Proof of life; Lowering drug costs; an aborted discussion by professional authors; WikiLeaks; and other important matters.

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Monday, March 13, 2017

“The wealth of our middle class has been ripped from their homes and then redistributed across the entire world.”

Donald Trump

Between 1965 and 2011, the official poverty rate was essentially flat, while the government spending per person on poverty programs rose by more than 900% after inflation.

Peter Cove

Liberalism is a philosophy of consolation for the West as it commits suicide.

James Burnham

If a foreign government had imposed this system of education on the United States, we would rightfully consider it an act of war.

Glenn T. Seaborg, National Commission on Education, 1983

bubbles

Every time I think I am recovering from the crud, I have a relapse. This time for sure, as Bullwinkle was fond of saying. I seem to have no more symptoms other than running out of energy; when I expel my tidal air I get wheezing, but some deep coughing clears that out. Maybe I had mild pneumonia, but I doubt it; friends tell me they had this cried for six weeks. But the weather is nice outside, and much of the domestic stress at chaos manor has been rectified, so things can improve rapidly. We have adjusted the staff taking care of Roberta, and the reconstruction of the house is in order.

I should get some time in the Monk’s cell, giving me a chance to run through Mamelukes; the interstellar colony book Steve Barnes, Larry Niven and I are working on; and the serious novel on artificial intelligence and robotics John De Chancie and I are doing. I can still work on non-fiction from down here in the chaos – after all, I wrote a lot of the columns in the press room at computer shows and AAAS meetings – but I can’t do fiction with constant distractions.

Speaking of which they are calling dinner. I’ll get this up fast to relieve curiosity; also I have finally recorded the subscriptions sent to the po box; I hadn’t been there in a month – actually in two months. Thank you all for renewing; there was a pretty big bundle.

I’ll have a substantive contribution and an amusing story later tonight.

bubbles

I posted this much before dinner.

 

I returned after dinner to write the rest of this.

 

bubbles

I thought I would have a substantive essay.  I have notes for several. unfortunately it is 2150, and I have had no time to work on it.  There are several things to contemplate. One is technical: the best keyboard I have found to work with is the keyboard of the ASUS ZenBook. The keys are large, larger than the keys of the Logitech Bluetooth keyboard I use on my main machine, but it’s a laptop; it doesn’t have the enormous disk capacity of my main machine, and maybe I just have a prejudice for big desktops; on the other hand, I can write faster on the ZenBook’s keyboard, and the ZenBook has at least as fast a CPU as does Eugene (this machine). On the gripping hand, Eugene has a lot of customizations; it has a big set of spam filtering rules, and a lot of junk mail addresses I have no idea of how to transfer to a laptop. It has a number of AutoCorrect rules that let me type faster with fewer corrections. It took a while to build that and I’d hate to lose it, but I have no notion of where that AutoCorrect table is stored. I suppose I can find it, and many of the other things on Eugene I want on a main machine, but since my stroke I am very nervous about starting big projects that I don’t really know how to do; that’s probably why I no longer do the monthly computing column. Intimidated; of course the most popular feature of the column was my log of attacking big problems and bulling through to a happy ending, but now I’m not so confident of the happy ending.

All of which argues that I should do that, and write up the experience in Chaos Manor Reviews, and I suppose I ought to do that. My experiments with keyboards since the stroke took away my touch typing capability have led me to the conclusion that the ZenBook keyboard is superior to any others I have tried – larger keys and better key separation, and all over better layout. It has output to a big screen, which is what I need to edit text – my eyes ain’t what they used to be – and since it has a docking station I can attach an enormous capacity disk to, I can simply copy Eugene’s D drive to that and it will be the ZenBook’s D drive. We’ll see about everything else.

