Category: Law

Scott Gottlieb’s Uncontrolled Spread

Scott Gottlieb’s Uncontrolled Spread is superb. I reviewed it for the WSJ. Here’s one bit:

If there’s one overarching theme of “Uncontrolled Spread,” it’s that the Centers for Disease Control and Prevention failed utterly. It’s now well known that the CDC didn’t follow standard operating procedures in its own labs, resulting in contamination and a complete botch of its original SARS-CoV-2 test. The agency’s failure put us weeks behind and took the South Korea option of suppressing the virus off the table. But the blunder was much deeper and more systematic than a botched test. The CDC never had a plan for widespread testing, which in any scenario could only be achieved by bringing in the big, private labs.

Instead of working with the commercial labs, the CDC went out of its way to impede them from developing and deploying their own tests. The CDC wouldn’t share its virus samples with commercial labs, slowing down test development. “The agency didn’t view it as a part of its mission to assist these labs.” Dr. Gottlieb writes. As a result, “It would be weeks before commercial manufacturers could get access to the samples they needed, and they’d mostly have to go around the CDC. One large commercial lab would obtain samples from a subsidiary in South Korea.”

At times the CDC seemed more interested in its own “intellectual property” than in saving lives. In a jaw-dropping section, Dr. Gottlieb writes that “companies seeking to make the test kits described extended negotiations with the CDC that stretched for weeks as the agency made sure that the contracts protected its inventions.” When every day of delay could mean thousands of lives lost down the line, the CDC was dickering over test royalties.

In the early months of the pandemic the CDC impeded private firms from developing their own tests and demanded that all testing be run through its labs even as its own test failed miserably and its own labs had no hope of scaling up to deal with the levels of testing needed. Moreover, the author notes, because its own labs couldn’t scale, the CDC played down the necessity of widespread testing and took “deliberate steps to enforce guidelines that would make sure it didn’t receive more samples than its single lab could handle.”

Read the whole thing.

Addendum: My previous reviews of Michael Lewis’s The Premonition, Slavitt’s Preventable and Abutaleb and Paletta’s Nightmare Scenario.

Covid markets in everything

A pastor is encouraging people to donate to his Tulsa church so they can become an online member and get his signature on a religious exemption from coronavirus vaccine mandates. The pastor, Jackson Lahmeyer, is a 29-year-old small-business owner running in the Republican primary challenge to Sen. James Lankford in 2022.

Lahmeyer, who leads Sheridan Church with his wife, Kendra, said Tuesday that in the past two days, about 30,000 people have downloaded the religious exemption form he created.

And:

Some institutions request a signature from a religious authority, but Charles Haynes, senior fellow for religious freedom at the Freedom Forum in Washington, said that those institutions could be on a shaky ground constitutionally. Haynes said that if a person states a sincere religious belief that they want to opt out of vaccination, that should be enough.

“He’s not really selling a religious exemption,” said Haynes, who compared Lahmeyer’s exemption offer to televangelists who sell things like prayer cloths. “He’s selling a bogus idea that you need one.”

Here is the full story, via Brett D.

What’s the Right Dose for Boosters?

The Biden administration says booster shots are coming, but the FDA hasn’t decided on the dose. Moderna wants a half-shot booster. Pfizer a full shot. But could the best dose for Americans and for the world be even less?

COVID-19 vaccines are the first successful use of mRNA vaccine technology, so a lot remains unknown. But identifying the smallest dose needed to provide effective boosting is critical to protect Americans from adverse effects, increase confidence in vaccines, and mitigate global vaccine inequity.

We’ve known since earlier this year that a half-dose of the Moderna vaccine produces antibody levels similar to the standard-dose and newer information suggests that even a quarter-dose vaccine may do the same. If a half or quarter dose is nearly as effective as a standard dose for first and second shots then a full dose booster may well be an overdose. The essential task of a booster is to “jog” the immune system’s memory of what it’s supposed to fight. Data from the world of hepatitis B suggest that the “reminder” need not be as intense as the initial “lesson.” And in the cases of tuberculosis, meningitis, and yellow fever vaccines, lower doses have been as good or better than the originals.

