Author: Art Diamond

Persian King Cyrus Tolerated Diversity of Religion and Culture

(p. C12) After another year that has cried out for inspiring leadership, I grasped glimmers of optimism from Matt Waters’s “King of the World,” a biography of Persian king Cyrus the Great.

. . .

Today Cyrus is revered as a model of pragmatic, benevolent rulership.

. . .

. . . Cyrus imposed or forbade no religion, language, ethnicity, dress code or culture on his native Persians or the many other peoples he ruled. Would that this were the case for his descendants today.

For the full review, see:

Timothy Potts. “12 Months of Reading; Timothy Potts.” The Wall Street Journal (Saturday, Dec. 10, 2021): C12.

(Note: ellipses added.)

(Note: the online version of the review has the date December 8, 2022, and has the title “Who Read What in 2022: Thinkers and Tastemakers.”)

The book praised by Timothy Potts is:

Waters, Matt. King of the World: The Life of Cyrus the Great. New York: Oxford University Press, 2022.

By 2030 mRNA Vaccines May Boost Immune Response of Metastatic Cancer Patients

(p. C4) The cofounders of BioNTech recently announced that vaccines targeting cancer may be available before the end of the decade. Researchers at Duke University are already developing a vaccine that targets mutations commonly arising in people with certain types of advanced breast cancer. Using the same mRNA technology deployed against Covid-19, these types of vaccines would not be administered prophylactically but, rather, used as a treatment to trigger a stronger immune response in patients with locally recurrent or metastatic disease. When it comes to conquering breast cancer, future medical historians will have plenty to write about.

For the full essay, see:

Lindsey Fitzharris. “A Medical Historian Confronts Breast Cancer.” The Wall Street Journal (Saturday, December 3, 2022): C4.

(Note: the online version of the essay has the date December 1, 2022, and has the same title as the print version.)

Project Entrepreneur Alex Oshmyansky Switched from Nonprofit to Profit to Raise Funds to Enable Project; Let Mark Cuban Take Credit for Project

(p. B1) DALLAS—When Mark Cuban got an email in 2018 from a stranger asking if he wanted to invest in a company dedicated to bringing down the cost of prescription drugs, he replied: “Tell me more.”

Today, the Dallas Mavericks owner and entrepreneur is helping steer the fledgling startup as it takes aim at high prescription drug prices and the industry middlemen who he says keeps them that way.

The Mark Cuban Cost Plus Drug Co. PBC, born from that brief email pitch from the company’s founder, Alex Oshmyansky, buys generic drugs from pharmaceutical manufacturers and sells them directly to patients online, rather than charging their insurance providers. By cutting out intermediaries and using a transparent pricing system, the pharmacy says it charges less than rivals for drugs: a 15% profit markup on a medicine’s cost, plus several dollars in fees for shipping and labor.

. . .

(p. B4) Several startups are attempting to reinvent parts of the pharmaceutical supply chain, removing costs by taking control of reimbursement, manufacturing and distribution.

Some firms, like ProvideGx and Civica Rx, are making drugs themselves so that they can control pricing and supply volumes. Others are selling directly to patients, bypassing the middleman known as pharmacy-benefit managers that traditionally handle drug coverage for health insurers.

A radiologist and former math prodigy, Dr. Oshmyansky received his undergraduate degree from the University of Colorado at Boulder at age 18, followed by an M.D. from Duke University and a Ph.D. in math from Oxford. He had the idea for a pharmacy after growing frustrated with pharmaceutical-industry pricing practices, such as companies hiking prices dramatically on decades-old drugs.

He planted the seed for the Cuban pharmacy in 2015 when he founded Osh’s Not-for-Profit Pharmaceuticals with a mission of manufacturing generic drugs and selling them to hospitals at a small markup on its costs.

He struggled to find investors to fund a nonprofit drug company, however, and eventually transitioned Osh’s into a for-profit entity. In 2018, he secured $1 million from investors through the Silicon Valley startup-incubator Y Combinator.

A few months later, in 2018, Dr. Oshmyansky emailed Mr. Cuban at his publicly available email address.

. . .

Eventually, Dr. Oshmyansky agreed to rename the company after Mr. Cuban in a bid to trade on his celebrity and attract free publicity.

