Category: Regulations

Key Healthcare Issue Is Not How to Divvy Up a Fixed Pie, But How to Grow the Pie Through New Cures

(p. A23) . . . in the second phase of my illness, once I knew roughly what was wrong with me and the problem was how to treat it, I very quickly entered a world where the official medical consensus had little to offer me. It was only outside that consensus, among Lyme disease doctors whose approach to treatment lacked any C.D.C. or F.D.A. imprimatur, that I found real help and real hope.

And this experience made me more libertarian in various ways, more skeptical not just of our own medical bureaucracy, but of any centralized approach to health care policy and medical treatment.

This was true even though the help I found was often expensive and it generally wasn’t covered by insurance; like many patients with chronic Lyme, I had to pay in cash. But if I couldn’t trust the C.D.C. to recognize the effectiveness of these treatments, why would I trust a more socialized system to cover them? After all, in socialized systems cost control often depends on some centralized authority — like Britain’s National Institute for Health and Care Excellence or the controversial, stillborn Independent Payment Advisory Board envisioned by Obamacare — setting rules or guidelines for the system as a whole. And if you’re seeking a treatment that official expertise does not endorse, I wouldn’t expect such an authority to be particularly flexible and open-minded about paying for it.

Quite the reverse, in fact, given the trade-off that often shows up in health policy, where more free-market systems yield more inequalities but also more experiments, while more socialist systems tend to achieve their egalitarian advantages at some cost to innovation. Thus many European countries have cheaper prescription drugs than we do, but at a meaningful cost to drug development. Americans spend obscene, unnecessary-seeming amounts of money on our system; America also produces an outsize share of medical innovations.

And if being mysteriously sick made me more appreciative of the value of an equalizing floor of health-insurance coverage, it also made me aware of the incredible value of those breakthroughs and discoveries, the importance of having incentives that lead researchers down unexpected paths, even the value of the unusual personality types that become doctors in the first place. (Are American doctors overpaid relative to their developed-world peers? Maybe. Am I glad that American medicine is remunerative enough to attract weird Type A egomaniacs who like to buck consensus? Definitely.)

Whatever everyday health insurance coverage is worth to the sick person, a cure for a heretofore-incurable disease is worth more. The cancer patient has more to gain from a single drug that sends the disease into remission than a single-payer plan that covers a hundred drugs that don’t.

. . .

. . ., the weakness of the liberal focus on equalizing cost and coverage is the implicit sense that medical care is a fixed pie in need of careful divvying, rather than a zone where vast benefits await outside the realm of what’s already available.

. . .

. . . once you’ve become part of the American pattern of trying anything, absolutely anything in order to feel better — and found that spirit essential to your own recovery — the idea of medical cost control as a primary policy goal inevitably loses some of its allure, and the American way of medical spending looks a little more defensible. To just try things without counting the cost can absolutely run to excess. But sometimes what seems like waste on the technocrat’s ledger is the lifeline that a desperate patient needs.

For the full commentary, see:

Ross Douthat. “Being Sick Changed My Views on Health Care.” The New York Times (Thursday, January 20, 2022): A23.

(Note: ellipses added.)

(Note: the online version of the commentary has the date January 19, 2022, and has the title “How Being Sick Changed My Health Care Views.”)

The commentary quoted above is related to the author’s book:

Douthat, Ross. The Deep Places: A Memoir of Illness and Discovery. New York: Convergent Books, 2021.

Patches of Plastic in Ocean Harbor Dense, Delicate, Diverse “Neuston” Sea Life

(p. D8) In 2019, the French swimmer Benoit Lecomte swam over 300 nautical miles through the Great Pacific Garbage Patch to raise awareness about marine plastic pollution.

As he swam, he was often surprised to find that he wasn’t alone.

“Every time I saw plastic debris floating, there was life all around it,” Mr. Lecomte said.