Lower doses could also reduce risks of adverse effects.

That’s myself and physicians Garth Strohbehn and William F. Parker on the Med Page Today. Strohbehn is an oncologist and specialist in optimizing doses for cancer drugs. William Parker is a pulmonologist and professor of medicine at the University of Chicago.

China campaign of the day

But a shift in investor sentiment suggests the days of China’s youth going under the knife in pursuit of perfection might be numbered, as President Xi Jinping tries to reshape the country’s cultural and business landscape as part of a “common prosperity” drive. S

ince the start of July, the market value of the country’s three biggest publicly traded medical aesthetics companies has fallen by a third, representing a collective loss of more than $17bn, despite the popularity of cosmetic procedures. Investment bank Citic estimated sales revenues in China’s aesthetic medicine market were more than Rmb330bn ($51bn) in 2020.

But analysts warn that the industry could suffer a heavy blow if Beijing concludes that the sector’s negative social influence is on a par with private tutoring and online gaming — industries where strict regulations have crushed the market values of dominant groups in recent months.

“It is perfectly possible we may see another industry disappear,” said Mark Tanner, managing director of China Skinny, a marketing company.

Here is more from the FT.

Operation Warp Speed: A Story Yet to be Told

Operation Warp Speed was by far the most successful government program against COVID. But as of yet there is very little discussion or history of the program. As just an indication I looked for references in a bunch of pandemic books to General Perna who co-led OWS with Moncef Slaoui. Michael Lewis in The Premonition never mentions Perna. Neither does Slavitt in Preventable. Nor does Wright in The Plague Year. Nor does Gottlieb in Uncontrolled Spread. Abutaleb and Paletta in Nightmare Scenario have just two index entries for Perna basically just stating his appointment and meeting with Trump.

Yet there are many questions to be asked about OWS. Who wrote the contracts? Who chose the vaccines? Who found the money? Who ran the day to day operation? Why was the state and local rollout so slow and uneven? How was the DPA used? Who lifted the regulations? How was the FDA convinced to go fast?

I don’t know the answer to these questions. I suspect when it is all written down, Richard Danzig will be seen as an important behind the scenes player in the early stages (I was involved with some meetings with him as part of the Kremer team). Grogan at the DPC seems under-recognized. Peter Marks at the FDA was likely extremely important in getting the FDA to run with the program. Marks brought people like Janet Woodcock from the FDA to OWS so you had a nominally independent group but one completely familiar with FDA policy and staff and that was probably critical. And of course Slaoui and Perna were important leaders and communicators with the private sector and the logistics group but they have yet to be seriously debriefed.

It’s also time for a revisionist account of President Trump’s Council of Economic Advisors. Michael Kremer and I spoke to the DPC and the CEA early on in the pandemic and argued for a program similar to what would later be called OWS. The CEA, however, was way ahead of the game. In Sept of 2019 (yes, 2019!) the CEA produced a report titled Mitigating the Impact of Pandemic Influenza through Vaccine Innovation. The report calculates the immense potential cost of a pandemic and how a private-public partnership could mitigate these costs–all of this before anyone had heard the term COVID. Nor did that happen by accident. Thomas Philipson, the CEA chair, had made his reputation in the field of economic epidemiology, incorporating incentives and behavioral analysis in epidemiological models to understand HIV and the spread of other infectious diseases. Eric Sun, another CEA economist, had also written with Philipson about the FDA and its problems. Casey Mulligan was another CEA chief economist who understand the danger of pandemics and was influenced by Sam Peltzman on the costs of FDA delay. So the CEA was well prepared for the pandemic and I suspect they gave Trump very good advice on starting Operation Warp Speed.

