(Roughly) Daily

Posts Tagged ‘public health

“You’re mugging old ladies every bit as much if you pinch their pension fund”*…

Who benefits from the commercial biomedical research and development (R&D)? Patients-consumers and investors-shareholders have traditionally been viewed as two distinct groups with conflicting interests: shareholders seek maximum profits, patients – maximum clinical benefit. However, what happens when patients are the shareholders?…

Adding investments by governmentally-mandated retirement schemes, central and promotional banks, and sovereign wealth funds to tax-derived governmental financing shows that the majority of biomedical R&D funding is public in origin. Despite this, even in the high-income countries patients can be denied access to effective treatments due to their high cost. Since these costs are set by the drug development firms that are owned in substantial part by the retirement accounts of said patients, the complex financial architecture of biomedical R&D may be inconsistent with the objectives of the ultimate beneficiaries…

It has been estimated that of the total $265 billion spent annually on biomedical research worldwide, over a third – $103 billion comes from public sources. Nevertheless, as public input capital is allocated predominantly into early stage research, nearly all output – medicines – is ultimately brought to the market by private firms. Importantly, these firms are not independent agents. They have owners-shareholders to report to. Until the end of the previous century the major type of owners-shareholders were individual households. At the turn of the millennium, however, they have been displaced by institutional investors, the largest of which are public retirements schemes or quasi-public funds, such as occupational pensions.

First, government money underwrites the basic R&D that goes into drug discovery and development, then public pension monies fund the private companies that bring those drugs to market. As the private companies are solving for highest profits, as opposed to optimal public health, those drugs are often priced out of the reach of the very people whose pension contributions funded their development. Drugs “priced out of reach” is certainly not a new phenomenon; AIDS drugs (to take one example) were priced by Western pharma companies at prices that rendered them inaccessible to most citizens of low-income countries in Africa and Asia. The pensioners in wealthy nations were, effectively, living off of the misery of those in poorer companies.

But the dynamic has continued, deepened– and come home to roost. Now patients in high-income countries are denied access to effective treatments due to their high cost, while these costs are being set by the drug development firms, owned in substantial part by the retirement accounts of those same patients, and benefiting from direct and indirect governmental support.

Investing in one’s own misery– the painful irony of pharma funding: “Pension and state funds dominating biomedical R&D investment: fiduciary duty and public health.”

[Image above: source]

* Ben Elton, Meltdown

###

As we untangle unintended consequences, we might send healthy birthday greetings to Charles Value Chapin; he was born on this date in 1856. A physician and epidemiologist, he was a pioneer in American public health. He co-founded in first bacteriological laboratory in the U.S. (in 1888) in Providence, were he was Superintendent of Health– a position he held for 48 years. In 1910, he established Providence City Hospital where infectious disease carriers could be isolated under aseptic nursing conditions; his success inspired similar health control measures throughout the U.S. A professor (at Brown) and prolific writer, his impact on health policy and practice was so broad that he was hailed as “the Dean of City Public Health Officials.”

source

“Gain not base gains; base gains are the same as losses”*…

When inventor Frederick Banting discovered insulin in 1923, he refused to put his name on the patent. He felt it was unethical for a doctor to profit from a discovery that would save lives. Banting’s co-inventors, James Collip and Charles Best, sold the insulin patent to the University of Toronto for a mere $1. They wanted everyone who needed their medication to be able to afford it. [see here]

Today, Banting and his colleagues would be spinning in their graves: Their drug, which many of the 30 million Americans with diabetes rely on, has become the poster child for pharmaceutical price gouging.

The cost of the four most popular types of insulin has tripled over the past decade, and the out-of-pocket prescription costs patients now face have doubled. By 2016, the average price per month rose to $450 — and costs continue to rise, so much so that as many as one in four people with diabetes are now skimping on or skipping lifesaving doses

Why Americans ration a drug discovered– and given free to the world– in the 1920s: “The absurdly high cost of insulin, explained.”