It will take a while, though. For the moment, Eugene with the Logitech K360 will just have to do.

bubbles

If you have not seen Peggy Noonan’s “A Surprising Show of Confidence” in the Saturday, March 4-5 issue of the Wall Street Journal, it’s worth your time. Ms. Noonan learned her way around the White House in Nixon days, and has remained a respectable – and my many respected – journalist since. She is nominally conservative but often realistic and objective. This is her reaction to President Trump’s speech to Congress, and shows that some journalists might be getting the news of the election in November. I meant to write about her piece a week ago, along with my analysis of the speech, but chaos intervened.

bubbles

I contemplate three essays. One is probably part of a longer discussion of how to “repeal and replace” Obamacare, and just how much of the income of the healthy do the unfortunates rightfully claim? That is, if I’m healthy and you’re not, how much of your health care bill do I have an obligation to pay? And if I don’t have that obligation, who does? Our grandchildren? Immigrants? If they’re entitled to “insurance whose rates are nor raised by prior conditions” – clearly a losing proposition to any insurance company – someone must pay. Who should it be, and how did they get that obligation?

(And please don’t argue Christian duty. That may well be true, but nothing stops you from donating to Christian hospitals and clinics and for that matter missionary doctors; but that can’t affect non-Christians, nor legal obligations; see all kinds of Supreme Court rulings on that subject.)

One answer to health care problems is reduction in costs of health care. That is quite obvious, and certainly not being neglected by President Trump, but one reason for those high costs, particularly to the elderly, is the costs of drugs and pharmaceuticals in general. For more on that, see

A Doctor to Heal the FDA

Scott Gottlieb may be Trump’s most important nominee.

https://www.wsj.com/articles/a-doctor-to-heal-the-fda-1489357456

in today’s Wall Street Journal editorials.

[snip]One of Dr. Gottlieb’s priorities will be moving generic medicines to market, and competition is the best way to reduce the price of treatments like the now infamous EpiPen. About 10% of 1,300 branded drugs “have seen patents expire but still face zero generic competition,” Dr. Gottlieb wrote in the Journal last year. “New regulations have, in many cases, made it no longer economically viable for more than one generic firm to enter the market.” Now he can roll back such arbitrary directives.

The press is overcome with relief that President Trump didn’t pick Jim O’Neill, a Peter Thiel pal who supports making drugs available to patients after testing for safety, though not for efficacy. But that idea is far from crazy, especially for drugs that treat rare diseases when no approved options exist. Why should desperate patients have to take a sugar pill so the FDA can satisfy its demand for 100% certainty that a drug works? [snip]

And of course there is room to debate just what phrase in the Constitution gives the Federal Government power to forbid sale of something they think ineffective, when they know it’s not harmful, but there is no proof of ineffectiveness? Why can the Feds forbid snake oil? And of course the argument is that they know snake oil just wastes the badly needed resources of desperate people who have a powerful motive to buy anything that gives them the shadow of a hope.

While I was sick I did participate in some chatter in other conferences; one of them was the SFWA Forums, which are open to members only, and quoting anything said there without explicit permission from the author is explicitly forbidden; a policy I have no argument with, but of course I can give myself permission to quote myself, and I do.

I said:

Someone might develop the technology, but the FDA will require tests costing tens of millions of dollars before they will let anyone sell that technology to users, even if the users have full knowledge that this is a new technology not certified by the government to be effective. That will prevent upstarts from getting into the business, so the already established companies are safe from competition from newcomers. The use of government to prevent new competition to established business has been going on for a long time.  Adam Smith wrote about it.

Once a bureaucracy is established it inevitably cooperates with the established businesses to prevent new entries that would be competition.  The cost of tests for any new drug — not just tests that it does not harm, but that it is “effective” — keeps Big Pharma safe from new competition.  People who see some technique as their holy hope must beg the bureaucrats to let them try it, but they are not often successful.

Exactly why the Constitution gives the Federal Government the right to forbid me from buying a drug is not clear.  The Volstead Act forbidding us from alcohol was declared unconstitutional, there being no grant of power to the federal government to prevent it, and it required the 18th Amendment to make federal prohibition possible.  It sure turned out well.  It was repealed.

There is no Constitutional grant of power for the FDA, but apparently, it can forbid not only narcotics and hemp, but competition to aspirin and for that matter snake oil, although which clause of the constitution gives that power to the feds is not clear.  Perhaps it is a penumbra of some emanation?

This was answered by stating the good intentions of the Congress in giving that authority, and references to Henry VIII and his attempts to ban medical fakes and their drugs.

