Latest Cato Research on Science and Public Policy https://www.cato.org/ en Americans Have Always Politicized Public Health https://www.cato.org/publications/commentary/americans-have-always-politicized-public-health Chelsea Follett <div class="lead mb-3 spacer--nomargin--last-child text-default"> <p>A deadly disease has emerged. There is no known treatment. Public opinion is split on how to tackle the outbreak. Those words could apply to the COVID-19 pandemic. In fact, they also apply to the yellow fever outbreak that swept through America’s capital city not long after the American Revolution. The 1793 episode shows us that the medical response to a&nbsp;crisis is easily politicized.</p> </div> , <div class="mb-3 spacer--nomargin--last-child text-default"> <p>Yellow fever is a&nbsp;viral disease that’s spread by mosquitoes. It often causes jaundiced or yellowed skin (hence its name), vomiting, bleeding and death. In the late summer of 1793, refugees from a&nbsp;yellow fever epidemic in the Caribbean fled to Philadelphia, which was then the capital city of the young United States of America. Their ships unfortunately also carried&nbsp;<em>Aedes aegypti&nbsp;</em>mosquitoes—vectors of the yellow fever virus.</p> <p>Within months, 11,000 people, or 20 percent of Philadelphia’s population at the time, contracted the disease. Of that number, around 5,000 people or 45 percent died. That amounted to about 10 percent of Philadelphia’s total population.</p> </div> , <aside class="aside--right aside--large aside pb-lg-0 pt-lg-2"> <div class="pullquote pullquote--default"> <div class="pullquote__content h2"> <p>As humanity tackles the serious, global problems presented by the current pandemic, we should learn the lessons of the past and know that beating COVID-19 will require clear heads and a&nbsp;reliance on reason and data. </p> </div> </div> </aside> , <div class="mb-3 spacer--nomargin--last-child text-default"> <p>For comparison, the World Health Organization has&nbsp;<a href="https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---3-march-2020" target="_blank">estimated</a>&nbsp;that the fatality rate for COVID-19 is 3.4 percent and a&nbsp;study in the British medical journal&nbsp;<em>The Lancet&nbsp;</em><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30185-9/fulltext%23tbl1" target="_blank">suggested</a>the fatality rate to be 3&nbsp;percent. Other estimates&nbsp;<a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30243-7/fulltext" target="_blank">claim</a>&nbsp;that the fatality rate is much lower than that. While experts are still unsure of the true fatality rate of the current pandemic, no research suggests it to be anywhere near what the Philadelphians endured in 1793.</p> <p>Philadelphia’s yellow fever epidemic understandably created a&nbsp;mass panic in the capital and prompted 17,000 people, including President George Washington and many other government officials, to leave the city and seek refuge in the countryside.</p> <p>Dr. Benjamin Rush, one of the&nbsp;signers of the Declaration of Independence, chose to remain in the city and tirelessly tended to the sick. It is said that he sometimes visited a&nbsp;hundred patients in a&nbsp;single day.</p> <p>Unfortunately, medicine was still primitive and many of Rush’s&nbsp;<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312212/" target="_blank">treatments</a>&nbsp;were counterproductive. They included bloodletting and prescribing calomel (i.e. toxic mercury chloride). Rush believed that his methods saved his own life from the illness. For most patients, however,&nbsp;Rush’s interventions almost certainly did more harm than good.</p> <p>Another Founding Father who chose to remain in Philadelphia was the then Secretary of the Treasury, Alexander Hamilton. Hamilton and his wife survived the disease and he attributed their recovery to comparatively mild treatments, including the quinine‐​rich&nbsp;bark&nbsp;of the cinchona tree. It is now known that quinine, a&nbsp;stimulant and malaria treatment, does not destroy the yellow fever virus. But it may have acted as a&nbsp;placebo.</p> <p>The question of yellow fever treatment quickly became political. Rush was a&nbsp;member of the Democratic‐​Republican Party, while Hamilton was a&nbsp;Federalist. Whether one favored mercury and bloodletting or milder treatments such as cinchona bark became a&nbsp;partisan issue.</p> <p>Which treatments Philadelphians read about depended on their preferred media outlet. The Federalist‐​sympathizing&nbsp;<em>Gazette of the United States</em>&nbsp;exclusively printed medical recommendations from Hamilton’s favored physician. The ostensibly impartial&nbsp;<em>Federal Gazette</em>&nbsp;<a href="https://www.jstor.org/stable/20093070?seq=1" target="_blank">overwhelmingly</a>&nbsp;published Rush’s advice and omitted conflicting viewpoints.</p> <p>The cause of the illness was also a&nbsp;partisan matter. The Democratic‐​Republicans believed that the disease was local in origin, while the Federalists blamed the recent refugees and their ships.&nbsp;“More than one‐​third of the most prominent national and local political leaders in Philadelphia took a&nbsp;public position on the cause of the epidemic,”&nbsp;<a href="https://www.jstor.org/stable/pdf/1917393.pdf?ab_segments=0%2525252Fbasic_SYC-5152%2525252Ftest&amp;refreqid=excelsior%25253A24a6b14124b9e8e73f32b66ce301f7fe" target="_blank">according</a>&nbsp;to University of Michigan historian Martin Pernick.&nbsp;“With few exceptions the [Democratic-]Republicans backed a&nbsp;domestic source of the fever, while Federalists largely blamed importation.”</p> <p>In that climate of extreme politicization, little progress was made toward finding an effective treatment. In the end, the yellow fever outbreak was defeated by luck—a cold winter killed off the disease‐​carrying mosquitoes and ended the epidemic. Over the years, as ships brought in more mosquitoes from abroad, other outbreaks of yellow fever flared up occasionally in coastal U.S. cities. A&nbsp;vaccine would not come into use until 1938.</p> <p>As the country combats the current pandemic, we should refrain from politicizing the issue and evaluate available treatments based solely&nbsp;on scientific evidence.&nbsp;Unfortunately, health policy discussions are often driven by party loyalty rather than evidence. Polling shows that opinions on the seriousness of the pandemic have become divided along partisan lines.</p> <p>Early on, President Donald Trump&nbsp;<a href="https://www.washingtonpost.com/graphics/2020/politics/trump-coronavirus-statements/" target="_blank">dismissed</a>&nbsp;the threat posed by COVID-19, and Republicans remain considerably&nbsp;<a href="https://www.nytimes.com/2020/03/13/us/politics/coronavirus-trump-polling.html" target="_blank">less worried</a>&nbsp;about the virus than Democrats. Nowadays, it is the Democrats who stand in the way of more rapid re‐​opening of the economy pushed by the Republicans. Of course, the true death rate of the novel coronavirus is still being studied, and hopefully political pressures will not hamper the search for the objective truth, whatever it may be.</p> <p>Treatments for COVID-19 have also become politicized. Remdesivir, a&nbsp;drug that combats Ebola, and hydroxychloroquine, an anti‐​malaria drug, are both being studied as possible COVID-19 treatments. In both cases, we have some initial ideas about their effectiveness, but more trials are needed to assess their efficacy against COVID-19. Yet&nbsp;<a href="https://www.wired.com/story/the-info-war-over-chloroquine-has-slowed-covid-19-science/" target="_blank">partisan fighting</a>&nbsp;about hydroxychloroquine has slowed down the process of determining the truth about that drug’s effectiveness against COVID-19. Let’s hope that similar pressures do not hamper further investigation of Remdesivir.</p> <p>As another example of politicization, consider the use of ultraviolet light against the virus. The method involves intermittently shining ultraviolet light through an endotracheal catheter, and is being explored as a&nbsp;potential treatment for coronavirus and other respiratory infections. After President Trump’s seeming endorsement of the technique, there has been a&nbsp;considerable&nbsp;<a href="https://www.wsj.com/articles/an-experimental-ultraviolet-light-treatment-for-covid-19-takes-political-heat-11588005938" target="_blank">backlash</a>&nbsp;against ultraviolet light therapies. Under pressure from political activists, YouTube and Vimeo removed videos about the experimental treatment, which is being studied at Cedars‐​Sinai Medical Center in Los Angeles. Similarly, Twitter suspended the account of a&nbsp;biotechnology company behind the new therapy.</p> <p>The research is still in an early phase, but it should not be dismissed purely on partisan grounds—whatever the current president’s opinion on the subject.</p> <p>We should not allow politics to drive what we believe about the virus or the best medical response, instead reviewing the available evidence with an open mind. Reflexively supporting or opposing a&nbsp;particular medical approach because of the endorsements of politicians makes no sense.</p> <p>The novel coronavirus pandemic may feel unprecedented, but of course humanity has&nbsp;<a href="https://humanprogress.org/article.php?p=2526" target="_blank">dealt</a>&nbsp;with the horrors of plagues and epidemics throughout history. As humanity tackles the serious, global problems presented by the current pandemic, we should learn the lessons of the past and know that beating COVID-19 will require clear heads and a&nbsp;reliance on reason and data.</p> </div> Wed, 20 May 2020 16:09:08 -0400 Chelsea Follett https://www.cato.org/publications/commentary/americans-have-always-politicized-public-health Elective Doesn’t Mean Non‐​Essential. Skip Sweeping Coronavirus Bans, Let Doctors Decide https://www.cato.org/publications/commentary/elective-doesnt-mean-non-essential-skip-sweeping-coronavirus-bans-let Jeffrey A. Singer <div class="lead mb-3 spacer--nomargin--last-child text-default"> <p>In my state of Arizona, Gov. Doug Ducey issued an executive order six weeks ago&nbsp;<a href="https://ktar.com/story/3091482/arizona-gov-doug-ducey-announces-elective-surgeries-to-resume-may-1/" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">banning elective surgeries</a>&nbsp;and procedures in order to conserve&nbsp;beds and equipment for an expected onslaught of COVID-19 patients. These orders have been in force&nbsp;<a href="https://www.beckersasc.com/asc-transactions-and-valuation-issues/35-states-canceling-elective-procedures.html" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">across the country</a>, and yet here&nbsp;and in&nbsp;<a href="https://abc7news.com/health/the-surge-that-never-came-leads-to-pay-cuts-for-some-bay-area-healthcare-workers/6121276/" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">many</a>&nbsp;other&nbsp;<a href="https://www.bridgemi.com/michigan-health-watch/beaumont-hospital-near-detroit-reopen-coronavirus-surge-never-came" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">areas</a>,&nbsp;the&nbsp;<a href="https://whyy.org/articles/philly-spends-5-million-on-coronavirus-surge-hospital-that-admitted-14-patients/" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">onslaught</a>&nbsp;never&nbsp;<a href="https://spectrumnews1.com/oh/columbus/news/2020/04/16/ohio-s-3-covid-19-emergency-surge-hospitals-remain-unused-" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">materialized</a>. Instead, hospitals are&nbsp;<a href="https://www.azcentral.com/story/news/local/arizona-health/2020/04/10/covid-19-arizona-draining-health-care-providers-coffers-coronavirus/2966972001/" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">half full</a>&nbsp;or&nbsp;<a href="https://www.newsweek.com/most-us-hospitals-are-empty-soon-they-might-closed-good-opinion-1500028" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">less</a>, and are furloughing or laying off nurses and other staff.&nbsp;<a href="https://www.newsweek.com/most-us-hospitals-are-empty-soon-they-might-closed-good-opinion-1500028" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">Likewise</a>&nbsp;in&nbsp;<a href="https://www.vox.com/2020/4/8/21213995/coronavirus-us-layoffs-furloughs-hospitals" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">other</a>&nbsp;parts of the country. Hospitals and private medical practices in small towns and rural areas are&nbsp;<a href="https://www.cnbc.com/2020/03/31/coronavirus-closures-could-ruin-rural-hospitals-medical-practices.html" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">struggling</a>&nbsp;to keep their doors open.</p> </div> , <div class="mb-3 spacer--nomargin--last-child text-default"> <p>What many people don’t know is that “elective” does not mean “non‐​essential.” It means the procedures can be planned instead of being rushed as an emergency.</p> <p>When elective procedures are restricted or discouraged, patients can suffer. Some are in pain from abdominal conditions. Others wait weeks for&nbsp;<a href="http://www.montgomeryherald.com/news/article_710cf660-8fb9-11ea-abc8-e3638cf14e5e.html" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">possibly malignant tumors</a>&nbsp;to be evaluated.&nbsp;<a href="https://www.usatoday.com/story/news/health/2020/03/23/cancer-patients-chemo-during-coronavirus-outbreak-canceled-appointments/2897880001/" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">Cancer</a>&nbsp;patients see&nbsp;<a href="https://health.usnews.com/conditions/articles/coronavirus-and-cancer-patients" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">chemotherapy</a>&nbsp;and other treatments interrupted. People remain immobilized awaiting hip replacement surgery or are deterred by blinding cataracts. Non‐​emergency&nbsp;<a href="https://www.cardiovascularbusiness.com/topics/practice-management/covid-19-pandemic-coronavirus-cath-labs-cardiology" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">cardiac catherizations</a>&nbsp;have to wait, as patients hope they won’t get a&nbsp;heart attack in the meantime.&nbsp;Cancer screening colonoscopies don’t get done.</p> </div> , <aside class="aside--right aside--large aside pb-lg-0 pt-lg-2"> <div class="pullquote pullquote--default"> <div class="pullquote__content h2"> <p>Not all elective procedures are equal. Doctors should have the discretion to decide which are necessary, even during a&nbsp;pandemic like coronavirus. </p> </div> </div> </aside> , <div class="mb-3 spacer--nomargin--last-child text-default"> <p><strong>Not all elective procedures are equal</strong></p> <p>A few of the&nbsp;governors are&nbsp;<a href="https://www.usatoday.com/story/news/health/2020/04/19/coronavirus-lockdown-reopening-states-us-texas-florida/5155269002/" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">relaxing the bans</a>, at least partially.&nbsp;My state ban was provisionally and gradually lifted May 1, but in some cases the damage may be too far along to repair.</p> <p>Even when it comes to&nbsp;elective procedures, one size does not fit all. As a&nbsp;general surgeon, I&nbsp;see patients with hernias that are only mildly symptomatic and have a&nbsp;minimal risk of strangulating. They can be scheduled weeks to months down the road. But I&nbsp;also see patients with uncomfortable gallbladder problems that prevent them from eating without pain&nbsp;or run a&nbsp;high risk of having gallstones obstruct the liver. They need surgery more promptly. Some patients present with masses in their abdomen, soft tissue&nbsp;or lymph nodes that might be malignant. For them, a&nbsp;procedure needs to be scheduled in a&nbsp;matter of days, not weeks or months.</p> <p>Patients needing elective procedures and treatments are not the only people impacted by this centralized approach to managing the COVID-19 attack. Patients have been urged to avoid visits to the doctor’s office or emergency room. The Medical University of South Carolina&nbsp;<a href="https://www.greenvilleonline.com/story/news/2020/03/18/should-you-go-your-routine-medical-appointment-during-coronavirus-outbreak-pandemic-doctor-advice/2864003001/" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">recommended</a>&nbsp;delaying non‐​critical or routine appointments. Orthopedists are even encouraging some patients with&nbsp;<a href="https://www.wxyz.com/news/coronavirus/doctors-urge-patients-with-broken-bones-to-avoid-emergency-rooms" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">broken bones</a>&nbsp;to stay home. Consequently, patients forgo important preventive maintenance of chronic health conditions or&nbsp;<a href="https://www.nytimes.com/2020/04/25/health/coronavirus-heart-stroke.html" target="_blank" rel="noopener" data-t-l="|inline|intext|n/a">fail to seek help for acute ones</a>. The resultant delay in crucial care is another unintended, and possibly fatal, consequence of top down policy.</p> <p>In my more than 35&nbsp;years in practice as a&nbsp;general surgeon, I’ve never witnessed a&nbsp;statewide ban imposed on elective procedures. Prior to the COVID-19 pandemic, it was not unusual for the Centers for Disease Control and Prevention to give advance notice to local public health officials and hospitals of an expected severe flu season that might overwhelm the health care system. The hospital administrators would then inform the medical staff and ask us to be very judicious when we schedule elective procedures. We willingly complied. But judicious meant&nbsp;we were trusted to use our judgment regarding things that could&nbsp;wait and things that really shouldn’t be postponed. And as the strain on the hospitals would abate, the administrators would signal us to resume more liberal scheduling.