In short, someone deserves credit for a multi-trillion-dollar saving government program! More importantly, we know a lot about CDC and FDA failure but in order to know what we should build upon we also need to know what worked. OWS worked. We need a history of how and why.

Secret Danish markets in everything

Denmark has paid the UK an undisclosed sum to accept 23 Afghan refugees who worked as interpreters for the Danish state for eight years.

According to a report by Swedish broadsheet Svenska Dagbladet, the interpreters were granted a residence permit in the UK after twelve of them had their visa applications to Denmark rejected and eleven wanted to travel to the UK themselves.

Even though the interpreters were technically employed by the British military, they worked for the Danes, wearing Danish uniform and received a Danish salary.

The amount — paid for in secret by the Danish state — has been calculated according to what it would cost the British to evacuate the interpreters, integrate them into society and pay social costs for five years. The payment has been confirmed by the Danish Ministry of Defence to SvD.

Here is the full story.

A new hurdle for vaccine development

Unless countries that have purchased vaccine doses and companies that have already brought vaccines into use agree to find ways to resolve the problem, manufacturers that trail the first wave of producers may not be able to prove that their vaccines work. Not only will that slow efforts to vaccinate the planet, it will block development of next-generation vaccines, and it will stymie efforts to answer key public health questions, like whether boosting with a different vaccine would generate better protection, or whether giving smaller — fractional — doses could protect more people more quickly…

The problem stems in part from the fact that at this point in the pandemic, it isn’t considered ethical to test new vaccines against placebos; instead they would have to be tested against one of the existing shots. But getting one’s hands on licensed or authorized vaccines for study purposes is nigh on impossible; all available doses have been snapped up by countries keen to vaccinate as many of their citizens as possible.

Contracts for those doses contain rigid stipulations about how the vaccines can be deployed. The doses often have to be used in the country that made the purchase; when the Biden administration wanted to share AstraZeneca doses with Canada and Mexico in March, it loaned the doses to get around the restrictions. Contracts also often stipulate that doses that have been purchased must be used for outbreak control, not for research purposes, Lurie said.

Here is the full story by Helen Branswell.  Obviously there is a market-oriented solution here, if only we care enough to implement it…

My Conversation with Ed Glaeser

I did David Cutler and Ed sequentially, based on their new co-authored book, here is the joint episode but there is also a separate link concerning Cutler.  Here is one excerpt from the general summary:

They joined Tyler for a special joint episode to discuss why healthcare outcomes are so correlated with education, whether the health value of Google is positive or negative, why hospital price transparency is so difficult to achieve, how insurance coding systems reimburse sickness over health improvement, why the U.S. quit smoking before Europe, the best place in America to get sick, the risks that come from over-treatment, the possible upsides of more businesses moving out of cities, whether productivity gains from remote work will remain high, why the older parts of cities always seem to be more beautiful, whether urban schools will ever improve, why we shouldn’t view Rio de Janeiro’s favelas as a failure, how 19th century fights to deal with contagious diseases became a turning point for governance, Miami’s prospects as the next tech hub, what David and Ed disagree on, and more.

And from my exchange with Ed:

COWEN: Let’s start with a simple question. All this enthusiasm about cities and agglomeration benefits — the pandemic comes along. A lot of people transition to work from a distance, and then we see big measured productivity gains. What has gone on there?

GLAESER: It reminds us that for many jobs, in a static sense, you can do this long-distance. You can make things work. I think many of us found this. We wrote this book in eight months over the pandemic year, distinctly away from each other, partially because there were no distractions, and all that was good.

However, you also need to recognize the limits of long-distance living. The most important of those limits is just it’s much less fun. It’s much less joyful, but while it seems as if it’s fine for static productivity, it seems distinctly more problematic for people learning and for onboarding new talent.

Let me just give you two types of studies, one of which is we have the call center studies. The father of that was the Nick Bloom paper, which was a randomized control trial in China. A more modern version is done by our students, Natalia Emanuel and Emma Harrington, which looks into American call centers.

