Imagine that a new pandemic hits and, sadly, you test positive. Luckily, we’re better prepared this time and a widely used, safe, convenient pill priced at only $1 is available and can reduce your risk of death by 56%. Would you take it?
Actually, such a drug was available during this pandemic. It has been on the market for decades.
This is from Charles L. Hooper and David R. Henderson, “In Pandemics, Old Drugs May Save Us,” Goodman Institute, Brief Analysis No. 145, March 18, 2022.
Another excerpt:
While newer drugs are often better than older drugs, older drugs have something that newer drugs don’t: they are cheap and widely available today. When a pandemic starts, they are all we have.
We estimate that using these drugs and vitamins could have saved hundreds of thousands of U.S. lives.
Finally:
Pandemics, by nature, move quickly. Drug and vaccine development, especially when highly regulated, are slow. The problem moves faster than the solution. however, there’s one good solution that’s hidden in plain sight: older drugs. The first place to look for useful therapies during a pandemic is older, generic drugs. These drugs offer Americans the prospect of reduced morbidity and mortality while simultaneously being very cheap. We just need the FDA to cease being a roadblock.
What about the statistical significance argument, which has been used to discredit, in particular, ivermectin? We address that in a forthcoming article in Regulation.
The table at the top is from our article.
Read the whole thing.
READER COMMENTS
zeke5123
Mar 23 2022 at 10:24am
Prof. Henderson,
I enjoyed your article. You cite a problem oft-mentioned (i.e., generic drugs don’t have a sponsor who wants to spend X number of dollars to generate results for a drug that they can’t make a profit on because it is off patent). Yet people very frequently do not offer a solution. While abolishing the FDA may be one attractive solution, politics is the art of the possible and I don’t believe that possible. Let me offer another solution.
If the President declares there is a pandemic, any sponsor that runs a clinical trial for a drug that passes (after detailed examination by the FDA) an (x%) reduction in mortality threshold receives a [x]b prize.
While this could be abused, I do think on balance it probably aligns incentives better in a pandemic world. I would love to have seen a robust, not designed-to-fail clinical trial for Ivermectin or HCQ. It would’ve helped settled the debate. If they do work, then the world could’ve been saved significant harm at a fraction of the cost (really even if the prize was 100b it would be a fraction of what was lost). If the drugs didn’t work, then at minimum that would be good to understand.
My understanding (and this could be faulty) is that the FDA trials also do not allow a cocktail of drugs to be used in a trial. This is why for certain off-label cancer treatments there is effectively a private FDA analog that clears the treatment for insurance to pay for it. I would hope that this bonus scheme would permit drug cocktails to be tested as well.
Alan Goldhammer
Mar 23 2022 at 1:03pm
Yes, you are indeed wrong on this point. FDA does allow such trial to proceed if the sponsor provides an adequate rationale.
I don’t understand what a “private FDA analog” is. Insurers will reimburse for treatments that work.
zeke5123
Mar 23 2022 at 2:22pm
I may be wrong on the multiple cocktail part — I had heard that but hadn’t verified it myself (which is why I stated I may be wrong).
For the second part, I was referring to an organization like NCCN which, inter alia, helps standardize off-label treatments.
Charles Hooper
Mar 24 2022 at 2:13pm
Yes. But the question is what evidence do they use to conclude that the drug works? Of course, one source can be the FDA, but then we’re back to the “no sponsor” problem.
Charles Hooper
Mar 24 2022 at 2:17pm
I agree that prizes have a lot of potential. The knowledge that a particular generic drug is useful for treating a particular condition is a public good. To make it work, there would need to be a number of controls in place to ensure that the clinical trials were run and analyzed properly and, further, that an organization wasn’t cheated out of a prize by a government agency that incorrectly assessed the results.
zeke5123
Mar 24 2022 at 4:24pm
Agreed. The devil is, as they say, in the details (and some of the details you point out are key details). With that said, given the whole Ivermectin snafu (regardless of what side you were on) it seems like a lesson to learn to prepare for the next pandemic. That is, we created a system where generics will necessarily be understudied and therefore people on both sides of the debate will legitimately argue for and against.
Charles Hooper
Mar 24 2022 at 10:29pm
I couldn’t agree more.
