Category: Government

The Democratic Deep State Looked the Other Way as Fraudsters Stole 10 BILLION Healthcare Dollars

When DOGE fired federal workers we saw televised scenes where the fired workers expressed outrage at how taxpayers would be hurt by the loss of devoted civil servants. So where were the devoted civil servants in 2023? Were they doing their jobs to be alert to the Medicare, and personal identity, fraud that cost the public about 10 billion (that is “billion” with a “b”) dollars?

When Elon Musk’s DOGE uncovered myriad examples of major fraud, I saw Democrats on television complain that of course they were against fraud too, but it should be pursued more slowly and systematically, following traditional procedures. The Democrats were running the federal government in 2023. What procedure were the Democrats using, fast or slow, to protect taxpayers from the fraudulent loss of 10 billion (that is “billion” with a “b”) dollars?

Our jerry-rigged government-run-and-regulated health care system is rife with middlemen. In a true free-market healthcare system, patients would directly pay for healthcare, without middlemen. Patients would have the information, and the incentive to act on the information, to detect, report, and pursue fraudsters. Some fraud would exist under any system, but my hypothesis is that much less of it would exist under a free-market system.

(If you are concerned that patients would not have enough funds to pay for healthcare themselves, we could adopt the much better insurance system once proposed by Susan Feigenbaum, combined with deregulation that would reduce healthcare costs–like no longer mandating Phase 3 clinical trials.)

And my secondary hypothesis is that if we have to have a jerry-rigged government-run-and-regulated system, the Republicans, a party full of former bourgeois entrepreneurs and business managers, will usually do a marginally better job of detecting and pursuing fraud.

I wonder if these hypotheses have ever been researched by any of those noble economists studying the field of Public Choice?

(p. A18) When hundreds of thousands of people enrolled in Medicare were billed for expensive medical equipment they never asked for in 2023, it was part of a $10.6 billion fraud, among the largest such schemes in the program’s history, federal prosecutors said this week.

. . .

Those involved in the fraud bought dozens of companies that were accredited to submit claims to Medicare and the program’s supplemental insurers, prosecutors say.

Then, using personal information stolen from more than a million Americans, the defendants filed billions of dollars in claims for equipment that had not been ordered by people enrolled in Medicare and was not delivered to them, according to the indictment.

Of the $10.6 billion that was fraudulently billed, the indictment says, the defendants collected more than $900 million, most of it coming from private “Medigap” insurers and the rest from the Medicare program itself.

Even if the patients themselves did not pay for the phantom supplies, which included urinary catheters, braces and other durable medical equipment, such schemes can affect Medicare recipients by causing premium costs to rise.

. . .

In 2019, the Justice Department uncovered a scheme that it said had defrauded the program of more than $1 billion with phony claims for back and knee braces. In April 2023, prosecutors charged 18 defendants in a nearly $500 million scheme that involved false billing for Covid-19 tests that were never administered.

For the full story see:

Santul Nerkar. “11 Accused of Medicare Fraud In Scheme Based in Russia.” The New York Times (Sat., June 18, 2025): A18.

(Note: ellipses added.)

(Note: the online version of the story has the date June 27, 2025, and has the title “U.S. Charges 11 in Russia-Based Scheme to Bilk Medicare of $10.6 Billion.”)

The better healthcare insurance system proposed by Susan Feigenbaum was proposed in:

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.

Public Should Beware of F.D.A.’s Lax Inspections of Drugs Made in India and China

On drug safety, the public puts its trust in the F.D.A. which frequently drops the ball. The public would be better off adopting caveat emptor, and seeking private means of assurance of safety. These would include certification (stamps of approval) from private organizations like the United States Pharmacopeial Convention (USP).

They might also choose to buy well-known name brands, since a well-known brand has more reputation capital to lose if they produce a bad batch, and thus can be expected to invest more in quality control. (Lester Telser made this argument–I need to seek where.)

(p. A10) A highly drug-resistant bacteria that was linked to eyedrops imported from India and that spread from person to person in a Connecticut long-term care center has prompted concerns that the strain could gain a foothold in U.S. health care settings, according to the Centers for Disease Control and Prevention.