Both of them find the same thing in terms of static productivity. If anything, it goes up, but the workers who go remote are much less likely to be promoted in both studies. One interpretation of this is that promotion in the call center work means that you actually are given the job of handling more difficult calls.

How would your boss know that you are good at handling difficult calls if they weren’t in the same room with you? How would you learn how to do those difficult calls if you weren’t around other people? So while the static productivity remains, you lose the dynamic benefits of being around other people.

Second piece of evidence it comes from Burning Glass Technologies and new hires. Even though Microsoft tells us that its programmers were just as productive, overall, new hires for programmers were down 42 percent between November 2019 and November 2020. Firms were clearly unwilling to take the same kind of risks of hiring new workers that they couldn’t inculcate in their corporate culture or screen them properly, or do any of those other things.

Even though measured productivity did well during the pandemic, there were still lots of disruptions. In particular, many younger workers who came of age really lost out as a result of this.

COWEN: If work from a distance goes fine in the short run, what’s the cross-sectional prediction about where it will persist in the future? Is it firms facing bankruptcy, firms with immediate projects now, possibly start-ups who will then later transition to all being together in one big happy family, but they’re afraid they’re going to fail before then? What should we expect?

GLAESER: I think we should expect young workers to be more likely to be brought together. Young firms, as well, because you’re very much at this learning, creative phase. I think the optimal work-from-home strategy is a couple of partners who are in an accounting practice and have decided they know each other perfectly well and are delighted to Zoom it in from wherever they are.

I think, unquestionably, working from home will remain a part of the economy. It may well be many workers end up spending 20 percent of their time working from home, even if they’re part of a generally full-time job. But for younger workers, for firms that are just getting started, I think being live is likely to continue being a major part of the work environment.

It also depends a lot on what your home environment is like. If you’re like us —  if you are a middle-aged professor who’s likely to have a comfortable home office, and maybe even not having kids at home anymore, certainly not kids who are crying all the time at home anymore — working at home is a lot more pleasant than if you’re a 23-year-old and live in a studio apartment in Somerville or New York or London.

Recommended!

My Conversation with David Cutler

I did Cutler and Ed Glaeser sequentially, based on their new co-authored book, here is the joint episode but I will create another link concerning Glazer.  Here is one excerpt from the general summary:

They joined Tyler for a special joint episode to discuss why healthcare outcomes are so correlated with education, whether the health value of Google is positive or negative, why hospital price transparency is so difficult to achieve, how insurance coding systems reimburse sickness over health improvement, why the U.S. quit smoking before Europe, the best place in America to get sick, the risks that come from over-treatment, the possible upsides of more businesses moving out of cities, whether productivity gains from remote work will remain high, why the older parts of cities always seem to be more beautiful, whether urban schools will ever improve, why we shouldn’t view Rio de Janeiro’s favelas as a failure, how 19th century fights to deal with contagious diseases became a turning point for governance, Miami’s prospects as the next tech hub, what David and Ed disagree on, and more.

And from David:

COWEN: But even if we adjust for that, education seems to matter a lot. It’s also puzzling to me — in your own work, it matters more at younger ages. You would think the returns are cumulative: it would really pay off when you’re 67 because you’ve invested in a stock portfolio for decades, but it matters most when you’re young. What’s your best micro account of that?

CUTLER: One of the things that’s super interesting is that, for example, people who live in cities — where there are more better-educated people — smoke less, even conditional on your own education. The same thing is true about age and so on.

I think it’s partly that cities and areas are run by upper-middle-class folks often. For example, the environment is set up in a way that’s more conducive to health when you have more upper-middle-income people. It’s much more difficult to smoke. There are healthier behaviors in general. There are parks and things like that. I think part of it is just that society is shaped by higher-income, higher-SES people, and that can be good for everyone who lives around those areas.

