Here’s what the Food and Drug Administration says about drug shortages:

Drug Shortages can occur for many reasons, including manufacturing and quality problems, delays, and discontinuations. Manufacturers provide FDA most drug shortage information, and the agency works closely with them to prevent or reduce the impact of shortages.

which is not particularly illuminating. I think a big part of the answer is supply chain problems. Relatively few pharmaceuticals are made in the United States from components made entirely in the United States. That is particularly true of generics. Most generics are manufactured either in China or India from components at least some of which are manufactured in China. That introduces many problems including that China has been subsidizing its pharmaceutical sector for the last 40 years which places China at a competitive advantage and Chinese pharmaceutical companies have been known to manipulate supply and prices to preserve market share. I suspect that Indian and American pharmaceutical companies are not above such shenanigans.

The United States both subsidizes and penalizes its pharmaceutical sector. Our very expansive patent system, for example, is a subsidy while our approval and health, safety, and environmental regulations are penalties.

The White House’s strategy for dealing with pharmaceutical shortages is described here. I doubt that the headline measures (creation of a Council on Supply Chain Resilience and using the Defense Production Act to make more pharmaceuticals in the U. S.) will have much short term effect.

BTW this article from the NIH is interesting.

When I was a kid our eye doctor(s) were Dr. Alvis and Dr. Alvis, father and son. “Young” Dr. Alvis was in his mid-60s which gives you some idea of how old “old” Dr. Alvis was. Old Dr. Alvis performed glaucoma tests completely by hand with a hand as steady as a rock. When you consider that all of this was 70 or more years ago, old Dr. Alvis must have been born right about the time of the American Civil War. He continued to practice into his 90s.

I hope there are still Dr. Alvises around.

The brouhaha of the day is the Colorado Supreme Court’s decision to bar Donald Trump from the Republican Party ballot on 14th Amendment grounds. I will leave the legal discussion to others and delegate my reaction on the politics of it to Eric Boehm at Reason.com:

What’s the endgame here? President Joe Biden (or whomever the Democratic nominee turns out to be) is likely to carry Colorado whether Trump is on the ballot or not. Let’s suppose courts in other blue states follow Colorado’s example. Now he’s missing from a bunch of states’ ballots, but not ones that are likely to affect the election’s outcome. What happens then?

In one scenario, Trump loses but his supporters are able to nurse a permanent grievance that the system wouldn’t even let their guy compete. Not for the abstruse reasons that Trump’s team tried to conjure up after the 2000 results came in, but because of something that’s easy to understand and easy to see as a legitimate grievance.

In another scenario, Trump wins the Electoral College—remember, these states weren’t likely to vote for him anyway—but with a far lower percentage of the popular vote. Indeed, the popular and electoral votes would be even more mismatched than in 2016 or 2000. In terms of democratic legitimacy, that outcome might be even worse for the future of the country.

But those are the two new possibilities that the Colorado’s Supreme Court has opened with its ruling on Tuesday. All in all, that seems like a decision that will make things worse, not better.

I continue to wonder what the operative definition of “democracy” is. Apparently, it’s not allowing candidates onto ballots now. That smacks of “burning the village in order to save it” but it’s the consequence of the slippery slope of using lawfare to manage elections.

How would you answer the question that Binyamin Applebaum asks in the New York Times, “Why Do We Still Build Houses Like We Did 125 Years Ago?” I think I would ask a question of my own: have you watched houses being built lately? And have you ever looked closely at a house built 125 years ago? We don’t build houses like we did 125 years ago. The construction methods, designs, and tools differ dramatically in all sorts of ways. Just to give one example 125 years ago here in the Chicago area practically all houses were wood frame houses (in Chicago those have been greatly restricted since the Great Fire).

