A Massachusetts Kamala voter solves what she perceives as the “Israel-Palestine Problem”

by philg

We walked to a friend from Maskachusetts shortly after the noble Gazans made the news for amputating a young American citizen’s arm, holding him hostage for 11 months, and then executing him shortly before he would have been rescued by the IDF. Hersh Goldberg-Polin was 23 years old, was not serving in the Israeli military, and “was reportedly working with an initiative that was using soccer to bring Israeli and Palestinian children together” (Wikipedia).

As with other Democrats, the murder of Hersh Goldberg-Polin did not dampen her enthusiasm for voting for Kamala Harris, who has pledged to continue funding Hamas (via UNRWA, a funding path that Donald Trump cut off and Joe Biden restored in 2021; unless the October 7 attacks cost more than $1 billion it is fair to say that the Biden-Harris administration funded 100 percent of it with our tax dollars). She did volunteer her belief that there was an urgent need to “solve the Israel-Palestine Problem”. I asked her why the Maskachusetts Righteous sympathies were there rather than with Black Lives Matter or American Women, two victimhood classes that had previously generated large rallies. She said that Democrats were still passionate about these causes, but couldn’t remember any BLM events post-October 7, 2023. I asked why the failure of the Palestinians to achieve their 1948 military goals made them more sympathy-worthy than any of the 1.5 billion residents of Africa, about whom she had never expressed any concern. She said, “I guess I hear more about the Palestinians in the news.”

What was her plan for resolving the conflict? She believed that Palestinian children were being indoctrinated by a message of Jew-/Israel-hatred in their schools (funded by US and EU taxpayers, of course) and that the solution was to bring them to the U.S. so that they could instead be indoctrinated by American schools (also funded by US taxpayers so perhaps this isn’t a huge change from a financial point of view). I didn’t point out that Queers for Palestine and similar rallies all around the U.S. show that there is plenty of “destroy Israel” energy among those who go through American K-12, but I did ask “Why would the typical Palestinian go to the trouble of having 5 kids and then just give them up voluntarily to American do-gooders running a reeducation scheme in which Christianity and Judaism have equal status to Islam?” Our Massachusetts Kamala voter said, “the parents can come too if they want.” I pointed out that, given Gaza’s world-leading population growth rate, almost every adult there has at least one minor child and, therefore, she was proposing that the entire population of Gaza be admitted to the United States to become American citizens. She said that it was indeed her expectation that the majority of Gazans would come to the U.S. I then pointed out that 50,000 babies had been born in Gaza during the recent battles (not to say “war” since that started in 1948 and the Palestinians have never accepted any kind of peace; there has been a continuous officially declared war going for 76 years now). Wouldn’t a new crop of Hamas warriors, therefore, be born soon enough and be able to carry on the fight even if most of their older brothers, sisters, and binary-resisters were peacefully voting for Democrats in Michigan? She didn’t seem to have considered the possibility that Gazans left behind, still getting unlimited food, education, health care, etc. free from UNRWA, would continue the Palestinian tradition of off-the-charts fertility. (See “Reproductive decisions in the lives of West Bank Palestinian women: Dimensions and contradictions” (2017, Global Public Health):

Palestinian women have one of the highest fertility rates in the world, averaging 4.38 births per woman. However, Palestinian fertility patterns are distinct from those of other developing nations, in that high fertility rates coexist alongside high levels of education and low levels of infant mortality – both of which have been established elsewhere as predictors of low total fertility rates.

).

I share this conversation because I thought it was an interesting window into the mind of a Kamala Harris voter. The best way to heal the world is a further expansion of low-skill immigration to the U.S.