</p> <p><strong>Sweeping bans aren’t the answer</strong></p> <p>With a&nbsp;one‐​size‐​fits‐​all ban imposed statewide by a&nbsp;centralized bureaucracy, it is impossible to adjust policy to fit the specific circumstances of each patient. Explaining to my hospital administrator why my patient’s hernia operation can’t wait four more weeks won’t do any good. After an official request to my hospital&nbsp;administration, I&nbsp;must sign an attestation that the procedure is an emergency, which my hospital needs in order to ensure that Ducey and Arizona’s Department of Health Services don’t punish the hospital for violating the ban on elective surgery. This kind of problem should be resolved more easily at the site, by discussions between hospital administrators and medical staff.</p> <p>In previous viral outbreaks, hospital administrators provided daily updates about their patient census and capacity, informing us of their ability to handle elective procedures. As hospitals in different regions of a&nbsp;state saw the surge in flu patients abate at different rates, each would inform their medical staff about liberalizing elective procedures accordingly.</p> <p>Statewide bans are less flexible. Maneuvering them can be like turning a&nbsp;battleship around. Decisions about lifting the bans are influenced by political as well as public health factors. Fear of public criticism fuels a&nbsp;tendency for politicians to be overly cautious. Bans are lifted across the board&nbsp;as opposed to being individualized and locally calibrated.</p> <p>Before governors began imposing anything resembling lockdowns on their state populations, the private sector had already taken major steps toward social distancing. Festivals and other events were canceled, professional sports leagues postponed or canceled their seasons&nbsp;and businesses were ordering their employees to work from home. This was all voluntary. Given good information and proper guidance by public health officials, the private sector and civil society can respond quickly and nimbly to a&nbsp;public health challenge like the one we face today.</p> <p>As past experience shows, the health care sector is no exception. Governors should leave the matter of elective procedures to the judgment of those on the front lines.</p> </div> Thu, 07 May 2020 13:18:16 -0400 Jeffrey A. Singer https://www.cato.org/publications/commentary/elective-doesnt-mean-non-essential-skip-sweeping-coronavirus-bans-let COVID-19 Should Make Us Grateful for Technology https://www.cato.org/publications/commentary/covid-19-should-make-us-grateful-technology Marian L. Tupy <div class="lead mb-3 spacer--nomargin--last-child text-default"> <p>In&nbsp;a&nbsp;way, everything is technology,” noted one of the world’s greatest economic historians, Fernand Braudel, in his monumental study<em>&nbsp;Civilization and</em>&nbsp;<em>Capitalism</em>. “Not only man’s most strenuous endeavors but also his patient and monotonous efforts to make a&nbsp;mark on the external world; not only the rapid changes … but also the slow improvements in processes and tools, and those innumerable actions which may have no immediate innovating significance but which are the fruit of accumulated knowledge,” he continued. Yes, land, labor, and capital (that’s to say, the factors of production) are important components of economic growth. In the end, however, human progress in general and global enrichment in particular are largely dependent on invention and innovation. That is surely even clearer now that humanity’s hopes for the end of the pandemic and for our liberation from the accompanying lockdown rest on further scientific breakthroughs within the pharmaceutical industry. Let’s take a&nbsp;brief look at the impact of technology on health care, food supply, work, and sociality in the time of COVID-19.</p> </div> , <div class="mb-3 spacer--nomargin--last-child text-default"> <p><strong>HEALTH CARE</strong><br> The impact of modern technology is surely most keenly felt and anticipated within the sphere of human health care. Consider some of the worst diseases that humanity has had to face in the past. Smallpox, which is thought to have killed an estimated 300 million people in the 20th century alone, originated in either India or Egypt at least 3,000&nbsp;years ago. Smallpox variolation, it seems, was practiced in China in the tenth century, but it was not until the late 18th century that Edward Jenner vaccinated his first patient against the disease. Smallpox was fully eradicated only in 1980. Similar stories could be told about other killer diseases. Polio, which can be seen depicted in Egyptian carvings from the 18th dynasty, is of ancient origin. Yet the disease wasn’t properly analyzed until the year of the French Revolution, with Jonas Salk’s vaccine appearing only in 1955. Today, polio is close to being eradicated (just 95 cases were reported in 2019).</p> <p>Malaria, probably humanity’s greatest foe, is at least 30 million years old (the parasite has been found in an amber‐​encased mosquito from the Paleogene period). It was only after the discovery of the New World that knowledge about the fever‐​reducing benefits of the bark of the cinchona tree spread to Europe and Asia. Quinine was first isolated in 1820, and chloroquine was introduced in 1946. Artemisinin drugs, which we still use, were discovered in the late 1970s. That’s to say that humanity lived with deadly diseases for millennia without fully knowing what they were, how they were transmitted, and how they could be cured. The fate of humanity, our ancestors thought, fluctuated under the extraneous influence of the “wheel of fortune” and there was nothing that anyone could do about it. One day you were alive and next day you were not.</p> </div> , <aside class="aside--right aside--large aside pb-lg-0 pt-lg-2"> <div class="pullquote pullquote--default"> <div class="pullquote__content h2"> <p>Let’s take a&nbsp;brief look at the impact of technology on health care, food supply, work, and sociality in the time of COVID-19. </p> </div> </div> </aside> , <div class="mb-3 spacer--nomargin--last-child text-default"> <p>Contrast that glacial pace of progress, and the fatalistic acceptance of disease and death, with our response time to the current pandemic. The Wuhan Municipal Health Commission reported the existence of a&nbsp;cluster of cases of “pneumonia” in Wuhan on December 31. On January 7&nbsp;the Chinese identified the pathogen (novel coronavirus) responsible for the outbreak. On January 11 China sequenced the genetic code of the virus, and the next day it was publicly available. That enabled the rest of the world to start making diagnostic kits to identify the disease. To take one example, the first COVID-19 infection in South Korea was identified on January 20. On February 4, the first test kit (made by Kogene Biotech) entered production. On February 7, the test kit was available at 50 locations around the country. Other countries followed suit.</p> <p>The World Health Organization, which declared COVID-19 a&nbsp;global pandemic on March 11, may have acted too late. Still, it is noteworthy that just two months expired between the first sign of trouble and the time when the entire world put measures in place to retard the spread of the disease. In the meantime, we have learned a&nbsp;lot about governmental incompetence and regulatory overreach. But we have also learned a&nbsp;great deal about the spread and symptoms of the disease. Instead of starting from scratch, medical specialists in Europe and America can draw on the expertise of their colleagues in the Far East. Before the telegraph appeared midway through the 19th century, it took up to a&nbsp;month for a&nbsp;ship to carry information from London to New York. Today, we learn about the latest COVID-19 news (good and bad) and research in seconds.</p> <p>By mid April, thousands of highly educated and well‐​funded specialists throughout the world were using supercomputers and artificial intelligence to identify promising paths toward victory over the disease. Some 200 different programs are underway to develop therapies and vaccines to combat the pandemic. They include studies of the effectiveness of existing antiviral drugs, such as Gilead’s Remdesivir, Ono’s protease inhibitor, and Fujifilm’s favipiravir. The effectiveness of generic drugs, such as hydroxychloroquine and chloroquine, is also being evaluated. Takeda is hard at work on convalescent plasma (TAK-888) in Japan, while Regeneron works on monoclonal antibodies in the United States. New vaccines, such as Moderna’s mRNA‐​1273, Inovio’s INO-4800, and BioNTech’s BNT162, are under development.</p> <p>We don’t know which of these treatments (if any) will work, but here is what we can be sure of: There has never been a&nbsp;better time for humans to face and defeat a&nbsp;global pandemic. The world is richer than ever before, and money is what enables us to sustain a&nbsp;massive pharmaceutical industry and pay for highly sophisticated medical research and development. Coronavirus may be deadly, but it is not the bubonic plague, which had a&nbsp;mortality rate of 50 percent. Luckily, it is a&nbsp;far milder virus that has reawakened us to the danger posed by communicable diseases. Once the immediate crisis is behind us, researchers will collect billions of data from dozens of countries and analyze the different governmental responses to the pandemic. That knowledge will be deployed by governments and the private sector to ensure that best practices are adopted, so that next time we are better prepared.</p> <p><strong>FOOD</strong><br> When the Black Plague struck Europe in 1347, the disease found the local population ripe for slaughter. Following the close of the Medieval Warm Period at the end of the 13th century, the climate turned cold and rainy. Harvests shrunk and famines proliferated. France, for example, saw localized famines in 1304, 1305, 1310, 1315–17, 1330–34, 1349–51, 1358–60, 1371, 1374–75, and 1390. The Europeans, weakened by shortages of food, succumbed to the disease in great numbers.</p> <p>The people of yore faced at least three interrelated problems. First, the means of transport and the transportation infrastructure were awful. On land, the Europeans used the same haulage methods (carts pulled by donkeys, horses, and oxen) that the ancients had invented. Similarly, much of Europe continued to use roads built by the Romans. Most people never left their native villages or visited the nearest towns. They had no reason to do so, for all that was necessary to sustain their meager day‐​to‐​day existence was produced locally. The second problem was the lack of important information. It could take weeks to raise the alarm about impending food shortages, let alone organize relief for stricken communities. Third, regional trade was seldom free (France did not have a&nbsp;single internal market until the Revolution) and global trade remained relatively insignificant in economic terms until the second half of the 19th century. Food was both scarce and expensive. In 15th‐​century England, 80 percent of ordinary people’s private expenditure went for food. Of that amount, 20 percent was spent on bread alone. Under those circumstances, a&nbsp;local crop failure could spell the destruction of an entire community. (Those who think that COVID-19 exposed the fragility of modern society should look up the Great Famine.)</p> <p>By comparison, by 2013 only 10 percent of private expenditure in the United States was spent on food, a&nbsp;figure that is itself inflated by the amount Americans typically spend in restaurants. Speaking of restaurants, while most have been forced to close their doors, the restaurateurs use apps to deliver excellent food at reasonable prices. Moreover, months into the COVID-19 pandemic, the shops are, generally, well stocked and regularly replenished by the largely uninterrupted stream of cargo flights, truck hauling, and commercial shipping. Due to the miracle of mobile refrigeration, fresh produce continues to be sourced from different parts of the United States and abroad. Shortly before writing this piece, I&nbsp;was able to buy oranges from California, avocados from Mexico, and grapes from Chile in my local supermarket. Globalization may be under pressure from both the left and the right of the U.S. political spectrum, but should the pandemic impair U.S. agricultural production, many will be forced to acknowledge the benefits of the global food supply and our ability to import food from COVID‐​19‐​unaffected parts of the world.</p> <p>This extensive and, at this point, still sturdy supply chain is, of course, a&nbsp;technological marvel. Computers collate information about items on the shelf that are in short supply, adjust the variety and quantity of items shipped between stores, fill new orders, etc. And so, commerce that’s still allowed to go on goes on. So does charity. Feeding America, a&nbsp;network of more than 200 food banks, feeds tens of millions of people through food pantries, soup kitchens, shelters, etc. Since 2005, the organization has been using a&nbsp;computerized internal market to allocate food more rationally. Feeding America uses its own currency, called “shares,” with which individual food banks can bid on the foods that they need the most. Grocery‐​delivery services bring food to the doorsteps of those who cannot or do not want to leave their homes. The old and the infirm can also use phones, emails, and apps to call upon volunteers to do their shopping and delivery.</p> <p><strong>WORK</strong><br> The nature of work has changed a&nbsp;lot over the last 200&nbsp;years or so. Before the industrial revolution, between 85 percent and 90 percent of the people in the Western world were farm laborers. Their work was excruciatingly difficult, as witnessed by one 18th‐​century Austrian physician who observed that “in many villages [of the Austrian Empire] the dung has to be carried on human backs up high mountains and the soil has to be scraped in a&nbsp;crouching position; this is the reason why most of the young people are deformed and misshapen.” People lived on the edge of starvation, with both the very young and the very old expected to contribute as much as they could to the economic output of the family (most production in the pre‐​modern era was based on the family unit, hence the Greek term&nbsp;<em>oikonomia</em>, or household management). In those circumstances, sickness was a&nbsp;catastrophe: It reduced the family unit’s production, and therefore its consumption.</p> <p>The industrial revolution allowed people to move from farms to factories, where work was better paid, more enjoyable, and less strenuous (which is largely why people in poor countries continue to stream from agricultural employment to manufacturing jobs today). Moreover, wealth exploded (real annual family income in the United States rose from $1,980&nbsp;in 1800 to $53,018&nbsp;in 2016). That allowed for ever‐​increasing specialization, which included a&nbsp;massive expansion of services catering to the desires of an ever‐​more‐​prosperous population. The service sector today consists of jobs in the information sector, investment services, technical and scientific services, health care, and social‐​assistance services, as well as in arts, entertainment, and recreation. Most of these jobs are less physically arduous, more intellectually stimulating, and better paid than either agricultural or manufacturing jobs ever were. Crucially, many of these service‐​sector jobs can be performed remotely. That means that even in the midst of the government‐​imposed economic shutdown, some work (about a&nbsp;third, estimates suggest) can go on. The economic losses from COVID-19, in other words, will be astronomical, but not total.</p> <p>My own organization, for example, shut its doors in mid March. Since then, everyone has been scribbling away at home or appearing on news shows around the world via the Internet. All of us are in regular contact via the phone, Zoom, and Microsoft Teams. Other organizations are doing the same. As we already discussed, a&nbsp;great deal of shopping is taking place online. Shipping and delivery companies are expanding, with Amazon hiring 100,000 additional workers in the United States. Home entertainment, of course, has grown tremendously, with Netflix adding millions of new customers and expanding its offerings with thousands of new films and television shows. With over 30 million American children stuck at home, online learning companies are booming, and educators from high‐​school teachers to college professors continue to perform their jobs remotely. Telehealth is expanding, allowing patients to see their doctors in a&nbsp;safe and convenient way. Even minor medical procedures, such as eye exams, can be conducted remotely, and multiple companies will deliver your new specs to your front door. Banking and finance are still going on, with many people taking advantage of low interest rates to refinance their mortgages. Finally, the often unfairly maligned pharmaceutical industry is expanding as we all wait and hope for the release of a&nbsp;COVID-19 vaccine or effective therapeutic treatment.</p> <p><strong>SOCIALITY</strong><br> Aristotle observed that “man is by nature a&nbsp;social animal” and noted that without friends we would be unhappy. But the role of sociality (that is to say, the tendency to associate in or form social groups) goes much deeper than that. As William von Hippel explained in his 2018 book&nbsp;<em>The Social Leap</em>, sociality is the mechanism by which&nbsp;<em>Homo sapiens</em>&nbsp;came about. When early hominids were forced down from the trees (perhaps as a&nbsp;result of a&nbsp;climatic change that dried up African forests), they became more vulnerable to predators. To cover longer distances between the fast‐​disappearing trees while maintaining a&nbsp;modicum of protection against other animals, our ancestors developed bipedalism, which allowed them to free their upper body to carry weapons such as sticks and stones.