Rampant Fraud in ‘Skin’ Bandages Paid by Medicare

A “quirk” in the Medicare law allows ‘skin’ bandage firms to charge, and have Medicare pay them, exorbitant prices. Are such quirks accidents or intentional? Medicare rules are so voluminous and obscure that few have an incentive to look carefully at the details. But the firms selling ‘skin’ bandages had an incentive. Entrepreneurs within these firms saw an opportunity and seized it. But they are what William Baumol called “destructive entrepreneurs.” Their energy and talent works against the general good.

Since patients are not paying, they have little incentive to reveal the fraud. So the taxpayers are robbed. In a system where the patients are the payers they would have an incentive to reveal fraud, and to seek alternatives to over-priced medical therapies.

But what of the poor, you ask? Susan Feigenbaum proposed an insurance system where patients would receive lump sum payments for different ailments. Then poor patients could be payers, and have the incentives of payer.

(p. 1) Seniors across the country are wearing very expensive bandages.

Made of dried bits of placenta, the paper-thin patches cover stubborn wounds and can cost thousands of dollars per square inch.

Some research has found that such “skin substitutes” help certain wounds heal. But in the past few years, dozens of unstudied and costly products have flooded the market.

Bandage companies set ever-rising prices for new brands of the products, taking advantage of a loophole in Medicare rules, The New York Times found. Some doctors then buy the coverings at large discounts but charge Medicare the full sticker price, pocketing the difference.

Partly because of these financial incentives, many patients receive the bandages who do not need them. The result, experts said, is one of the largest examples of Medicare waste in history.

Private insurers rarely pay for skin substitutes, arguing that they are unproven and unnecessary. But Medicare, the government insurance program for seniors, routinely covers them. Spending on skin substitutes exceeded $10 billion in 2024, more than double the figure in 2023, according to an analysis of Medicare data done for The Times by Early Read, a firm that evaluates costs for large health companies.

Medicare now spends more on the bandages than on ambulance rides, anesthesia or CT scans, the analysis found.

. . .

(p. 19) . . . experts in health care costs said the spike had been driven . . . by sellers and doctors taking advantage of Medicare’s pricing rules. The government will reimburse any price that a company sets for brand-new skin substitutes, even if it is far above the market average. The higher the price, the larger the doctors’ cut.

And the bigger the bandage, the more they can charge. For one patient in Nevada, Medicare spent $14 million on skin substitutes over the course of a year, according to billing records reviewed by The Times. The wound of a patient in Washington State persisted after Medicare paid $6 million for the coverings. A man in Texas got $1.3 million of bandages despite having no wound at all. Health executives trying to ferret out suspicious spending identified these patients and shared their stories with The Times.

As the Trump administration — and particularly the new Department of Government Efficiency run by Elon Musk — aims to shrink the federal purse, profligate Medicare spending is a ripe target, experts said.

Companies have billed Medicare for hundreds of thousands of urinary catheters that doctors never ordered. Other schemes have peddled urine tests and knee braces. In 2023, a federal watchdog agency flagged skin substitute spending as wasteful for both taxpayers and Medicare enrollees, who ultimately pay the costs with higher premiums.

“It’s the patients, it’s the taxpayers — unfortunately everyone is footing a part of the bill for this outsized spend,” said Dana Rye, an executive with Duly Health and Care, a Chicago-based medical group where payments for skin substitutes have risen 1,400 percent since 2022.

. . .

Five years ago, the most expensive skin substitute cost $1,042 per square inch, while some were as cheap as $45. Today, the three most expensive products on the market each cost more than $21,000. (Samaritan Biologics, a company in Memphis that sells the three products, did not answer questions about why they cost so much.)

Companies can set such high prices because of a quirk in Medicare pricing rules, industry experts said. For the first six months of a new bandage product’s life, Medicare will set the reimbursement rate at whatever price a company chooses. After that, the agency adjusts the reimbursement to reflect the actual price paid by doctors after any discounts.

To circumvent the reimbursement drop, some companies simply roll out new products.

In April 2023, Medicare began reimbursing $6,497 for every square inch of a bandage called Zenith, sold by Legacy Medical Consultants, a company in Fort Worth, Texas. Six months later, Zenith’s reimbursement fell to $2,746.

That month, October 2023, Medicare began reimbursing $6,490 for a new Legacy product, a “dual layer” bandage called Impax.

Marketing materials for the two products use identical photographs and similar language. The company describes both products as providing “optimal wound covering and protection during the treatment of wounds.”

