Category: Medicine
*Self-Help is Like a Vaccine*, by Bryan Caplan
This is one of the best and most correct self-help books. Bryan describes it as follows:
I’ve been writing economically-inspired self-help essays for almost two decades, Self-Help Is Like a Vaccine compiles the most helpful 5-7% of my advice.
Of Bryan’s recent string of books, this is the one I agree with the most. Bryan offers some further description:
Like my other books of essays, Self-Help Is Like a Vaccine is divided into four parts.
- The first, “Unilateral Action,” argues that despite popular nay-saying and “Can’t-Do” mentalities, you have a vast menu of unexplored choices. Where there’s a will, there’s a way. While most “minorities of one” are fools, cautious experimentation and appreciation of good track records, not conformism, is the wise response.
- The next section, “Life Hacks,” offers a bunch of specific suggestions for improving your life. Only one hack has to work out to instantly justify your purchase of the book.
- “Professor Homeschool” brings together all of my best pieces on teaching my own kids. I have over a decade’s experience: I taught the twins for grades 7-12, all four kids for Covid, and my 10th-grader is working one room away from me as I write. Except during Covid, homeschooling is a fair bit of extra work, but if you’re still curious, I’ve got a pile of time-tested advice.
- I close the book with “How to Dale Carnegie.” As you may know, I’m a huge fan of his classic How to Win Friends and Influence People. Not because I’m naturally a people-pleaser; I’m not. But with Dale’s help, I have managed to make thousands of friends all over the planet. Few skills are more useful, both emotionally and materially.
You can buy the book here.
Mpox Vaccines Stuck in Limbo: WHO is at Fault
In 2022, Mpox, a viral disease endemic to parts of Africa and primarily transmitted through close contact—especially sexual contact between men—spread to developed countries, including the United States. The U.S. saw over 30,000 cases and approximately 58 deaths. Despite two available vaccines there was not nearly enough supply to vaccinate even the high-risk populations. Fortunately, health authorities adopted vaccination strategies my colleagues and I had recommended for COVID such as first doses first and fractional dosing. For example, several small studies (e.g. here and here) suggested that 1/5 doses delivered intradermally could be effective and the FDA, EMA, and the UK all recommended this fractional dosing strategy. As result, the US was able to vaccinate around 800,000 people and the epidemic ended (natural immunity and other preventive measures also played a role).
Unfortunately, a new Mpox variant is now spreading in the Democratic Republic of the Congo and nearby countries. Here’s the crazy part: despite declaring Mpox a public health emergency on August 14, the WHO has not approved any Mpox vaccines. You might think, “Who cares what the WHO authorizes?” After all, the FDA, EMA, and the UK have all granted emergency approval. But here’s the catch: the WHO’s approval is crucial for GAVI, the vaccine alliance that donates vaccines to developing countries. Without WHO approval, GAVI is reluctant to provide vaccines to the Congo. To add insult to injury, the Congo itself has approved the Jynneos and LC16 vaccines. Yet, the WHO refuses to authorize and GAVI to donate these vaccines, citing vague concerns about safety and efficacy.
Stephanie Nolen at the NYTimes has a very good piece on this mess:
Three years after the last worldwide mpox outbreak, the W.H.O. still has neither officially approved the vaccines — although the United States and Europe have — nor has it issued an emergency use license that would speed access.
One of these two approvals is necessary for UNICEF and Gavi, the organization that helps facilitate immunizations in developing nations, to buy and distribute mpox vaccines in low-income countries like Congo.
While high-income nations rely on their own drug regulators, such as the Food and Drug Administration in the United States, many low- and middle-income countries depend on the W.H.O. to judge what vaccines and treatments are safe and effective, a process called prequalification.
But the organization is painfully risk-averse, concerned with a need to protect its trustworthiness and ill-prepared to act swiftly in emergencies, said Blair Hanewall…
In addition, no one has followed the other practice my colleagues and I recommended for COVID (which Operation Warp Speed did), namely advance market commitments. So the vaccine manufacturers have basically been twiddling their thumbs and not gearing up for greater production. (The Congo can also be faulted for not buying more on their own account.)
All of this means that when the WHO does authorize and the vaccines begin to flow, we will still desperately need strategies like fractional dosing.
Hat tip: Ben H. and special thanks to Witold Wiecek.
Was the Great Stagnation originally a problem of human capital?
That is the topic of my latest Bloomberg column. Here is one key part of the argument:
There are numerous theories as to why [the Great Stagnation started in the early 1970s]: oil price shocks, more stringent government regulations, an increased emphasis on environmental protection over economic growth, and the collapse of the Bretton Woods international monetary order. In my 2011 book The Great Stagnation, I blame the disappearance of the low-hanging fruit that resulted from powerful machines and plentiful fossil fuels.
Some of those likely are factors. Now an economist, Nicholas Reynolds of the University of Essex, claims to have found a new villain in this economic story: a negative shock to the quality of human capital in America.
Americans born after 1947 and before the mid-1960s — the first of whom were just entering their prime working years in 1971 — did not see economic gains comparable to those of their predecessors. But the problems of this cohort are more far-reaching. They had more problems as young children, and they did worse in school in the 1960s, accounting for the educational declines of that era, such as lower test scores and higher dropout rates.
Birthweights also declined in the 1980s, a sign that the post-1947 cohort was less healthy, most of all when it comes to maternal health. You might think that development is due to intervening economic factors. But the post-1947 world is still wealthier than what came before, so it is not obvious why an economic slowdown, but not absolute decline, should have created such significant health problems.
It’s not just that Americans born after 1955 stopped getting taller, whereas Europeans didn’t. There are deeper problems, such as the alarming rise in the midlife mortality rate since 1999. These “deaths of despair” may also be a legacy from this 1947 break in Americans’ quality of health.
I am not sure that is all true, but if so it is very important and would constitute a significant revision in our understanding of 20th century economic history. And what happened in the late 1940s? There it gets tricky:
The obvious question is what exactly happened in about 1947 to put the US on this less constructive path. There is no obvious smoking gun, but the cohort decline seems to start in adolescence, prior to entering labor markets. So perhaps it is something in the structure of American society, or in US public health practices, rather than stemming from traditional macroeconomic factors.
One possible cause is an increase in postwar automobile usage, and thus higher levels of lead exposure, given the lead additives in gasoline at the time. There is no direct evidence for this claim, but lead has been shown to have significant negative impacts on human development, and some researchers blame it for the later higher US crime rates.
Still, it is not obvious why lead should lead to such a sharp break in the data. And if lead is the main culprit, then there should be major improvements forthcoming, as lead additives were fully banned from American gasoline in 1996, with a phase-out starting in the 1970s.
A second possibility is that the baby boom generation was so large that there was a decline in quality of care given to each child.
Very much worth a ponder, and then some.
The Lifetime Costs of Bad Health
What generates the observed differences in economic outcomes by health? How costly it is to be unhealthy? We show that health dynamics are largely driven by ex-ante fixed heterogeneity, or health types, even when controlling for one’s past health history. In fact, health types are the key driver of long spells of bad health. We incorporate these rich health dynamics in an estimated structural model and show that health types and their correlation with other fixed characteristics are important to account for the observed gap in economic outcomes by health. Monetary and welfare losses due to bad health over the life cycle are large, concentrated, and to a large extent due to factors pre-determined earlier in life. A large portion of the related monetary costs is due to income losses, especially for people of working age, while a substantial portion of the welfare losses arises because health affects life expectancy.
That is from a new ReStud paper by Mariacristina De Nardi, Svetlana Pashchenko, and Ponpoje Porapakkarm. I feel very fortunate to have lived for so long with essentially good health the whole way.
Tabarrok on China: World of DAAS Podcast
I was very pleased to appear on Safegraph CEO Auren Hoffman’s World of DAAS podcast. We covered lots of material including this (lightly edited) bit on China.
