Quick hits (part I)

1) Just another day in American-style corporate health care:

Mallinckrodt Pharmaceuticals announced today that the company expects to pay $15.4 million in a settlement with the U.S. Justice Department after allegations that Questcor Pharmaceuticals, which Mallinckrodt acquired in 2014, had bribed doctors and their staff to prescribe an incredibly expensive drug.

Two whistleblowers came forward in April to accuse Questcor of trying to boost profits for Acthar, a medication primarily for infants with seizures. Questcor raised the price of the medication by almost 100,000 percent (not a typo) from just $40 in 2000 to $38,892 today, despite the fact that Acthar has been on the market since 1952. Mallinckrodt currently rakes in about $1 billion per year from Acthar, according to CNN. [emphases mine]

“Mallinckrodt denies any wrongdoing on the part of Questcor during the relevant period, and intends to vigorously defend the company in this matter,” the company said in a press release.

Mallinckrodt has previously pointed out that the drug price of Acthar was raised by Questcor before Mallinckrodt bought it. But that doesn’t change the fact that Questcor appears to have been purchased by Mallinckrodt precisely because it was making money hand over fist.

Nor does it change the fact that about $8,000 of the price hikes on Athcar have reportedly occurred since Mallinckrodt bought Questcor. And the $15.4 million fine, which has yet to be finalized with the DOJ, pales in comparison to how much money the company is currently taking in on the drug.

While the company denies wrongdoing, the whistleblower lawsuit alleges that the “illegal practices that Questcor had been engaging in since 2007 have knowingly been continued since the merger and acquisition of Questcor by Mallinckrodt.”

Acthar is used for infantile spasms, which afflict roughly 2,000 babies in the U.S. each year, but Mallinckrodt has expanded the use of Acthar for other ailments like rheumatoid arthritis. A 60 Minutes report from May of 2018 raised serious questions about how well the drug actually works for arthritis in seniors, and an expert who spoke with 60 Minutes said that there’s “no evidence” Acthar works for rheumatoid arthritis despite the fact that Mallinckrodt reportedly makes about $500,000 each year for prescriptions treating the condition.

Curiously, there’s a drug called Synacthen that’s identical to Acthar and sells for just $33 in Canada. So why isn’t Synacthen available in the U.S.? Because Mallinckrodt bought the U.S. rights to Synacthen and simply doesn’t make it available to American consumers.

Ugh.  Also, Infantile Spasms are a particularly serious type of seizure.  So wrong.

2) Roxanne Gay says freak out.  Drum says, maybe not so much:

And there’s more. The headline unemployment rate is at its lowest rate in half a century and the long-term unemployment rate is lower than it was at the height of the housing bubble. Household earnings are up about $8,000 over the past five years. Blue-collar wages have increased by more than $1 per hour. The poverty rate has dropped for three straight years and is now lower than at any time aside from the peak of the dotcom boom. Despite the best efforts of Republicans, Obamacare continues to provide health coverage for nearly 20 million additional people compared to a decade ago. Among teens, cigarette smoking is down; alcohol use is down; other drug use is down; teen pregnancy is down; and arrests are down. The US economy is the most robust in the world. About 700,000 new citizens are naturalized every year, up from 100,000 in 1980. Same-sex marriage is legal in all 50 states. And on a personal note, there’s been a huge surge in new treatments for multiple myeloma, which means that I will probably be blathering on your computer for many years to come.

My message here is simple. If you cherry pick all the bad stuff that’s happened in the past few years, you can make a case for being pretty discouraged. If you cherry pick all the good stuff, you can make a case that everything is fine. The real reality is somewhere in-between. So if you feel like being discouraged, don’t let me get in your way. But there’s always good and bad in the world, and there’s no reason to insist otherwise.

Except for climate change, where we’re still on track to commit planetary suicide and no one is truly taking it seriously. That’s just a pure nightmare.

Oh, yeah, except climate change.

3) My colleague, Andrew Taylor, makes a pretty interesting argument about liberal bias among political science professors using social science.  Though, this liberal is no big fan of implicit bias (heck, among other things, we’ve got enough explicit bias these days):

Yet, although academic political scientists consider themselves experts who have built robust models validated by all sorts of empirical studies, they seem to believe the kinds of misinformed and prejudicial attitudes and anti-social and harmful behavior they attribute to just about everyone else have somehow evaded them.