. . .

The outbreak has renewed longstanding concerns about the quality and frequency of the F.D.A.’s overseas inspections.

In June 2020, Senator Chuck Grassley, Republican of Iowa, held an oversight hearing on the F.D.A.’s foreign inspection process, noting that the plants were given 12 weeks’ advance notice, “plenty of time to doctor up a facility to make sure that it passes inspection.” The agency has since received budget authority to conduct unannounced overseas inspections.

. . .

The F.D.A. paused overseas inspections during the height of the coronavirus pandemic, and the number of foreign inspections remained low last year, at 684 compared with 3,272 in 2019, according to agency data.

The F.D.A. has 4,000 overseas facilities to inspect, with about 20 percent in India; one of its six inspector positions in that country was vacant in late 2021, according to a report issued last year by the Government Accountability Office.

For over-the-counter drugs, the F.D.A. uses a system that essentially lists a medication recipe. Companies can make the products without express agency approval but are expected to follow agency rules for manufacturing quality products, said John Serio, a lawyer with Withers who has pharmaceutical clients.

“If you’re not out there inspecting facilities,” Mr. Serio said, “these sorts of problems will crop up because there’s no threat that if you’re out of compliance that the inspector will come knocking at your door.”

For the full story see:

Christina Jewett and Andrew Jacobs. “Drug-Resistant Bacteria Linked To Eyedrops Can Easily Spread.” The New York Times (Mon., April 3, 2023 [sic]): A10.

(Note: ellipses added.)

(Note: the online version of the story has the same date as the print version, and has the title “Drug-Resistant Bacteria Tied to Eyedrops Can Spread Person to Person.”)

The F.D.A.’s lax inspections of generic drugs made in India is documented in:

Eban, Katherine. Bottle of Lies: The Inside Story of the Generic Drug Boom. New York: Ecco, 2019.

Computer Chip Industrial Policy Subsidies Are an Unfair Waste of Taxpayer Funds

An “industrial policy” occurs when the federal government attempts to pick a technology that will be important in the future, and then subsidize it. T.J. Rodgers is an insider in the computer chip industry and has written a credible op-ed analyzing two attempts at industrial policy in his industry, the Sematech consortium in 1987, and the Chips and Science Act in 2022.

He makes a compelling case that Sematech did not work and that the Chips and Science Act is not working either.

Rodgers gives us more evidence that Secretary of the Treasury and Harvard President Larry Summers was right when he wrote “the government is a crappy venture capitalist.”

If the feds’ industrial policy on computer chips has failed, why do we think its industrial policy on cancer cures will succeed? (Nixon and Biden’s cancer “moonshots” amounted to picking, and then subsidizing, what they hoped would be cancer cures.)

By the way, when Rodgers stood up against welfare to his industry, he appears to have been an exemplar of Robert Nozick’s ideal CEO: maximizing profits subject to ethical side-constraints.

(p. A15) My mother was a fifth-grade teacher in Oshkosh, Wis. She earned $25,000 a year. Why should chip companies, some of the wealthiest corporations in the world, take money from her and other ordinary citizens? Today’s massive $280 billion Chips and Science Act of 2022, the latest semiconductor welfare program, is even less justified than Sematech was.

. . .

To my knowledge, Sematech contributed nothing of note to U.S. semiconductor technology. Its Final Report in 1997 served up platitudes about “catching up with Japan” and fostering “industry cooperation.”

Decades later, the Semiconductor Industry Association—now a group of lobbyists in Washington—began “saving” the chip industry again. This time the target is China, despite the fact that its best wafer foundry is SMIC, an also-ran in the foundry business. China is less a competitive threat today than Japan was in 1987.

. . .

Today, 100 high-performance computers can be put on one chip. The companies that know how to design 100-billion-transistor chips for a critical function such as artificial intelligence are much more valuable than the companies that carve commodity chips out of silicon wafers, like those in China. While the biggest chip-manufacturing company in China is worth $54 billion, a single U.S. chip company, Nvidia, is worth $3.4 trillion—58 times as much—and it doesn’t even make its own chips. Why are we doing this again?

