Category: Public Policy

At least, the title of this post is typical of the mantra against the practices of drug pharmaceutical companies, according to Peter W. Huber’s “Of Pills and Profits: In Defense of Big Pharma,” in Commentary magazine (HT: Arts & Letters Daily).

Huber, a senior fellow of the Manhattan Institute, summarizes in brief the anti-drug company argument, and then goes on to examine what truth there is in such claims. He says of the difference between creating and administering drugs, “Getting drug policy right depends mainly on getting that difference straight—the difference, that is, between ministering to the sick and making medicines—and grasping its implications from the start. Big Pharma’s critics do not even try.”

He goes on:

Pricing is indeed the key. Whether the first pill typically costs $100 million or $1 billion to develop, replicating it costs less—a thousand times less, or perhaps a million times less. This slope—precipice, really—is far steeper than most of the other hills and valleys of economic life. It complicates things immeasurably. It also largely explains the gulf between the industry’s perception of reality and that of the critics.

Huber gives some explanation of the function of the price mechanism in pharmaceutical markets, and says, “Economists have established—as rigorously as things ever get established by the dismal science—that there is no efficient price, no ‘right’ price. Any scheme is, from one perspective or another, inefficient, unreasonable, or worse.” He argues that the high prices for boutique drugs like Viagra in the developed world help fund the provision of desperately needed drugs in the developing world. This is the situation created by so-called “price discrimination”.

The situation he says, is similar to that of airline travel: “Business travelers get soaked, college students fly almost for free, and the jumble of prices in between drives most people nuts. But the planes are packed full, and that drives the average price of a ticket way down. The rich fly, and the much less rich fly, too.” There is, I would think, a similar model at play in the work of plastic surgeons who charge Hollywood millionaires huge sums to do face lifts and tummy tucks, and then use a portion of the money they make doing that to do pro bono work for burn victims and deformed children.

The complexity of the pricing situation is what critiques of drug companies tend to ignore. Concludes Huber, “This kind of behavior is not aberrant or anomalous—it is an inevitable and essential part of groping toward the right price where there is no right at the end of the tunnel. Somehow or other, the average price of the pill has to end up high enough to pay off the up-front cost.”

If Huber’s analysis is correct, it is interesting to see how a nonprofit drug company, like the one profiled in today’s New York Times article, “A Small Charity Takes Lead in Fighting a Disease,” fits into the picture. The NYT article itself exemplifies many of the criticisms against pharmaceuticals that Huber summarizes.

Huber points to the vagaries of government regulation and private insurance, which greatly affect the drug market. One explanation for the situation that a nonprofit drug company like OneWorld Health attempts to address is that “big drug companies shun some drugs and embrace others because, collectively, the FDA, doctors, patients, insurers, and juries push costs higher, and prices lower, on some categories of drugs and not on others, to the point where some make economic sense and some do not.”

Indeed, OneWorld Health is working with a drug for black fever that, according to the NYT, administered “a series of cheap injections was identified decades ago but then died in the research pipeline because there was no profit in it.” There is, effectively, a partnership at play between for profit and nonprofit drug companies. OneWorld Health didn’t develop the drug in the first place, but on that point is dependent on the work of for profits.

Huber says:

Universities and small biotechs license their innovations to Big Pharma because they lack the capital, scale, and expertise required for mass manufacturing, because they wouldn’t know how to sell the same drug five times in succession (to the FDA, doctors, patients, insurers, and juries), and because a vast and swampy system separates pharmaceutical innovation from the treatment of real patients at prices that will cover cost and earn a profit. The little guys just don’t have what it takes to finish the job.

But OneWorld Health, in the case of the drug mentioned above (paromomycin), “has conducted the medical trials needed to prove that the drug is safe and effective. Now it is on the verge of getting final approval from the Indian government. A course of treatment with the drug is expected to cost just $10, and experts say it could virtually eliminate the disease. If approval is granted as expected this fall, it will be the first time a charity has succeeded in ushering a drug to market.”

