“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.

Pfizer Refused Federal Subsidy so They Could “Liberate” Their “Scientists From Any Bureaucracy”

In September [2020], the CEO of Pfizer, Albert Bourla, appeared on CBS News’s “Face the Nation,” where he was asked about not accepting government funding for development.

“The reason why I did it was because I wanted to liberate our scientists from any bureaucracy,” Bourla explained. “When you get money from someone that always comes with strings. They want to see how we are going to progress, what type of moves you are going to do. They want reports. I didn’t want to have any of that. I wanted them — basically I gave them an open checkbook so that they can worry only about scientific challenges, not anything else.”

“And also,” he added, “I wanted to keep Pfizer out of politics, by the way.”

For the full story, see:

Philip Bump. “No, Pfizer’s Apparent Vaccine Success Is Not a Function of Trump’s ‘Operation Warp Speed.” The Washington Post (online posted Monday, November 9, 2020).

(Note: bracketed year added.)

Unintended Consequences of Centralized Lockdown in India Spread Covid-19

(p. A1) SURAT, India — The crowds surged through the gates, fought their way up the stairs of the 160-year-old station, poured across the platforms and engulfed the trains.

It was May 5 [2020], around 10 a.m. Surat was beastly hot, 106 degrees. Thousands of migrant laborers were frantic to leave — loom operators, diamond polishers, mechanics, truck drivers, cooks, cleaners, the backbone of Surat’s economy. Two of them were Rabindra and Prafulla Behera, brothers and textile workers, who had arrived in Surat a decade ago in search of opportunity and were now fleeing disease and death.

. . .

They were among tens of millions of migrant workers stranded without work or food after Prime Minister Narendra Modi imposed a national coronavirus lockdown in March. By spring and summer, these workers were so desperate that the government provided emergency trains to carry them back to their home villages. The trains were called Shramik Specials, because shramik means “laborer” in Hindi.

But they became the virus trains.

India has now reported more coronavirus cases than any country besides the United States. And it has become clear that the special trains operated by the government to ease suffering — and to counteract a disastrous lack of lockdown planning — instead played a significant role in spreading the coronavirus into almost every corner of the country.

The trains became contagion zones: Every passenger was supposed to be screened for Covid-19 before boarding but few if any were tested. Social distancing, if promised, was nonexistent, as men pressed into passenger cars for journeys that could last days. Then the trains disgorged passengers into distant villages, in regions that before had few if any coronavirus cases.

. . .

(p. A12) On March 24 [2020], at 8 p.m., Mr. Modi hit the lockdown switch. In a televised address, he ordered the entire nation to stay inside their homes for three weeks — starting in four hours.

The decision was pure Modi: sudden, dramatic and firm, like when he abruptly wiped out nearly 90 percent of India’s currency bills in 2016, a bolt-from-the-blue measure that he said was necessary to fight corruption but proved economically devastating.

Prafulla and Rabindra Behera had just finished a dinner of rice, lentils and potatoes, their usual fare. They lived in squalid, bare rooms in Surat’s industrial zone, sleeping wall to wall on the floor with a half dozen other laborers. Within minutes of Mr. Modi’s address, they started getting calls.

“Everyone was thinking the same: This will be over soon and somehow we’ll pass the days,” Rabindra said.

At the time, India had fewer than 600 known virus cases.

Many experts have criticized Mr. Modi’s government for overlooking the plight of migrant laborers, who suddenly had no work, no income and no support network in the cities. The government’s Covid-19 task force lacked migrant specialists and was hardly representative of India. Of its 21 members, only two were women and the rest were largely upper-caste men. Many of the migrant laborers came from lower castes and economically underprivileged backgrounds.

. . .

In Surat, the Behera brothers were down to their last bag of rice. They could not work — the factories were closed. But they weren’t allowed to leave the city, where virus cases were beginning to surge.

“We were trapped,” Rabindra said.

On May 1, India’s Labor Day, the railways ministry made a grand announcement: Shramik Specials. Routes were drawn up from Surat, Mumbai, Chennai, New Delhi, Ahmedabad and other cities deep into rural areas.

. . .

The Beheras were told they would quarantine for 21 days at a center and each was given a toothbrush, a slice of soap, a bucket to wash with and a thin sheet to sleep on.

