Pharmaceutical marketing

From Wikipedia, the free encyclopedia

Many countries have measures in place to limit advertising by pharmaceutical companies.

 

Pharmaceutical company spending on marketing far exceeds that of its research budget. In Canada, $1.7 billion was spent in 2004 to market drugs to physicians; in the United States, $21 billion was spent in 2002. In 2005, money spent on pharmaceutical marketing in the United States was estimated at $29.9 billion with one estimate as high as $57 billion. When the U.S. numbers are broken down, 56% was free samples, 25% was pharmaceutical sales representative "detailing" (promoting drugs directly to) physicians, 12.5% was direct to user advertising, 4% on detailing to hospitals, and 2% on journal ads. There is some evidence that marketing practices can negatively affect both patients and the health care profession.

To health care providers

Marketing to health-care providers takes three main forms: activity by pharmaceutical sales representatives, provision of drug samples, and sponsoring continuing medical education (CME). The use of gifts, including pens and coffee mugs embossed with pharmaceutical product names, has been prohibited by PHRMA ethics guidelines since 2008. Of the 237,000 medical sites representing 680,000 physicians surveyed in SK&A's 2010 Physician Access survey, half said they prefer or require an appointment to see a rep (up from 38.5% preferring or requiring an appointment in 2008), while 23% won't see reps at all, according to the survey data. Practices owned by hospitals or health systems are tougher to get into than private practices, since appointments have to go through headquarters, the survey found. 13.3% of offices with just one or two doctors won't see representatives, compared with a no-see rate of 42% at offices with 10 or more doctors. The most accessible physicians for promotional purposes are allergists/immunologists – only 4.2% won't see reps at all – followed by orthopedic specialists (5.1%) and diabetes specialists (7.6%). Diagnostic radiologists are the most rigid about allowing details – 92.1% won't see reps – followed by pathologists and neuroradiologists, at 92.1% and 91.8%, respectively.

E-detailing is widely used to reach "no see physicians"; approximately 23% of primary care physicians and 28% of specialists prefer computer-based edetailing, according to survey findings reported in the 25 April 2011, edition of American Medical News (AMNews), published by the American Medical Association (AMA).

PhRMA Code

The Pharmaceutical Research and Manufacturers of America (PhRMA) released updates to its voluntary Code on Interactions with Healthcare Professionals on 10 July 2008. The new guidelines took effect in January 2009."

In addition to prohibiting small gifts and reminder items such as pens, notepads, staplers, clipboards, paperweights, pill boxes, etc., the revised Code:

• Prohibits company sales representatives providing restaurant meals to healthcare professionals, but allows them to provide occasional modest meals in healthcare professionals’ offices in conjunction with informational presentations"
• Includes new provisions requiring companies to ensure their representatives are sufficiently trained about applicable laws, regulations, and industry codes of practice and ethics.
• Provides that each company will state its intentions to abide by the Code and that company CEOs and compliance officers will certify each year that they have processes in place to comply.
• Includes more detailed standards regarding the independence of continuing medical education.
• Provides additional guidance and restrictions for speaking and consulting arrangements with healthcare professionals.

Free samples

Free samples have been shown to affect physician prescribing behavior. Physicians with access to free samples are more likely to prescribe brand name medication over equivalent generic medications. Other studies found that free samples decreased the likelihood that physicians would follow standard of care practices.

Receiving pharmaceutical samples does not reduce prescription costs. Even after receiving samples, sample recipients remain disproportionately burdened by prescription costs.

It is argued that a benefit to free samples is the “try it before you buy it” approach. Free samples give immediate access to the medication and the patient can begin treatment right away. Also, it saves time from going to a pharmacy to get it filled before treatment begins. Since not all medications work for everyone, and many do not work the same way for each person, free samples allow patients to find which dose and brand of medication works best before having to spend money on a filled prescription at a pharmacy.

Continuing medical education

Hours spent by physicians in industry-supported continuing medical education (CME) is greater than that from either medical schools or professional societies.

Pharmaceutical representatives

Currently, there are approximately 81,000 pharmaceutical sales representatives in the United States pursuing some 830,000 pharmaceutical prescribers. A pharmaceutical representative will often try to see a given physician every few weeks. Representatives often have a call list of about 200-300 physicians with 120-180 targets that should be visited in 1-2 or 3 week cycle. 

Because of the large size of the pharmaceutical sales force, the organization, management, and measurement of effectiveness of the sales force are significant business challenges. Management tasks are usually broken down into the areas of physician targeting, sales force size and structure, sales force optimization, call planning, and sales forces effectiveness. A few pharmaceutical companies have realized that training sales representatives on high science alone is not enough, especially when most products are similar in quality. Thus, training sales representatives on relationship selling techniques in addition to medical science and product knowledge, can make a difference in sales force effectiveness. Specialist physicians are relying more and more on specialty sales reps for product information, because they are more knowledgeable than primary care reps. 

The United States has 81,000 pharmaceutical representatives or 1 for every 7.9 physicians. The number and persistence of pharmaceutical representatives has placed a burden on the time of physicians. "As the number of reps went up, the amount of time an average rep spent with doctors went down—so far down, that tactical scaling has spawned a strategic crisis. Physicians no longer spend much time with sales reps, nor do they see this as a serious problem." 

Marketers must decide on the appropriate size of a sales force needed to sell a particular portfolio of drugs to the target market. Factors influencing this decision are the optimal reach (how many physicians to see) and frequency (how often to see them) for each individual physician, how many patients suffer from that disease state, how many sales representatives to devote to office and group practice and how many to devote to hospital accounts if needed. To aid this decision, customers are broken down into different classes according to their prescription behavior, patient population, and of course, their business potential. 

Marketers attempt to identify the set of physicians most likely to prescribe a given drug. Historically, this was done by measuring the number of total prescriptions (TRx) and new prescriptions (NRx) per week that each physician writes. This information is collected by commercial vendors. The physicians are then "deciled" into ten groups based on their writing patterns. Higher deciles are more aggressively targeted. Some pharmaceutical companies use additional information such as:

• Profitability of a prescription (script),
• Accessibility of the physician,
• Tendency of the physician to use the pharmaceutical company's drugs,
• Effect of managed care formularies on the ability of the physician to prescribe a drug,
• The adoption sequence of the physician (that is, how readily the physician adopts new drugs in place of older treatments), and
• The tendency of the physician to use a wide palette of drugs
• Influence that physicians have on their colleagues.