COWEN: To the extent education makes you healthier by lowering your stress and raising your relative status — which is a possible hypothesis — what are the policy implications of that? What should we do?

CUTLER: Part of what we’re learning over time is that social insurance programs are actually having a bigger and more sustained effect on health than we had thought they did. For example, we’ve always thought of Medicare and Medicaid as being the primary social insurance programs that affect health, but then there’s research that the WIC program — Women, Infants, and Children — affects health, that food stamp programs affect health, that TANF benefits affect health, that housing policies can affect health.

COWEN: And you think that’s through lowering stress as one mechanism?

Recommended!

Britney freed?

Britney Spears’s father, James P. Spears, who agreed earlier this summer to eventually step down from his own role in the conservatorship that has overseen her finances and controlled much of her life since 2008, filed a petition on Tuesday asking the court to “now seriously consider whether this conservatorship is no longer required.”

The filing marked a turnaround for Mr. Spears, who long insisted that the guardianship — which was imposed 13 years ago amid concerns over the singer’s mental health and possible drug use — was in his daughter’s best interest. Last month, he said he would eventually step aside from his role overseeing the singer’s finances once there could be “an orderly transition to a new conservator,” but argued that he should not be immediately removed. Until now, he has not said that the conservatorship should end, something that Ms. Spears announced she wanted publicly for the first time in a June court hearing, when she called the arrangement “abusive.”

Here is more from the NYT.

Why the defenses of Australia do not persuade me

Alex laid out some complaints about Covid policy down under, I have been receiving emails and tweets arguing the following:

1. Australia is choosing a perfectly acceptable point on the liberty vs. safety frontier.

2. The Australian decision to do extreme lockdowns is democratic, and most Australians support it.

And sometimes I see a third point, which as far as I can tell is true:

3. Australia doesn’t have much in the way of ICU excess capacity, so a Covid surge would hit the country especially hard.

I think those responses, however, are missing the point of the critique.  I would stress that if Covid risk has you with your back against the wall and the government is forcing extremely restrictive measures on your citizenry, you should be implementing the following in an urgent manner:

a. Twice a week rapid antigen tests for everyone.  (Plenty of time to prep for this one.)

b. Much stronger incentives to vaccinate people more rapidly, including with the large stock (six million or so?) of AstraZeneca vaccines.  Demand side incentives, supply side incentives, whatever can be done.  Let’s throw the kitchen sink at this one.  But as it stands, I just don’t see the urgency.

c. Mobile monoclonal antibody units, as they are used in Florida (modest progress here).

d. Maybe other emergency measures too?  I’ve been hearing for decades that Australia has such a great health care system so surely they can make lots of progress on these and other fronts?

As far as I can tell from this great distance, Australia is doing none of these.  And, while there is some disquiet about lockdowns, few of its citizens are demanding that they do any of those positive measures.  Not many of its well-known politicians are proposing those ideas either.  (Please feel free to correct me if that is wrong!…but I just don’t see word of it on-line.)

If Australia implemented all of those policies, or even just one of them, they could attain a much better “liberty vs. lives” frontier, no matter where you think the government should end up on that frontier.  They could save lives, and enjoy more liberty.

And that is the great shame and indeed I would say crime.  There seems to be an incredible complacency that people in some parts of the country will put up with the current measures and not demand the government look for more practical measures to boost both liberty and security.

So when you write me and suggest “this is democratic and the people approve,” yes that is exactly the problem.

The robot culture that is Singapore

The robot scans its surroundings also for offenses like Illegal hawking, improperly parked bicycles, assembly of more than five people in line with prevailing Covid-19 safety management measures and e-scooters and motorcycles driving on footpaths.

In case a suspicion arises, the robot takes video footage and sends it to a command and control center which feeds the material into a video analytics system programmed to recognise a person’s posture and other visual indicators of “wrongdoing.”