The actual question he’s asking is why don’t we mass produce houses, building them in factories? The reason varies from place to place but a big reason is that unions have opposed such construction for as long as I can remember. Here in Illinois “modular homes” are theoretically legal but present practical problems because each locality may have different construction and zoning requirements. They’re even tougher to build in Missouri since manufacturers must, effectively, be licensed by the state and get state approval for their plans.

Joe Klein piles onto the New York Times:

As a native New Yorker and a lifelong journalist, the New York Times has been a lodestar in my life. It is an addiction, a trusted friend, a pain in the ass. I have written for the Times Sunday Book Review. I’ve had six books reviewed in the Times, for good and ill. Most important, I’ve worked alongside Times colleagues—especially overseas, and on political campaigns—and found them to be not just first-rate, but extremely courageous in their pursuit of the truth…and boon companions, besides. This is not about them.

But there has been a sickness to the place, a growing intellectual rot that has been apparent for the past 40 years, a debilitating moral pomposity that has rendered the Times untrustworthy, in subtle ways, on some issues; not on everything, but certainly on the cultural issues that are most divisive in our society right now. This diminution tracks, a bit too perfectly, with the decline of freedom—and the rise of identity politics—on elite college campuses and in the Democratic Party.

Here are some snippets:

This last part cuts to my own beef with the Times: the paper’s frequent inability to be honest about race, crime, welfare, poverty and education. This bias perfectly mirrored the Democratic Party’s recent failure to speak the truth about these issues which, I believe, provided the fuel for Donald Trump’s right-wing populism. It was also a form of racial condescension, an inability to recognize the complexities of the black community, to understand that the “activists” so often quoted in the Times represented only a slice of black opinion. It was also, too often, a form of cowardice, an inability to tell unpleasant truths and stand up to the racial extremists in its own ranks, like those who marketed the 1619 Project.

and:

The academic left is infuriated by wealth in a way most American are not. It has also, foolishly, embraced identity as economics faded as a casus belli, fitting out the rest of society—especially the media and publishing—with the shackles of political correctness, of illiberality, of the excessive DEI nonsense so brilliantly demonstrated by the university presidents last week. Much of Left-thinking has become painfully out-of-date, a boutique ideology.

but especially:

Far more profound is the disservice the Times has done the urban poor. There is a strangled adherence to the mouldy tenets of industrial-age, welfare-state liberalism: more money is always the answer to social programs that don’t work, crime is too often a consequence of deprivation rather than depravity, the police are brutal and racist, racism is immutable and central; there has been no progress toward an integrated, multi-cultural, multi-racial society. All of these are dangerous oversimplifications.

In my experience—a half -century now, starting with an informal tutorial at the feet of Daniel Patrick Moynihan—there are three essential components to a successful anti-poverty agenda: family preservation, neighborhood stability that comes with strict law enforcement and more creative schooling. (Other factors like better housing and mental health facilities certainly don’t hurt.) But you don’t often read about family structure, outrageous street behavior or the collapse of our inner city public schools often in the Times. Which is only the beginning:

Read the whole thing.

As I see it the problem is that Pat Moynihan was a liberal, the Timesmen are progressives, and progressives are not liberals.

I agree with some things in Walter Russell Mead’s latest Wall Street Journal column and disagree with others. For example, I disagree with this:

With less than a year before a challenging election, the Biden administration risks getting caught in a political doom loop. President Biden’s perceived weakness at home undermines his authority in dealing with foreign leaders, while the deteriorating global picture erodes his popularity at home.

As a general rule Americans don’t care about foreign policy. I doubt that a single person who voted for Joe Biden in 2020 will vote for Donald Trump in 2024 because of the “deteriorating global picture”. They might stay home but it still won’t move them to vote for Trump. They might because Joe Biden’s term has seen the highest inflation in 40 years or the situation at our southern border is in disarray but “deteriorating global picture”? Not a chance.