Separately, given the success that Hamas has enjoyed after taking and killing American hostages what happens to U.S. citizens in other parts of the world going forward? Since taking American hostages Hamas has secured from the Biden-Harris administration (a) promises of continued funding, (b) a $230 million pier (admittedly washed away quickly), (c) support for the Hamas-sought “permanent ceasefire” that leaves Hamas leaders alive and well and permanently in charge of Gaza, (d) pressure on Israel for a long delay in the IDF operation in Rafah, which turns out to be where at least one American hostage was held and killed (see “Harris warns it would be a ‘mistake’ for Israel to invade Rafah” (CNN, March 25, 2024)) and “Kamala Harris says Israel assault on Rafah ‘would be a huge mistake’” (Guardian)), and (e) diplomatic recognition by a variety of purported U.S. allies and military client states as leaders of their own sovereign nation (“Spain, Norway and Ireland formally recognize a Palestinian state as EU rift with Israel widens” (AP)). What’s the downside to taking American hostages in the Biden-Harris era?

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How are Brazilians doing now that they’ve eliminated the biggest threat to their democracy?

by philg

Here’s Jair Bolsonaro, characterized by media elites as “far right”, “authoritarian”, and “a threat to democracy”, in 2023 (from “Exiled Bolsonaro lives it up in Florida as legal woes grow back home” (Guardian)):

The Brazilian masses responded to elite advice and voted to preserve their democracy (50.9:49.1), but the threat wasn’t completely extinguished. “The Big Lie Is Going Global. We Saw It in Brazil.” (New York Times, November 14, 2022), for example:

Donald Trump’s playbook of poisoning the polity with misinformation … is being exported and deployed beyond the United States and becoming a transnational threat to democracy.

Mr. Trump’s methods were energetically adopted in Brazil by his authoritarian, right-wing friend Jair Bolsonaro, who pushed misinformation during his presidency, seeded distrust in the electoral system for years and, eventually, tried to discredit the electoral process in Brazil after losing the presidential election to Luiz Inácio Lula da Silva last month.

It’s bad enough when a threat to democracy speaks and even worse when he/she/ze/they doesn’t speak:

For more than 44 hours after his electoral defeat, Mr. Bolsonaro maintained a dangerous silence

So long as the government does not control all media and social media, democracy is unsafe:

The attempts of Mr. Bolsonaro and his supporters to create uncertainty about Brazil’s future could be the new global norm as would-be autocrats are embracing the Big Lie as a legitimate political strategy.

NYT, today, “How Brazil’s Experiment Fighting Fake News Led to a Ban on X”:

To combat disinformation, Brazil gave one judge broad power to police the internet.

That justice, Alexandre de Moraes, has since carried out an aggressive campaign to clean up his country’s internet, forcing social networks to pull down thousands of posts, often giving them a deadline of just hours to comply.

It has been one of the most comprehensive — and, in some ways, most effective — efforts to combat the scourge of internet falsehoods.

When his online crackdown helped stifle far-right efforts to overturn Brazil’s election, academics and commentators wondered whether the nation had found a possible solution to one of the most vexing problems of modern democracy.

Then, on Friday, Justice Moraes blocked the social network X across Brazil because its owner, Elon Musk, had ignored his court orders to remove accounts. As part of the blackout order, the judge said internet users who tried to circumvent his measure in order to keep using X could be fined nearly $9,000 a day, or more than what the average Brazilian makes a year.

Justice Moraes has continued to use the threat to democracy as a justification for his actions. In his order on Friday, he said Mr. Musk’s refusal to comply with orders to suspend accounts “represents an extremely serious risk to the municipal elections in October” in Brazil.

How else are Brazilians being protected from threats to their democracy? The current government has the opposition leader more or less under house arrest: “Brazil’s Bolsonaro must hand in his passport for coup investigation” (state-sponsored NPR, February 2024). Brazil is on the right side of history, according to the best minds of Harvard, Columbia, and Berkeley: “Brazil president withdraws his ambassador to Israel after criticizing the war in Gaza” (state-sponsored PBS, May 2024; “Lula has been a frequent critic of Israel’s offensive in Gaza, which he compared to the Holocaust earlier this year.”). [Note that the “Holocaust” is being exacerbated by a population explosion.]

Some additional warnings that Brazilian voters heeded:

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NASA at Oshkosh (saving our planet with plastic bags)

by philg

From nasa.gov:

The NASA pavilion at EAA AirVenture (“Oshkosh”) 2024:

(These are the plastic bags that are good for the environment?)