The patch was less a garbage island than a garbage soup of plastic bottles, fishing nets, tires and toothbrushes. And floating at its surface were blue dragon nudibranchs, Portuguese man-o-wars, and other small surface-dwelling animals, which are collectively known as neuston.

Scientists aboard the ship supporting Mr. Lecomte’s swim systematically sampled the patch’s surface waters. The team found that there were much higher concentrations of neuston within the patch than outside it. In some parts of the patch, there were nearly as many neuston as pieces of plastic.

“I had this hypothesis that gyres concentrate life and plastic in similar ways, but it was still really surprising to see just how much we found out there,” said Rebecca Helm, an assistant professor at the University of North Carolina and co-author of the study. “The density was really staggering. To see them in that concentration was like, wow.”

. . .

Dr. Helm and her colleagues pulled many individual creatures out of the sea with their nets: by-the-wind sailors, free-floating hydrozoans that travel on ocean breezes; blue buttons, quarter-sized cousins of the jellyfish; and violet sea-snails, which build “rafts” to stay afloat by trapping air bubbles in a soap-like mucus they secrete from a gland in their foot. They also found potential evidence that these creatures may be reproducing within the patch.

The findings were posted last month on bioRxiv and have not yet been subjected to peer review. But if they hold up, Dr. Helm and other scientists say, it may complicate efforts by conservationists to remove the immense and ever-growing amount of plastic in the patch.

. . .

. . . Dr. Helm said there is [an] . . . implication of the study: Organizations working to remove plastic waste from the patch may also need to consider what the study means for their efforts.

There are two nonprofit organizations working to remove floating plastic from the Great Pacific Patch. The largest, the Ocean Cleanup Foundation in the Netherlands, developed a net specifically to collect and concentrate marine debris as it is pulled across the sea’s surface by winds and currents. Once the net is full, a ship takes its contents to land for proper disposal.

Dr. Helm and other scientists warn that such nets threaten sea life, including neuston. Although adjustments to the net’s design have been made to reduce bycatch, Dr. Helm believes any large-scale removal of plastic from the patch could pose a threat to its neuston inhabitants.

“When it comes to figuring out what to do about the plastic that’s already in the ocean, I think we need to be really careful,” she said.

For the full story, see:

Annie Roth. “Marine Animals Float Amid Patch Of Pacific Garbage.” The New York Times (Tuesday, May 10, 2022): D8.

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

(Note: the online version of the story was updated May 8, 2022, and has the title “The Ocean’s Biggest Garbage Pile Is Full of Floating Life.”)

Helm’s co-authored draft paper is:

Chong, Fiona, Matthew Spencer, Nikolai Maximenko, Jan Hafner, Andrew McWhirter, and Rebecca R. Helm. “High Concentrations of Floating Life in the North Pacific Garbage Patch.” bioRxiv (posted April 28, 2022): 2022.04.26.489631.

F.A.A. Can Take Many Years to Certify Innovative Aviation Technologies

(p. 6) Despite the excitement about e-planes, the Federal Aviation Administration has never certified electric propulsion as safe for commercial use. Companies expect that to change in the coming years, but only gradually, as safety concerns are worked out.

. . .

The consensus within the industry is that the F.A.A., which regulates half the world’s aviation activity, is several years from certifying urban air mobility.

“It’s a big burden of proof to bring new technology to the F.A.A. — appropriately so,” Mr. Clark said. Currently the certification process for a new plane or helicopter takes two to three years on average. For an entirely new type of vehicle, it could be considerably longer. (One conventionally powered aircraft that can take off and land without a runway had its first flight in 2003. It remains uncertified.)

For the full story, see:

Ben Ryder Howe and Tristan Spinski. “Covid Patient In Shanghai Describes Life In Isolation.” The New York Times, SundayBusiness Section (Sunday, April 17, 2022): 1 & 6-7.

(Note: ellipsis added.)

(Note: the online version of the story was updated April 18, 2022, and has the title “The Battery That Flies.”)