For the full story, see:

Joseph Walker. “Mark Cuban Lands a Job at an Online Pharmacy.” The Wall Street Journal (Saturday, Dec. 10, 2022): B1 & B4.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the story has the date December 9, 2022, and has the title “Mark Cuban Has New Job: Working at Online Discount Pharmacy.”)

After Getting $170 Billion in Government Subsidies, Hospitals “Were Major Financial Beneficiaries of the Pandemic”

(p. B12) . . . hospitals . . . were major financial beneficiaries of the pandemic, receiving more than $170 billion in subsidies to defray their operating losses. A study looking at the finances of more than 2,000 hospitals concluded that financial losses from Covid-19 were largely offset by government relief in 2020, keeping profit margins largely intact. What is more, says Dr. Ge Bai, a professor who conducted the study with two other academics, profit rose significantly in 2021 as government aid persisted even as non-Covid activity rebounded.

“Contrary to the public perception, the industry benefited from the pandemic,” says Dr. Bai, a professor of health policy at the Johns Hopkins Bloomberg School of Public Health.

For the full commentary, see:

David Wainer. “A Profitable Prognosis.” The Wall Street Journal (Saturday, November 5, 2022): B12.

(Note: ellipses added.)

(Note: the online version of the commentary has the date November 4, 2022, and has the title “HEARD ON THE STREET; Hospitals Say They’re Still Ailing From Covid-19. Their Investors Feel Better.”)

Philosopher Argues That Human Flourishing Has Grown With “Access to Fossil Fuels”

(p. C13) The brilliance of Alex Epstein’s recent “Fossil Future” is that he writes not as a scientific expert but as a philosopher.

. . .

What is the best course of action to improve human flourishing? His answer is clear and unapologetic: more plentiful, reliable, abundant access to fossil fuels. The climate-disaster-related death rate, he points out, is 98% lower today than it was just a century ago—largely owing to innovations powered by fossil fuels. The right way to handle climate change isn’t to reverse it but to master its effects—a thesis that is as provocative as it is intuitive.

For the full review, see:

Vivek Ramaswamy. “12 Months of Reading; Vivek Ramaswamy.” The Wall Street Journal (Saturday, Dec. 10, 2021): C13.

(Note: ellipsis added.)

(Note: the online version of the review has the date December 8, 2022, and has the title “Who Read What in 2022: Thinkers and Tastemakers.”)

The book praised by Vivek Ramaswamy is:

Epstein, Alex. Fossil Future: Why Global Human Flourishing Requires More Oil, Coal, and Natural Gas–Not Less. New York: Portfolio, 2022..

Heat Deaths Rise Mostly Due to Rise in Fragile Aging Population

(p. A17) One recent and much-cited Lancet report appears deliberately deceptive.

The study offers a frightening statistic: Rapidly rising temperatures have increased annual global heat deaths among older people by 68% in less than two decades. That stark figure has been cited all over, from the BBC and Time to the Washington Post and the Times of India, the world’s largest-selling English-language daily.

. . .

Annual heat deaths have increased significantly among people 65 and older world-wide. The average deaths per year increased 68% from the early 2000s to the late 2010s. But that is almost entirely because there are so many more older people today than there were 20 years ago, in no small part thanks to medical innovations that keep us alive longer. Measured across the same time span the Lancet maps heat deaths, the number of people 65 and older has risen by 60%, or almost as much as heat deaths. When the increase in heat mortality is adjusted for this population growth, the actual rise that can be attributed to rising temperatures is only 5%.

It is hard not to see the Lancet study’s failure to adjust this figure as a deliberate act of deception.

For the full commentary, see:

Bjorn Lomborg. “The Lancet’s ‘Heat Death’ Deception.” The Wall Street Journal (Saturday, November 5, 2022): A17.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date November 4, 2022, and has the title “Climate Change and the Lancet’s ‘Heat Death’ Deception.”)

Firms Nimbly Shift Shipping Away from Unionized and Bottlenecked California Ports

(p. B1) Sharpie maker Newell Brands Inc. is opening distribution centers in Pennsylvania and North Carolina to lessen dependence on seaports in California. Abercrombie & Fitch Co. is moving more merchandise through New York and New Jersey to avoid West Coast bottlenecks. Air-conditioning manufacturer Trane Technologies PLC is sending most of its cargo this year through ports in the South, instead of the Los Angeles area.