That is odd. The last time I checked, political science professors were human beings. They are surely not immune from theories of human behavior they hold and have validated under scientific conditions.

One such in-vogue theory is unconscious or implicit bias. This is the idea that individuals are inherently prejudiced against others from certain groups. Social scientists use the theory to explain pervasive racism and prejudice against out or minority groups in all walks of life. The idea is that although a person may feel they judge others neutrally or on merits unrelated to group membership, they hold biases, admittedly often small, that they are incapable of correcting.

These attitudes adversely affect the individuals who constitute their object. Compounded, they can have material effects on public policy and social outcomes.

Although the theory has vocal critics and some proponents recognize its limited capacity to predict the behavior of individuals, the academy has produced a great deal of confirmatory published experimental and survey research.

Academics consider bias particularly pervasive in homogenous populations. Political science is certainly homogenous. A number of studies show the discipline’s professors are overwhelmingly liberal and largely identify as Democrats—by about 10 to 1 according to a study of North Carolina and Florida faculty I recently co-authored and that is forthcoming in a flagship journalof the American Political Science Association.

Actually, I’m not sure of the research on this (and, sorry, not going to check right now), but in my experience (okay, with myself and other informed PS professors) being aware of various cognitive biases actually really does make us less susceptible to them.  How many other people discuss the “sunk cost trap” while in line with friends at lunch?

4) Dana Milbank on how for Trump, D-Day was all about… Donald Trump.

5) It’s bad enough to have really bad people among Catholic priests.  Even worse when they are Catholic bishops:

During his 13 years as bishop in West Virginia, one of the poorest states in the nation, Bransfield spent $2.4 million in church money on travel, much of it personal, which included flying in chartered jets and staying in luxury hotels, according to the report. Bransfield and several subordinates spent an average of nearly $1,000 a month on alcohol, it says. The West Virginia diocese paid $4.6 million to renovate Bransfield’s church residence after a fire damaged a single bathroom. When Bransfield was in the chancery, an administrative building, fresh flowers were delivered daily, at a cost of about $100 a day — almost $182,000 in all.

Bransfield, 75, drew on a source of revenue that many parishioners knew little about, oil-rich land in Texas donated to the diocese more than a century ago. He spoke of church money as if it were his to spend without restriction, according to the report.

“I own this,” he is quoted as saying on many occasions.

6) I read $2 a Day about poverty in America as NC State incoming Freshman reading a couple years ago.  It was really good.  And I assign this summary to my Public Policy class.  Turns out, new research strongly suggests that it significantly overstates extreme poverty in America.  That said, there still is too much extreme poverty in America.

7) Really excited to see the updated Hall of Fossils next time I visit the Smithsonian Museum of Natural History.  I also like that they reference the last major renovation in the early 1980’s.  I still have very fond memories of my dad taking me to a members only reception for the re-opening featuring dinosaur cookies.

8) Dara Lind with a terrific article on how the border crisis really is a crisis now.  And why.  A must-read.  I added this to my Public Policy syllabus for next semester.

9) Meanwhile a harrowing Politico article on life for poor women in Honduras:

What do you do when you fear for your life and the state won’t protect you? Or if the state might make your already tenuous situation worse? The fraught calculations that face Sofia and her mom are endemic across Honduras, a country that remains in the grip of a rash of violence against women and girls. For some, the answer is simple and disruptive: They have to leave. When exhausted families, mothers toting babies and young women traveling alone arrive at the southern border of the United States, it’s not just gang violence or criminality in general that they’re fleeing. It’s also what Sofia whispers about to her bunny: men who beat, assault, rape and sometimes kill women and girls; law enforcement that does little to curtail them; and laws that deny many women who do survive the chance to retake control and steer their own lives.

As of 2015, Honduras ranked among a tiny group of nations, including war-racked Syria and Afghanistan, with the highest rates of violent deaths of women. Although Honduras’ overall murder rate has decreased in recent years, it remains one of the deadliest countries in the world, and the murder rate has been declining more slowly for female victims. Murder remains the second-leading cause of death for women of childbearing age.

