Changing the way drugs are patented

One of the big problems with drug research is the conflict between producing low cost drugs that can manage or treat various medical conditions and allowing drug manufactures the ability to remain in business by ensuring a profit. These conflicting objectives are further stressed in third-world and developing countries that do not have robust middle class populations that can afford high price medication or insurance that will cover this medication. However, it also must be understood on the issue of drug company profits that drug development successes have become more difficult in modern times and these successes must pay for the research and development of both the successes and the failures.

Originally fully functional patents, not provisional patents, offered market exclusivity sans negotiated licenses, for 17 years. However, patents issued after June 8, 1995 now have an original operation period of 20 years. In addition there are various options for extending the intellectual property protection of a patent based on how long it takes for the FDA to approve the drug for marketing and sale or if the drug falls into a specific category of treatment.

Drug companies also have other “less genuine” strategies for extending market exclusivity of a drug most notably “evergreening”. Evergreening typically involves making minute changes in drug formulation like the inclusion of chirality (left-handed and right-handed isomers), different inactive components or specific hydrate forms. Both the initial time period and evergreening have been widely criticized by generic drug advocates looking to hasten the emergence of lower cost options in the marketplace. Evergreening is viewed as especially troublesome because it is frequently thought of as gaming the system and a form of patent trolling by producing a weak secondary patent or change to support a nearly expired primary patent.

Unfortunately for generic drug advocates it is difficult to expect a significant change in the general length or structure of patent protections without a trade-off because of the research and development costs associated with drug development. Generic drug manufactures do not have to absorb the costs associated with drug discovery typically involving high-throughput active compound analysis and lengthy clinical trials. While the general costs associated with drug development are incredibly controversial with some estimates ranging from the upper hundreds of millions of dollars to even billions of dollars and other estimates ranging in the lower hundreds of millions of dollars, no rational person disputes that it costs at least tens to hundreds of millions of dollars to produce a new drug that fails in a phase 3 clinical trial and hundreds of millions of dollars to produce a successful new drug. Therefore, drug manufactures must have sufficient opportunity to neutralize those costs and other general overhead with revenue from their successes. While the principle creator of a drug can license production to another company, the lower prices that emerge in combination of the time limit associated with the patent greatly limit revenue and overall profitability.

Notwithstanding the fairness element in drug manufacturing profitability, waiting 15+ years for lower cost options of various new drugs is too long, especially in a world where bacteria resistance to existing antibiotics and understanding of biological methodologies associated with neurological diseases have advanced at a rapid pace. Therefore, a compromise needs to be reached that will allow drug companies to recoup their R&D losses as well as produce sufficient revenue for future research, yet still hasten the time taken for low cost generics to appear in the marketplace. The best strategy may be to create a mandatory compulsory license in the patent system for drugs that automatically triggers after a shorter market exclusivity period.

For example instead of a 20 year exclusivity period what if drug patents were 5 years of market exclusivity followed by a 10% royalty in perpetuity derived from price on all generics based off that patent. This strategy would allow lower cost generics to enter the marketplace typically 15 years earlier than they do now. While this arrangement will work better for those who want access to pharmaceuticals for poorer individuals both in developed and developing countries, does it allow pharmaceutical companies to cover the costs of R&D and continued expansion? This is a difficult question to answer in all situations because there are various moving parts, but a general idea to the efficacy of this idea can be demonstrated through a general example.

Suppose company A produces an effective suppressive treatment, drug A, for condition A. Note that this treatment must be taken continuously over a period of time, i.e. it is not viewed as a “cure”. This characterization is not surprising because a vast majority of pharmaceutical drugs that are commonly consumed in modern society have this feature, i.e. one prescription of statins do not permanently reduce cholesterol. Therefore, because drug A has to be taken constantly, multiple prescriptions will be filled over the course of a year; for this example the number of prescriptions per year for drug A will be 4. However, it has also been noted that due to the cost of non-generic drugs certain consumers “split pills” lengthening the total time required to fully consume a full prescription. Due to this behavior the example will assume that 3.5 prescriptions will cover a single year for drugs under patent. The price of drug A while on patent is 150 dollars per prescription with a manufacturing cost of 20 dollars yielding a profit of 130 dollars per prescription.

Typically due to the large prices of patent drugs the marketplace is limited to the more developed world. In this example the marketplace for drug A will be 900 million individuals and if condition A has an occurrence rate of 2% that would create a potential customer base of 18 million individuals. Over time this customer base will increase due to other individuals coming down with condition A and current consumers remaining on drug A. This increase will equal 1% of the current customer base (i.e. last year’s customer base). Starting as a new drug it makes sense that drug A will not acquire a full market share on the first year of its introduction. The market share will be 5% for the first year increasing to 10% for year 2, 20% for year 3, 40% for year 4 and leveling off at 70% for year 5 and beyond. For the current on patent method it will be assumed that no other company will be licensed to manufacture drug A and that after the patent expires in 20 years drug A will be pushed out of the marketplace entirely by lower price generics.

In the new suggested patent idea after 5 years on patent a 10% royalty for all generics would activate. Access to generics would open the entire rest of the world to treatment by drug A for condition A (another approximately 6.1 billion individuals). Since a number of chronic drugs are influenced by excess food consumption and less exercise it stands to reason that the occurrence rate for condition A in these developing and third-world countries will be lower. For the purpose of this example the occurrence rate for these new potential consumers will equal 50% the occurrence rate in the developed world (i.e. 1%). This scenario will produce an additional 30.5 million potential consumers for drug A. Generic prices are significantly lower than on patent drug prices, thus for this example the average generic price, which will service all individuals after 5 years even those in the developed world, will be 80% lower (i.e. 30 dollars per prescription). Due to the lower price, consumers will not feel the need to “split pills” thus the recommended 4 prescriptions per year will be observed. It is assumed that charitable organizations and NGOs will assist low-income consumers with purchases in poor countries. However, while NGOs and the like will help due to continuing income gaps, existing alternative strategies that have been utilized while drug A was under patent and distribution concerns in various countries where market stability is in question the global marketplace penetration of generic drug A will be 50%.

Table 1 below summarizes the major features of each strategy:

Table 1 – Important Initial Condition Elements

Current Patent Method:

Initial Customer Base – 18 million;
On Patent Years - 20
New Customers – 1% growth per year;
Price - $150;
Occurrence Rate – 2%;

New Patent Method:

Initial Customer Base – 18 million;
On Patent Years - 5
New Customers – 30.5 million after year 5 and 1% growth;
Price - $30;
Occurrence Rate – 1%;


After analysis of the above scenario the major results are summarized in the below table:

Table 2 – Important Financial Results

Current Method:

Total Revenue after 20 years - $9,952,552,601
Total Revenue after 40 years - $9,952,552,601
Total Consumers per year after 20 years - 4,754,302
Total Consumers per year after 40 years - 0

New Method:

Total Revenue after 20 years - $5,211,049,656
Total Revenue after 40 years - $10,260,542,661
Total Consumers per year after 20 years - 74,872,229
Total Consumers per year after 40 years - 93,272,020

Breakeven Year - 39

Not surprisingly after 20 years the current method produces a larger profit for company A versus the new proposed method. However, after 40 years the new proposed method creates more profit. After both 20 and 40 years the number of consumers that are aided by the new method is significantly larger. The most debilitating controllable factor preventing greater yearly revenue from the new method is market penetration. In the above example the 50% market penetration was viewed as conservative. If market penetration were 70% the breakeven year would be between year 30 and year 31. Of course it must be acknowledged that the nature of this example is heavily influenced by various factors, thus this result cannot be taken as the typical result in all situations.

Clearly the new method is superior for drugs that do not have an initial high price point like antibiotics. Another advantage of using this method for antibiotics is that while there exists the small probability that human beings will one day no longer suffer from the chronic conditions (high cholesterol, high blood pressure, erectile dysfunction, etc.) heavily reducing the need for these types of drugs, it is very unlikely that humans, sans becoming cyborgs, will be able to escape pathogenic infection and the need for antibiotics. Therefore, this new method should work better for antibiotic research in long standing companies versus the current system.

It should be noted that at least two important elements were excluded from the above analysis that should have significant economy impact due to a lack of specifics and pertinent information. First, the principle pharmaceutical developer, company A, typically will spend millions of dollars in direct to consumer advertisement and hundreds of millions marketing to physicians. It is rational to expect that a disproportionate amount of these advertising dollars will be spent in the initial launch of the drug to create interest and market share. However, it stands to reason that at least 50% of the total money spent on advertisement will occur between patent years 6 to 20. Under the new system this money would not be spent on advertisement and could be directed towards other activities like future research.

Second, as discussed above various pharmaceutical companies devote significant resources both in researcher labor and money to increase the length of their patents through the process of evergreening. Under this new system pharmaceutical companies would not have the ability to extend the patent, thus would not devote financial capital and man-hours to trying. The total value of these resources is unknown, but it stands to reason that an appropriate estimate is in the millions of dollars in direct capital with the additional costs born of the unknown opportunity costs of devoting valuable research staff to try to save the patent on an expiring drug rather than research a new drug.

Another side benefit from this system should be a reduction of the counterfeit drug market. The principle reason that counterfeit drugs are a desirable criminal enterprise is the high per unit profit margins. However, with only five years of patent protection the longevity of the counterfeit marketplace is significantly eroded making it financially risky for individuals to attempt to create a supply chain to forge these types of pharmaceuticals. Even if individuals do counterfeit these types of drugs the overall potential for harm is significantly lessened because of the small patent window before safe generics can enter the market replacing the counterfeit drugs.

