Why isn’t downward competitive pressure on drug prices more effective?

Using current methods of inventing drugs, Borisy believes it will be possible to create new medicines that mimic the effects of existing big sellers, and bring them to market in a matter of years. Then EQRx will sell them to insurers and large hospital systems at a discount, displacing the innovators. Because its medicines will be cheaper to develop, EQRx will be able to make a handy profit despite these lower prices. The key question is whether health insurers and giant hospital systems have gotten desperate enough to want to shake up the system.

Quite simply, Borisy is going to invent and develop new drugs, and sell them for less money than the competition. He calls this “a radical proposition.” In any other sector, it would just be called “business.”

But the branded drug business is different, in part for structural reasons but also because people and doctors tend to be reticent to switch to a new medicine just because it’s cheaper. That has helped lead to dramatically higher prices.

Why, Borisy asks, have prices of, for instance, cancer drugs gone up eightfold over 20 years if the technology to make new medicines is steadily improving, and if we are, in fact, as he says, in “a golden age of biotech and pharmaceutical innovation”?

EQRx is his antidote. On Monday morning, the company is also announcing that it has raised $200 million from a bevy of top tech and biotech investors.

Over the next 10 years, Borisy said, he’d like for EQRx to start developing somewhere in the ballpark of 50 different experimental medicines. He wants the company to come out with its first medicine in five years, and to have 10 drugs within a decade.

Will this succeed?  Even if so, why did it take so long for this to happen?  The article offers this explanation:

There are multiple reasons creating a company like EQRx will be difficult. The idea of creating a “fast-follower” — a new drug that is much like an existing one — is anything but new. In fact, it has yielded some of the pharmaceutical industry’s biggest sellers. Lipitor followed several other cholesterol medicines to market, but became the best-selling drug in the world in the 2000s. Rheumatoid arthritis treatment Humira, the industry’s current best-seller, was introduced after two similar medicines, Remicade and Enbrel, were already on the market.

But fast-followers do not compete on price, because lowering price has not historically resulted in selling more units of a drug. Instead, the least successful medicine in a category will sometimes raise its price to make up for lost market share, and the best-sellers will often follow, raising their own prices.

Here is the full Matthew Herper piece, via Sarah Constantin.  Model this!

Thursday assorted links

What should I ask John McWhorter?

I will be doing a Conversation with him, with an associated public event.  Here is part of his Wikipedia profile:

John Hamilton McWhorter V…is an American academic and linguist who is associate professor of English and comparative literature at Columbia University, where he teaches linguistics, American studies, philosophy, and music history. He is the author of a number of books on language and on race relations, and his writing has appeared in many prominent magazines. His research specializes on how creole languages form, and how language grammars change as the result of sociohistorical phenomena.

So what should I ask him?

And if you wish to register for February 17, here is the link.

What to make of the new U.S.-China trade deal?

That is the topic of my latest Bloomberg column, here is one excerpt:

The U.S. has established its seriousness as a counterweight to China, something lacking since it largely overlooked China’s various territorial encroachments in the 2010s. Whether in economics or foreign policy, China now can expect the U.S. to push back — a very different calculus. At a time when there is tension in North Korea, Hong Kong, Taiwan and the South China Sea, that is potentially a significant gain.

…Currently the U.S. is working hard to keep Huawei equipment out of the forthcoming 5G networks in many countries. (Imagine letting the KGB run the American phone network in say 1980, and you can see what is at stake here.) For that campaign to succeed, even partially, the U.S. needs some credible threats of punishment, such as withholding intelligence or even defense protection from allies. The course of the trade war has made those threats more plausible. If you are Germany, and you see that the U.S. has been willing to confront the economic and military power of China directly, you will think twice about letting Huawei into your network.

A third set of possible benefits relates to the internal power dynamics in the Chinese Communist Party. For all the talk of his growing power, Chinese President Xi Jinping has not been having a good year. The situation in Hong Kong remains volatile, the election in Taiwan did not go the way the Chinese leadership had hoped, and now the trade war with America has ended, or perhaps more accurately paused, in ways that could limit China’s future expansion and international leverage. This trade deal takes Xi down a notch, not only because it imposes a lot of requirements on China, such as buying American goods, but because it shows China is susceptible to foreign threats.

The U.S. still is keeping $360 billion of tariffs on Chinese goods, hardly a propitious sign that China made a great bargain. There is even speculation that China will not report the full deal to its citizens…

It is a common argument that being tough with other countries strengthens the hard-liners in those countries. But in China the hard-liners had been growing in power and influence anyway. This trade war, and the resulting first phase of a trade deal, shows there is a cost to China for being so hard-line.