“Byzantine Health Care System” Slowed Rollout of Effective COVID Anti-Viral Medication Paxlovid

(p. A16) GREENBELT, Md. — Last month, the owner of a small pharmacy here secured two dozen courses of Pfizer’s new medication for treating Covid-19, eager to quickly provide them to his high-risk customers who test positive for the virus.

More than a month later, the pharmacy, Demmy’s, has dispensed the antiviral pills to just seven people. The remaining stock is sitting in neatly packed rows on its shelves here in the suburbs of Washington, D.C. And the owner, Adeolu Odewale, is scrambling to figure out how to get the medication, Paxlovid, to more people as cases have increased over 80 percent in Maryland in recent days.

“I didn’t expect that I was still going to be sitting on that many of them,” he said of the pills he still has on hand. “It’s just that people need to know how to get it.”

. . .

But with the medication now more abundant, pharmacists, public health experts and state health officials say that encouraging the right people to take it, and making it easier for them to access, could help blunt the effects of another Covid wave.

State health officials say that many Americans who would be good candidates for Paxlovid do not seek it out because they are unaware they qualify for it, hesitant about taking a new medication, or confused by the fact that some providers interpret the eligibility guidelines more narrowly than others.

Since the medication has to be prescribed by a doctor, nurse practitioner or physician assistant, people have to navigate an often byzantine health care system in search of a prescription, then find a pharmacy that carries the treatment, all within five days of developing symptoms. The medication, prescribed as three pills taken twice a day for five days, is meant to be started early in the course of infection.

. . .

More than 630,000 courses of the drug — roughly a third of the supply distributed to date — are currently available, and the federal government has been sending 175,000 courses to states each week, according to federal data.

. . .

Giving pharmacists prescribing power could help people get the treatment much more quickly and easily, public health experts say. But regulators at the F.D.A. and other federal health officials believe there is reason to not allow pharmacists to prescribe Paxlovid themselves, even though some Canadian pharmacists can do so. The treatment can interfere with certain medications and should be prescribed at a lower dose for people with kidney impairment, which is measured with a blood test.

Pharmacists say that they are highly trained and well equipped to conduct such screening themselves. Michael Ganio, senior director of pharmacy practice and quality at the American Society of Health-System Pharmacists, said pharmacists could get Paxlovid to patients faster if they could prescribe it, “without having to call a physician’s office and wait for a call back, and hope it happens within five-day period.”

For the full story, see:

Noah Weiland. “Plenty of Covid Pills, Not Many Prescriptions.” The New York Times (Wednesday, April 27, 2022): A16.

(Note: ellipses added.)

(Note: the online version of the story has the date April 26, 2022, and has the title “With Supply More Abundant, Pharmacies Struggle to Use Up Covid Pills.” The online version says that the article appeared on p. A18 of the print version, but in my National edition of the print version, it appeared on p. A16.)

Art Diamond Discusses “Policy Hurdles in the Fight Against Aging” on Caleb Brown’s Cato Daily Podcast

Caleb Brown, of the Cato Institute, posted an interview with me yesterday (May 27, 2022) on his “Cato Daily Podcast.” The topic, “Policy Hurdles in the Fight against Aging,” is related to a chapter in my book-in-progress on medical entrepreneurship that is to be entitled Less Costs, More Cures: Unbinding Medical Entrepreneurs.

Sugarman Spent $500,000 in a Losing Fight Against a $100,000 FTC Fine

(p. A12) Though many of his wackier ideas bombed, Mr. Sugarman came up with a big winner now and then, including pocket calculators in the early 1970s and his BluBlocker sunglasses, designed to filter out ultraviolet and blue light waves, starting in the 1980s.

. . .

Trouble came in 1979 when the Federal Trade Commission accused him of violating a rule requiring firms to send out mail-order items promptly or notify customers of delays. Mr. Sugarman said the delays were caused by blizzards and a computer breakdown. The FTC proposed a $100,000 fine.