But the next morning, Prafulla awoke with a splitting headache. A doctor didn’t think he had coronavirus but suggested, as a precaution, that he be moved into the courtyard, away from the other men.

The following morning, Prafulla could barely breathe and called his wife on his cellphone.

“Come and bring the girls,” he whispered. “I need to see you.”

An hour later, he was dead. A subsequent test revealed that Prafulla Behera was Ganjam’s first coronavirus death.

For the full story, see:

Jeffrey Gettleman, Suhasini Raj, Sameer Yasir, Karan Deep Singh and Atul Loke. “Rails Spread Virus as Workers Fled India’s Cities.” The New York Times (Wednesday, December 16, 2020): A1 & A12-A13.

(Note: ellipses added.)

(Note: the online version of the story was updated Feb. [sic] 2, 2021, and has the title “The Virus Trains: How Lockdown Chaos Spread Covid-19 Across India.”)

Basing Jobs on Skills Instead of Credentials Increases Fairness, Efficiency, and Opportunity

(p. B5) For the past four decades, incomes rose for those with college degrees and fell for those without one. But a body of recent and new research suggests that the trend need not inevitably continue.

As many as 30 million American workers without four-year college degrees have the skills to realistically move into new jobs that pay on average 70 percent more than their current ones. That estimate comes from a collaboration of academic, nonprofit and corporate researchers who mined data on occupations and skills.

. . .

“We need to rethink who is skilled, and how skills are measured and evaluated,” said Peter Q. Blair, a labor economist at Harvard, who was a member of the research team.

In recent years, labor experts and work force organizations have argued that hiring should increasingly be based on skills rather than degrees, as a matter of fairness and economic efficiency. The research provides quantified evidence that such a shift is achievable.

. . .

The researchers published a broad look at the jobs, wages and skills of workers who have a high school diploma but not a four-year college degree as a National Bureau of Economic Research working paper this year. They found a significant overlap between the skills required in jobs that pay low wages and many occupations with higher pay — a sizable landscape of opportunity.

. . .

A report published this week, involving most of the same researchers, examined the pathways to higher-paying jobs for these workers, their experience and the obstacles encountered. It employed proprietary data and interviews, as well as the government data used in the first study.

For the full story, see:

Steve Lohr. “Up to 30 Million Workers in U.S. Have Abilities to Earn 70% More.” The New York Times (Monday, December 7, 2020): B5.

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

(Note: the online version of the story has the date Dec. 3, 2020, and has the title “Up to 30 Million in U.S. Have the Skills to Earn 70% More, Researchers Say.”)

The National Bureau of Economic Research (NBER) working paper mentioned above is:

Blair, Peter Q., Tomas G. Castagnino, Erica L. Groshen, Papia Debroy, Byron Auguste, Shad Ahmed, Fernando Garcia Diaz, and Cristian Bonavida. “Searching for Stars: Work Experience as a Job Market Signal for Workers without Bachelor’s Degrees.” National Bureau of Economic Research, Inc., NBER Working Paper #26844, March 2020.

The later report that used proprietary data and interviews is:

“Navigating with the Stars: Reimagining Equitable Pathways to Mobility.” Opportunity@Work, Nov. 2020.

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.”)

The Handful Who “Called the Government’s Bluff and Stayed”

(p. A12) ACHRISTCHURCH, New Zealand — First the houses and cars vanished. Fences, driveways and the other remaining markers of suburban life followed. Now, only stretches of green remain — an eerie memorial to two earthquakes that leveled Christchurch, New Zealand’s second-largest city, 10 years ago.

The undulating expanse, which begins two miles from downtown Christchurch, was deemed uninhabitable after the quakes, the second of which killed 185 people on Feb. 22, 2011. The 8,000 properties it encompassed were bought by the government and razed, the remnants swept away.

. . .

When the government sought to buy out thousands of homeowners after the 2011 quake, it intended to give them certainty about their futures. Many were angered by the offer, which was based on four-year-old property valuations.

Some were compelled to accept in order to pay their mortgages, others when officials warned that red-zoned areas would no longer be served by utilities, infrastructure or insurance.

A handful of residents called the government’s bluff and stayed.