Huber concludes that in the future “we will fare better, much better, if we streamline regulation, curb litigation, and unleash prices to make vaccines as alluring to Big Pharma as Viagra and Vaniqa.” But in the meantime, it may be that efforts like OneWorld Health can help at least some of those who fall through the cracks. Says Dr. Ahvie Herskowitz, one of the backers of OneWorld Health, “We fill a gap pharma companies cannot because they have to make a profit.”

And on the biggest obstacle to getting vaccines and drugs like paromomycin to those who need it, for profit and nonprofit drug companies seem to agree: “The government will be the biggest challenge,” says Dr. C. P. Thakur, a former Indian health minister who oversaw a OneWorld Health trial of paromomycin.

Blog author: jballor
Friday, July 28, 2006
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You may know that a traditional way of interpreting the Ten Commandments involves articulating both the explicit negative prohibitions as well as the implicit positive duties. So, for example, the sixth commandment prohibiting murder is understood in the Heidelberg Catechism to answer the question, “Is it enough then that we do not kill our neighbor in any such way?” by saying, “No. By condemning envy, hatred, and anger God tells us to love our neighbors as ourselves, to be patient, peace-loving, gentle, merciful, and friendly to them, to protect them from harm as much as we can, and to do good even to our enemies.”

This method of interpretation is not unique to the Reformed, and is also exemplified in the Roman Catholic exposition of the Decalogue in the Catechism of the Catholic Church. See, for example, what the Catechism says in the context of this commandment about the duty toward the human person, including the embryo: it “must be defended in its integrity, cared for, and healed, as far as possible.”

As part of its exposition of the positive duties enjoined by this commdandment, the Heidelberg Catechism states, “I am not to harm or recklessly endanger myself either.”

It is with this in mind that I want to raise the question of the validity of extreme sports. You can see what I consider to be some rather uncritical approaches by Christians to the topic in this cover story from the January 2006 Banner, “Going to the Extreme,” and this from Leadership Journal, “Planes, Chains, and Automobiles,” about the combination of extreme sports and church.

Now clearly this is a matter for prudential judgment. Not all extreme sports are created equal. Snowboarding is probably less dangerous than bungee jumping. It would be much more dangerous for me, an untrained amateur, to try and go climb a mountain than it would be for a trained and seasoned climber.

And surely John Stossel’s observations about the real dangers we face everyday are relevant. When asked to do stories on sensational topics, like exploding BIC lighters, Stossel did some digging to find out what kinds of things really are dangerous. As he writes in Give Me a Break, “I found the accident data fascinating. Turns out hot tap water, stairs, bunk beds, and drowning in bathtubs kills more people than most risks we hysterically warn people about.”

Even so, there’s something about the intentional seeking of danger that is at best morally questionable. This moral reality is I think part of what Stephen King’s story The Running Man is about. Even the most experienced and seasoned extreme sport aficionado cannot eliminate all the risk, and that’s of course part of the appeal. Does attempting to scale Mt. Everest count as reckless endangerment?

Clearly extreme sports are big business, as ESPN now has devoted a lot of coverage to the so-called X Games, and there is even an extreme sports cable channel. But do these sports, at least in some of their permutations, violate the sixth commandment?

“‘Disproportionate’ in What Moral Universe?” asks Charles Krauthammer in today’s Washington Post.

He continues:

When the United States was attacked at Pearl Harbor, it did not respond with a parallel “proportionate” attack on a Japanese naval base. It launched a four-year campaign that killed millions of Japanese, reduced Tokyo, Hiroshima and Nagasaki to cinders, and turned the Japanese home islands into rubble and ruin.

Disproportionate? No. When one is wantonly attacked by an aggressor, one has every right — legal and moral — to carry the fight until the aggressor is disarmed and so disabled that it cannot threaten one’s security again. That’s what it took with Japan.