</p> <p>Even more important was the invention of cooperation. While a&nbsp;stick‐​wielding ape is slightly better‐​off than an unarmed one, a&nbsp;group of armed apes is much better at dispatching predators. Individuals in more cooperative bands survived to adulthood and bred more often, resulting in more‐​cooperative species. Furthermore, since living alone was tantamount to a&nbsp;death sentence, selfish apes who didn’t care about being ostracized for not pulling their weight died off, resulting in a&nbsp;desire for communal cooperation and a&nbsp;deep‐​rooted fear of rejection by the group.</p> <p>The early hominids had brains more like those of chimps than those of modern humans. That’s because the evolutionary pressures that created the former — such as predation and food scarcity — could be overcome without tremendous intelligence. These pressures to survive were part of the physical landscape — a&nbsp;challenging but static environment that didn’t require a&nbsp;lot of cognitive ability to navigate. The environmental pressure that resulted in modern humans was the social system itself. The social landscape is much more dynamic than the physical one. Once they had banded together in groups, our ancestors were forced to forge relationships with, and avoid being exploited by, individuals with divergent and constantly shifting interests. Those who couldn’t keep up with the increasingly complex social game either died or were unable to mate.</p> <p>This new pressure created a&nbsp;positive evolutionary cycle: Banding together created more complex social systems, which required bigger brains; bigger brains needed to be fed; and the best way to get more food was more cooperation and a&nbsp;more sophisticated social system. The main cognitive development that evolved from this evolutionary cycle is known as the “theory of mind.” In short, the theory of mind is the ability to understand that other minds can have different reasoning, knowledge, and desires from your own. While that seems basic, the theory of mind distinguishes us from all other life on Earth. It allows us to determine whether an affront, for example, was intentional, accidental, or forced. It allows us to feel emotions such as empathy, pride, and guilt — abilities that are keys to a&nbsp;functioning society.</p> <p>So sociality and human beings are inseparable, as we have all been clearly reminded by the sudden restrictions on our ability to interact with others. As we sit at home, working away on our computers or watching television, most of us feel a&nbsp;tremendous sense of isolation (“social distancing”) from our family, friends, and colleagues. The urge to be around others is innate to us. It is who we are. Dissatisfied with impersonal modes of communication, such as email and texting, we have rediscovered the need for a&nbsp;face‐​to‐​face interaction with our fellow humans. To that end, we utilize digital platforms such as Zoom, Google Hangouts, Facebook Live, and FaceTime to catch up on the latest news in other people’s lives, or simply to complain about the misery of loneliness and the pathetic inadequacy of our public officials (of both parties). Throughout the nation, people engage in virtual happy hours, dinners, book clubs, fitness classes, religious services, and group meditation. As my Cato Institute colleague Chelsea Follett recently wrote, “Technology has made it easier than ever to hold a&nbsp;physically‐​distanced ‘watch party’ synchronized so that viewers in different locations see the same part of a&nbsp;movie at the same time. For those who like to discuss movies as they watch, technology also enables a&nbsp;running group commentary of each scene in real time.” In the saddest of cases, technology enables people to say goodbye to dying friends and relatives. In a&nbsp;very real sense, therefore, technology keeps us sane (or, at the very least, saner).</p> <p>Technology, then, allows us to cope with the challenges of the pandemic in ways that our ancestors could not even dream about. More important, technology allows our species to face the virus with grounds for rational optimism. In these dark days, remember all the scientists who are utilizing the accumulated store of human knowledge to defeat COVID-19&nbsp;in record time and all the marvelous (not to say miraculous) ways the modern world keeps us well fed, psychologically semi‐​balanced, and (in many cases) productively engaged.</p> </div> Thu, 30 Apr 2020 08:56:47 -0400 Marian L. Tupy https://www.cato.org/publications/commentary/covid-19-should-make-us-grateful-technology The Role of Science During Pandemic https://www.cato.org/multimedia/cato-daily-podcast/role-science-during-pandemic Terence Kealey, Caleb O. Brown <div class="mb-3 spacer--nomargin--last-child text-default"> <p>Why have some Asian nations performed so well relative to the United States in containing the coronavirus without nearly the devastating economic fallout? Terence Kealey argues that it comes down to prevailing attitudes about the role of science.</p> </div> Wed, 29 Apr 2020 17:46:27 -0400 Terence Kealey, Caleb O. Brown https://www.cato.org/multimedia/cato-daily-podcast/role-science-during-pandemic South Korea Listened to the Experts https://www.cato.org/publications/commentary/south-korea-listened-experts Terence Kealey <div class="lead mb-3 spacer--nomargin--last-child text-default"> <p>South Korea, the US and the UK all reported their first Covid‐​19 cases around the same time: on&nbsp;<a href="https://is.cdc.go.kr/upload_comm/syview/doc.html?fn=157965701876400.pdf&amp;rs=/upload_comm/docu/0030/" target="_blank">January 20</a>,&nbsp;<a href="https://www.cdc.gov/media/releases/2020/p0121-novel-coronavirus-travel-case.html" target="_blank">January 21</a>, and&nbsp;<a href="https://www.bbc.com/news/health-51325192" target="_blank">January 31</a>, respectively. How things unfolded from there, unfortunately for the US and UK, has been strikingly different.</p> </div> , <div class="mb-3 spacer--nomargin--last-child text-default"> <p>Today, South Korea is reporting less than 100 new cases a&nbsp;day, the UK is reporting around 4,000 new cases a&nbsp;day, and the US is reporting around 30,000. But while numbers in South Korea have fallen, in the US and UK they&nbsp;<a href="https://coronavirus.jhu.edu/data/new-cases" target="_blank">have been rising exponentially</a>&nbsp;(around 20,000 new cases a&nbsp;day a&nbsp;week ago, about 8,000 new cases a&nbsp;day a&nbsp;week before that). We don’t yet know if the exponential rise in the US has been halted or not, or whether the figure will plateau at around 30,000 new cases a&nbsp;day.</p> <p>Nonetheless, the great success story is South Korea, and we know how they did it: they tested.</p> <p>On December 31, 2019,&nbsp;<a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen" target="_blank">Chinese officials informed</a>&nbsp;the World Health Organization they had identified an unknown pneumonia, and on January 10, with impressive speed, Professor Yong‐​Zhen Zhang of Fudan University, Shanghai,&nbsp;<a href="http://virological.org/t/novel-2019-coronavirus-genome/319" target="_blank">published the virus’s RNA sequence</a>. (An RNA sequence can be used as the basis of a&nbsp;diagnostic test.)</p> <p>By February 4, Kogene Biotech of Seoul had not only developed one but had also&nbsp;<a href="https://asia.nikkei.com/Spotlight/Caixin/In-Depth-Why-South-Korea-is-winning-the-coronavirus-battle" target="_blank">had it approved</a>&nbsp;by the Korea Centers for Disease Control and Prevention (KCDC). And by February 10, was&nbsp;<a href="https://is.cdc.go.kr/upload_comm/syview/doc.html?fn=158129831690400.pdf&amp;rs=/upload_comm/docu/0030/" target="_blank">reporting its findings</a>&nbsp;on the first 2,776 people to have been tested.</p> <p>At that point, there were only 27 confirmed cases in South Korea, so — in another impressive demonstration of speed — the South Korean authorities tested each of them and, more importantly, isolated those who tested positive and monitored their contacts.</p> <p>Initially, the authorities were swamped by the numbers of people who needed testing, but South Korean officials have&nbsp;<a href="https://www.nytimes.com/2020/03/23/world/asia/coronavirus-south-korea-flatten-curve.html" target="_blank">tested contacts</a>&nbsp;of those who have been infected. The authorities have made tests freely available and set up drive‐​in stations,&nbsp;<a href="https://www.cnn.com/2020/03/02/asia/coronavirus-drive-through-south-korea-hnk-intl/index.html" target="_blank">modeled on</a>&nbsp;McDonald’s and Starbucks for anyone to use. Those who tested positive were then isolated, with the result that the epidemic was swiftly controlled without the country as a&nbsp;whole needing to be shut down.</p> <p>In the US and many other countries, however, a&nbsp;lack of testing kits prohibited the identification and isolation of individuals, so whole populations and whole economies have had to close down instead. By comparison, South Korea has been spared that fate partly by the government’s response and partly by the swift reaction of its biotech industry.</p> <p>After Kogene’s test was approved, a&nbsp;second company, Seegene,&nbsp;<a href="https://www.cnn.com/2020/03/12/asia/coronavirus-south-korea-testing-intl-hnk/index.html" target="_blank">got its own approved</a>&nbsp;on February 12, and two more, SolGent and SD Biosensor,&nbsp;<a href="http://www.koreabiomed.com/news/articleView.html?idxno=7561" target="_blank">got theirs approved</a>&nbsp;on February 27.</p> <p>Yet the US and many of its peers could have been prepared.</p> <p>President Barack Obama, for example, had established the Directorate for Global Health Security and Biodefense within the National Security Council, specifically to anticipate pandemics such as Covid‐​19. But two years ago, the&nbsp;<a href="https://www.washingtonpost.com/news/to-your-health/wp/2018/05/10/top-white-house-official-in-charge-of-pandemic-response-exits-abruptly/" target="_blank">Trump administration forced out&nbsp;</a>the directorate’s leadership and&nbsp;<a href="https://www.washingtonpost.com/opinions/2020/03/16/no-white-house-didnt-dissolve-its-pandemic-response-office/" target="_blank">fused its rump</a>&nbsp;into a&nbsp;new directorate for counterproliferation.</p> <p>Asked if the novel coronavirus had prompted him to reconsider his support for cuts to the Centers for Disease Control and Prevention, the National Institutes of Health, and the World Health Organization,&nbsp;<a href="https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-conference/" target="_blank">President Trump replied</a>, “I’m a&nbsp;business person — I&nbsp;don’t like having thousands of people around when you don’t need them. When we need them, we can get them back very quickly.”</p> <p>Yet the people who can tell Trump when he needs them are the very people he doesn’t like having around. If you wait for doctors by the bedsides to tell you lots of people have fallen ill, it’s too late to prevent a&nbsp;disease from becoming a&nbsp;pandemic.</p> <p>Trump’s lack of seriousness, compared with South Korean President Moon Jae-in’s, has been pointed.</p> <p>On January 30,&nbsp;<a href="https://english1.president.go.kr/Briefingspeeches/Speeches/747" target="_blank">President Moon was saying</a>&nbsp;that preventative “measures should be strong enough to the point of being considered excessive.” Trump, on the other hand, spent most of February saying the disease was no more of a&nbsp;threat than the flu, that it would suddenly disappear, and&nbsp;<a href="https://twitter.com/realdonaldtrump/status/1236634209516752896" target="_blank">would later blame&nbsp;</a>the “Fake News media” for criticism of his response.</p> <p>Britain under Boris Johnson has been as insouciant.&nbsp;<a href="https://www.youtube.com/watch?v=vOHiaPwtGl4#t=6m0s" target="_blank">Johnson advocated</a>&nbsp;striking a&nbsp;balance between restrictive measures and a&nbsp;strategy of “taking it on the chin,” under which increasing numbers of people would become infected until the virus would “move through the population.”</p> <p>But, as the interviewers protested during the very interview at which Johnson revealed his strategy, his policy was bound to fail because Britain’s hospitals, under its single‐​payer National Health Service, lacked the capacity to handle the influx.</p> <p>In pursuit of efficiency, Britain’s hospitals have&nbsp;<a href="https://www.euronews.com/2019/12/11/the-nhs-has-barely-survived-under-tories-boris-johnson-s-victory-death-death-knell-view" target="_blank">little spare capacity</a>, and it would take very few extra patients to swamp them. As, indeed, swiftly came to pass:&nbsp;<a href="https://www.cnn.com/2020/03/23/uk/uk-coronavirus-lockdown-gbr-intl/index.html" target="_blank">Britain has instituted</a>&nbsp;a&nbsp;virtual lockdown nationwide, while the US has issued federal guidelines on social distancing but continues to operate under a&nbsp;patchwork of state and local orders on what kinds of businesses can remain open and whether citizens can gather.</p> <p>Neither has gone as far as China’s&nbsp;<a href="https://www.cnn.com/2020/03/24/asia/coronavirus-wuhan-lockdown-lifted-intl-hnk/index.html" target="_blank">lockdown in Wuhan</a>, which included a&nbsp;ban on travel in and out of the area, unless citizens were rated as safe to move about by a&nbsp;phone app that tracked likelihood of infectious contact.”</p> <p>South Korea was sensitive to the dangers of the virus because of the country’s experience with SARS (severe acute respiratory syndrome coronavirus, which spread in 2002 and 2003) and MERS (the Middle East respiratory syndrome‐​related coronavirus of the 2015 South Korean outbreak).</p> <p>In establishing the Directorate for Global Health Security and Biodefense within the National Security Council, Obama evidently had hoped to preempt future pandemics, bringing US policy closer in line with more‐​prepared countries like South Korea. But perhaps he was flouting human nature. Perhaps we’re not very good, as a&nbsp;species, in learning from the experiences of others.</p> <p>In the 1722 “Journal of the Plague Year,” describing the bubonic plague in London in 1665, Daniel Defoe wrote of “the Supine Negligence of the People themselves, who during the long Notice, or Warning, they had of the Visitation, yet made no Provision for it.” When Trump recently said that Covid‐​19 was something “you can never really think is going to happen,” he may have been speaking for anyone who resists preparing for abstract dangers.</p> <p>The British populist politician Michael Gove in 2016 spoke for similar swaths in the UK when he declared that “people in this country have had enough of experts.” Yet the one politician who has come out this crisis well is President Moon Jae‐​in of South Korea, who listened very carefully to the experts. There may be a&nbsp;lesson there.</p> </div> Tue, 07 Apr 2020 09:37:19 -0400 Terence Kealey https://www.cato.org/publications/commentary/south-korea-listened-experts Coronavirus Testing Delays Caused by Red Tape, Bureaucracy and Scorn for Private Companies https://www.cato.org/publications/commentary/coronavirus-testing-delays-caused-red-tape-bureaucracy-scorn-private Jeffrey A. Singer <div class="lead mb-3 spacer--nomargin--last-child text-default"> <p>Chaos, disorganization and cluelessness describe the current state of COVID-19 testing in the United States. Doctors, hospitals and state labs give patients needing tests the&nbsp;<a href="https://urldefense.com/v3/__https:/www.syracuse.com/coronavirus/2020/03/in-syracuse-coronavirus-testing-runs-into-officials-confusion-and-doctors-reluctance.html__;!!PIZeeW5wscynRQ!8FruzFYkMXLCfQxm5oGEL9vvMpykz6odHVlRDSB2PNvewr700rEwXg3lc9WnEnqhikY$" target="_blank">runaround</a>, each pointing to the other as the place to get tested. Some people&nbsp;<a href="https://urldefense.com/v3/__https:/twitter.com/acarvin/status/1237864733786566658__;!!PIZeeW5wscynRQ!8FruzFYkMXLCfQxm5oGEL9vvMpykz6odHVlRDSB2PNvewr700rEwXg3lc9WnW0rH2rA$" target="_blank">self‐​quarantine for days</a>&nbsp;awaiting their results, only to be told the lab misplaced or bungled the test. As of March 11, the U.S. trailed most of the developed world in tests administered, with per capita&nbsp;<a href="https://urldefense.com/v3/__https:/www.statista.com/chart/21108/covid-19-tests-performed-per-million-of-the-population/__;!!PIZeeW5wscynRQ!8FruzFYkMXLCfQxm5oGEL9vvMpykz6odHVlRDSB2PNvewr700rEwXg3lc9WnDPDlKD4$" target="_blank">numbers</a>&nbsp;virtually the same as Vietnam’s.</p> </div> , <div class="mb-3 spacer--nomargin--last-child text-default"> <p>A rigid federal regulatory regime that fails to make use of the innovation, flexibility and speed of the private sector is largely to blame.</p> <p>Testing is essential to managing an epidemic. It allows public health officials to determine who is infected and needs isolation from others and which of their contacts need isolation, as well. Such information allows for more precise targeting of public health responses, making it possible to avoid quarantining the entire population and shutting down large swaths of the economy, as we have had to do.</p> <p>The Food and Drug Administration requires an onerous approval process to bring any test to market. Once the FDA granted “emergency use authorization” to the Centers for Disease Control and Prevention to distribute and conduct the coronavirus test that it had developed, the CDC took control of distributing and administering tests while the private sector and foreign‐​developed tests were kept out of the process during the crucial weeks between when the virus was first identified in December and when it started rapidly spreading among the American public. The obstacles to private‐​sector action are only now being lifted.