Auren Hoffman (23:06.518):
Now, you’ve thought a lot about things like reshoring, building manufacturing capacity. How do you think we could be thinking about that differently?
Alex (23:24.058)
I understand that there are some concerns about China, and there is an argument and I think it’s a legitimate argument, that there are some things such as chips that we want to make sure, it’s not good to have them located in Taiwan, right? We want to make sure that we onshore those. However, I have three concerns. One is, fundamentally, I don’t think China and the United States have such a clash of interest. Of course, it’s not perfect harmony, but there’s a lot of harmony of interest between China and the United States. We do lot of trade with China, which benefits both China and the United States.
..China’s getting richer Okay, people are worried because they’re getting more military whatever but also what this means is that people in China are getting cancer. Well now there’s 1 .4 billion people who want to cure for cancer, and they’re willing to put some money into it, right? And then that’s going to increase the amount of research and development for all kinds of high-tech goods, which is amazing for us. Like, I would be thrilled if an American wins the Nobel Prize for curing cancer. I would be 99.5 % as happy if a Chinese scientist wins a Nobel Prize for curing cancer.
So we have a lot to gain from a richer China. That’s point one. Point two is that, yeah, I get the idea that we want to onshore chip manufacturing, but I think we want to friendshore, right? So we don’t want to just have protection against all countries. Like I get it, okay, a hundred percent tariff on your Chinese EVs. It’s kind of crazy, but all right. However, let’s reduce tariffs on Germany.
Let’s reduce tariffs on Europe. In fact, let’s create a free trade, even a free immigration block among the Western democracies, you know, including Japan, Australia, New Zealand. So, let’s not turn a small problem in foreign policy, which is to make sure that we have a ready military supply. Let’s not turn that into trying to create a fortress America Which is going to make us poorer and actually less safe instead, you know, let’s build up the free world. Okay, let’s create an immigration and free trade with Europe and Canada and Mexico and so forth. Let’s build up the free world. That’s point two.
Point three is that look. It’s very, very easy to take a foreign policy argument and turn it into rent seeking for the benefit of special interests and protectionism for the benefit of special interests. Right? So at one point in the United States, probably even still today, you know, we were prohibiting mohair imports. Okay. Why? Because we use mohair to make military uniforms. The whole thing is ridiculous. But it’s very easy, almost inevitable, that this kind of argument is turned into a special interest trough.
I think this is one of my best podcast appearances because we covered some new material on crime, the universities, why Tyler and I are able to cooperate on so many projects, a conspiracy theory I believe and more. Listen to the whole thing.
US Human Experimentation Without Consent or Contract
In July 1946, 20-year-old Helen Hutchison walked into the Vanderbilt University prenatal clinic in Nashville, Tennessee. Helen found herself pregnant after her husband had returned from combat in World War II. The pregnancy, however, had not been easy. During her visit to the clinic Helen’s doctor handed her a small drink.
“What is it?” she asked.
“It’s a little cocktail,” her doctor replied. “It’ll make you feel better.”
“Well I don’t know if I should be drinking a cocktail,” she responded in jest.
“Drink it all. Drink it all down” (quoted in Welsome 1999, p. 220).Helen did as her doctor ordered.
Three months later Helen’s daughter, Barbara, was born. Not long after, Helen began to experience some frightening health problems; her face swelled, and her hair fell out. She then experienced two miscarriages, one of which necessitated 16 blood transfusions (Welsome 1999, p. 220). Baby Barbara experienced her own health problems from early childhood. She suffered from extreme fatigue and developed an autoimmune disorder and eventually skin cancer.
…Unbeknownst to Helen, she and her unborn baby had been subjects in a government-funded experiment. She was one of hundreds of women who received an experimental “cocktail” between 1945 and 1947 during one of their prenatal visits, compliments of the U.S. Atomic Energy Commission (AEC), which provided the materials (Wittenstein 2014, p. 39).
The 829 women of the Vanderbilt clinic were but a few of hundreds of thousands of individuals, mostly U.S. citizens, who would be subjected to illegal experiments and suffer human-rights violations during in the post-World War II period at the hands of scientists with funding and materials provided by the U.S. government. These experiments were meant to provide the government with information about the effects of atomic weapons on the human body to advance military capabilities in the name of “national security.”
This paper tells the story of U.S. government activities related to human experimentation after World War II.
That’s Coyne and Hall writing on Dr. Mengele, USA Style: Lessons from Human Rights Abuses in Post World War II America. It’s interesting that these immoral experiments using radiation and also agents of chemical warfare are less well known to the public than say the Tuskegee Study even though they involved far more people.
New data on marijuana legalization
That is the topic of my latest Bloomberg column, and here is one excerpt:
What do the numbers show? A new study from the Federal Reserve Bank of Kansas City offers some important keys toward an answer.
Start with the good news, or what appears to be the good news. Post-legalization, incomes in legalizing states grew by about 3%, home prices went up by 6%, and populations rose by about 2%. The researchers used appropriate statistical controls, but there is some question about causation vs. correlation. At the very least, it seems highly likely that state GDP went up: A state with legal marijuana can sell it, including to users in other states. Selling marijuana is a new business, and like any new business, it boosts the local economy.
But it is not so simple. Measures of GDP and GDP per capita are usually good metrics for human well-being — but not always. Cigarette sales, for instance, are not as beneficial for citizens as much as the initial GDP boost might indicate, because nicotine is bad for most people…
In states with legal marijuana, self-reported usage rose by 28%. Meanwhile, substance use disorders increased by 17%. Chronic homelessness went up by 35%, a possible sign that marijuana use leads to a downward financial spiral, and perhaps job loss, for many users. Arrests increased by 13%, although reported crime did not itself go up.
And in sum:
That said, these results are hardly a great advertisement for the legalization experiments. They stand in jarring contrast to what advocates promised: an end to black markets, safer marijuana and a better-protected user population. And if I may be allowed to think less like an economist for a moment, I confess I don’t feel good about a social practice that lowers effective IQ. No one smokes pot to perform better on their SATs.
I remain of two minds on the entire question.
Worth a ponder.
Jake Seliger is Dead
We all knew it was coming but it’s no less painful to learn that Jake Seliger has died. I never met Jake in person but we were pen pals? email pals? blog friends? for well over a decade. We shared an interest in speeding up drug research and development, including FDA deregulation, an interest which long preceded Jake’s cancer diagnosis. But mostly I thought he was a great writer and human being. His essays were always thoughtful and without pretense or sentimentality.
Jake’s wife, Bess Stillman is now 7 months pregnant with their daughter. Bess is an ER physician and a remarkable woman. Here is an interview with her on the infuriating difficulty of getting a patient enrolled in a clinical trial in the United States. Here is How to Say It, her gripping telling on the Moth Radio hour of how she tells people their loved ones have died. If you wonder about the title of this post, that is why. Do read How to Let Go on her last days with Jake. Sigh.
Here is Jake:
One virtue of a prolonged end is that I feel like I’ve said everything I have to say. I don’ t know that I have a favorite, but I’m fond of “I know what happens to me after I die, but what about those left behind?” Same with “How do we evaluate our lives, at the end? What counts, what matters?” I’m tempted to keep citing others, but if you scroll down into the archives you will find them. I meant to turn these essays into a memoir, but that is a project never to be completed by me. Bess assures me that she’s going to complete the project and do her best to get it published. We’ve created so much together in the process of building our life, and Bess says that doesn’t need to stop just because I’m not physically here, and that putting both our baby and our book into the world gives her immediate future the purpose that she’ll badly need.