Yes; but how does the Federal Government get the power to forbid me from buying snake oil if I want to?  Or some new drug product that the FDA doesn’t “know” to be effective, even though there is no evidence that it is harmful? It took decades before the FDA finally approved aspirin as a possible blood thinner. A Glendale dentist had noticed that patients who routinely took aspirin had fewer strokes than those who didn’t. It was amazing how much effort was put into keeping him from saying that at medical conventions. Now, of course, it’s accepted wisdom. I doubt it would be if he hadn’t been a persistent nuisance insisting that it seemed to work.  Of course there’s no big money in preventative use of aspirin.

I have nothing against the FDA having the power to insist on labeling accuracy, and even to require that the seller label a drug “Not Approved by the FDA. Take at your own risk. This could be useless.” Well, I sort of do because I find no grant of power giving the Feds any control over that sort of thing, but we’ve let them do it for so long that it’s well established; but after they insist that the seller tell you that the Government doesn’t think this will do you any good, and maybe it will kill you, why do they employ armed agents to prevent you from selling it when it is properly labeled  “The FDA thinks you ought to avoid this stuff”? Or stronger labels. “The FDA believes this is a scam, and it may kill you.  Don’t buy it.”

I know some desperate people with terminal problems who’d be willing to try all kinds of stuff. Probably none of it will do them any good. They can afford snake oil. Why is this the people’s business? I can understand the government not wanting to make snake oil an entitlement and have to pay for it. I don’t understand why they won’t let me buy it.

You can argue that making them inform you that’s they think it’s worthless is a good idea, but it’s still your business if you want it anyway.

It was pointed out that this power is part of the power to regulate Interstate Commerce, and of course that is the Court decision. Rather wordily and not very brilliantly I said

My question is, where did the federal government get the power to substitute its judgment for mine when it comes to questions of my health or my children’s? 

The obvious solution is to take that away.  I can understand requiring proper labeling (although the source of that authority is subject to debate). I can understand requiring the label to say “The FDA has not approved this. Beware.  But to say it can’t be sold at all because some say it is not effective is another story.  if a doctor I trust says that snake oil is good for me, and the government disagrees, why should the government be involved at all?  Of course it really has to be snake oil, derived from snakes, or it has to explain that it isn’t, it’s really just swamp water; but isn’t even that the province of the states?

At which point came an eloquent assertion of people’s rights to be protected from fraudsters and snake oil salesmen who drain away the resources of people who desperately need them.

To which I said:

Because some citizens are incompetent all citizens must be deprived of the power to make what government thinks is a bad decision.  Understood.  Alas, I cannot agree.

Hardly the most brilliant argument I have ever made, but there it is. I did get one chap to say he agreed with me, this being Liberalism vs. Libertarianism; not precisely what I was arguing. There followed a long discussion of Liberalism vs. Libertarianism, and a protest that this was not assertion of control over people, but protecting them from obvious harm.

Since I am neither Liberal nor Libertarian, I wouldn’t know.  I thought I was pointing out that protecting people from things they don’t want to be protected from looks a lot like control. Children need to be protected from pederasts. One of those protections is jailing people who have child pornography on their hard disks; even cartoons of child pornography. How it got there is of no concern; claiming you didn’t know it was there is no defense.

In a case forty years ago, a chap was suspected of embezzling from a bank; also with mail fraud; both federal crimes. There wasn’t enough evidence to get a search warrant, but the feds were morally certain that he was guilty and a search of his house would prove it.  A federal postal inspector mailed him, registered mail, some kiddie porn (printed; this is before the Internet). The chap had to sign for it. Now they had absolute proof that he had kiddie porn in his house, obtained a warrant from a friendly judge, searched his house, ignored the porn but found plenty of evidence of embezzling, and charged him.  I expect it would be easier now to download a video file to someone, and in these days of terabyte hard drives it would not be noticed until discovered by a search team…

Good way to protect people?