Physicians are perhaps the most important component in sales. They write the prescriptions that determine which drugs will be used by people. Influencing the physician is the key to pharmaceutical sales. Historically, this was done by a large pharmaceutical sales force. A medium-sized pharmaceutical company might have a sales force of 1000 representatives. The largest companies have tens of thousands of representatives around the world. Sales representatives called upon physicians regularly, providing clinical information, approved journal articles, and free drug samples. This is still the approach today; however, economic pressures on the industry are causing pharmaceutical companies to rethink the traditional sales process to physicians. The industry has seen a large scale adoption of Pharma CRM systems that works on laptops and more recently tablets. The new age pharmaceutical representative is armed with key data at his fingertips and tools to maximize the time spent with physicians.

Peer influence

Key opinion leaders

Key opinion leaders (KOL), or "thought leaders", are respected individuals, such as prominent medical school faculty, who influence physicians through their professional status. Pharmaceutical companies generally engage key opinion leaders early in the drug development process to provide advocacy and key marketing feedback. Some pharmaceutical companies identify key opinion leaders through direct inquiry of physicians (primary research). Recently, pharmaceutical companies have begun to use social network analysis to uncover thought leaders; because it does not introduce respondent bias, which is commonly found in primary research; it can identify and map out the entire scientific community for a disease state; and it has greater compliance with state and federal regulations; because physician prescribing patterns are not used to create the social network.

Alternatives to segmenting physicians purely on the basis of prescribing do exist, and marketers can call upon strategic partners who specialize in delineating which characteristics of true opinion leadership, a physician does or does not possess. Such analyses can help guide marketers in how to optimize KOL engagements as bona fide advisors to a brand, and can help shape clinical development and clinical data publication plans for instance, ultimately advancing patient care.

Colleagues

Physicians acquire information through informal contacts with their colleagues, including social events, professional affiliations, common hospital affiliations, and common medical school affiliations. Some pharmaceutical companies identify influential colleagues through commercially available prescription writing and patient level data. Doctor dinner meetings are an effective way for physicians to acquire educational information from respected peers. These meetings are sponsored by some pharmaceutical companies.

Journal articles and technical documentation

Recent legal cases and US congressional hearings have provided access to pharmaceutical industry documents revealing new marketing strategies for drugs. Activities once considered independent of promotional intent, including continuing medical education and medical research, are used, including paying to publish articles about promoted drugs for the medical literature, and alleged suppression of unfavorable study results.

Private and public insurers

Public and private insurers affect the writing of prescriptions by physicians through formularies that restrict the number and types of drugs that the insurer will cover. Not only can the insurer affect drug sales by including or excluding a particular drug from a formulary, they can affect sales by tiering, or placing bureaucratic hurdles to prescribing certain drugs. In January 2006, the United States instituted a new public prescription drug plan through its Medicare program. Known as Medicare Part D, this program engages private insurers to negotiate with pharmaceutical companies for the placement of drugs on tiered formularies.

To consumers

Only two countries as of 2008 allow direct to consumer advertising (DTCA): the United States and New Zealand. Since the late 1970s, DTCA of prescription drugs has become important in the United States. It takes two main forms: the promotion or creation of a disease out of a non-pathologic physical condition or the promotion of a medication. The rhetorical objective of direct-to-consumer advertising is to directly influence the patient-physician dialogue. Many patients will inquire about, or even demand a medication they have seen advertised on television. In the United States, recent years have seen an increase in mass media advertisements for pharmaceuticals. Expenditures on direct-to-users advertising have more than quintupled in the seven years between 1997 and 2005 since the FDA changed the guidelines, from $1.1 billion in 1997 to more than $4.2 billion in 2005, a 19.6% annual increase, according to the United States Government Accountability Office, 2006).

The mass marketing to users of pharmaceuticals is banned in over 30 industrialized nations, but not in the US and New Zealand, which is considering a ban. Some feel it is better to leave the decision wholly in the hands of medical professionals; others feel that users education and participation in health is useful, but users need independent, comparative information about drugs (not promotional information). For these reasons, most countries impose limits on pharmaceutical mass marketing that are not placed on the marketing of other products. In some areas it is required that ads for drugs include a list of possible side effects, so that users are informed of both facets of a medicine. Canada's limitations on pharmaceutical advertising ensure that commercials that mention the name of a product cannot in any way describe what it does. Commercials that mention a medical problem cannot also mention the name of the product for sale; at most, they can direct the viewer to a website or telephone number operated by the pharmaceutical company. 

Reynold Spector has provided examples of how positive and negative hype can affect perceptions of pharmaceuticals using examples of certain cancer drugs, such as Avastin and Opdivo, in the former case and statins in the latter.

Drug coupons

In the United States, pharmaceutical companies often provide drug coupons to consumers to help offset the copayments charged by health insurers for prescription medication. These coupons are generally used to promote medications that compete with non-preferred products and cheaper, generic alternatives by reducing or eliminating the extra out-of-pocket costs that an insurers typically charge a patient for a non-preferred drug product.

Economics

Pharmaceutical company spending on marketing exceeds that spent on research. In 2004 in Canada $1.7 billion a year was spent marketing drugs to physicians and in the United States $21 billion were spent in 2002. In 2005 money spent on pharmaceutical marketing in the United States was estimated at $29.9 billion with one estimate as high as $57 billion. When the US number are broken down 56% was free samples, 25% was detailing of physicians, 12.5% was direct to users advertising, 4% on hospital detailing, and 2% on journal ads. In the United States approximately $20 billion could be saved if generics were used instead of equivalent brand name products.

Although pharmaceutical companies have made large investments in marketing their products, overall promotional spending has been decreasing over the last few years, and declined by 10 percent from 2009 to 2010. Pharmaceutical companies are cutting back mostly in detailing and sampling, while spending in mailings and print advertising grew since last year.

Regulation and fraud

European Union

In the European Union, marketing of pharmaceuticals is regulated by EU (formerly EEC) Directive 92/28/EEC. Among other things, it requires member states to prohibit off-label marketing, and direct-to-consumer marketing of prescription-only medications.

United States

In the United States, marketing and distribution of pharmaceuticals is regulated by the Federal Food, Drug, and Cosmetic Act and the Prescription Drug Marketing Act, respectively. Food and Drug Administration (FDA) regulations require all prescription drug promotion to be truthful and not misleading, based on "substantial evidence or substantial clinical experience", to provide a "fair balance" between the risks and benefits of the promoted drug, and to maintain consistency with labeling approved by the FDA. The FDA Office of Prescription Drug Promotion enforces these requirements. 

In the 1990s, antipsychotics were "still seen as treatments for the most serious mental illnesses, like hallucinatory schizophrenia, and recast them for much broader uses". Drugs such as Abilify and Geodon were given to a broad range of patients, from preschoolers to octogenarians. In 2010, more than a half-million youths took antipsychotic drugs, and one-quarter of nursing-home residents have used them. Yet the government warns that the drugs may be fatal to some older patients and have unknown effects on children.

Every major company selling the drugs—Bristol-Myers Squibb, Eli Lilly, Pfizer, AstraZeneca, and Johnson & Johnson—has either settled recent government cases, under the False Claims Act, for hundreds of millions of dollars or is currently under investigation for possible health care fraud. Following charges of illegal marketing, two of the settlements in 2009 set records for the largest criminal fines ever imposed on corporations. One involved Eli Lilly’s antipsychotic Zyprexa, and the other involved Bextra. In the Bextra case, the government also charged Pfizer with illegally marketing another antipsychotic, Geodon; Pfizer settled that part of the claim for $301 million, without admitting any wrongdoing.

The following is a list of the four largest settlements reached with pharmaceutical companies from 1991 to 2012, rank ordered by the size of the total settlement. Legal claims against the pharmaceutical industry have varied widely over the past two decades, including Medicare and Medicaid fraud, off-label promotion, and inadequate manufacturing practices.

Company	Settlement	Violation(s)	Year	Product(s)	Laws allegedly violated (if applicable)
GlaxoSmithKline	$3 billion	Off-label promotion/failure to disclose safety data	2012	Avandia/Wellbutrin/Paxil	False Claims Act/FDCA
Pfizer	$2.3 billion	Off-label promotion/kickbacks	2009	Bextra/Geodon/Zyvox/Lyrica	False Claims Act/FDCA
Abbott Laboratories	$1.5 billion	Off-label promotion	2012	Depakote	False Claims Act/FDCA
Eli Lilly	$1.4 billion	Off-label promotion	2009	Zyprexa	False Claims Act/FDCA

Evolution of marketing

The emergence of new media and technologies in recent years is quickly changing the pharmaceutical marketing landscape in the United States. Both physicians and users are increasing their reliance on the Internet as a source of health and medical information, prompting pharmaceutical marketers to look at digital channels for opportunities to reach their target audiences.

In 2008, 84% of U.S. physicians used the Internet and other technologies to access pharmaceutical, biotech or medical device information—a 20% increase from 2004. At the same time, sales reps are finding it more difficult to get time with doctors for in-person details. Pharmaceutical companies are exploring online marketing as an alternative way to reach physicians. Emerging e-promotional activities include live video detailing, online events, electronic sampling, and physician customer service portals such as PV Updates, MDLinx, Aptus Health (former Physicians Interactive), and Epocrates. 

Direct-to-users marketers are also recognizing the need to shift to digital channels as audiences become more fragmented and the number of access points for news, entertainment and information multiplies. Standard television, radio and print direct-to-users (DTC) advertisements are less relevant than in the past, and companies are beginning to focus more on digital marketing efforts like product websites, online display advertising, search engine marketing, social media campaigns, place-based media and mobile advertising to reach the over 145 million U.S. adults online for health information. 

In 2010, the FDA's Division of Drug Marketing, Advertising and Communications issued a warning letter concerning two unbranded consumer targeted Web sites sponsored by Novartis Pharmaceuticals Corporation as the websites promoted a drug for an unapproved use, the websites failed to disclose the risks associated with the use of the drug and made unsubstantiated dosing claims.

Scattered disc

From Wikipedia, the free encyclopedia

Eris, the largest known scattered-disc object (center), and its moon Dysnomia (left of object)

The scattered disc (or scattered disk) is a distant circumstellar disc in the Solar System that is sparsely populated by icy small solar system bodies, which are a subset of the broader family of trans-Neptunian objects. The scattered-disc objects (SDOs) have orbital eccentricities ranging as high as 0.8, inclinations as high as 40°, and perihelia greater than 30 astronomical units (4.5×10⁹ km; 2.8×10⁹ mi). These extreme orbits are thought to be the result of gravitational "scattering" by the gas giants, and the objects continue to be subject to perturbation by the planet Neptune. 

Although the closest scattered-disc objects approach the Sun at about 30–35 AU, their orbits can extend well beyond 100 AU. This makes scattered objects among the coldest and most distant objects in the Solar System. The innermost portion of the scattered disc overlaps with a torus-shaped region of orbiting objects traditionally called the Kuiper belt, but its outer limits reach much farther away from the Sun and farther above and below the ecliptic than the Kuiper belt proper.

Because of its unstable nature, astronomers now consider the scattered disc to be the place of origin for most periodic comets in the Solar System, with the centaurs, a population of icy bodies between Jupiter and Neptune, being the intermediate stage in an object's migration from the disc to the inner Solar System. Eventually, perturbations from the giant planets send such objects towards the Sun, transforming them into periodic comets. Many objects of the proposed Oort cloud are also thought to have originated in the scattered disc. Detached objects are not sharply distinct from scattered disc objects, and some such as Sedna have sometimes been considered to be included in this group.

Discovery

Traditionally, devices like a blink comparator were used in astronomy to detect objects in the Solar System, because these objects would move between two exposures—this involved time-consuming steps like exposing and developing photographic plates or films, and people then using a blink comparator to manually detect prospective objects. During the 1980s, the use of CCD-based cameras in telescopes made it possible to directly produce electronic images that could then be readily digitized and transferred to digital images. Because the CCD captured more light than film (about 90% versus 10% of incoming light) and the blinking could now be done at an adjustable computer screen, the surveys allowed for higher throughput. A flood of new discoveries was the result: over a thousand trans-Neptunian objects were detected between 1992 and 2006.

The first scattered-disc object (SDO) to be recognised as such was 1996 TL₆₆, originally identified in 1996 by astronomers based at Mauna Kea in Hawaii. Three more were identified by the same survey in 1999: 1999 CV₁₁₈, 1999 CY₁₁₈, and 1999 CF₁₁₉. The first object presently classified as an SDO to be discovered was 1995 TL₈, found in 1995 by Spacewatch.

As of 2011, over 200 SDOs have been identified, including 2007 UK₁₂₆ (discovered by Schwamb, Brown, and Rabinowitz), 2002 TC₃₀₂ (NEAT), Eris (Brown, Trujillo, and Rabinowitz), Sedna (Brown, Trujillo, and Rabinowitz) and 2004 VN112 (Deep Ecliptic Survey). Although the numbers of objects in the Kuiper belt and the scattered disc are hypothesized to be roughly equal, observational bias due to their greater distance means that far fewer SDOs have been observed to date.