10) Terrific interview with the creator of HBO’s “Chernobyl” on the nature of truth and stories and the show.

11) This Reason satirical campaign video meets used car ads is really, really good:

12) Seth Masket on the potential costs of not impeaching:

But even if we assume there would be a political price for impeachment, that does not mean that declining to impeach would be without consequence. For one thing, if there are voters who would be bothered by impeachment, there are quite a few others who would be bothered by the lack of it. The idea that Trump has clearly committed impeachable acts but Democrats in the House of Representatives won’t punish him because they think it will hurt them in the next election is not a particularly inspiring message, especially for a party that keeps urging people to put country before party.

On top of that calculus, it’s entirely possible Trump wins re-election whether Democrats pursue impeachment or not. He’s won before, incumbents usually win re-election, and they almost always do during a growing economy. What’s the lesson coming out of that election? “We might have removed him but failed to so here he is for another four years”?

It’s important to consider just what the lessons of this presidency will be for subsequent administrations and congressional parties. If Democrats decide that, despite widespread lawbreaking, impeachment just isn’t on the table because conviction is unlikely and there may be political costs, then it would effectively remove impeachment as a serious constraint on presidential actions. And given that the Department of Justice has also removed itself from control of the president, that would basically mean that presidents truly are above the law as long as they serve…

But fairly or not, Democrats have been placed in the position of determining whether to prosecute presidential lawbreaking. Either choice may have negative consequences, but the decision should be evaluated not just in terms of what will happen this year or next, but for the decades to come.

12) I’m sorry, but I’m so not impressed by arbitrary feats such as climbing Everest and returning home all within 14 days.  The key is living in a hypoxia chamber rather than actually acclimating at the mountain.

13) Endorse: Students should stop treating faculty as expendable.  That said, as a middle-aged white male, I hardly ever run into this anymore.

14) Damn, the willful ignorance of Republicans on climate is just breathtaking.  And, I’m not going to just blame Trump– he’s, symptom, not cause here:

Fifty or 100 years from now, we may well say that President Trump’s concerted effort to exacerbate climate change — and that’s precisely what it is — was the single worst thing he did in a presidency full of horrors. A new report from the New York Times gives new details about just how diabolical his administration’s actions have been:

In the next few months, the White House will complete the rollback of the most significant federal effort to curb greenhouse-gas emissions, initiated during the Obama administration. It will expand its efforts to impose Mr. Trump’s hard-line views on other nations, building on his retreat from the Paris accord and his recent refusal to sign a communiqué to protect the rapidly melting Arctic region unless it was stripped of any references to climate change.

And, in what could be Mr. Trump’s most consequential action yet, his administration will seek to undermine the very science on which climate change policy rests.

The goal appears to be to keep the government from ever confirming that climate change exists and, failing that, to do everything it can to make it look less serious than it is. The administration also plans to create a new panel to downplay climate change and discredit legitimate science on the topic, led by National Security Council senior director William Happer, who once said, “The demonization of carbon dioxide is just like the demonization of the poor Jews under Hitler.”

15) And you can very much appreciate Tom Nichols’ take on “Chernobyl” without watching the show.

16) Catherine Rampell with a good take (and I’m disappointed in Warren here), “Everyone’s got a climate plan. So where’s the carbon tax?”

To be clear, the candidates’ proposals include many other good ideas. They all say we should eliminate subsidies for fossil-fuel companies. They all boost federal investment in and incentives for R&D in clean technology. This is critically necessary, especially for basic research, which private companies might not be sufficiently incentivized to undertake on their own.

But then things go off the rails.

The plans devote a lot of verbiage to talking about the magical properties of government procurement — that is, using the deep pockets of the government to purchase more energy-efficient products. Warren, for instance, analogizes her own plan, which includes a $1.5 trillion federal procurement commitment, to the industrial policy America previously undertook for the space race and our mobilization against Nazi aggression.

But in both of those historical comparisons, “The goal wasn’t to create a commercial product,” points out David Popp, a Syracuse University professor who specializes in environmental economics. “The government was the consumer.”