Yes, often people do need protecting, and law officers need a victory over very clever criminals every now and then. Government is a positive good, not merely necessary. No one wants to live in a Hobbesian society where life is solitary, poor, nasty, brutish, and short. Hobbes solved that problem: absolute monarchy. He protects you, you submit to him.  In 1648 the English decided that had gone too far. Then they found they needed the King after all, and brought his son back. In 1688 the decided they needed a king, but not that one, and came up with a new balance between King and Parliament. That experiment was still going on in 1776. The Convention of 1787 had all that in mind when they drafted the Constitution (sorry to repeat what used to be taught in 5th grade). It’s always a balance between government doing too much, and places where anarchy reigns and it does too little. There are always people who think we have too much government and those who think we have too little. We will hardly settle that here.

I was trying to point out that people with perfectly good motives for protecting others do end up controlling them for their own good, and sometimes the protected people resent the hell out of it.

There followed a long discussion of child pornography laws irrelevant to this discussion, as well as discussion of various food supplements not approved by the FDA which some people found helpful and some did not. There was other chatter on that subject. You are very likely sick of the subject, but there’s a point to this long exposition (other than a desire to give you something I wrote while neglecting you; I do know it’s not my best).

Much of that discourse was in response to some well-made arguments I regret I cannot quote either the assertion or my answer without skating closer to the rules than I care to go. At one point, I said:

Here in southern California we have either a severe cold or bit-worse-than-moderate-flu going around. Laid me low for a week, and I find that many friends have lost four or five weeks to it;.  One couple eventually developed pneumonia. I have found Alka-Seltzer Plus, sudafed, and lots of down time the only things that work, and I’m slowly climbing out of it, but it’s quite real. I credit the myriad pills I take daily with keeping it from being as severe with me as it was for some of my younger friends.

We come now to the close of this, and the point. There was a long and impassioned defense of the good intentions of the authorities, and the good work they do. I replied:

Surely there is a way to let people mind their own business that doesn’t involve sending SWAT teams to raid a business for selling things that aren’t harmful? Particularly if they are clearly labeled?  I’m of the opinion that you should be able to sell snake oil so long as it is properly labeled; indeed, I have no objection to a label that says “The US Government believes the claims made for this stuff are ridiculous and absurd, and a waste of your money”  — and that it contains what it says it is, namely actual snake oil. 

Jailing doctors for prescribing off label — there aren’t enough billion dollar tests of the effectiveness of this for a particular disorder that it might work on, but you can prescribe it for something else — seems to me a bit of a stretch and a power I can’t find in the Constitution.  Whether a state can do that I can’t say.

The urge for well meaning people to mind someone else’s business for their own good is fairly strong.

The states may have inherited the crown powers of Henry VIII, but the federal government got only those granted in the Constitution, as witness the failure of the Volstead Act until the passage of the Prohibition Amendment, whereupon the feds could protect people from drinking alcohol. A well meant act with side effects severe enough that the Amendment was later repealed.

John Adams said that in America we believe that each man is the best judge of his own interests; of course he was speaking of the nation as a whole, not of the states with their inheritance of crown powers which used those powers in quite different ways one from another.

It is always good to protect small children from profit seeking capitalists, but how does that apply to protecting Jim Baen and me from SAMe, which we had to have brought to us from Italy where it was sold on the open market but prohibited in the US?  Now of course it is open market here in the US, but for years it was confiscated at the border if detected.  Possibly a folly, but one I indulge in.

Good intentions are not always justification for protecting people from their follies — or what others perceive as follies. Like aspirin as a heart attack preventative.

At which point there was a plea from an officer I respect to stop this discussion; no reasons given. I was ready to do so, but it continued anyway, and after other exchanges I said:

But surely there is room for disagreement on the effectiveness of various vitamins and other food supplements?  Linus Pauling was probably wrong about the universal effectiveness of saturation bombing with Vitamin C, but perhaps stupid is the wrong word to apply to a Nobel Prize winner?  And it may be that it is effective on some and not others, but we do not yet know how to distinguish one from another, so we use “psychosomatic effect” to “explain” the actual data that suggests that some do indeed have dramatic cures while others do not?  