</p> <p>“Emergency use authorization” is a&nbsp;scaled‐​down approval process that requires fewer criteria to be met to speed a&nbsp;test or treatment to market when time is of the essence. But even a&nbsp;more streamlined process&nbsp;<a href="https://www.bloomberg.com/news/articles/2020-03-12/a-berlin-biotech-company-got-a-head-start-on-coronavirus-tests" target="_blank">didn’t allow tests developed abroad</a>&nbsp;and&nbsp;<a href="https://www.politico.com/news/2020/03/06/coronavirus-testing-failure-123166" target="_blank">distributed by the World Health Organization</a>&nbsp;to make the grade. According to&nbsp;<a href="https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-4/" target="_blank">White House officials, the WHO test</a>&nbsp;was meant for research purposes and didn’t meet American quality control standards amid concern about incorrect results. Yet other countries have been using the test, suggesting our federal government let the perfect be the enemy of the good.</p> <p>As a&nbsp;result of the CDC’s being the sole organization to make and distribute the authorized test kits, the agency needed to strictly ration distribution. Because of the tight supply, the CDC initially set very restrictive criteria on testing individuals. To make matters significantly worse, by mid‐​February, the CDC had learned that many of its tests, for all the supposed focus on quality control, were inconclusive because of a&nbsp;<a href="https://urldefense.com/v3/__https:/www.washingtonpost.com/health/what-went-wrong-with-the-coronavirus-tests/2020/03/07/915f5dea-5d82-11ea-b29b-9db42f7803a7_story.html__;!!PIZeeW5wscynRQ!8FruzFYkMXLCfQxm5oGEL9vvMpykz6odHVlRDSB2PNvewr700rEwXg3lc9WnNuxoKPg$" target="_blank">flaw</a>&nbsp;in one of its components and needed to be fixed. Meanwhile, no competing manufacturers were ready to meet the increasing demand.</p> <p>The FDA should have sought to ameliorate the domestic shortage of test kits by granting authorization for tests already in use in other countries. However, the FDA doesn’t simply grant reciprocal approval of drugs or tests approved in other countries — they must go through an FDA&nbsp;<a href="https://www.fda.gov/media/83209/download" target="_blank">approval</a>&nbsp;process.</p> <p>In this country, many public health labs, private‐​sector organizations and universities grew anxious to develop their own tests. Yet the CDC&nbsp;<a href="https://urldefense.com/v3/__https:/www.cdc.gov/csels/dls/locs/2020/reminder_covid-19_diagnostic_testing.html__;!!PIZeeW5wscynRQ!8FruzFYkMXLCfQxm5oGEL9vvMpykz6odHVlRDSB2PNvewr700rEwXg3lc9Wn8rwG7fs$" target="_blank">warned</a>&nbsp;them not to do their own testing without first getting the emergency use authorization from the FDA, a&nbsp;cumbersome process that discouraged many from acting.</p> <p>Dr. Helen Chu, an infectious disease expert in Seattle working with the&nbsp;<a href="https://urldefense.com/v3/__https:/seattleflu.org/updates__;!!PIZeeW5wscynRQ!8FruzFYkMXLCfQxm5oGEL9vvMpykz6odHVlRDSB2PNvewr700rEwXg3lc9WnQjifQPM$" target="_blank">Seattle Flu Study</a>, began&nbsp;<a href="https://urldefense.com/v3/__https:/www.nytimes.com/2020/03/10/us/coronavirus-testing-delays.html__;!!PIZeeW5wscynRQ!8FruzFYkMXLCfQxm5oGEL9vvMpykz6odHVlRDSB2PNvewr700rEwXg3lc9WnoNbiecQ$" target="_blank">performing</a>&nbsp;COVID-19 tests on patients without FDA authorization. The FDA and the CDC warned her to stop. A&nbsp;defiant Chu and her colleagues found&nbsp;<a href="https://urldefense.com/v3/__https:/news.yahoo.com/seattle-lab-uncovered-washingtons-coronavirus-053628224.html__;!!PIZeeW5wscynRQ!8FruzFYkMXLCfQxm5oGEL9vvMpykz6odHVlRDSB2PNvewr700rEwXg3lc9WniMhbsfc$" target="_blank">several</a>&nbsp;cases in the Seattle area.</p> <p>Finally, on Feb. 29, the FDA&nbsp;<a href="https://urldefense.com/v3/__https:/www.washingtonpost.com/health/2020/02/29/new-fda-policy-will-expand-coronavirus-testing/__;!!PIZeeW5wscynRQ!8FruzFYkMXLCfQxm5oGEL9vvMpykz6odHVlRDSB2PNvewr700rEwXg3lc9Wnkeo0-Wo$" target="_blank">announced</a>&nbsp;it would fast‐​track the emergency use authorization for public‐ and private‐​sector labs by reducing several regulatory hurdles, such as shortening the&nbsp;<a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-new-policy-help-expedite-availability-diagnostics" target="_blank">length&nbsp;</a>of clinical trials needed for approval.</p> <p>Now private‐​sector labs are rising to the occasion. On Friday, the FDA approved a&nbsp;test by&nbsp;<a href="https://urldefense.com/v3/__https:/www.marketwatch.com/story/roche-coronavirus-test-gets-emergency-fda-approval-2020-03-13__;!!PIZeeW5wscynRQ!8FruzFYkMXLCfQxm5oGEL9vvMpykz6odHVlRDSB2PNvewr700rEwXg3lc9WnGge-iGI$" target="_blank">Roche</a>&nbsp;labs that can yield results in just a&nbsp;few hours on machines already in more than 100 labs across the country, which are able to process thousands of tests every 24&nbsp;hours. In many states, university medical centers also now have fast‐​tracked testing authorization. In Ohio, for example, the Cleveland Clinic and the&nbsp;<a href="https://urldefense.com/v3/__https:/www.wvxu.org/post/cincinnati-hospitals-coronavirus-we-are-prepared-we-are-collaborating-we-are-transparent*stream/0__;Iw!!PIZeeW5wscynRQ!8FruzFYkMXLCfQxm5oGEL9vvMpykz6odHVlRDSB2PNvewr700rEwXg3lc9Wn4Ln5P24$" target="_blank">University of Cincinnati</a>&nbsp;are operating “<a href="https://urldefense.com/v3/__https:/fox8.com/news/coronavirus/cleveland-clinic-university-hospitals-begin-drive-thru-coronavirus-testing/__;!!PIZeeW5wscynRQ!8FruzFYkMXLCfQxm5oGEL9vvMpykz6odHVlRDSB2PNvewr700rEwXg3lc9WnCA3cv0M$" target="_blank">drive‐​thru</a>” testing.</p> <p>Still, the U.S. is playing a&nbsp;major game of catch‐​up that it might lose. And we only need to take a&nbsp;look at South Korea to see how we could have been in a&nbsp;better position if we’d let private industry play a&nbsp;larger role in testing. Whereas the U.S. has run 26 tests per million members of the population thus far,&nbsp;<a href="https://www.statista.com/chart/21108/covid-19-tests-performed-per-million-of-the-population/" target="_blank">South Korea has run</a>&nbsp;more than 4,000 tests per million. There, new cases have been declining as public health authorities have been able to do a&nbsp;better job of early detection and isolation. They report a&nbsp;fatality rate of&nbsp;<a href="https://www.bbc.com/news/world-asia-51836898" target="_blank">0.7 percent</a>.</p> <p>South Korea’s testing capabilities are the result of years of working closely with the private sector to harness its advantages. Seoul enacted a&nbsp;<a href="https://urldefense.com/v3/__https:/www.propublica.org/article/how-south-korea-scaled-coronavirus-testing-while-the-us-fell-dangerously-behind__;!!PIZeeW5wscynRQ!8FruzFYkMXLCfQxm5oGEL9vvMpykz6odHVlRDSB2PNvewr700rEwXg3lc9Wn4H4SrIk$" target="_blank">reform</a>&nbsp;after a&nbsp;health crisis triggered by the Middle East Respiratory Syndrome in 2015, which allowed the government to give almost immediate approval to testing systems developed in the private sector in an emergency.</p> <p>It’s a&nbsp;sad irony that a&nbsp;country that prides itself on a&nbsp;tradition of free enterprise and “rugged individualism” has downplayed the value of private initiative and adopted a&nbsp;top‐​down government‐​run posture toward managing emergencies.</p> <p>Meanwhile, in bottom‐​up fashion, private “social distancing” initiatives — from the cancellation of events to self‐​quarantining to companies’ having their employees work remotely — fueled a&nbsp;rapid response by the general public to an unprecedented public health crisis.</p> <p>When the crisis ends, among its lessons should be a&nbsp;renewed respect for the power and beneficence of private institutions.</p> </div> Wed, 18 Mar 2020 08:43:21 -0400 Jeffrey A. Singer https://www.cato.org/publications/commentary/coronavirus-testing-delays-caused-red-tape-bureaucracy-scorn-private Coronavirus Has Come for Australia https://www.cato.org/publications/commentary/coronavirus-has-come-australia Doug Bandow <div class="lead mb-3 spacer--nomargin--last-child text-default"> <p>Sydney, Australia: The island that counts as a&nbsp;continent in the south Pacific suffered through a&nbsp;difficult summer. Massive bushfires hit Australia in December and January. In February came the rains. They helped extinguish the blazes still raging but caused massive flooding. All that remained were for swarms of locusts to appear.</p> </div> , <div class="mb-3 spacer--nomargin--last-child text-default"> <p>Instead, in March coronavirus, lately taking the name COVID-19, made a&nbsp;visit. After Home Affairs Minister Peter Dutton announced recently&nbsp;that he tested positive for the virus, most Australians probably would prefer the locusts. Most Americans probably would agree.</p> <p>Luckily, I&nbsp;arrived early during the period of plagues. I&nbsp;missed the worst of the fires but I&nbsp;got drenched in the rain, while spending the month in Sydney. I&nbsp;was scholar‐​in‐​residence at the Centre for Independent Studies, a (classical) liberal, or libertarian, think tank. Australia always is a&nbsp;wonderful place to visit. Outside events made this a&nbsp;particularly challenging time to go.</p> </div> , <aside class="aside--right aside--large aside pb-lg-0 pt-lg-2"> <div class="pullquote pullquote--default"> <div class="pullquote__content h2"> <p>Australians seem likely to avoid the chaotic and costly disorder now evident in Italy and Spain, and perhaps in transit to the U.S. It is a&nbsp;lesson which Americans should take to heart before the next crisis.</p> </div> </div> </aside> , <div class="mb-3 spacer--nomargin--last-child text-default"> <p>Although President Donald Trump apparently imagined, at least initially, that COVID-19 would be little worse than the common cold, the potential global impact of the coronavirus—becoming a&nbsp;true pandemic around the globe—was evident early. For reasons of cost and convenience, I&nbsp;originally planned to fly from Washington, D.C. to Sydney via Beijing. The itinerary was cheaper, I&nbsp;knew the airport well, and international transit was easy. I&nbsp;even had a&nbsp;Chinese visa if there were flight problems and I&nbsp;got delayed.</p> <p>As my departure date in January approached that evidently had become a&nbsp;very bad choice, so I&nbsp;switched airlines. By the time I&nbsp;traveled the U.S. had cut air travel to and from China. Australia did likewise.</p> <p>That was a&nbsp;tougher decision for Canberra than Washington. The president might love Chinese President Xi Jinping, but America’s own appears to be less than enamored of the Chinese—along with just about everyone else from every other country. One suspects that if he could have his way he would keep all foreigners out, at least if they did not come carrying bags of cash. Thus, for President Trump the China ban was win‐​win: appear tough and exclude foreigners.</p> <p>Australia can’t be quite so cavalier in its treatment of the People’s Republic of China. The PRC is the leading trading partner DownUnder. Business relationships are strong. Tourists are many. Chinese students fill universities—indeed, schools are warning that if that ban is not lifted soon, the rest of this academic year will be lost.</p> <p>Obviously, America’s ties to the PRC also are strong but matter much less to the economy. And with the two nations in a&nbsp;trade war relations have been more frayed as late. Hostility toward China remains lower in Australia. Still, the PRC’s role, especially moneyed meddling in politics, has created much unease in Australia. There also is concern over economic dependence on Beijing when the latter is aggressively pressing territorial claims in the region. Nevertheless, nuance is more the name of the policy game toward China.</p> <p><a href="https://nationalinterest.org/blog/korea-watch/5-reasons-donald-trump-cant-copy-south-koreas-coronavirus-strategy-133262" target="_blank">South Korea became another COVID-19 hotspot</a>. The U.S. government still has not imposed any controls on travel from the latter and little more than a&nbsp;week ago immigration control did not ask about recent travel there (in contrast to China and Iran). Stationing nearly 30,000 troops there complicates matters. In this regard, the Australians proved tougher. In early March, after I&nbsp;left DownUnder, Canberra barred entry to those who had been in the Republic of Korea and Italy; Australian citizens and permanent residents from those nations faced a&nbsp;14‐​day quarantine on returning. Explained Prime Minister Scott Morrison, the “ban is put in place because it affords the best protection and enables us to slow down the rate of transmission.”</p> <p>Japan, with extensive economic ties to both China and the ROK, has been desperately attempting to prevent an epidemic that would threaten the Olympics, which is just five months off. If Tokyo fails to halt the contagion Australia might have to sever travel with yet another regional partner and leading economy. This would leave the latter even more reliant on Southeast Asia, countries especially vulnerable to the disease’s spread given their relative poverty and poor health systems.</p> <p>DownUnder must be concerned about the possibility of international isolation. Having limited contact with China and South Korea, should Japan, to which Canberra is merely recommending against travel, join the ban list Australia would find itself cut off from the major economies of the region. With population and economy more than 15 times the size of Australia’s, the U.S. can better weather temporary autarky.</p> <p>As the government started isolating the country, I&nbsp;joined most Australians in spending February watching events that seemed afar: the Chinese city of Wuhan turning into a&nbsp;ghost town, the virtual end of air travel with China, the plight of the 3711 people imprisoned (“quarantined”) on the Diamond Princess cruise ship in Yokohama harbor, and scores of Australians repatriated and then placed in quarantine on Christmas Island.</p> <p>Despite hope that a&nbsp;very splendid isolation might protect them, Australians engaged in panic‐​buying of toilet paper even before I&nbsp;left. More recently shelves reportedly have been emptying of it, along with face masks and hand sanitizers, like in America. The coronavirus threat seemingly remains low—just 156 confirmed cases late last week—but the virus is present and spreading. There is Dutton, Australia’s equivalent of Attorney General William Barr. And Tom and Rita Hanks, who both tested positive while the former was shooting a&nbsp;film in country. Although they apparently were infected outside of the two main population centers of Sydney and Melbourne, that demonstrates the widespread nature of the threat of infection.</p> <p>Morrison, a&nbsp;Pentecostal Christian, is positioned at the right‐​side of the ruling Liberal‐​National coalition, which won an unexpected victory in national elections a&nbsp;year ago that mimicked Trump’s triumph, running up strong gains in rural and mining areas while sacrificing some urban/​suburban seats. However, Morrison is no Trump. The former is an essentially conventional politician, despite being out of sync with media and urban elites. He leads but does not dominate his party, which enjoys only a&nbsp;narrow majority in a&nbsp;parliamentary system. Most important, he does nuance and learns from mistakes.</p> <p>He took his family on an unannounced vacation to Hawaii amid the fires and unsurprisingly lost the verdict of the court of public opinion. In practice, his presence was unnecessary, but the optics were terrible. On February 28, the day I&nbsp;left town, a&nbsp;wiser Morrison triggered the government’s emergency plan on COVID-19. Rather than play down the challenge, he warned: “We believe the risk of global pandemic is very much upon us.” He spoke not of avoiding but preparing “for such a&nbsp;pandemic.”</p> <p>At the same time state and territorial health ministers met to go over logistics—preparing testing, stockpiling medicines, and opening clinics. The first was to ensure that tests were easily available and widespread. After Beijing released the genome, the government turned to private industry to ensure adequate testing capability. Even with all this effort there are fears of shortfalls as other countries limit exports of the kits. Washington’s response looks downright incompetent in contrast.</p> <p>Collecting drugs is to prepare for the worst cases. The clinics are to treat COVID-19 patients, reducing the burden on hospitals and emergency rooms. A&nbsp;University of Queensland virologist involved in the process, Ian Mackay, observed: “In terms of the amount of time and human hours that have gone into the planning, it’s massive.” Everyone hopes the extra effort won’t prove necessary. But no Australian wants to be in the Pacific equivalent of Italy or Spain.</p> <p>Or America. The disparity of effort makes me wish I&nbsp;was still sitting in my hotel room in Sydney.</p> <p>The Dutton and Hanks cases have added urgency to Australia’s effort. The minister merely met President Trump and several top White House aides. He undoubtedly has had significantly more contact with numerous Australian government officials. Hanks is a&nbsp;name recognizable worldwide; his infection demonstrates to all that truly no one is immune.</p> <p>Event cancellations have turned into a&nbsp;cascade. Some sports events are going forward without spectators. The government has banned gatherings of over 500 people and is “advising against” unnecessary foreign travel. However, so far universities plan to continue to hold classes, while dropping nonessential events.