Subdivisions of trans-Neptunian space

The eccentricity and inclination of the scattered-disc population compared to the classical and 5:2 resonant Kuiper-belt objects

Known trans-Neptunian objects are often divided into two subpopulations: the Kuiper belt and the scattered disc. A third reservoir of trans-Neptunian objects, the Oort cloud, has been hypothesized, although no confirmed direct observations of the Oort cloud have been made. Some researchers further suggest a transitional space between the scattered disc and the inner Oort cloud, populated with "detached objects".

Scattered disc versus Kuiper belt

The Kuiper belt is a relatively thick torus (or "doughnut") of space, extending from about 30 to 50 AU comprising two main populations of Kuiper belt objects (KBOs): the classical Kuiper-belt objects (or "cubewanos"), which lie in orbits untouched by Neptune, and the resonant Kuiper-belt objects; those which Neptune has locked into a precise orbital ratio such as 2:3 (the object goes around twice for every three Neptune orbits) and 1:2 (the object goes around once for every two Neptune orbits). These ratios, called orbital resonances, allow KBOs to persist in regions which Neptune's gravitational influence would otherwise have cleared out over the age of the Solar System, since the objects are never close enough to Neptune to be scattered by its gravity. Those in 2:3 resonances are known as "plutinos", because Pluto is the largest member of their group, whereas those in 1:2 resonances are known as "twotinos". 

In contrast to the Kuiper belt, the scattered-disc population can be disturbed by Neptune. Scattered-disc objects come within gravitational range of Neptune at their closest approaches (~30 AU) but their farthest distances reach many times that. Ongoing research suggests that the centaurs, a class of icy planetoids that orbit between Jupiter and Neptune, may simply be SDOs thrown into the inner reaches of the Solar System by Neptune, making them "cis-Neptunian" rather than trans-Neptunian scattered objects. Some objects, like (29981) 1999 TD₁₀, blur the distinction and the Minor Planet Center (MPC), which officially catalogues all trans-Neptunian objects, now lists centaurs and SDOs together.

The MPC, however, makes a clear distinction between the Kuiper belt and the scattered disc, separating those objects in stable orbits (the Kuiper belt) from those in scattered orbits (the scattered disc and the centaurs). However, the difference between the Kuiper belt and the scattered disc is not clear-cut, and many astronomers see the scattered disc not as a separate population but as an outward region of the Kuiper belt. Another term used is "scattered Kuiper-belt object" (or SKBO) for bodies of the scattered disc.

Morbidelli and Brown propose that the difference between objects in the Kuiper belt and scattered-disc objects is that the latter bodies "are transported in semi-major axis by close and distant encounters with Neptune," but the former experienced no such close encounters. This delineation is inadequate (as they note) over the age of the Solar System, since bodies "trapped in resonances" could "pass from a scattering phase to a non-scattering phase (and vice versa) numerous times." That is, trans-Neptunian objects could travel back and forth between the Kuiper belt and the scattered disc over time. Therefore, they chose instead to define the regions, rather than the objects, defining the scattered disc as "the region of orbital space that can be visited by bodies that have encountered Neptune" within the radius of a Hill sphere, and the Kuiper belt as its "complement ... in the a > 30 AU region"; the region of the Solar System populated by objects with semi-major axes greater than 30 AU.

Detached objects

The Minor Planet Center classifies the trans-Neptunian object 90377 Sedna as a scattered-disc object. Its discoverer Michael E. Brown has suggested instead that it should be considered an inner Oort-cloud object rather than a member of the scattered disc, because, with a perihelion distance of 76 AU, it is too remote to be affected by the gravitational attraction of the outer planets. Under this definition, an object with a perihelion greater than 40 AU could be classified as outside the scattered disc. 

Sedna is not the only such object: (148209) 2000 CR105 (discovered before Sedna) and 2004 VN112 have a perihelion too far away from Neptune to be influenced by it. This led to a discussion among astronomers about a new minor planet set, called the extended scattered disc (E-SDO).  2000 CR105 may also be an inner Oort-cloud object or (more likely) a transitional object between the scattered disc and the inner Oort cloud. More recently, these objects have been referred to as "detached", or distant detached objects (DDO).

There are no clear boundaries between the scattered and detached regions. Gomes et al. define SDOs as having "highly eccentric orbits, perihelia beyond Neptune, and semi-major axes beyond the 1:2 resonance." By this definition, all distant detached objects are SDOs. Since detached objects' orbits cannot be produced by Neptune scattering, alternative scattering mechanisms have been put forward, including a passing star or a distant, planet-sized object.

A scheme introduced by a 2005 report from the Deep Ecliptic Survey by J. L. Elliott et al. distinguishes between two categories: scattered-near (i.e. typical SDOs) and scattered-extended (i.e. detached objects). Scattered-near objects are those whose orbits are non-resonant, non-planetary-orbit-crossing and have a Tisserand parameter (relative to Neptune) less than 3. Scattered-extended objects have a Tisserand parameter (relative to Neptune) greater than 3 and have a time-averaged eccentricity greater than 0.2.

An alternative classification, introduced by B. J. Gladman, B. G. Marsden and C. Van Laerhoven in 2007, uses 10-million-year orbit integration instead of the Tisserand parameter. An object qualifies as an SDO if its orbit is not resonant, has a semi-major axis no greater than 2000 AU, and, during the integration, its semi-major axis shows an excursion of 1.5 AU or more. Gladman et al. suggest the term scattering disk object to emphasize this present mobility. If the object is not an SDO as per the above definition, but the eccentricity of its orbit is greater than 0.240, it is classified as a detached TNO. (Objects with smaller eccentricity are considered classical.) In this scheme, the disc extends from the orbit of Neptune to 2000 AU, the region referred to as the inner Oort cloud.

Orbits

Distribution of trans-Neptunian objects, with semi-major axis on the horizontal, and inclination on the vertical axis. Scattered disc objects are shown in grey, objects that are in resonance with Neptune in red. Classical Kuiper belt objects (cubewanos) and sednoids are blue and yellow, respectively.

The scattered disc is a very dynamic environment. Because they are still capable of being perturbed by Neptune, SDOs' orbits are always in danger of disruption; either of being sent outward to the Oort cloud or inward into the centaur population and ultimately the Jupiter family of comets. For this reason Gladman et al. prefer to refer to the region as the scattering disc, rather than scattered. Unlike Kuiper-belt objects (KBOs), the orbits of scattered-disc objects can be inclined as much as 40° from the ecliptic.