Jim Baen found in his search of the literature (mostly from overseas literature) that SAMe has a dramatic beneficial effect, at least on some people.  At the time it was very expensive in the United States because it was illegal; perhaps it was much to the benefit of those manufacturing it to have the United States government involved in keeping the price high?  But it was so popular in some parts of Europe that there was competition in selling it, so the price there was low.  For years, the US spent money preventing the importation of SAMe, and people like Jim Baen and me spent money acquiring it. Eventually the US restriction was dropped, and you can buy it on line at reasonable prices now.  No one ever asserted that it was harmful; only that it was not “effective”; yet a great many people, here and abroad, thought it was effective in many ways.  Perhaps we were fooling ourselves, and the placebo effect was triggered, and there was nothing more to it.  Perhaps, but what little continued research there is suggests otherwise.

The point being, what power in the Constitution gives the Federal government the authority to keep the price high?  Perhaps the states have inherited that power from the Crown, but the Constitution explicitly rejects the notion that the Federal Government (as opposed to the States) inherited any powers at all, and has none not explicitly granted in the Constitution of 1789 as amended. I can well imagine that the Feds can and perhaps should refuse to pay for anything not proven effective by the FDA itself, but that brings up entitlement in general and that is certainly not a subject for this discussion; but not paying for someone’s use of a disputed substance is not the same as having Customs officials seize and presumably destroy a product not shown to be harmful  and in fact widely used elsewhere on the grounds that the FDA has not seen the results of a tens of millions of dollars double blind study of its effectiveness, and Federal officials’ judgment is superior to that of individual citizens.

We went through all this in the California battle over compulsory use of helmets for motorcycle riders.  For years cyclists protested that they have the right not to wear a helmet.  Now they do not, because head injuries use a lot of medical resources, some of those — probably nearly all, now — are provided by public money, and helmet protection is a reasonable requirement.  That has been accepted by most motorcycle associations, reluctantly by some. But surely that argument is far more reasonable than one substituting a public official’s judgment for that of a citizen when it comes to the use of SAMe — or snake oil, for that matter.

The discussion is not unimportant; perhaps it should be transferred to another topic,

That was too much. A SFWA moderator, backed by the officer who had requested that the discussion halt, locked the conference, and it sits in frozen silence. The reason given was that it was too personal, and I was privately informed that there were complaints about me. Since I named no one at any time, I mildly protested that I was unaware of what was personal about it that would be personally offensive to professional writers voluntarily reading a topic no one could possibly feel required to read.

The answer I got was that these discussions upset some members, and that a SFWA forum was no place for political discussions at all. And that’s the point: we have come to this, that a professional writers’ association finds that we can no longer have discussions that include politics because some members (who voluntarily read the topic) find it upsetting, and toxic, presumably because they disagree with the opinions expressed. For the life of me I cannot tell you what professional science fiction writer would find anything I said there personally offensive. Disagree, yes, of course; many disagree; that is to be expected, and it is those the FDA will rally to support the proposition that the FDA should insist that generic prescription of Name Brand drugs whose patents have expired be forbidden until double blind tests of the generic drug’s effectiveness have proved its effectiveness.

I think health care costs can be drastically lowered by letting doctors have more room to try different remedies; obviously only with informed consent of the patient, but medical associations I would suppose will work to assure that; but apparently the entire discussion can’t be discussed in a science fiction professional organization because some members are upset over encountering opinions contrary to their own – and if it can’t be discussed there, where the devil can it be discussed?

bubbles

I suppose another discussion of immigration enforcement is in order, but nothing will change physics: transporting ten million people to the borders will take time and many resources just to do; and the inevitable legal tangles will take more. Surely it’s best to start with the least desirable? In which case, do we have to let those who aren’t among the worst know they’re safe, at least for years? Or will that just make them bolder in protest rather than calming their fears? Perhaps a random process: undocumented immigrants arrested in a protest face a 5% chance of being deported? But that makes this a farce, and is not what we need.