What else was going on? NASA arranged to have a Boeing Starliner parked in front:

The NISAR mission was featured. This was supposed to be launched in January 2022 and will supposedly be able to measure displacements of parts of Earth’s surface as small as 3.5 mm. I’m not sure if this includes vertical displacement, e.g., to see whether sea levels are indeed rising to the point that owners of multi-$billion lower Manhattan and Boston real estate portfolios need to be bailed out by taxpayers in the Midwest. The satellite will supposedly be able to watch glaciers and ice sheets moving. I don’t think that it can measure sea level directly because the Science Users’ Handbook says “Provide observations of relative sea level rise from melting land ice and land subsidence.” How many migrants could have been housed for the cost of this mission? “NISAR launch slips to 2025” (July 29, 2024) says “with NASA alone spending more than $1 billion in formulation and development of the mission”. Taxpayers spend about $200,000 per year per migrant family welcomed in New York ($140k/year for food and housing and then let’s assume another $60,000/year for health care and other benefits). So if we hadn’t spent money on NISAR we could have supported 1,000 additional migrant families for five years.

NASA was also featuring the X-66, a collaboration with Boeing on an airliner that could possibly cut fuel burn by 30 percent, mostly via high aspect ratio wings (as you might see on a glider). We’re in a “climate crisis” according to our ablest minds, e.g., Kamala Harris, and “communities of color are often the hardest hit”. When will communities of color see some relief from the X-66? NASA says that if everything goes perfect the X-66 might get into the air as soon as 2028 and then, in the year 2050, we’ll be in a net-zero phase for aviation. The United Nations forecasts that world population will grow to approximately 10 billion by 2050. So we’ll have more people taking more trips, mostly in planes that were built to current designs, and the result will be much less environmental impact.

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Unrealized capital gains are already taxed by the federal government…

by philg

… for those who renounce U.S. citizenship.

There has been a bit of an uproar regarding the Democrats’ plan to tax unrealized capital gains and Republicans are complaining that it is an unprecedented new area for the federal government. But this isn’t a new area, at least when it comes to Americans who decide that they’re never going to pay U.S. taxes again. The IRS web page regarding the expatriation tax:

IRC 877A imposes a mark-to-market regime, which generally means that all property of a covered expatriate is deemed sold for its fair market value on the day before the expatriation date. Any gain arising from the deemed sale is taken into account for the tax year of the deemed sale notwithstanding any other provisions of the Code. Any loss from the deemed sale is taken into account for the tax year of the deemed sale to the extent otherwise provided in the Code, except that the wash sale rules of IRC 1091 do not apply.

And a detail page:

Section 877A(a) generally imposes a mark-to-market regime on expatriates who are covered by section 877A, providing that all property of a covered expatriate is treated as sold on the day before the expatriation date for its fair market value.

For purposes of the mark-to-market regime, the covered expatriate is deemed to have sold any interest in property that he or she is considered to own under the rules of this paragraph other than property described in section 877A(c). For purposes of computing the tax liability under the mark-to-market regime, a covered expatriate is considered to own any interest in property that would be taxable as part of his or her gross estate for Federal estate tax purposes under Chapter 11 of Subtitle B of the Code as if he or she had died on the day before the expatriation date as a citizen or resident of the United States.

In computing the tax liability under the mark-to-market regime, a covered expatriate must use the fair market value of each interest in property as of the day before the expatriation date in accordance with the valuation principles applicable for purposes of the Federal estate tax, except as otherwise provided in this paragraph.

How often does this happen? “IRS steps up enforcement of the individual expatriation tax” (KPMG partner; June 2024):

The number of individuals who renounce their U.S. citizenship or terminate their green card status has increased significantly since the enactment of the current expatriation tax regime in 2008. Lists of these individuals published quarterly by the IRS in the Federal Register show that the number of individuals expatriating has increased from 312 in 2008 to 3,260 in 2023, with a peak of 6,705 in 2020.