SDOs are typically characterized by orbits with medium and high eccentricities with a semi-major axis greater than 50 AU, but their perihelia bring them within influence of Neptune. Having a perihelion of roughly 30 AU is one of the defining characteristics of scattered objects, as it allows Neptune to exert its gravitational influence.

The classical objects (cubewanos) are very different from the scattered objects: more than 30% of all cubewanos are on low-inclination, near-circular orbits whose eccentricities peak at 0.25. Classical objects possess eccentricities ranging from 0.2 to 0.8. Though the inclinations of scattered objects are similar to the more extreme KBOs, very few scattered objects have orbits as close to the ecliptic as much of the KBO population.

Although motions in the scattered disc are random, they do tend to follow similar directions, which means that SDOs can become trapped in temporary resonances with Neptune. Examples of possible resonant orbits within the scattered disc include 1:3, 2:7, 3:11, 5:22 and 4:79.

Formation

Simulation showing Outer Planets and Kuiper Belt: a) Before Jupiter/Saturn 2:1 resonance b) Scattering of Kuiper-belt objects into the Solar System after the orbital shift of Neptune c) After ejection of Kuiper-belt bodies by Jupiter

The scattered disc is still poorly understood: no model of the formation of the Kuiper belt and the scattered disc has yet been proposed that explains all their observed properties.

According to contemporary models, the scattered disc formed when Kuiper belt objects (KBOs) were "scattered" into eccentric and inclined orbits by gravitational interaction with Neptune and the other outer planets. The amount of time for this process to occur remains uncertain. One hypothesis estimates a period equal to the entire age of the Solar System; a second posits that the scattering took place relatively quickly, during Neptune's early migration epoch.

Models for a continuous formation throughout the age of the Solar System illustrate that at weak resonances within the Kuiper belt (such as 5:7 or 8:1), or at the boundaries of stronger resonances, objects can develop weak orbital instabilities over millions of years. The 4:7 resonance in particular has large instability. KBOs can also be shifted into unstable orbits by close passage of massive objects, or through collisions. Over time, the scattered disc would gradually form from these isolated events.

Computer simulations have also suggested a more rapid and earlier formation for the scattered disc. Modern theories indicate that neither Uranus nor Neptune could have formed in situ beyond Saturn, as too little primordial matter existed at that range to produce objects of such high mass. Instead, these planets, and Saturn, may have formed closer to Jupiter, but were flung outwards during the early evolution of the Solar System, perhaps through exchanges of angular momentum with scattered objects. Once the orbits of Jupiter and Saturn shifted to a 2:1 resonance (two Jupiter orbits for each orbit of Saturn), their combined gravitational pull disrupted the orbits of Uranus and Neptune, sending Neptune into the temporary "chaos" of the proto-Kuiper belt. As Neptune traveled outward, it scattered many trans-Neptunian objects into higher and more eccentric orbits. This model states that 90% or more of the objects in the scattered disc may have been "promoted into these eccentric orbits by Neptune's resonances during the migration epoch...[therefore] the scattered disc might not be so scattered."

Composition

The infrared spectra of both Eris and Pluto, highlighting their common methane absorption lines

Scattered objects, like other trans-Neptunian objects, have low densities and are composed largely of frozen volatiles such as water and methane. Spectral analysis of selected Kuiper belt and scattered objects has revealed signatures of similar compounds. Both Pluto and Eris, for instance, show signatures for methane.

Astronomers originally supposed that the entire trans-Neptunian population would show a similar red surface colour, as they were thought to have originated in the same region and subjected to the same physical processes. Specifically, SDOs were expected to have large amounts of surface methane, chemically altered into complex organic molecules by energy from the Sun. This would absorb blue light, creating a reddish hue. Most classical objects display this colour, but scattered objects do not; instead, they present a white or greyish appearance.

One explanation is the exposure of whiter subsurface layers by impacts; another is that the scattered objects' greater distance from the Sun creates a composition gradient, analogous to the composition gradient of the terrestrial and gas giant planets. Michael E. Brown, discoverer of the scattered object Eris, suggests that its paler colour could be because, at its current distance from the Sun, its atmosphere of methane is frozen over its entire surface, creating an inches-thick layer of bright white ice. Pluto, conversely, being closer to the Sun, would be warm enough that methane would freeze only onto cooler, high-albedo regions, leaving low-albedo tholin-covered regions bare of ice.

Comets

Tempel 1, a Jupiter-family comet

The Kuiper belt was initially thought to be the source of the Solar System's ecliptic comets. However, studies of the region since 1992 have shown that the orbits within the Kuiper belt are relatively stable, and that ecliptic comets originate from the scattered disc, where orbits are generally less stable.

Comets can loosely be divided into two categories: short-period and long-period—the latter being thought to originate in the Oort cloud. The two major categories of short-period comets are Jupiter-family comets (JFCs) and Halley-type comets. Halley-type comets, which are named after their prototype, Halley's Comet, are thought to have originated in the Oort cloud but to have been drawn into the inner Solar System by the gravity of the giant planets, whereas the JFCs are thought to have originated in the scattered disc. The centaurs are thought to be a dynamically intermediate stage between the scattered disc and the Jupiter family.

There are many differences between SDOs and JFCs, even though many of the Jupiter-family comets may have originated in the scattered disc. Although the centaurs share a reddish or neutral coloration with many SDOs, their nuclei are bluer, indicating a fundamental chemical or physical difference. One hypothesis is that comet nuclei are resurfaced as they approach the Sun by subsurface materials which subsequently bury the older material.

The False Promise of ‘Medicare for All’

Cost is only part of the problem. Single-payer systems create long waits and delays on new drugs.

By Scott W. Atlas

Nov. 12, 2018 6:48 p.m. ET 

Original link:   https://www.wsj.com/articles/the-false-promise-of-medicare-for-all-1542066511

 

Illustration: Chad Crowe

Health care was a priority for midterm voters, and for good reason. In nearly five years since ObamaCare’s major provisions came into effect, insurance premiums have doubled for individuals and risen 140% for families, even while deductibles have increased substantially. Hospitals and doctors continue to flee ObamaCare’s coverage network, to the point that almost 75% of plans are now highly restrictive. ObamaCare also encouraged a record pace of consolidation among hospitals and physician practices. All these developments will raise health-care prices, as fewer hospitals compete for payers.

