Fred08.com? Fred Dead? Only in My Head

OK, OK, I admit it. I'm weak.

Although I unilaterally fired his ass from thenewswalk.com news ticker, Fred Thompson just got 50 bucks out of me. Anyone who's lazy, hates people, and is the only true conservative running for president can't be all bad, and that makes him 3 for 3 with me. Plus, he never says anything genuinely stupid.

Do not, under any circumstances, go to his website and contribute yourself. Just don't. You ain't lazy, you love people, and you're not even all that conservative.

Plus, you dig candidates who say stupid stuff all the time. Here's your man. Or maybe this one. Not Fred, though.

Huckabee, Schmuckabee, Fred's Dead: Is Mitt a Twit?

Like Fred Thompson before him, Mike Huckabee is about to squander thenewswalk.com bump that comes with the honor of being the subject of our news ticker in the right column.

Huck has leapt to near the top of the polls, but you just don't accuse your opponent of believing that Satan is Jesus' brother. Even if it were true, which it apparently ain't, that's just bad form.

Neither do I, a putative Christian, want a president who advertises himself as a "Christian Leader." I'm also putatively a Catholic, and I don't want any "Catholic Leaders" as my president either. I prefer my sectarianism in this republic mellow and understated, invisible even, just like the Founders did. "Christian Leader" means Pat Robertson, and the Republican Party didn't like that noise the first time around after he finished second in the 1988 Iowa Caucuses.

The general electorate liked it even less. Huck, you're out. I like Christians. I'm married to one. But too much is way too much.

National Review, which founded modern conservatism, and which historically has been more Catholic and Jewish than Protestant, has endorsed Mitt Romney, who is none of the above, Mormonism being its own thing.

Harkening back to Abraham Lincoln, who said he'd fight to preserve the Union even if it meant not freeing a single slave, National Review endorses Romney to preserve the unity of the conservative movement, even if it means not electing a Republican to the presidency in '08.

[Well, they didn't admit the last part, but that's what's going on here.]

So, OK. I can dig that. Mitt Romney gets thenewswalk.com ticker now. Me, I think Mitt's a plastic man and genuinely weird, like Gore and Kerry before him, who deserved to lose. Weird like he put his family dog on the roof of his car for 10 hours on a trip, and then insisted the doggie liked it, even though the car was covered in doggie poo.

I mean, that's weird, I don't care how cleancut His Mittness looks.

I don't want a weird president. If Romney's the GOP nominee, I can't guarantee he gets my conservative vote, just because I happen to be a conservative. But Brother Mitt, you have our news ticker now, with all the perks and responsibilities it entails.

Prove to us that you ain't weird, please? I wanna believe.

A Word About "Authorized" Generics

Patents are valuable, often enough, and economic value attracts the sort of attention that honey elicits from bugs. And so whole industries evolve around legal challenges to patents, and the more valuable a given patent, the stronger the incentive to use the courts to redistribute wealth. Moreover, litigation is expensive, and the risk of losing a pharmaceutical patent to a challenger---to a generic drug producer in this context---analytically is equivalent to a shortening of the patent period expectationally. The process, therefore, reduces the expected returns to investment in the research and development of new medicines, and reduces as well the development of me-too drugs, that is, competition in the pharamceutical market.

And that is why the geniuses in Congress who want to limit the ability of innovative pharmaceutical producers to settle such lawsuits with payments to the challengers are utterly myopic in their view that such limits would increase (generic) competition and thus lower prices. In the very short run, maybe. But the increased challenges to patents would have the longer-run effect of reducing the flow of new medicines, and thus competitive pressures from them with respect to older, more-established drugs. That this is so obvious is the central reason that many in Congress cannot understand it.

[cross-posted from www.medicalprogresstoday.com/blog/]

The View From the Top...

... is always top-down, particularly in that city of the exalted, Washington D.C. So what is it this time? "A Food and Drug Administration medical reviewer said it wasn't clear if consumers could safely and effectively use a proposed Merck & Co. cholesterol-lowering drug without a prescription." (Wall Street Journal, December 11)

And that just about sums it all up, doesn't it? Forget consultations between doctors and their patients. Forget the heterogeneous characteristics and needs of millions of individual patients. Forget the huge informational advantage engendered by ongoing experience, modern mass communication, and individual trial and error. Forget the reality that some very substantial proportion of prescriptions are for off-label uses. Sorry: The Beltway knows best, children---because it says so---and "safety and effectiveness" is one-size-fits-all.

