“A Public Choice Analysis of Mandated Randomized Double-Blind Clinical Trials”

My “A Public Choice Analysis of Mandated Randomized Double-Blind Clinical Trials” was presented on April 13, 2021 in the Law & Economics session of the Association of Private Enterprise Education meetings. I am grateful to Ray DeGennaro and Matthew McClanahan for including me in McClanahan’s session and to Lauren Nicole Hughes for recording the session on her smartphone.

To some extent, the presentation was an outgrowth of my book:

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

On Vaccines and Economics, Europe Suffers “the Same Bureaucratic and Intellectual Rigidity”

(p. A25) Europe’s vaccination debacle will almost surely end up causing thousands of unnecessary deaths. And the thing is, the continent’s policy bungles don’t look like isolated instances, a few bad decisions made by a few bad leaders. Instead, the failures seem to reflect fundamental flaws in the continent’s institutions and attitudes — including the same bureaucratic and intellectual rigidity that made the euro crisis a decade ago far worse than it should have been.

The details of the European failure are complex. But the common thread seems to be that European officials were not just risk averse, but averse to the wrong risks. They seemed deeply worried about the possibility that they might end up paying drug companies too much, or discover that they had laid out money for vaccines that either proved ineffective or turned out to have dangerous side effects.

So they minimized these risks by delaying the procurement process, haggling over prices and refusing to grant liability waivers. They seemed far less worried about the risk that many Europeans might get sick or die because the vaccine rollout was too slow.

For the full commentary, see:

Paul Krugman. “A Fiasco That’s Very European: Vaccines.” The New York Times (Friday, March 19, 2021): A25.

(Note: the online version of the commentary has the date March 18, 2021, and has the title “Vaccines: A Very European Disaster.”)

Press Should Be “Watchdog, Not Partisan Attack Dog”

(p. 7) WASHINGTON — I’ve been waiting for this moment. The moment when some on the left would react indignantly to journalists doing their job.

It was so enthralling and gratifying to assail Donald Trump as a liar and misogynist that it was bound to be jarring when the beast slouched out of town and liberals had to relearn the lesson that reporters don’t — or shouldn’t — suit up for the blue team.

. . .

. . . , the left declared it a national emergency and acted as though all journalistic objectivity should be suspended. Some thought that the media should ignore Trump’s news conferences and tweets and that the only legitimate interview with Trump was one where you stabbed him in the eye with a salad fork.

Many reporters offered sharp opinions, the kind not seen before in covering a president.

. . .

A whole generation of journalists was reared in the caldera that was Trump’s briefing room.

Some Washington reporters have been worried about this for some time, that the left would “work the refs,” as one put it, and turn on the media and attack if they dared to report something that could endanger the Republic (a.k.a. hurt a Democrat).

But the role of the press in a functioning democracy is as watchdog, not partisan attack dog. Politicians have plenty of people spinning for them. They don’t need the press doing that, too.

For the full commentary, see:

Maureen Dowd. “Democrats, High on Their Own Supply.” The New York Times, SundayReview Section (Sunday, February 28, 2021): 7.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Feb. 27, 2021, and has the title “High on Their Own Supply.”)

Only Very Few of Those Vaccinated Get Covid-19, and When They Do, Symptoms Are Mild or Absent

(p. A8) Nearly 83 million Americans have received at least one dose of a Covid vaccine, and it’s unclear just how many of them will have a “breakthrough” infection, though two new reports suggest the number is very small.

One study found that just four out of 8,121 fully vaccinated employees at the University of Texas Southwestern Medical Center in Dallas became infected. The other found that only seven out of 14,990 workers at UC San Diego Health and the David Geffen School of Medicine at the University of California, Los Angeles tested positive two or more weeks after receiving a second dose of either the Pfizer-BioNTech or Moderna vaccines. Both reports, published on Tuesday [March 23, 2021] in the New England Journal of Medicine, show how well the vaccines work in the real world, and during a period of intense transmission.

. . .

Only some of the virus-positive health workers in the California study showed symptoms, . . ., and they tended to be mild, suggesting that the vaccines were protective. That echoes data from the vaccine trials indicating that breakthrough infections were mild and did not require hospitalizations. Some people had no symptoms at all, and were discovered only through testing in studies or as part of their medical care.

For the full commentary, see:

Denise Grady. “The Vaccinated Can Get Covid, but the Odds are Slim.” The New York Times (Wednesday, March 24, 2021): A8.

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

(Note: the online version of the commentary has the date March 23, 2021, and has the title “Vaccinated People Can Get Covid, but It’s Most Likely Very Rare.”)

The study discussed above is:

Sacerdote, Bruce, Ranjan Sehgal, and Molly Cook. “Why Is All Covid-19 News Bad News?” National Bureau of Economic Research, NBER Working Paper #28110, Nov. 2020.