Since 2022, spending on Zenith and Impax has exceeded $2.6 billion, according to Early Read’s analysis.

. . .

A cottage industry of doctors and nurses make house calls to treat wounds. Some skin substitute companies pitch themselves to wound care doctors by offering a cut of the rising bandage prices.

Dr. Caroline Fife, a wound care doctor from Texas who often writes about industry excesses, shared on her blog last year an email she received from an undisclosed skin substitute company. The company boasted that other doctors had developed “a healthy revenue stream” from its bandages and that a patch smaller than a credit card “would generate a little over $20,000 for your practice.”

Some companies offer doctors a “bulk discount” of up to 45 percent, according to doctor interviews and contracts reviewed by The Times. But doctors then collect a Medicare reimbursement for the full price of the product.

For the full story, see:

Sarah Kliff and Katie Thomas. “‘Skin’ Bandages Cost Medicare, And Doctors Get a Cut of Billions.” The New York Times, First Section. (Sun., April 13, 2025): 1 & 19.

(Note: ellipses added.)

(Note: the online version was updated April 14, 2025, and has the title “Medicare Bleeds Billions on Pricey Bandages, and Doctors Get a Cut.”)

The article by William Baumol praised in my initial comments is:

Baumol, William J. “Entrepreneurship: Productive, Unproductive, and Destructive.” The Journal of Political Economy 98, no. 5, Part 1 (Oct. 1990): 893-921.

The article by Susan Feigenbaum praised in my initial comments is:

Feigenbaum, Susan. “Body Shop’ Economics: What’s Good for Our Cars May Be Good for Our Health.” Regulation 15, no. 4 (Fall 1992): 25-31.

“A.I.s Are Overly Complicated, Patched-Together Rube Goldberg Machines Full of Ad-Hoc Solutions”

A.I. can be a useful tool for searching and summarizing the current state of consensus knowledge. But I am highly dubious that it will ever be able to make the breakthrough leaps that some humans are sometimes able to make. And I am somewhat dubious that it will ever be able to make the resilient pivots that all of us must sometimes make in the face of new and unexpected challenges.

(p. B2) In a series of recent essays, [Melanie] Mitchell argued that a growing body of work shows that it seems possible models develop gigantic “bags of heuristics,” rather than create more efficient mental models of situations and then reasoning through the tasks at hand. (“Heuristic” is a fancy word for a problem-solving shortcut.)

When Keyon Vafa, an AI researcher at Harvard University, first heard the “bag of heuristics” theory, “I feel like it unlocked something for me,” he says. “This is exactly the thing that we’re trying to describe.”

Vafa’s own research was an effort to see what kind of mental map an AI builds when it’s trained on millions of turn-by-turn directions like what you would see on Google Maps. Vafa and his colleagues used as source material Manhattan’s dense network of streets and avenues.

The result did not look anything like a street map of Manhattan. Close inspection revealed the AI had inferred all kinds of impossible maneuvers—routes that leapt over Central Park, or traveled diagonally for many blocks. Yet the resulting model managed to give usable turn-by-turn directions between any two points in the borough with 99% accuracy.

Even though its topsy-turvy map would drive any motorist mad, the model had essentially learned separate rules for navigating in a multitude of situations, from every possible starting point, Vafa says.

The vast “brains” of AIs, paired with unprecedented processing power, allow them to learn how to solve problems in a messy way which would be impossible for a person.

. . .

. . ., today’s AIs are overly complicated, patched-together Rube Goldberg machines full of ad-hoc solutions for answering our prompts. Understanding that these systems are long lists of cobbled-together rules of thumb could go a long way to explaining why they struggle when they’re asked to do things even a little bit outside their training, says Vafa. When his team blocked just 1% of the virtual Manhattan’s roads, forcing the AI to navigate around detours, its performance plummeted.

This illustrates a big difference between today’s AIs and people, he adds. A person might not be able to recite turn-by-turn directions around New York City with 99% accuracy, but they’d be mentally flexible enough to avoid a bit of roadwork.

For the full commentary see:

Christopher Mims. “We Now Know How AI ‘Thinks.’ It Isn’t Thinking at All.” The Wall Street Journal (Saturday, April 26, 2025): B2.

(Note: ellipses added.)

(Note: the online version of the commentary has the date April 25, 2025, and has the title “We Now Know How AI ‘Thinks’—and It’s Barely Thinking at All.”)

