First, check out this moronic video from some group called questioncopyright.org.  It runs only a minute, though it seems longer.

This has helped me understand the file-stealing crowd.  I thought they were sociopaths or merely morally bankrupt.  But this video makes it clear that they suffer from an incapacity for critical thinking, and these lines from the song (written by someone named Nina Paley) make the case:

If I steal your bicycle, you’ll have to take the bus.

But if I just copy it, there’s one for each of us.

Copy a bicycle?  You mean like, scan it?  Or download it?  If you copy my bike, you’ll have to work.  And even before you copy the bike, you’ll have to learn: how to weld, how to use tools. And then (get the smelling salts ready) you’ll  have to buy (what a concept) the metal tubing and tires and gears and spend time assembling them maybe even thinking about how to arrange the gears.  You might have to sweat, you might get your hands dirty.

And you know what?  In the end, you will have created something where there was nothing before.  It won’t be a copy.  It will be yours.  Then maybe all the clones with all their stolen discs and books at the end of the video won’t look so cute.

Sharing ideas with everyone

That’s why copying is fuuuuuuun!

Yeah.  Tons o’ fun when what’s being copied is the result of someone else’s sweat and the source of their livelihood.

If you need a succinct refresher on what copyright is and isn’t, go here.

Every time I bring this up I hear, “Look at the Grateful Dead – they let people record them live and share the tapes and it only increased attendance at their shows.”

Apples and oranges.  The Dead’s revenues came from their tours, not their records.  Those so-called bootlegs (they can’t be real bootlegs if they’re sanctioned) advertised their concerts, which were not free.  You had to pay to see the Dead live. (That was not intentional. Okay, maybe a little.)

An author’s published work, on the other hand, is his concert. Giving away a free excerpt might draw people in, but if he doesn’t make the sale, he doesn’t eat.  Of course newbie (or talentless) authors with no prospect of sales might offer free downloads of their work in the hope of gaining an audience for their later work, but it’s their work so they can choose to do what they wish with it.

“A torrent download of a book isn’t necessarily a lost sale.”

Really?  I hear this ad nauseam.  Don’t know about you, but I’ve yet to open my email and find an offer for free downloads of any author’s work.  I’ve downloaded my own work from pirate sites to see what kind of quality they were offering (mostly .txt files) but I had to go looking for them.  I had to Google/Bing the sites, then I had to search out my titles within those sites.

So it’s clear to me that you can’t make an illegal download of a book unless you make a specific search.  And you don’t go searching unless you’re interested.  If you were interested enough to engage in that process and were unable to find a freebie, chances seem pretty good you’d fork over a few bucks for a single title.

So yeah, it’s a lost sale.  Maybe not 100%, but can we go maybe 75%?  With three million downloads from these four sites alone – 4shared, scribd, wattpad, and docstoc – and even more from rapidshare, the biggest offender (source), we’re talking serious theft.

“The pirated downloads will introduce people to your work and generate more sales.”

This is the most naive.  People act in patterns.  People who steal without repercussions will continue to steal. (Thief  is the proper word – because they know damn well they’ve no right to what they’re taking.)  If you steal The Tomb and like it, are you going to run to Amazon and pay for Legacies and Conspiracies and the others?  Are you going to pay even the measly $2.99 pricetag I’ve put on old titles I’ve uploaded myself when just about every freaking word I’ve ever written is available for free download?  I don’t know about your planet, but that’s not about to happen on mine.

Image by Joe Shlabotnik via Flickr

WTF?!?!?

There it is, bold-faced, italicized, underlined, with multiple exclamation points and question marks.

Why?

Because I’m being ripped off left and right.  I know because Google Alert informs me almost daily of the torrent downloads of my fiction available all over the Net – from as far away as Vietnam.

Chasing them is like playing Whack-A-Mole – slug one and two more pop up.  Some writers consider it the cost of doing business in the digital age, and I guess that’s the mindset that will preserve your sanity.   Some sites charge per download, some charge by time (e.g., $x for 36 hours of unlimited downloads) and some don’t charge at all.

Any way they operate, they’re thieves.  They’ve taken my work – something that would not exist without my effort – digitized it, then published it without my permission.  I already have a publisher.  My agent argues over clauses and even placement of commas before I sign.  I lease my work to them in exchange for royalties with which I pay my mortgage and buy food and gas and all that good stuff.

These guys are stealing my sales, which is robbery.  And robbery is committed by thieves.

But what gets me is the way these thieves justify it.

A recent site I visited – a freebie – has hundreds, maybe thousands of books available for download (I didn’t count) but only two of mine.  I say “only” because a lot of them have the entire run of my Repairman Jack novels (13 so far) for download in a single zip file.  (All of those titles are available as ebooks on Amazon and other sites, so each of those downloads is costing me a pile of royalties.)