The NEJM articles mentioned above are:

Daniel, William, Marc Nivet, John Warner, and Daniel K. Podolsky. “Early Evidence of the Effect of Sars-Cov-2 Vaccine at One Medical Center.” New England Journal of Medicine (March 23, 2021).

Keehner, Jocelyn, Lucy E. Horton, Michael A. Pfeffer, Christopher A. Longhurst, Robert T. Schooley, Judith S. Currier, Shira R. Abeles, and Francesca J. Torriani. “Sars-Cov-2 Infection after Vaccination in Health Care Workers in California.” New England Journal of Medicine (March 23, 2021).

U.S. Media Covid-19 Stories More Negative than World Media Stories and than Scientific Journal Stories

(p. A8) Bruce Sacerdote, an economics professor at Dartmouth College, noticed something last year about the Covid-19 television coverage that he was watching on CNN and PBS. It almost always seemed negative, regardless of what was he seeing in the data or hearing from scientists he knew.

When Covid cases were rising in the U.S., the news coverage emphasized the increase. When cases were falling, the coverage instead focused on those places where cases were rising. And when vaccine research began showing positive results, the coverage downplayed it, as far as Sacerdote could tell.

But he was not sure whether his perception was correct. To check, he began working with two other researchers, building a database of Covid coverage from every major network, CNN, Fox News, Politico, The New York Times and hundreds of other sources, in the U.S. and overseas. The researchers then analyzed it with a social-science technique that classifies language as positive, neutral or negative.

The results showed that Sacerdote’s instinct had been right — and not just because the pandemic has been mostly a grim story.

The coverage by U.S. publications with a national audience has been much more negative than coverage by any other source that the researchers analyzed, including scientific journals, major international publications and regional U.S. media. “The most well-read U.S. media are outliers in terms of their negativity,” Molly Cook, a co-author of the study, told me.

About 87 percent of Covid coverage in national U.S. media last year was negative. The share was 51 percent in international media, 53 percent in U.S. regional media and 64 percent in scientific journals.

For the full commentary, see:

David Leonhardt. “The Pandemic Is a Grim Story, but is Bad news the Only Kind?” The New York Times (Wednesday, March 24, 2021): A8.

(Note: the online version of the commentary has the same date as the print version, and has the title “Bad News Bias.”)

The study discussed above is:

Sacerdote, Bruce, Ranjan Sehgal, and Molly Cook. “Why Is All Covid-19 News Bad News?” National Bureau of Economic Research, NBER Working Paper #28110, Nov. 2020.

“We Are the People. Who Are You?”

(p. A16) A Tel Aviv University sociologist named Nissim Mizrachi who spent years studying those voters and grappling with their rejection of liberalism thought he understood why.

The problem was not, he said, as some liberals contend, that Jews of Mediterranean origin, or Mizrahim, were confused about what was best for them. They weren’t suffering from Stockholm syndrome or “false consciousness.”

What liberals failed to see, the professor asserted, was that working-class Mizrahim were consciously spurning liberalism for a reason: what they see as the endgame of the liberal worldview is not a world they wish to inhabit.

“It’s really hard for liberals to imagine that their message, their vision itself, poses a threat to the core identity of other people,” Professor Mizrachi, 58, said in an interview.

His description of liberalism’s blind spots, published in the newspaper Haaretz a year ago, shook the Israeli left like an ideological bunker-busting bomb, and could hold lessons for another deeply polarized society in the West.

. . .

“You keep ridiculing us and presenting us as undemocratic and dangerous,” he said, articulating the non-liberal view. “But we are the people. Who are you?’”

. . .

“This is the lesson maybe for you,” Professor Mizrachi said. “OK, you won the election, fine. But don’t forget that red America is still there.”

For the full story, see:

David M. Halbfinger. “Explaining Right-Wing Politics in America, via the Middle East.” The New York Times (Saturday, December 19, 2020): A16.

(Note: ellipses added.)

(Note: the online version of the story was updated Dec. 23, 2020, and has the title “To Understand Red-State America, He Urges a Look at Red-State Israel.”)

“Celebrities Have Access to Better Care Than Ordinary People”

As the passages quoted below suggest, Trump’s friends may have had access to drugs that not everyone had access to. But it also should be acknowledged that Trump was pushing for Covid-19 drugs to be available sooner and with fewer restrictions.

(p. A25) Both the Regeneron and Eli Lilly therapies are meant for people who are at risk of getting sick enough with Covid to be hospitalized, not those who are hospitalized already. The emergency use authorization for the Regeneron treatment specifically says that it is “not authorized” for “adults or pediatric patients who are hospitalized due to Covid-19.”