My big question is how President Kamala Harris will collect long-term money from the targets of her extended (not exactly new, as noted above) unrealized capital gains tax. A person targeted by the tax has two choices:

  1. pay President Harris for unrealized capital gains in 2026 (let’s assume it takes a while for this to be implemented), 2027, 2028, and every subsequent year until death
  2. pay President Harris for unrealized capital gains at long-term rates in 2025 and then never pay income taxes to President Harris, the U.S. government, or any other government again (expatriation)

Why wouldn’t a rational target of the new tax choose Option 2? He/she/ze/they renounces U.S. citizenship, moves his/her/zir/their assets into an offshore Dutch trust (as U2 did) and moves to any country that doesn’t dig into offshore assets/income for computing income tax. Or establish a residence in Italy and pay a flat tax rate of €200,000 a year (recently bumped up from the €100,000/year rate established in 2017, which means it has kept roughly even after adjusting for inflation in the costs of things that rich people buy, but the bump doesn’t affect people who signed up for this prior to August 2024). Or simply move to a country that doesn’t impose any income tax (KMPG on relocation to Monaco). If the expat is nostalgic, he/she/ze/they can return to the US for 30-60 days per year, depending on the employment situation, without becoming subject to U.S. taxation.

There is a lot to like about living in the U.S. (especially here in Florida!), but is it worth paying 100X as much in taxes compared to living in some other part of the world? If there are friends you want to see buy them a first class ticket to Heathrow and push your way through the pro-Hamas rallies to a night of theater. Or, if you’re truly one of those who has taken more than he/she/ze/they needs, send the Gulfstream or Airbus Corporate Jet to pick up the friends.

Here’s a place in northern Italy that costs less than a tract house in Palm Beach County ($2.7 million for a modern house on 22 acres):

If you don’t mind a little maintenance, a castle in Sicily on 7 acres:

Given the tax savings, maybe there isn’t any need for maintenance. Just buy a new house every few years with a fraction of what would have been paid in unrealized capital gains tax and give the old house to a charity.

Separately, why didn’t the Democrats impose their new tax regime during the first two years of the Biden-Harris administration when they had control of both houses of Congress and the White House? How can Kamala Harris simultaneously say that she agrees with everything that Joe Biden did (or read from a teleprompter) and also that she will do completely different stuff starting January 2025?

Related:

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Will the U.S. have to give up the First Amendment as a result of open borders?

by philg

A few months ago I wondered if the Second Amendment right to bear arms was compatible with mass immigration: How can a country have a right to bear arms and also an open border? (people with violent criminal histories can walk into the U.S. become citizens since we don’t have access to databases in all of the countries that are enriching us)

The U.K. doesn’t have a constitution, but the peasants there thought that they had a right to free speech until recently when they learned that opinions regarding mass immigration needed to be expressed within strict limits (example). This post is about whether the U.S. will need to formally repeal both the First and Second Amendments in order to create greater harmony in a country that is more densely packed with humans who have nothing in common other than not liking where they used to live.

We’ve already had to restrict the right to express disagreement with the state religion. See, for example, Adolfo Martinez’s 16-year prison sentence for taking a sacred Rainbow Flag off an Iowa church and burning it in the middle of the street (Reason describes it as a 15-year sentence, but maybe that is because of a confusion about credit for time served? Interestingly, the pastor of the purportedly “turn the other cheek” church was delighted with the heretic’s sentence, about what Attempted Murder might have gotten).

Elites and peasants have completely opposite financial interests when it comes to low-skill immigration (see the Harvard analysis in “Yes, Immigration Hurts American Workers” finding a $500 billion/year transfer from the working class to the elite at pre-Biden/Harris levels of immigration and in pre-Biden/Harris dollars). This division has been explicit in the U.K. where the peasants voted, via Brexit, to reduce low-skill immigration and the elites simply ignored them. From The Telegraph, August 22, 2024:

For nearly 30 years the public have voted for lower immigration, only for politicians of all stripes to raise it. Even after Brexit, when we finally regained control of our borders, the public were betrayed. Decisions taken in 2019 relaxed controls and sent net migration spiralling to historically unprecedented levels. Freedom of movement with Europe was replaced with a system so liberal it effectively amounted to freedom of movement with the rest of the world.