Just because the public sector buys more energy-efficient lightbulbs, electric cars or solar panels doesn’t mean the (much larger) private sector will, absent price incentives. Especially if we add conditions to the production of those green goods that actually increase their costs to consumers, as some of these plans do.

17) Greg Sargent:

Amazingly, after all we’ve seen, there’s still a tendency in some quarters to treat the falsehoods regularly told by President Trump, and echoed by his media allies, as a somewhat exaggerated but basically conventional form of political dishonesty.

But Trump and certain of his media partisans have long been engaged in something altogether different — something that can only be described as concerted and deliberate disinformation…

It’s the disinformation, stupid

It should be impossible to watch these diatribes in full without quickly realizing that this isn’t ordinary political dishonesty — some level of artifice is an inevitable feature of politics — but rather is something much more insidious. What’s notable is the sheer comprehensiveness of the effort to create an alternate set of realities whose departure from the known facts seemingly aims to be absolute and unbridgeable…

Disinformation and ‘constitutional rot’

Don’t take my word for it. With Trump’s lies and distortions now numbering over 10,000, serious political theorists have noted this aspect of Trumpian disinformation. See this Jacob Levy essay, which argues that Trump’s autocratic reshaping of reality on multiple fronts depends on the delegitimization of other institutional authority.

Or see this Jack Balkin essay on “constitutional rot.” One key sign of our breakdown, Balkin argues, is the fact that Trump has the backing of what can only be understood as “domestic propaganda machines.”

Such propaganda, Balkin notes, “undermines the crucial role of deliberation and the search for truth in a democracy. Propaganda attempts to put everything in dispute, so that nothing can be established as true.” It “undermines shared criteria of reasoning, good faith attempts at deliberation, and mutual accommodation between political opponents in democracies.”

17) Smoking gun evidence that NC Republicans lied to the courts for political gain.  I’m sure Democratically-appointed judges will care.  Would be nice if Republican-appointed ones would, too.  You know, rule of law and all that.

About Steve Greene
Professor of Political Science at NC State http://faculty.chass.ncsu.edu/shgreene

2 Responses to Quick hits (part I)

  1. R. Jenrette says:

    Oh where is the bonnie and bold hero who can lift us up from this miasma of corruption and lust for power? Where is the one who can raise our spirits and blow away the clouds of deception and hate?
    In our hour of need, we must all reach deep into our souls to become that hero. Together we can chase the barbarians out of our temple of democracy and become the people our Founders hoped for.

  2. Nicole K says:

    #1) That’s just how pricing drugs for rare diseases works across the board. The companies know that the high prices are going to mostly be paid by health insurance companies and not by the people who are taking the medicine. And they usually give away drugs like this to people who are either underinsured or lack insurance for free or for some very minimal monthly payment under $50. Then they just subsidize the copays for patients with health insurance until they hit their out of pocket maximum and then the health insurance company pays the full price for the rest of the year until the cycle starts over again the next year.

    In a perverse way, many people who need specialty drugs actually either don’t know how much they actually cost or don’t care because they’re getting copay assistance from drug companies that maxes their out of pocket maximums early in the year.

    That’s why it’s stupid to say that this is anything but a clear example of market failure, but the specialty drug makers have basically created a system that keeps patients from complaining and shifts costs completely to insurers. Yeah, that probably raises prices for everyone, but specialty drugs treat rare conditions and represent a very small slice of the healthcare market.

    It’s also why the most effective front-line treatment for narcolepsy isn’t on the BCBSNC Obamacare prescription drug formulary anymore, so patients who need it have to get a formulary exemption to get insurance to cover it. And unless you’ve been taking it for a long time, that’s a drawn out and time-consuming process for both patients and doctors because you’ve got to try and fail a series of drugs, most of which require prior authorization, before your exemption request will be taken seriously by the insurance company.

    I don’t think the system is going to change anytime soon. The pharmaceutical lobby basically has been getting whatever it wants from Congress since the Truman Administration. The high number of members of congress that own stock in these drug companies also means they benefit from the current system remaining the way that it exists.

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