Though having my life cut short by cancer is horrible, I’ve still in many ways been lucky. Most people never find the person who completes them, I think, and I have. I’ve been helped so much. Numerous oncologists have gone above and beyond. Many people, friends and strangers, have asked if there is anything they can do to help. The #1 thing is to support Bess and our soon-to-be-born daughter, Athena, whatever “support” may mean—the most obvious way is the Go Fund Me, as any remaining funds will go to Athena. I wish she could grow up with her father, but that is not an option. Being a single mom is hard;[1] growing up without a parent is hard; I cannot see what Athena’s future holds, except that I think and hope it will be bright, even though I will not be in it, save for the ways in which friends and family promise to keep me alive for her.
Markets in Everything: Fentanyl Precursors
Reuters: To learn how this global industry works, reporters made multiple buys of precursors over the past year. Though a few of the sales proved to be scams, the journalists succeeded in buying 12 chemicals that could be used to make fentanyl, according to independent chemists consulted by Reuters. Most of the goods arrived as seamlessly as any other mail-order package. The team also procured secondary ingredients used to process the essential precursors, as well as basic equipment – giving it everything needed to produce fentanyl.
The core precursors Reuters bought would have yielded enough fentanyl powder to make at least 3 million tablets, with a potential street value of $3 million – a conservative estimate based on prices cited by U.S. law enforcement agencies in published reports over the past six months.
The total cost of the chemicals and equipment Reuters purchased, paid mainly in Bitcoin: $3,607.18.
I don’t doubt that Reuters did what they say they did. I have trouble believing, however, that the implied profit margins are so high. A gram of cocaine costs about $160 on the street and $13 to $70 trafficked into the US and ready to sell. Thus, the street price to production cost is at most 12:1 and perhaps as low as 2.3:1. Note that this profit margin includes the costs of jail etc. I think Reuters overestimates fentanyl street prices by a factor of 2 which would still give a ratio of 415:1 which is way too high. Let’s say fentanyl sells for $1.5 million on the street then to get the ratio to a very generous 20:1 we need costs of $75,000 so my guess is that Reuters has underestimated costs by a significant amount in some manner.
Happy to receive clarification or verification from those with more expertise in the business.
I do accept Reuters point that fentanyl is cheap and easy to produce.
The whole story is excellent.
Does Income Affect Health? (an RCT)
This paper provides new evidence on the causal relationship between income and health by studying a randomized experiment in which 1,000 low-income adults in the United States received $1,000 per month for three years, with 2,000 control participants receiving $50 over that same period. The cash transfer resulted in large but short-lived improvements in stress and food security, greater use of hospital and emergency department care, and increased medical spending of about $20 per month in the treatment relative to the control group. Our results also suggest that the use of other office-based care—particularly dental care—may have increased as a result of the transfer. However, we find no effect of the transfer across several measures of physical health as captured by multiple well-validated survey measures and biomarkers derived from blood draws. We can rule out even very small improvements in physical health and the effect that would be implied by the cross-sectional correlation between income and health lies well outside our confidence intervals. We also find that the transfer did not improve mental health after the first year and by year 2 we can again reject very small improvements. We also find precise null effects on self-reported access to health care, physical activity, sleep, and several other measures related to preventive care and health behaviors. Our results imply that more targeted interventions may be more effective at reducing health inequality between high- and low-income individuals, at least for the population and time frame that we study.
That is from a new NBER working paper by
Every Stock is a Vaccine Stock, Revisited
In May 2020, I wrote a post titled Every Stock is a Vaccine Stock highlighting that the stock market reaction to good vaccine news indicated that vaccines were worth trillions and that most of this value was external to the vaccine manufacturers, meaning that the vaccine manufacturers were under-incentivized.
It’s not surprising that when Moderna reports good vaccine results, Moderna does well. It’s more surprising that Boeing and GE not only do well they increase in value far more than Moderna. On May 18, for example, when Moderna announced very preliminary positive results on its vaccine it’s market capitalization rose by $5b. But GE’s market capitalization rose by $6.82 billion and Boeing increased in value by $8.73 billion.