In the first quarter of this year, the government issued more family visas to the dependants and relatives of Somali nationals (269) than it did work visas to physicists, chemists and biologists from all other countries put together (198).

Despite the increase in spousal visas, Labour have already scrapped the plan to raise the minimum income requirement for family visas from £29,000 to £38,700. It’s a return to the type of low-skilled immigration that has burdened, not boosted, our economy.

I was chatting recently with a friend who Zooms it into a $500,000/year job from a multi-acre property in the Boston suburbs. She said, “I’m going to vote for Harris because we need more immigration. It is too difficult to find people to work on the house and yard at a reasonable price.” (She’s registered to vote in Maskachusetts so, of course, her vote won’t matter, but I found her reasoning interesting.) This explicit wish for lower market-clearing wages seems like the kind of expression that will need to be suppressed because it would inevitably lead to disharmony. On the other side, we would need to suppress “dangerous and false narratives” (MSNBC) that open borders are conducive to crime and drugs. If a narrative is “dangerous” then shouldn’t we want to prevent people from providing that narrative? I hope that we can all agree that danger is bad and safety is good. See also “Politicians’ talk of a border ‘invasion’ is speech that experts say has gotten people killed” (Ohio Capital Journal, April 2024). We don’t want people being killed merely because we can’t get rid of an outdated part of the Constitution that might have made sense when the U.S. was young, small, and socially cohesive.

From the United Nations:

“We all have to remember that hate crimes are preceded by hate speech.” This is how Adama Dieng, UN’s Special Adviser on the Prevention of Genocide, starts the Stopping Hate Speech video. “We have to bear in mind that words kill. Words kill as bullets”, he continued.

If we want to prevent violence among the disparate groups that now reside in the U.S., won’t we need to prevent unauthorized speech?

Here are some folks who could use a cooling off in prison, for example:

(“Deport All Illegals” doesn’t make sense given our asylum laws that nobody proposes changing. As soon as a person says “I felt unsafe back home” he/she/ze/they is a legal asylum-seeker. The “Assimilate” sign also makes no sense. If we are offering immigration on the basis of a lack of safety in some other country there is no reason to believe that someone here to take us up on our offer of asylum has any affinity for what used to be considered American culture.)

Loosely related… Kamala Harris says that a muscular president can ban guns (or at least some types of guns) without amending the Constitution:

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Americans are racist and sexist and that’s why Kamala Harris is favored to win the November election?

by philg

We are informed that Americans are racist and sexist and that’s why we need to discriminate against white and Asian males in university admissions, job applications, and government contracting. We are also informed that Kamala Harris, who identifies as a “Black woman” is likely to win the November Presidential election, e.g., “Democrats Kick Off Convention With Harris Ahead of Trump in Polls and Betting Odds” (TIME, August 19, 2024).

Can these facts be logically consistent?

(Of course, a person identifying as “Black” already won two U.S. presidential elections, but at the time this person identified as “male” rather than “female”, so the question of the effect of combined racism and sexism didn’t arise.)

From the U.S. government: “The federal government’s goal is to award at least 5% of all federal contracting dollars to women-owned small businesses each year.” and “Each year, the federal government contracts to Small Disadvantaged Businesses (SDBs). This amount makes up about 10% of all annual federal contracting dollars.”

What’s “disadvantaged”?

There is a rebuttable presumption that the following individuals are socially disadvantaged: Black Americans; Hispanic Americans; Native Americans (Alaska Natives, Native Hawaiians, or enrolled members of a Federally or State recognized Indian Tribe); Asian Pacific Americans (persons with origins from Burma, Thailand, Malaysia, Indonesia, Singapore, Brunei, Japan, China (including Hong Kong), Taiwan, Laos, Cambodia (Kampuchea), Vietnam, Korea, The Philippines, U.S. Trust Territory of the Pacific Islands (Republic of Palau), Republic of the Marshall Islands, Federated States of Micronesia, the Commonwealth of the Northern Mariana Islands, Guam, Samoa, Macao, Fiji, Tonga, Kiribati, Tuvalu, or Nauru); Subcontinent Asian Americans (persons with origins from India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the Maldives Islands or Nepal); and members of other groups designated from time to time by SBA

If Kamala Harris also identifies as “Indian” then she is doubly “disadvantaged”.