It is not only inside the Beltway that this sort of arrogance is to be found, but it is the Beltway in which it is rewarded so consistently and in which it simply is more than a way of life. It is a mindset.

[cross-posted from www.medicalprogresstoday.com/blog/]

What Is a Mandate?

A good fight is always fun to watch, particularly if it is only political blood that is being spilled, and it is flowing freely in the Democratic free-for-all in the context of health care reform. Senators Clinton, Edwards, and Obama are united in their policy preferences for "reforms" that inexorably will lead to a single-payer system of health care insurance and to all of the perversities attendant upon it. Anyway, one way to reduce the taxpayer cost---not the true economic cost---of such a system is to force those who otherwise would find health insurance not worth its cost to buy it anyway. They would pay more than the benefits they receive, and so would subsidize others.

Such an "individual mandate" for all is part of the Clinton and Edwards proposals, and for children in the Obama plan. So: How would the government enforce this requirement? Edwards is quite clear: He would require proof of insurance with the annual filing of income-tax returns, and in the absence of such documentation the IRS would automatically enroll the scofflaws in a plan. And if the freeloaders refuse to pay the premiums? Wages will be garnished! The IRS becomes ever friendlier!

Hillary, after having blasted Obama for not having a mandate, and thus not "covering" everyone, finally has been forced to admit, sort of, that a mandate is meaningless without enforcement, and that she too might consider garnishment of wages and the like. Obama, more honest than the other two---not an exacting challenge---has not responded with a proposal for expanded coercion, and indeed has not explained even how the mandate for kids is to be enforced.

So let us be very clear: Mandates will be hard to enforce, and so the cost estimates in the respective plans---for this reason and host of others---will come a cropper. Which illustrates an eternal truth: Government planning cannot work, never has worked, and always yields unexpected effects less than salutary. Will our crack journalists covering this issue understand any of this? Not a safe bet. Not at all.

[cross-posted from www.medicalprogresstoday.com/blog/]

Super-Sized Stupidity, Beltway-Style

Well, not exactly the Beltway this time, but instead a member of the D.C. Council, David A. Catania, who without any doubt at all looks in the mirror and sees Senator Catania. After all, they all drink the same water. Anyway, Comrade Catania now proposes to license pharmaceutical sales representatives, in an effort to rein in "disreputable agents who drive up the costs of prescription drugs."

Got that? Restricting the supply of reps through licensing will reduce costs! And how will this bit of alchemy be achieved? Elementary, Watson: No longer will we have pharmaceutical representatives who can "mislead doctors and patients into buying the most expensive drugs on the market, shunning reasonably priced generics or drugs that could be just as effective." After all, sayeth the deep-thinking Catania, "the agents' salaries are dependent on sales, [so that] they sometimes give the wrong impressions about drugs and present themselves as medical professionals."

So there we have it. Doctors who are licensed are fools, but pharmaceutical representatives who are licensed are wise and scrupulous. Oh, by the way, since Comrade Catania seems not to propose a change in the way that "the agents' salaries" are determined, it is not quite clear how licensing would change their incentives. And speaking of which, incentives for deception are far weaker than Catania assumes, given that the reps and the pharmaceutical producers have ongoing relationships with the medical providers, so that deception now carries a real risk of damaged business tomorrow. After all, do the representatives not place some value on their credibility? And, of course, there is the FDA: Is Catania oblivious to the fact that the reps are not allowed to make claims not approved by the FDA? Perhaps Catania is generalizing from the record of dishonesty observed eternally in the world of politics---the D.C. government is not exactly a model of good-government progress---a possibility magnified by the view of reality shaped by a lifetime outside the real world.

More wisdom from Comrade Catania: "If [licensing] is good enough for cosmetologists, it ought to be good enough for the pharamceutical company." Catania, naturally, has this precisely backward: Just as market forces are quite sufficient to lead cosmetologists toward honest behavior, so the same is true for pharamceutical representatives, who have to deal with physicians and others who are not idiots. But Catania must truly believe that they are idiots, just as the political class believes that the rest of us are children rather than citizens. That we have to pay their salaries is a monument to the perversities of that sausage factory known as lawmaking.