However, one of the biggest concerns with this new suggestion is that while it will work for “blockbuster” drugs and should provide a boon to critical new antibiotic research, smaller marketplace drugs, most notably for orphan conditions, would be hurt due to the limited volume profitability potential. Both blockbuster drugs and antibiotics work in this new system because of the volume of individuals who will take these drugs over the decades long lifespan. Drugs for orphan conditions by definition do not have a large volume of potential consumers. This lack of a customer base is why orphan conditions have typically been neglected for so long in general practice. Those companies that do attempt to create drugs for these conditions are motivated largely by the ability to corner a market with small volume but large per unit profit margins. Cutting patent protection for these orphan drugs by 75% would be devastating for their profitability, which would lead companies not to attempt to discover them in the first place. Therefore, if the above suggestion is incorporated into new patent enforcement then a special condition must be made for orphan condition research.

Changing the operational nature of patents, especially in such a volatile market, due to the critical nature of pharmaceuticals in human longevity, cannot be taken lightly. The suggestion above attempts to address the two conflicting forces in the field by allowing drug developers the ability to take advantage of their successes to produce the necessary revenue to produce additional successes while also ensuring a humanitarian morality that drives the desire to place quality pharmaceuticals into the hands of those in need at affordable prices. The above financial analysis identifies the 5-year lifetime 10% royalty patent idea as a viable alternative to the current patent structure. However, as noted above an exception clause must be made for drugs that are being developed for orphan conditions lest those diseases may continue to be forsaken due to their characteristics as a financial loser. Overall while there are some financial elements that were only generally covered in the above analysis due to a lack of information and differential situations, it currently stands to reason from a logical perspective that changing the patent enforcement rules for pharmaceutical drugs could be a win-win for both global consumers and pharmaceutical companies.

Restoring the Arctic

There are numerous environmental concerns surrounding the progression of human-derived global warming. One of the most pressing is the persistent loss of Arctic ice. Due to a vast majority of global warming related heat being absorbed by the ocean all oceanic temperatures have increased, regardless of location, with the Arctic receiving the greatest temperature increase due to its lower base temperature. This increase has been significant enough that the ice extent at the summer minimum, which consistently occurs in September, has resulted in a net loss of 11% per decade since 1979 with a loss of 1.1 meters of mean ice thickness between 1980 and 2000.1,2 This loss of thickness has produced a general shift in the ice type from older multi-year ice to new single year ice resulting in an overall replacement of about 40% of the thick and old multi-year ice with single year ice.3 Coinciding with this empirical evidence various global and regional climate models have predicted that the situation will only get worse in the future.4

The chief purpose of ice in the Arctic, from a global warming standpoint, is to increase ocean albedo due to its reflective surface versus the darker surface of the water itself. When sunlight strikes the transparent/white surface of ice a vast majority of it is reflected back into the atmosphere. When sunlight strikes the dark blue, sometimes black, surface of Arctic water a vast majority of the light and its associated heat content is absorbed by the ocean rather than reflected back into the atmosphere. On a general level this heat absorption is a positive feedback effect where the more heat absorbed the more ice melts leading to even more heat absorbed, etc. Normally the ocean and its system of currents operate as a heat sink to control surface and atmospheric temperatures; however, this new massive heat absorption reduces sink efficiency allowing more heat to remain in the atmosphere increasing the detrimental effects associated with global warming. A secondary effect is that greater amounts of ice melt will increase global sea level rise in the future placing more coastal and even slightly inland cities at risk as well as negatively affecting Arctic wildlife by eliminating “land” surfaces for hunting and habitation.

With these near-future negative environmental events born from a lack of Arctic ice one would reason that it is important to find and execute a methodology that would increase Arctic ice volume and longevity. The most obvious means of increasing Arctic ice would be to eliminate the human derived excess heat, which would restore typical Arctic ocean temperatures seen in the 50s and 60s and even further past. One means of accomplishing this goal is to simply reverse the actions that lead to the heating. While reducing global carbon emissions is an important and critical step in addressing global warming, the realistic timetable for cooling the Arctic through carbon mitigation then reliance on natural processes is still decades if not even over a century away. Based on the rate of melting a more immediate solution will be required.

Recalling the albedo-heat feedback cycle from above, one method to break that cycle would be to increase the albedo of the ocean. Not surprisingly it is nearly impossible to change the natural color of the ocean due to its size and natural mixing, thus changing ocean albedo will require human intervention to change the surface albedo of the Arctic ocean. The easiest method is to mimic nature itself and increase surface ice by enhancing ice formation. Obviously enhancing ice formation will require large amounts of water; fortunately meeting this supply requirement is not a problem for water can be taken from the ocean itself and re-deposited on existing ice.

One of the principle reasons this strategy works is that ice is a quality thermal insulator, which can increase the speed of water freezing. In addition nucleation may also play a role in this ice formation enhancement where ice-forming nucleus tend to trigger freezing of under-cooled water droplets at higher temperatures when in solid contact versus liquid immersion.5-7 While the reason for this enhancement is unknown it is suspected that there are thermodynamically favorable interactions at the air-water interface8,9 leading to contact nucleation as a manifestation of an enhanced surface nucleation rate.5 Basically the liquid environment reduces the uniformity of the air-water interface reducing the efficiency of nucleation. Another important influencing factor may be that nucleation near the surface is greater because of a greater freedom of motion, thus the kinetic rate coefficient is larger at the surface than in the bulk (regardless of that bulk being solid or liquid); this change is important because the change in activation energy between phase changes is exponential.5 Overall the important point to take home is that water sprayed on to the surface of ice has a higher probability of freezing into new ice versus that water remaining adjacent or beneath the ice (all things being equal).

However, increasing ice formation will require managing the temperature increases that have lead to the reduced ice in the first place. There are two chief methods for addressing this temperature question. The first method is to take the water from the ocean and run it through a heat exchanger to remove a sufficient amount of heat to produce an appropriate freezing probability. The chief drawbacks to this method are the energy required to operate the heat exchanger and what to do with the heat absorbed from the water. The heat exchanger needs to be operated with an energy medium that has a very small carbon footprint otherwise the negative aspect of the added CO2 to the atmosphere through this method will more than likely exceed the benefits of adding more Arctic ice. In addition the heat removed from the water must be stored properly because if it is released to the environment it will either enter the atmosphere or the ocean, either result would largely mitigate any advantage to increasing Arctic ice.

The second method involves drawing ocean water not from the surface, but from deeper water near the bottom of the thermocline where the average temperature is much lower. The weakness of the first method is the reliance on the heat exchanger and its energy demands. Unfortunately while the second method eliminates the heat exchanger it cannot eliminate the need for additional energy usage because instead of using a heat exchanger a pump is required. The unknown question is which method will require more energy. Overall unless the first method is significantly more energy efficient, the second method should be favored because there is no excess heat to manage. While the power requirements for the pump and eventual energy consumption are easy to calculate experimentation will have to be conducted to identify the appropriate pumping rate, spray volume, and spray angle.

An important secondary question is what should be done about the salt in the supply water? One possibility would involve removing the salt because salt “decreases” the freezing point of water making it more difficult to form ice and could even result in ice sheet perforation. An alternative strategy would involve retaining the salt, which would strengthen down-welling currents when the ice melts. The best means to determine the best strategy would simply be to test this ice formation methodology and closely observe how the rate of secondary ice formation changes depending on the current temperature and time of year without any salt removal. If the formation rate is not sufficient then the salt will need to be removed.

If water cannot be used due to energy requirements the other major option for creating a change in the ocean surface albedo in an environmental neutral method is cover the water surface with bubbles. One of the chief advantages of this second option is that bubbles require little energy to create, thus the operational costs for such a system are low.10,11 Bubbles increase ocean surface albedo by increasing the reflective solar flux by providing voids that backscatter light.10 In addition modeling the reflective behavior of bubbles is similar to aerosol water drops because light backscattering is cross-sectional versus being mass or volume dependent and the spherical voids in the water column have the same refractive index characteristics.10 Note that ocean surface albedo varies with angle of solar incidence. Common values are less than 0.05 at 12:00, below 0.1 at 65 degrees solar zenith angle and a maximum albedo, which range from 0.2 to 0.5, at solar zenith angle 84 degrees.12-15 Based on this comparison information the principle formula governing brightening is:

DeltaF = DeltaA * Io * So * (1-Cf) * Tu * Td

where DeltaF = change in brightening; DeltaA = change in albedo on water surface; Io = solar irradiance; So = cosine of solar zenith angle; Cf = fraction of cloud cover; Tu = upwelling transmissive; Td = down-welling transmissive;10

Experiments have already demonstrated the creation of hydrosols from the expansion of air saturated water moving through vortex nozzles, which applies the appropriate level of shearing forces creating a swirling jet of water.11 Also by using an artificial two-phase flow smaller microbubbles can be created, which can even result in interfacial films through ambient fluid pressure reduction.12 Microbubbles can possibly form these films because they typically last longer than visible whitecap bubbles, which rise and bust in seconds. Note that whitecaps are froth created from breaking waves and can increase ocean albedo up to 0.22 from the common 0.05-0.1 values.16

While whitecaps from waves and wakes do provide increased surface albedo, the effect is ephemeral. Microbubble lifespan can be influenced by local surfactant concentration and fortunately the Arctic has limited natural surfactant concentration that would influence this lifespan, thus granting more control in the process of creating those bubbles (less outside factors that could unduly influence bubble lifespan). For example, if these bubbles are created through technological means additional elements can be added to the reactant water like a silane surfactant that could add hours to the natural lifespan.17 Bubble lifespan is probably the most important characteristic for this form of ocean albedo increase both from an economic and efficiency standpoint. However, while most surfactants and other agents like glycerin are typically not environmentally detrimental, the massive amounts required for increasing bubble longevity may make its use economically and environmentally unsustainable.

Another method for creating microbubbles comes from biomedical engineering where microfluidic procedures and sonication are used to enhance surfactant monolayers to stabilize microbubble formation.18 However, there are two common concerns about this method. First, it is used primarily in a laboratory largely for diagnostic and therapeutic applications, not in the field; therefore there may be questions about transition, especially for the dramatic increase in production scale that will be required for Arctic use. Second, while sonication increases stabilizing time, it limits control of microbubble size distribution, which could limit the total reflectiveness of the bubbles.19,20

An expanded and newer laboratory technique, electrohydrodynamic atomization, generates droplets of liquids and applies coaxial microbubbling to facilitate control over microbubble size. Unfortunately one concern with this technique is that as mentioned above ideal bubble size is in microns, but this technique is currently only able to create single digit millimeter sized bubbles.18 However, the increased size may be offset by the increased stability of the bubble (less overall reflection, but longer residence time). Comparison testing will be required to make the appropriate judgment.

The final method for increasing ice formation involves devising a piece of technology that can absorb excess heat from the Arctic Ocean. At first thought such an idea seems unlikely due to the size of the Arctic Ocean and its environmental inputs. However, it may not be as far-fetched as it seems. The key to making such a strategy viable is efficiency and scale within the utilized technology.

Scale is achieved through a design that is small enough that it can be produced at reasonable cost with a reasonable level of speed. Efficiency is typically achieved through producing a device that is self-cycling and thereby producing an autonomous operation. If human involvement is required beyond “pushing the start button” then efficiency is significantly compromised. Tie that efficiency loss in a single unit and multiply it by the units required for scale and the result can be devastating in both the terms of cost and viability.

If the objective is to withdraw heat from the ocean the most important element in the device is what agent will be utilized to accomplish this task. Ironically water is one of the best insulators of heat, which is why it is used for cooling purposes in power plants, thus removing heat could prove difficult. Fortunately there is promising research that supports the idea of incorporating zeolite as the heat absorbent material. Zeolite is a mineral make up of SiO2-, various AlO2 groups and alkali-ions and is capable of absorbing gaseous molecules including water due to its crystalline structure. When zeolite absorbs a gas it retains heat due to the absorption enthalpy.21 In addition because zeolite is commonly produced synthetically for use as molecular sieves and washing detergents it is cheap (50 – 75 cents /kg) and environmentally neutral.21

A good example of how zeolite is used in heat absorption is seen through their use in absorption refrigerators. Absorption refrigerators consist of two connected but independent vessels, the evaporator and absorber. The evaporator vessel acts as a quasi-vacuum containing only the vapor pressure of a liquid, which is usually water. When the valve connecting the two vessels is opened the water vapor moves into the absorption vessel and is absorbed by the zeolite reducing the vapor pressure. The loss of pressure causes a phase change as the water become liquid. Eventually the zeolite becomes saturated ceasing the heat transfer between the zeolite and the water. In the refrigerator model at a later time the zeolite is superheated condensing the absorbed water vapor and returning it to the evaporator vessel.

However, the secondary functionality of the above refrigerator design, zeolite recovery through heating, is not applicable in an oceanic environment. The water and resultant heat must be released from the zeolite so it can be reused, but this release will produce excess heat, which is similar to the problem of using a heat exchanger in the first strategy, there is no good place on the open ocean to store the heat without avoiding environmental release. One strategy to address this issue with a small movable device is when the zeolite becomes “full” the device can return, via a small battery powered motor, to a “mother” ship of sorts where the zeolite heat release process can be conducted. After restoring the zeolite to its rest state the device can return to the Arctic to withdraw more heat. After sufficient time the “mother” ship will be “full” of heat and would return to a land base, most likely Iceland due to its geothermal reserves as an energy source and well, to properly off-load the heat stores. Granted this method will place some limits on overall efficiency due to the trips between the Arctic and heat releasing stop over points, but necessary to manage the heat problem.

In the end the positive feedback associated with the warming-albedo reduction relationship is a legitimate threat to carbon mitigation and remediation strategies as a whole. Therefore, society needs to appreciate the time discrepancies associated with restoring colder temperatures to the Arctic Ocean in effort to preserve Arctic ice, especially during the summer. A technology-based solution will be required. Three possible strategies have been presented above in general detail to attempt to break this warming-albedo reduction relationship. One of the advantages of all of these strategies is that they can be experimentally explored with little overall detriment due to their ephemeral nature. Basically if the results are not similar to what is anticipated the experiments can be stopped with little environmental or economic damage. Overall something needs to be done about increased rate of warming in the Arctic and the dramatically increased rate of ice lost if global carbon mitigation strategies are going to be fully effective at reducing the detrimental effects of global warming.

Citations –

1. Perovich, D, and Richter-Menge, A. “Loss of sea ice in the Arctic.” Annu. Rev. Mar. Sci. 2009. 1:417–441.

2. Rothrock, D, Percival, D, and Wensnahan, M. “The decline in Arctic sea-ice thickness: Separating the spatial, annual, and interannual variability in a quarter century of submarine data.” J. Geophys. Res. 2008. 113:C05003.

3. Kwok, R. “Observational assessment of Arctic Ocean sea ice motion, export, and thickness in CMIP3 climate simulations.” J. Geophys. Res. 2011. 116:C00D05.

4. Bjork, G, Stranne, C, and Borenas, K. “The sensitivity of the Arctic Ocean sea ice thickness and its dependence on the surface albedo parameterization.” Journal of Climate. 2013. 26:1355-1370.

5. Shaw, R, Durant, A, and Mi, Y. “Heterogeneous surface crystallization observed in undercooled water.” Journal of Physical Chemistry B Letters. 2005. 109:9865-9868.

6. Vali, G. In Nucleation and Atmospheric Aerosols; Kulmala, M., Wagner, P., Eds.; Pergamon: New York, 1996.

7. Pruppacher, H, and Klett, J. Microphysics of Clouds and Precipitation, 2nd ed.; Kluwer Academic Pub.: Norwell, MA, 1997. Chapters 7 and 9.

8. Djikaev, Y, et Al. “Thermodynamic conditions for the surface-stimulated crystallization of atmospheric droplets.” J. Phys. Chem. A. 2002. 106:10247. doi:10.1021/jp021044s.

9. Tabazadeh, A, Djikaev, Y, and Reiss, H. “Surface crystallization of supercooled water in clouds.” PNAS. 2002. 99(25):15873-15878.

10. Seitz, F. “On the theory of the bubble chamber.” Physics of Fluids. 1958. 1: 2-10.

11. Seitz, F. “Bright Water: hydrosols, water conservation and climate change.” 2010.

12. Evans, J.R.G, et Al. “Can oceanic foams limit global warming?” Clim. Res. 2010. 42:155-160.

13. Davies, J. “Albedo measurements over sub-arctic surfaces.” McGill Sub-Arctic Res Pap. 1962. 13:61–68.

14. Jin, Z, et Al. “A parameterization of ocean surface albedo.” Geophys Res Letters. 2004. 31:L22301.

15. Payne, R. “Albedo of the sea surface.” J Atmos Sci. 1972. 29:959–970.

16. Moore, K, Voss, K, and Gordon, H. “Spectral reflectance of whitecaps: Their contribution to water-leaving radiance.” J. Geophys. Res. 2000. 105:6493-6499

17. Johnson, B, and Cooke, R. “Generation of Stabilized Microbubbles in Seawater.” Science. 1981. 213:209-211

18. Farook, U, Stride, E, and Edirisinghe, J. “Preparation of suspensions of phospholipid-coated microbubbles by coaxial electrohydrodynamic atomization.” J.R. Soc. Interface. 2009. 6:271-277.

19. Wang, W, Moser, C, and Weatley, M. “Langmuir trough study of surfactant mixtures used in the production of a new ultrasound contrast agent consisting of stabilized microbubbles.” J. Phys. Chem. 1996. 100:13815–13821.

20. Borden, M, et Al. “Surface phase behaviour and microstructure of lipid/PEG emulsifier monolayer-coated microbubbles.” Colloids Surf. B: Biointerfaces. 2004. 35:209–223.

21. Kreussler, S, and Bolz, D. “Experiments on solar adsorption refrigeration using zeolite and water.”

Unions and College Athletes – What Happens Next

On March 26, 2014 the Chicago office of the National Labor Relations Board (NLRB) ruled that the football players of Northwestern University are employees of the university not simply student-athletes, thus they have the ability to form a union and have the general protections afforded to all employees under federal law. While there are numerous hurdles left for college athletes to climb before officially having the ability to join a union long-term, this post will not deal with whether or not this ruling is legally valid and will survive NCAA appeal or the methodology behind their formation and operation of the future union(s), but will instead ask what steps a union should take to enrich the lives of college athletes.