Do read the whole thing, and note that we still should be agnostic.  Nonetheless extreme TDS is preventing people from thinking rationally about this one, and thus I view my column as a correction to most of what you are seeing in MSM.

Damir Marusic and Aaron Sibarium interview me for *The American Interest*

It was far-ranging, here is the opening bit:

Damir Marusic for TAI: Tyler, thanks so much for joining us today. One of the themes we’re trying to grapple with here at the magazine is the perception that liberal democratic capitalism is in some kind of crisis. Is there a crisis?

TC: Crisis, what does that word mean? There’s been a crisis my whole lifetime.

And:

TC: I think addiction is an underrated issue. It’s stressed in Homer’s Odyssey and in Plato, it’s one of the classic problems of public order—yet we’ve been treating it like some little tiny annoyance, when in fact it’s a central problem for the liberal order.

And:

AS: What about co-determination?

TC: There are too many people with the right to say no in America as it is. We need to get things done speedier, with fewer obstacles that create veto points. So no, I don’t favor that.

And:

AS: John Maynard Keynes.

TC: I suppose underrated. He was a polymath. Polymaths tend to be underrated, and Keynes was a phenomenal writer. I’m not a Keynesian on macroeconomics, but when you read him, it’s so fresh and startling and just fantastic. So I’d say underrated.

And:

AS: Slavoj Zizek, the quirky communist philosopher you debated recently.

TC: Way underrated. I had breakfast with Zizek before my dialogue with him, and he’s one of the 10 people I’ve met who knows the most and can command it. Now that said, he speaks in code and he’s kind of “crazy,” and his style irritates many people because he never answers any question directly. You get his Hegelian whatever. He has his partisans who are awful, but ordinary intellectuals don’t notice him and he’s pretty phenomenal actually. So I’d say very underrated.

Here is the full interview, a podcast version is coming too.

Are the ex-royals good enough for Canada?

For example, many of the ways to get permanent residency in Canada require applicants to have specialized skills or high levels of education. Prince Harry trained as a military officer at the Royal Military Academy Sandhurst, but he does not have a university degree, which lawyers said would be a major stumbling block for him.

“I doubt very much they would apply for permanent residency,” said Sergio R. Karas, an immigration lawyer in Toronto. “That would not be a good option for them.”

From the sound of the NYT article by Ian Austen, they will likely enter as “visitors,” a status for which they do not need additional authoritzation.

Wednesday assorted links

1. Residential home services: “Our results show that more stringent licensing regulations are associated with less competition and higher prices but not with any improvement in customer satisfaction as measured by review ratings or the propensity to use the platform again.”

2. Philip Wallace on Andrew Yang.

3. The culture that is Louisiana.

4. The deepest hole we have dug.

5. Vincent Geloso on state capacity libertarianism.

6. Is Brazil tanking without daylight savings time?

My Conversation with the excellent Reid Hoffman

This one is better than the other available conversations with Reid, here is the transcript and audio.  Here is part of the CWTeam summary:

Reid joined Tyler to talk about all these leverage points and more, including the Silicon Valley cultural meme he most disagrees with, how Wittgenstein influenced the design of LinkedIn, mystical atheism, what it was like being on Firing Line, why he’s never said anything outrageous, how he and Peter Thiel interpret The Tempest differently, the most misunderstood thing about friendship, how to improve talent certification, what’s needed from science fiction, and his three new ideas for board games.

Excerpt:

COWEN: If we think of Peter Thiel and Elon Musk, they could arguably, by the standards of many people, be called weird. I’ve reviewed all the books you’ve written and a lot of your public talks. I can’t recall you saying a single thing that’s outrageous in any way whatsoever. Why aren’t you weirder?

HOFFMAN: [laughs] Maybe I mask it better. That’s my Straussian element, that I hide my weirdness. I would say that a little bit of it comes down to a theory about what is the right way of evolving discourse.

I think I probably do have a variety of views that people would think is weird. I, for example, think of myself as a mystical atheist, which is neither the full atheist category nor any religious category, but some blend in the middle. Or the fact that I actually think that the notion of capitalism is one of the world’s leading interesting technologies, but it’s not a particularly good philosophy, and you’d think that’s odd for an entrepreneur or an investor, and so forth.

So I have areas where I would say groups of people would think I’m weird. I may not highlight it because I tend to always speak in a way to, how do I think I help us make the most progress? And I would only say the weird things if I thought that was the thing that would result from that.

