Journal damn_registrars's Journal: So this is what capitalist choice looks like? 66
I ran into a situation recently when trying to get a prescription filled for one of my sons recently (he's under 18). We have two main drug store chains here where we live, we'll call them "A" and "B". There are other options but these are the main players.
For no particular reason I've always had my own prescriptions filled at "A". A while ago my wife and I were talking about trying "B" in the future but we never progressed beyond talking about it.
Then we ran into supply issues getting our son's prescription filled at "A". Our son's doctor suggested we try "B" so we did; I asked a pharmacist at "B" if they had his prescription available and they said yes, so it seemed like a good thing to do.
Except I then went there after the prescription had been called in - mind you we had to adjust the dosing to match what was available but that wasn't terribly difficult - only to find that our insurance wasn't accepted there. All other things being equal the prescription would be $15 at "A" or around $50 at "B" (in other words full retail price at "B").
So then I was directed to a different pharmacy, that exists in some other local retailers. I went there and was told they couldn't fill that prescription for new patients currently; hence two different pharmacies that I could use could not fill the prescription while one I could not use could.
I'm sure this make sense to someone. All I see is another way that we are lining the pockets of the wealthy shitheads that run the most morally bankrupt industry the world has ever known.
For no particular reason I've always had my own prescriptions filled at "A". A while ago my wife and I were talking about trying "B" in the future but we never progressed beyond talking about it.
Then we ran into supply issues getting our son's prescription filled at "A". Our son's doctor suggested we try "B" so we did; I asked a pharmacist at "B" if they had his prescription available and they said yes, so it seemed like a good thing to do.
Except I then went there after the prescription had been called in - mind you we had to adjust the dosing to match what was available but that wasn't terribly difficult - only to find that our insurance wasn't accepted there. All other things being equal the prescription would be $15 at "A" or around $50 at "B" (in other words full retail price at "B").
So then I was directed to a different pharmacy, that exists in some other local retailers. I went there and was told they couldn't fill that prescription for new patients currently; hence two different pharmacies that I could use could not fill the prescription while one I could not use could.
I'm sure this make sense to someone. All I see is another way that we are lining the pockets of the wealthy shitheads that run the most morally bankrupt industry the world has ever known.
Eric Hobsbawm Made a Great Point (Score:2)
So if you want capitalism's invisible hand to do its thing, it is important to minimize the regulatory capture and let competition find the lower price.
Of course, when it comes to things like medicine, we don't exactly want J. Random Pharma making peoples' head's 'splode as they try to maximize profits. My kids are not l
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Purity is hard to come by.
Yeah, really.. surrender is the better option.
anyone claiming that they have a magic wand to wave to whisk the problems out to the cornfield is probably pulling one's leg.
We have Article V. What could be more magical?
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surrender is the better option.
No political process concludes without some sort of compromise. I guess if you want to label realistic, real-world interactions "surrender", that is your prerogative.
Article V. What could be more magical?
Well, magic, encapsulated in wands or otherwise, does not exist. Article V is a Constitutional process. It's not clear what "magic" (however you would define it) is on offer.
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So if you want capitalism's invisible hand to do its thing, it is important to minimize the regulatory capture and let competition find the lower price.
There is no incentive in health insurance for the industry to find the lowest price. The only incentive the insurers have is to maximize their own profit. This is economics 101 here; the sweet spot in profit is the intersection of supply and demand.
The industry has had decades to improve the product, and the best they've done is make it more expensive. The product never improves because there is no reason to, and there is no benefit in bringing new vendors in either as that only makes the whole oper
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There is no incentive in health insurance for the industry to find the lowest price.
There would be, were there some competitive drivers at work. Factors such as public safety and patent law perturb the situation.
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There is no incentive in health insurance for the industry to find the lowest price.
There would be, were there some competitive drivers at work.
Oh they are competing plenty, just not on the behalf of the consumer. They are competing to see who can rake in the most cash. There's a reason why it's not uncommon for executives to jump from one insurance company to another.
Factors such as public safety and patent law perturb the situation.
The first is an illusion. The second has absolutely nothing to do with the insurance industry.