The hierarchy of U.S. ports is getting shaken up. Companies across many industries are rethinking how and where they ship goods after years of relying heavily on the western U.S. as an entry point, betting that ports in the East and the South can save them time and money while reducing risk.

Their reasons range from fears of a dockworkers strike along the West Coast and a repeat of the bottlenecks that roiled supply chains early in the pandemic to a reduced dependence on Chinese production and the need to get products to all parts of the country faster.

In August [2022], Los Angeles lost its title as busiest port in the nation to the Port of (p. B6) New York and New Jersey as measured by the number of imported containers. It trailed its East Coast rival again in that measure during September and October, according to the Pacific Merchant Shipping Association and ports data.

The share of all U.S. containerized cargo handled by Los Angeles and a neighboring port in Long Beach fell through the first 10 months of the year to a combined 25% as measured by weight, according to census data analyzed by Jason Miller, interim chair of Michigan State University’s supply chain management department. That was their lowest level in nearly two decades, down from a height of 33%.

Other ports benefiting from this shift include Savannah, Ga., Houston and Charleston, S.C.

For the full story, see:

Paul Berger. “New Routes for Big Business.” The Wall Street Journal (Saturday, Dec. 10, 2022): B1 & B6.

(Note: bracketed year added.)

(Note: the online version of the story was updated Dec. 14, 2022, and has the title “California Long Ruled Shipping in U.S. Importers Look to East.”)

Share of Insulin Revenues Going to Middlemen Pharmacy Benefit Managers (PBMs) Increased by 155%

(p. B12) Pharmacy-benefit managers, or PBMs, have captured a growing slice of America’s world-leading drug spending during the past decade. The spotlight could soon shift to them.

. . .

While the three largest manufacturers of insulin—Eli Lilly, Novo Nordisk and Sanofi—charge more for their products in the U.S. than they do elsewhere, their take of overall spending has been decreasing in recent years as the relative power of middlemen has grown. PBMs have steadily gained negotiating clout by consolidating and merging with large insurance companies. The three largest PBMs are owned by CVS Health Corp. (which owns insurer Aetna), UnitedHealth Group Inc. and Cigna Corp.

. . .

. . . increases in recent years have mostly been passed on to PBMs in the form of heavy discounts that are hidden from public view.

A recent study by University of Southern California scholars showed that, between 2014 and 2018, the share of a hypothetical $100 insulin expenditure accruing to manufacturers decreased by 33%. During that same period, total U.S. spending on insulin hasn’t budged, but the share of insulin expenditures retained by PBMs has increased by 155%.

. . .

“What’s happening in this market is that the middlemen are making more and more money,” said University of Southern California professor Neeraj Sood, one of the authors of the study who has previously done consulting work for drug companies.

Yet the drug-pricing provisions in the recently passed Inflation Reduction Act singularly focused on what manufacturers charge while ignoring other players that take a slice of profits farther down the chain.

For the full commentary, see:

David Wainer. “HEARD ON THE STREET; Sanders, Musk Miss the Mark on Insulin.” The Wall Street Journal (Tuesday, November 22, 2022): B12.

(Note: ellipses added.)

(Note: the online version of the commentary has the date November 21, 2022, and has the title “HEARD ON THE STREET; Elon Musk, Bernie Sanders and Others Miss the Mark Over Pricey Insulin.”)

The academic study co-authored by Sood, and mentioned above, is:

Van Nuys, Karen, Rocio Ribero, Martha Ryan, and Neeraj Sood. “Estimation of the Share of Net Expenditures on Insulin Captured by Us Manufacturers, Wholesalers, Pharmacy Benefit Managers, Pharmacies, and Health Plans from 2014 to 2018.” JAMA Health Forum 2, no. 11 (2021), doi:10.1001/jamahealthforum.2021.3409.

