Picture of the Day
These two almond trees are about half a mile from my house; I visit them every day on my morning walk.
There’s an article in yesterday’s New York Times about a new drug shortage: intravenous sodium bicarbonate. What is really ridiculous about this shortage is that most home kitchens have a supply of this most basic of drugs. Bicarbonate is used to relieve excessive acid levels in the blood; as such, it is particularly needed in hospitals and emergency rooms to treat seriously ill patients and for open-heart surgery.
What is even more absurd is that the Food and Drug Administration has no power to alleviate or prevent this situation. From the article:
Andrea Fischer, a spokeswoman for the Food and Drug Administration, said companies were asked to notify the agency of problems, but “there are no requirements that firms keep emergency supplies or that they stock up prior to any changes they make.”
She said the agency was in close contact with the companies and “exploring all possible solutions to this critical shortage, including temporary importation, to help with this shortage until it’s resolved.”
Ms. Fischer said the agency had recently made progress in preventing supply problems. In 2011, it tracked 251 new shortages, an all-time high. But by 2016, she said, there were only 23 new shortages. Currently, more than 50 drugs are classified as being in shortage on the F.D.A. website.
“Unfortunately,” she said, “not all shortages can be prevented.”
The bicarbonate is supplied by two major companies, Pfizer and Amphastar. The shortage began several months ago when Pfizer acquired Hospira and changed its distribution plan from five regional centers to just one national warehouse as part of a “reorganization” (read: extraction of profits from the company that was bought out.) When Pfizer ran low, demand increased and Amphastar was quickly overwhelmed. Now, only large hospitals with compounding pharmacies that can produce the drug from scratch ingredients are receiving sufficient supplies.
Finally, this shortage is just one of many; currently, fifty drugs are in critically short supply, all of them cheap and readily available generic drugs. It appears that, in the absence of adequate regulation, drug companies are skimping on quality control and maintenance at plants that produce cheap generics in order to improve profit margins and possibly create shortages that allow them to increase prices. This problem has been nationally recognized for years: reports on shortages go back at least five years, and at one time, over two hundred such drugs were in short supply. The FDA is using its persuasive powers with drug companies, but in the absence of competent regulation, they have no legal power to force companies to plan ahead or even notify pharmacies early.
It seems that drug companies are gung ho to produce expensive new “wonder drugs” (not necessarily better, but under patent) and not so keen to produce staple drugs that don’t allow for high profit margins or benefit from advertising to push consumers to demand brand names. This is just one more example of why health care does not go well with unregulated capitalism. Capitalism works well in selling breakfast cereal but not so well when supplying materials and services that everyone needs, can’t live without, and can’t always afford to pay a premium for.
Don the Con has a few weak points, among them an understanding of global politics. Thus it is not surprising that he would try to get closer to Sunni Arab countries and give Iran the cold shoulder– while at the same time claiming to want to have better relations with Russia, which heavily supports Iran and the current government of Syria:
Tamara Cofman Wittes, a former State Department official who worked on the Middle East under Mr. Obama, said Mr. Trump’s goal of aligning with the Sunni states fundamentally conflicted with his desire for closer relations with Russia, which has sided with Iran in bolstering the government in Syria’s civil war. Allowing President Bashar al-Assad to remain in power in Syria under Iran’s thumb is precisely the outcome the Sunni states and Israel oppose, noted Ms. Wittes, who is now at the Brookings Institution in Washington.
But no matter: our collaboration with Saudi Arabia will produce “jobs, jobs, jobs” for the defense industry. First on the list is a $110 billion package of weapons for the Saudis, including advanced weapons the Obama administration with-held because they could be used to target civilians in Yemen. Nor does it matter to Don that Saudi Arabia is a highly repressive monarchy, while Iran is a slightly less repressive democratic republic. These fine points of global governance are beyond Don the Con, who favors autocrats like Vladimir Putin (who has hollowed out his country’s putative democracy and kills his opponents with impunity) and Rodrigo Duterte (who has made his country a killing field for anyone suspected of involvement in “drugs” and who has recently banned public cigarette smoking.)
In fact, Don seems to have trouble with basic consistency (he’s a hypocrite, along with everything else):
Mrs. Trump stood near her husband with her hair uncovered, as is common for visiting American first ladies. The country’s tradition is for Saudi women to cover their heads in public. (In 2015, Mr. Trump criticized Michelle Obama on Twitter for not wearing a head scarf during an official visit here. Hillary Clinton and Chancellor Angela Merkel of Germany also did not cover their hair during trips to the country.)
This comment is in response to a Paul Krugman opinion piece called, “What’s wrong with Republicans?”:
lamsmy
africa
Historically, Mr. Krugman is correct. The Democratic party was founded as a platform to hash out varying ideas. The Republican Party was founded on the principle of pushing one main idea.
So the Republicans have always seen the Dems as unprincipled because they did stand for one binding “good”. But since Reagan, this has morphed into a place where Republicans see themselves as the only true patriots and protectors of America. Democrats are considered disloyal, untrustworthy socialists out to destroy the US.
Ryan, McConnell, and their ilk don’t really see any need to research issues, prepare and publish detailed policy, negotiate in good faith, all the essential steps in good governance, for the simple reason that they (in their own minds) are always right and the Dems are always wrong.
Too many Americans have a very poor grasp of history, current events, how science and journalism are supposed to work, and basic civics. Uniformed and scared, they will always cling to the simple feelgood slogans of the Republicans. Trump was the ultimate expression of this boastful head-in-the-sand approach.This does not bode well for the future of your country.
Comment of the Day: Sadomasochism
Henrik
Sweden
As a Scandinavian and European, I can not understand the sadomasochism of the American people. A sizable number of voters, and indeed congress delegates, admire the person who keeps penalizing them. For me this resembles the love-hate relation between the abuser and abusee. Normally, this kind of behaviour should be harboured in its infancy, instead we have a full-grown bull at the highest office in the free world, who keeps hurting most people around him. At the same time the co-abusers (read congress) applaud this behaviour. Why is pain excused so broadly in the American society? I can not get my head around this. Maybe the old proverb “No pain no gain” rings in everybody’s head, instilling them with the thought that pain is a precursor of success. Life is not beyond an insurmountable hurdle, but here and now!
Last fall, I wrote a blog note about this Pieczenik person that related an odd piece of text that I found at the end of the Wikipedia article about him. The text was as follows:
On November 1, 2016, Pieczenik announced on his youtube channel that Hillary and Bill Clinton “effected a silent civilian coup through corruption and coaptation. However, people in the intelligence community formally initiated a countercoup through supplying information to Julian Assange and Wikileaks in order to prevent Hillary Clinton from becoming the next president of the United States, while also convicting and indicting President Obama, Loretta Lynch, and all others who were implicit in the cover-up of the massive corruption that occurred under the Clinton Foundation.” [34]
Well, I coincidentally and randomly checked Wikipedia today and found that text is gone. So, I guess this person is really a writer of fiction and probably is an evil behind-the-scenes conspiracy nut. I guess. I can’t figure it out. Maybe the text really refers to the Wikileaks stuff from the Russians that sank Hillary along with the voter suppression, propaganda, Don’s study of Hitler’s speeches, and all the rest. At least Obama and his crew aren’t in jail– maybe because Don thinks Barack is a “really great guy” for not criticizing him.
At any rate, I don’t think “people in the intelligence community” initiated a counter-coup; the information supplied to Wikileaks came from the Russians. That “silent civilian coup” by Clinton stuff is pure alt-right alternate facts. Writing fiction is good training for making up stuff to confuse the ignorant Trump voters.
Here’s a comment (from an opinion piece in the New York Times that complains that Don the Con is a child in a man’s body):
DianaID
Maplewood, NJ
Tony Schwartz, Donald Trump’s co-author of Art of the Deal, who had deep remorse regarding creating the myth of Donald Trump the deal maker. He is the man who said, in a New Yorker article that “I genuinely believe that if Trump wins and gets the nuclear codes there is an excellent possibility it will lead to the end of civilization.” And while you think he is a child, Roberts, who spent many months with him, considers him a sociopath.
He had to deal with his short attention span that left him with “a stunning level of superficial knowledge and plain ignorance” and an inability to concentrate or focus. He could not imagine him absorbing information in the Situation Room. And clearly he can’t or can’t focus and understand on what he should do or say as President.
All very accurately and sadly predicted.
The New York Times has written in an editorial that Don the Con’s Washington hotel, located in a government building, has suddenly started doing big business since the election. Before that, the hotel was deserted, with rooms going at steep discounts. Naturally, a naive person would think that the President owning a hotel in Washington that serves international government clientele (who are rushing to book rooms) is an obvious violation of the emoluments clause, which states that elected officials may not receive anything of value from foreign governments without the explicit permission of Congress.