The chief reason behind the desire of college athletes to unionize is that currently they have no effective power to participate in the decisions and operations of the NCAA governance on any level. For workers one of the major advantages of a union is it coordinates focus and awareness across and between participating parties. This focus is critical to creating scale power because workers in any industry have little power if only able to act on their own or in small groups. Unfortunately for college athletes this scale power critical for maximizing bargaining ability from this ruling is only limited to private universities in states with NLRBs that rule similarly to the Chicago office; public universities are governed by existing state law, so there will be other obstacles for unionization for these universities, especially due to the fact that 24 states have active right-to-work legislation restricting unionization. However, ignoring this concern for a moment what would college athletes require of universities with the new power to form a union?

The most public complaint/driving force used by Northwestern athletes is a concern regarding medical coverage. In 2005 the NCAA mandated that athletes must be covered by health insurance in some form with limited restrictions on the provider (basically the insurance could be from the university, individually purchased, from the athlete’s parents, etc.). In addition the NCAA operates a “catastrophic injury” insurance policy through the Mutual of Omaha when an injured athlete has medical costs that typically exceed $90,000 born from a single injury event (although it can be $75,000 for universities that participate in the NCAA Group Basic Accident Medical Program).

While many universities provide medical insurance to athletes as part of the scholarship, the chief problems with this structure is a lack of legal requirement (most do it out of a form of social responsibility), a lack of transparency and a lack of uniformity as various universities have various types of insurance coverage. Most athletes receive proper medical attention when injured, but these three above problems catalyze the probability of athletes entering a state of “medical limbo” with regards to their treatment. Not surprisingly these are the “horror” stories that major media periodically latches on to; however, the problem is that these types of stories are not unique to athletes, but afflict non-athletes as well, thus are not an inherent problem in the college system.

Clearly the current system of medical coverage does have its holes, but holes that are easily repaired especially in the face of new legal protections. Note that for football players it is difficult, despite the “certainty” of concussion proponents, to directly link participating in football to brain damage that occurs decades later. Understandably it is reasonable to suggest that there is an increased probability for future brain damage from playing football, but to suggest that any element of damage can be derived exclusively from playing football is incredibly difficult. Therefore, while it makes logical sense to extend medical coverage for college athletes beyond their playing days, this extension should have a valid time limit. There are two strategies for negotiation.

The first strategy would be to focus on a simple flat time period that would be applied to all athletes and extend beyond the individual’s playing career. For example a good time period appears to be five years, which is also used by the NFL. Therefore, suppose an athlete stops playing sports for University A on March 28, 2015 under such a system this individual would be covered by the university’s healthcare program until March 28, 2020 regardless of whether or not they are still a student. This strategy appears fair because it allows all athletes to have sufficient time to recover from all major physical and short-term mental injuries acquired while playing sports for a particular university.

However, some may view a flat rate as inappropriate because it treats all athletes as equal despite the amount of time these athletes may have actually participated in the given sport. Therefore, a second strategy would be to focus on an extension tied directly to the length of time a sport was played. For example one could create a system where an athlete is covered by the university’s healthcare program for an additional two years after the playing career is concluded for each year the individual played. So if an individual played ice hockey for two years and stopped playing on April 3, 2015 under such a system this individual would be covered until April 3, 2019. This system would operate on the mindset that the longer a person played the higher the probability of acquiring an longer-term injury, thus the longer an individual plays the longer that individual should have extended health coverage.

While the exact details of such a system would have to be developed through negotiation between the union and each particular university or possibly the NCAA directly, it stands to reason that this healthcare coverage would be secondary coverage in that it would fill any gaps in principle coverage that the individual receives from their employer. If the individual does not receive health insurance from their job then this university-affiliated coverage would apply. However, the time period on this coverage would be concurrent with any employer insurance. Basically if an individual stopped playing on June 30, 2015 got a job that provided health insurance on July 15, 2015 and was laid off on April 17, 2018 under a five year fixed time program their coverage with the university would still end on June 30, 2020 despite not using that coverage for almost 3 years due to the coverage provided by the job.

Obviously the university should cover an athlete in some way until the NCAA catastrophic policy would take over and this university coverage policy must be transparent to the point where potential recruits can actually see what is covered and what is not covered. Additionally there should be a minimum level of coverage mandated by the NCAA to ensure appropriate medical treatment. One could argue that this legal mandate is addressed by the Affordable Care Act (ACA) and while true, the ACA may not be permanent due to the zeal of certain members of Congress to repeal it, thus the need for a separate required NCAA mandate. Finally another element could be negotiated would be healthcare substitution. Suppose an athlete wants more coverage than the university is willing to offer, the university could include an additional healthcare stipend at equal monetary value of the standard university healthcare coverage to help pay the athlete pay for the other more desired policy.

Staying in the medical area one raises the question could a union actually change the number of games and/or when those games are played in a particular sport? Over the last few decades the number of college games that various sports have scheduled has increased significantly due to increased travel options and most notably the expansion of incentive to play these games (television money). Clearly the probability of injury increases and the probability of academic success decreases when the number of games an individual plays increase; therefore, could a union attempt to actually reduce the number of games that their particular sport plays? While this idea may be an interesting one, success would be difficult simply because of the money involved with playing each game in these high value college sports.

The principle mission of colleges is to provide an advanced level of education that further prepares individuals to become productive members of society. Unfortunately that principle mission and being an athlete has come into some level of conflict in recent years with the added workload attributed to participating in college athletics. Due to the extensive practice, travel and game schedules the available academic options of athletes at a number of universities have been compromised. In some situations athletes have been confronted with the choice of majoring in subject x or playing sport y because of the inability to schedule and/or attend the required classes.

One of the chief elements driving this conflict is that despite a 1991 decree by the NCAA that limited the number of required countable athletically related activities (CARA) to four hours per day and twenty hours per week, almost all institutions have worked around those restrictions by allow coaches to organize “voluntary” practices. Of course the secret that is not a secret is these “voluntary” practices are not really voluntary; at least not for non-star players who if they do not attend typically find themselves with reduced playing time. It is through these “voluntary” practices and workouts along with travel time that the NLRB could cite an average workload for football players at Northwestern at 40-50 hours per week despite the 1991 limitation. This designation by the NLRB is somewhat controversial because some argue that participation in additional practices behooves the athlete because it enhances their playing ability, similar to non-athletes like musicians and actors, thus these practices should not be controversial relative to the 20 hour CARA limit. However, the controversy stems from the team organized nature of these activities versus the athletes simply putting in the work lifting weights, conditioning, etc. by their lonesome.

In addition to this extended workload for the average week the length of time over a calendar year that athletes have to invest is significant. For example for football players the regular season begins around Labor Day (typically on the preceding Thursday) and depending on the conference ends on the second Saturday or Sunday in December with bowl games starting anywhere from two weeks to six weeks later. During the off-season football players begin preparing for the coming season through an extensive conditional program that involves multiple practices per week that typically starting early in the morning. In general for most sports the conflict between educational opportunities can be broken down as such – during the regular season afternoon classes are off-limits because of practice and game priorities and during the off-season a selection of morning classes are off-limits because of practice and conditioning priorities. How is an individual supposed to pursue their academic and athletic dreams if these conflicts exist?

A union could address this conflict by using expanded legal protections for those who wish to treat “voluntary” practices as exactly that voluntary. Any changes in the playing status of an individual who only abides by the required practice hours would force the authority structure (typically the head coach) to explain the demotion, which would become significantly more difficult with a union behind the scenes protecting players. In addition to practice hours, unions could also address the “big brother” type system that most universities create to “help” athlete time management including types of classes taken, where one sits, how much study hall is attended, personal travel arrangements, where the athlete lives, acquisition of money from family members, etc. Additionally a union could organize “vacation” time for athletes that could be used during the off-season for recuperation purposes. Finally more flexibility could be added to the practice system in the off-season allowing athletes to attend either a morning or an afternoon conditioning session allowing greater class selection ability for their education.

Another popular idea for unions would be to establish new policy governing athletic scholarships. Skipping the period where athletic scholarships were controversial due to their non-academic and possibly non-amateur nature, the first “generation” of athletic scholarships covered four years and had sufficient certainty in that it was rather difficult to cancel the scholarship even if an athlete struggled with injury. Even when these four-year scholarships fell out of favor, early on in the one-year renewal system a university scholarship committee, not athletic directors or athletic coaches, made decisions regarding renewal. Unfortunately due to Proposition 39 in 1973 both four-year scholarships and scholarship committees became rare replaced by single year scholarships renewed year-by-year by the head coach. While Proposition 39 was later rescinded in 2011 allowing universities to offer multiple year scholarships once again, most universities have retained the one-year renewal model.

It may be too much and not appropriate to attempt to go back to the four year guaranteed athlete scholarship, but a union could ask for increased scholarship allowances for injured players as well as a return to scholarship committees, removing a significant element of power from head coaches to “encourage” athletes to devote more time to athletics. In addition the expansion of scholarships after the conclusion of a playing career based on the total time of performance could serve as a valuable tool for the acquisition of a degree. One example of this idea would be for every year an individual plays for a university team that individual would receive an additional half year scholarship, thus playing for four years would yield that individual an additional two years on a specialized scholarship not related directly to the athletic program. Clearly before any scholarship idea is administered it would have to be applied separately from other scholarships because it would not be appropriate to trade one scholarship from a financial need student to an athlete.

The ability to transfer between universities without eligibility penalty would also be a point of interest for negotiation. Currently the transfer rules are rather restrictive towards athletes. The biggest problem with transfer rules is the lack of uniformity. Too many rules depending on type of school, conference, and sport, but the chief component to almost all of the transfer rules, especially for those transfers between major programs (4-year schools), is that the athlete has to sit out at least one year and take a full class load for both semesters (not summer) to establish academic “residence” before he/she is able to play.

In addition these rules have been viewed as rather hypocritical in that coaches routinely breach their contracts to leave for another “better” university job while athletes do not have that same freedom. Realistically it would make more practical sense that an athlete should be allowed to transfer retaining all remaining eligibility at any point during the off-season with the ability to play immediately pursuant to their existing academic eligibility. The university the athlete is departing from should have no ability to prevent the transfer through legal means. However, similar to its current prohibition it would not be appropriate to allow athletes to transfer during their playing season.

Of course the elephant in the room regarding the potential new employee statues of college athletes is whether or not they should be paid in financial capital that is not simply earmarked for educational expenses. This blog has addressed this issue before in the following post [http://www.bastionofreason.blogspot.com/2011/03/paying-college-athletes.html] and a vast majority of the argument still holds up regardless of whether or not college athletes are regarded as employees or students. However, there is an interesting angle that exists within the gap between amateur and professional status.

One could make the argument that it is still possible for college athletes to be regarded legally as employees and retain their amateur status, although the importance of this distinction is somewhat foggy. Maintenance of amateur status could be achieved through requesting a form of stipend that could be used to cover college-based expenses outside the scope of the scholarship. Most scholarships cover tuition, room and board, and direct educational materials like books and software, but do not cover common “everyday” expenses like personal travel expenses, non-team associated food, and other miscellaneous expenses. The stipend should fill this gap with the exact amount negotiated based on a general uniformity across all universities with an effective cost of living adjustment based on where the university is located.

A secondary advantage for the NCAA as an organization to providing this stipend is that it could offer protection against anti-trust litigation. Some argue that capping scholarships at the cost of attendance constitutes unlawful restraints on commercial activity. While this argument is suspect because the NCAA is not a monopoly nor is it required for future employment in the NBA, there does exist the possibility that a court could rule against the NCAA on this issue. However, agreeing to stipend restrictions through a collective bargaining processes should offer sufficient non-statutory labor exemption protection from anti-trust litigation mitigating one avenue for players to sue in an attempt to acquire a form of revenue sharing.

While revenue sharing is unlikely and a stipend is uncertain, college athlete unions could negotiate a payment structure for athletes when the university or third parties make additional funds from direct usage of their likeness or name. The one significant drawback to this possibility is that this very issue is currently moving through the courts via the Ed O’Bannon trial and could come to a conclusion before the union issue has resolved. However, if the union issue is resolved before the Ed O’Bannon case then both sides may be in favor of negotiating a settlement structure on this issue.

Unfortunately lost in the controversy of the decision by the NLRB ruling is that despite the ability to form a union, college athletes at private universities may not have sufficient power to make any real changes. The chief problem is the issue of scarcity. The difference in skill level between the Top 50% and the Top 10% of college athletes is small and with customer loyalty at the college level firmly behind the university versus the athletes that participate for that university the power of a strike in effort to enforce demands is limited. Universities only have a limited amount of scholarships and there would be more than enough individuals of similar talent and willingness to play by the rules of the current system to fill in for any striking athletes. In fact university would more than likely just have to sweep through the intramurals to replace a vast majority of the initial scholarship talent.

These “replacement” athletes would not produce any significant loss of revenue for the university because most of the money acquired from college football and basketball involve television contracts with the affiliated conferences, thus as long as the university fields a team, no matter how bad, the university will receive a vast majority of their planned revenue. The real power of a strike be the negative precedence created by striking athletes and how it will negatively influence future recruitment, thereby potentially hurting the bottom-line of the university through the continuation of a poor quality product that could eventually lead to dismissal from the conference and loss of the television contracts. However, would the first group of striking athletes be willing to act as sacrificial lambs to accomplish this goal because if they transfer to another university the power is lost and they would more than likely not receive a renewal of their athletic scholarships in the aftermath?

Therefore, the real power of the NLRB ruling may actually be the basic legal protections that come with recognizing student-athletes as employees. Overall while most of the above changes should be made solely because it allows the athletes to genuinely be student-athletes and it is morally right, a new college athlete union structure may have to pick its battles if it wants to produce change beyond the basic protections of the law.

Transparency in Medical Care

There is a concern that one of the principle reasons for why healthcare costs are so expensive and why the Affordable Care Act (ACA) will have a limited influence on healthcare costs is that there is little direct information pertaining to prices for given services. This “blind” pricing creates an environment of uninformed consumption where individuals hope that they receive a competitive/fair price rather than know they got a competitive price. Therefore, some individuals believe that if hospitals and other medical institutions list their prices for given services consumers will be able to comparison shop using market forces and competition to lower prices. To this end a number of proponents for this form of transparency hope for the establishment of a procedure marketplace similar in design to existing online booking agents like Expedia, Travelocity, etc.

Note that a number of transparency sites already exist operated by various insurance companies. Some of these insurance companies, like Cigna and United Healthcare, have sites that are fairly effective at demonstrating to consumers differences in price between various hospitals for various procedures whereas others like Healthnet and Kaiser Permenente have sites that fair badly at accomplishing this goal.1 Unfortunately most people do not realize that these sites exist because few people actually use them. It stands to reason that the existence of these individual sites provides support for the creation of a centralized procedure marketplace. However, there are some important issues that must be addressed before this new procedure marketplace (PrMa) could be developed.

First, it is not accurate to compare medical services to consumer goods like pears or toilet paper. The principle distinction between these two categories is that there is a limited supply market for medical services, which involve inherent price modifiers. Basically there are only a limited number of physicians and surgeons that can perform a given examination or procedure. Therefore, even if hospital A offers a lower price on an angioplasty versus hospital B there are only so many angioplasties hospital A can perform, thus the influence of the lower price on business gained for hospital A and business lost for hospital B is conditional and limited; depending on the market size this limit may allow hospital B to avoid lowering their prices even in a transparent and competitive environment and yet retain the same number of patients/customers.

Another problem is that supporters of a PrMa appear to view it in the most simplistic manner possible where all parties pay for medical services out of their own pocket rather than utilize health insurance as a cost modifier. Clearly this presumption is inaccurate, especially after the passage of the ACA placing a mandate on health insurance coverage for all citizens of the United States. Therefore, any transparency in prices will need to include the reduced negotiated rates by given insurance providers as well as co-payments and deductibles for given plans in addition to clear information regarding hospitals that are in a given network. Even if transparency is created for these elements there still exists significant price inelasticity based on the factors tied to the insurance companies.

Extending on this above point is a major reason Expedia and similar sites work is because consumers can select any flight from any participating airline and the price shown is the price paid, there are no second party negotiations creating changes in that price. Airlines participate because there is typically a glut of supply (available seats) and selling a seat at a 20% discount is superior to not selling a seat at all and this sale is more efficient on Expedia and other similar sites. A PrMa site could not produce similar results because there is more complexity. Due to a limited number of surgeons and operating venues there is a supply-based limiting factor that heavily influences the ability to profit due to volume for healthcare providers. Therefore, hospitals are going to charge as much as they can in order to maximize profits. This limiting factor makes it difficult for insurance companies to undercut a competitor to increase customer number; this fact also ignores the ease of switching insurance companies.

This limiting factor creates an environment where health insurance companies do not have ultimate bargaining power with healthcare providers. There is a limit to how much of a “discount” health insurance companies can negotiate based on competing profit potential for both insurance companies and hospitals. Finally based on market segregation of health insurance there is little reason for health insurance companies to participate in such a website. Due to the limiting supply factor it stands to reason that they would be as likely to lose money as make money, thus there is no real reason for any to actually participate in such service unless required by law.

The problem is further complicated in that customers purchasing plane tickets have a greater level of flexibility increasing the value of the transparency. For example suppose a person wants to travel to Miami and one week later wants to travel to Stockholm. The lack of contract between different airlines allows this individual to purchase a ticket from carrier A for price x to travel to Miami and then purchase a ticket from carrier B for price y to travel to Stockholm. In a PrMa the consumer is tied to their insurance company. Person A cannot easily switch insurance companies even if another insurance company has negotiated a lower price on a particular surgery at hospital A. Basically this restriction limits most consumers to only comparing prices between different hospitals not different insurance companies. Even for those shopping for new health insurance policies have difficulties because of a lack of knowledge regarding what procedures they would need in the future.

Worse still there are significant legal questions associated with transparency laws that conflict with gag clauses, most favored nation/provider arguments and possible trade secrets. Gag clauses are the most concerning challenge disallowing the publication of provider-insurer contracts. Arguments on the grounds of trade secrets and most favored providers are usually fairly soft and are cited more for their ability to act as a litigation threat versus their legal viability; however, courts have become more corporation friendly in the past decade and could buy an argument regarding the way a price is negotiated between insurance company and healthcare provider as a form of trade secret as strange as it sound intuitively for revealing a final price would not reveal any negotiation strategy.