Britain was never invaded by Germany in World War II. Did it respond to the Blitz and V-1 and V-2 rockets with “proportionate” aerial bombardment of Germany? Of course not. Churchill orchestrated the greatest air campaign and land invasion in history, which flattened and utterly destroyed Germany, killing untold innocent German women and children in the process.

Now I don’t take Krauthammer to be trying to undermine the principle of proportionality in just war itself, but rather to be arguing for a different way to apply that principle in this conflict compared to how some others, including Prof. Bainbridge, have done. He continues, “The perversity of today’s international outcry lies in the fact that there is indeed a disproportion in this war, a radical moral asymmetry between Hezbollah and Israel: Hezbollah is deliberately trying to create civilian casualties on both sides while Israel is deliberately trying to minimize civilian casualties, also on both sides.”

I would respond to Krauthammer, however, that simply being attacked on your own sovereign soil does not give carte blanche to pursue your enemies in whatever manner and to whatever extent you deem fit. And even if your enemies are conducting themselves in an evil fashion that ignores just war principles, which clearly Hezbollah are, you are not then relieved of your moral duty to conduct war justly.

The assertion that by being attacked in whatever fashion “one has every right — legal and moral — to carry the fight until the aggressor is disarmed and so disabled that it cannot threaten one’s security again” simply does not follow, and itself seems to undermine the principle of proportionality. The only way to guarantee that your security cannot ever be threatened again is to utterly destroy and annihilate your opponent…and this is not something that just war theory allows for.

As previous discussion here has determined, the validity of the causus belli and the legitimacy of jus ad bellum does not mean that the principles of jus in bello no longer apply.

Blog author: jballor
Thursday, July 27, 2006
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“All forms of gambling are predatory and immoral in their very essence,” says Rev. Albert Mohler.

I don’t agree, at least insofar as his identification of what makes gambling essentially immoral is not necessarily unique to games of chance: the enticement for people to “risk their money for the vain hope of financial gain.” Stock markets come to mind.

Indeed, as I’ve pointed out before, there is no single coherent Christian position regarding gambling per se. For example, the Catechism of the Roman Catholic Church states, “Games of chance (card games, etc.) or wagers are not in themselves contrary to justice. They become morally unacceptable when they deprive someone of what is necessary to provide for his needs and those of others.” It further elucidates the complications by stating that “the passion for gambling risks becoming an enslavement. Unfair wagers and cheating at games constitute grave matter, unless the damage inflicted is so slight that the one who suffers it cannot reasonably consider it significant.”

I find this to be a rather more nuanced and accurate reflection of the reality of gambling when compared to Dr. Mohler’s blanket condemnation. I’m not convinced, for instance, that weekend poker games are “predatory and immoral in their very essence.” (Well, when I’m involved perhaps they are a bit predatory, but maybe not immoral!)

Even so, we can agree about the basic hypocrisy that comes from the current political state of gambling in America, in which institutional structures are put in place to benefit the government and particular special interests, against the interests of the most vulnerable and potential competitors. The stakes are so high, in fact, that the temptations and possibilities for corruption are staggering (see, for example, the Abramoff scandal).

Responding to a piece on Slate by Jacob Weisberg, Mohler acknowledges that it “is a helpful reminder of the hypocrisy at the heart of the entire gambling issue as handled in our society.”

More here at TCS Daily.

In addition, here is the CRC denominational statement on gambling:

Pastors and church councils are urged to expose all destructive influences on people’s lives that seek to trivialize or render irrelevant the providence of God. They must also caution against the impact of materialism, take decisive action to combat the evil of gambling, and minister compassionately to those addicted to or victimized by lotteries.

And check out this piece from The Banner, “Texas Hold ‘Em – Finding God in Poker,” as well as the responses here under the section, “Gambling and Grace.”