[cross-posted from www.medicalprogresstoday.com/blog/]

Democrats Love Sausage, Too [or at least they did...]

One of my favorite quotes is from Otto von Bismarck:

God has Special Providence for drunks, fools, and the United States of America.

Words to live by, and we Americans surely do.

Uncle Otto is also known for

There are two things you will never wish to watch: the making of sausage and the making of legislation.

Now, it was well-known by key members of congress, including leading Democrats---not to mention the papers---that certain members of al-Qaeda were captured and then subjected to "harsh" interrogation, including waterboarding. Putatively, as a result, these monsters gave up the goods, and innocent lives were saved from their nefarious plans.

Sausage was made.

Nobody felt very good about it, but everybody---everybody---knew what was what.

Tapes of the process were made. Since no good could come of them being revealed to the world except to show how horrible sausage-making is, and how awful the United States of America must be to make it, somebody at the CIA had the tapes destroyed.

The fellow's name seems to be Jose A. Rodriguez, Jr., who was in charge of such things. Perhaps they'll throw him in jail, if they can find something to charge him with. He is presently unavailable for comment.

Now some of us are looking for someone to blame for doing what was necessary to save innocent lives, but Mr. Rodriguez took it upon himself to make sure that couldn't happen. Did he break some law? I have no idea.

But make no mistake, we all wanted the sausage. And if now they pass some legislation against making it, I don't want to watch that either.

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Hearken Sinners: The End Is Near

The Wall Street Journal today has a front-page article on the "grim prognosis" facing Big Pharma, as a number of big-selling drugs soon will lose patent protection even as the companies have fewer new products in the pipeline, as the FDA has become ever-more averse to purported safety risks, and as the costs of drug development rise sharply, in particular for late-stage safety-and-effectiveness trials. This article is certain to engender a lot of discussion and commentary: The firms are shrinking, and the article implies that fewer cures are in the offing, although the heavier implicit focus is on the issue of investment in pharmaceutical stocks and the like.

Yes, there are important problems facing the pharmaceutical industry, but color me far less pessimistic than the article implies. To begin, note what the article does not say, to wit, that research budgets are shrinking. That suggests that the capital market still views pharmaceutical R&D as profitable endeavors prospectively, regardless of what Moody's and the other rating bureaucracies say, green-eyeshade institutions that almost always look backward rather than forward.

Note as well that the recent decline in new drug introductions has a lot to do with the fact that PDUFA was passed in 1992, which had the effect of speeding the approval process significantly (for awhile, anyway), and a bow-wave of drugs was approved in the late-90s to early 2000s period. To some nontrivial degree, the more-recent slowdown has to do with an approval cycle driven by that early PDUFA experience.

The real news, which really is not news at all, is that the FDA and the rest of the relevant part of the Beltway are driven more than ever by powerful political incentives to avoid negative headlines. And so drugs are too safe and are approved too slowly, which means that more death and suffering occurs because beneficial medicines are held off the market too long. Perhaps more important, the industry is changing significantly because pharmacological science is changing: The era of individualized medicines is looming as a direct effect of advances in biological and genetic science. That may be bad for the bureaucrats, and in the short term for the firms forced to deal with them; but in the larger sense this technological advance will yield a huge advance in our ability to reduce human suffering, and no newspaper article can tell me that such a scientific revolution will not prove salutary in spades for Pharma's bottom line.

[cross-posted from www.medicalprogresstoday.com/blog/]

Sue the FDA!

Well, now, surprise: Dennis and Kimberly Quaid have sued Baxter Healthcare, the producers of heparin, after their newborn twins were given large overdoses of the drug at Cedars Sinai Hospital in Los Angeles. The suit claims that Baxter was negligent in packaging because both the small and large dosage vials had labels with blue backgrounds, when the vials "should have been completely distinguishable [by] size and shape."

Of course, that might have engendered confusion with some other medicine(s), but, anyway, all pharmaceutical packaging, warnings, etc. must be approved by the FDA. So why aren't the happy parents suing the FDA? And, by the way, why have the Quaids decided not to sue Cedars Sinai, the staff of which made the error? Baxter had sent a letter warning health-care workers to to read the heparin labels carefully, but the suit argues that an "urgent" warning should have been sent. Anyone want to guess the likely outcome if everyone starts using "urgent" warnings so as to keep the lawyers at bay? Hint: Remember the boy crying "Wolf!"