</p> <p>Moreover, the government announced the creation of a&nbsp;bipartisan national cabinet, sort of a “war cabinet,” made up of top national, state, and territorial officials to meet weekly. As Morrison explained: “Each and every state and territory represented here is completely sovereign and autonomous in the decisions they make, but what we have agreed to do together is to work together and be unified and is consistent and coordinated as possible in our national response. That means from time to time sharing resources. It means if there is a&nbsp;need to assist each other with various needs, then this group will work closely together to achieve that end.”</p> <p>Although getting 50 U.S. state governors together, in the same way, isn’t feasible, states should be communicating and coordinating. The degree of epidemic will vary by area and most of the practical issues created will be best addressed at the same level. Mutual cooperation, therefore, is essential.</p> <p>There are many broad similarities between the U.S. and Australia. Most Americans would feel comfortable living DownUnder, though the political spectrum is a&nbsp;notch or two to the left. When it comes to fighting COVID-19, however, there is little doubt that Canberra has done a&nbsp;better job. Australians seem likely to avoid the chaotic and costly disorder now evident in Italy and Spain, and perhaps in transit to the U.S. It is a&nbsp;lesson which Americans should take to heart before the next crisis.</p> </div> Mon, 16 Mar 2020 09:17:05 -0400 Doug Bandow https://www.cato.org/publications/commentary/coronavirus-has-come-australia Veronique de Rugy discusses COVID-19 on Reason TV https://www.cato.org/multimedia/media-highlights-tv/veronique-de-rugy-discusses-covid-19-reason-tv Thu, 12 Mar 2020 11:47:27 -0400 Veronique de Rugy https://www.cato.org/multimedia/media-highlights-tv/veronique-de-rugy-discusses-covid-19-reason-tv Terence Kealy on Scientocracy https://www.cato.org/multimedia/cato-audio/terence-kealy-scientocracy Tue, 03 Mar 2020 14:18:10 -0500 Terence Kealey https://www.cato.org/multimedia/cato-audio/terence-kealy-scientocracy The Future of Space https://www.cato.org/publications/policy-report/future-space Robert Zubrin, Berin Szóka <div class="lead mb-3 spacer--nomargin--last-child text-default"> <p>In his book <em>The Case for Space: How the Revolution in Spaceflight Opens Up a&nbsp;Future of Limitless Possibility</em>, <strong>Robert Zubrin</strong>, founder and president of the Mars Society, tells the amazing true story of a&nbsp;new generation of entrepreneurial endeavors in space, such as SpaceX and Blue Origin. He also lays out some bold predictions for the future. At a&nbsp;Cato book forum in October, Zubrin outlined that vision. <strong>Berin Szóka</strong>, president of TechFreedom, shares the enthusiasm for spaceflight but offered a&nbsp;dose of Hayekian humility about our ability to predict economic outcomes.</p> </div> , <div class="mb-3 spacer--nomargin--last-child text-default"> <p><strong>ROBERT ZUBRIN:</strong> This photo is something that many of you may have seen online. This is February 2018, the launch and landing of the Falcon Heavy by Elon Musk’s SpaceX. Now, anyone who saw this no doubt thought it was cool, but if you don’t know the background to this, you don’t know how cool this really was. Because in 2010, President Obama put together a blue-ribbon committee headed up by my old boss Norm Augustine, the CEO of Lockheed Martin, to evaluate whether George W. Bush’s moon initiative was possible within acceptable cost limits. They concluded that it was not. According to them, development of a heavy lift vehicle would take at least 12 years and cost at least, wait for it, $36 billion. Now Musk has done it in six years at a cost of less than $1 billion, and to cap it all, the thing is three-quarters reusable. So this launch was a shot heard round the world.</p> <p><img right="" data-src="https://www.cato.org/sites/cato.org/files/images/cpr-v42n1/cpr-v42n1-5-3.png" class=" lozad" />What Musk did has was not merely introduced a very desirable aerospace system but also proven a principle: that it is possible for a well-led entrepreneurial team to do things in a third the time of the federal government at less than a tenth the cost — things that previously it was thought only the governments of major powers could do. And not only that, but the private sector can do things that governments could not do at all despite 60 years of trying. And with that, SpaceX has set off an international space race. You have Jeff Bezos’s Blue Origin, Richard Branson’s Virgin Galactic, and even companies not led by billionaires using their discretionary cash in order to become immortal through historic achievement. Companies started by working engineers, people with no more means than most middle-class people but who managed to get investment.</p> <p>One incredible example is Rocket Lab, a New Zealand company founded by a working engineer, that mobilized $300 million in investment. They have reached orbit with a launch from New Zealand. This is not science fiction, folks. This is real stuff, and it’s really happening. New Zealand has no space program, but they’ve achieved this through the initiative of private citizens and investors. And since this race has been unleashed, it has shown that it is going to be self-driving. First of all, Musk himself, with his breakthroughs in reusability, has reduced the cost of space launch by a factor of five. The cost of space launch went down a lot from Sputnik through the Apollo landing as we became competent in the various space-flight technology and pretty much developed the whole bag of tricks during that 12 years of the initial space race.</p> <p>That was done by governments in the early era. They got the job done, and they reduced the price of space launch from millions of dollars a kilogram to $10,000 a kilogram. But there it stayed for 40 years until 2009. Between 2009 and 2019, as SpaceX has entered the field, it’s fallen from $10,000 a kilogram to $2,000 a kilogram. And Musk is trying to make even that price point obsolete. He’s working on a new propulsion system, a launch system called Starship, which will be fully reusable and will knock down the cost of space launch by another factor of three. So, we’re headed toward $700 a kilogram or even $500 a kilogram. And the cheaper launch is, the more launches there are going to be. That’s elementary economics. It’s cheaper, more people will do it.</p> <p>Last year, there were about a hundred satellite launches in the whole world. SpaceX got 24 of them. They got a quarter of the lot. This is one relatively small launch company compared to its competitors like United Launch Alliance, the joint operation of Boeing and Lockheed Martin. They did a quarter of the total number of launches worldwide in 2018 and, really, the majority of the world market that was open for bids. Most of the rest of those were China or Russia or other governments, so you couldn’t compete for it at all. Now, because of the lowering of launch costs, I think very quickly we’re going to see 200 or 300 satellite launches a year. That in turn will contribute to further lowering of launch costs, as the cost of launch is spread out over more launches. But also, it will contribute to the lowering of spacecraft costs, because they will be being produced in more numbers. Furthermore, the designers of spacecraft will be less conservative.</p> <p>For the past half century, the prevailing wisdom among spacecraft designers is don’t use anything that hasn’t been used before; because the launch is so expensive, you don’t want to risk your whole spacecraft for a 20 percent improvement in some system. So it became like the person who won’t see any movies he hasn’t seen before. That’s not the way to get a broad education, is it? That’s where spacecraft development has been stuck since the moon landings.</p> <p>But now there is another revolution that has been going on, really driven by technological developments outside the space community. That’s spacecraft miniaturization. We’re now seeing micro-spacecraft, 10-kilogram spacecraft, that can do things that previously it took a 1,000-kilogram spacecraft to do. They’re much smaller and lighter and therefore much cheaper to launch. They’re also cheaper to build. These are million-dollar spacecraft instead of hundreds of millions of dollars. And that’s another innovation which will facilitate the opening of space.</p> <p>That’s just what we’ve seen so far, in the past 10 years or so. I do believe, though, that if we’re going to make space travel comparable to air travel, it will still have to get much cheaper. Air travel from here to Los Angeles is maybe $5 a kilogram, not $500 a kilogram. How do we get there? You can’t do it with 300 satellite launches a year or something like that. But reusable launch vehicles open up a new market altogether, which is surface-to-surface flight on Earth. For the past 3,000 years, people have made money on the ocean. Some have made money actually taking wealth from the ocean, for instance, by fishing or mining. But far more wealth has been developed on the ocean by using the ocean as a global low-drag medium for commerce.</p> <p>The ocean connects ports across the world with less drag than is available on land. And that’s where the serious money in maritime activity has been. Well, space is a zero-drag medium connecting every point on Earth to every point. You can travel from anywhere on Earth to every other place on Earth in less than an hour if you go through space. Of course, this is unthinkable with expendable vehicles, but it becomes rational, or at least conceivable, with reusable vehicles. I’ve run the numbers.</p> <p>Now, we won’t see this everywhere to everywhere. It probably is going to have to be from ports, so you can launch offshore and land offshore and not have all the noise and rockets in the city. But the Starship, if it was used as a transport of this kind, could probably be feasible with a ticket price Los Angeles to Sydney of around $20,000.</p> <p>To be sure, that is more than I’ve ever paid for an airplane ticket! But that is the price of a first-class ticket from Los Angeles to Sydney right now. And all those people get is a tablecloth, a free drink, and a reclining bed. Whereas with this, you’re getting there in less than an hour instead of 15 hours, and you’re getting half an hour of zero gravity and the stars of space out your window. And now instead of hundreds of flights per year, we’re talking about the possibility of hundreds of flights every day.</p> <p>If you get a bigger market like this, then you can start making spacecraft components at costs comparable to other things. A rocket engine is less complex than your car, but your car costs $20,000 or something like that. A rocket engine, you’re not going to get one for less than millions. Why? Because one is a mass production item and the other isn’t. But if you start producing rocket engines, not in ones or twos, but in thousands, tens of thousands, then they become cheaper. Same thing for all the other flight systems, and this will open up the way for orbital commerce — things like orbital research labs, even orbital manufacturing. These were demonstrated in principle on the International Space Station but could not even remotely be commercial because of the tremendous costs of the space shuttle and also the bureaucracy of the space station. But now, if you’re talking about cutting the cost of access to orbit by an order of magnitude, and furthermore that means that there’ll be private space stations, which won’t put up four years of red tape before you can fly to your experiment on it and so forth, you’re going to start seeing that kind of stuff. That’s the future we have to look forward to because we’ve finally unleashed markets and entrepreneurism in space.</p> <p><strong>BERIN SZÓKA:</strong> It’s really an honor to be here. Dr. Zubrin’s book The Case for Mars inspired me in a very profound way when I read it in 2004. If you can remember that moment, Burt Rutan had just won the X Prize for becoming the first person to send a reusable vehicle with a person in it into space twice in two weeks. And that was a real moment — it felt like a second Sputnik. I was a young law clerk at that point. I had just graduated law school, and I read a lot of books, but the one that moved me most was The Case for Mars. It inspired me. A lot of that book is really about the power of ideas to inspire people. I think you’ll get that when you read this new book, <em>The Case for Space</em>, which I would highly recommend that you do. But what I would tell you from that experience, from getting so inspired by Dr. Zubrin’s previous book, is that what was happening at that point back in 2004 is really two distinct things.</p> <p>Prophecy is one thing, but timing’s quite another. So, my advice to all of you who are interested in this field is probably you shouldn’t quit your day jobs. You probably shouldn’t try to do what I tried to do, which was that I decided to build my legal career in space law and start an institute for space law and policy. ISLAP is the cleverest think tank name you’ve never heard of because, well, it didn’t get off the ground. It turned out there really wasn’t a market for that. I have done some space law work over the last 15 years, but it’s been very, very slow going. And that’s really the nature of this field. Dr. Zubrin may be right about everything he says, but I don’t think anybody in this room, including him, can predict how long any of these things will take.</p> <p>When he says, for instance, in one of the most inspiring passages of the book, that, “All of this can soon become attainable. A new force is broken loose, a new tree is growing. We have only to water it, foster it, clear its way upward and make sure that no one does anything to kill it” — in some sense, I think that’s true and I find that vision very compelling. I do consider him a prophet, but I quibble with the word “soon.” We really have no idea how long that’s going to take, and more importantly, we really don’t know what it’s going to look like. He describes a number of things that could be plausible scenarios, that could be plausible business models, and those things could happen. But if I have learned one thing about technology policy over the last 15 years of working in the field, it’s the point that — appropriately enough here in the F. A. Hayek Auditorium — the most fundamental thing for us to understand is just how little we can imagine about the future.</p> <p>The future really is an unknowable place, and there will be an infinite number of challenges to overcome. We don’t know how long it will take people to do those things, and most critically, we don’t which things will actually make money. Because at the end of the day, there are grand institutional forces at work here. Governments will do what they’re going to do. There are real national security issues at stake, and the national security of the United States is going to drive this country to invest in certain things, and that’s going to play an important role in what the settlement of the space frontier looks like. But at the end of the day, the promise that he describes, you can think of that as macroeconomics. Yes, there’s a new world that you can see from Spain in 1492, and there are all sorts of prophecies you could make about how that new world will be colonized or opened up or what that will look like, but nobody could possibly have imagined what it actually looked like because there really wasn’t any one master plan.</p> <p>It was a countless endless array of plans and endless iterations. And Dr. Zubrin knows that, to be sure. I’m not saying that he’s trying to design a single top-down technocratic future. But he is an engineer, and that mentality is hard to break, and it pops up throughout the book. He’s got particular plans that he’s particularly excited about, and I hope that they come true, but I don’t think that we’re going to get to space in any sort of clear path. I don’t think there is any bridge from here to there. There’s not a single there. The settlement of the space frontier — fundamentally at its best, it really ought to be about excitement, yes, and about what the future could look like, but at the same time, we need a kind of humility. We have to recognize that Julian Simon was right: the ultimate resource really is human ingenuity, and the resources of space are really only there for what we make of them.</p> <p>We’ll see what happens with them. I just caution everyone in reading the book and thinking about this not to fall prey to the particular obsession that people have with one way of doing something — the idea that Mars is our future and it’s the terraforming of Mars that’s going to happen. Because it creates a kind of confirmation bias. If you start from that premise, you end up reasoning backwards, and this comes across pretty clearly in certain parts of the book.</p> <p>But the question of what is the business model, what are the economics that will actually make that sustainable, is fundamentally impossible to answer from our perspective today. You can’t simply say, well, people will figure things out and that will drive innovation and that will support the business model. That may be true over the course of hundreds of years. But what will actually sustain development step by step, quarter by quarter, as companies have to justify the decisions they’re making, is marginal cost and marginal revenue. It’s the same economics that has driven our economy today and will always drive our economy. People have to make their businesses viable, and the challenges in doing that are really quite considerable.