Religiosity of Some Environmentalists Obscures Unsettled Science on Climate-Change Questions

(p. C13) The emerging religiosity in the climate-change debate obscures the diversity of questions at issue. Are global surface temperatures indeed rising to problematic levels? Are human beings principally responsible for this effect, and can they reasonably reverse it by altering their behaviors? Steven E. Koonin, in “Unsettled” (2021), has shown that the answers to these questions are far more complicated than we’ve been led to believe.

For the full review, see:

Vivek Ramaswamy. “12 Months of Reading; Vivek Ramaswamy.” The Wall Street Journal (Saturday, Dec. 10, 2021): C13.

(Note: the online version of the review has the date December 8, 2022, and has the title “Who Read What in 2022: Thinkers and Tastemakers.”)

The book praised by Vivek Ramaswamy is:

Koonin, Steven E. Unsettled: What Climate Science Tells Us, What It Doesn’t, and Why It Matters. Dallas, TX: BenBella Books, 2021.

Collins and Fauci Did Not Seek Open Debate on the Great Barrington Declaration

(p. A15) The Trump Twitter ban almost pales in comparison with the speech limitations routinely enforced on discussion of climate and Covid. Instead of “hate” or “violence,” the elastic pretext for speech restriction here is “settled science.”

The essence of science was once open debate. But that’s no longer true. In a now-infamous 2020 email, National Institutes of Health Director Francis Collins wrote Anthony Fauci that the Great Barrington Declaration, a dissent from Covid-lockdown policy, needed “a quick and devastating published take down,” which soon appeared in the press.

For the full commentary, see:

Henninger, Daniel. “WONDER LAND; They Want to Shut You Up.” The Wall Street Journal (Thursday, December 15, 2022): A15.

(Note: the online version of the commentary has the date December 14, 2022, and has the title “WONDER LAND; They Want to Shut You (and 303 Creative) Up.”)

Nonprofit Hospitals Get $60 Billion in Annual Tax Breaks in Order to Aid the Poor, but Often Use High-Pressure Opaque Tactics to Collect Full Payment

(p. A1) Nonprofit hospitals must have financial-assistance policies for needy patients, under federal requirements tied to an estimated $60 billion in annual tax breaks.

They often make that aid hard to get. Hospitals put up obstacles, delay checking eligibility and sometimes press for payments that aren’t refunded even if a patient eventually gets qualified for assistance.

That is according to a Wall Street Journal analysis of thousands of nonprofit hospital policies in filings to the Internal Revenue Service and posted by hospitals, as well as thousands of pages of internal documents from government hospitals obtained through public-record requests and the experiences of dozens of advocates and patients who have (p. A9) applied for aid.

. . .

An earlier Journal analysis of Medicare filings highlighted how little of nonprofit hospitals’ billions in revenue goes toward financial help for low-income patients. The new analysis uncovered the barriers many hospitals place in the way of patients who should qualify for assistance—even under the hospitals’ own criteria.

Under tax laws, nonprofit hospitals are set up to function as charities benefiting their communities. Government facilities, whose policies the Journal also looked at, are also intended to serve the public, though they aren’t subject to all the same IRS requirements as private nonprofits. The Journal found that many of these hospitals act like for-profit businesses in their efforts to get paid, even by those who can’t afford it.

. . .

Separate from the analysis of nonprofit hospitals’ IRS documents, the Journal also obtained internal documents on patient-billing procedures from large state and local government hospitals, including academic medical centers, through public-records requests. These hospitals share a similar mission with private nonprofits to serve communities.

The thousands of pages of procedures, scripts and other training material for hospital staff give an inside look at how some hospitals routinely push patients toward payment, including through installment plans that may come with interest. The guidelines often play down or don’t raise the option of financial assistance. Adding to the pressure, these tactics are often deployed before the patient gets care.

In a document titled “Collections Scripting for Non-Emergent Visits,” used by Georgia-based Augusta University Health System, staffers are supposed to start by requesting the entire amount due from the patient, saying, “How would you like to take care of that today?”

For the full story, see:

Anna Wilde Mathews, Andrea Fuller and Melanie Evans. “Some Hospitals Skimp on Aid.” The Wall Street Journal (Friday, Nov. 18, 2022): A1 & A9.

(Note: ellipses added.)

(Note: the online version of the story has the date November 17, 2022, and has the title “Hospitals Often Don’t Help Needy Patients, Even Those Who Qualify.”)