Alan Goldhammer
Mar 23 2022 at 12:59pm
This paper is highly misleading and lacks any references that would allow a skilled reader to make any judgement about the quality of the information in Table 1. The authors want to posit that all of the compounds (and they are not all drugs) in Table 1 reduce mortality resulting from Covid infections. I am familiar with most of the raw data having written daily newsletter during the first 10 months of the pandemic. Most of the trials for all of these compounds were worthless for countless reasons. Some of the compounds such as ivermectin and hydroxychloroquine were subject to well controlled trials and found to have no efficacy at all. Some of the others were only in poorly controlled observational trials which are difficult to rely on.
It’s fine to bash the FDA and throughout my career in the pharma industry (30 years), there were times where their decisions were indeed puzzling. However, a hit piece on the agency deserves to have solid data backing up the thesis which is sadly lacking in this paper.
Mark Brophy
Mar 23 2022 at 8:50pm
A randomized clinical trial of ivermectin recently published in JAMA showed that 13 people died, 3 from the ivermectin group and 10 from the non-ivermectin group. From this data, the study concluded that ivermectin doesn’t work. However, if you gave the results to people, everyone would’ve chosen ivermectin because the data clearly show that it works.
JFA
Mar 23 2022 at 9:17pm
That’s because: 1) the main outcome was requiring oxygen treatment and the ivermectin group needed oxygen more than the control group and 2) the estimate on mortality was incredibly noisy, with a 95% CI for relative risk of 0.09 – 1.11.
I can’t speak to the recruitment and effective randomization (though the control and treatment seem well balanced), but my takeaway from the study is that it falls in the camp of ivermectin being a not effective treatment. If your prior is that ivermectin is super effective (56%), then this study should make you think ivermectin is less effective than you think. But as someone who doesn’t think ivermectin is that effective, I also wouldn’t rest my case on this one study either.
Charles Hooper
Mar 24 2022 at 2:31pm
Ivermectin has been studied for COVID-19 in 81 studies by 782 scientists with trials involving 128,840 patients. Hydroxychloroquine has been studied by 5,240 scientists in 331 studies involving 453,570 patients.
We should note that these two drugs have been studied in far more patients than the drugs the FDA actually approved for COVID-19.
Alan, are you prepared to say that all of these studies were either bad or found no benefit? If, for example, I highlight a particular study that showed a benefit, you could explain to me why the study was faulty? And that we could do this same exercise for the approximately 70 studies of ivermectin that showed a benefit? You could explain to me what was wrong in all 70 of these studies?
Charles Hooper
Mar 24 2022 at 2:42pm
Ivermectin has been tested in 81 studies by 782 scientists in trials involving 128,840 patients. Hydroxychloroquine has 331 studies by 5,240 scientists involving 453,570 trials.
Alan, are you saying that all of these trials either showed no benefit or were faulty? So, for instance, you could explain to me what was wrong with the 70 or so trials of ivermectin and the 200 or so trials of hydroxychloroquine that did show a benefit?
steve
Mar 23 2022 at 4:29pm
There are now many dozens of papers on Ivermectin. If you assumed every study is a good one and averaged the results of every study I doubt it goes over 50%, but it might. However, if you eliminate studies that are clearly fraudulent (especially common among the studies that claim 90% success rates) it would definitely be less than 50%. Then if you eliminate studies that are poorly done, probably fraudulent etc you find there is no effect or a small effect. If you look at prospective studies, ones that have controls and randomization, and ones that are big enough to be meaningful, then you see that Ivermectin probably has no effect. That should not be surprising if you are aware of the lab studies on Ivermectin.
If not every, then I would bet over 90% of US hospitals tried these drugs. We tried them. Did not see any effect and if a drug had a 50% effect we would have noticed right away. One of the worst parts of this pandemic is that people who have no ability to assess whether treatments work or not are making strong declarations about efficacy and people are believing them. I understand that people desperately wanted some of these older drugs to work but they didnt.
Steve
Charley Hooper
Mar 24 2022 at 2:48pm
First, in terms of published results, researchers have already done this job of filtering out weak trials. After these trials are excluded, ivermectin showed an 82% benefit in prophylaxis, 70% in early treatment, and 56% in late treatment.
Second, you’ve supposedly tested these drugs in your practice. Did you do that in an organized fashion? How many patients did you use? What results did you find? Did you publish your results?
steve
Mar 24 2022 at 5:06pm
They have not filtered them out, not in the meta-analyses you are offering. Lets look at what you consider a good study from your quotes.
““Consider one COVID patient outcome: the need for invasive ventilation. In a randomized, double‐blind, placebo‐controlled clinical trial by Ranjini Ravikirti et al., of 55 patients in the ivermectin arm, only one patient needed invasive ventilation while five in the placebo group of 57 did. In other words, it appears that ivermectin reduced the need for ventilators by 80%. Yet, the study’s authors concluded, “This study did not find any benefit with the use of ivermectin in … the use of invasive ventilation in mild and moderate COVID-19.”