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The first is an illusion.
The illusory nature of public safety does not render it unimportant.
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Factors such as public safety and patent law perturb the situation.
The first is an illusion
The illusory nature of public safety does not render it unimportant.
Are you aiming to shift the topic entirely to public safety, with no connection to the opening subject of the corrupt Health Insurance Industry?
I really expected that you were bringing it up to suggest they are tied together. Hence my reply is that any connection between them is an illusion. My apologies if my statement did not make it clear that I was calling that an illusion; I expected that was what you were trying to bring up. If you are looking to steer the discussion in a completely different d
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the opening subject of the corrupt Health Insurance Industry
What is a non-corrupt industry, in your view?
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the opening subject of the corrupt Health Insurance Industry
What is a non-corrupt industry, in your view?
I don't know if there is an industry that is completely free of corruption. However I cannot think of an industry that has fewer moral restraints than the Health Insurance Industry. I honestly believe they look up to the local Law Bar as an aspirational guidepost for morality.
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Me editorial opinion may be a novel one, but I would suggest "ethical" restraint in a secular context.
Not that there seem to be many "ethical" constraints at work these days. . .
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I am sincerely curious what you might mean by a "moral" restraint. To me, "moral"="religious".
I say that morality is not always dependent on religion. If you want to go with "ethical" instead, I'm fine with that. If you really want to know what I mean by moral though I'd say making decisions that are intended to cause the least harm to people. Swinging your fist around randomly just to see how much space is around you is not moral, as you could hurt someone (likewise firing a gun randomly). To me morality is about being a good neighbor and a good human being. If someone needs a book and/or a p
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"Moral" = arbitrary ruleset imposed by authority.
"Ethical" = system informed by logic.
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This is a very useful distinction, but one that our so-called "culture" would prefer to conflate, since no one wants to think
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Having said all that, if the Health Insurance Industry is unethical, then there is probably something legally actionable on offer.
We can split hairs on ethics vs morals all we want. What there is no room for discussion is that the Health Insurance Industry makes decisions based on profit. They make life and death decisions for people every day, and profit is always a factor in their decisions. ROI should not decide who lives and dies.
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What there is no room for discussion is that the Health Insurance Industry makes decisions based on profit.
I cannot refute you as a general matter, but my wife's career has been spent researching ADPKD. Governments offer incentives for companies to work on indications for which there really is not a business model. Which sounds swell, except that the market is distorted, and resources are put against broken window [wikipedia.org] efforts. There is no free lunch, whether the government plays games with the definition of "free lunch" or not.
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Governments offer incentives for companies to work on indications for which there really is not a business model
I've had roles in several stages of grant writing, grant review, and grant approval through NIH and NSF. Money is not just handed out willy-nilly, there has to be solid science behind the proposal for it to get funded, and good reason for why it should be funded over other applications competing against it. The grant submission process is itself a giant pain in the ass that torpedoes many careers as well.
There is no free lunch, whether the government plays games with the definition of "free lunch" or not.
Nobody working on government funded scientific research is under any illusion of a free lunch. They
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They aren't looking for anything free, they want to contribute. At the end of the day though industry doesn't like to fund basic science as it is more difficult to sell to shareholders.
This is true of R&D in general, as well as basic science. The canonical example is Bell Labs [wikipedia.org], which of course begat Unix.
I don't dispute the value in doing basic research. The sad truth is that, as a means of accruing political power, those research projects have a low %/vote ratio.
Bread and circuses earn far more votes. Always have.
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I don't dispute the value in doing basic research.
So then why are you angry at the NIH? They fund more basic research in our country than anyone.
The sad truth is that, as a means of accruing political power, those research projects have a low %/vote ratio.
I'm really not sure how to parse that statement out. I don't know many - arguably any aside from myself - voters who actually look at how often a congressional candidate votes for or against science research funding. And I'll tell you it is a very, very murky metric. NIH funding almost always gets bundled in to large funding bills, and the congressional members have to vote them up or down. That makes it im
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So then why are you angry at the NIH? They fund more basic research in our country than anyone.