A conference draft of the paper that Vafa co-authored on A.I.’s mental map of Manhattan is:

Vafa, Keyon, Justin Y. Chen, Ashesh Rambachan, Jon Kleinberg, and Sendhil Mullainathan. “Evaluating the World Model Implicit in a Generative Model.” In 38th Conference on Neural Information Processing Systems (NeurIPS). Vancouver, BC, Canada, Dec. 2024.

Health Freedom Is a Right AND Can Yield More and Faster Therapies

The headline of the article on the front page of the NYT says “No Evidence for Healing Powers,” and goes on to slam unsophisticated right-wingers as irresponsibly pushing ivermectin as a therapy for cancer. In the article the NYT publishes a ludicrous picture from a right-winger’s Facebook page where he has spread veterinary ivermectin cream on his tongue and says “tastes like dead cancer.”

But this is unfair and tendentious caricature. A friend recently sent me an Instagram post by a chiropractor suffering from glioblastoma who has taken ivermectin and mebendazole. He briefly sketches the hypothesized mechanisms for activity of the two drugs, consistent with research published in scientific papers.

Glioblastoma is a serious, often fatal, brain cancer. He had surgery, but knows that surgery often does not cure, so he threw a Hail Mary and took ivermectin and mebendazole. These drugs have long track-records for safety, having been tested and approved for other uses. Doctors can, and have, prescribed drugs for off-label uses for decades.

Decades ago minoxidil was approved as an blood pressure medicine. I asked my then-doctor to prescribe it for me for its rumored effects as a hair loss cure. He did, so I crushed the tablets and somehow applied them to my scalp, which proceeded to itch, but not grow hair. It was a low-risk, modest-chance-of-success experiment. I think I had a right to try it, and that no government or expert had a right to forbid it. (Eventually minoxidil was approved for hair loss and branded Rogaine–which still didn’t work for me.)

In a free country adults should have wide latitude to make decisions about what risks they take; to scuba dive, to drive NASCAR, to go into space, and yes to take ivermectin and mebendazole. And the ludicrous right-winger? Hey, maybe even he has rights.

The NYT headline says there is “no evidence” for ivermectin. Below I cite a survey article that identifies 24 articles published in scientific journals identifying mechanisms by which ivermectin may be effective against cancer. There’s plenty of evidence, just not from randomized double-blind clinical trials (RCTs). But as long-time readers of this blog may remember, I have posted many entries giving useful actionable evidence that takes forms other than RCTs.

“No evidence”? Maybe the NYT was seeking plausible deniability by running its article on April 1st.

Oh, and by the way, allowing health freedom might sometimes result in better and faster therapies. I am currently reading Rethinking Diabetes by Gary Taubes. He tells the story (pp. 346-356) of Richard K. Bernstein, an engineer with Type 1 diabetes who was suffering from various serious ailments from his diabetes, in spite of the doctors saying it was being well-controlled by insulin. In his 40s, he was only expected to live another 10 years. Well he bought a new device that was not supposed to be bought by patients. The medical profession thought patients could not handle the information. (His wife was an MD, so he ‘bought’ it by asking her to buy it for him.) The device allowed him to get frequent readings of his blood sugar, and thereby to better control it, ultimately through changes in diet. When he tried to share what he had learned, he had trouble finding anyone who would take him seriously, so in his 40s he enrolled in medical school, and started publishing papers and books describing his results.

Richard K. Bernstein died on April 15, 2025 at age 90.

[Below are some relevant quotations from a NYT companion piece to the front-page article. The companion piece provides only slightly less tendentious background information on ivermectin.]

(p. A21) . . . there is not evidence to support people taking ivermectin to treat cancer.

. . .

Scientists do not dispute that ivermectin is powerfully effective — against parasites. The drug was such a breakthrough in the fight against tropical parasitic diseases that two scientists who studied it won the Nobel Prize in 2015.

The Food and Drug Administration has approved ivermectin tablets to treat certain parasitic infections, and the agency has authorized ivermectin lotions to kill lice and creams to help with rosacea. Veterinarians also use the drug to prevent and treat parasitic diseases in animals.

. . .

Studies in human cells suggest that the drug may kill certain types of cancer cells in a way that triggers the immune system, said Dr. Peter P. Lee, chair of the department of immuno-oncology at Beckman Research Institute of City of Hope in Duarte, Calif. In mouse studies, Dr. Lee has seen that the drug, on its own, does not shrink breast tumors. But it’s possible that the drug may have benefits for breast cancer when used alongside existing cancer immunotherapy, he said. Researchers are studying a combination of ivermectin and an investigational cancer drug in people with breast cancer.