* Hesiod (See also Proverbs 28:20: “he that maketh haste to be rich shall not be innocent”)

###

As we ponder pleonexia, we might send healing birthday greetings to Edward Lawrie Tatum; he was born on this date in 1909. A geneticist, he shared half of the Nobel Prize in Physiology or Medicine in 1958 with George Beadle for showing that genes control individual steps in metabolism. During World War II, his work was of use in maximizing penicillin production, and it has also made possible the introduction of new methods for assaying vitamins and amino acids in foods and tissues. Tatum and Joshua Lederberg (the winner of the other half of the 1958 Nobel award), discovered genetic recombination in bacteria.

His discoveries were made freely available to the scientific community.

source

“Don’t be afraid to break things. Don’t be romantic. Don’t take the time to breathe. Don’t aim for perfect. And whatever you do, keep moving.”*…

Eric Feigl-Ding picked up his phone on the first ring. “Busy,” he said, when asked how things were going. He had just finished up an “epic, long” social media thread, he added — one of hundreds he’s posted about society’s ongoing battle with the coronavirus. “There’s so many different debates in the world of masking and herd immunity and reinfection,” he explained, among other dimensions of the pandemic. “We at FAS, we’ve been kind of monitoring all the debates and how we’re seeing signals in which the data goes one way, the debate goes the other,” he said, referring to his work with the Federation of American Scientists, a nonprofit policy think tank. He rattled off a rapid-fire sampler of hot-button Covid-19 topics: the growing anti-vaxxer movement, SARS-CoV-2 reinfection and antibodies, the body of research suggesting masks could decrease viral load, along with a quick mention of the debate among experts about what “airborne” means.

This whirlwind tour through viral Covid-19 themes felt like the conversational equivalent of Feigl-Ding’s Twitter account, which has grown by orders of magnitude since the dawn of the pandemic. The Harvard-trained scientist and 2018 Congressional aspirant posts dozens of times daily, often in the form of long, numbered threads. He’s fond of emojis, caps lock, and bombastic phrases. The first words of his very first viral tweet were “HOLY MOTHER OF GOD.”

Made in January, weeks before the massive shutdowns that brought U.S. society to a halt, that exclamation preceded his observation that the “R0” (pronounced “R-naught”) of the novel coronavirus — a mathematical measure of a disease’s reproduction rate — was 3.8. That figure had been proposed in a scientific paper, posted online ahead of peer review, that Feigl-Ding called “thermonuclear pandemic level bad.” Further in that same Twitter thread, he claimed that the novel coronavirus could spread nearly eight times faster than SARS.

The thread was widely criticized by infectious disease experts and science journalists as needlessly fear-mongering and misleading, and the researchers behind the pre-print had already tweeted that they’d lowered their estimate to an R0 of 2.5, meaning that Feigl-Ding’s SARS figure was incorrect. (Because R0 is an average measure of a virus’s transmissibility, estimates vary widely based on factors like local policy and population density; as a result, researchers have suggested that other variables may be of more use.) He soon deleted the tweet — but his influence has only grown.

At the beginning of the pandemic, before he began sounding the alarm on Covid-19’s seriousness, Feigl-Ding had around 2,000 followers. That number has since swelled to over a quarter million, as Twitter users and the mainstream media turn to Feigl-Ding as an expert source, often pointing to his pedigree as a Harvard-trained epidemiologist. And he has earned the attention of some influential people. These include Ali Nouri, the president of FAS, who brought Feigl-Ding into his organization as a senior fellow; the journalist David Wallace-Wells, who meditated on Feigl-Ding’s “holy mother of God” tweet in his March essay arguing that alarmism can be a useful tool; and former acting administrator of the Centers for Medicare and Medicaid Services Andy Slavitt. (“We all learn so much from you,” he tweeted at Feigl-Ding in July.) Ronald Gunzburger, senior adviser to Maryland Gov. Larry Hogan, even wrote a letter to Feigl-Ding attesting to how his “intentionally provocative tweet” in January “elevated the SARS-CoV-2 virus to the top of our priorities list.”