COWEN: So there are weird things that are in your mind?

HOFFMAN: Yes, yeah.

And:

COWEN: How did your interest in the late Wittgenstein influence the construction and design of LinkedIn? I’m sure they ask you this all the time in interviews.

HOFFMAN: [laughs] All the time. The question I’ve always been expecting. I would say that the notion of thinking about — a central part of later Wittgenstein is to think that we play language games, that the way that we form identity and community, both of ourselves and as individuals, is the way that we discourse and the way that we see each other and the way that we elaborate language.

That pattern of which ways we communicate with each other, what’s the channel we do, and what’s the environment that we’re in comes from insights from — including later Wittgenstein, who I think was one of the best modern philosophers in thinking about how language is core to the people that we are and that we become.

COWEN: What else from philosophy influenced the construction and design of LinkedIn?

Recommended.  For help in arranging this Conversation I am very much indebted to Ben Casnocha.

The United States is Starved for Talent

The US offers a limited number of H1-B visas annually, these are temporary 3-6 year visas that allow firms to hire high-skill workers. In many years, the demand exceeds the supply which is capped at 85,000 and in these years USCIS randomly selects which visas to approve. The random selection is key to a new NBER paper by Dimmock, Huang and Weisbenner. What’s the effect on a firm of getting lucky and wining the lottery?

We find that a firm’s win rate in the H-1B visa lottery is strongly related to the firm’s outcomes over the following three years. Relative to ex ante similar firms that also applied for H-1B visas, firms with higher win rates in the lottery are more likely to receive additional external funding and have an IPO or be acquired. Firms with higher win rates also become more likely to secure funding from high-reputation VCs, and receive more patents and more patent citations. Overall, the results show that access to skilled foreign workers has a strong positive effect on firm-level measures of success.

Overall, getting (approximately) one extra high-skilled worker causes a 23% increase in the probability of a successful IPO within five years (a 1.5 percentage point increase in the baseline probability of 6.6%). That’s a huge effect. Remember, these startups have access to a labor pool of 160 million workers. For most firms, the next best worker can’t be appreciably different than the first-best worker. But for the 2000 or so tech-startups the authors examine, the difference between the world’s best and the US best is huge. Put differently on some margins the US is starved for talent.

Of course, if we play our cards right the world’s best can be the US best.

Sam Altman on start-up talent

I look for founders who are scrappy and formidable at the same time (a rarer combination than it sounds); mission-oriented, obsessed with their companies, relentless, and determined; extremely smart (necessary but certainly not sufficient); decisive, fast-moving, and willful; courageous, high-conviction, and willing to be misunderstood; strong communicators and infectious evangelists; and capable of becoming tough and ambitious.

Some of these characteristics seem to be easier to change than others; for example, I have noticed that people can become much tougher and more ambitious rapidly, but people tend to be either slow movers or fast movers and that seems harder to change. Being a fast mover is a big thing; a somewhat trivial example is that I have almost never made money investing in founders who do not respond quickly to important emails.

Also, it sounds obvious, but the successful founders I’ve funded believe they are eventually certain to be successful.

Here is the full blog post — agree or disagree?

The best available fix for real wage stagnation

That is the topic of my latest Bloomberg column, here is one excerpt:

In other words, the frontier areas for overcoming wage stagnation are several-fold. First is a greater freedom to build, so that housing supply can rise and prices can fall. That also would enable more upward mobility by easing moves to America’s more productive (but also more expensive) regions. Second are steps to lower the cost of medical care through greater competition and price transparency. Third, American higher education is hardly at its optimum point of efficiency, innovation and affordability.

If those sectors displayed some of the dynamism and innovativeness of that marks America’s tech sector, the combination of declining prices and rising quality could give living standards a boost. And since rent, health care and tuition tend to be higher shares of the incomes of poorer people, those changes would help poorer people the most.

Think of it as a rooftops piece, combined with a discussion of why wages actually have seen slow growth as of late.

Tuesday assorted links

1. The most checked out books of all time from the New York Public Library.  #1 is The Snowy Day, by Ezra Jack Keats.

2. Why gaming is outperforming TV, recommended.

3. Flying has become much cheaper over the last five years (sometimes trotted out as a case of “monopoly,” because the number of major carriers went down).

4. Deaflix: Deaf Entertainment Network.

5. Bagel Union > Mafia.

Big Data+Small Bias << Small Data+Zero Bias

Among experts it’s well understood that “big data” doesn’t solve problems of bias. But how much should one trust an estimate from a big but possibly biased data set compared to a much smaller random sample? In Statistical paradises and paradoxes in big data, Xiao-Li Meng provides some answers which are shocking, even to experts.