For the full commentary see:

T.J. Rodgers. “Semiconductor Subsidies? Tried and Failed.” The Wall Street Journal (Weds., June 4, 2025): A15.

(Note: ellipses added.)

(Note: the online version of the commentary has the date June 3, 2025, and has the same title as the print version.)

Robert Nozick discusses ethical side constraints in:

Nozick, Robert. Anarchy, State, and Utopia. New York: Basic Books, Inc., 1974.

During the Pandemic “Experts” Suppressed the Open Continual Inquiry That Is Science

The governmental violation of the basic rights of citizens, especially the right of free speech, is the most painful and lasting legacy of the Covid-19 pandemic. To flourish in the future, it is worth our time to remember what happened and defend those who protected free speech and the pursuit of true science, which is a method of continual inquiry, not a body of fixed beliefs.

(p. C7) “Science,” the great theoretical physicist Richard Feynman wrote, “is the belief in the ignorance of experts.” The incorrigibly curious Feynman knew that skepticism and a willingness to assimilate new evidence propel the scientific endeavor. Yet by 2020, in response to a global pandemic, the dominant part of America’s political and media class had turned the imperative to “follow the science” into an expression of almost religious reverence for the judgment of experts. Many educated and otherwise intelligent Americans, meanwhile, made a single, bespectacled government scientist their idol: “In Fauci We Trust” read their lawn signs and bumper stickers.

Their faith was misplaced. Credentialed experts, especially those in the fields of epidemiology and public health, had tied themselves to badly flawed theories, closed their minds to new evidence and thrown the mantle of “science” over value judgments for which they had no special competence.

“An Abundance of Caution,” by the journalist David Zweig, documents the poor evidentiary basis for the prolonged school closures and attendant follies such as masking requirements and social distancing. Mr. Zweig distinguished himself throughout the pandemic by his willingness to question the assumptions of self-identified “Covid hawks.” When he dug into the epidemiological modeling papers whose projections seemed decisively to rule out the safety of opening schools, he found “a never-ending matryoshka doll” of citations, resting ultimately on an assumption conceded to be “arbitrary” by its initial author.

Mr. Zweig shows how evidence emerged early on—in March 2020—that the virus did not pose a serious threat to children. American public-health professionals remained largely impervious to this fact.

. . .

“In Covid’s Wake,” by the Princeton political scientists Frances Lee and Stephen Macedo, mostly remains within the idiom of polite academic prose, but they state with disarming plainness that “elite institutions failed us” by giving in to panic. Ms. Lee and Mr. Macedo marvel at how consensus plans—none of which would have required extended lockdowns—were thrown out before Americans ever began dying, in part because public-health experts were entranced by China’s harsh restrictions. American policymakers had sound advice ready at hand, but most of them took the view that safety outweighed individual liberties, economic activity and quality of life.

Where Mr. Zweig emphasizes incuriosity, Ms. Lee and Mr. Macedo stress the willful suppression of reasonable debate, including the unfortunate tendency to paint critics of lockdowns and mask mandates as racists, quacks and conspiracy theorists. Such conduct was especially evident on the question of Covid-19’s origins, as top scientists vilified anyone suggesting the virus may have leaked from a lab in Wuhan, China. Credulous journalists, academics and other cultural arbiters, the authors remind us, embraced the effective censorship of those who questioned the official line.

. . .

Ms. Lee and Mr. Macedo catalog reams of data to show that, before the availability of vaccines, areas imposing the severest restrictions earned no discernible health benefits.

. . .

(p. C8) In 2024 the U.S. House’s Select Subcommittee on the Coronavirus Pandemic issued a genuinely impressive 500-page report, covering Covid-19’s origins, the fraud in pandemic-response programs and the effectiveness or otherwise of various interventions.

For the full review see:

Philip Wallach. “Failing the Pandemic Test.” The Wall Street Journal (Wednesday, April 19, 2025): C7-C8.

(Note: ellipses added.)

(Note: the online version of the review has the date April 18, 2025, and has the title “‘An Abundance of Caution’ and ‘In Covid’s Wake’: Failing the Pandemic Test.”)

The books under review are:

Macedo, Stephen, and Frances Lee. In Covid’s Wake: How Our Politics Failed Us. Princeton, NJ: Princeton University Press, 2025.

Zweig, David. An Abundance of Caution: American Schools, the Virus, and a Story of Bad Decisions. Cambridge, MA: The MIT Press, 2025.

The over-500-page 2024 report issued by the House’s Select Subcommittee on the Coronavirus Pandemic, and praised above, is:

Pandemic, Select Subcommittee on the Coronavirus. “After Action Review of the Covid-19 Pandemic: The Lessons Learned and a Path Forward.” U.S. House of Representatives. Washington, D.C., Dec. 4, 2024.

Nicholas Wade Highlighted That Early Email to Fauci Supported Lab-Leak Origin of Covid-19

Distinguished science journalist Nicholas Wade was one of the first and the few to early-on risk being canceled by providing evidence in favor of the lab-leak origin of Covid-19.

(p. A13) They told the world that the Covid-19 virus clearly couldn’t have been manipulated in the laboratory. But what they actually thought at first sight was that it had been.

The letter from five virologists published in Nature Medicine on March 17, 2020, was the single most influential statement in capturing the public narrative about the origin of SARS-CoV-2. Here was an authoritative statement from leading experts assuring the public that in terms of the virus’s origin “we do not believe that any type of laboratory-based scenario is plausible.”

But that’s the exact opposite of what these experts thought after taking their first look at the virus. A large batch of emails exchanged with Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, was made available this week to BuzzFeed and the Washington Post under the Freedom of Information Act. For the most part the emails concern meeting arrangements or messages from cranks and have been redacted of any meaningful information. But one significant email escaped the censor’s black marker.

On Jan. 31, 2020, shortly after the SARS-CoV-2 genome had been decoded, Kristian Andersen, the five virologists’ leader, emailed Dr. Fauci that there were “unusual features” in the virus. These took up only a small percentage of the genome, so that “one has to look really closely at all the sequences to see that some of the features (potentially) look engineered.”

Mr. Andersen went on to note that he and his team “all find the genome inconsistent with expectations from evolutionary theory.” It isn’t clear exactly what he meant by this striking phrase. But anything inconsistent with an evolutionary origin has to be man-made.

For the full commentary see:

Nicholas Wade. “Fauci Email Bolsters the Lab-Leak Theory.” The Wall Street Journal (Monday, June 5, 2021 [sic]): A13.

(Note: the online version of the commentary has the date June 4, 2021 [sic], and has the same title as the print version.)

Correll Managed Georgia-Pacific Well and Then Used Those Skills to Save a Failing Hospital

In my Openness book, I make the case for the many benefits of an economic system of innovative dynamism. One of the lesser, but still important, benefits was first identified by Joseph Schumpeter. He argued for a spillover effect of innovative dynamism. The skills, knowledge, and technologies created by innovative entrepreneurs in the for-profit sector of the economy, are also applied and imitated in the nonprofit and government sectors. So where there is innovative dynamism, not only is the market more creative and efficient, but both the nonprofit and the government sectors are more creative and efficient.

A good example may be Pete Correll who acted entrepreneurially as CEO of Georgia-Pacific to bring more stability to the business by acquiring the James River Corporation, maker of Quilted Northern, and guided the Georgia-Pacific firm through years of lawsuits over asbestos. He eventually sold Georgia-Pacific to Koch Industries, Inc. My impression is that Charles Koch then applied his market-based management system to make the Georgia-Pacific part of his business much more efficient and innovative. [Query: does Koch’s achievement undermine my claim that Pete Correll had acted entrepreneurially in his earlier management of Georgia-Pacific? Or can both Correll and Koch have been good manager/entrepreneurs, but in different ways at different times?]

But according to his obituary in the WSJ, his greatest achievement may have been in taking over a near-bankrupt Atlanta public (aka government) hospital, reorganizing it from government to nonprofit, and modernizing its management and technology.

Carrell’s obituary in the WSJ:

James R. Hagerty. “CEO Helped Save A Public Hospital.” The Wall Street Journal (Sat., June 5, 2021 [sic]): A9.

(Note: the online version of the WSJ obituary has the date June 2, 2021 [sic], and has the title “Retired CEO Saved an Atlanta Public Hospital.”)

For Charles Koch’s entrepreneurial market-based management system see:

Koch, Charles G. The Science of Success: How Market-Based Management Built the World’s Largest Private Company. Hoboken, NJ: Wiley & Sons, Inc., 2007.

My book mentioned in my initial comments is:

Diamond, Arthur M., Jr. Openness to Creative Destruction: Sustaining Innovative Dynamism. New York: Oxford University Press, 2019.

Trump Is a Change Agent Because He Can Take the Ill Will of the Stagnationists

In an earlier blog entry I pondered Charlie Munger’s sage analysis that agents of change must often be willing to take the “ill will” aimed at them from the stagnationists who benefit from stasis. The stagnationists may be corrupt, or incompetent, or simply lack the imagination or the energy to do something in a better way.

Agents of change are scarce because most of us care a lot about what other people think of us. We experience psychic stress if we are systematically stigmatized, or even just ignored. Donald Trump may be capable of making major changes because, through temperament or resolve, he has found a way to shut out the psychic stress; a way to take the ill will.

Kessler’s commentary, quoted below, was published early in the pandemic, on Feb. 10, 2020. At that point Kessler believed that Trump’s success with the economy would get Trump re-elected. But as the months of 2020 rolled on, the pandemic increasingly hurt Trump’s prospects; hence the source of the pandemic still matters a lot, and whether the vaccine was intentionally delayed a few weeks, to release it just after the election, also still matters a lot.

A key question is whether Trump still has the core “agenda of tax cuts, deregulation and originalist judges” that Kessler believed was the Trump core agenda in 2016.

I hope yes, but fear no. In 2025 are tariffs and industrial policy part of the “distraction” (aka “MacGuffin”) Kessler posits, or are they part of Trump’s core agenda?

(p. A15) Is he a disease or a cure? Like him or hate him, there’s tons of spilled ink trying to assess President Trump’s governing style. To me, the key to understanding Trumpism is remembering why he was elected.

What do I mean? Voters chose Donald Trump as an antidote to the growing inflammation caused by the (OK, deep breath . . .) prosperity-crushing, speech-inhibiting, nanny state-building, carbon-obsessing, patriarchy-bashing, implicit bias-accusing, tokey-wokey, globalist, swamp-creature governing class—all perfectly embodied by the Democrats’ 2016 nominee. On taking office, Mr. Trump proceeded to hire smart people and create a massive diversion (tweets, border walls, tariffs) as a smokescreen to let them implement an agenda of tax cuts, deregulation and originalist judges.

Those reforms have left the market free to do its magic and got the economy grooving like it’s 1999. The daily Trump hurricane—like the commotion over the Chiefs from Kansas—makes the media focus on the all-powerful wizard while ignoring the policy makers behind the curtain.

Alfred Hitchcock called this kind of distraction a “MacGuffin”—something that moves the plot along and provides motivation for the characters, but is itself unimportant, insignificant or irrelevant. It can be a kind of sleight of hand, a distraction, and Mr. Trump uses his own public persona as a MacGuffin in precisely that way. The mobs decked in “Resist” jewelry fall for it every time.

For example, Sen. Bernie Sanders used his remarks during the Senate impeachment trial to point out that the media had documented some 16,200 alleged lies by President Trump. The MacGuffin worked! Mr. Sanders and his peers are focused on the president’s words, while most voters see the real plot unfolding in America—millions of jobs and rising wages.

The president’s success comes from his ability to shrug off critics.  . . .  Rather than cower at the criticism he faces from the mobs, he probably smirks and thinks to himself, “Yeah, I don’t believe in that” and tweets away.

That’s the only reaction that can withstand today’s far left, which has become increasingly self-righteous.