But as Feigl-Ding’s influence has grown, so have the voices of his critics, many of them fellow scientists who have expressed ongoing concern over his tweets, which they say are often unnecessarily alarmist, misleading, or sometimes just plain wrong. “Science misinformation is a huge problem right now — I think we can all appreciate it — [and] he’s a constant source of it,” said Saskia Popescu, an infectious disease epidemiologist at George Mason University and the University of Arizona who serves on FAS’ Covid-19 Rapid Response Taskforce, a separate arm of the organization from Feigl-Ding’s work. Tara Smith, an infectious disease epidemiologist at Kent State University, suggested that Feigl-Ding’s reach means his tweets have the power to be hugely influential. “With as large of a following as he has, when he says something that’s really wrong or misleading, it reverberates throughout the Twittersphere,” she said…

A scientist has gained popularity as Covid’s excitable play-by-play announcer. But some experts want to pull his plug: “Covid’s Cassandra: The Swift, Complicated Rise of Eric Feigl-Ding.”

* Social media “influencer” Gary Vaynerchuk

###

As we interrogate influence, we might send bombastic birthday greetings to Ted Knight; he was born on this date in 1923. An actor and comedian, he was well-known as Henry Rush in Too Close for Comfort, and Judge Elihu Smails in Caddyshack; but he is surely most famous for his role as newscaster Ted Baxter on The Mary Tyler Moore Show.

THE MARY TYLER MOORE SHOW, Ted Knight, Mary Tyler Moore, 1970-1977

source

“Not with a bang, but with a whimper”*…

 

death

Death Table from Tuberculosis in the United States, prepared for the International Congress on Tuberculosis, September 21 to October 12, 1908. Image: U.S. National Library of Medicine

 

Recent history tells us a lot about how epidemics unfold, how outbreaks spread, and how they are controlled. We also know a good deal about beginnings—those first cases of pneumonia in Guangdong marking the SARS outbreak of 2002–3, the earliest instances of influenza in Veracruz leading to the H1N1 influenza pandemic of 2009–10, the outbreak of hemorrhagic fever in Guinea sparking the Ebola pandemic of 2014–16. But these stories of rising action and a dramatic denouement only get us so far in coming to terms with the global crisis of COVID-19. The coronavirus pandemic has blown past many efforts at containment, snapped the reins of case detection and surveillance across the world, and saturated all inhabited continents. To understand possible endings for this epidemic, we must look elsewhere than the neat pattern of beginning and end—and reconsider what we mean by the talk of “ending” epidemics to begin with…

Contrary to hopes for a tidy conclusion to the COVID-19 pandemic, history shows that outbreaks of infectious disease often have much murkier outcomes—including simply being forgotten about, or dismissed as someone else’s problem: “How Epidemics End.”

* T. S. Eliot, “The Hollow Men”

###

As we contemplate the end, we might send insightful birthday greetings to Nettie Maria Stevens; she was born on this date in 1861.  A geneticist– and one of the first American women to achieve recognition for her contributions to scientific research– she built on the rediscovery of Mendel‘s paper on genetics (in 1900) with work that identified the mechanism of sexual selection: its determination by the single difference between two classes of sperm—the presence or absence of (what we now call) an X chromosome.

220px-Nettie_Stevens source

 

“Crises and deadlocks when they occur have at least this advantage, that they force us to think”*…

 

Capitalism

 

In the spirit of Nehru’s sage injunction…

The COVID19 pandemic has exposed a strange anomaly in the global economy. If it doesn’t keep growing endlessly, it just breaks. Grow, or die.

But there’s a deeper problem. New scientific research confirms that capitalism’s structural obsession with endless growth is destroying the very conditions for human survival on planet Earth.

A landmark study in the journal Nature Communications, “Scientists’ warning on affluence” — by scientists in Australia, Switzerland and the UK — concludes that the most fundamental driver of environmental destruction is the overconsumption of the super-rich.

This factor lies over and above other factors like fossil fuel consumption, industrial agriculture and deforestation: because it is overconsumption by the super-rich which is the chief driver of these other factors breaching key planetary boundaries.

The paper notes that the richest 10 percent of people are responsible for up to 43 percent of destructive global environmental impacts.

In contrast, the poorest 10 percent in the world are responsible just around 5 percent of these environmental impacts…

It confirms that global structural inequalities in the distribution of wealth are intimately related to an escalating environmental crisis threatening the very existence of human societies.