Mr. Sugarman counterattacked with a pamphlet, “The Monster That Eats Business,” an indictment of the FTC illustrated with cartoons in the style of Mad magazine. He accused FTC officials of hounding him over trivial lapses. After six years of fighting, he agreed to a settlement requiring him to pay a fine of $115,000 over four years. Mr. Sugarman said he had spent $500,000 on legal fees and added that “we are completely innocent of the charges.”

The success of BluBlocker sunglasses dug him out of that hole. Mr. Sugarman had a home on Maui, where he published a weekly newspaper. He flew small airplanes. He drove a Ferrari Testarossa. He looked dapper in his BluBlockers.

For the full obituary, see:

James R. Hagerty. “Marketing Guru Survived His Flops and Found Hits.” The Wall Street Journal (Saturday, April 2, 2022): A12.

(Note: ellipsis added.)

(Note: the online version of the obituary has the date March 29, 2022, and has the title “Marketing Maverick Survived Flops, Found Hits.”)

Imposing Permanent Daylight Savings Time Is Like Imposing Permanent Jet Lag

(p. A19) . . . when the U.S. Senate recently passed a bill to make daylight-saving time permanent, sleep experts became more alarmed.

Legislators picked the wrong time, they say.

Our internal clocks are connected to the sun, which aligns more closely with permanent standard time, says Muhammad Adeel Rishi, a pulmonologist and sleep physician at Indiana University. When the clocks spring forward, our internal clocks don’t change but are forced to follow society’s clock rather than the sun. DST is like permanent social jet lag.

Dr. Rishi is one of the authors of a 2020 position statement from the American Academy of Sleep Medicine, a professional society, supporting making standard time—not daylight-saving time—permanent.

. . .

One of the big problems with permanent DST, objectors note, is that in the winter the sun will rise later and many schoolchildren will be walking to school in the dark.

On the western edge of the eastern time zone in Indiana, for instance, the sun won’t rise in the winter until about 9 a.m., notes Dr. Rishi. “You’re basically putting these kids two hours off from their circadian biology,” he says.

For the full commentary, see:

Sumathi Reddy. “YOUR HEALTH; Body Clock Needs Sun In Morning.” The Wall Street Journal (Thursday, March 24, 2022): A19.

(Note: ellipses added.)

(Note: the online version of the commentary has the date March 23, 2022, and has the title “YOUR HEALTH; Why Permanent Daylight-Saving Time Is Seen as Bad for Your Health.”)

Pre-Covid Federal Pandemic Plans Did Not Include Lockdowns

(p. A19) California Gov. Gavin Newsom announced the first statewide U.S. stay-at-home order on March 19, 2020. All U.S. states and most other countries have long since abandoned lockdowns as oppressive, ineffective and exorbitantly expensive. But why did free countries adopt such a strategy to begin with?

. . .

Stay-at-home orders weren’t part of the script in pre-Covid federal pandemic plans. The idea of “flattening the curve” through what are known as “layered non-pharmaceutical interventions” can be traced to an influential 2007 Centers for Disease Control and Prevention guidance paper, updated in 2017. Contemplating a severe pandemic with a 2% case fatality rate, the CDC recommended now-familiar strategies, such as masking, surface disinfection and temporary school closings.

Yet aside from suggesting limits on mass gatherings, the CDC paper makes no mention of closing workplaces. Instead, it concludes that such a severe pandemic could warrant recommending that employers “offer telecommuting and replace in-person meetings in the workplace with video or telephone conferences.” The closest it comes to lockdowns is recommending “voluntary home quarantine” for people with an infected family member.

. . .

When Western nations were confronted with Covid-19, they seemed to believe the Communist Party’s unproven claims about the efficacy of lockdowns. In the end, every other country got some variant of the virus and some variant of China’s official response. The world has learned to live with the former, as politically accountable leaders found they couldn’t maintain draconian restrictions forever. The people of China will be forced to endure the latter indefinitely.

For the full commentary, see:

Eugene Kontorovich and Anastasia Lin. “Covid Lockdowns Were a Chinese Import.” The Wall Street Journal (Thursday, March 24, 2022): A19.

(Note: ellipses added.)

(Note: the online version of the commentary has the date March 23, 2022, and has the same title as the print version.)

Covid Policy Should Have Taken Account of Costs of Lockdowns and Mandates

(p. A17) Reducing the incidence of disease isn’t necessarily desirable if excessive prevention, in the form of lockdowns or school closures, is more costly to society than the damage done by an illness. We don’t close highways to minimize accidental deaths, despite the existence of dangerous drivers. Yet this is exactly what we’re doing when the government intervenes to limit the spread of communicable diseases by, for instance, mandating vaccines that don’t prevent transmission.

. . .

In early 2020, University of Chicago economists estimated that about 80% of the total damage from Covid came from prevention efforts that hindered economic activity, and only 20% from the direct effects of the disease itself. This analysis motivated me and others to recommend that initial efforts to stop the spread should focus on older people, who are at higher risk of severe illness and not as active in the economy as younger people. This would allow younger people to keep the economy going while limiting the spread of the disease among those most at risk from it. Some in the public-health community, like the signers of the Great Barrington Declaration, eventually saw the light.

My Chicago colleague Casey B. Mulligan has found that total monthly Covid-related harms fell from 2020 to 2021, even as the number of deaths rose. In tax terms, this is an effect not unlike that of the Laffer curve—a lower rate may increase revenue because of growth in the tax base. Similarly, vaccines and treatments reduced the costs associated with getting sick—call it the “disease tax”—but also increased social and economic activity, allowing the infection to spread. Even if the disease tax is paid by more people, the costs are outpaced by the overall benefit derived from the subsequent tsunami of economic activity.

For the full commentary, see:

Tomas J. Philipson. “An Economic Evaluation Of Covid Lockdowns.” The Wall Street Journal (Saturday, January 20, 2022): A17.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date January 19, 2022, and has the same title as the print version.)

During Pandemic, Delayed Medical Procedures Rose from 4.6 to 6 Million in England’s Socialized Healthcare System

(p. A8) LONDON — Lara Wahab had been waiting for more than two years for a kidney and pancreas transplant, but months had passed without any word. So last month she called the hospital, and got crushing news.

There had been a good match for her in October [2021], the transplant coordinator told her, which the hospital normally would have accepted. But with Covid-19 patients filling beds, the transplant team could not find her a place in the intensive care unit for postoperative care. They had to decline the organs.

“I was just in shock. I knew that the N.H.S. was under a lot of strain, but you don’t really know until you’re waiting for something like that,” she said, referring to the National Health Service. “It was there, but it sort of slipped through my fingers,” she added of the transplant opportunity.

Ms. Wahab, 34, from North London, is part of an enormous and growing backlog of patients in Britain’s free health service who have seen planned care delayed or diverted, in part because of the pandemic — a largely unseen crisis within a crisis. The problems are likely to have profound consequences that will be felt for years.

The numbers are stark: In England, nearly 6 million procedures are currently delayed, a rise from the backlog of 4.6 million before the pandemic, according to the N.H.S. The current delays most likely impact more than five million people — a single patient can have multiple cases pending for different ailments — which represents almost one-tenth of the population. Hundreds of thousands more haven’t been referred yet for treatment, and many ailments have simply gone undiagnosed.

For the full story, see:

Megan Specia. “In Britain, an Ever-Growing Backlog of Non-Covid Care.” The New York Times (Thursday, January 27, 2022): A8.

(Note: bracketed year added.)

(Note: the online version of the story was updated January 27, 2022, and has the title “‘I Feel Really Hopeless’: In U.K., Millions See Non-Covid Health Care Delayed.”)