I decided to drop him an email: “Well, at least you aren’t charging for them, but you are stealing from me.  You are duplicating my intellectual property — from which I make my living — and giving it away for free. I’m not going to threaten you because I have neither the time, will, nor resources to back that up, so I’ll simply ask you to remove my work from your list.  It’s the right thing to do.”

Simple, direct, non-threatening, appealing to his better instincts, right?  And he replies…with URLs on his site that require me to jump through a series of identity hoops to prove who I am before he’ll remove my property from his site.

Here’s the thing with this particular thief and others like him: they think they’re providing a service to the Internet community by making “literature” (his term) available.  Well, if they want to do that, fine, but stick to  public domain titles – a zillion classics are PD – and leave the work of  living, working writers alone.

They use the library model: libraries buy one copy and give it to many readers.  They’re just doing the same.

Uh-uh. Libraries get the book back after each reading.  And libraries pay for every copy on their shelves.  Not so the torrent thieves.  They download a slew of titles from one site and set up their own.  Then someone downloads their copies and sets up another site.  I know because I’ve downloaded one of my titles from a number of sites and they all had identical formatting errors.  They’re out there cloning copies.  And there’s no guilt, no regard for the writer’s property.

But the topper, the push that sent me to the keyboard today, came on last night’s Colbert show.  This bonehead, David Shields, “wants writers to ignore the laws regarding appropriation and create new forms for the 21st century.”  The video clip runs less than five minutes.  You’ve got to see it to believe it.  Watch it here and then come back.

The gall of this clown.  But Colbert was the perfect guy to interview him.  One of his comments was a thing of beauty:

Could I create new forms for the 21st century by ignoring property rights and obliterating my neighbor’s front door?  Because you know what would look good in my house? Your things.

That pretty much sums it up.

Is it okay to go into a sculptor’s studio, make casts of his creations, then sell them in your gallery?  Of course not.  But somehow it’s okay to go into an author’s head and steal his work and duplicate it ad infinitum.

Are you following this?

Good.  Because I’m not.  Moral contortions like this confuse the hell out of me, leaving me muttering, WTF?!?!?

The FDA says Yes, basing its decision on the JUPITER study. (Another in a long line of clinical trials with awkward titles that yield a catchy acronym: Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin.)

JUPITER was randomized, double-blind, and placebo-controlled, involving 1315 sites in 26 countries.  The nearly 18,000 subjects were men 50 years or older and women 60 or older with no history of cardiovascular disease, an LDL level below 130 mg, triglycerides below 500, and a high-sensitivity C-reactive protein (hsCRP) level of 2.0 or higher. (The level of hsCRP is supposedly related to coronary artery inflammation.)

Half were put on Crestor (rosuvastatin), a potent statin, and half on placebo.  The Crestor group experienced a 50% drop in LDL and 37% drop in hsCRP. The study was scheduled to run 5 years but was stopped shy of two when it became clear that the placebo group was experiencing a significantly higher incidence of vascular events.  The committee thought it unethical to continue.

Dr. Paul Ridker, inventor of the CRP test, was quoted in a recent NY Times article:

“We found a 55 percent reduction in heart attacks, 48 percent reduction in stroke, 45 percent reduction in angioplasty surgery…I felt I had one shot at a controversial hypothesis…and it worked really well.”

Pretty impressive at first glance…but relative statistics are tricky.  A look at the raw data is revelatory.  Only 68 patients out of the nearly 9,000 in the placebo group had heart attacks – 0.37%.  For the Crestor group, it was 31 or 0.17%.  Yeah, that’s a 55% relative reduction but only 0.2% absolute reduction.  A difference of 1 patient for every 500.

“That’s statistically significant but not clinically significant,” said Dr. Steven W. Seiden, a cardiologist… At $3.50 a pill, the cost of prescribing Crestor to 500 people for a year would be $638,000 to prevent one heart attack. “The benefit is vanishingly small,” Dr. Seiden said. “It just turns a lot of healthy people into patients and commits them to a lifetime of medication.”

So, what’s a family practitioner like myself supposed to do with a 62-year-old patient with no other risk factors whose LDL is 125 and whose hsCRP is 2.5?  This could be the 1 in 500 I could save from angioplasty.  Or not.

Elevated CRP looks like a definite risk factor.  I feel obliged to offer something, but…

I have questions.  Does the benefit translate to all statins, or just Crestor?  Would another hydrophilic statin (pravastatin, for instance) be just as effective? Pravastatin runs about $0.11 a pill at Wal-Mart, as opposed to Crestor’s $3.50.