The Democrats’ solution would make the problem far worse. Single-payer health care is an alluringly simple concept: a government guarantee for all medical care. Advocates insist that such care is “free.” The constitution of Britain’s National Health Service states: “You have the right to receive NHS services free of charge”—ignoring that the U.K. funds the program by taxing citizens some $160 billion a year, even with its severe limits on access to specialists, drugs and technology.

For California alone, single-payer health care would cost about $400 billion a year—more than twice the state’s annual budget. Nationwide “Medicare for all” would cost more than $32 trillion over its first decade. Doubling federal income and corporate taxes wouldn’t be enough to pay for it. No doubt, that cost would be used to justify further restrictions on health-care access.

But the problems with single-payer go well beyond cost. In the past half-century, nationalized programs have consistently failed to provide timely, high-quality medical care compared with the U.S. system. That failure has countless consequences for citizens: pain, suffering and death, permanent disability, and forgone wages.

Single-payer programs usually impose long waiting lists and delays unheard of in the U.S. Last year, a record 4.2 million patients were on England’s NHS waiting lists; 362,600 patients waited longer than four months for hospital treatment as of that March, and 95,252 waited longer than six months. By this July, 4,300 people had been on the wait list more than a year—all after receiving their diagnosis and referral—according to NHS England’s “Referral to Treatment” waiting-times data.

In Canada last year, the median wait time between seeing a general practitioner and following up with a specialist was 10.2 weeks, while the wait between seeing a doctor and beginning treatment was about five months. According to a Fraser Institute study, the average Canadian waits three months to see an ophthalmologist, four months for an orthopedist and five months for a neurosurgeon.

In single-payer systems, even patients referred for “urgent treatment” often wait months. More than 19% of patients in Britain’s NHS wait two months or longer to begin their first urgent cancer treatment, while 17% wait more than four months for brain surgery. In Canada the median wait for neurosurgery after seeing a doctor is about eight months. Canadians with heart disease wait three months for their first treatment. And if you need life-changing orthopedic surgery in Canada, like a hip or knee replacement, you’ll likely have to wait a startling 10 months.

America’s system is much quicker. Aside from transplants, one paper by the Organization for Economic Cooperation and Development states, “waiting lists are not a feature in the United States.”

A study in Health Affairs found that “in contrast to England, most United States patients face little or no wait for elective cardiac care.” The Agency for Healthcare Research and Quality has said that low-risk U.S. heart patients “sometimes have to wait all day or even be rescheduled for another day” for catheterization—that is, a wait for even one day is considered unusual.

Calls for reform were widespread in American media in 2009, though waits for appointments at that time averaged 21 days for five common specialties. With the exception of orthopedist appointments for knee pain, those waits were for healthy checkups, the lowest medical priority. In the U.S. even waits for checkups are usually far shorter than waits for seriously ill patients in countries with single payer.

Single-payer systems also impose long delays before debuting the newest drugs for cancer and other serious diseases. A 2011 Health Affairs study showed that the Food and Drug Administration approved 32 new cancer drugs in the decade after 2000, while the European Medicines Agency approved 26. All 23 drugs approved by both Europe and the U.S. were available to American patients first. Two-thirds of the 45 “novel” drugs in 2015 were approved in the U.S. before any other country.

These waits and restrictions have severe consequences for patients. Single-payer systems have proved inferior to the U.S. in outcomes for almost all serious diseases, including cancer, diabetes, high blood pressure, stroke and heart disease.

Meanwhile, the nations most experienced with single-payer systems are moving toward private provision. Sweden has increased its spending on private care for the elderly by 50% in the past decade, abolished its government’s monopoly over pharmacies, and made other reforms. Last year alone, the British government spent more than $1 billion on care from private and other non-NHS providers, according to the Financial Times. Patients using single-payer care in Denmark can now choose a private hospital or a hospital outside the country if their wait time exceeds one month.

A single-payer “guarantee” is no promise of access to quality medical care. If brought to the U.S., the only reliable promises of single-payer would be worse health care for Americans and higher taxes. America’s poor and middle class would suffer the most from a turn to single-payer, because only they would be unable to circumvent the system.
 
Dr. Atlas is a senior fellow at Stanford’s Hoover Institution and author of “Restoring Quality Health Care: A Six Point Plan for Comprehensive Reform at Lower Cost.”

Appeared in the November 13, 2018, print edition.

Oort cloud (updated)

From Wikipedia, the free encyclopedia

This graphic shows the distance from the Oort cloud to the rest of the Solar System and two of the nearest stars measured in astronomical units. The scale is logarithmic, with each specified distance ten times further out than the previous one. Red arrow indicates location of Voyager 1, a space probe that will reach the Oort cloud in about 300 years.

 

An artist's impression of the Oort cloud and the Kuiper belt (inset). Sizes of individual objects have been exaggerated for visibility.

The Oort cloud (/ɔːrt, ʊərt/), named after the Dutch astronomer Jan Oort, sometimes called the Öpik–Oort cloud, is a theoretical cloud of predominantly icy planetesimals proposed to surround the Sun at distances ranging from 2,000 to 200,000 AU (0.03 to 3.2 light-years). It is divided into two regions: a disc-shaped inner Oort cloud (or Hills cloud) and a spherical outer Oort cloud. Both regions lie beyond the heliosphere and in interstellar space. The Kuiper belt and the scattered disc, the other two reservoirs of trans-Neptunian objects, are less than one thousandth as far from the Sun as the Oort cloud.

The outer limit of the Oort cloud defines the cosmographical boundary of the Solar System and the extent of the Sun's Hill sphere. The outer Oort cloud is only loosely bound to the Solar System, and thus is easily affected by the gravitational pull both of passing stars and of the Milky Way itself. These forces occasionally dislodge comets from their orbits within the cloud and send them toward the inner Solar System. Based on their orbits, most of the short-period comets may come from the scattered disc, but some may still have originated from the Oort cloud.

Astronomers conjecture that the matter composing the Oort cloud formed closer to the Sun and was scattered far into space by the gravitational effects of the giant planets early in the Solar System's evolution. Although no confirmed direct observations of the Oort cloud have been made, it may be the source of all long-period and Halley-type comets entering the inner Solar System, and many of the centaurs and Jupiter-family comets as well.

The existence of the Oort cloud was first postulated by Estonian astronomer Ernst Öpik in 1932.

Hypothesis

There are two main classes of comet: short-period comets (also called ecliptic comets) and long-period comets (also called nearly isotropic comets). Ecliptic comets have relatively small orbits, below 10 AU, and follow the ecliptic plane, the same plane in which the planets lie. All long-period comets have very large orbits, on the order of thousands of AU, and appear from every direction in the sky.

A. O. Leuschner in 1907 suggested that many comets believed to have parabolic orbits, and thus making single visits to the solar system, actually had elliptical orbits and would return after very long periods. In 1932 Estonian astronomer Ernst Öpik postulated that long-period comets originated in an orbiting cloud at the outermost edge of the Solar System. Dutch astronomer Jan Oort independently revived the idea in 1950 as a means to resolve a paradox:

• Over the course of the Solar System's existence the orbits of comets are unstable and eventually dynamics dictate that a comet must either collide with the Sun or a planet or else be ejected from the Solar System by planetary perturbations.
• Moreover, their volatile composition means that as they repeatedly approach the Sun, radiation gradually boils the volatiles off until the comet splits or develops an insulating crust that prevents further outgassing.

Thus, Oort reasoned, a comet could not have formed while in its current orbit and must have been held in an outer reservoir for almost all of its existence. He noted that there was a peak in numbers of long-period comets with aphelia (their farthest distance from the Sun) of roughly 20,000 AU, which suggested a reservoir at that distance with a spherical, isotropic distribution. Those relatively rare comets with orbits of about 10,000 AU have probably gone through one or more orbits through the Solar System and have had their orbits drawn inward by the gravity of the planets.

Structure and composition

The presumed distance of the Oort cloud compared to the rest of the Solar System

The Oort cloud is thought to occupy a vast space from somewhere between 2,000 and 5,000 AU (0.03 and 0.08 ly) to as far as 50,000 AU (0.79 ly) from the Sun. Some estimates place the outer edge at between 100,000 and 200,000 AU (1.58 and 3.16 ly). The region can be subdivided into a spherical outer Oort cloud of 20,000–50,000 AU (0.32–0.79 ly), and a torus-shaped inner Oort cloud of 2,000–20,000 AU (0.0–0.3 ly). The outer cloud is only weakly bound to the Sun and supplies the long-period (and possibly Halley-type) comets to inside the orbit of Neptune. The inner Oort cloud is also known as the Hills cloud, named after Jack G. Hills, who proposed its existence in 1981. Models predict that the inner cloud should have tens or hundreds of times as many cometary nuclei as the outer halo; it is seen as a possible source of new comets to resupply the tenuous outer cloud as the latter's numbers are gradually depleted. The Hills cloud explains the continued existence of the Oort cloud after billions of years.

The outer Oort cloud may have trillions of objects larger than 1 km (0.62 mi), and billions with absolute magnitudes brighter than 11 (corresponding to approximately 20-kilometre (12 mi) diameter), with neighboring objects tens of millions of kilometres apart. Its total mass is not known, but, assuming that Halley's Comet is a suitable prototype for comets within the outer Oort cloud, roughly the combined mass is 3×10²⁵ kilograms (6.6×10²⁵ lb), or five times that of Earth. Earlier it was thought to be more massive (up to 380 Earth masses), but improved knowledge of the size distribution of long-period comets led to lower estimates. The mass of the inner Oort cloud has not been characterized. 

If analyses of comets are representative of the whole, the vast majority of Oort-cloud objects consist of ices such as water, methane, ethane, carbon monoxide and hydrogen cyanide. However, the discovery of the object 1996 PW, an object whose appearance was consistent with a D-type asteroid in an orbit typical of a long-period comet, prompted theoretical research that suggests that the Oort cloud population consists of roughly one to two percent asteroids. Analysis of the carbon and nitrogen isotope ratios in both the long-period and Jupiter-family comets shows little difference between the two, despite their presumably vastly separate regions of origin. This suggests that both originated from the original protosolar cloud, a conclusion also supported by studies of granular size in Oort-cloud comets and by the recent impact study of Jupiter-family comet Tempel 1.

Origin

The Oort cloud is thought to be a remnant of the original protoplanetary disc that formed around the Sun approximately 4.6 billion years ago. The most widely accepted hypothesis is that the Oort cloud's objects initially coalesced much closer to the Sun as part of the same process that formed the planets and minor planets, but that gravitational interaction with young gas giants such as Jupiter ejected the objects into extremely long elliptic or parabolic orbits. Recent research has been cited by NASA hypothesizing that a large number of Oort cloud objects are the product of an exchange of materials between the Sun and its sibling stars as they formed and drifted apart, and it is suggested that many—possibly the majority of—Oort cloud objects did not form in close proximity to the Sun. Simulations of the evolution of the Oort cloud from the beginnings of the Solar System to the present suggest that the cloud's mass peaked around 800 million years after formation, as the pace of accretion and collision slowed and depletion began to overtake supply.

Models by Julio Ángel Fernández suggest that the scattered disc, which is the main source for periodic comets in the Solar System, might also be the primary source for Oort cloud objects. According to the models, about half of the objects scattered travel outward toward the Oort cloud, whereas a quarter are shifted inward to Jupiter's orbit, and a quarter are ejected on hyperbolic orbits. The scattered disc might still be supplying the Oort cloud with material. A third of the scattered disc's population is likely to end up in the Oort cloud after 2.5 billion years.

Computer models suggest that collisions of cometary debris during the formation period play a far greater role than was previously thought. According to these models, the number of collisions early in the Solar System's history was so great that most comets were destroyed before they reached the Oort cloud. Therefore, the current cumulative mass of the Oort cloud is far less than was once suspected. The estimated mass of the cloud is only a small part of the 50–100 Earth masses of ejected material.

Gravitational interaction with nearby stars and galactic tides modified cometary orbits to make them more circular. This explains the nearly spherical shape of the outer Oort cloud. On the other hand, the Hills cloud, which is bound more strongly to the Sun, has not acquired a spherical shape. Recent studies have shown that the formation of the Oort cloud is broadly compatible with the hypothesis that the Solar System formed as part of an embedded cluster of 200–400 stars. These early stars likely played a role in the cloud's formation, since the number of close stellar passages within the cluster was much higher than today, leading to far more frequent perturbations.

In June 2010 Harold F. Levison and others suggested on the basis of enhanced computer simulations that the Sun "captured comets from other stars while it was in its birth cluster". Their results imply that "a substantial fraction of the Oort cloud comets, perhaps exceeding 90%, are from the protoplanetary discs of other stars".