“Educating the public” with pre-recorded messages

Then, the robot blares out a pre-recorded message, for example, “Please do not smoke in prohibited areas such as covered walkways.” The message is meant to “educate the public and deter such behaviours,” according to a release by the project team.

The robotic watchdog is a joint project involving five public Singapore agencies, namely the Home Team Science and Technology Agency, or HTX, the National Environment Agency, the Land Transport Authority, the Singapore Food Agency and the Housing and Development Board. It will go on for a three-week trial phase for now.

During the trial, the robot will be used for education and deterrence, rather than enforcement, the authorities said. The aim is to collect data to improve the analytics system and fine-tune any kinks.

Here is the full story, via Jasper C.

Gaming is coming to get us

That is the theme of my latest Bloomberg column, the first part concerns culture, but here is the section on government regulation:

The self-contained nature of games also means they will be breaking down government regulation. Plenty of trading already takes place in games — involving currencies, markets, prices and contracts. Game creators and players set and enforce the rules, and it is harder for government regulators to play a central role.

The lesson is clear: If you wish to create a new economic institution, put it inside a game. Or how about an app that gamifies share trading? Do you wish to experiment with a new kind of stock exchange or security outside the purview of traditional government regulation? Try the world of gaming, perhaps combined with crypto, and eventually your “game” just might influence events in the real world.

To date the regulators have tried to be strict. It is currently difficult to build fully realized new worlds without creating something that is legally defined as an unregistered security. Those regulations don’t receive a lot of attention from the mainstream media, but they are rapidly becoming some of the most significant and restrictive rules on the books.

At the same time, regulators are already falling behind. Just as gaming has outraced the world of culture, so will gaming outrace U.S. regulatory capabilities, for a variety of reasons: encryption, the use of cryptocurrency, the difficulties of policing virtual realities, varying rules in foreign jurisdictions and, not incidentally, a lack of expertise among U.S. regulators. (At least the Chinese government’s attempt to restrict youth gaming to three hours a week, while foolhardy, reflects a perceptive cultural conservatism.)

Both the culture-weakening and the regulation-weakening features of games follow from their one basic characteristic: They are self-contained worlds. Until now, human institutions and structures have depended on relatively open and overlapping networks of ideas. Gaming is carving up and privatizing those spaces. This shift is the big trend that hardly anyone — outside of gaming and crypto — is noticing.

If the much-heralded “metaverse” ever arrives, gaming will swallow many more institutions, or create countervailing versions of them. Whether or not you belong to the world of gaming, it is coming for your worlds. I hope you are ready.

And the piece has a good footnote on how gaming relates to postmodernism.

“Conspicuous corruption”

People can exhibit their status by the consumption of particular goods or experiential purchases; this is known as “conspicuous consumption”; the practice is widespread and explains the market characteristics of a whole class of goods, Veblen goods, demand for which increase in tandem with their price. The value of such positional goods lies in their distribution among the population—the rarer they are, the more desirable they become. At the same time, higher income, often associated with higher status, has been studied in its relation to unethical behavior. Here we present research that shows how a particular Veblen good, illicit behavior, and wealth, combine to produce the display of illegality as a status symbol. We gathered evidence at a large, country-level, scale of a particular form of consumption of an illictly acquired good for status purposes. We show that in Greece, a developed middle-income country, where authorities cannot issue custom vanity license plates, people acquire distinguishing plate numbers that act as vanity plate surrogates. We found that such license plates are more common in cars with bigger engines and in luxury brands, and are therefore associated with higher value vehicles. This cannot be explained under the lawful procedures for allocating license plates and must therefore be the result of illegal activities, such as graft. This suggests a pattern of “conspicuous corruption”, where individuals break the law and use their gains as status symbols, knowing that the symbols hint at rule-breaking, as long as the unlawful practice cannot be incontestably established.

Here is the link by Panos Louridas and Diomidis Spinellis, via the excellent Kevin Lewis.