While some inaccurate social media posts claim that ivermectin can treat cancer because tumors themselves are parasitic, the promise of ivermectin for cancer has nothing to do with its anti-parasitic effect, Dr. Lee said. Rather, it seems that the drug may be able to modulate a signal involved with cancer growth.

But doctors still need larger, randomized clinical trials to better understand whether ivermectin could treat cancer. Just because a drug seems to work in animals doesn’t mean those results will translate into real-world outcomes, Dr. Johnson noted. There are “hundreds of medications that look to be promising in a preclinical setting” every year, he said, adding, “The vast majority of those will never be shown to be effective in humans.”

. . .

Doctors generally view ivermectin as safe at the doses prescribed to treat parasitic infections.

For the full story, see:

Dani Blum. “What Ivermectin Can and Can’t Do, and What the Dangers Are.” The New York Times (Tues., April 1, 2025): A21.

(Note: ellipses added.)

(Note: the online version has the date March 31, 2025, and has the title “What Ivermectin Can (and Can’t) Do.” In the first quoted sentence, the print version says “no evidence” and the online version says “not evidence.”)

The Blum article that I just quoted and cited, is a secondary companion article to a longer front-page article, also on ivermectin:

Richard Fausset. “No Evidence for Healing Powers, but ‘Tastes Like Dead Cancer’.” The New York Times (Tues., April 1, 2025): A1 & A21.

(Note: the online version has the date March 31, 2025, and has the title “Why the Right Still Embraces Ivermectin.”)

The paper cited below reviewed the published scientific literature as of 2020 on the mechanisms through which ivermectin could have anti-cancer effects, finding 24 articles documenting one or more mechanisms.

Tang, Mingyang, Xiaodong Hu, Yi Wang, Xin Yao, Wei Zhang, Chenying Yu, Fuying Cheng, Jiangyan Li, and Qiang Fang. “Ivermectin, a Potential Anticancer Drug Derived from an Antiparasitic Drug.” Pharmacological Research 163 (Jan. 2021): 105207.

Tang and co-authors are optimistic in their summary section quoted below. [In this quote IVM is “ivermectin” and MDR is “multidrug resistance”.]

. . ., the broad-spectrum antiparasitic drug IVM, which is widely used in the field of parasitic control, has many advantages that suggest that it is worth developing as a potential new anticancer drug. IVM selectively inhibits the proliferation of tumors at a dose that is not toxic to normal cells and can reverse the MDR of tumors. Importantly, IVM is an established drug used for the treatment of parasitic diseases such as river blindness and elephantiasis. It has been widely used in humans for many years, and its various pharmacological properties, including long- and short-term toxicological effects and drug metabolism characteristics are very clear. (Tang et al. Jan. 2021, pp. 7-8)

The paper cited below reviewed the published scientific literature as of 2019 on the effect of mebendazole on cancer, and found 26 in vitro studies showing anti-cancer biological effects, 14 in vivo studies showing anti-tumor effects, and six Phase 1 or Phase 2 clinical trials listed in ClinicalTrials.gov.

Guerini, Andrea Emanuele, Luca Triggiani, Marta Maddalo, Marco Lorenzo Bonù, Francesco Frassine, Anna Baiguini, Alessandro Alghisi, Davide Tomasini, Paolo Borghetti, Nadia Pasinetti, Roberto Bresciani, Stefano Maria Magrini, and Michela Buglione. “Mebendazole as a Candidate for Drug Repurposing in Oncology: An Extensive Review of Current Literature.” Cancers 11, no. 9 (Aug. 2019): article #1284.

Gary Taubes’s book, praised by Marty Makary and Siddhartha Mukherjee, and mentioned by me near the end of my commentary, is:

Taubes, Gary. Rethinking Diabetes: What Science Reveals About Diet, Insulin, and Successful Treatments. New York: Knopf, 2024.

[I thank Ivette Locay for sending me a link useful for my commentary.]

Director of the N.I.H. Was “Subject to Censorship by the Actions of the Biden Administration”

During the Covid-19 pandemic, I had an invited essay cancelled by the OECD in which I argued for freedom of speech in science, and especially for toleration of a diversity of views during the pandemic. So I have sympathy for the attacks Dr. Bhattacharya suffered during the pandemic and wish him well as the Director of the National Institutes of Health.