Synthesising knowledge from across the scientific community, the paper identifies capitalism as the main cause behind “alarming trends of environmental degradation” which now pose “existential threats to natural systems, economies and societies.”…

The research provides an important scientific context for how we can understand many earlier scientific studies revealing that industrial expansion has hugely increased the risks of new disease outbreaks.

Just last April, a paper in Landscape Ecology found that deforestation driven by increased demand for consumption of agricultural commodities or beef have increased the probability of ‘zoonotic’ diseases (exotic diseases circulating amongst animals) jumping to humans. This is because industrial expansion, driven by capitalist pressures, has intensified the encroachment of human activities on wildlife and natural ecosystems.

Two years ago, another study in Frontiers of Microbiology concluded presciently that accelerating deforestation due to “demographic growth” and the associated expansion of “farming, logging, and hunting”, is dangerously transforming rural environments. More bat species carrying exotic viruses have ended up next to human dwellings, the study said. This is increasing “the risk of transmission of viruses through direct contact, domestic animal infection, or contamination by urine or faeces.”

It is difficult to avoid the conclusion that the COVID19 pandemic thus emerged directly from these rapidly growing impacts of human activities. As the new paper in Nature Communications confirms, these impacts have accelerated in the context of the fundamental operations of industrial capitalism.

The result is that capitalism is causing human societies to increasingly breach key planetary boundaries, such as land-use change, biosphere integrity and climate change.

Remaining within these boundaries is essential to maintain what scientists describe as a “safe operating space” for human civilization. If those key ecosystems are disrupted, that “safe operating space” will begin to erode. The global impacts of the COVID19 pandemic are yet another clear indication that this process of erosion has already begun…

Humanity’s “own goal”? “Capitalism is destroying ‘safe operating space’ for humanity, warn scientists.”

Pair with “A New Land Contract“…

Weirdly enough, the land system that we have today has its origins in a problem specific to medieval kings, which is ‘how do I fund military campaigns and defence, without paying to keep a standing army?’

And it was William the Conqueror who perfected the answer. It was a piece of paper. And on that piece of paper was basically an agreement between the Crown and a noble, saying ‘if you provide men for military campaigns when I ask, in exchange I will grant you a monopoly over your own private fiefdom, where you can levy as high taxes as people can bear to pay’.

So effectively — rent is the original tax, paid via lords to the King.

In fact the word ‘feudal’ derives from the latin word feudalis — for ‘fee’. In other words, rent. So the whole system of government by which the Normans ruled over the Anglo Saxons was based on rent…

So what you’re left with is a set of power relations in society: an enforced system of servitude and control. As the economist Henry George pointed out, it is essentially a diluted version of slavery.

“Ownership of land always gives ownership of people… Place one hundred people on an island from which there is no escape. Make one of them the absolute owner of the others — or the absolute owner of the soil. It will make no difference — either to owner or to the others — which one you choose. Either way, one individual will be the absolute master of the other ninety-nine.”

And “Basic income isn’t just a nice idea. It’s a birthright“…

A basic income might defeat the scarcity mindset that has seeped so deep into our culture, freeing us from the imperatives of competition and allowing us to be more open and generous people. If extended universally, across borders, it might help instil a sense of solidarity – that we’re all in this together, and all have an equal right to the planet. It might ease the anxieties that gave us Brexit and Trump, and take the wind out of the fascist tendencies rising elsewhere in nativism that is spreading across much of the world.

We’ll never know until we try. And try we must, or brace ourselves for a 21st century of almost certain misery…

As Paul Romer (and so many others) have observed, a crisis is a terrible thing to waste”…

[TotH to Patrick Tanguay (@inevernu)]

* Jawaharlal Nehru

###

As we ruminate on remedies, we might recall that it was on this date in 1864 that President Abraham Lincoln signed the Yosemite Valley Grant Act (Senate Bill 203), giving California the Yosemite Valley and the nearby Mariposa Big Tree Grove “upon the express conditions that the premises shall be held for public use, resort, and recreation.”

Mirror Lake, Yosemite
Carleton E. Watkins, photographer, circa 1860.
source: Library of Congress

 

%d bloggers like this: