How Should New Antibiotics Be Developed?

This may come as a bolt from the blue but private corporations are not in business for the public good. The entire idea behind a private corporation is to find a need, satisfy it, and make money doing it. That’s why power companies don’t implement the kind of redundancy security experts say our power grid needs—they cannot make money if they do it. And it’s why pharmaceutical companies aren’t investing in the development of new antibiotics as Robert Langreth frets about at Bloomberg Businessweek:

Achaogen Inc. spent 15 years racing to develop antibiotics against resistant superbugs. It targeted one of the most-feared superbugs lurking in intensive care units: carbapenem-resistant Enterobacteriaceae, or CRE, a strain that can kill up to half the people it attacks. Last June its first drug, Zemdri, which kills CRE bacteria in the test tube, was approved by U.S. regulators. From a public health perspective, Achaogen is a success. But as a business, it’s a failure. Zemdri’s sales in its first six months on the market were less than $1 million. Achaogen filed for bankruptcy in April.

The failure has set off alarm bells among infectious disease doctors and public health experts. Big drug companies have been exiting antibiotic research for years, prompting the U.S. government and medical charities to step in with research funding. Now health experts are realizing that research funding doesn’t matter if there’s no market for the drugs when they get approved. “We have a broken antibiotic market, and this is a stunning example of how broken it is,” says Helen Boucher, a doctor at Tufts Medical Center and treasurer of the Infectious Diseases Society of America. The IDSA is “very worried” that other biotechs with promising new antibiotics are going to collapse if something isn’t done, she says.

Developing new antibiotics is a lot harder than it used to be. The low-hanging fruit was picked long ago.

The article goes on to thrash a bit about strategies for dealing with the situation. Solutions aren’t that difficult to propose. There are some things we can’t expect private companies to do. It used to be that the thought of governments actually building and doing things wasn’t as horrifying as it has become.

We might also want to think about cracking down on the abuse of antibiotics, both here and abroad. Overuse and misuse are among the reasons that we need to find new antibiotics in the first place. Maybe we should be imposing trade sanctions on countries that sell antibiotics over the counter. Heresy, I know.

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Do We Have a White Nationalist Terrorism Problem?

Maybe I’m being obtuse but I found Clint Watts’s post at RealClearDefense on the subject above terribly garbled. Is the source of my confusion the implication that Americans are somehow responsible for white nationalist terrorism everywhere?

Mosques are attacked abroad and desecrated in the States. American synagogues in Pittsburgh and San Diego have become the site of mass shootings. White nationalist terrorism has long been on the rise. Why doesn’t America do something about it?

Is it the conflating of political posturing with terrorism?

Not long after the election of President Barack Obama, all indicators pointed to a dramatic rise in domestic terrorism in the U.S. White supremacist threats mounted after America elected its first African-American president. Online conspiracy theories regarding the president’s citizenship and religion helped fuel a rise in racism intertwined with domestic politics. Alongside race-based groups, anti-government groups rose as well, powered by erroneous beliefs about abortion, repealing of the Second Amendment, or declaration of martial law.

Is it the failure to apprehend the fundamental difference between Islamist terrorism that reaches us and a single armed nutcase that kills people at worship in Southern California?

From 2001 to the summer of 2016, the threat of international jihadists far outpaced domestic extremists. Al Qaeda, the Islamic State, and their legions of inspired supporters knew who they wanted to attack and why. They were highly motivated to commit violence to advance their agendas. The challenge for jihadists came down to whether they could gain access to high-profile targets and whether they had the weapons, bombs, skills, and experience to pull off an attack. For domestic extremists in America, nearly all had or could acquire weapons; some even had training, but few were focused on who and where to attack—and almost none were willing to commit violence.

Today, domestic extremist violence outpaces Islamist extremism, and the character of the threat has changed dramatically in the last three years. Right-wing extremists and international jihadists from the last decade have many parallels and some differences.