(p. B1) Dr. [Jay] Bhattacharya, who has a medical degree and is a professor of medicine but never practiced, burst into the spotlight in October 2020, when he co-wrote an anti-lockdown treatise, the Great Barrington Declaration. It argued for “focused protection” — a strategy to protect the elderly and vulnerable while letting the virus spread among younger, healthier people.

Many scientists countered that walling off at-risk populations from the rest of society was a pipe dream.

The nation’s medical leadership, including Dr. Francis S. Collins, who retired last week, and Dr. Anthony S. Fauci, then director of the National Institute of Allergy and Infectious Diseases, denounced the plan. Referring to Dr. Bhattacharya and his co-authors as “fringe epidemiologists,” Dr. Collins wrote in an email that “there needs to be a quick and devastating takedown of its premises.”

Dr. Bhattacharya told senators on Wednesday [March 5, 2025] that he had been “subject to censorship by the actions of the Biden administration.” Past N.I.H. officials, he said, “oversaw a culture of cover-up, obfuscation and a lack of tolerance for ideas that differ from theirs.”

For the full story see:

Benjamin Mueller and Sheryl Gay Stolberg. “Guarded Nominee for N.I.H. Faces Sharp Questions on Vaccines and Research Cuts.” The New York Times (Thursday, March 6, 2025): A18.

(Note: bracketed date added.)

(Note: the online version of the story has the date March 5, 2025, and has the title “Guarded N.I.H. Nominee Faces Sharp Questions on Vaccines and Research Cuts.”)

George Church Is Optimistic About A.I., but in 2019 Also Was Optimistic He Would Reverse Aging in Dogs by 2022

Steve Lohr had an article in the NYT promoting the possibility that generative intelligence from A.I. will bring us scientific breakthroughs quicker. A new startup called “Lila” is trying to achieve this. George Church of Harvard is onboard.

Back on Sun., Dec. 8, 2019, 60 Minutes on ran a very optimistic segment in which Church says that through his lab’s work on gene editing, age reversal for dogs “might be a couple years away and then that takes another ten years to get through the human clinical trials” (Church as quoted in Pelley 2019).

In Lohr’s recent article, Church is quoted as saying ““I think science is a really good topic for A.I.” (Church as quoted in Lohr, p. B5). The article describes science as basically a mechanical process of trial and error. Some science is like that, like when Gerhard Domagk had his lab crank through hundreds of chemicals to find one (Prontosil) that was a broad spectrum antibiotic. Maybe A.I. could more efficiently crank through a large set of possibilities. The only example of medical advance through A.I. in the article is that “Lila’s A.I. has generated novel antibodies to fight disease” (Lohr, p. B5).

A.I. can combine what is known in novel ways and produce text that is new, but is not necessarily sensible, correct, or useful, let alone a profound leap.

So it is not clear to me how well A.I. could help define and prioritize the possibilities. Lila scientists are feeding their A.I. program scientific literature, presumably weighting differing views by some bibliometric measures, like citations or journal rankings. But often a leap or breakthrough is at first rejected by the top journals, and not heavily cited by the establishment.

I do not see how A.I. could identify those early breakthroughs, much less be the source of them. And making and identifying such breakthroughs are key steps in scientific progress.

I was was pumped when I heard Church’s optimism in 2019 for longevity breakthroughs. But now it is more than five years later, and I have not seen claims of age reversal for dogs, let alone for humans. Maybe Covid delayed progress. Or maybe Church is not a good judge of what is required for scientific breakthroughs. This latter possibility seems more likely given Church’s hyper-enthusiasm for generative A.I.

Steve Lohr’s article is:

Lohr, Steve. “A.I. May Hasten Leaps in Science.” The New York Times (Thurs., March 13, 2025): B1 & B5.

(Note: the online version of the Steve Lohr article has the date March 10, 2025, and has the title “The Quest for A.I. ‘Scientific Superintelligence’.”)

A transcript of the 60 Minutes segment on Church is:

Pelley, Scott. “A Harvard Geneticist’s Goal: To Protect Humans from Viruses, Genetic Diseases, and Aging.” In 60 Minutes. CBS News, (Sun., Dec. 8, 2019).

Croatian Government Does Not Learn from Distant Past (or Recent Past) That Price Controls Do Not Work

In Croatia, as in the United States, inflation resulted when each government “flooded the country with cash” to buy votes during the Covid pandemic.

(p. 4) In 301 A.D., the Emperor Diocletian made a bold but ultimately unsuccessful bid to address the inflation that was rampaging across the eastern half of the divided Roman Empire.