The patient may refuse. Or think Crestor is too expensive, in which case I’ll probably try pravastatin.  Like everything else in clinical practice, treatment has to be tailored to the individual on a case-by-case basis.  And as happens so many times in science, new information raises more questions than it answers.

Image via Wikipedia

According to the NY Daily News, if Assemblyman Felix Ortiz has his way, yes.

The Brooklyn Democrat has introduced a bill that would ban the use of salt in New York restaurants – and violators would be smacked with a $1,000 fine for every salty dish.

“It’s time for us to take a giant step,” Ortiz said yesterday. “We need to talk about two ingredients of salt: health care costs and deaths.”

He claims billions of dollars and thousands of lives would be saved if salt was taken off the menu altogether.

There’s little argument that too much salt causes high blood pressure, which can lead to heart attacks

One teensy-weensy problem: the science isn’t clear that a ban will change a thing.  Unlike anthropogenic global warming, the debate is NOT over.  (See an excellent overview of the sodium debate in the NY Times.)

Dr. David A. McCarron, a nephrologist at he University of California at Davis, has called into question studies (especially from the UK) that claim it’s possible to get people to reduce their salt consumption.  Surveys in 33 countries show that no matter where you are (unless it’s a sodium-challenged region) we all consume about the same amount of salt.

The results were so similar in so many places that Dr. McCarron hypothesized that networks in the brain regulate sodium appetite so that people consume a set daily level of salt.

If so, nutrition nannies like Ortiz could wind up exacerbating the country’s obesity epidemic.

…if future policies reduce the average amount of salt in food, people might compensate by seeking out saltier foods — or by simply eating still more of everything.

As for low-salt diets reducing strokes and heart attacks, in a recent article in JAMA, Dr. Michael H. Alderman of Albert Einstein College of Medicine has his doubts.  He found that clinical outcomes were improved in fewer than half of the studies he surveyed.  In fact, some showed worse outcomes.

“When you reduce salt, you reduce blood pressure, but there can also be other adverse and unintended consequences. As more data have accumulated, it’s less and less supportive of the case for salt reduction, but the advocates seem more determined than ever to change policy.”

Some people can wail away with that salt shaker until their food looks like Mount Fuji and not experience the slightest uptick in their blood pressure.  Others of us are not so lucky.  It makes sense for people with high BP and/or renal disease to watch their sodium intake.  That’s a personal responsibility.  But banning sodium use in restaurants is bad public policy that could cause further expansion of our already excessive waistlines.

Worse, it’s bad culinary policy too.  To quote Tom Colicchio of Top Chef:

Anybody who wants to taste food with no salt, go to a hospital and taste that.

Image via Wikipedia

I was lunching with a couple of other family practitioners and we were all wondering what happened to the seasonal flu this year.  We’d gone through February, the traditional peak month of the flu season, and the virus was (as the cliche goes) conspicuous by its absence.

Turned out we weren’t alone.  An article in the Wall Street Journal (“The Flu Season that Fizzled“) wondered the same thing.  For example: The University of Virginia’s health clinic usually sees about 130 students a week with flu this time of year.  Now it’s 3-5 a week.

Flu has peaked in late February or early March in 20 of the past 26 flu seasons, said Lyn Finelli, the CDC’s chief of flu surveillance and outbreak response.

So why not this year?  The answer is a shrug.  No one knows for sure.

Maybe it’s all the raised consciousness about personal hygiene – the handwashing and coughing into one’s sleeve. I attended a mystery writers convention (Bouchercon) in the fall where the organizers had posted signs with caveats about handshaking and such.  I found Lee Child standing near one so we jokingly bumped elbows instead of shaking hands.

Sometimes a pandemic virus bumps a seasonal flu off the grid.  H1N1 doesn’t make the headlines anymore, but it’s taken its toll since it appeared last April: 57 million cases and nearly 12,000 deaths (mostly in the under-24 population). Compare that to a typical year when seasonal strikes about 25 million people  and directly kills 8,000 (usually at the older end of the population curve).

Don’t write off H1N1 yet.  Spring break may spark new waves of cases on campuses.  But we shouldn’t see a spike like we saw in October.  Barring a significant mutation in the virus, the 57 million people who survived H1N1 infection are immune, and 86 million were vaccinated.  That’s a big pool of immunity.

Whatever the reason, we seem to have dodged the much-anticipated double-barreled blast of flu this year.

Current plans are to include H1N1 in the 2010-11 seasonal flu vaccine, which will further expand the immune pool.  And the new target population for the vaccine is virtually everyone over 6 months of age.