Let me give it a shot. Every single Islamist terrorist group of international reach has had state sponsorship. Osama Bin Laden’s Al Qaeda was sponsored by Saudis. DAESH has had Saudi sponsorship. Do you see a pattern emerging here? The Taliban is sponsored by the Pakistanis. I could go on.

Contrast that with the murders in the Poway synagogue. I have heard no credible allegations of any state sponsorship of the evil cretinous perpetrator of those murders. I haven’t even heard allegations of a conspiracy in that attack. Just one malfactor who found likeminded people to support his venomous beliefs on the Internet.

The proper instrumentality for dealing with such isn’t the U. S. military or the FBI. It’s local law enforcement. Let’s not make a federal case of this.

The reality is that in a country of 330 million people a certain number will be vicious and with the enormous power that modern weaponry gives to individuals they will be able to do a significant amount of harm in a very short period of time. No foreseeable course of action will change either of those factors and holding out the possibility that there is such a course of action is delusional.

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Only the Dead Have Seen the End of War

I encourage you to read this offering at Small Wars Journal on ending the war in Afghanistan:

From January to April of this year, a National War College professor and eight student-combat veterans, Team 6031,[6] met weekly to consider two subjects: the American experience in conflict termination, and the potential for ending the war in Afghanistan. The material that follows is not meant to provide negotiators a searchlight to guide their journey, but only a few, well-lit candles to draw the attention of interested observers to important, and sometimes overlooked issues. We make no claim to having a comprehensive solution to ending the war in Afghanistan, only a few well-considered thoughts on the process and its aftermath.

We have divided our observations on Afghanistan into those about ending wars in general, U.S. objectives, negotiating peace in alternative formats, and creating the infrastructure and policy for future development and the maintenance of peace.

and here are their recommendations:

  • First, to remain patient and guided by long term objectives.
  • Second, to march in lockstep with its Afghan and coalition partners.
  • Third, to keep pressure on Pakistan to make peace and encourage Iran, India, China and Russia to play constructive roles.
  • Fourth, to seek a nationwide ceasefire as soon as possible.
  • Fifth, to accelerate interagency and coalition planning for post-conflict Afghanistan, and
  • Finally, to craft a new strategic narrative to convince friends and foe alike that the United States is in Afghanistan not just for a temporary peace or a “decent interval,” but also to accomplish its long-term strategic objectives.

IMO it is overwhelmingly likely that, tired of endless war with no discernible end or advantage to us, we will simply remove our troops and declare an end to our war. Let’s not be deluded into believing that will end the war. It will merely end our involvement.

If there is any lesson here it should be the grave immorality of going to war without the will to achieve your objectives. It is the worst possible course of action.

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The National Sport

This morning I was musing about the national sport. To what degree does the national sport of a country reflect the national character and to what degree does it influence it? For a century baseball was without question America’s national sport. Baseball’s heroes were American heroes, its stories American stories, and its myths American myths.

In roughly the third quarter of the last century, partly driven by how non-telegenic baseball is and the transition from sports being something you participated in or experienced in person to its being something you watched on television, football began to elbow baseball aside. I haven’t looked it up but I’m confident that more people watched the Superbowl this year than watched the World Series.

Football is very different from baseball and requires different traits and abilities. Do we reflect those traits now?

On a disquieting note I worry that professional wrestling is becoming our new national sport. Everything about it is artificial, contrived, and exaggerated. Our politics certainly resemble professional wrestling more closely than it does baseball or football.

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Unrepresentative Sample

Washington Post columnist Jonathan Capehart decided to gauge the popularity of the field of Democratic presidential candidates by putting the matter to his Twitter followers. The results were interesting:

What I found out was actually rather interesting. I couldn’t get through all of the more than 1,000 responses that I’d received by 1 p.m. on Thursday, but I got through enough to notice a really interesting pattern among my admittedly unscientific and self-selecting sample. While the new polls show former vice president Joe Biden as the runaway favorite in the crowded field, he’s not among the favorites of the folks who responded to me.

Sen. Kamala D. Harris (D-Calif.) was the favorite by far. She was the first choice of 117 respondents. That includes the 10 people who gave her all three of their slots and six people who gave her two out of the three. Seventy-five gave Harris their second slot, and 24 more made her their third choice.

Sen. Elizabeth Warren (D-Mass.) was the next favorite with 49 people giving her their first slot. But folks loved giving her their second slot, as 82 of them did, the most of any candidate. Another 51 responders made Warren their third choice, again the most of anyone in my count. Biden snagged 17 first slots, 17 second and 48 third.

I have no idea of the demographic breakdown of Mr. Capehart’s Twitter followers. I doubt that he does, either. I would speculate that whatever their demographic characteristics they aren’t representative of anything other than Jonathan Capehart’s Twitter followers.

I found this statement particularly interesting:

Harris represents the future of the Democratic Party: A woman and person of color in a party whose foundation rests with African American women.

There are so many things wrong with that statement it’s hard to know where to start. Presently, 74% of Americans are white. The proportion of voters is larger. The percentage of African American women is about 8%. IMO if the future of the party resides in African American women, the party is in terrible, terrible trouble.

But here’s another question for you. Whom does Kamala Harris represent? Do African American women accept her as a “woman of color” or, as Eugene Scott wondered:

Harris has had some different life experiences than many black Americans. Her father is a Jamaican immigrant; her mother is a Tamil Indian immigrant. Her husband is a white man from New York. While she was born in Oakland — a city with a rich history of African American activism — Harris spent her early childhood in Berkeley, Calif., and worshiped at a Hindu temple in addition to attending black Baptist services. She attended high school in Montreal before returning to the United States for college at Howard University, a historically black college.

IMO her candidacy will occasion a debate which is encapsulated here:

“This whole argument that we’re saying she’s not black is really ridiculous,” Yvette Carnell, co-founder of the American Descendants of Slavery movement, told the Philadelphia Inquirer. “We’re saying there is a difference in the justice demands for people who are descendants of slaves in this country and those who were enslaved in Jamaica.”

Carnell fleshed out the argument further Wednesday, tweeting:

“Kamala Harris doesn’t have that in her lineage. She’s anchored in two affluent, immigrant parents. It’s really simple. So since Kamala Harris doesn’t have this experience in her background, or a track record that expresses this understanding, and she announced during MLK Week, at Howard University, of course she’s going to get pressed HARD on the specificity of her #ADOS Agenda.”

(The ADOS, or American Descendants of Slavery, movement seeks to draw attention to the policy issues affecting the lives of blacks who descended from American slaves.)

That’s not frivolous. It will be a serious issue within the black community and it may well be one that the Democratic Party might wish to avoid.

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Riddle Me This

The editors of the Chicago Tribune, who did not endorse Gov. J. B. Pritker’s election to governor presumably at least in part in opposition to his signature campaign promise—to introduce a graduated income tax to Illinois, are critical of the Illinois Senate’s passage of the amendment to the state constitution to enable the tax:

After giving the matter seven minutes (not hours) of thoughtful deliberation, Illinois Senate Democrats voted Wednesday to put on the November 2020 ballot a constitutional amendment to impose a system of graduated income tax rates on taxpayers. No Senate Republican voted yea.

The promise from Gov. J.B. Pritzker is that under his plan, voter approval of the amendment would mean tax breaks for 97 percent of Illinoisans. But who knows, because Senate Democrats changed Pritzker’s plan, and House members could too. Senators tweaked the tax rates — and they larded up their package with two more promises: If voters approve the graduated-rates amendment, their legislation would eliminate the state estate tax. It also would freeze school district property tax rates if the state meets its school funding obligations.

The stated intent is to increase state revenues to enable the state to pay the public pensions they’ve promised.

Now riddle me this. Will the proposed legislation decrease, increase, or have no effect on state revenues? I honestly have no idea. I do not believe that any serious study has been done of the matter. Certainly not during the seven minutes of debate the Senate gave it. IMO it is quite possible that the proposed legislation will actually reduce state revenues significantly in the name of increasing them.