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A new government? Or no government

Dr. Pournelle, hope that you are now on top of the cold or whatever it is… seems to be an epidemic around Northwest Florida as well.
This comes from Sign of the Times (https://www.sott.net/article/345144-A-week-in-the-life-of-the-American-kleptocracy) I submit this without any ability whatsoever to vet or verify. The salient quote seems to me to be this:
“This begs the question: if the government is overstepping its authority, abusing its power, and disregarding the rule of law but no one seems to notice—and no one seems to care—does it matter if the government has become a tyrant?
Here’s my short answer: when government wrongdoing ceases to matter, America will have ceased to be.”
In this article our current form of government is represented as a “Kleptopcracy” meaning a rule by thieves and enforced by “techotyrany” (ie: CIA, NSA).
The examples quoted range far and wide but all seem to tie into our current political malaise and mistrust of government in general.
John Thomas

 

I am no anarchist, nor am I Liberal or Libertarian; and having been read out of the Conservative movement I feel no need to defend them. I do think there are elements of a ship that exists only to serve its crew in what we have at present. And Bunny Inspectors?

bubbles

WikiLeaks and Umbrage

Dear Mr. Pournelle,
I’ve been following a useful series of articles in the (London) Times regarding Russian cyberwarfare. An article this Sunday caught my attention (http://www.thetimes.co.uk/past-six-days/2017-03-12/focus/yo-bro-im-totally-watching-you-zcxtckcq9) Here are a few brief quotes.
‘But perhaps the most significant element of the cache was the claim by WikiLeaks that the CIA’s “umbrage” division” had been “fabricating” Russian hacks against the West. …
‘One British intelligence source told The Sunday Times that this was the key “revelation” in the WikiLeaks dump, and would be used to discredit western-backed allegations about Russian cyber-attacks on Britain and the U.S.
‘The source added: “Winston Churchill famously once said: ‘In wartime, truth is so precious that she should always be attended by a bodyguard of lies.’
“In the Russian manual of disinformation, lies are so precious they should always be attended by a bodyguard of truth. Assange’s Russian masters have inserted a conspicuous lie in these documents, which are otherwise largely accurate.
“Wikileaks claims that the Americans have stolen Russian cyber-weapons are are now using them. Doubtless this line of defense will be used in Washington in the coming months by parties with an interest in muddying the waters.”
‘The party with the greatest interest in Washington in “muddying the waters” is Russia …’
And further down:
‘Michael Hayden, former CIA director, said “I’m now pretty close to the position that WikiLeaks is acting as an arm, as an agent, of the Russian Federation.”‘
I would use WikiLeaks as a source of information extremely cautiously; if at all.
Yours,
Allan E. Johnson

I distrust most intelligence sources; one of my jobs was once to sort out credible technological threats. There is a strong incentive for spies to find what they’re looking for. And of course an astonishing number of agents on the other side are turned by ours, leading to the obvious speculation…

bubbles

Health Insurance

Dear Dr Pournelle,

So far I have resisted the temptation to comment on the Trump Presidency. But the following comments on Obamacare vs Trumpcare might be of interest.

The Irish healthcare system is hardly ideal, in fact it’s a shambles. Public healthcare (funded from general taxation) is great for certain things but not so good when there’s a shortage of hospital beds or specialists. Private healthcare, which is funded by individuals who can afford to pay the premium, effectively allows you to jump the queue and get a better level of care. We have several providers in Ireland.

While private health insurance is frequently paid for or subsidised by employers, it’s not tied to the job. So if I quit work or change jobs, I can contact the insurer and agree to continue my payments and thus not break my cover. I can switch providers or change plan with no break in cover. If I am starting cover (for the first time or after a break in cover) or if I increase my level of cover, then pre-existing conditions are excluded for a minimum of 6 months. So buying cover right after I find a nasty lump won’t work.

This isn’t all ideal. While healthcare in Ireland is typically 5x cheaper than the US, some specialised treatments and drugs are not available. And even the private system can have capacity issues. Premium costs are going steadily up. Public healthcare staff here move to other countries where working conditions are better and salaries higher.

I do not envy the legislators trying to sort out the system in the US. In Ireland there have been moves politically to eliminate the existing two-tiered system but so far nothing has come of it.

Best wishes,

Simon Woodworth.

I don’t envy them either. There must be ways to lower costs.

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Freedom is not free. Free men are not equal. Equal men are not free.

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