Prices of everything from purple thread and feathers to slaves and cattle were dictated by his Edict on Maximum Prices. Violators faced the death penalty. Diocletian gave up power about four years after issuing his edict, watching his measure fail from his sprawling retirement palace in the heart of what became the city of Split in Croatia.

Now Croatia’s government is trying a similar tactic to rein in prices that have soared in recent years and sparked protests and retail boycotts by the country’s beleaguered consumers.

. . .

The rules that came into effect this month are the Croatian government’s third attempt at controlling prices by fiat since September 2022. The first two efforts were largely ineffective, with retailers simply refusing to stock most price-controlled goods.

. . .

Economists blame the increases on a three-headed hydra of pandemic-era economic rescue packages that flooded the country with cash, increases in public sector wages and retailers rounding up prices after Croatia adopted the euro in 2023.

. . .

John H. Cochrane, an economist and fellow at the Hoover Institution, a research center, pointed to the role Diocletian’s edict played in causing shortages and fueling a black market.

“It’s like trying to stem the symptoms rather than treating the underlying disease,” Mr. Cochrane said of price controls. “It offers people the appearance of help for a while, and then it takes a few weeks or, a month or two, for all the problems to break out.”

For the full story, see:

Joe Orovic. “A Croatian Plan to Rein In Prices Echoes the Tack of an Emperor.” The New York Times, First Section. (Sun., March 9, 2025): 4.

(Note: ellipses added.)

(Note: the online version was updated March 10, 2025, and has the title “Echoing a Roman Emperor, Croatia Tries to Cap Soaring Prices.” Where there is a slight difference in wording, the passages quoted above follow the online version.)

Mark Twain “Dared to State Things That Others Only Thought”

I have read three of Ron Chernow’s massive biographies, the ones on Rockefeller, Washington, and Hamilton. Because they are massive, reading them takes a long time, at least for a slow reader like me. But I learned a lot that is important or useful from them, especially the ones on Rockefeller and Hamilton. Because I am an admirer of both Chernow and Twain, I look forward to also reading Chernow’s biography of Twain.

(p. C7) More than a century after his death, Mark Twain remains one of the most recognizable voices in American literature—the author of “The Adventures of Tom Sawyer” (1876), “Life on the Mississippi” (1883) and “Adventures of Huckleberry Finn” (1884), the latter among the most consequential novels ever written in English and possibly (if you believe Ernest Hemingway) the source of American literature itself.

. . .

In his biography of the famed satirist, Ron Chernow tracks, with patience and care, Twain’s journey over nearly eight tumultuous decades. Mr. Chernow’s tale is enlivened by blazing quotes from Twain’s prodigious interviews, diaries and letters.  . . .  The quotes tend to burn a hole in the page, and it’s difficult for a biographer to recover. Mr. Chernow, whose lives of George Washington, Alexander Hamilton and Ulysses S. Grant are revered for their sound scholarship, clear writing and strong narrative drive, weaves Twain’s sizzling remarks almost seamlessly into his own narrative.

We watch as Twain lunges from coast to coast, rolling up and down the Mississippi (as a riverboat pilot in his early days), moving from country to country, writing books and articles, investing large sums in various hair-brained schemes.

. . .

This was, in Twain’s own phrase, the Gilded Age. He admired, even idealized, those who made huge sums of money through their entrepreneurial energy and acumen. He had the same energy, but he didn’t have the right vehicles for speculation nor the business sense to make his investments pay off. As Mr. Chernow observes, Twain could well have enjoyed an easy life of writing and giving lectures, having married a wealthy woman and published several bestsellers. “Instead, he had started a publishing house and financed a typesetter”—the Paige Compositor, which was supposed to replace manual typesetting but failed spectacularly because of engineering flaws—“before he had the expertise or requisite fortune to bring them to completion.” His expenses soon dwarfed his income and he was forced to abandon his Hartford mansion, never to return.

. . .

Twain was “a man who professed to be chronically lazy,” says Mr. Chernow, yet he left behind him a vast portfolio of writings that included 30 books, several thousand magazine articles and some 12,000 letters. “Mark Twain had not only moved people to laughter and tears with his books,” Mr. Chernow writes, “but had challenged them with unorthodox views as he ventured out from his safe cubbyhole as the avuncular humorist. He had dared to state things that others only thought.” It’s because of this bravery, and his peerless gift for expression, that we still value him and will never stop reading his books, which never grow old.

For the full review see:

Jay Parini. “A Most American Writer.” The Wall Street Journal (Saturday, May 10, 2025): C7.