There is always a little bit of good thrown in with the bad. The NIH is a bureaucracy first; its mission a distant second.
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So then why are you angry at the NIH? They fund more basic research in our country than anyone.
The NIH is a bureaucracy first; its mission a distant second.
I'm really not sure what you mean by that, and I'd like to know. The vast overwhelming majority of their budget directly goes to grant awards for basic research. Furthermore most grant reviews that are done at the NIH are done by professionals who already have full time positions elsewhere and only go there once a year to review and score grants. The total number of employees at NIH - including those funded on competitive grants to do research there in person - is less than 19,000.
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I'm really not sure what you mean by that, and I'd like to know. The vast overwhelming majority of their budget directly goes to grant awards for basic research. Furthermore most grant reviews that are done at the NIH are done by professionals who already have full time positions elsewhere and only go there once a year to review and score grants. The total number of employees at NIH - including those funded on competitive grants to do research there in person - is less than 19,000.
If you believe religiously in the NIH
There are no statements of faith there. Those are all facts, that are all backed up by documented experiences and observations. Zero faith is required to accept any of what I wrote as it is all publicly available data.
The religious statement came from you, where you made a fact-free statement about its bureaucracy. Yes there is bureaucracy involved there, as there is at any organization that employs more than a dozen or so people anywhere - but your claim of it being "bureaucracy first" is not suppo
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Those are all facts, that are all backed up by documented experiences and observations.
As a staunch Daniel Hannan fan, https://www.amazon.com/New-Road-Serfdom-Warning-America-ebook/dp/B003V1WSDC/ [amazon.com] still rings true.
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You could actually provide a fact-based reason to dislike them, and build an argument around that.
And all you did was repeat your hatred for them, with not a fact in sight. You're conveniently overlookng the thousands of jobs created every year by NIH grants that do groundbreaking scientific research for the public benefit.
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And all you did was repeat your hatred for them, with not a fact in sight. You're conveniently overlookng the thousands of jobs created every year by NIH grants that do groundbreaking scientific research for the public benefit.
I don't hate the NIH staff: I don't even know them.
You showed a rabid hatred for the NIH, based on zero facts. Another fact I will give you is that the NIH could not exist if nobody worked there; how can you hate an institution made of people if you don't hate the people who make up that institution? That doesn't make sense.
What I despise is the worship of bureaucracy on offer.
Nobody is worshipping a bureaucracy. I am pointing out that essentially everything you have said so far about the NIH is false. You could just acknowledge that and return to your e
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You showed a rabid hatred for the NIH, based on zero facts.
Yes, I actively hate the homo bureaucratus infestation that reduces people to livestock.
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You showed a rabid hatred for the NIH, based on zero facts.
Yes, I actively hate the homo bureaucratus infestation that reduces people to livestock.
So how many bureaucrats do you think work at the NIH? If we were looking instead at a for-profit corporation with 19,000 total employees, how many administrators and managers would you find to be an acceptable number for that company?
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Bureaucracy is a (remarkably successful) invention that lets an organization run open-loop.
A legitimate grip against the U.S. is that, as the world's reserve currency, our government can do the stupidest, even deadliest things, with impunity.
Going to Single Payer and importing the NIH would be a cure so much worse than the disease that only a Progressive could love surfing the resulting dow
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So how many bureaucrats do you think work at the NIH? If we were looking instead at a for-profit corporation with 19,000 total employees, how many administrators and managers would you find to be an acceptable number for that company?
You still didn't answer the questions. Instead you went for some weird hand-wringing.
Notably you have not been able to suggest anything that would in slightest improve accessibility or affordability of health care for anyone. Single payer is the only way to correct these problems. We've tried all the other options and they all failed terribly. You can wait for the current system to kill you as well, or you can open your eyes and realize what needs to happen. The sooner you do the latter the sooner
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Single payer is the only way to correct these problems.
Let me fix that for you:
"Single payer is the only way to exacerbate these problems, while shrilly screaming about how some Emmanuel Goldstein figure is holding back Holy Progress."