For the full commentary see:

Andy Kessler. “President Donald J. MacGuffin.” The Wall Street Journal (Monday, February 10, 2020 [sic]): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date February 9, 2020 [sic], and has the same title as the print version.)

Stop Subsidizing Corn Growing to Reduce Corn Syrup Consumption and Make America Healthy Again

In a recent blog entry I discussed how consumption of corn syrup may increase obesity and how government subsidies to corn growing and quotas on the import of sugar, lead to increased consumption of corn syrup. In the entry below, I document brief comments by Robert F. Kennedy, Jr. on corn syrup.

(p. A15) In my speech endorsing Donald Trump, I said we need to love our kids more than we hate each other. That means coming together to address common problems, and few are more urgent than the chronic-disease crisis. Americans are becoming sicker, beset by illnesses that our medical system isn’t addressing effectively.

. . .

Mr. Trump has made reforming broken institutions a cornerstone of his political life. He has become the voice of countless Americans who have been let down by our elites. He could unite the country by making it his priority to make America healthy again. Here are some specific policy ideas:

. . .

• Reform crop subsidies. They make corn, soybeans and wheat artificially cheap, so those crops end up in many processed forms. Soybean oil in the 1990s became a major source of American calories, and high-fructose corn syrup is everywhere.

For the full commentary see:

Robert F. Kennedy Jr. “Trump Can Make America Healthy Again.” The Wall Street Journal (Friday, Sept. 6, 2024): A15.

(Note: ellipses added.)

(Note: the online version of the commentary has the date September 5, 2024, and has the same title as the print version.)

The Classical Liberal Economist’s Current Job: Minimize the Harm from Tariffs, Maximize the Benefits from Deregulation and Downsizing Government

I used to run into Richard Burkhauser at economics meetings occasionally and always enjoyed talking with him and hearing about his research. I believe Richard’s activity in the first Trump administration makes sense: if tariffs are going to be imposed, do them in a way that minimizes the damage to the economy. Although not mentioned in the article quoted below, I am sure Richard also did what he could to further the part of Trump’s agenda that was positive for he economy: reducing regulations so entrepreneurs can innovate and create jobs, and downsizing the government so taxpayers can keep more of their earnings.

(p. 1) Partway through a panel discussion at a recent economics conference in San Francisco, Jason Furman, a former adviser to President Barack Obama, turned to Kimberly Clausing, a former member of the Biden administration and the author of a book extolling the virtues of free trade.

“Everyone in this room agrees with your book,” Mr. Furman said. “No one outside of this room agrees with your book.”

The academics and policy wonks gathered in the hotel conference room laughed, but the comment captured something real: After decades of helping to shape policy on weighty matters like taxes and health insurance, economists find that their influence is at a low ebb.

. . .

(p. 6) Mr. Trump, in his first term, had few economists in top roles, and perhaps the most prominent exception — Peter Navarro, a Harvard-trained economist who was an adviser on trade policy — held skeptical views on trade, particularly with China, that put him far outside the economic mainstream. (In a 2016 survey of academic economists, not a single respondent said putting tariffs on China to encourage domestic production would be a good idea.)

Economists who held more mainstream views had limited influence. Richard Burkhauser, a Cornell University professor who served on Mr. Trump’s Council of Economic Advisers, said he and his colleagues quickly understood that there was little point in trying to talk Mr. Trump out of imposing tariffs.

“The most forlorn economists at the C.E.A. specialized in trade,” he said. If they had tried to fight tariffs, he said, “that would have been the last meeting we were at.”

Instead, Mr. Burkhauser said, economists focused on a different question: If the administration was going to impose tariffs, how could it do them in the least painful way possible?

For the full story see:

Ben Casselman. “Economists See Influence Wane in Policy Circles.” The New York Times, SundayBusiness Section (Sun., January 12, 2025): 1 & 6.

(Note: ellipsis added.)

(Note: the online version of the story has the date Jan. 10, 2024, and has the title “Economists Are in the Wilderness. Can They Find a Way Back to Influence?”)