</p> <p>I’m a lawyer. I’m not an engineer. I don’t have a degree in nuclear physics. I suspect no one else here does besides Dr. Zubrin, so I’m not going to get into the kinds of debates with him that you would hear at a space conference where people who are actually engineers or actually physicists would say, “Well, you might underestimate how serious the proper radiation is to deal with, or the effects of microgravity.” I’ll just talk about a few things that I know something about. I’ve talked a little bit about economics. It’s a big part of what I do. The internet revolution is, I think, an important contrast to this, right? The internet revolution is in many ways very similar. It is about settling the electronic frontier. That’s why we have the Electronic Frontier Foundation. That’s why people think about cyberspace as a vast uncharted territory. But the single most important lesson to draw from that is that nobody could have imagined what the internet of today looks like from back in 1995 or 2000 or 2005, or even 2010 or 2015. It is constantly changing, and if I got up here today and told you the future is X, Y, and Z and artificial intelligence is going to do the following, I would of course be proven wrong, right?</p> <p>Now, there are some constants Dr. Zubrin can describe, and he does that very usefully. There are some important factors that really are just matters of physics, and they do lend themselves to certain kinds of launch architecture. For those reasons, this book is incredibly worth reading. It’s important to understand those things about the future, what it takes to get outside the Earth’s gravity, why the moon is an easier base of operations than the Earth is, and the like. All those things are essentially based on constants of physics. Those are things that an engineer is eminently qualified to talk about. But when it comes to making predictions about what will actually close business cases, I’m not qualified to do that. He’s not qualified to do that. We can do it notionally. It’s useful to think about those things, but don’t confuse those for predictions of what the future’s really going to look like step by step. It’s inherently going to be messier than that.</p> <p>And, so, then we come to my area of expertise. I’m a policy wonk; I’m a lawyer. I deal with what Congress does and how law works every day. And when I read a book like this, I inevitably see that when an author attempts to bring things down to today and to what this audience can do, the audience is encouraged. The readers are encouraged to do things like supporting private space companies. Because they are going to face a lot of obstacles, and he’s absolutely right. It’s really important and valuable for someone to tell a story as compelling as his. Where prophecy plays an important role is in inspiring people — inspiring people to go into careers. As the book points out, the number of people who got degrees in hard sciences went through the roof after the Apollo project.</p> <p>People like me were inspired by the success of Burt Rutan in 2004. People are being inspired today, and it’s similarly important to inspire people to make their voices heard in our democratic process to defend companies that are facing regulatory obstacles. That’s all very useful. But then it comes to the actual policy issues, and what exactly is it that we can do as policy matter? Now, once again, I agree with Dr. Zubrin about his suggestions for the most part. He’s absolutely right that the way that the government buys services today, on a cost-plus basis, completely skews the way that procurement works. It skews the nature of the space economy. Changing that would make a big difference. It’s not the silver bullet that’s somehow going to radically instantly change the market, but it will make a difference — an important difference on the margin. But that alone is not going to make private-sector businesses viable.</p> <p>NASA was designed to create jobs spread across as many congressional districts as possible. This is just a political reality. We could want it to change, but that’s not going to make it change overnight. So, while government can play a role here in being helpful, I think it’s a mistake to expect too much from government. Similarly, NASA having a better plan for how to get to the moon would make a difference. But fundamentally, my concern is what we might get is a repeat of the Apollo program, where we ultimately go and have what we in the space world call “flags and footprints.” We get excitement out of that and that has some value. But what really matters is jump-starting a sustainable private-sector presence where people can make money on a regular basis. And he does describe some scenarios where that could happen, but some of those scenarios really involve some pretty significant assumptions about what might happen in the future. I think there are significantly more difficult problems than the problems that SpaceX faced in trying to lower launch costs. So to say that this is all going to happen once certain technology is developed on Earth and it’s somehow going to just spark a revolution that settles the space frontier, I think that underestimates how difficult these problems are and how long it is going to take to solve them.</p> </div> Tue, 11 Feb 2020 17:18:37 -0500 Robert Zubrin, Berin Szóka https://www.cato.org/publications/policy-report/future-space Terence Kealey discusses government‐​funded science on Kibbe on Liberty https://www.cato.org/multimedia/media-highlights-tv/terence-kealey-discusses-government-funded-science-kibbe-liberty Sat, 01 Feb 2020 11:35:43 -0500 Terence Kealey https://www.cato.org/multimedia/media-highlights-tv/terence-kealey-discusses-government-funded-science-kibbe-liberty Burning Waters to Crystal Springs? U.S. Water Pollution Regulation over the Last Half Century https://www.cato.org/publications/research-briefs-economic-policy/burning-waters-crystal-springs-us-water-pollution David A. Keiser, Joseph S. Shapiro <div class="lead mb-3 spacer--nomargin--last-child text-default"> <p>In 1969, the Cuyahoga River in Cleveland, Ohio, ignited. Historically, this fire was unremarkable — rivers elsewhere in the United States had caught fire throughout the 19th and early 20th centuries, and the Cuyahoga had blazed at least 13 times since 1868. But the 1969 event attracted enormous attention and outrage, and the fire is often listed as one reason behind the passage of U.S. environmental laws in the early 1970s.</p> </div> , <div class="mb-3 spacer--nomargin--last-child text-default"> <p>The Cuyahoga has not burned since 1969 and is now home to 40 species of fish. But water pollution issues are not just a&nbsp;part of history. Today, more than half of U.S. rivers and lakes violate environmental standards, and 4–28 percent of Americans in a&nbsp;typical year receive drinking water from systems that violate health‐​based standards. Flint, Michigan, recently exposed 100,000 residents to dangerous levels of lead in drinking water. Contaminated drinking water leads an estimated 16 million Americans to suffer from gastrointestinal illnesses annually.</p> <p>Polls also suggest that water pollution has been Americans’ top environmental concern for at least 30&nbsp;years. Sixty percent of Americans today list drinking‐​water pollution and also river and lake pollution as great concerns. In every survey since 1989, the share concerned about these issues has substantially exceeded the share expressing concern about air pollution, climate change, or other environmental problems.</p> <p>The federal government sought to address these concerns by creating the Environmental Protection Agency (EPA) in 1970, the Clean Water Act in 1972, and the Safe Drinking Water Act in 1974. The Clean Water Act regulates “surface waters” — rivers, lakes, and some ocean areas. Whether the Clean Water Act regulates groundwater, which includes subsurface aquifers, is legally disputed. The Safe Drinking Water Act regulates drinking water, which includes groundwater or surface water that is purified by a&nbsp;drinking‐​water treatment plant and then transported by pipe to households and businesses.</p> <p>A half century later, these laws still manage U.S. surface and drinking water. Since 1970, the United States has spent approximately $4.8 trillion (in 2017 dollars) to clean up surface‐​water pollution and provide clean drinking water, or more than $400 annually for every American. In the average year, this accounts for 0.8 percent of the gross domestic product, making clean water arguably the most expensive environmental investment in U.S. history. By comparison, the average American spends $60 annually on bottled water.</p> <p>We ask four main questions: What forces led to these laws? How do they regulate pollution? How effective and efficient have they been? Why has recent economic research focused relatively little on water pollution, and what can remedy this lack of research? We illustrate that water pollution provides an excellent setting to learn about externalities, cost‐​benefit analysis, local public goods, fiscal federalism, regulatory design, nonmarket valuation, and other classic economic issues. Indeed, water pollution is a&nbsp;textbook example of an externality — introductory texts have long used the example of a&nbsp;plant dumping waste into a&nbsp;river and causing people downstream to suffer to illustrate the concept of externalities.</p> <p>We emphasize several main conclusions. Many measures of drinking‐ and surface‐​water pollution have fallen since the EPA’s founding, due at least in part to the Clean Water Act and Safe Drinking Water Act. The progress, however, is incomplete. William Ruckelshaus, first head of the EPA, noted, “Even if all of our waters are not swimmable or fishable, at least they are not flammable.”</p> <p>But while these large investments in drinking water do appear to create substantial health benefits, existing evidence suggests that estimated costs of most investments in cleaning up rivers, lakes, and oceans exceed their measured benefits. A&nbsp;summary of cost‐​benefit analyses of 240 regulations implemented by the federal government between 1992 and 2017 finds that out of five categories of regulations (surface water, drinking water, air pollution, greenhouse gases, and all other regulations, including nonenvironmental ones), surface‐​water regulations are the only category where total estimated costs exceed total estimated benefits. Estimated total benefits are only 80 percent of estimated total costs, and the mean regulation has benefits that are only 57 percent of its costs. Sixty‐​seven percent of surface‐​water regulations fail a&nbsp;cost‐​benefit test, compared to 20 percent of drinking‐​water regulations and 8&nbsp;percent of air pollution regulations.</p> <p>It is noted that many of these estimates have difficulty quantifying several important channels of benefits and may be understating true benefits. But even if costs are underestimated, there are several reasons regulation of surface‐​water quality could produce smaller net benefits than other types of environmental investments. For example, surface‐​water policy does not typically use market‐​based instruments, such as cap‐​and‐​trade markets or pollution taxes, which are generally cost effective. Beyond specific policy choices, surface waters may be more substitutable than other environmental goods — changing the river where a&nbsp;person goes fishing or boating may be less costly than changing the air a&nbsp;person breathes or the water a&nbsp;person drinks.</p> <p>Unfortunately, economic research on water pollution and its regulation has been limited. An important task for research is to assess which investments in surface‐​water pollution create net benefits and ways to make these investments more effective.</p> <p><strong>NOTE:</strong><br>This research brief is based on David A. Keiser and Joseph S. Shapiro, “U.S. Water Pollution Regulation over the Last Half Century: Burning Waters to Crystal Springs?,” <em>Journal of Economic Perspectives</em> 33, no. 4 (2019): 51–75, <a href="https://www.aeaweb.org/articles?id=10.1257/jep.33.4.51" target="_blank">https://​www​.aeaweb​.org/​a​r​t​i​c​l​e​s​?​i​d​=​1​0​.​1​2​5​7​/​j​e​p​.​3​3​.4.51</a>.</p> </div> Wed, 22 Jan 2020 03:00:00 -0500 David A. Keiser, Joseph S. Shapiro https://www.cato.org/publications/research-briefs-economic-policy/burning-waters-crystal-springs-us-water-pollution The Systematic Prohibition of U.S. Drug Science https://www.cato.org/publications/outside-articles/systematic-prohibition-us-drug-science Mon, 30 Dec 2019 03:00:00 -0500 Trevor Burrus https://www.cato.org/publications/outside-articles/systematic-prohibition-us-drug-science Scientocracy: The Tangled Web of Public Science and Public Policy https://www.cato.org/multimedia/events/scientocracy-tangled-web-public-science-public-policy Patrick J. Michaels, Terence Kealey, Holden Thorp, Jason Kuznicki <p>In 2005 John Ioannidis of Stanford University published a&nbsp;paper with the dramatic title of “Why Most Published Research Findings are False.” Dismayingly, we now know that he was right. In <em>Scientocracy</em> we explore how science has gone wrong and illustrate it with examples from nutrition, radiation, climate, and other branches of research.</p> Tue, 17 Dec 2019 14:01:06 -0500 Patrick J. Michaels, Terence Kealey, Holden Thorp, Jason Kuznicki https://www.cato.org/multimedia/events/scientocracy-tangled-web-public-science-public-policy A Ban on Flavored E‐​Cigs Will Put Adolescents in Greater Danger https://www.cato.org/blog/ban-flavored-e-cigs-will-put-adolescents-greater-danger Jeffrey A. Singer <p><span><span><span><span><span><span><span><span><span><span><span>As of December 2019, eight states have <a href="https://www.publichealthlawcenter.org/resources/states-and-tribes-stepping-protect-communities-dangers-e-cigarettes-actions-and-options">acted</a> to ban the sale of flavored e‐​cigarettes. Other states are <a href="https://www.cpr.org/2019/11/26/a-2020-storm-is-brewing-over-raising-colorados-tobacco-age-and-banning-flavored-vape-products/">contemplating</a> bans in 2020. </span></span></span></span></span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span><span><span><span><span>I have pointed out <a href="https://www.nydailynews.com/opinion/ny-oped-the-vaping-panic-is-out-of-hand-20190920-ll6djbwnczffbphckaqjflxa3i-story.html">here</a> and <a href="https://www.cato.org/blog/massachusetts-legislators-rush-judgment-vaping-destined-cause-more-harm">here</a> why banning flavored vaping products will deny adult tobacco smokers a&nbsp;proven means of quitting harmful tobacco smoking. </span></span></span></span></span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span><span><span><span><span>In fact, nicotine e-cigarettes—of which more than 90 percent of adult tobacco quitters prefer the flavored kind—are <a href="https://www.nhs.uk/news/heart-and-lungs/e-cigs-twice-effective-nicotine-patches-gum-or-sprays-quitting/">twice as effective</a> as nicotine gum or patches in helping smokers stop. We recently learned from the Centers for Disease Control and Prevention that virtually every case of EVALI (e‐​cigarette or vaping product‐​use associated lung injury) is due to bootleg THC vaping cartridges containing vitamin E&nbsp;acetate.</span></span></span></span></span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span><span><span><span><span>The states of <a href="https://www.seattletimes.com/seattle-news/washington-state-bans-vape-products-containing-vitamin-e-acetate-thought-to-be-linked-to-illness/">Washington</a> and <a href="https://www.westword.com/marijuana/colorado-pot-industry-bans-additive-linked-to-vaping-illness-11545124">Colorado</a>, where recreational cannabis is legal, banned the use of vitamin E&nbsp;acetate in the manufacture of any THC vaping cartridges by state‐​based companies in reaction to the CDC report.</span></span></span></span></span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span><span><span><span><span>It has been illegal to sell e‐​cigarettes to persons under age 18 since 2016. The reason lawmakers are targeting flavored vaping products is because underage e‐​cigarette users prefer the flavored variety. But, as mentioned above, so do adults trying to quit tobacco. </span></span></span></span></span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span><span><span><span><span>Now comes a&nbsp;new study published in the December issue of the peer‐​reviewed journal <em><a href="https://www.sciencedirect.com/science/article/pii/S2352853219301373?via%3Dihub">Addictive Behaviors Reports</a> </em>that found 80 percent of adolescents aged 13–17 who were able to obtain <em>JUUL</em> brand e‐​cigarettes got them from “at least one social source (e.g. ‘someone bought for me, someone offered me’) in the past 30&nbsp;days.” The rest were able to buy them, usually at convenience stores or gas stations.</span></span></span></span></span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span><span><span><span><span>Keep in mind, <em>JUUL </em>brand e‐​cigarettes, the most popular brand on the market, are legally produced and do not contain vitamin E&nbsp;or THC (which is federally prohibited). </span></span></span></span></span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span><span><span><span><span>The many arguments against a&nbsp;panic‐​driven ban on flavored e‐​cigarettes resonated with US Senator Ron Johnson (R‐​Wisconsin), who sent a&nbsp;<a href="https://www.jsonline.com/story/news/politics/2019/11/13/ron-johnson-sends-letter-trump-urging-him-back-off-vaping/4182015002/">letter</a>, co‐​signed by several other senators, urging President Trump against going through with his plans to implement a&nbsp;federal ban on flavored vaping products. The letter appeared to help. The President <a href="https://www.washingtonpost.com/national/health-science/trump-pulls-back-from-flavored-vaping-ban/2019/11/17/30853ece-07ae-11ea-924a-28d87132c7ec_story.html">backed off</a>&nbsp;from&nbsp;his plan in late November. </span></span></span></span></span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span><span><span><span><span>In <a href="https://www.latimes.com/business/story/2019-11-22/trump-youth-vaping-health-flavored-e-cigarettes">announcing</a> the change, President Trump said, “If you don’t give it [flavored vaping cartridges] to them, it’s going to come here illegally.” </span></span></span></span></span></span></span></span></span></span></span><span><span><span><span><span><span><span><span><span><span><span>He’s correct.</span></span></span></span></span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span><span><span><span><span>There is already <a href="https://www.cato.org/blog/war-drugs-meets-war-vaping-wont-end-well">evidence</a> that the Mexican drug cartels are getting into the vaping cartridge business. Now with this new evidence of the ease with which teens are able get safer and legally produced e‐​cigarettes through “social sources,” it is easy to see how dangerous, tainted, products smuggled along the cartel routes will quickly fill the void created by a&nbsp;flavored vaping ban.</span></span></span></span></span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span><span><span><span><span>State lawmakers should restrain&nbsp;the&nbsp;impulse to “do something” in reaction to a&nbsp;largely media‐​driven panic that ignores the abundant evidence.</span></span></span></span></span></span></span></span></span></span></span></p> Fri, 13 Dec 2019 13:59:37 -0500 Jeffrey A. Singer https://www.cato.org/blog/ban-flavored-e-cigs-will-put-adolescents-greater-danger Terence Kealey discusses the governance of science on the Centre for the Study of Governance and Society CSGS podcast https://www.cato.org/multimedia/media-highlights-radio/terence-kealey-discusses-governance-science-centre-study Fri, 13 Dec 2019 11:57:03 -0500 Terence Kealey https://www.cato.org/multimedia/media-highlights-radio/terence-kealey-discusses-governance-science-centre-study What’s the Matter with Significance? https://www.cato.org/blog/whats-matter-significance Peter Van Doren, David Kemp <p>Discussions about statistical significance are not usually found in newspapers, but the&nbsp;<em>Associated Press&nbsp;</em>recently had <a href="https://apnews.com/12cf3d07354c47b3b9bb552776071522">such a&nbsp;discussion</a> about the results of a&nbsp;clinical trial involving a&nbsp;heart drug. Statistical significance refers to whether a&nbsp;study finds a “real” effect or whether any differences measured are a&nbsp;result of chance. For example, in the case of the heart drug study, the authors attempt to measure whether the drug reduces patients’ mortality by comparing the mortality of patients on the drug to people not on the drug. The statistical significance reflects the authors’ confidence that the difference (reduced mortality) they find is not a&nbsp;fluke. As the article correctly states, “Significance is reflected in a&nbsp;calculation that produces something called a&nbsp;p‐​value. Usually, if this produces a&nbsp;p‐​value of less than 0.05, the study findings are considered significant. If not, the study has failed the test [i.e., the findings cannot be differentiated from random chance].”</p> <p>The heart drug study had a&nbsp;p‐​value of .059, meaning that the study’s authors are 94.1 percent confident that the apparent lower mortality they found for patients on the drug than for those not on the drug is real. By the standard .05 p‐​value (95 percent confidence level) criterion, the study’s findings are not considered statistically significant.</p> <p>In all scientific research (including clinical trials), scientists must make a&nbsp;tradeoff between the likelihood of accepting a&nbsp;false finding because it does reach statistical significance even though it is a&nbsp;statistical fluke (a false positive or Type I&nbsp;error) or rejecting a&nbsp;real finding because a&nbsp;study doesn’t reach statistical significance (a false negative or Type II error). Reducing the probability of Type I&nbsp;errors inherently increases the probability of Type II errors, and vice versa. In medicine, this tradeoff is between the possibility of ignoring a&nbsp;beneficial medical finding that does not reach statistical significance and endorsing a&nbsp;fruitless or harmful medical finding that does reach statistical significance.</p> <p>The lead investigator of the heart drug study believes that by rejecting their findings because they don’t reach a&nbsp;p‐​value of .05 their study falls in the former category: “the drug in fact produced a&nbsp;real benefit and…a larger or longer‐​lasting study could have reached statistical significance.” But the article also refers to a&nbsp;study of another heart drug that “found a&nbsp;significant treatment effect for patients born in August but not July, obviously just a&nbsp;random fluctuation.”</p> <p>What should be done about these tradeoffs? The article correctly states that the traditional cutoff of .05 is arbitrary and should be abolished. Instead, studies should report the p‐​value and other accompanying evidence to allow the reader to decide how to use the results of scientific and medical studies.</p> <p>These are old issues. Van Doren discussed them over 10&nbsp;years ago in a&nbsp;<a href="https://www.cato.org/sites/cato.org/files/serials/files/cato-journal/2008/5/cj28n2-16.pdf">review</a> of <em>The Cult of Statistical Significance</em> by Stephen Ziliak and Deirdre McCloskey in the <em>Cato Journal.</em> The <em>AP&nbsp;</em>article echoes many of Ziliak and McCloskey’s points and the relevance of statistical significance and other seemingly scientific questions to public policy and decision‐​making remains. Many health and safety decisions are delegated to bureaucracies that allegedly use scientific methods to decide what products and practices to allow on the market. In reality, values enter into these decisions in a&nbsp;variety of ways, including questions about how large sample sizes should be, the costs and benefits of decisions, and what level of statistical significance is accepted.</p> <p>Policy debates <a href="https://www.cato.org/blog/fight-over-particulate-matter">often ignore</a> the value questions inherent even in scientific research and fail to recognize that people with different values will come to their own conclusions based on the information available to them. Regulators and researchers should gather and disseminate this information without injecting their own values or rejecting findings based on an arbitrary level of statistical significance.</p> Thu, 05 Dec 2019 14:45:37 -0500 Peter Van Doren, David Kemp https://www.cato.org/blog/whats-matter-significance Robert Zubrin on The Case for Space https://www.cato.org/multimedia/cato-audio/robert-zubrin-case-space Sun, 01 Dec 2019 03:00:00 -0500 Robert Zubrin https://www.cato.org/multimedia/cato-audio/robert-zubrin-case-space Hope from Europe on Economic Liberty https://www.cato.org/blog/hope-europe-economic-liberty Ryan Bourne <p>Last week I&nbsp;attended and spoke at a&nbsp;conference hosted by&nbsp;<a href="https://live.ft.com/Events/2019/FT-Business-Regulation-Forum-Prague">the Financial Times and JTI</a>&nbsp;on economic regulation in Prague.</p> <p>During my panel on the regulation of AI and other innovative new technologies, I&nbsp;made five substantive points about the economics and public policy implications of new technologies:</p> <ol> <li>As far as possible, policymakers should allow permissionless innovation rather than be overly precautionary, only intervening when there was a&nbsp;clear need to do so for some specific application in a&nbsp;given&nbsp;product market.</li> <li>Where regulatory oversight occurs and new products compete with existing goods, policymakers shouldn’t automatically try to shoehorn innovations into current regulatory strictures to maintain a “level playing field.” New products often come with new safety features, for example, changing the balance of risks or mitigating previously perceived market failures. As such, innovation can compete with the regulator as well as incumbent products.</li> <li>Discussion of highly speculative extreme worst‐​case scenarios and ethical imperfections of new technologies sometimes seemingly ignore that the current world is not perfect, and human beings themselves exhibit biases. It’s a&nbsp;mistake to try to make perfect what is ever‐​evolving and already very good, especially if doing so deters other new innovations through fines or heavy compliance costs.</li> <li>In some fields where regulation is perceived to be&nbsp;needed, the rules&nbsp;should aim merely to solve the perceived problem proportionately and provide certainty for business. As Alexander Kryvosheyev from JTI explained, for businesses, regulatory clarity can be as&nbsp;important as the regulation itself. It may be that in some areas industry protocols and sharing of best practice can be facilitated, obviating the need for direct government regulation, but we should be ever mindful of the risk of cronyism and capture if this type of forum is provided through government.</li> <li>Regulatory policy is a&nbsp;terrible tool for dealing with distributional concerns re: the winners and losers of technological change.</li> </ol> <p>All in all, I&nbsp;found the messages well received and the conference somewhat heartening.</p> <p>Speaker after speaker in what was a&nbsp;central and eastern Europe heavy event bemoaned the tendency for Europe to be overly prescriptive with regulation and a&nbsp;mere talking shop for genuine pro‐​growth reform. Many indicated how the US was their beacon for a&nbsp;better environment for innovation in respect of new technologies.</p> <p>What was clear though was an apparent appetite for change. Central and eastern European countries have already experienced significant economic upheaval over the past three decades. That means perhaps they are more willing to embrace a&nbsp;radicalism on moving in a&nbsp;market‐​friendly direction. Certainly, <a href="https://www.vlada.cz/en/media-centrum/aktualne/speech-of-prime-minister-babis-at-ft-business-regulation-prague-forum-177392/">Czech Prime Minister Andrej Babiš</a> talked a&nbsp;good game about the need for pro‐​market liberalization both domestically and within the EU, at one stage saying explicitly, “the biggest problem for regulation is in Brussels, not Prague,” and lamenting that “the European Union has no vision.”</p> <p>With much Brexit Remain‐​sympathizing commentary both here and in the UK seeking to retrospectively paint the EU as a&nbsp;bastion of economic liberty, it was cheering to re‐​hear the sort of pro‐​liberty eurosceptic critiques of yesteryear and a&nbsp;determination to make Europe more open to wealth‐​enhancing innovation.</p> Tue, 05 Nov 2019 16:05:43 -0500 Ryan Bourne https://www.cato.org/blog/hope-europe-economic-liberty Jeffrey A. Singer discusses innovations in harm reduction on the Cover2 podcast (part 2) https://www.cato.org/multimedia/media-highlights-radio/jeffrey-singer-discusses-innovations-harm-reduction-cover2 Wed, 23 Oct 2019 10:55:04 -0400 Jeffrey A. Singer https://www.cato.org/multimedia/media-highlights-radio/jeffrey-singer-discusses-innovations-harm-reduction-cover2 Greenhouse Gas Emissions and the California Waiver https://www.cato.org/blog/greenhouse-gas-emissions-california-waiver Peter Van Doren <p>Since the 2016 election, the Trump administration has intended to freeze or repeal vehicle fuel economy and emissions standards. Last summer, the administration announced a&nbsp;plan to freeze Corporate Average Fuel Economy (CAFE) standards and to revoke a&nbsp;waiver that allows California to set its own vehicle emissions standards. While there has apparently not been much headway in the efforts to freeze CAFE standards, President Trump <a href="https://www.cnn.com/2019/09/18/politics/epa-trump-california/index.html">recently</a> tweeted his intention to officially revoke the California waiver.</p> <p>As I&nbsp;discussed in a&nbsp;<a href="https://www.cato.org/blog/cafe-standards">blog</a> last year, CAFE standards are a&nbsp;costly and imperfect remedy to limit vehicle emissions. They were originally enacted to address an entirely different problem: the oil shocks of the 1970s and soaring oil prices. The rules have since been repurposed to address greenhouse gas emissions, but they are an inefficient and clumsy tool.</p> <p>But while the flaws of CAFE standards are straightforward, the costs and benefits of the California waiver are more ambiguous. The waiver, which was originally granted because of unique weather and geographic conditions around Los Angeles that make it particularly susceptible to smog, has also been repurposed to address vehicle greenhouse gas emissions. California is allowed to set vehicle emissions standards that are stricter than the federal government, and states are able to pick whether they follow the federal standards or California’s.</p> <p>I argued in <a href="https://www.cato.org/blog/cafe-standards">my blog</a> last summer that, while CAFE standards should be repealed, the California waiver does serve a&nbsp;purpose, though its use as a&nbsp;tool to combat greenhouse gas emissions is ineffective:</p> <blockquote><p>Regulation of pollutants that affect local air quality should be decentralized because both the costs and benefits are local. But reduction of CO<sub>2</sub> emissions is a&nbsp;global public good. Any benefits accrue to the world’s climate even though the costs are local. This mismatch between the geographic incidence of costs and benefits imply that a&nbsp;waiver that exempts one state makes no sense in the context of CO<sub>2</sub> emissions and has the potential to unduly increase compliance costs for automakers.</p> </blockquote> <p>In <a href="https://energyathaas.wordpress.com/2019/09/23/waving-goodbye-to-the-california-waiver/">a&nbsp;recent blog post</a>, James Sallee, an economist at UC Berkeley and the Energy Institute at Haas, makes the point that not only are the benefits of California’s higher vehicle emissions standards diffuse while costs are concentrated on Californians, but the benefits themselves are undermined by the fact that the state’s higher standards allow car companies to sell less efficient cars elsewhere. Sallee argues,</p> <blockquote><p>The federal greenhouse gas rule for automobiles, called Corporate Average Fuel Economy (CAFE) standards, require automakers to sell vehicles that, on average, have fuel economy above a&nbsp;certain threshold. If California has its own, stricter greenhouse gas rule, the cars sold in California still count as part of the federal fleet under CAFE. This means that every Leaf, Prius and <a href="https://www.caranddriver.com/news/a29089178/tesla-porsche-nurburgring-ev-record/">Tesla</a> sold in California improves the industry’s federal average. That enables automakers to sell more <a href="https://www.caranddriver.com/ford/mustang-shelby-gt500">Mustangs</a> and Suburbans in the rest of the country, which means that much, if not all, of the greenhouse gas mitigation that takes place in California will be offset by increased emissions throughout the nation.</p> <p>The application of this so called “<a href="https://energyathaas.wordpress.com/2018/04/15/carbon-markets-waterbeds-and-you/https:/energyathaas.wordpress.com/2018/04/15/carbon-markets-waterbeds-and-you/">waterbed effect</a>” to California fuel economy standards was described elegantly in a&nbsp;<a href="https://www.sciencedirect.com/science/article/abs/pii/S0095069611001021">paper</a> by Larry Goulder, Mark Jacobsen and Arthur van Benthem back in 2012. They studied the implementation of a&nbsp;California‐​specific fuel economy rule and concluded that between two‐​thirds and three‐​quarters of emissions reductions in California would be offset by increases in other states. In the meantime, the burden of complying with strong regulations would fall on Golden State consumers.</p> </blockquote> <p>Sallee’s point reinforces the argument that the California waiver has, just like CAFE standards, been ineffectively repurposed as a&nbsp;tool to limit greenhouse gas emissions. But despite its flaws, California and 22 other states <a href="https://www.washingtonpost.com/climate-environment/2019/09/20/california-sues-trump-administration-after-revoking-authority-limit-car-pollution/">filed a&nbsp;lawsuit</a> challenging the Trump administration’s revocation of the waiver. Perhaps they’d be less willing to fight for the waiver if they realized their higher emissions standards burden Californians with increased costs but only provide minimal benefits.</p> <p><em>Written with research assistance from David Kemp.</em></p> Tue, 01 Oct 2019 16:20:33 -0400 Peter Van Doren https://www.cato.org/blog/greenhouse-gas-emissions-california-waiver Beefy Arguments for Libertarianism https://www.cato.org/blog/beefy-arguments-libertarianism Terence Kealey <p>The most important recent paper in nutrition wasn’t written by a&nbsp;nutritionist and it wasn’t written about nutrition. Rather, it was written by a&nbsp;statistician, John Ioannidis of Stanford University, and it was titled <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124">“Why most published research findings are false.”</a> It has been cited 7,500 times (i.e., a&nbsp;lot) because it really does show that most published research findings are false.</p> <p>Moreover, most research findings in the so‐​called ‘hard’ sciences such as math, physics or chemistry are true, which by process of&nbsp;elimination means that almost all the findings published in the ‘soft’ sciences are false. And sciences don’t come much softer than nutrition.