Other concerns are that such a pricing tool would only be applicable for preventative or chronic care versus acute/emergency conditions for individuals suffering from a stroke could hardly compare prices on the Internet or telephone on which hospital to be rushed to for lifesaving surgery. Also unlike airlines, prices for medical services are influenced by geographical cost of living because they are not as volume flexible. Therefore, it must be guaranteed that new competitive transparency does not lead to such a great price reduction that it hurts healthcare workers. Clearly due to their earned skill set physicians will have salary security, but nurses, medical technicians and other “more disposable” hospital personnel could be fired or receive a cut in salary in order to maintain hospital profits if prices drop significantly due to increased competition. This salary cut could damage the overall care in the hospital because cost of living for a given region would create an inherent price and salary floor creating staffing shortages.

One concern that may not be imperative to address is the alteration of hospital and insurance billing practices. Some individuals believe that hospital and insurance billing need to be changed to more specific invoice-like documents with less medical and/or technical jargon so consumers can easily identify what goods and services are charged at what prices. However, an itemized breakdown of price may not be necessary because consumers don’t care about what each individual item involved in a medical procedure costs, they only care about the total cost of the procedure. For example patients staying overnight for observation do not need to know how much hospital food, catheters and pain medication cost individually, just the total cost of spending the night.

However, there is an important consideration for multiple pricing in a transparent real-time marketplace. By necessity hospitals outsource certain responsibilities to other medical service providers (radiologists, anesthesiologists, etc.) where some of the large price tag procedures require multiple bills from these multiple service providers. Therefore, diligent maintenance of transparency will be required to track each time a specific provider changes the price for his/her/its services to ensure accuracy in the overall price.

Fortunately one of more easily solvable concerns is that prices need to be intertwined with quality of the service. There is a natural psychology for consumers to equate a lower price with lower quality, especially if the difference in price is hundreds to thousands of dollars. Therefore, safety records for hospitals will need to be referenced in addition to the price for their services otherwise individuals may be reluctant to select lower priced service options defeating the entire point of price transparency.

Another significant concern that is seemingly never considered by PrMa proponents is that these direct price comparison tools may actually increase costs instead of reducing them. The idea of transparency functions on a general principle of capitalism that businesses with a common product will compete against each other because it is generally thought that consumers should migrate to the lower priced good, quality being similar; however, what individuals typically forget about this principle is that a goal of modern capitalism is to maximize profits.

Current gag clauses between hospitals and insurance providers limit the information that insurance providers and hospitals have to maximize profits. For example suppose hospital A charges $1,000 for a service and hospital B charges $2,500 for a service. In the current environment this difference is not readily known even between hospitals. In most versions of the transparent environment desired by proponents this information would be available to all parties. What stops hospital A from raising their price on the particular service from $1,000 to $2,000 instead of hospital B lowering their price from $2,500 to $1,250? This possibility should be a serious concern for transparency proponents.

Currently it appears that a dream of creating an Expedia-like website for comparison of prices and quality of care for various medical procedures will be very difficult, if not impossible to achieve. A better option would be focusing on expanding the transparency procedure comparison websites that some health insurance companies have already set up. Creating state and federal statutes to expand the details, features and accuracy of these websites on an individual basis should effectively deal with large disparities in price between hospitals and other medical providers. The reason this strategy will work is that individuals cannot jump between insurance companies and their respective coverage easily and the ACA demands all individuals have health insurance or face a fine; after a few years this fine will be of sufficient size that almost all individuals will have health insurance. Therefore, if all insurance companies have effective price transparency websites, those run by Cigna and United Healthcare are a suitable start, then consumers who are already “locked-in” to company will have a website that will help them plan for more cost effective medical treatment. Overall transparency procedure proponents should focus on the creation and optimization of these individual websites and phone information tied to specific insurance companies due to their ease of establishment and greater effectiveness versus a broad all-encompassing system.

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Citations –

1. http://www.pbgh.org/component/content/article/10/199-health-plan-shopping-services-evaluation

Early Departing Athletes and Education

There is widespread belief that the NBA and NCAA will work together in the near future to establish an age/experience floor for potential prospects where individuals who want to play in the NBA will need to attend at least two years of college or have some form of equivalent experience. This change would be an important element in establishing a meaningful methodology to attack the general perception of a lack of education among student athletes who leave college early to play professionally. In the current system a number of individuals focus on their NBA prospects through their adherence to the one-year minimum rule, but that “year” in college is really only about four-five months with only the first semester or first two quarters actually mattering because these individuals are only focused on maintaining their basketball eligibility. For these “one-and-done” players after eligibility is assured there is no further incentive to attend class and utilize the value of the scholarship.

A change in the minimum requirement from one year to two years forces these players to take classes seriously for at least one and half genuine years. This extra effort is especially important because for a vast majority of freshman, regardless of their athletic affiliations, the first year of college is much more general in the educational focus which limits the usefulness of that education without follow-up from the specificity of major study in sophomore, junior and senior years. Therefore, it could be argued that spending only a “year” in college is a generally meaningless 4-5 months that has little value to a “one-and-done”.

If the two-year minimum is established there still needs to be a focus applied to athletes to ensure that the educational opportunities they receive are suitable and targeted. Note that while the topic focuses on educational opportunities for student athletes in general, there will be additional attention paid to student athletes who leave college early before completing their degrees in an attempt to acquire employment as a professional athlete; therefore, this discussion primarily involves football and male basketball players. Finally it is important to acknowledge the fact that most student athletes, despite the stereotypes, actually complete school with a degree in a field that allows them to have a promising future career outside of playing sports.

One of the problems with a career as a professional athlete is that it has an inherently short lifespan. Very few athletes play beyond the age of 35 and those who do either play at a league minimum or on the waning years of a long-term contract that will be their last contract. Understand that there should be little sympathy for these individuals because league salary minimums in all four major sports (football, baseball, basketball and hockey) are considerably higher than a vast majority of jobs. However, with a career lasting only 5-15 years and 25-35+ years remaining before eligibility for Social Security, a majority of players will need to find secondary careers to fill this gap.

Facilitating the development of this second career can be difficult because these individuals have been competing in athletics for their prime adult professional development years and entry into a secondary career marketplace will typically result in competition with younger more experienced and prepared candidates. Due to the connections-based elements in the job market some of these athletes can parlay their fame into opportunity, but for most this strategy will not work. Therefore, colleges must create a new strategy for education that can help athletes manage these weaknesses when attempting to acquire a second career after their playing days are over.

With regards to this second career some individuals have argued that student-athletes should be allowed to major in their participating sport, i.e. football players should be allowed to major in “football”, basketball players in “basketball”, etc. Clearly this idea is not so ridiculous that it should be immediately dismissed out of hand with a sarcastic attitude that such a “degree” would be cookie-cutter and worthless. However, the problem with the various proposals that embody this idea is that the degree is not targeted. Society is continuously becoming more and more specialized and the idea behind this new type of “sports” major is too broad. Think about the nature of the job application process, when application-sorting software is “thinning the herd” is it going to select an application for the interview process if that individual majored in “basketball”?

Some could argue that the general failure of the “sports” major to attract the attention of employers and their resume software would be more indicative of negative stereotyping than lack of skill. While there would be some truth to this belief, the generality of the major itself would lead software and humans to draw their own negative conclusions regarding the efficacy of the major. Simply seeing a particular sport implies a focus on playing that sport not on other associated analytical intricacies. Proponents would argue that this is not correct, but even if the studied curriculum supports that position, there is still limited information regarding exactly what elements were studied. It is akin to comparing a major in medicine versus a major in radiology; one clearly defines the section of expertise where the other defines generality.

Unfortunately the weakest aspect of these proposals is that some of the proposed curriculum for a degree in “football” includes “labs” that are worth credit, but appear to be nothing more than simple practice sessions. Proponents would counter that performing arts majors typically receive credit for conducting practice sessions to hone their skills, so there should be little difference between those majors and this new “sport” major. While on its face this comparison may seem apt it runs into a philosophical problem regarding longevity. Most careers as a musician, actor, or even dancer can last decades while a career as a professional athlete typically lasts only five-ten years. This timeframe difference places a greater weight for value on practice for performance arts versus athletes.

Another concern regarding these “lab” sessions is that the failure rate for becoming a professional athlete is incredibly high even for those individuals who believe and have others who believe that they will be successful. Failure as a professional athlete would result in a career change, but the “lab” sessions acting as valid credits towards a major would be basically worthless to the individual due to their general player-only specificity. Therefore, it would be better if a more flexible study system were developed in place of these labs.

Also having such a specific major would compartmentalize athletes both among each other and among other non-student athletes, which could lead to problems. For example while everyone likes to believe in honest evaluation, among student athletes there have been numerous examples of favoritism within numerous universities, especially for football and male basketball players due to the money involved in those particular sports and general passion. Isolating numerous athletes in the same general academic regiment could increase the probability that standards become lax further reducing the usefulness of the degree. Additionally how many different specific sport majors are going to exist? Will female field hockey players have a “field hockey” major or will wrestlers have a “wrestling” major? What influence would this expansion have on resource utilization at a given university?

A final immediate concern with the idea of a “sport” major is that it seems unnecessary. In some context to a cynic it feels like a strategy to simply increase the probability of retaining eligibility for the student-athlete. Again the short length of career associated with a professional athlete limits the usefulness of such a major due to its generality; basically it is a major for the first five to ten years of an individual’s career with little value in the last twenty to thirty. Going forward with such a mindset is institutionally irresponsible. Instead creating a targeted program for athletes among already existing majors with an increased level of flexibility for appropriate specificity seems more appropriate to support the multiple phases of an athlete’s career as well as their mental growth.