Brooklands, a semirural area, is home to the most united display of red-zone defiance. When the land there was judged unlivable, most residents sold up and left, but a little over a dozen homes remain.

“It’s beautiful,” said one of the homeowners, Stephen Bourke. “There’s no one here. It’s paradise.”

A project manager in the civil construction industry, Mr. Bourke repaired his 80-year-old wooden villa himself. “It doesn’t leak,” he said. “It’s all on an angle, but we’ve water-sealed it.”

Ramshackle bus shelters remain on Brooklands’s single-house streets, although no buses arrive. Surviving homes are flanked by overgrown lots.

The local authorities still collect trash and mow the verges, contrary to warnings in 2011 that they would stop, but the roads are potholed and uneven.

Mr. Bourke said he saw little point in moving elsewhere, given that much of New Zealand is prone to earthquakes and floods.

“It’s all very well having these politicians turn up and tell people where they can go,” he said. “But where are you going to tell me to go in New Zealand that’s safe to live?”

For the full story, see:

Charlotte Graham-McLay. “Years After Quakes, City Leaves a Hush Where Homes Stood.” The New York Times (Tuesday, February 23, 2021): A12.

(Note: ellipsis added.)

(Note: the online version of the story has the date Feb. 21, 2021, and has the title “10 Years After Christchurch Quake, a Hush Where 8,000 Homes Once Stood.”)

In the Early Fight Against COVID-19 in China “Front-Line Bureaucrats Were Consumed With Paperwork”

(p. A15) After Chinese leader Xi Jinping ordered rural poverty eliminated by 2020, bureaucrats in the southwestern city of Mianyang got busy—with paperwork.

Instructed to devote 70% of their time to the campaign, they diligently filled out forms certifying compliance, a practice known as “leaving marks,” said Pang Jia, a local judicial clerk who joined the effort. When higher-ups demanded photographic proof of their home visits, some aid workers made up for missing winter photos by posing in cold-weather clothing during summer house calls, Ms. Pang said.

Since taking power in late 2012, Mr. Xi has realigned Chinese politics with his domineering style and a top-down drive to forge a centralized state under the Communist Party. But his efforts are running into an old foe: bureaucracy.

Party observers say the drive for centralization in a sprawling nation too often fosters bureaucratic inertia, duplicity and other(p. A10)unproductive practices that are aimed at satisfying Beijing and protecting careers but threaten to undermine Mr. Xi’s goals.

Indeed, some local officials have become so focused on pleasing Mr. Xi and fulfilling party mandates that they can neglect their basic duties as public servants, sometimes with dire results.

As the new coronavirus spread in Wuhan in late 2019, for instance, local authorities were afraid to share bad news with Beijing. That impeded the national response and contributed to the death toll, according to a Wall Street Journal investigation.

Mr. Xi and other senior officials publicly lamented how front-line bureaucrats were consumed with paperwork instead of fighting the contagion. Officials dedicated hours each day to filling out multiple documents for agencies making overlapping requests for information, including residents’ body temperatures and symptoms.

For the full story, see:

Chun Han Wong. “Xi Jinping’s Eager Minions Snarl His China Plans.” The Wall Street Journal (Monday, March 8, 2021): A15.

(Note: the online version of the story has the date March 7, 2021, and has the title “Xi Jinping’s Eager-to-Please Bureaucrats Snarl His China Plans.”)

Long Beach Supermarket Workers Lose Jobs Due to Higher Minimum Wage

(p. A15) As these things always do, it started out with the best intentions. In January [2021] the City Council of Long Beach, Calif., adopted an ordinance requiring large grocery-store chains to pay employees an extra $4 an hour. The idea was to reward them for the risks they took by doing their jobs amid the Covid-19 pandemic.

It didn’t turn out that way. In response to the ordinance, Kroger Co. announced it would close two Long Beach supermarkets.

. . .

As one of the world’s largest retailers, Kroger makes an easy villain. But instead of blaming “reckless capitalism,” might the fault lie with the reckless politicians who passed this measure? Thanks to their intervention, instead of finding an extra $4 an hour in their paychecks, nearly 200 grocery workers will now have no paychecks at all unless they are transferred to another store or find another job. It’s but the latest illustration of economist Thomas Sowell’s dictum that whatever a government might set it at, “the real minimum wage is always zero.”