Blog author: dphelps
Thursday, July 27, 2006
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Ohio Court Limits Eminent Domain

Sunglasses

Hunger, disease, the waste of lives that is extreme poverty are an affront to all of us. To Jeff [economist Jeffrey Sachs] it’s a difficult but solvable equation. An equation that crosses human with financial capital, the strategic goals of the rich world with a new kind of planning in the poor world. –Bono, Foreward to The End of Poverty by Jeffrey Sachs, italics mine.

I am informed by philologists that the “rise to power” of these two words, “problem” and “solution” as the dominating terms of public debate, is an affair of the last two centuries, and especially of the nineteenth, having synchronised, so they say, with a parallel “rise to power” of the word “happiness” for reasons which doubtless exist and would be

Mustaches

interesting to discover. Like “happiness”, our two terms “problem” and “solution” are not to be found in the Bible-a point which gives to that wonderful literature a singular charm and cogency. . . . On the whole, the influence of these words is malign, and becomes increasingly so. They have deluded poor men with Messianic expectations .. . which are fatal to steadfast persistence in good workmanship and to well-doing in general. . . . Let the valiant citizen never be ashamed to confess that he has no “solution of the social problem” to offer to his fellow-men. Let him offer them rather the service of his skill, his vigilance, his fortitude and his probity. For the matter in question is not, primarily, a “problem”, nor the answer to it a “solution”. –L. P. JACKS, Stevenson Lectures, 1926-7

This proper way of serving others also leads to humility. The one who serves does not consider himself superior to the one served, however miserable his situation at the moment may be. Christ took the lowest place in the world—the Cross—and by this radical humility he redeemed us and constantly comes to our aid. Those who are in a position to help others will realize that in doing so they themselves receive help; being able to help others is no merit or achievement of their own. This duty is a grace. The more we do for others, the more we understand and can appropriate the words of Christ: “We are useless servants” (Lk 17:10). We recognize that we are not acting on the basis of any superiority or greater

Says Masses

personal efficiency, but because the Lord has graciously enabled us to do so. There are times when the burden of need and our own limitations might tempt us to become discouraged. But precisely then we are helped by the knowledge that, in the end, we are only instruments in the Lord’s hands; and this knowledge frees us from the presumption of thinking that we alone are personally responsible for building a better world. In all humility we will do what we can, and in all humility we will entrust the rest to the Lord. It is God who governs the world, not we. We offer him our service only to the extent that we can, and for as long as he grants us the strength. — Benedict XVI, Deus Caritas Est

How can government best uphold Christian values? The right’s traditional answer is through legislating morality issues that are central to family values or the sanctity of life. It looks like the left will counter this with an expanded version of government. Andrew Lynn looks at the growing competition for the religious vote in the context of Sen. Barack Obama’s recent speech to Call to Renewal.

Read the entire commentary here.

Blog author: jcouretas
Wednesday, July 26, 2006
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It’s a deceptively simple idea. Everyone would be allocated an identical annual carbon allowance, stored as points on an electronic swipe-card. Points would be deducted for every purchase of non-renewable energy. People who did not use their full allocation, such as people who do not own a car, would be able to sell their surplus carbon points into a central bank. High energy users could then buy them – motorists who used their allocation would still be able to buy petrol, with the carbon points drawn from the bank and the cost added to their fuel bills. To reduce total UK emissions, the overall number of points would shrink each year.

Tech Central calls this "This Year’s Dumbest Political Idea…." More analysis along these lines here.

The Chimp seems interested in it, though. And hey – maybe we could just skip the "electronic swipe-card" and go straight to the microchip.

No plastic to dispose of.

UPDATE: This writer misses the whole "identical carbon allowance" thing, but has another ethical problem with carbon rationing by way of a national identity register.

I am totally opposed to ID cards and am involved in the campaign. However, I am also deeply concerned about climate change and cannot see any solution to it, other than carbon rationing, that is both effective and equitable. The survival of human existence is clearly an issue besides which even the disasters likely to arise from ID cards will pale into insignificance.