A cure for COVID-19 would be worth trillions to the world but only billions to the creator. The stock market is illustrating the massive externalities created by innovation. Nordhaus estimated that only 2.2% of the value of innovation was captured by innovators. For vaccine manufacturers it’s probably closer to .2%.
Who can internalize the externalities? Moderna clearly can’t because if they could then on May 18 Moderna would have increased in value by $20.52b ($4.97b+$6.82b+$8.73b) and GE and Boeing wouldn’t have gone up at all. Massive externalities.
A clever institutional investor like Blackrock or Vanguard could internalize some of the externalities by encouraging Moderna to work even faster and invest even more, even to the extent of lowering Moderna’s profits. Blackrock would more than make up for the losses on Moderna by bigger gains on other firms in its portfolio. Blackrock does indeed understand the incentives, although its unclear how much beyond jawboning they can actually do, legally.
I’d like to see more innovation in mechanisms to internalize externalities–perhaps in a pandemic vaccine firms should be given stock options on the S&P 500. Until we develop those innovations, however, the government is the best bet at internalizing the externality by paying vaccine manufacturers to increase capacity and move more quickly than their own incentives would dictate. Billions in costs, trillions in benefits.
A new paper by Acharya, Johnson, Sundaresan and Zheng formulizes this intuition. The authors combine a model of preferences in which uncertainty can be priced with an estimate of the stock market reaction to vaccine news and conclude that “ending the pandemic would have been worth from 5% to 15% of total wealth”.
One measure of the ex ante cost of disasters is the welfare gain from shortening their expected duration. We introduce a stochastic clock into a standard disaster model that summarizes information about progress (positive or negative) toward disaster resolution. We show that the stock market response to duration news is essentially a sufficient statistic to identify the welfare gain to interventions that alter the state. Using information on clinical trial progress during 2020, we build contemporaneous forecasts of the time to vaccine deployment, which provide a measure of the anticipated length of the COVID-19 pandemic. The model can thus be calibrated from market reactions to vaccine news, which we estimate. The estimates imply that ending the pandemic would have been worth from 5% to 15% of total wealth as the expected duration varied in this period.
Disappearing polymorphs
Here’s a wild phenomena I wasn’t previously aware of: In crystallography and materials science, a polymorph is a solid material that can exist in more than one crystal structure while maintaining the same chemical composition. Diamond and graphite are two polymorphs of carbon. Diamond is carbon crystalized with an isometric structure and graphite is carbon crystalized with a hexagonal structure. Now imagine that one day your spouse’s diamond ring turns to graphite! That’s unlikely with carbon but it happens with other polymorphs when a metastable (locally) stable version becomes seeded with a stable version.
The drug ritonavir originally used for AIDS (and also a component of the COVID medication Paxlovid), for example, was created in 1996 but in 1998 it couldn’t be produced any longer. Despite the best efforts of the manufacturer, Abbott, every time they tried to create the old ritonavir a new crystalized version (form II) was produced which was not medically effective. The problem was that once form II exists it’s almost impossible to get rid of it and microscopic particles of form II ritonavir seeded any attempt to create form I.
Form II was of sufficiently lower energy that it became impossible to produce Form I in any laboratory where Form II was introduced, even indirectly. Scientists who had been exposed to Form II in the past seemingly contaminated entire manufacturing plants by their presence, probably because they carried over microscopic seed crystals of the new polymorph.
Wikipedia continues:
In the 1963 novel Cat’s Cradle, by Kurt Vonnegut, the narrator learns about Ice-nine, an alternative structure of water that is solid at room temperature and acts as a seed crystal upon contact with ordinary liquid water, causing that liquid water to instantly freeze and transform into more Ice-nine. Later in the book, a character frozen in Ice-nine falls into the sea. Instantly, all the water in the world’s seas, rivers, and groundwater transforms into solid Ice-nine, leading to a climactic doomsday scenario.