Separately, I’m struggling to understand how an immigrant from Singapore is “disadvantaged” by originating in a country with a substantially higher average GDP per capita, a substantially higher average IQ, and substantially lower tax rates, than the U.S. Social justice is when an immigrant from Singapore with a Ph.D. in chemistry gets a government contract ahead of someone who grew up in a West Virginia Medicaid-fueled opioid mill town?

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How is Zoom stock worth less today than before coronapanic?

by philg

Some folks are using Zoom stock as an example of the pain that some Americans would suffer if the Democrats’ plan to tax unrealized capital gains were implemented. They posit a prescient investor who paid $100 for the stock just as coronapanic was unfolding, then got taxed based on the $337/share price at the end of 2020, and just held onto the stock for the ride back down below $100 (remember that the loss in real dollars is even more severe; adjusted for purchasing power, the $100 paid in 2020 had a purchasing power of closer to $200 today, e.g., for a house):

Today’s topic is not the wisdom of forcing successful Americans to pay their fair share, but on how the Zoom price today can be lower than the Zoom price before coronapanic. Zoom was worth $92 per share in August 2019, for example, before SARS-CoV-2 had infected even a single human, with or without a cloth mask to protect him/her/zir/theirself.

Given that Zoom was a curiosity in 2019 and is something that hundreds of millions of people today still use regularly, how can the company be worth less?

Let’s also consider the purportedly efficient market and the purported wisdom of crowds of investors. Zoom had potential, so it was worth a lot in 2019. What would have been an impossible dream for Zoom investors? How about governors all around the U.S. making it illegal for people to meet in person (except at liquor and marijuana stores in California, Massachusetts, etc.)? U.S. state and local governments did more for Zoom than investors could ever have hoped for and yet the company still hasn’t lived up to the expectations of 2019.

How did the investors of 2019 get it so wrong?

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Follow-up to American Factory, Taiwan edition

by philg

Happy Labor Day to those who celebrate by working!

Back in 2020, I covered Netflix: American Factory, a documentary of what happens when Chinese glass-making experts try to train Americans to be useful and also what happens to foreign investors when Democrat politicians circle the investment. In case you missed it, the New York Times ran an interesting follow-up to this movie: “What Works in Taiwan Doesn’t Always in Arizona, a Chipmaking Giant Learns” (August 8, 2024).

TSMC modeled its facility in Phoenix on one at home. But bringing the company’s complex manufacturing process to America has been a bigger challenge than it expected.

“We keep reminding ourselves that just because we are doing quite well in Taiwan doesn’t mean that we can actually bring the Taiwan practice here,” said Richard Liu, the director of employee communications and relations at the site.

In recent interviews, 12 TSMC employees, including executives, said culture clashes between Taiwanese managers and American workers had led to frustration on both sides. TSMC is known for its rigorous working conditions. It’s not uncommon for people to be called into work for emergencies in the middle of the night. In Phoenix, some American employees quit after disagreements over expectations boiled over, according to the employees, some of whom asked not to be named because they were not authorized to speak publicly.

While it was under construction, the company sent American engineers to Tainan for training and to shadow their Taiwanese counterparts, observing TSMC’s all-hands-on-deck way of working up close.

Jefferson Patz, an engineer fresh off a master’s degree from the University of California, San Diego, went to Tainan in 2021 for 18 months of training shortly after he joined the company.

“Oh, my gosh, people work hard,” Mr. Patz said. He recalled that this initial impression had given him a strong sense of what it took to succeed in the industry.

After returning to Arizona, Mr. Patz said, employees were expected to pitch in with work outside their job descriptions because construction of the facility was behind schedule.

This approach did not sit well with everyone. Workers were required to do whatever was needed to finish the most pressing job, he said. Some of the American workers also found it difficult to spend a long stretch of time in Taiwan.