Fascinating statement. "anon" seems to fear that people will be more afraid of climate change than of giving up their individual and economic freedoms. Evangelicals generally see the reign of anti-christ as an economically-dominated one, but what if carbon credits become the currency of the day? Is the climate "crisis" (real or imagined) driving us inexorably in this direction?

OK, all you Actonites out there: What’s the Christian response? How would you address anon’s concerns?

UPDATE: Ok, how about a CO2 credit lottery? That makes just as much sense.

Blog author: jcouretas
Tuesday, July 25, 2006
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Headline: It’s a Sin to Fly, Says Church

Actually, "It’s a Sin to Fly, Screams Headline" would be more appropriate. Here’s what the Church (or rather, the Bishop of London) actually says:

“Making selfish choices such as flying on holiday or buying a large car are a symptom of sin. Sin is not just a restricted list of moral mistakes. It is living a life turned in on itself where people ignore the consequences of their actions.”

I think there’s merit to this. How far removed really from "loving thy neighbor" is making the decision to walk or bike to the corner store instead of jumping into your car? From an energy and pollution standpoint, perhaps not too far. As Archbishop Williams puts it in the article, we "make moral choices" on all sorts of things (money, sex, time) all the time.

He’s not saying don’t fly. He’s admonishing folks to consider the impacts and act accordingly. An admonishment easily taken out of context.

Dr Chartres’ comments seem to have elicited confusion and outrage in some sections of the media and in parts of the transport industry. This morning the Daily Mail newspaper accused the Church of England of turning the Gospel into “a party political broadcast for the Greens” and said that it should focus instead on its shrinking pews – adding that these would not be filled by reminding people of environmental concerns.

Based on the success other pastors are having, I think they’re dead wrong on that last point. Anyway, I think the liberal/secular media folks are fundamentally upset about one thing:

The Church has caught on to ecology as a moral value.

And those in liberal and secular circles don’t like it one bit, despite this being something Greens have been preaching in the media for decades. They hate polluters! But they hate being coopted even more. Or even worse, having any behavior described as (gasp!) SINFUL.

‘Hey, pal – don’t push your religion on me!’ he said as he tossed his aluminum can into the recycling bin…

Shrug, says me. It’s fair to say that the organized church has suffered chronically from legalism, and folks have to right to be wary of that. But watching the Greens wriggle around on this one is so entertaining, it’s almost sinful. [Hat tip]

Blog author: jballor
Tuesday, July 25, 2006
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Today’s NYT editorializes: “a country that consumes one-quarter of the world’s oil supply while holding only 3 percent of the reserves will never be able to drill its way to lower oil prices, much less oil independence.”

You’ll often hear the complaint that Americans use more than their fair share of the world’s oil. We’re addicted to it, some say. After all, so goes the reasoning, we have less than one-half of one percent of the world’s population, but we “consume one-quarter of the world’s oil supply.” Seems wildly out of proportion, doesn’t it?

That is, until you take into account that the United States economy represents somewhere between 20 and 30 percent of gross world product (depending on how you calculate it). So the US also produces wealth that is wildly out of proportion to our share of the world’s population.

There is a real correspondence between economic power and the use of fossil fuels. That’s part of the reality I was pointing to in this week’s Acton Commentary: “Fossil fuels would thus have the created purpose of providing relatively cheap and pervasive sources of energy. These limited and finite resources help raise the standard of living and economic situation of societies to the point where technological research is capable of finding even cheaper, more efficient, renewable, and cleaner sources of energy.”

And here’s just one more side note. Without too much exaggeration, you could say that today’s electric cars are really coal-powered. If you look at the sources of electricity in the US, “coal provides over half of the electricity flowing into American homes.” That means that in one ideal world of the alternative fuel crowd, when you plug your car in, you’re plugging it in to a coal plant (this is also why the idea of consumer carbon credits is catching on). The energy and environmental issues in the world are about far more than “gas guzzling” SUVs.