(Note: ellipses added.)

(Note: the online version of the review has the date May 9, 2025, and has the title “‘Mark Twain’: The Most American Writer.”)

The book under review is:

Chernow, Ron. Mark Twain. New York: The Penguin Press, 2025.

Immunotherapy Can Succeed as First Line of Attack Against Solid Tumors

About two to three percent of solid tumor cancer patients have tumors with what is called “mismatch mutations.” Researchers at Memorial Sloan Kettering have announced success at using immunotherapy to treat patients with these mutations. Many had their tumors completely disappear. Johns Hopkins oncologist Bert Vogelstein called the results “groundbreaking” (as quoted in Kolata 2025, p. A24).

The cures matter most, but what also matters is that immunotherapy was the first line of treatment, so the patients did not have to suffer the “grisly” side effects that often come with the traditional surgery, radiation, and chemo treatments.

The upside is huge. The downside is that it only works for two to three percent of solid tumor patients, and the drug costs about $100,000 per patient.

Kolata’s article is:

Gina Kolata. “Immunotherapy Drug Spares Cancer Patients From Grisly Treatments.” The New York Times (Weds., April 28, 2025): A24.

(Note: the online version of Kolata’s article has the date April 27, 2025, and has the title “Medicine Spares Cancer Patients From Grisly Surgeries and Harsh Therapies.”)

The academic paper published online in The New England Journal of Medicine is:

Cercek, Andrea, Michael B. Foote, Benoit Rousseau, J. Joshua Smith, Jinru Shia, Jenna Sinopoli, Jill Weiss, Melissa Lumish, Lindsay Temple, Miteshkumar Patel, Callahan Wilde, Leonard B. Saltz, Guillem Argiles, Zsofia Stadler, Oliver Artz, Steven Maron, Geoffrey Ku, Ping Gu, Yelena Y. Janjigian, Daniela Molena, Gopa Iyer, Jonathan Coleman, Wassim Abida, Seth Cohen, Kevin Soares, Mark Schattner, Vivian E. Strong, Rona Yaeger, Philip Paty, Marina Shcherba, Ryan Sugarman, Paul B. Romesser, Alice Zervoudakis, Avni Desai, Neil H. Segal, Imane El Dika, Maria Widmar, Iris Wei, Emmanouil Pappou, Gerard Fumo, Santiago Aparo, Mithat Gonen, Marc Gollub, Vetri S. Jayaprakasam, Tae-Hyung Kim, Julio Garcia Aguilar, Martin Weiser, and Luis A. Diaz. “Nonoperative Management of Mismatch Repair–Deficient Tumors.” The New England Journal of Medicine (April 27, 2025), DOI: 10.1056/NEJMoa2404512.

Rice Prices Soar as Japan Government Pays Rice Farmers to NOT Grow Rice

The long-standing policy of Japan’s government is to pay rice famers to grow less rice in order to raise the price of rice, so that rice farmers will earn more. In February 2025 the price of rice in Japan rose by 81 percent and supermarkets limited how much rice consumers could purchase. The average earnings of rice farmers in 2022 was about $23,000 and was not high enough to stop the exodus of rice farmers from farming.

Maybe Japan does not have a comparative advantage in growing rice, possibly due to high land prices and worker wages. Maybe in a totally free world market, Japan would not and should not grow much rice, buying it instead from places where land and wages are cheaper. The Japanese government, and the rest of us too, should embrace laissez-faire.

Source of the Japan rice story is:

River Akira Davis and Hisako Ueno. “Japanese Rice Farmers Blame Shortages on ‘Misguided’ Government Rules.” The New York Times (Mon., March 31, 2025): B4.

(Note: the online version of the NYT article has the date March 30, 2025, and has the title “In Tokyo, Rice Farmers Protest ‘Misguided’ Rules Fueling Shortages.”)

“Republicans in Congress Have Embarked on a Spree of Deregulation”

If Trump achieves a new Golden Age it will be through his “spree of deregulation” (as the NYT labels it), not through his tariffs.

(p. 24) As President Trump moves unilaterally to slash the federal bureaucracy and upend longstanding policies, Republicans in Congress have embarked on a spree of deregulation, using an obscure law to quietly but steadily chip away at Biden-era rules they say are hurting businesses and consumers.

In recent weeks, the G.O.P. has pushed through a flurry of legislation to cancel regulations on matters large and small, from oversight of firms that emit toxic pollutants to energy efficiency requirements for walk-in freezers and water heaters.