Meng gives the following example. Suppose you want to estimate who will win the 2016 US Presidential election. You ask 2.3 million potential voters whether they are likely to vote for Trump or not. The sample is in all ways demographically representative of the US voting population but potential Trump voters are a tiny bit less likely to answer the question, just .001 less likely to answer (note they don’t lie, they just don’t answer).

You also have a random sample of voters where here random doesn’t simply mean chosen at random (the 2.3 million are also chosen at random) but random in the sense that Trump voters are as likely to answer as are other voters. Your random sample is of size n.

How big does n have to be for you to prefer (in the sense of having a smaller mean squared error) the random sample to the 2.3 million “big data” sample? Stop. Take a guess….

The answer is…here. Which is to say that your 2.3 million “big data” sample is no better than a random sample of that number minus 1!

On the one hand, this illustrates the tremendous value of a random sample but it also shows how difficult it is in the social sciences to produce a truly random sample.

Meng goes on to show that the mathematics of random sampling fool us because it seems to deliver so much from so little. The logic of random sampling implies that you only need a small sample to learn a lot about a big population and if the population is much bigger you only need a slightly larger sample. For example, you only need a slightly larger random sample to learn about the Chinese population than about the US population. When the sample is biased, however, then not only do you need a much larger sample you need it to large relative to the total population. A sample of 2.3 million sounds big but it isn’t big relative to the US population which is what matters in the presence of bias.

A more positive way of thinking about this, at least for economists, is that what is truly valuable about big data is that there are many more opportunities to find random “natural experiments” within the data. If we have a sample of 2.3 million, for example, we can throw out huge amounts of data using an instrumental variable and still have a much better estimate than from a simple OLS regression.

Gangs really matter

We study the effects that two of the largest gangs in Latin America, MS-13 and 18th Street, have on economic development in El Salvador. We exploit the fact that the emergence of gangs in El Salvador was in part the consequence of an exogenous shift in US immigration policy that led to the deportation of gang leaders from the United States to El Salvador. Using the exogenous variation in the timing of the deportations and the boundaries of the territories controlled by the gangs, we perform a spatial regression discontinuity design and a difference-in-differences analysis to estimate the causal effect that living under the rule of gangs has on development outcomes. Our results show that individuals living under gang control have significantly worse education, wealth, and less income than individuals living only 50 meters away in areas not controlled by gangs. None of these discontinuities existed before the arrival of gangs from the US. The results are not determined by exposure to violence, lower provision of public goods, or selective migration away from gang locations. We argue that our findings are mostly driven by gangs restricting residents’ mobility and labor choices. We find that individuals living under the rule of gangs have less freedom of movement and end up working in smaller firms. The results are relevant for many developing countries where non-state actors control parts of the country.

That is from a new paper by Nikita Melnikov, Carlos Schmidt-Padilla, and Maria Micaela Sviatschi.  Via the excellent Samir Varma.

Urban growth and its aggregate implications

That is the title of a new paper by Gilles Duranton and Diego Puga.  This piece goes considerably beyond previous research by having a more explicit model of both urban-rural interactions, and also possible congestion costs arising from more YIMBY.  Here are a few results of the paper:

1. If you restricted New York City and Los Angeles to the size of Chicago, 18.9 million people would be displaced and per capita rural income would fall by 3.6%, due to diminishing returns to labor in less heavily populated areas.

2. The average reduction in real income per person, from this thought experiment, would be 3.4%.  You will note that NIMBY policies are in fact running a version of this policy, albeit at different margins and with a different default status quo point.

3. If you were to force America’s 11 largest cities to be no larger than Miami, real income per American would fall by 7.9%.

4. If planning regulations were lifted entirely, NYC would reach about 40 million people, Philadelphia 38 million (that’s a lot of objectionable sports fans!), and Boston just shy of 30 million (ditto).

5. Output per person, under that scenario, would rise in NYC by 5.7% and by 13.3% in Boston.  That said, under this same scenario incumbent New Yorkers would see net real consumption losses of 13%, whereas for Boston the incumbent losses are only about 1.1%.

6. The big winners are the new entrants.  On average, real income would rise by 25.7%.

7. Alternatively, in their model, rather than laissez-faire, if America’s three most productive cities relaxed their planning regulations to the same level as the median U.S. city, real per capita income would rise by about 8.2%.

8. In all of these cases the authors calculate the change in rural per capita income, based on resulting population reallocations.

Recommended, I am very glad to see more serious work in this area.