Not Every Fluoride Worry Is Anti-Science Misinformation

Emily Oster is an economist who believes that ordinary citizens are not uniformly stupid and ill-informed. Maybe they even have rights. So she suggests the public health authorities stop condescending and shouting commands and start offering the public nuanced information about varying levels of certainty and risk.

(p. 4) Robert F. Kennedy Jr. said this month that the new Trump administration would recommend removing fluoride from public water supplies. The suggestion that fluoride was unsafe was immediately criticized by many public health experts as anti-science misinformation.

But there’s a real danger to painting everyone with concerns about fluoride as a conspiracy theorist. It’s not that we should remove fluoride from tap water (we shouldn’t), but fluoride is a complex topic, and glossing over that complexity — as public health experts and agencies often do — leaves people understandably skeptical.

Public health agencies typically tell people what to do and what not to do, but they don’t regularly explain why — or why people might hear something different from others. They also often fail to prioritize. In the end, advice for a range of topics is delivered with the same level of confidence and, seemingly, the same level of urgency. The problem is that when people find one piece of guidance is overstated, they may begin to distrust everything.

. . .

Deservedly or not, public health authorities lost a lot of trust, especially during the pandemic, and they have struggled to get it back. This has left an opening for others. The reaction from public health officials often seems to be to yell the same thing, only more loudly. This isn’t working.

For the full commentary see:

Emily Oster. “How to Talk About Fluoride, Vaccines and Raw Milk.” The New York Times, SundayOpinion Section (Sun., November 17, 2024): 4.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Nov. 13, 2024, and has the title “There’s a Better Way to Talk About Fluoride, Vaccines and Raw Milk.”)

Medical Entrepreneur Fired for Nimbly Pivoting to Get Job Done

Back in early 2021, the Moderna vaccine was not yet widely available. Protocols mandated who could get the scarce shots, prioritizing health care workers, senior citizens, and those with severe diseases. Each vial contained enough for 10 doses, but the doses had to be given with six hours, before the vaccine spoiled. On Dec. 29 Dr. Hasan Gokal, a Pakistani immigrant, worked at the county’s first vaccination event, set up for health care workers. Near the end of the scheduled event a health care worker showed up and a nurse punctured a new vial to give the worker the shot.

Now, what to do with the remaining nine doses? He got on the phone and drove around seeking and finding several senior citizens who wanted the vaccine. Exhausted with a half-hour until the vaccine expired, he gave the final dose to his wife, who had pulmonary sarcoidosis, which was indicated in the protocols as a qualification for the vaccine.

Dr. Gokal’s supervisor and the director of human resources then fired Dr. Gokal:

The officials maintained that he had violated protocol and should have returned the remaining doses to the office or thrown them away, the doctor recalled. He also said that one of the officials startled him by questioning the lack of “equity” among those he had vaccinated.

“Are you suggesting that there were too many Indian names in that group?” Dr. Gokal said he asked.

Exactly, he said he was told. (Barry 2021, p. A5)

A couple of weeks later, the county district attorney charged Dr. Gokal with theft of doses of the vaccine.

Dr. Gokal acted as a medical entrepreneur. His job was to save lives by administering the vaccine. He nimbly pivoted in a difficult situation. For that he was punished–fired and charged with a crime.

The growing promulgation and enforcement of protocols limit physicians from acting as mission-oriented entrepreneurs. They are limited in their use of judgement based on their own experiences, they are limited in innovating, and sometimes they are even limited in using all of a scarce vaccine. These limits may be part of the reason that so many physicians today experience frustration and burn-out.

[As of the time of the writing of the NYT article cited below, Dr. Gokal remained fired from his job, and still was in legal jeopardy.]

My source for the facts of Dr. Gokal’s case, is the NYT article:

Dan Barry. “Racing the Clock, a Doctor Gave Out the Vaccine.” The New York Times (Thurs., February 11, 2021 [sic]): A1 & A5.

(Note: the online version of the NYT article was updated June 23, 2023 [sic], and has the title “The Vaccine Had to Be Used. He Used It. He Was Fired.”)