Comets

Comet Hale–Bopp, an archetypical Oort-cloud comet

Comets are thought to have two separate points of origin in the Solar System. Short-period comets (those with orbits of up to 200 years) are generally accepted to have emerged from either the Kuiper belt or the scattered disc, which are two linked flat discs of icy debris beyond Neptune's orbit at 30 AU and jointly extending out beyond 100 AU from the Sun. Long-period comets, such as comet Hale–Bopp, whose orbits last for thousands of years, are thought to originate in the Oort cloud. The orbits within the Kuiper belt are relatively stable, and so very few comets are thought to originate there. The scattered disc, however, is dynamically active, and is far more likely to be the place of origin for comets. Comets pass from the scattered disc into the realm of the outer planets, becoming what are known as centaurs. These centaurs are then sent farther inward to become the short-period comets.

There are two main varieties of short-period comet: Jupiter-family comets (those with semi-major axes of less than 5 AU) and Halley-family comets. Halley-family comets, named for their prototype, Halley's Comet, are unusual in that although they are short-period comets, it is hypothesized that their ultimate origin lies in the Oort cloud, not in the scattered disc. Based on their orbits, it is suggested they were long-period comets that were captured by the gravity of the giant planets and sent into the inner Solar System. This process may have also created the present orbits of a significant fraction of the Jupiter-family comets, although the majority of such comets are thought to have originated in the scattered disc.

Oort noted that the number of returning comets was far less than his model predicted, and this issue, known as "cometary fading", has yet to be resolved. No dynamical process are known to explain the smaller number of observed comets than Oort estimated. Hypotheses for this discrepancy include the destruction of comets due to tidal stresses, impact or heating; the loss of all volatiles, rendering some comets invisible, or the formation of a non-volatile crust on the surface. Dynamical studies of hypothetical Oort cloud comets have estimated that their occurrence in the outer-planet region would be several times higher than in the inner-planet region. This discrepancy may be due to the gravitational attraction of Jupiter, which acts as a kind of barrier, trapping incoming comets and causing them to collide with it, just as it did with Comet Shoemaker–Levy 9 in 1994.

Tidal effects

Most of the comets seen close to the Sun seem to have reached their current positions through gravitational perturbation of the Oort cloud by the tidal force exerted by the Milky Way. Just as the Moon's tidal force deforms Earth's oceans, causing the tides to rise and fall, the galactic tide also distorts the orbits of bodies in the outer Solar System. In the charted regions of the Solar System, these effects are negligible compared to the gravity of the Sun, but in the outer reaches of the system, the Sun's gravity is weaker and the gradient of the Milky Way's gravitational field has substantial effects. Galactic tidal forces stretch the cloud along an axis directed toward the galactic centre and compress it along the other two axes; these small perturbations can shift orbits in the Oort cloud to bring objects close to the Sun. The point at which the Sun's gravity concedes its influence to the galactic tide is called the tidal truncation radius. It lies at a radius of 100,000 to 200,000 AU, and marks the outer boundary of the Oort cloud.

Some scholars theorise that the galactic tide may have contributed to the formation of the Oort cloud by increasing the perihelia (smallest distances to the Sun) of planetesimals with large aphelia (largest distances to the Sun). The effects of the galactic tide are quite complex, and depend heavily on the behaviour of individual objects within a planetary system. Cumulatively, however, the effect can be quite significant: up to 90% of all comets originating from the Oort cloud may be the result of the galactic tide. Statistical models of the observed orbits of long-period comets argue that the galactic tide is the principal means by which their orbits are perturbed toward the inner Solar System.

Stellar perturbations and stellar companion hypotheses

Besides the galactic tide, the main trigger for sending comets into the inner Solar System is thought to be interaction between the Sun's Oort cloud and the gravitational fields of nearby stars or giant molecular clouds. The orbit of the Sun through the plane of the Milky Way sometimes brings it in relatively close proximity to other stellar systems. For example, it is hypothesized that 70 thousand years ago, perhaps Scholz's star passed through the outer Oort cloud (although its low mass and high relative velocity limited its effect). During the next 10 million years the known star with the greatest possibility of perturbing the Oort cloud is Gliese 710. This process could also scatter Oort cloud objects out of the ecliptic plane, potentially also explaining its spherical distribution.

In 1984, Physicist Richard A. Muller postulated that the Sun has a heretofore undetected companion, either a brown dwarf or a red dwarf, in an elliptical orbit within the Oort cloud. This object, known as Nemesis, was hypothesized to pass through a portion of the Oort cloud approximately every 26 million years, bombarding the inner Solar System with comets. However, to date no evidence of Nemesis or the Oort cloud have been found, and many lines of evidence (such as crater counts), have thrown their existence into doubt. Recent scientific analysis no longer supports the idea that extinctions on Earth happen at regular, repeating intervals. Thus, the Nemesis hypothesis is no longer needed to explain current assumptions.

A somewhat similar hypothesis was advanced by astronomer John J. Matese of the University of Louisiana at Lafayette in 2002. He contends that more comets are arriving in the inner Solar System from a particular region of the postulated Oort cloud than can be explained by the galactic tide or stellar perturbations alone, and that the most likely cause would be a Jupiter-mass object in a distant orbit. This hypothetical gas giant was nicknamed Tyche. The WISE mission, an all-sky survey using parallax measurements in order to clarify local star distances, was capable of proving or disproving the Tyche hypothesis. In 2014, NASA announced that the WISE survey had ruled out any object as they had defined it.

Future exploration

Artist's impression of the TAU spacecraft

Space probes have yet to reach the area of the Oort cloud. Voyager 1, the fastest and farthest of the interplanetary space probes currently leaving the Solar System, will reach the Oort cloud in about 300 years and would take about 30,000 years to pass through it. However, around 2025, the radioisotope thermoelectric generators on Voyager 1 will no longer supply enough power to operate any of its scientific instruments, preventing any exploration by Voyager 1. The other four probes currently escaping the Solar System either are already or are predicted to be non-functional when they reach the Oort cloud; however, it may be possible to find an object from the cloud that has been knocked into the inner Solar System. 

In the 1980s there was a concept for a probe to reach 1,000 AU in 50 years called TAU; among its missions would be to look for the Oort cloud.

In the 2014 Announcement of Opportunity for the Discovery program, an observatory to detect the objects in the Oort cloud (and Kuiper belt) called the "Whipple Mission" was proposed. It would monitor distant stars with a photometer, looking for transits up to 10,000 AU away. The observatory was proposed for halo orbiting around L2 with a suggested 5-year mission. It has been suggested that the Kepler observatory may also be able to detect objects in the Oort cloud.