It is important to note that these targeted programs will not be mandatory in any way; clearly it is the prerogative of any individual to study whatever he/she desires in college. However, for those individuals who do not have a strong opinion about what they want to do after their playing days are over a brief interview should be conducted with career counselors before enrollment to identify interests. The key issue in these targeted programs is to apply the experience and skills that athletes acquire during their playing days to ease the transition from primary career as a player to the secondary career as something else.

The first step to identifying these educational programs is to identify the most likely secondary career possibilities. While some caution may be prudent to avoid stereotyping regarding the intelligence of most athletes, the real nature of this identification is to focus on the interests of the athletes. Obviously one of the most popular secondary careers is broadcasting either on a national stage for an organization like NBC, ESPN or FOX or on a local level typically on radio broadcasts for the alma mater. Another common option is to move from player to coach or front office position for a particular sports organization. The third and last “common” secondary career is moving from player to agent using experience in the industry as a player and interactions with existing agents to create a credential basis.

In addition to these “common” secondary careers other possibilities for athletes include becoming a financial advisor or accountant to help other players manage their money successfully; also modern sports have embraced the inclusion of advanced statistical analysis to help make personnel decisions opening up numerous additional job opportunities in these analytical fields for sports organizations. Quality medical personnel are almost always in demand allowing former athletes to become medical trainers for various institutions, either high schools and colleges or a sports team, without the need to acquire medical degrees. Finally for a number of former athletes maintaining quality physical performance demands understanding nutrition and proper off-the-field exercise regimens, elements that can be used to transition into a secondary career as a personal trainer. Fortunately most colleges already offer coursework that grant the necessary skills to succeed in these fields. With this in mind it is appropriate for schools to properly guide student-athletes who are interested in them to the necessary course work to maximize success.

These secondary career strategies are easily established for those who stay in college and receive a degree; however, what does a university do about individuals who leave college early for the professional ranks before acquiring a degree? Clearly if these individuals want to maximize their success at the professional ranks they cannot continue to attend classes due to only a limited amount of time available to spend in class versus studying and practicing at the professional level. Therefore, if pursuit of a degree is postponed for typically at least five years, what is the strategy to initiate a return to this pursuit? One of the obvious problems with restarting study after a long layoff is the diminishment of knowledge over that layoff. Some educational critics cite this “loss of knowledge” as a reason for administering year-round school because of time off for just the three months of summer. Imagine what type of loss will occur over five or more years, one might think that an individual would have to start all over from the beginning. So what should be done?

There are two important elements to this “return to education” issue. The first element is what financial responsibilities do colleges have to former student-athletes who leave for the professional leagues early and then later want to return to continue their education? When a player leaves for the pros that individual foregoes any remaining eligibility to compete at the college/amateur level; therefore, any continuation of an athletic scholarship would be unlikely because there is no quid-pro-quo involved. However, a special academic scholarship could be created for returning former players if those players had certain grade point averages upon leaving the college treating this returning player similar to an academic scholarship received by an incoming high school student. Note that a grade point average floor is required for this new scholarship category because such a floor demonstrates that these former players were taking their studies seriously and actually acquiring knowledge for a secondary career instead of simply trying to maintain their eligibility.

Another possible strategy is to simply extend the athletic scholarship as a single sided element. Some would support this strategy because overall due to economy of scale universities have to invest only a very small amount of money per student and it could be argued that the player in question produced more than fair value during his/her playing days and this scholarship is simply balancing that budget.

The second element is how to prime the returning player for reentry into the educational environment. Unfortunately there is no easy means to accomplish this priming because these “new” incoming students have been away from a study heavy environment for years. It would be difficult to simply go back to square one and start over. One strategy would involve incorporating a pass-fail system for certain classes during the first semester back and then use a grading system for the second semester and beyond; this would create a gauged “stress” environment for the returning players ramping up the difficulty with time allowing for acclimatization to the study environment. However, one concern with this method is that students will not take the first semester seriously because it is pass-fail and thus will not develop the proper mindset for future classes when the grading system changes. The best option may be simply to develop course work so there are interactive elements that catalyze interest in the study portions of the work because of their necessity to succeed in the interactive portions. This design would also help students who are entering these particular fields from high school as well.

Another important element for this priming is to eliminate any stigma associated with age. Some individuals have trepidation about returning to college because at the age of 28+ they think that society feels it is strange that a person so “old” is still attempting to acquire a degree. Another negative rationality may be that returning to college because their playing career is over brands the individual as a failure. Neutralizing these negative elements chiefly involves creating a mindset where returning to college does not represent failure, but instead the pathway to secondary success because the time allotted for their first career has now ended and it is time to find success in another career.

The most important elements to addressing the concern with athletes and their education are course design and associated interest. The first important step is when an athlete enters the college environment to inform the individual of the probability that he will be able to retire after their playing career is over (very low) and identify their interests to gauge what field will produce a desired secondary career. Linking interest instead of simply focusing on keeping the athlete eligible will actually increase eligibility probability through increased engagement and work interest as well as increase skill acquisition. Clearly one of the critical duties of college is to further the development of quality individuals who will produce positive effects in society, thus course work to this end must be taught early; however, there must also be introductory courses for skills required to pursue the secondary career as well.

Overall the creation of a “sport” major for certain sports appears to be a needless strategy that has few benefits. The general gamble of such a degree is that an individual majoring in Basketball will be able to somehow use the major to significantly enhance his ability to make more money as a professional basketball player to the point where once the playing career ends that individual will have enough money to effectively retire from the workforce. This strategy is a gamble because if that does not happen due to bad luck, injury or just lack of ability then this individual will have acquired a major that is effectively worthless even more so than the stereotypical “sociology” or “general studies” degrees that are ridiculed by other parties. Some may counter that a “sports” major would allow secondary careers like the ones mentioned above, but the flaw with that argument is that there is no reason to establish a “sports” major because specialization majors for those types of careers already exist. Basically a “sports” major would be perceived, and due to the typically proposed “labs” taking credits and time, effectively be a dumb down version of those already existing majors. Therefore, instead of establishing a “sports” major, the goal of improving education among athletes should focus on better applying what colleges already offer to what interests student-athletes.

A Possible Strategy for Dealing with Stroke Damage

Interestingly despite the hype and fear attributed to cancer, stroke is the second leading cause of death in the developed world behind only heart disease and responsible for approximately 10% of deaths worldwide.1,2 There are two major types of stroke: ischemic and hemorrhagic. An ischemic stroke is due to a lack of blood flow largely born from a blockage (arterial embolism, thrombosis, etc.). A hemorrhagic stroke is due to a hemorrhage in the brain resulting in abnormal blood flow creating significant losses in most areas of the brain and overflows in others. Not surprisingly limiting blood flow to the brain can rapidly facilitate the loss of brain function due to cellular malfunction and death resulting in difficulty moving one or more parts of the body, trouble talking and hearing, visual difficulty, as well as other motor and cognitive breakdowns eventually leading to death.

Ischemic strokes are more common than hemorrhagic (approximately 80% to 20%) and have four major causes: 1) Thrombosis; 2) Venous thrombosis; 3) Embolism; 4) Systemic hypoperfusion.1,3 Thrombosis involves the obstruction of a blood vessel due to clot formation in the local region. Embolisms are obstructions, typically clots, fat globules or gas bubbles, that form elsewhere in the body that result in blocked blood flow in some other region away from the location of the obstruction. Systemic hypoperfusion is a general decrease in blood supply born from a psychological condition like shock. Due to the fatal outcomes associated with a stroke numerous methods have been developed to recognize its onset, occurrence and aftermath. The onset of most strokes involve face weakness, arm drift and abnormal speech as early symptoms.4

These symptoms only describe overt strokes; another type of stroke is covert where symptoms are relatively absent. Fortunately covert strokes typically result in less brain damage than overt strokes. However, despite the reduced permanent damage, covert strokes are much more common (5x more probable) and can result in significant mental problems like dementia and depression.5 Unfortunately the ongoing problem with strokes is that despite continuing advances in treatment and rehabilitation a vast majority of people who suffer from a stroke will have a permanent cognitive and/or motor impairment.

Some prevention methodologies have been proposed to reduce the probability of a stroke or reduce the damage that occurs during a stroke. Not surprisingly there is significant support for routine physical activity as a means to reduce the probability of an ischemic stroke.6-8 In fact meta-analysis suggests that the benefits of exercise are indiscriminate with regards to sex and that the most active individuals have a 25% reduced rate of stroke versus those who are least active.7

One rationality for why consistent exercise is able to achieve this result is the improvement of vascular function, which increases blood flow efficiency, reduces hypertension and limits infarct size.9,10 Another possibility may simply be that those who exercise the most have healthier lifestyles on a whole then those who do not exercise a lot; however, this rationality foregoes the general health benefits exercise brings. Unfortunately due to the nature of a stroke there is little one can do from a preventative standpoint beyond live a reasonably healthy life of no smoking, no to very moderate drinking, exercise and proper diet.