For the full commentary, see:

William McGurn. “The Human Cost of a Minimum Wage.” The Wall Street Journal (Tuesday, February 16, 2021): A15.

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

(Note: the online version of the commentary has the date February 15, 2021, and has the same title as the print version.)

Bernie Sanders Is Uncomfortable that Twitter Censored Trump

Do you think there is truth to the critique that liberals have become too censorious and too willing to use their cultural and corporate and political power to censor or suppress ideas and products that offend them?

Look, you have a former president in Trump, who was a racist, a sexist, a xenophobe, a pathological liar, an authoritarian, somebody who doesn’t believe in the rule of law. This is a bad-news guy. But if you’re asking me, do I feel particularly comfortable that the then-president of the United States could not express his views on Twitter? I don’t feel comfortable about that.

Now, I don’t know what the answer is. Do you want hate speech and conspiracy theories traveling all over this country? No. Do you want the internet to be used for authoritarian purposes and an insurrection, if you like? No, you don’t. So how do you balance that? I don’t know, but it is an issue that we have got to be thinking about. Because yesterday it was Donald Trump who was banned, and tomorrow, it could be somebody else who has a very different point of view.

I don’t like giving that much power to a handful of high-tech people. But the devil is obviously in the details, and it’s something we’re going to have to think long and hard on.

For the whole interview, see:

Klein, Ezra, interviewer. “An Unusually Optimistic Conversation With Bernie Sanders; The Vermont senator discusses the Rescue Act, cancel culture, the filibuster and more.” The Ezra Klein Show, on the New York Times web site. (Tuesday, March 23rd, 2021).

(Note: the first sentence question is by interviewer Ezra Klein. The following answer is by Senator Bernie Sanders.)

WHO Team Unable to Conduct a Thorough and Impartial Study of Wuhan Origin of Covid-19

(p. A1) . . . , as the WHO-led team finalizes its full report on the Wuhan mission, a Wall Street Journal investigation has uncovered fresh details about the team’s formation and constraints that reveal how little power it had to conduct a thorough, impartial examination—and call into question the clarity its findings appeared to provide.

. . .

(p. A10) The WHO asked the U.S. to recommend government experts for the team, but it didn’t contact the three that Washington put forward, according to current and former U.S. officials.

. . .

On Jan. 23, 2020, a WHO emergency committee recommended that a WHO-led group of scientists should “review and support efforts to investigate the animal source of the outbreak.”

. . .

Tedros Adhanom Ghebreyesus, the WHO’s director-general, discussed the matter with President Xi Jinping in a January 28 meeting. The next month, a WHO-led team, including two U.S. government experts, visited China.

Local officials appeared committed to a search and described work they had under way, according to people on that trip. But no studies emerged over the following weeks.

. . .

The team included leading specialists in animal health, epidemiology and virology, and government experts from Germany, Russia and Japan.

It included one scientist from the U.S.: Peter Daszak, a zoologist and president of EcoHealth Alliance, a New York-based nonprofit.

Dr. Daszak had experience hunting for the origins of emerging human viruses in animals, including 16 years working with researchers in China. He was on a team that pinpointed bats as the source of the coronavirus behind SARS.

Some U.S. officials and scientists were concerned some of his nonprofit’s work in China posed a conflict of interest. EcoHealth had in past years provided funding to the Wuhan Institute of Virology as part of a grant from the U.S. National Institutes of Health. The WIV is at the center of assertions by the Trump administration that the pandemic virus could have come from a lab, and Dr. Daszak had publicly dismissed the possibility.

In applying for a spot on the team, Dr. Daszak said, he described his expertise and provided a conflict-of-interest statement to the WHO including his work with the WIV.

. . .

On Jan. 28 [2021], a year to the day from the WHO director-general’s meeting with President Xi, they were cleared to begin field visits and face-to-face meetings with Chinese counterparts. For the remainder of the trip, they were restricted mainly to one part of a hotel due to more quarantine rules and forced to eat separately from Chinese counterparts—preventing the kind of informal conversations team members said were often the most fruitful in such efforts. Their contact with anyone outside the team was limited.