However, I agree with this:

This is not a world that is becoming more stable, and it is not a world in which American interests or values are becoming more secure. It is not a world in which America’s rivals and enemies are gaining respect for the president. It is not a world in which America’s waning powers of deterrence can long hold back the rising tide of aggression and war.

and this is a prudent warning:

The Indo-Pacific has been quieter lately, but only because China remains committed to its creeping gradualism, or “cabbage leaf strategy.” Building new islands, equipping them as military bases, harassing American ships and planes, challenging Taiwanese airspace, staging invasion exercises: The cabbage slowly grows, one leaf at a time.

These days, China is looking toward rich fishing grounds and the adjacent shoals and atolls that, under widely recognized legal principles, form part of the Philippines’s Exclusive Economic Zone. The EEZ’s Scarborough and Second Thomas shoals have long attracted fishing fleets. Increasingly, they are attracting aggressive Chinese maritime militia and coast-guard forces as well.

The Philippines controlled the Scarborough Shoal before 2012, but China pushed Manila aside, advancing Beijing’s legally baseless claims to most of the South China Sea. Philippine fishing boats still attempt to fish in these troubled waters, but Chinese maritime militia and coast-guard vessels harass and obstruct them, deploying inflatable boats, buoys and a “long-range acoustic device” that temporarily incapacitate Philippine crew members. This month Chinese ships fired water cannons and rammed Philippine vessels trying to bring fuel and food to Philippine crews in the area.

Looking for diplomatic solutions, Philippine President Ferdinand Marcos Jr. met with Chinese leader Xi Jinping at the Asia-Pacific economic summit in San Francisco last month. While Biden administration officials hailed improved U.S.-China relations following the summit, Beijing’s response to the Philippines was chilly. Jose Manuel Romualdez, the Philippine ambassador to the U.S., said Mr. Xi’s answers to Mr. Marcos’s requests were “disappointing,” “evasive” and “noncommittal.” Mr. Xi “didn’t say anything,” Mr. Romualdez told the Japanese newspaper Nikkei Asia.

Chinese provocations have only increased since the summit. Chinese forces are moving against the Philippine presence in the Second Thomas Shoal. “It’s pure aggression,” Phillipine Gen. Romeo Brawner Jr. told the Associated Press. A wooden-hulled ship he was aboard, posing no threat to Chinese vessels, was blasted by water cannons and bumped by Chinese forces as it brought supplies to a small military force stationed on a long-marooned Philippine navy ship at the shoal.

China turned up the heat another notch on Dec. 11, when 11 Chinese vessels entered the Second Thomas Shoal, with up to 27 vessels present all week. “Next after the water cannon is probably ramming and also they will attempt to board our vessel,” Philippine Vice Adm. Alberto Carlos told CNN Philippines.

Amid escalating Chinese pressure, Philippine officials are trying to rouse Washington and its allies to respond. Calling the South China Sea a flashpoint comparable to the Taiwan Strait, Ambassador Romualdez told Nikkei that conflict near the Philippines could be “the beginning of another war, world war.”

It may come as a surprise to Americans including President Biden and his advisors but other countries have interests of their own and they’re not always aligned with American interests. That includes China.

I have no idea what will happen if Donald Trump is elected to a second term in 2024. We haven’t had a president serve two terms with a hiatus between them for 130 years, since Grover Cleveland. Consequently, although not unprecedented we shouldn’t make any assumptions about what will or will not happen. However, we have a pretty good idea of what to expect from a second Biden term although his advanced age may have some impact. Foreign policy always seems to land like a ton of bricks on president in their second terms and I doubt that a second Biden term will be any different.

I tend to think that President Biden’s disapproval rating at home and the “deteriorating global picture” have a common cause: bad assumptions. Bad assumptions about the economy and about the world. I doubt that a second term will improve those.

Thomas Fazi makes the following observation:

But Zelenskyy isn’t just facing criticism over the way forward for Ukraine; some are now saying that the entire strategy was botched from the start. Oleksii Arestovych, Zelenskyy’s former presidential advisor now turned critic, recently wrote that “the war could have ended with the Istanbul agreements, and a couple hundred thousand people would still be alive”, referring to a round of peace talks that took place in March and early April 2022, mediated by Turkey.