So lets link to the fuller version of the study.
https://c19ivermectin.com/ravikirti.html
Note that the primary outcome actually favors placebo, as do several other of the outcomes. You focus only on ventilation and death. If Ivermectin is 59% or more effective, your claim, we should expect all of those numbers to favor Ivermectin. Except we really dont because the study is so small it is pretty meaningless. None of the numbers numbers meet your definition of significance (p<0.05) except for D/C. This is the kind of study you should regard as moderately interesting but does not constitute proof of anything, The results are more likely just random occurrence.
In our internal study we stopped at about 600 pts. Ours was pretty similar to that of Ravikirti. We did not publish since it was a negative study and like many others with a negative study didnt have much interest. Already knowing the lab studies our priors were that it was unlikely to work.
Steve
Jon Murphy
Mar 23 2022 at 4:55pm
I like this line. It gets to something I am noticing more and more. There seems to be a sort of “state of nature” style reasoning that is applied to policy. By that I mean that there seems to be an implicit assumption that “we have to do something” because nothing currently exists. This was painfully obvious at the beginning of the pandemic, though I have seen it in discussions of externality
Dylan
Mar 23 2022 at 5:05pm
As Steve mentions though, it isn’t like we weren’t doing something at the beginning of the pandemic. All of these drugs were tried extensively by physicians who were looking for anything that might work, that’s how we got the observational data we have today. And people took that observational data and tried to replicate it in formal studies. Turns out, when we ran clinical trials, most didn’t pan out, and some had more risk than benefit. That’s the way it goes most of the time unfortunately.
Jon Murphy
Mar 24 2022 at 3:27am
Correct. Lots of somethings were being done. But the modeling and analysis that experts were conducting were acting as of nothing was being done.
Dylan
Mar 23 2022 at 4:59pm
While I may often disagree with what Prof. Henderson writes, I don’t generally get angry. This piece gets awfully close.
I agree with Alan that the piece is highly misleading, and that may be too gentle of a word. As he says, you don’t source the data for the tables, but I think it is fair to say that those numbers are not the consensus view of efficacy. My guess, from reading prior pieces by Mr. Hooper, is that this is a simplistic meta-analysis that does nothing to control for differences in study design. Maybe I’m wrong, but hard to tell since the numbers are presented as straight fact.
At the end of the piece you make two proposals for how to reform the FDA
1) Prevent the FDA from issuing warnings against off-label use and
2) Allow for full off label promotion
On the first, you rely on the fact that they have been used “billions or trillions” of times. Yet nowhere do you discuss the fact that Ivermectin, the drug where you previously complained about the FDA warnings, was being used at doses far exceeding the dose studied in humans and approved by the FDA. And that we know that higher doses are dangerous. Then there are subtler safety issues, like the fact that a drug deemed safe to treat a deadly disease may not be safe in the context of a less serious problem. Take Tysabri for example, this is an effective drug to treat MS, but a small subset (~0.2%) of patients taking the drug develop PML, which is often fatal. While the risk/benefit might make sense for MS, we probably wouldn’t want to recommend this as a treatment for the common cold, even if it was 100% effective (disclaimer: to the best of my knowledge, no one has studied Tysabri in the common cold)
On off label-promotion, you can make a case that the FDA should allow more, but the one your present is not compelling. First, you don’t describe the current state and all the ways companies can and do promote off-label use. Health Affairs covers this in a more balanced way. Second, ironically, your piece illustrates why more liberal off-label promotion may be a bad idea…we would get misleading and incomplete “data” showing efficacy where none exists, like what you present in the tables throughout the article.
I understand that you have philosophical issues with the FDA and how it operates, and that is fine. However, your argument would be stronger if you more thoroughly steelmanned the other side of the debate.
Phil H
Mar 24 2022 at 5:56am
For me, the pandemic in general, and the ivermectin thing in particular, have been very illuminating about what expertise is. Even people who are clearly very smart and accomplished fell down the ivermectin hole and *can’t get themselves out*. This is now part of my understanding of what it means to have expertise in a field: it’s the ability to change your mind, borne, I guess of the process of going through two or three intellectual revolutions in your field, seeing how ideas can be replaced, and accepting that your own ideas can change. If you haven’t followed a field closely for a couple of decades, you won’t have experienced that.
It’s just reinforced for me the value of institutions. Flawed though the medical establishment no doubt is, it’s better than a bunch of economists saying, “I’m smart, I bet I can work this out better than them.” And of course, the same goes in reverse: doctors shouldn’t be taken to be experts on the economy.
JFA
Mar 24 2022 at 7:22am
“Flawed though the medical establishment no doubt is, it’s better than a bunch of economists saying, “I’m smart, I bet I can work this out better than them.””
To be fair, I wouldn’t take David’s post as being equal to “all economists recommend ivermectin”. Lot’s of economists don’t, and there have been plenty of doctors recommending ivermectin, as well. On the whole, if I wanted to learn about a particular medical topic, I wouldn’t just rely on doctors. Most doctors are quite innumerate (there’s actually a lot of literature on this) and not good about thinking about risks and tradeoffs (this is especially true for public health people). While I remain puzzled at the continued recommendation of ivermectin by David, I think it’s important read that perspective; it’s just that some (many? most?) people will only read that one perspective.
Phil H
Mar 24 2022 at 12:40pm
That’s fair, thanks.
Jon Murphy
Mar 24 2022 at 7:29am
Which makes one wonder why you object to this post at all, then.
Mark Z
Mar 24 2022 at 11:11pm
I don’t know, I remember reading a slew of health experts in December asserting confidently based on one flimsy study that omicron was no less deadly than delta, and savaging anyone who disagreed, while many amateurs were the first to notice the mounting evidence that it was in fact significantly less deadly. I think the main lesson of the pandemic is there’s no substitute for analytical thinking.
On this particular point, it doesn’t seem like the experts are changing their minds. It seems most were skeptical from the start, as they typically are of new drugs with some observational evidence in their favor; such a priori skepticism of drugs is probably warranted, but it is consistent with Scott Alexander’s observation that when people are right, usually it’s because the heuristic or bias they consistently apply turned out to be right in this instance.
Charles Hooper
Mar 24 2022 at 3:01pm
We would be happy talking about data, sources, and methodologies but were unable to given the space limitations and purpose of our article.
Ivermectin has been tested in 81 studies by 782 scientists in trials involving 128,840 patients.
In meta-analyses, ivermectin was shown to reduce mortality by 55% (41 trials; 116,053 patients), need for ventilation by 35% (14; 30,854), ICU admission by 54% (8; 22,347), hospitalization by 39% (22; 39,918), help recovery by 49% (27; 4,513); reduce cases by 78% (15; 13,297), and improve viral clearance by 55% (24; 2,733).
Where would you like to start? Or are you just going to say that we can’t understand the data because we are economists?
Dylan
Mar 24 2022 at 4:33pm
It has nothing to do with being an economist but with seemingly not understanding that meta-analysis is more complicated than simply adding up a bunch of trials with different protocols, doses, some-randomized, some not, and spitting out an answer. The Scott Alexander piece you reference in the Cato piece goes into this in depth, diving into the majority of the trials, yet nothing you write in either piece hints at the level of complexity (and you also seem to completely mischaracterize Scott’s views to boot)
Charles Hooper
Mar 24 2022 at 10:42pm
How did we mischaracterize Scott’s views? Scott’s views seem pretty clear from his article.
Dylan
Mar 25 2022 at 11:21am
You say that Scott says “He tentatively concluded that, when ivermectin is given early in an infection, the studies indicate the drug reduces mortality by 40 percent, which is just barely statistically significant (significance: p = 0.04).” What he actually says is:
A couple of things are important here. The 40% mortality comes from the Popp study, but the confidence intervals are too large to draw a conclusion. And that his work mostly agrees with this. I don’t see where he actually calculates a mortality reduction himself (and as he says elsewhere he’s just adding raw numbers to get a rough idea, which is “probably statistically illegitimate”)
Later in the summary he says this:
From reading your article, that is not at all what I assumed Scott’s views were. Hence, in my opinion, it seemed like you mischarecterized them.
By the way, the ivermectin saga is a good illustration of why I’m not convinced by your arguments to have the FDA only responsible for safety and that efficacy will be figured out in the market. What you end up getting is a lot of low quality trials that can’t be directly compared to one another, all using different treatment protocols, and in the end, even with 81 trials and over 100,000 patients treated, we don’t have a good answer on if the drug works. Most of the experts that look at the data say that we can’t really tell, but any effect is likely small. Yet others can look at the same data and think it is a miracle cure.
zeke5123
Mar 25 2022 at 1:23pm
But Dylan that already happens. A large amount of Cancer drugs are off-label usages. Intermediates such as NCCN help establish efficacy which insurance companies rely upon to pay for these expensive drugs — drugs that the FDA has never reviewed for efficacy in the cancer context.