Some could argue that one should take anti-coagulants like warfarin or blood thinners like aspirin, but these pharmaceutical agents are more reactionary treatments intended to prevent repeat strokes or secondary short-term strokes (similar to aftershocks) versus reducing damage derived from principle strokes. Aspirin is especially used by individuals who have previously suffered myocardial infarctions or with high cardiovascular risk factors like atherosclerosis.5 Some also support the use of clopidogrel and dipyridamole to increase the probability of platelet flow to avoid platelet aggregation, which can lead to clot formation.5 However, there are some concerns that improper timing in treatment with anti-coagulation agents could create a net physiological detriment.11 After the event ischemic strokes are commonly treated with thrombolysis (i.e. clot busting drugs) or intra-arterial fibrinolysis (site injection through a catheter) whereas hemorrhagic strokes typically require neurosurgery due to the excessive bleeding.5

However, these reactionary methods are active methods for reducing damage born from a stroke, which are largely dependent on the existence of secondary available parties because the suffering individual is frequently rendered incapable of assisting him/herself. The development of a passive method to reduce damage without the need to take drugs would go a long way to increasing the probability for reducing damage from strokes, reducing long-term healthcare costs and increasing qualify of life. One possibility for a more passive “damage prevention” therapy revolves around neutralization of reactive oxygen species (ROS).

In the 80s it was theorized that oxidative stress induced damage from ROS was prevalent in the reperfusion stage of post-ischemic strokes and accounted for a significant amount of damage, especially because cells have a reduced capacity to neutralize ROS in ischemic stroke conditions.12-16 The origin of ROS in cerebral ischemia is derived from the events that occur during reoxygenation after spontaneous or thrombolytic reperfusion. The abnormally large and rapid influx of oxygen after the depravation of oxygen leads to accelerated enzymatic reactions, especially in the electron transport chain facilitating the creation of larger than normal concentrations of ROS.

In addition there is a slower build-up of natural antioxidants due to transcription and translation delays due to the lack of oxygen and other signaling molecules. Unfortunately there are still questions regarding the exact mechanisms of this injury, i.e. if it differs from oxidative damage born from ROS in other parts of the body, but the presence of peroxynitrite (ONOO-) and hydroxyl radicals (OH-) are considered important for significant ischemic damage due to their aggressive and indiscriminate damage potentials.17,18

If the ROS damage theory is correct then an obvious prevention strategy would be to increase antioxidant concentrations. However, increasing these concentrations on a dietary or pharmaceutical level has an immediate problem in that both types of antioxidants have difficulties passing the blood brain barrier, if they can at all. Another problem is that there are questions to the general effectiveness of significant antioxidant concentrations derived from pharmaceutical origins where consumption may actually endanger health rather than improve it due to restraints on the ability of cells to absorb these antioxidants.

Another concern with an antioxidant strategy is that while ROS are cytotoxic at large concentrations most also have important roles as signaling molecules that regulate various processes like cellular differentiation, proliferation and apoptosis or even protect against bacterial infections.19-21 Thus there is the possibility that increasing antioxidant concentration too much can neutralize these signaling operations and create negative biological outcomes. Therefore, an alternative strategy is required if antioxidants are going to be utilized to reduce ROS damage in strokes.

The best strategy seems to be providing a natural reactant molecule that will allow the body to facilitate increased natural antioxidant protection. One option for achieving this “on-site limited neutralization” strategy may be increasing gaseous biological hydrogen. Previous research has demonstrated that hydrogen can selectively reduce ONOO- and OH- and have a protective effect on cerebral, hepatic, intestinal, lung and myocardium I/R injury along with neonatal hypoxia ischemia and cerebral ischemia.22-27 This protective effect seems to depend on hydrogen concentrations of approximately 25 umol/L.22

The antioxidant effect of hydrogen also has various secondary advantages: 1) its high natural permeability allows it to penetrate biomembranes and diffuse into the cytosol, mitochondria and nucleus; 2) it appears to have a specific selectivity which targets highly reactive ROS leaving less active ROS to perform their necessary secondary messenger signaling functions; 3) a toxicity threshold that is so high that hydrogen is basically non-toxic at any realistic concentration.22

There are two major methods for increasing gaseous hydrogen concentration in the body. First, direct consumption typically achieved by consuming hydrogen-doped water or inhaling hydrogen gas. Hydrogen water is commonly created through electrolysis increasing free hydrogen concentration to anywhere from 0.6 mM to 0.8 mM whereas inhalation of hydrogen gas typically occurs in a 2% by volume hydrogen mixture.28 Basically the feed is designed to replace nitrogen with hydrogen maintaining oxygen concentration.

The second method for increasing biological hydrogen concentration utilizes bacteria in the intestinal system. Bacteria are able to produce excess amounts of hydrogen as a byproduct of fermentation. In most situations there is little to no biological influence from this hydrogen production due to the typical level of normal hydrogen concentrations.29 However, if an individual consumes certain foods fermentation levels can be increased dramatically producing a biologically relevant effect.

One of these key “hydrogen producing” foods is lactulose. Lactulose is a synthetic sugar comprised of one fructose and one galactose molecule and is commonly used in the treatment of constipation.30 The principle reasons for the hydrogen capacity of lactulose is its complex nature and it cannot be digested by the human digestive infrastructure. 20 grams of lactulose can increase exhaled hydrogen to a similar level as 300 ml hydrogen saline with a longer resident time in the body.2,30 While lactulose is relatively non-toxic from a direct consumption perspective there are some concerns that excessive and routine consumption can result in an increased probability for small intestinal bacterial overgrowth.

What is the methodology behind how hydrogen is able to neutralize ROS? Past research supports increasing hydrogen concentrations leading to increases in HO-1, CAT and SOD all agents that are able to neutralize various ROS.31,32 However, after more detailed analysis hydrogen also seems to increase the expression of nuclear factor (erythroid-derived 2)-like 2 (Nrf2).16 Nrf2 is viewed as one of the principle pathways that governs the expression of molecules which act to neutralize oxidative stressors. Some believe that this activation is based on a form of hormesis where H2 is able to mitigate the effects of more toxic ROS species allowing overexpression of less toxic ROS, which leads to the activation of Nrf2 eventually neutralizing the lesser ROS species.22 In scenarios that lack sufficient H2 concentrations there is a higher probability of the more toxic ROS trigger cell damage and apoptosis limiting the future activation of the Nrf2 pathway leading to a cascade damage effect.

This hormesis process is thought to occur as followed. Under normal conditions Nrf2 is stored in the cytoplasm by Kelch like-ECH-associated protein (Keap1) and is tagged by Cullin 3 for ubiquitination resulting in a typical half-life of only 20 minutes. Under oxidative stress conditions it is thought that cysteine residues in Keap1 are disrupted dramatically reducing the probability of Cullin 3 tagging both through reducing binding efficiency and increasing Nrf2 mobility as disruption of Keap1 allows Nrf2 to translocate into the nucleus. Presence in the nucleus allows Nrf2 to form a heterodimer with small Maf protein and bind antioxidant response element (ARE) that activates numerous anti-oxidative genes initiating their transcription and translation.

However, hormesis is a somewhat controversial idea biologically. So others believe that hydrogen directly activates Nrf2-dependent genes like HO-1 and it is Nrf2 activation that results in the neutralization of ROS. This belief is supported by research where the protective effects of hydrogen were lost in Nrf2-deficient mice.31 While there exists the possibility that hydrogen can directly scavenge ROS the activation of Nrf2 appears to be the dominant method behind the correlation between increased hydrogen concentration and reduced ROS damage. However, the exact relationship between hydrogen, ROS neutralization and Nrf2 activation remains unclear. Despite the lack of specific details in this relationship, both the consumption of hydrogen doped saline/water and the consumption of lactulose increase hydrogen concentrations in vivo and also has neuroprotective effects with regards to strokes.27

Another possible mechanism for hydrogen-induced protection could involve not hydrogen directly, but the conversion of hydrogen to hydrogen sulfide (H2S). There is some evidence to suggest that H2S is a cytoprotective against oxidative stress in similar context to Nrf2,33-36 especially with regards to peroxynitrite (ONOOH/ONOO-) or hypochlorite (HOCL).37,38 While some believe that this antioxidant ability is derived from direct scavenging of oxidants due to its comparable reactivity to cysteine and glutathione,33,38,39 this belief does not seem accurate because the reaction between H2S and ROS is too slow41 and the H2S concentration is too low in vivo40,42 even despite the possibility of metallic catalyst availability.43 Therefore, H2S may interact with Nrf2 increasing expression rates and thereby increasing its protective effects against ROS. Of course one of the problems with theorizing about the role of H2S as an antioxidant is the lack of reliable methods to specifically measure H2S in vivo to tie H2S concentration increases to Nrf2 concentration increases.44,45

There is remaining uncertainty corresponding to increasing gaseous hydrogen concentration in the blood and its role in managing stroke damage, but studies in mice have demonstrated encouraging results regarding stroke induced damage reduction that should drive further study in humans.2,27 In fact some preliminary studies with lactulose has demonstrated reduced symptoms in Parkinson disease patients.27 With the general cost of lactulose or hydrogen doped water being very cheap if this method is applicable to reducing damage from strokes in a passive manner (just drink x amount of hydrogen doped water a day) millions of dollars can be saved in healthcare expenses as well as increasing the quality of life for numerous people. Overall while this hydrogen preventative theory is in its early stages of development, it would be in the best interest of official organizations like the American Stroke Association to investigate human applications of increasing hydrogen concentrations to reduce stroke damage.


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