to the Atlantic and the Pacific, with sword.

What do you think Genghis or Shaka Zulu would have done if they invented guns and ships first? They're human. They would have conquered Europe and enslaved Europeans. Indeed, many Europeans were enslaved by North African slave traders.

Europeans do lose battles. It is racist to think otherwise. Didn't the Japanese win the Russo-Japanese war? Wasn't the Muslim world on the offensive when Europeans were in disarray? Weren't China and India the centers of the world economy for hundreds of years?

All civilizations rise and fall. Europeans had a great run from 1492 to 2008. China is currently the top dog, even if many people in the West haven't realized it. And they didn't get rich from Western aid, and they sure didn't benefit from the export of that oh-so-Western ideology of communism, thought up by a dead white guy named Karl Marx.

They created their wealth and are lifting a billion plus people out of poverty.

When they're on top, which they already are, are you going to still claim that the West is the sole driver of history, that everyone is what they are because of Western action or inaction? Or will you agree that China (and India, and all the others) are human too, and can build up their own societies without "help" from the West? Because China doesn't want your aid and it sure doesn't want your pity. But it'd be happy to sell you a chip for $199, as an equal partner in a trade.