That would be naive. Even though, in this case, a specific clause in the contract for the hotel (in an historic government building) prohibits elected officials from having “any share” or “any benefit” from running it. However, Don the Con’s appointed leadership in the General Services Administration has stated that they have no problems with his ownership. The only way to punish Don for this contract violation and unconstitutional behavior is to impeach him, which will not happen until there is a Democratic majority in the House.
Someone has filed suit against Don in federal court for this little bit of self-dealing, but it is too little and too late because the profits have started rolling in to his hotel. Foreign diplomats and roving officials have “thronged” the place, moving their parties in from other hotels. Don is profiting, bigly, from his Electoral College victory.
According to the acting assistant secretary of state for Near Eastern affairs at the State Department, the Syrian government has built a crematory at its military prison outside Damascus to dispose of the bodies from the mass executions that it has been carrying out there. If this is true, it will show clearly that Bashar al-Assad and his administration are guilty of mass murder. This is an irresistible reminder of a certain German dictator responsible for WW II. Details on Syria’s incinerators can be found in this NYT article. I’d like to see Donald tweet about this.
I’m not kidding– this is a historic revelation. No-one who supports al-Assad is clean. The Iranians and the Russians are helping a mass murderer. The world is descending into another period that can only be described as the beginning of WW III. The Syrian government has responded to its devastating drought by oppressing its starving citizens and has now reached the logical conclusion that it needs to kill most of them.
In a completely separate but somehow intimately related situation in South America, a country is collapsing without an invasion: Venezuela’s economy shrank by ten percent last year, faring as badly as Syria. Venezuela’s autocratic leader and its elite have been feuding for twenty years and oppressing the citizenry with savage bands of thugs who kill demonstrators in the streets.
In yet a third totally unrelated country, North Korea, the unresolved enmity of a war left over from the retreat of Japanese forces at the end of WW II has led to an Orwellian situation for twenty-five million people. Their “dear leader” is threatening the US with nuclear weapons so he can counter our threats to annihilate him.
Thirty years ago, North Korea experienced a famine that required UN food aid. The US response to that crisis ( and to the crisis in Africa involving Hutu-Tutsi massacres ) was grossly inadequate and foreshadowed our failure to respond to current famines. Failure to respond to crises like these has led to a downward spiral of more oppressive local leadership and further deterioration of infrastructure.
These and other situations in the world today are at their roots related to fights over oil resources (Venezuela thought it could prosper purely on oil exports but failed to maintain its producing infrastructure because of corruption) and climate change that is causing severe droughts in the Near East and Africa (Syria has been in a drought for fifteen years that is said to be the worst in 500 years –see this Vice article.)
The basic problem is that the world is too crowded and too dependent on oil production; not enough emphasis has been put on developing agriculture, renewable power resources, and equitable distribution of goods. The US has not helped: instead of exporting our excess food and contraceptive technology, we have been getting fatter while poor people procreate and starve. The world is heating up and billions could die in a war that would make WW II look like a skirmish.
The story below is another example of how unrestrained capitalism can distort markets by creating enormous profits for a few while gouging many. Medicine is one area of life where the profit motive should not be allowed to reign supreme. Putting a high price on relief of suffering diminishes human lives.
Nuedexta is a combination of dextromethorphan and quinidine, two cheap generic drugs, that is effective for “pseudobulbar affect” (PBA), a disorder characterized by excessive or involuntary laughing and crying. The disorder is uncommon and often misdiagnosed; it is usually brought on by a small stroke or amyotrophic lateral sclerosis (Lou Gehrig’s disease.) It is estimated to affect 2 million Americans.
The company that bought the patent from the researchers who discovered it was sold for $3.5 billion in 2014 and sales of the drug earned $218 million last year. Sales are lucrative because the drug combination costs about $700 a month (while the generic ingredients sell for less than $20.)
Sales have been driven by TV advertising, including a particularly effective spot done by the actor Danny Glover. Pharmaceutical companies spent a total of $6.4 billion on advertising last year, and anyone who watches cable TV news will attest to the ubiquity of drug ads. The US is one of only two companies in the world that allows TV advertising of drugs.
(All the above is sourced from an article in the New York Times from today.)
In order to give fair remuneration to those who researched the combination of these two drugs while at the same time not over-burdening the consumer, a patent on the mixture can be granted as per routine, but the price of the combination should be regulated so as not to produce an absurd result– a markup of over 3000%. Perhaps a 300% surcharge would be more reasonable. These issues call for fine judgements, not “whatever the market will bear.”