If you decrease state income tax for 97% of taxpayers whether you increase or decrease revenues by increasing taxes on the other 3% depends on how deftly they avoid the increase or whether they remain in place to shoulder the tax. If the measure actually decreases revenues it could be a real disaster given the state’s present lousy credit rating.

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The Peasants Are Revolting

I think you may find David Brooks’s most recent New York Times column interesting as I did. I don’t agree with all of his assessments but IMO they’re worth considering. He’s trying to contrast what has happened to the Republican Party over the last several years with what is going on in the Democratic Party now:

The Republican Party has been disrupted from the bottom. In 2016, the educated Republican elites were happy to embrace conventional Republican themes. It was the Republican base that was fed up and wanted Trump — something completely different.

The Democratic Party is facing disruption from the top. In the early stages of the current political season, Democratic rank and file seem to be embracing Biden and his traditional Democratic themes. It’s the coastal, highly educated elites who are fed up and want something transformative.

In other words, the Republican story is a story of populist radicalization; the Democratic story so far is a story of elite radicalization.

I’m not sure that’s actually what has been going on. Yes, yes, that’s the media narrative—the Trump phenomenon is the result of unwashed, uneducated bumpkins from the hinterlands refusing to accept what their betters know is good for them. I think what’s closer to the truth is more like what John Kass calls “the Combine”, i.e. that the Congressional leadership, Republican and Democratic, agreed more with each other than they did with the party rank and file.

But on this I think that Mr. Brooks and I agree:

The crucial voters in this primary election could turn out to be African-Americans. Right now, Biden is dominant among these voters. In a field of more than 20 candidates, 50 percent of nonwhite voters support Biden. Some of these voters like Biden’s longstanding loyalty to the party and its causes; some like his partnership with Obama; some are members of what you might call the Disillusion Caucus. They believe that given the racism and sexism endemic in American society you’ve got to nominate a white man if you want your party to win.

If these voters stay where they are, it will be hard for a disrupter to win. So far white progressives have done a poor job of wooing minority support or even marching in step with minority voters. They talk a lot about social justice but don’t support the candidates that minority voters actually support. Highly educated coastal progressives live privileged, affluent lives but define their identity as allies of the oppressed. This privileged pose involves all sorts of psychological contortions that don’t resonate with a lot of rank-and-file voters.

It will be interesting to see if any other candidates — Kamala Harris? Cory Booker? — can manage to span these two camps. Pete Buttigieg would seem to be an option, but his support so far is massively from the college-educated. Right now, Biden is in a strong position — offering progressive policies to a party that is exhausted and doesn’t want permanent revolution.

Consider the recent mayoral election in Chicago. Black voters voted overwhelmingly for a black candidate in the primaries. That itself marked something of a change from past elections. But the candidate that most black voters supported wasn’t either of the black candidates that eventually faced off in the general election. Their support came primarily from the white Northwest Side or the white Lake Shore.

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The CBO’s Rain

The Congressional Budget Office has produced a report on the considerations in implementing a “Medicare for All”-type program. The report is here. Here’s the report’s own quick summary:

The transition toward a single-payer system could be complicated, challenging, and potentially disruptive. To smooth that transition, features of the single-payer system that would cause the largest changes from the current system could be phased in gradually to minimize their impact. Policymakers would need to consider how quickly people with private insurance would switch their coverage to the new public plan, what would happen to workers in the health insurance industry if private insurance was banned entirely or its role was limited, and how quickly provider payment rates under the single-payer
system would be phased in from current levels. Although the transition toward a single-payer system would require considerable attention from policymakers, this report does not focus on the transition process.

At the Washington Post Amy Goldstein adds:

The political hurdles also were quickly evident from industry reaction to the report. Charles N. “Chip” Kahn III, president of the Federation of American Hospitals, called a single-payer system “a high-stakes gamble” asking, “Is it worth the risk of upending health care for every American when the law on the books already contains a road map to universal coverage?”