A physician with experience administering the new monoclonal antibodies, who didn’t want to use his name because he’s not authorized by his hospital to speak publicly, said giving them to Giuliani “appears to be an inappropriate use outside the guidelines of the E.U.A. for a very scarce resource.” Very scarce indeed: According to the Department of Health and Human Services, as of Wednesday the entire country had about 77,000 total doses of the Regeneron cocktail and almost 260,000 doses of Eli Lilly’s monoclonal antibody treatment. That’s less than you’d need to treat everyone who’d tested positive in just the previous two days.

Right now, the criteria for distributing these drugs can be murky. Robert Klitzman, co-founder of the Center for Bioethics at Columbia, said that the federal government allocates doses to states, states allocate them to hospitals and hospitals then decide which patients among those most at risk will get treated. Some states have developed guidelines for monoclonal antibody treatment, “but my understanding is that most states have not yet done that,” Klitzman said.

Hospitals try to come up with ethical triage frameworks, but Klitzman told me there are often workarounds for V.I.P.s. He said it helps to know someone on the hospital’s board. Such bodies typically include wealthy philanthropists. Often, he said, when these millionaires and billionaires ask hospital administrators for special treatment for a friend, “hospitals do it.”

Why? “Hospitals have huge financial problems, especially at the moment with Covid,” he said. They’ve had to shut down profitable elective surgeries and treat many people without insurance. More than ever, he said, they “need money that is given philanthropically from potential donors.”

In other words, Giuliani was right: Celebrities have access to better care than ordinary people. “When someone is in the public eye, or if someone is a potential donor, or has already been a donor to a hospital, then there’s folks in the hospital hierarchy, in the administration, who are keenly aware if they’re coming in, if they’re present, if they need something,” said Shoa Clarke, a cardiologist and professor at Stanford University School of Medicine. Covid, which is leading to rationing of medical resources, only magnifies this longstanding inequality.

For the full commentary, see:

Michelle Goldberg. “Why Trump Cronies Get Covid Meds.” The New York Times (Saturday, December 12, 2020): A25.

(Note: the online version of the commentary has the date Dec. 10, 2020, and has the title “Covid Meds Are Scarce, but Not for Trump Cronies.” The passage quoted above includes several sentences, and a couple of words, that appear in the online, but not in the print, version of the commentary.)

In Primary Debates, Biden and Harris Led Democratic Presidential Candidates in Use of “Filler Phrases”

(p. A6) Here’s the deal: Presidential candidates issue plenty of pointed barbs in debates, but they use a lot of filler language, too.

Phrases such as “let’s be clear” and “the end of the day,” buy the speaker time to collect themselves, think ahead and formulate an answer. Among the Democratic contenders, the fact is, Vice President Joe Biden utters them most frequently (and “the fact is” has been his most-used phrase).

The Wall Street Journal identified 23 commonly used three-, four- and five-word phrases and their variations spoken by candidates during the four Democratic presidential debates and tracked the number of times they were said.

Mr. Biden used almost six filler phrases for every 1,000 words he spoke, the highest rate among the Democrats still running and far above their average of 2.6.

Asked about the findings, Biden spokesman TJ Ducklo said, “The fact of the matter is that poll after poll has shown that Joe Biden is the candidate who will defeat” President Trump.

. . .

After Mr. Biden, who racked up 77 instances of the phrases in the debates, the next highest totals belonged to Sens. Kamala Harris and Bernie Sanders.

For the full story, see:

Lindsay Huth and Lakshmi Ketineni. “The Fact Is, Candidates Use a lot of Filler Phrases.” The Wall Street Journal (Wednesday, November 20, 2019): A6.

(Note: ellipsis added.)

(Note: the online version of the story has the same date as the print version, and has the title “The Fact Is, Democratic Candidates Use a lot of Filler Phrases.”)

Dictator Rawlings Transformed Ghana from Dictatorship to Democracy

I heard a plausible plenary lecture a few years ago at an APEE meeting where the African speaker argued that African autocrats would never voluntarily give up power, because doing so would mean they would trade personal riches for personal poverty. It was a sad but plausible argument, though one that makes Jerry Rawlings’s life especially intriguing.

(p. A22) Jerry Rawlings, a former Ghanaian Air Force officer who led two military coups before steering his country toward democracy with an authoritarian hand, died on Thursday in the nation’s capital, Accra.

. . .

By the time he left office voluntarily 22 years later, he had served two presidential terms brought about by free elections and had established Ghana as a rare democratic example on the continent. Today, peaceful handovers of power are routine in the country, hardly the case with the country’s neighbors.