It soon became evident to foreign officials and scientists tracking the mission that the team’s itinerary was partly designed to bolster China’s official narrative that the government moved swiftly to control the virus. The team’s first visit was to a hospital where they met a doctor Beijing feted as the first to raise alarms through official channels about an outbreak of unknown pneumonia. The next day, after another hospital visit, the team went to an exhibition commemorating Chinese authorities’ early “decisive victory in the battle” against the virus, paying tribute to President Xi’s leadership.

. . .

Team members said it became clear to them that Chinese authorities would mostly present only their data analysis, not the raw numbers. And they hadn’t completed some short-term tasks the team had hoped for, including detailed studies of blood samples from before December 2019 and compiling a definitive list of animals sold at the Huanan market.

Among the 30 to 60 Chinese participants were nonscientists, including foreign-ministry officials, team members said. China’s team leader has said his team included 17 experts. The Chinese foreign ministry said none of its officials were in the expert group.

A heated exchange during one meeting touched on the pivotal question of how widely the virus spread around Wuhan before the first confirmed case, who Chinese officials say got sick on Dec. 8, 2019.

. . .

After leaving Wuhan, some international team members qualified their verdict on the laboratory. They lacked the authority, expertise or access to conduct a full examination of the WIV or any other research facility, several said publicly or to the Journal.

Several said that they hadn’t been able to see the raw data or original safety, personnel, experiment and animal-breeding logs—which many other scientists say are necessary elements of a full investigation.

“It’s just a great coup by China,” said Daniel Lucey, a clinical professor of medicine at the Geisel School of Medicine at Dartmouth who also teaches at Georgetown University.

A thorough investigation of a potential lab leak would require experts with forensic skills similar to those who do weapons or biowarfare inspections, scientists including Dr. Dwyer said.

“We didn’t see the actual data there,” Dr. Dwyer said. “It would be nice to have seen that, particularly around the testing of their staff and so on. But that didn’t come through. They could still provide that.”

For the full story, see:

Jeremy Page, Betsy McKay, and Drew Hinshaw. “WHO’s Hunt for Covid’s Origins Stumbled in China.” The Wall Street Journal (Thursday, March 18, 2021): A1 & A10.

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

(Note: the online version of the story has the date March 17, 2021, and has the title “How the WHO’s Hunt for Covid’s Origins Stumbled in China.” Where there were differences in wording between the online and the print versions, the passages quoted above follow the online version.)

Vaccine Immunity, Plus Natural Immunity from Getting Covid-19, Equals Herd Immunity Soon

The author of the passages I quote below is a surgeon and professor at the Johns Hopkins School of Medicine and has authored The Price We Pay, which I recently read. It is a disturbing, eye-opening, excellent account of why the costs of drugs are high and rising.

(p. A17) Anthony Fauci has been saying that the country needs to vaccinate 70% to 85% of the population to reach herd immunity from Covid-19. But he inexplicably ignores natural immunity. If you account for previous infections, herd immunity is likely close at hand.

. . .

Dr. Fauci’s vaccination-only path to herd immunity has significantly influenced the national conversation. KNBC-TV in Los Angeles has a county-by-county vaccine tracker showing a bar graph of the percentage of Californians vaccinated, with the zone 70% to 85% labeled “herd immunity.” Currently, it’s at 26%. The false construct does create a greater urgency for everyone to get vaccinated. But it also creates false justification for continued excessive restrictions on freedom. And it raises the possibility that authorities are misallocating the limited vaccine supply by failing to direct it toward people without natural antibodies.

. . .

Some experts claim they don’t talk about natural immunity because we shouldn’t trust it. But a recent Public Health England study found that less than 1% of 6,614 healthcare workers who had Covid-19 developed a reinfection within five months—even though many of them work with Covid patients. Other experts believe natural immunity is powerful. “Natural immunity after Covid-19 infection is likely lifelong, extrapolating from data on other coronaviruses that cause severe illness, SARS and MERS,” says Monica Gandhi, an infectious-disease physician and professor at the University of California.

For the full commentary, see:

Marty Makary. “Herd Immunity Is Near, Despite Fauci’s Denial.” The Wall Street Journal (Thursday, March 25, 2021): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date March 24, 2021, and has the same title as the print version.)

The Makary book praised above is:

Makary, Marty. The Price We Pay: What Broke American Health Care–and How to Fix It. New York: Bloomsbury Publishing, 2019.