The question is whether we’d be better off with intermediates like NCCN or like the FDA.
Alan Goldhammer
Mar 24 2022 at 8:15am
I’m only going to add this final comment to this blog post. There was a tremendous amount of screening done in the early days of the pandemic to see if older drugs might demonstrate some efficacy against SARS-CoV-2 (the virus responsible for COVID-19. In vitro viral cultures of the virus made such studies pretty easy to do. An Australian group were the first ones to report the utility of of ivermectin in halting viral replication in vitro. However, it’s important to note that no plausible mechanism of action for this compound was reported out. I noted this in my newsletter and commented that while interesting much more work needed to be done to understand this.
A short time later, a pre-print appeared (since peer reviewed and published) that appeared to be the nail in the coffin for this drug as a COVID therapeutic. Using the Australian data and looking at the clinical pharmacology of ivermectin (the amount of drug that actually gets into the blood stream; a critical piece of information as this is predictive of inhibitory activity), they noted that the Australian in vitro dose could not be reached in humans and that you could not achieve the necessary inhibitory concentration with a 10 fold increase in the recommended human dose! Of course, at such a high level you encounter safety issues with the drug.
Intrepid readers who wish to pursue this further might want to explore the National Library of Medicine’s Clinical Trials database that shows 88 registered trials on ivermectin. Note that this is double the number of trials shown in the table that Hooper and Henderson have published in their article.
If ivermectin really worked, it would be standard of care for either COVID prophylaxis or treatment. With with hydroxychloroquine, it does not work and has not been adopted by the vast majority of clinicians treating COVID patients.
steve
Mar 24 2022 at 8:25am
Since you guys have a lot of expertise on Ivermectin what do you think about the new paper on Ivermectin and Strongyloidiasis? If you have not read it already, I know that is unlikely since this is in your area of expertise, I can provide the link. No paywall.
“Most doctors are quite innumerate”
I think the correct way to look at is that many either dont understand statistics well or they understand but let personal experience dominate their decisions. From my POV this is changing. The newer folks coming out of training have, in general, had more exposure and a better understanding of how to assess the statistical analysis of literature. We actually do talk with each other and a lot of people do have strong math/stats backgrounds so we do sort things out. The public health people get paid to evaluate things from the health POV. By and large they are not assessing the economic impact. TBH I think that should be done by others. That means someone(s) needs to then look at all of the effects put together and make decisions.
Steve
JFA
Mar 24 2022 at 9:37am
I don’t really have an opinion on a paper that you haven’t provided any information about. Given that ivermectin is the standard of care for Strongyloidiasis and Strongyloidiasis has virtually no bearing on my life, I don’t have an opinion on it. I’m gonna guess that most doctors whose patients don’t have worms also don’t have much of an opinion on it either. When my dad starts spouting non-sense about vaccines for children being child abuse and that his doctor buddy says HCQ and ivermectin are good treatments for Covid, I decided to read up on it so that I can at least give him some version of reality that is less lopsided. As a statistician, I have the training to do that. That’s great that the more doctors are getting better acquainted with statistics, but I still wouldn’t take my doctor’s say so as gospel. I would use their expertise as a starting point. I know enough doctors who have recommended ivermectin to not take what doctor’s say as God’s truth.
Regarding public health people: “The public health people get paid to evaluate things from the health POV. By and large they are not assessing the economic impact.” Then I’d say that public health experts should refrain from adamantly pushing various policies and instead say “here is what we think would happen to the path of the virus under these various scenarios”. I think most have gone way beyond that. Maybe they get paid to view things from a health POV, but perhaps it would behoove them to consider other POVs (or at the very least, acknowledge the existence of tradeoffs). To be clear, I also think that is the role of economists as well.
steve
Mar 24 2022 at 10:30am
Here is the link. I was kind of hoping Dave would give his opinion using his expertise on Ivermectin.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790173
Do you really want the public health people to try to be experts on everything? I dont. I expect them to give opinions on the health outcomes of the topics at hand. For covid that should have been hospitalizations, deaths, long term effects, and what the effects of mitigation might be. I expect them to make a vigorous argument for conserving health and life. Someone else should make arguments about the economic outcomes. Then you need someone to synthesize those arguments and we decide on policy. It certainly seemed like public health people were setting policy but I think in most cases it was actually politicians setting policy. Were they too deferential to public health people? That’s a value judgment.