Given the last point you will perhaps not be surprised to learn that the hat tip goes to Eliezer Yudkowsky who worries about such things.
Good news on Covid and your brain
Results: All six cognitive tests, measured before January 1, 2020, are significant predictors of infection status during the pandemic. The two subjective cognition measures show no significant association with infection. We replicate earlier cross-sectional findings of a negative association between COVID-19 infection and subsequent cognition. However, once accounting for baseline cognition, no significant associations are found for either the tests or the subjective measures. For three of the six cognitive tests the effects change signs.
Conclusions and relevance: We find no evidence for a negative association between COVID-19 infection and subsequent measures of cognitive functioning. The associations found in earlier studies may at least partly reflect reverse causation.
That is from a new research paper by Bas Weerman, et.al. Via the excellent Kevin Lewis.
Update on the Supervillains (maybe that’s you)
The law’s price controls will also deter companies from developing new medicines. A study I co-authored estimated that 135 fewer drugs will come to market through 2039 because of the Inflation Reduction Act. Research firm Vital Transformation’s forecast is even bleaker, predicting that the U.S. could lose 139 drugs within the next decade.
Dozens of life-sciences companies have announced cuts to their research and development pipelines because of the 2022 law. These announcements have come in earnings calls and filings with the Securities and Exchange Commission—where deliberate misstatements would expose executives to civil and criminal penalties—so they can’t be chalked up to political posturing.
That is from Tomas Philipson at the WSJ. It is worth noting this kind of academic research has not been effectively rebutted, rather what you usually hear in response is a bunch of snarky comments about Big Pharma and the like.
And to repeat myself yet again: if you are ever tempted to cancel somebody, ask yourself “do I cancel those who favor tougher price controls on pharma? After all, they may be inducing millions of premature deaths.” If you don’t cancel those people — and you shouldn’t — that should broaden your circle of tolerance more generally.
Testing for Bird Flu is Too Slow
Remember my warnings about the FDAs takeover of lab developed tests?
…Lab developed tests have never been FDA regulated except briefly during the pandemic emergency when such regulation led to catastrophic consequences. Catastrophic consequences that had been predicted in advanced by Paul Clement and Lawrence Tribe. Despite this, for reasons I do not understand, the FDA plan is marching forward but many other people are starting to warn of dire consequences.
Well the plan marched forward and here we are. Regarding tests for bird flu:
KFFNews: Clinical laboratories have also begun to develop their own tests from scratch. But researchers said they’re moving cautiously because of a recent FDA rule that gives the agency more oversight of lab-developed tests, lengthening the pathway to approval. In an email to KFF Health News, FDA press officer Janell Goodwin said the rule’s enforcement will occur gradually.
However, Susan Van Meter, president of the American Clinical Laboratory Association, a trade group whose members include the nation’s largest commercial diagnostic labs, said companies need more clarity: “It’s slowing things down because it’s adding to the confusion about what is allowable.”
One of the motivations for Operation Warp Speed and my work during the pandemic on things like advance market commitments was that firms wouldn’t invest enough in tests because diseases might fizzle out. The extreme costs of shutting down the economy, however, mean that it’s well worth paying for some tests for diseases that fizzle out if tests are ready when a disease doesn’t fizzle out.
Creating tests for the bird flu is already a risky bet, because demand is uncertain. It’s not clear whether this outbreak in cattle will trigger an epidemic or fizzle out. In addition to issues with the CDC and FDA, clinical laboratories are trying to figure out whether health insurers or the government will pay for bird flu tests.
We need a pandemic trust fund to ramp up advance market commitments when necessary.
On the plus side, I do approve of the new program to pay farmers and farm workers for testing. For example:
Friday’s incentives announcement included a $75 payment to any farm worker who agrees to give blood and nasal swab samples to the CDC.
“Bird flu” has now infected more than 50 types of mammals. To be clear, bird flu may yet fade but every potential pandemic pathogen is a test of readiness and we still are getting a C+ at best.