The twins "appear to be doing well." But the lawsuit proceeds so as "to save other children from this fate. [The Quaids are] not looking for money." Right.

What is clear is that "similar" vials are not identical, and that if "blue backgrounds" are the only similarity, then the culpability of Baxter is far from obvious under any definition. But the litigation lottery proceeds apace, and shouldn't the rich and famous get to play too? That all of us ultimately will be the losers is not something that we can sue over.

[cross-posted from www.medicalprogresstoday.com/blog/]

The Road To Serfdom

And so it continues: "Policy advisers for Clinton on Saturday said she would consider a proposal to garnish the wages of some U.S. residents who can afford health insurance but do not obtain coverage"---Long Island Newsday, 12/1.

So if we take the Democratic proposals and combine them---a rather crude approach, but not without predictive value---we will have mandatory enrollment in insurance plans, mandatory acceptance by insurance plans, mandatory checkups and other preventive care, mandatory employer-sponsored plans, and, of course, mandatory taxes to pay for all of this government compassion. Is anyone in the press paying attention to the implications of all this coercion?

Fred Fired, Huck Hired

We put Fred Thompson on our news ticker in the right column back before he declared his candidacy. He was the most interesting thing going.

Me, I still dig Fred---he's the most solid conservative in my view---certainly the most thoughtful---but I think he's not in it to win it, but to hang around and pick up the pieces if the other candidates crash and burn. [See the previous "I, Freddie."]

The latest numbers are out, and there's a new candidate for Mr. Interesting---

The Rasmussen Reports daily Presidential Tracking Poll for Monday shows Giuliani with 20% support nationwide while Huckabee attracts 17%. Fred Thompson is at 14%, John McCain at 13% and Mitt Romney at 11%. Ron Paul attracts 7% of Likely Republican Primary voters nationwide and no other Republican candidate reaches 2%...

Now, I'm skeptical that a tax-loving creationist can win nomination, but we need to keep our eye on Arkansas governor Mike Huckabee, for good or ill.

Welcome, Governor, and good luck. Please don't make us look like idiots.

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CNN: The Corrupt News Network?

I woke up this morning to fire alarms in my house (fortunately no fire), which will certainly get the sleep out of your eyes really fast. I almost felt the same way when I made my typical morning trek to the LA Times website when what do I see? A headline that I still don’t believe I read: “CNN: Corrupt News Network: A self-serving agenda was set for the Republican presidential debates.” Can this be? Objective news from the LA Times? I wonder if it showed up in the print version, but maybe not, because next to it was a little red “Discuss.” Oh boy, I’ll discuss.

In case you are not familiar with the disgrace CNN heaped upon itself this week at the so-called Republican debate, you can read about it here or here. One of those two is Howard Kurtz of the Washington Post. That amazed me of course, but what’s next, the New York Times? I believe in miracles, but that would actually be irrefutable proof of the existence of God.

So here is some of what that LA Times media guy, Tim Rutten, had to say:

The United States is at war in the Middle East and Central Asia, the economy is writhing like a snake with a broken back, oil prices are relentlessly climbing toward $100 a barrel and an increasing number of Americans just can't afford to be sick with anything that won't be treated with aspirin and bed rest.

So, when CNN brought the Republican presidential candidates together this week for what is loosely termed a "debate," what did the country get but a discussion of immigration, Biblical inerrancy and the propriety of flying the Confederate flag?

In fact, this most recent debacle masquerading as a presidential debate raises serious questions about whether CNN is ethically or professionally suitable to play the political role the Democratic and Republican parties recently have conceded it.

Selecting a president is, more than ever, a life and death business, and a news organization that consciously injects itself into the process, as CNN did by hosting Wednesday's debate, incurs a special responsibility to conduct itself in a dispassionate and, most of all, disinterested fashion. When one considers CNN's performance, however, the adjectives that leap to mind are corrupt and incompetent.

This could have come right out of the mouth of Rush Limbaugh! In fact, much of it did! I grew up politically in the era BR (before Rush), which means before talk radio, cable news, and the blogosphere, and this story is indicative of just how much the playing field has changed since Reagan was in office. Then CBS, NBC, ABC, Public television and radio, and the big dailies ruled the roost. When they determined what the reigning paradigm would be on a story it was very difficult to challenge and get heard. Hey CNN, it’s a new day!