On that occasion, Russian and Ukrainian negotiators had reached a tentative agreement on the outlines of a negotiated interim settlement — whereby Russia had agreed to withdraw troops along the lines prior to February 24, 2022 in exchange for Ukraine’s neutrality — but the deal was allegedly blocked by Boris Johnson and representatives of the American State Department and the Pentagon. Even David Arakhamia, the parliamentary leader of Zelenskyy’s own Servant of the People party who led the Ukrainian delegation in peace talks with Moscow, recently claimed that Russia was “ready to end the war if we accept neutrality”, but that the talks ultimately collapsed for several reasons — including Johnson’s visit to Kyiv informing Ukrainian officials that they should continue fighting.

You will note that is not unlike what I have been arguing here for some time. However, Mr. Zelenskyy is holding fast to his “maximalist” objectives. Mr. Fazi concludes:

From the US perspective, a democratic regime change in Ukraine would arguably be the preferable solution; but, as noted, elections aren’t on the table at the moment. This doesn’t mean that change isn’t coming, though; if anything, it only heightens the risk of Zelensky’s opponents — inside and outside of the country — trying to get rid of him by other means. Indeed, Zelenskyy himself recently expressed concern that a new Maidan-type coup is being plotted in Ukraine — though he accused Russia, not local enemies, of being behind these plans. Regardless of how credible one believes this scenario to be, it speaks to Zelenskyy’s changing status on the world stage: as Western countries, and important segments of the Ukrainian establishment, look for an exit strategy, Zelenskyy is no longer seen as an asset — but as a liability.

At Fortune Rick Wartzman has an article that fills in the blanks on how “college for all” became the prevailing educational and economic policy in the United States:

In the wake of “A Nation at Risk,” curricula at most high schools became more academically demanding, with added requirements in mathematics, science, English, and social studies. More homework was assigned; more classroom time was scheduled.

But by ushering in these academic reforms, the report’s greatest legacy may well have been this: It reinforced the idea that unless every student wound up going to college, we had failed them—and they had failed themselves.

In particular, “A Nation at Risk” cemented the bachelor’s degree, in the words of a Century Foundation analysis, as “more and more the gold standard for the transition from youthful dependency to adult independence as a worker and as a fully empowered individual and citizen.”

The result is that—despite some recent, high-profile pushback against this “college-for-all” mindset and mounting skepticism about the “return on investment” of a college degree—we have consigned those who don’t have a four-year diploma to lesser-than status. Along the way, we have overlooked the fact that people express their brainpower in all sorts of ways, many of which can’t be captured by how fast they divide polynomials, how adeptly they can dissect Moby Dick, or how high they score on the SAT.

The proportion of the population affected by this bias is enormous, and the costs are staggeringly high.

concluding that the policy “has failed America”.

I wouldn’t put it quite that way. I would say that the primary beneficiaries of the policy have been colleges and there is a mismatch among the jobs our economy is creating, our population, and the policy. Billions have been spent on the policy and most that has gone to colleges and universities who have used it to increase the size of their administrative staffs.

Pew Research has found that 40% of recent college grads are ‘underemployed”, i.e. they’re taking jobs that don’t require a college degree. Just about a million U. S. go to H1-B holders or are outsourced offshore. I suspect that is a substantial undercount.

I would also make a more controversial claim: “college for all” ignores half of the population who are not interested in college or unable to complete college. We need a policy that is better aligned with the population we have and the economy we have rather than those we wish we had.

I persist in wanting to know the definition of democracy presently being used by people who insist that’s what they’re defending.

Example:

Recently the Chicago City Council acted to prevent a referendum vote on whether Chicago should continue its “sanctuary city” status. I genuinely want to know how the members of the City Council who voted to bar the referendum define democracy.