Whether you're diabolical (driving the problem) or simply foolish (and playing along witlessly), you have to understand that Fauci blew away the remaining shreds of credibility Your Team had. Those with common sense believe not a thing you say.
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Fauci
Is a popular boogeyman for Your Team who does
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You have provided precisely zero suggestions for ways to repair our broken health care system
You're hung up on "fix". There is no "fix". There is only the economic framework in which rent-seeking is minimized and service delivery is maximized.
When the government exceeds its lane of passively enforcing minimal standards and gets into active market distortions, costs go up, rent-seekers line their wallets, and delivery suffers.
"Your Team's" idolatrous soteriological faith in the government remains the chief bugaboo across topics ranging from health care to housing to education.
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service delivery is maximized.
Why would giving more power to the Health Insurance Industry - while allowing them to demand yet more money from customers for less service - somehow lead to the maximization of service delivery? That doesn't make any sense, being as the Health Insurance Industry maximizes profit by preventing service from being delivered. Our country has been bull-headedly following one path for decades now and it keeps getting worse. The only solution is to get off this path and follow the path that works, the path th
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your hobby horse should see a therapist
Ethics are whatever the law says.
No, being legal doesn't make something ethical
ethical /eTHkl/ [sic]
adjective
relating to moral principles or the branch of knowledge dealing with these.
"ethical issues in nursing"
synonyms: moral, social, behavioral
And all morals are man made, from the meat, not divinity
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your hobby horse should see a therapist
I can see visiting a physical therapist if recovering from an injury. But why waste time on a therapist when I have a pastor, who speaks from wisdom?
Ethics are whatever the law says.
No, being legal doesn't make something ethical
Is adultery ethical? I think it's immoral, but there is really no ethically binding requirement to honor marriage vows, is there? A divorce may ensue, sure, but so what? The kids may end up in therapy or something, I suppose. Divorces kinda happen, right?
But this is why I reject the synonymous treatment of morality and ethics. Butchering one's children is wil
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Why would giving more power to the Health Insurance Industry
There are two objects of interest: the person needing health care, and the person providing the care. Minimizing the resistance in the rest of the circuit maximizes the power delivered.
Government is the ultimate short circuit in this electrical metaphor. The bureaucracy will suck up 'trons and waste resources slaughtering the unborn and carving the children who survive to infancy. What a depraved day we live in.
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"Moral" = objective ruleset imposed by Author of Creation.
"Ethical" = system informed by human logic that can rationalize the darndest things.
One other point is that these are orthogonal. As we move around the planet's surface, we are guided by a "moral compass" exerting a torque upon our (generally) ethical behavior.
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There are two objects of interest: the person needing health care, and the person providing the care. Minimizing the resistance in the rest of the circuit maximizes the power delivered.
Yet the Health Insurance Industry maximizes their profit when they maximize the resistance between those two objects. They figured that out decades ago. This is why so many of the insurance companies have the top paid CEOs in many states.
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So...if we minimize the rent-seekers, red-tape, and grift...
But the proposals you've offered only reinforce the existing system. The way to get rid of the wasteful spending is to destroy the system and start over with something that works and costs less. You will never reduce consumer costs with any of the proposals you or your team have championed. Only Single Payer can accomplish that.
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Is adultery ethical?
It's a violation of a contract. Is that "ethical"? Is war ethical? Do you feel the same cause célèbre for those innocent lives lost?
some referring to themselves as "Christian"
Right? Even the trumpians are calling themselves "Christian".. The gall!
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Is war ethical? Do you feel the same cause célèbre for those innocent lives lost?
There is a Law of Armed Conflict that aims to minimize the collateral damage https://en.wikipedia.org/wiki/International_humanitarian_law [wikipedia.org], so that would answer your question in the affirmative.
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But the proposals you've offered only reinforce the existing system.
Please explain to me how filtering out the noise is hurting the signal. This is a fustakrakitchian inversion. Occasionally I wonder if you guys coordinate or something.
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Yeah, it shows that Christianity is exactly the opposite of the trumpism you advocate.. You only get one or the other, when are you going to choose?
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the corrupt Health Insurance Industry?