To do so, they are employing a little-known 1996 law, the Congressional Review Act, that allows lawmakers to reverse recently adopted federal regulations with a simple majority vote in both chambers. It is a strategy they used in 2017 during Mr. Trump’s first term and are leaning on again . . .

. . .

Because resolutions of disapproval under the Congressional Review Act need only a majority vote, they are some of the only legislation that can avoid a filibuster in the Senate. This allows them to circumvent the partisan gridlock that stands in the way of most significant bills.

So far this year, Mr. Trump has signed three such measures: one overturning Biden-era regulations on cryptocurrency brokers, another canceling fees on methane emissions and a third doing away with additional environmental assessments for prospective offshore oil and gas developers. Another five, including one that eliminates a $5 cap on bank overdraft fees, have cleared Congress and await Mr. Trump’s signature.

That is a much slower pace than eight years ago, when Republicans erased 13 Obama administration rules within Mr. Trump’s first 100 days in office. Before then, the law had been successfully used only once, when President George W. Bush reversed a Clinton-era ergonomics rule.

Now Republicans are trying to go much further with the law, including using it to effectively attack state regulations blessed by the federal government. The House this week passed three disapproval resolutions that would eliminate California’s strict air pollution standards for trucks and cars by rejecting waivers from the Environmental Protection Agency that allowed them to take effect.

. . .

Republicans, . . ., argue that the scope of their review prerogatives should not be determined by unelected bureaucrats.

“It’s members of Congress — not the G.A.O., not the parliamentarian — who decides how we proceed under the C.R.A.,” Representative Chip Roy, Republican of Texas, said in a speech on the House floor.

For the full story, see:

Maya C. Miller. “Republicans Use an Obscure Statute to Roll Back Biden-Era Regulations.” The New York Times, First Section. (Sun., May 4, 2025): 24.

(Note: ellipses added.)

(Note: the online version has the date May 3, 2025, and has the title “Republicans in Congress Use Obscure Law to Roll Back Biden-Era Regulations.” The online version says that the print version of the article in the New York edition was on p. 20 of the First Section. But in my National edition of the print version the article was on p. 24 of the First Section.)

Girls Who Are Skilled in Both STEM and Non-STEM Fields, Usually Prefer Non-STEM Fields

Gender discrimination is not the only explanation for there being more men than women in STEM jobs, according to the research summarized in the passages quoted below.

(p. C3) Scores of surveys over the last 50 years show that women tend to be more interested in careers that involve working with other people while men prefer jobs that involve manipulating objects, whether it is a hammer or a computer. These leanings can be seen in the lab, too. Studies published in the Personality and Social Psychology Bulletin in 2016, for example, found that women were more responsive to pictures of people, while men were more responsive to pictures of things.

Consistent with what men and women say they want, the STEM fields with more men, such as engineering and computer science, focus on objects while those with more women, such as psychology and biomedicine, focus on people.

Given the push to get more people—and especially more girls—interested in STEM, it is worth noting that talented students of both sexes tend to avoid a career in math or science if they can pursue something else. STEM jobs aren’t for everyone, regardless of how lucrative they may be.

A study of more than 70,000 high-school students in Greece, published in the Journal of Human Resources in 2024, found that girls on average outperformed boys in both STEM and non-STEM subjects but rarely pursued STEM in college if they were just as strong in other things. A study of middle-aged adults who had been precocious in math as teens, published in the journal Psychological Science in 2014, found that only around a quarter of the men were working in STEM and IT.

Large-scale studies around the world show that women are generally more likely than men to have skills in non-STEM areas, while men who are strong in math and science are often less skilled elsewhere. But while everyone seems to be concerned about whether girls are performing well in STEM classes, no one seems all that troubled by the fact that boys are consistently underperforming in reading and writing.

For the full essay see:

Hippel, William von. “Why Are Girls Less Likely to Become Scientists?” The Wall Street Journal (Saturday, March 8, 2025): C3.

(Note: the online version of the essay has the date March 6, 2025, and has the same title as the print version.)

Hippel’s essay, quoted above, is adapted from his book:

Hippel, William von. The Social Paradox: Autonomy, Connection, and Why We Need Both to Find Happiness. New York: Harper, 2025.

The academic study published in the Journal of Human Resources and mentioned above is:

Goulas, Sofoklis, Silvia Griselda, and Rigissa Megalokonomou. “Comparative Advantage and Gender Gap in Stem.” Journal of Human Resources 59, no. 6 (Nov. 2024): 1937-80.