TSMC should be able to make this work simply by paying $2 million/year to each worker in order to get smart conscientious people from among the U.S. population of 335 million (or maybe 350 million if we count the undocumented more accurately), but that could be a painful hit to profits! Let’s check out the labor pool in Taiwan vs. Arizona. World Population Review:

The same source gives an average IQ for Arizona of 98, substantially lower than Taiwan’s average of 106 (I question the use of 5 digits of precision, but maybe someone with a higher IQ than mine prepared the above table). American average IQ is falling, so the spread between AZ and Taiwan will only get worse.

How about conscientiousness, the willingness to show up to work every day and try to do every step of a procedure correctly? That’s heritable and the Americans with the highest fertility are those who barely work (source; the high fertility of those earning $300,000+/year can be ignored on a population-wide basis because there aren’t a lot of those parents).

Maybe it won’t matter for profits how ill-suited the average American worker is to working in a state-of-the-art fab because TSMC will be so stuffed with U.S. tax dollars that they can pay to get the workers they need.

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Bad Pharma, 2024 edition

by philg

Ten years ago… Book review: Bad Pharma:

Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects. Regulators see most of the trial data, but only from early on in a drug’s life, and even then they don’t give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion. In their forty years of practice after leaving medical school, doctors hear about what works through ad hoc oral traditions, from sales reps, colleagues or journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are even owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it’s not in anyone’s financial interest to conduct any trials at all.

The book notes that the British government refuses to pay more for a new drug than the value added by that drug in terms of quality adjusted life years compared to cheap generics or other existing treatments. In the U.S., by contrast, the government and private insurers pay whatever the pharma company asks or, perhaps, a discount off whatever the pharma company asks.

Our ruling elites (I hesitate to say “the Biden administration” because it is unclear what role Joe Biden has been playing) have been touting a recent scheme to pay a little less for some drugs. This scheme is analyzed by Professor Vinay Prasad in “Price negotiation does not save money when keep you paying for drugs that don’t work”:

The Biden Administration saves 6 billion and then loses tens of billions with bad drug policy

They lowered the price of a drug that has no good evidence it is better than older drugs. Consider Entresto (above). Entresto— sacubitril valsartan 160mg BID— beat enalapril 10 mg BID in PARADIGM. Since then it failed in post MI and in HFpEF. It’s one the few drugs that ‘works’ in HFrEF but not post-MI. The dose tested in Paradigm was the MAXIMAL Entresto dose with a dizzying dose of ARB. But few people get this dose in real life. There is NO EVIDENCE that the prescribed doses in the US in 2024 (lower than maximal dose) are better than ace-s, which are dirt cheap.

You can lower the price of drugs, but you lose when you spend billions on covid drugs that have no evidence of efficacy. In recent years the Biden administration approved COVID boosters for toddlers, and spent 10 billion on Paxlovid. There is no evidence either of these interventions work in the current climate. So congrats on your 6 billion in savings, too bad we blew 10 billion on unproven products. (Net impact -4 billion dollars)

For every drug you negotiate prices on, the FDA is approving at least 5x as many new drugs based on poor evidence.

Summary: some things never change!

(The relative cost efficiency of the British health care system combined with the descent into Third World status for Britain is kind of confusing. The U.S. plainly wastes at least 10 percent of GDP via health care (closer to 15 percent if we compare to Singapore). How is it that we’re still so much more prosperous than the UK and most European nations?)

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What did you do to celebrate Black Business Month?

by philg

A display on August 9, 2024 at our local Bank of America in Jupiter, Florida:

Note that no other ethnic, racial, gender ID, or sexual preference group was explicitly featured by Bank of America in a rotating display. Their only focus for August, apparently, is Black Business Month.

Readers: Now that the month is nearly over, what did you do to celebrate?

American Airlines was running a “Black Film Festival” (no other ethnic or racial group was featured) on August 17, 2024, at least:

(The screen shot shows me trying to catch up on Florida literature with an audiobook of Miami Blues, also made into a movie with Alec Baldwin (holding a gun).)

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