I think what you really saw is that politicians did what was popular in their own area. Florida was less restrictive because that is what the people in his state expected and supported. In New Jersey it was more restrictive because the people in that state supported it.
“That’s great that the more doctors are getting better acquainted with statistics, but I still wouldn’t take my doctor’s say so as gospel. I would use their expertise as a starting point. I know enough doctors who have recommended ivermectin to not take what doctor’s say as God’s truth.”
When in doubt I ask the mathematicians in the family, the statistician our department employs or even the spouse of one of my docs who is a specifically a bio-statistician. At this point I couldn’t construct one of those funnel graphs they love so much in meta-analyses to save my life, but I know people who can. (And I wish people understood the issue better when a meta-analysis is used.)
Steve
JFA
Mar 24 2022 at 11:37am
“Do you really want the public health people to try to be experts on everything? I dont.”
I don’t want them to be experts on everything, but I think having a conception of tradeoffs (even while focusing one’s analysis on a single priority) is useful. When an expert in one field pushes a policy (rather than just describing that policy’s effects) that has large impacts beyond their expertise, then I think a bit of humility is warranted. I think a defense of siloing disciplines is not the way to go.
When you say politicians did what was popular in their area, I think you are not considering how those ideas became popular. For example, closing schools (in many places for a year or more) was justified based on what public health experts were saying. In my area, the schools didn’t do anything without at least the implicit approval of the health department. It was that focus on a single priority (and deference to experts who were only focused on that single priority) that was so detrimental to so many people. I’d say I’m glad some economists (notably Emily Oster) stepped in to bring some sanity to the discussion over school closures. (Side note: I think the conversation about schools (like many other issues during this pandemic) was so complicated because people brought in their polarized political allegiances into the discussion.)
“When in doubt I ask the mathematicians in the family, the statistician our department employs or even the spouse of one of my docs who is a specifically a bio-statistician.” Thumbs up.
zeke5123
Mar 24 2022 at 4:27pm
Indeed. They need to be at least aware of the trade-offs in terms of public health! I want my public health experts to think economics even if their subject matter expertise is in health.
steve
Mar 24 2022 at 4:36pm
But there were a lot of schools that were closed only very briefly so clearly those places were not listening exclusively to public health people.
Would I like public health people to be more aware of and address other aspects other than the public health angle? Sure, but it just isn’t going to happen very often. You are trying to turn hedgehogs into foxes. One of the things you have to learn when you manage specialists is how to manage them. By and large they are going to obsess over their area of expertise and there isn’t much you can do about it. When you manage them you have to be the one to integrate other info into your decisions.
Steve
JFA
Mar 24 2022 at 8:57pm
“Sure, but it just isn’t going to happen very often. You are trying to turn hedgehogs into foxes.”
Ha… that may be true. I liked that line. Cheers.
Vivian Darkbloom
Mar 24 2022 at 11:44am
“Then I’d say that public health experts should refrain from adamantly pushing various policies and instead say “here is what we think would happen to the path of the virus under these various scenarios”
Very true. This was a *huge* problem with respect to the response to the Covid pandemic. The public health point of view is one of many different considerations when considering the proper policy response. “Public health experts” are not inclined, much less capable, of assessing the economic impact, the effect on children and their education, the long-term negative effects on civil liberties, etc., etc. In theory, our political leaders are responsible for making those decisions based on the difficult tradeoffs those decisions inevitably entail. But, how many political leaders are brave enough not to, de facto, delegate overall policy to them? To do so makes them easy targets of political rhetoric (e.g. “you are responsible for x number of deaths”). In this regard, I think the politics regarding responses to emergencies was permanently changed (for the worse) with Katrina.
My advice to the next president and governors: Listen carefully to counsel given by the likes of Dr. Fauci; but, don’t let them take center stage as Trump did with regard to Fauci. Let the public know that you’ve listened to a myriad of experts from various fields and that *your* decision is based on an appropriate balancing of multiple considerations.
steve
Mar 24 2022 at 4:27pm
Nicely said. I have been trying to say the thing but worded poorly.
Steve
Michael
Mar 24 2022 at 4:54pm
Some people, usually from the left, suggest that an alternative to the current, patent-based system, drug development could work instead by a prize-based system.
I mostly think that wouldn’t work. But isn’t “repurposing of existing therpaies” one area where a prize-based system it could work?
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