Here’s my question. According to The Centers for Medicaid and Medicare Services, Medicare spending per beneficiary is over $20,000 per year. According to the Kaiser Family Foundation, the average employer contribution for employee health care insurance was $5,477 (82% of the total). How do you reconcile those two facts with a plan than in theory would cost no more than is being spent at present, particularly if M4A is to cover an additiona 10% of the American people? What will not be covered?

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A Tale of Two Narratives

There are two competing narratives about what happened in the presidential election of 2016. According to one narrative an incompetent doofus prevailed over the obviously more competent female opponent by virtue of Republican shenanigans and the antiquated electoral college. In the other narrative a wily challenger prevailed over an incompetent but highly credentialed unpopular female candidate, losing primarily states that have large electoral vote counts primarily because of their immigrant non-voting populations, a violation of the principle of “one person one vote”. I don’t believe that either narrative is entirely true or entirely false. I think that Democrats are relying too heavily on the imaginary story they’ve told themselves about the 2016 election.

At RealClearPolitics David Brady, Morris Fiorina and Douglas Rivers raise the disquieting possibility that whether Donald Trump is re-elected may depend on whom the Democrats nominate:

Is it really the case that any Democrat can beat Trump? On closer inspection, that outcome looks less certain. For starters, history shows that one shouldn’t put much faith in trial-heat polls 18 months ahead of a presidential election. Moreover one recent survey experiment by YouGov indicates that a surprisingly large proportion of the electorate – about 40 percent — reports that the choice between President Trump and a Democratic challenger depends on the identity of the Democrat. These voters are “in play” or “up for grabs.” There are more of them than there are completely committed Democratic or Trump voters.

YouGov polled 3,000 Americans between Feb. 28 and March 3. We asked our respondents how they would vote in an election between Trump and nine declared or potential Democratic candidates (Joe Biden, Cory Booker, Julian Castro, Kirsten Gillibrand, Kamala Harris, Amy Klobuchar, Beto O’Rourke, Bernie Sanders, and Elizabeth Warren). To avoid voter fatigue we did not ask each voter to make eight decisions. Rather, each voter chose between Trump and three randomly selected Democrats, so roughly 1,000 respondents participated in each trial heat. If respondents said that they would vote for the Democrat in all three trial heats or Trump in all three, we then asked: Would you always (never) vote for any Democrat?

Democrats led in seven of the nine trial heats, but the “always Trump” and “never Trump” blocks were nearly identical in size: 36 of respondents said they would vote for the Democratic candidate in all three matchups and 35 percent said they would vote for Trump in all three. When asked the follow-up question, about one in seven said that there was a Democratic nominee who would cause them to switch parties. The good news for Democrats is that there are more Trump supporters who are willing to consider voting for a Democrat than vice versa. The bad news for Democrats is that 40 percent of the electorate say that their vote in 2020 depends upon the identity of the Democratic nominee. This is the largest segment of the electorate and consists of three groups:

  • People who preferred Trump over a Democrat in one or two of the three trial heats and a Democrat over Trump in the others (4%).
  • People who favored all of the three Democratic candidates in the matchups we asked them about, but in the follow-up question said that there was a Democrat who, if nominated, would cause them to vote for Trump (11%).
  • People who were unsure of how they would vote in at least one of the three trial heats (26%).

Unregistered voters are disproportionately represented in the last group. Among registered voters, the Democratic advantage is larger (38% never Trump, 31% always Trump, and 31% depends), but nearly a third of registered voters are “available” for Trump depending on whom the Democrats nominate.

Read the whole thing.

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When Bill Met Loretta

RealClearInvestigations says they’ve obtained a transcript of the House Judiciary Committee and the House Committee on Oversight and Government Reform’s interview of Loretta Lynch about the meeting on the tarmac between her and former President Bill Clinton on June 27, 2016. You might find it interesting.

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