You should quit your bellyaching, it's your fault, for following the herd and reelecting for their handmaidens instead of seeking out candidates that will properly regulate them. Ah, but you would rather commit arson...
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the corrupt Health Insurance Industry?
seeking out candidates that will properly regulate them
I have seen zero presidential candidates willing to call them out as disastrously bad for our country and to propose a single payer solution to this disaster. My US House district has become more blue over time and we have yet to have a candidate here who would do that.
There is no way to properly regulate the Health Insurance Industry. It needs to be abolished. It should have been killed off decades ago. Instead it becomes a stronger monster with each passing year.
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There is no way to properly regulate the Health Insurance Industry.
That is a lie. You are full of it.
Instead it becomes a stronger monster with each passing year.
Bla bla bla... you're just another whiner. Your choice to follow and reelect the DNC/GOP makes them stronger and it's just as much your fault as all the others that do. Your actions have consequences, but like Mr. Smith, you are in denial
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There is no way to properly regulate the Health Insurance Industry.
That is a lie. You are full of it.
If you think the Health Insurance Industry can be saved by regulations, your optimism on the matter will some day kill you and everyone important to you. The industry needs to be dismantled completely. There is nothing of value there, it needs to go away. No amount of regulation will ever right the ship.
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You're just repeating the same bullshit excuses. If you want to dismantle the insurance industry you have to vote for people that will do it, and vote them out if they fail. Since you just follow along with the rest, you're own lack of effort places the blame directly on you, along with the rest that just reelect the same old shit over and over.. That is not the insurance industry's fault, it's yours. So really, you're just talking nonsense and being your usual obtuse self. Like Mr. Smith says, you cannot a
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Fine, so you won't even make the feeblest effort. Whatever... None of your lame excuses absolve you from the blame for the part you play in making your insurance industry all powerful.
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Fine, so you won't even make the feeblest effort.
You're making a really big assumption there. You're both assuming that there is a representative running in my district who wants to abolish the for-profit Health Insurance Industry, and that for some reason I did not vote for that person. You have no support for either of those claims.
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You're making a really big assumption there.
No, I'm not.. You vote democrat no matter what they put up. You just follow the rest. You can only be taken seriously if you vote outside the DNC/GOP cabal when you fail to find a suitable candidate during the primaries. Until then all your excuses that you repeat over and over are merely that, excuses, and very lame ones, naively believing the lies they tell, and you keep reelecting them when they don't do what they say. You are to blame for whatever power the insurance industry has every time you vote for
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patent law perturb the situation.
Patent law distorts the economics of pharma trying to break even on the ridiculous R&D costs of a new drug application.
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the ridiculous R&D costs of a new drug
I've been involved in the basic science work that leads to drug discovery. I know more than most people about what goes in to the R&D. The bulk of the expenses go in to the earliest phase, when scientists are working on compound selection for drug targets. The science takes a lot of time, and a lot of resources. The vast overwhelming majority of drug candidates never pass that point, they fail somewhere in the model organism phase before they can ever make it to human testing. All that work takes
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Enrolling patients; managing the various trials; global regulatory compliance. Not to pooh-pooh your point about basic research, but the end-to-end costs are non-trivial.
I would never claim the later stages to be inexpensive. I merely want to point out that the earliest stages are where most of the time and money actually goes. Sometimes the way the money is tracked makes it difficult to show that.
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the ridiculous R&D costs of a new drug application.
Because I have never seen a cost from the process that I would consider the least bit ridiculous. There is a lot of hard work that is done at every stage, and it has to be paid for somehow.
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The perverse incentives are so rampant that, like talking about the national debt/budget deficit, one wonders if the simplest thing to do is just let the whole rotten edifice just crash.
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From my second-hand discussions with the wife, pharma as an industry is only slightly more sane than the government.
There are a lot of different arms to pharma. You previously were talking about R&D, which I know quite a bit about. If you want to get to marketing or other bits that is a different discussion. Legal - especially patent defense - is yet another different matter.
That doesn't mean that 100% of R&D is squeaky clean, either. I will defend the R&D folks though as not being the primary source of corruption in the industry. Like so many other matters, rotting starts from the head.