Mr. Rawlings’ contradictory legacy — brutal beginnings, uncompromising military rule, then free elections — underscores the difficult path to democratic governance still faced by many African nations. But in Ghana at least, where Mr. Rawlings is regarded as something of a founding father after the country’s difficult first steps, democracy is an assumption.

Given Ghana’s first experiences of him, that outcome would not have been predicted. He appeared at first to have all the makings of one of the continent’s classic military autocrats.

For the full obituary, see:

Adam Nossiter. “Jerry Rawlings, Strongman Turned Statesman Who Steered Ghana to Democracy, Dies at 73.” The New York Times (Friday, November 13, 2020): A22.

(Note: ellipsis added.)

(Note: the online version of the obituary has the date Nov. 12, 2020, and has the title “Jerry Rawlings, From Coup-Plotter to Ghanaian Statesman, Dies at 73.”)

Epidemic Showed Limits of China’s “Government-Driven, Top-Down Solutions”

(p. B1) WULONGQIAO, China — A devastating disease spreading from China has wiped out roughly one-quarter of the world’s pigs, reshaping farming and hitting the diets and pocketbooks of consumers around the globe.

China’s unsuccessful efforts to stop the disease may have hastened the spread — creating problems that could bedevil Beijing and global agriculture for years to come.

. . .

The epidemic shows the limits of China’s emphasis on government-driven, top-down solutions to major problems, sometimes at the expense of the practical. It has also laid bare the struggle of a (p. B6) country of 1.4 billion people to feed itself.

. . .

When the swine fever began to spread 16 months ago, the Ministry of Agriculture told the country’s local governments to cull all pigs in herds if there was even one sick animal, and to compensate the farmers. The ministry authorized local governments to pay up to $115 for the largest pigs, a cap later raised to $170. Before the epidemic, however, many pigs sold for $250 or more apiece, particularly breeding sows, according to government data. With the epidemic, the price has soared to $600 or more.

To get that partial reimbursement, many farmers had to deal with tightfisted local officials. The ministry said it would reimburse local governments only for between 40 percent and 80 percent of their costs. Local governments also had to provide proof, often including laboratory tests, that pigs died of African swine fever and not some other ailment.

As a result, culling has been slow. Official data show only 1.2 million pigs, or less than 0.3 percent of the country’s herds, have been culled. It is not clear where the rest of the country’s vanished herds went, but food experts say many were likely butchered and turned into food. That would worsen the spread, because the disease can lurk in meat for months.

For the full story, see:

Keith Bradsher and Ailin Tang. “China Flubs Effort to Halt Lethal Turn of Pig Illness.” The New York Times (Thursday, December 26, 2019): B1 & B6.

(Note: ellipses added.)

(Note: the online version of the story has the date Dec. 17, 2019, and has the title “China Responds Slowly, and a Pig Disease Becomes a Lethal Epidemic.”)

For California Electricity Regulator: “Safety Is Not a Glamorous Thing”

(p. A1) PG&E’s collapse has exposed the California Public Utilities Commission’s failure to hold the utility accountable on safety. The CPUC (p. A12) for years focused attention elsewhere, on setting rates and pushing for cleaner power.

Now, the agency tasked with regulating utility safety is struggling to refocus on the issue while also grappling with its failure to prevent the state’s second electricity crisis in two decades.

. . .

From the early 2000s, the commission’s focus was on setting rates and implementing Sacramento’s renewable-energy goals. Starting in 2002, three consecutive governors, two Democrats and a Republican, signed bills ratcheting up the percentage of wind and solar power utilities had to buy.

These mandates required investor-owned utilities such as PG&E to change their mix of generation, effectively phasing out burning coal and lowering reliance on natural gas while signing contracts to buy electricity from new solar and wind farms. The CPUC oversaw these deals, as well as figuring out how to integrate thousands of new rooftop solar installations.

“Was there a considerable amount of resources placed on policy? Yeah, there was,” says Timothy Alan Simon, a commissioner between 2007 and 2012 and now a utilities consultant. “It’s a challenge to balance between the safety aspects and the need for policy deliberation.”

Michael Peevey, a former Southern California Edison president, and CPUC president between 2002 and 2014, was a vocal champion of renewable-energy policies. Now retired, he says the regulator was large enough to focus on safety and renewables simultaneously but that it was tough to get Sacramento lawmakers excited about funding safety.

When compared with eliminating coal and adding solar energy, he says, “Safety is not a glamorous thing.”

For the full story, see:

Ruth Simon. “PG&E Regulators Failed to Stop Crisis.” The Wall Street Journal (Saturday, December 9, 2019): A1 & A12.

(Note: ellipsis added.)

(Note: the online version of the story has the date December 8, 2019, and has the title “‘Safety Is Not a Glamorous Thing’: How PG&E Regulators Failed to Stop Wildfire Crisis.”)