</p> <p>So, is coffee bad for you? Currently not, but a&nbsp;few years ago it was, and a&nbsp;few years before that it wasn’t, and a&nbsp;few years before that it was, and a&nbsp;few years before that it wasn’t–and almost all those findings were false because, as John Ioannidis has shown, the statistics used to justify those sorts of study, whether pro‐​coffee or anti‐​coffee, were rarely good enough to support any conclusion at all. The abuse of statistics is the greatest block to good science today.</p> <p>In the past, nutrition research was about deficiencies; and it was good research. Do we need vitamins? Yes. Do we need essential minerals? Yes. Do we need protein? Yes. We can be sure about those findings. But nutrition research today is about excess. Is too much meat or carbohydrate or fat bad for you? And what does ‘too much’ mean? We rarely know the answers to such questions.</p> <p>Sadly, one of the few facts we do know about modern nutrition is that the outbreak, in 1980, of the current epidemic of obesity and type 2&nbsp;diabetes, followed hard on the issuance by the federal government, in 1977, of advice to eat less fat and more carbohydrate: and that as the American people dutifully followed this advice, so they got fatter and more diabetic. We don’t know if that was a&nbsp;coincidence or whether it was cause‐​and‐​effect, but as Thoreau said, “some circumstantial evidence is very strong, as when you find a&nbsp;trout in the milk.”</p> <p>We’ve long understood&nbsp;chicken and fish to be safe, but <a href="https://annals.org/aim/fullarticle/2752328/unprocessed-red-meat-processed-meat-consumption-dietary-guideline-recommendations-from">a&nbsp;new study has been released</a> suggesting that both red meat (beef, pork, lamb or venison) and processed meat (sausages, bacon, ham, hot dogs) are also safe; and the panjandrums of the nutrition orthodoxy are outraged. “This report has layers of flaws and is the most egregious abuse of evidence that I&nbsp;have ever seen,” <a href="https://www.theguardian.com/food/2019/sep/30/research-red-meat-poses-no-health-risk">said</a> Walter Willett of Harvard. “Their recommendations are really irresponsible,” <a href="https://www.kmov.com/red-and-processed-meat-are-ok-to-eat-controversial-new/article_e52a5ccf-3d5b-5516-8519-f230042a40ed.html">said</a> Frank Hu of Harvard. A&nbsp;contrarian would immediately assume, therefore, that the study in question must be marvelous. Is it?</p> <p>Well, it represents part of a&nbsp;new wave in nutrition, in which a&nbsp;group of scientists who have no financial ties to the food industry set themselves up, like the justices of the Supreme Court, to adjudicate as a&nbsp;panel&nbsp;on a&nbsp;field of research. And, again like the justices of the Supreme Court, they are not frightened from disagreeing with each other and from voting differently from each other. That represents a&nbsp;useful advance in science, as scientists move away from papers that present a&nbsp;monolithic consensus to papers that admit a&nbsp;more conflicted recognition of doubt.</p> <p>How did the scientists in this new study vote? Well, in essence, they agreed that the evidence just isn’t very good. It’s probable that both ordinary meat and processed meat might be bad for you, but they don’t seem to be very bad, and the authors of the paper suggested that their badness does not justify the disruption of a&nbsp;person’s lifestyle by their going vegetarian, let alone vegan. Also, the authors suggested, switching from meat to other foods (pizzas for example) might incur other risks.</p> <p>My own feeling is that this new study is less important than the media reports suggest. Everybody agrees that the evidence about the dangers of meat, processed or otherwise, is necessarily weak (nutrition research is difficult to perform, as people need to be studied over decades and people’s knowledge of their own diets is often surprisingly vague), but everyone also agrees that meat, processed or otherwise, is probably a&nbsp;bit bad for you. The authors of this new study have introduced a&nbsp;value judgement, in that they’ve tried to determine if the health benefits of going vegetarian or vegan can justify the disruption to a&nbsp;person’s lifestyle, and I’m not sure the authors have the data to justify such a&nbsp;value judgement: how do you balance health risks over lifestyle changes? Is that not comparing apples and oranges?</p> <p>On the other hand, the authors have done a&nbsp;public service by highlighting how modest the health benefits–real though they may be–of shifting to a&nbsp;vegetarian or vegan diet might be, and (again) how weak is so much nutrition research.</p> <p>Where does this leave us? As so often, it leaves us in the hands of the three most‐​trusted writers in nutrition. Amazingly, not one is a&nbsp;nutritionist (all three are journalists) and their advice clashes, but the person who reads Gary Taubes, Nina Teicholz and Michael Pollan, and who then tries to synthesize their judgments into one culinary world view, will be following the best food advice currently going.</p> <p>There is a&nbsp;libertarian lesson to be learned in this—in a&nbsp;2018 policy analysis, I&nbsp;noted the federal government may be <a href="https://www.cato.org/publications/policy-analysis/why-does-federal-government-issue-damaging-dietary-guidelines-lessons">institutionally incapable of providing wise dietary advice</a>. If the base of knowledge is inadequate or incapable of being adequate, any emanating advice will be inadequate. When that advice comes from government bureaucracies burdened by politics and interest groups, the science and advice must overcome even greater adversaries.</p> Tue, 01 Oct 2019 13:04:00 -0400 Terence Kealey https://www.cato.org/blog/beefy-arguments-libertarianism Politicians’ Support for Population Control Is Dangerous https://www.cato.org/publications/commentary/politicians-support-population-control-dangerous Chelsea Follett <div class="mb-3 spacer--nomargin--last-child text-default"> <p>Recently, when asked if he would act to “curb population growth” because “the planet cannot sustain this growth,” Vermont Senator Bernie Sanders answered in the affirmative, noting he would focus on “poor countries around the world.”</p> <p>Former Vice President Joe Biden, one of Sanders’ rivals and current leading contender for the Democratic nomination, previously voiced acceptance of China’s one‐​child (now two‐​child) policy, telling a&nbsp;Chinese audience, “Your policy has been one which I&nbsp;fully understand — I’m not second‐​guessing — of one child per family.”</p> <p>The problem with embracing a&nbsp;demographic goal to “curb population growth” rather than leaving each family to make their own decisions is that it often results in coercion. Also, the very idea of “overpopulation” is fundamentally misguided.</p> <p>Today, China’s two‐​child policy still limits family sizes and requires that parents apply for birth permits. This year, one couple who could not afford a&nbsp;fine of $9,570 for violating family planning regulations, had their modest life savings seized. While rarer than under the one‐​child policy, there are even still cases of forced sterilization and abortion.</p> <p>“A third baby is not allowed so we are renting a&nbsp;home away from our village. The local government carries out pregnancy examinations every three months. If we weren’t in hiding, they would have forced us to have an abortion,” one Chinese father of three told the BBC.</p> <p>The idea of population control is old. In 1798, an English clergyman, Thomas Robert Malthus, published An Essay on the Principle of Population, warning population growth would deplete natural resources. To prevent famine, he thought it morally permissible to “court the return of the plague” by having the poor live in swamps and even to ban “specific remedies for ravaging diseases.” His nonchalant attitude toward the welfare of the poor would prove an enduring part of overpopulation alarmism.</p> <p>In the 1960s and 1970s, Malthus’ view became resurgent. In 1966, U.S. President Lyndon Johnson made foreign aid dependent on countries adopting population control. In 1969, President Richard Nixon established a&nbsp;separate Office of Population within USAID and gave it a $50 million annual budget. In 1977, the head of the office, Dr. Reimert Ravenholt, said that he hoped to sterilize a&nbsp;quarter of the world’s women.</p> <p>By the 1980s, the background document to the International Conference on Family Planning, co‐​written by the United Nations Population Fund, International Planned Parenthood Federation, and Population Council, decreed, “When provision of contraceptive information and services does not bring down the fertility level quickly enough to help speed up development, governments may decide to limit the freedom of choice of the present generation.”</p> <p>Neo‐​Malthusianism spread among international organizations and government leaders. The neo‐​Malthusians offered financial support to the cause of curbing population growth, rewarding governments in poor countries that enacted population control while sounding no alarms when those measures became coercive.</p> <p>India’s Prime Minister Indira Gandhi declared an Emergency (1975–77) suspending civil liberties and mandated some 11 million sterilizations. China’s one‐​child policy (1979–2015) saw over 300 million Chinese women fitted with IUDs modified to be irremovable without surgery, over 100 million sterilizations, and over 300 million abortions, many coerced. In 1983, the UNFPA bestowed the first Population Award prize to Indira Gandhi and to Qian Xinzhong, the man who was then in charge of China’s one‐​child policy.</p> <p>Ironically, population growth can be beneficial. Wherever people are free to engage in innovation and exchange, economist Julian Simon noted they are the “ultimate resource,” increasing the supply of other resources, discovering alternatives, and improving efficiency.</p> <p><a href="https://www.cato.org/publications/policy-analysis/simon-abundance-index-new-way-measure-availability-resources">Research</a> has found every 1&nbsp;percent increase in population lowers commodity prices by almost 1&nbsp;percent, meaning each person helps decrease scarcity, on average.</p> <p>Today, population is at an all‐​time high, yet wherever economic freedom allows humanity to realize its innovative potential, prosperity has exceeded our ancestors’ imaginations.</p> <p>Human wellbeing is improving rapidly, as chronicled on websites like<a href="https://humanprogress.org/"> Human​Progress​.org</a> (of which I&nbsp;am managing editor) and<a href="https://ourworldindata.org/"> Our World in Data</a>. Whatever challenges, environmental or otherwise, may loom ahead, it will be human ingenuity that will have to rise to the occasion.</p> <p>The more minds working on solutions, the better.</p> <p>In any case, birth rates tend to fall without coercion as countries grow richer. But the potential for human rights abuses alone is sufficient reason to oppose aiming to “curb population growth.”</p> </div> Fri, 13 Sep 2019 16:31:06 -0400 Chelsea Follett https://www.cato.org/publications/commentary/politicians-support-population-control-dangerous Terence Kealy gives a lecture on the “Myth of Scientific Objectivity,” hosted by CrossFit Health https://www.cato.org/multimedia/media-highlights-tv/terence-kealy-gives-lecture-myth-scientific-objectivity-hosted Sun, 11 Aug 2019 10:46:00 -0400 Terence Kealey https://www.cato.org/multimedia/media-highlights-tv/terence-kealy-gives-lecture-myth-scientific-objectivity-hosted President Trump Delivers Lifesaving Deregulation https://www.cato.org/publications/commentary/president-trump-delivers-lifesaving-deregulation Steve H. Hanke <div class="lead mb-3 spacer--nomargin--last-child text-default"> <p>How many of you noticed the most life‐​changing story of the week? Yesterday, President Trump made a&nbsp;stunning&nbsp;<a href="https://www.whitehouse.gov/briefings-statements/remarks-president-trump-signing-executive-order-advancing-american-kidney-health/" target="_blank">speech</a>&nbsp;announcing regulatory changes that will save thousands of American lives each year. </p> </div> , <div class="mb-3 spacer--nomargin--last-child text-default"> <p>As the President noted,&nbsp;<a href="https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/" target="_blank">roughly 100,000</a>&nbsp;Americans with kidney disease are awaiting a&nbsp;transplant from a&nbsp;donor. About 20,000 Americans are awaiting transplants of other organs. </p> <p>These estimates are, if anything, on the low side. Indeed, there are many people who never bother with the transplant waiting list because, under the current system, their prospects of receiving a&nbsp;transplant are so low. Last year, there were about&nbsp;<a href="https://unos.org/data/transplant-trends/" target="_blank">21,000</a>&nbsp;kidney transplants in the United States, but the transplant waiting list has remained stuck in the 90,000 to 100,000 person range for some years. If you are old, or even a&nbsp;young person in frail health, you won’t receive a&nbsp;kidney. Donor kidney’s are reserved for more “deserving” recipients. Shockingly, it’s estimated that&nbsp;<a href="https://jasn.asnjournals.org/content/jnephrol/early/2018/11/10/ASN.2018101030.full.pdf" target="_blank">43,000</a>&nbsp;Americans die prematurely each year because they don’t receive a&nbsp;life‐​saving kidney transplant. For context, this exceeds the number of people who die in&nbsp;<a href="https://www.nsc.org/road-safety/safety-topics/fatality-estimates" target="_blank">car accidents</a>&nbsp;each year. </p> <p>The shortage of kidneys and other organs is substantially, and probably fully, the fault of inhumane government regulations. The federal government has regulated national organ procurement since the&nbsp;<a href="https://history.nih.gov/research/downloads/pl98-507.pdf" target="_blank">National Organ Transplant Act of 1984</a>. Since then, the waiting lists have increased in length. </p> <p>The shortages of kidneys and livers, the second most needed organ, are especially sad. After all, an adequate supply is readily available. Unlike other organs, kidneys and livers can be donated by living persons, who, after their donation, can continue to lead normal lives. Recently, Fox News correspondent&nbsp;<a href="https://www.foxnews.com/opinion/ed-henry-im-becoming-a-liver-donor-for-the-sister-i-love-so-she-can-live-a-long-and-healthy-life" target="_blank">Ed Henry</a>&nbsp;announced that he will donate part of his liver to save the life of his sister with liver disease. He not only anticipates saving the life of his sister, but also leading a&nbsp;normal life after the donation. </p> <p>President Trump’s life‐​saving&nbsp;<a href="https://www.whitehouse.gov/briefings-statements/president-donald-j-trump-taking-bold-new-approach-advance-kidney-health/" target="_blank">executive order</a>&nbsp;is multipronged. The change that will probably save the most lives is the provision that allows for reimbursement of organ donors’ lost wages and childcare expenses. Currently, organ donors spend money out of their own pocket and time to donate. My good friend and longtime collaborator donated one of his kidneys several years ago. For his efforts, which included traveling to a&nbsp;distant hospital and undergoing multiple tests and interviews, he received free parking at the hospital’s garage and a&nbsp;free lunch at the hospital’s cafeteria. In the process, he burned up a&nbsp;significant portion of his annual leave time. </p> <p>The reimbursement provision that is contained in the executive order will offset some of the donors’ costs. Accordingly, the provision will substantially increase the supply of kidneys. It also makes excellent economic sense. Kidney dialysis costs&nbsp;<a href="https://www.usrds.org/2018/view/v2_09.aspx#Figure_9_8" target="_blank">$76,000</a>&nbsp;or more per year and can last for years while a&nbsp;patient slowly works to the top of the kidney transplant waiting list – or dies first. By avoiding the heavy costs associated with dialysis, transplantation has a&nbsp;very rapid payback period of less than two years. In consequence, the expansion of the supply of kidneys will save the federal government, which pays the expenses of dialysis for patients not covered by private insurance, billions of dollars a&nbsp;year. </p> <p>President Trump’s actions go near the edge of what current law allows. As I&nbsp;wrote in a&nbsp;<a href="https://www.forbes.com/sites/stevehanke/2018/12/28/lets-fund-the-border-wall-and-save-up-to-5000-lives-a-year-too/#4d4c9ef95b0a" target="_blank">December 2018&nbsp;<em>Forbes</em>&nbsp;column</a>, the federal government should go further. It should allow compensation to donors in addition to the payment of lost wages and expenses. Reasonable levels of compensation should be enough to eliminate the shortages of&nbsp;<a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajt.13490" target="_blank">kidneys</a>&nbsp;and&nbsp;<a href="https://sites.krieger.jhu.edu/iae/files/2019/06/The-Case-for-a-Market-for-Livers-1.pdf" target="_blank">livers</a>&nbsp;entirely. This would require action by the Congress to&nbsp;<a href="https://www.organreform.org/" target="_blank">reform</a>&nbsp;the National Organ Transplant Act. </p> <p>Deregulation has been one of the major, and usually underreported, successes of the Trump administration. Trump is the first president since Ronald Regan to pursue a&nbsp;broad deregulatory agenda. A&nbsp;proxy measure of regulatory activity is the number of pages on new regulations published in the&nbsp;<a href="https://www.federalregister.gov/" target="_blank"><em>Federal Register</em></a><em>.</em>&nbsp;In 2016, Barack Obama’s last year as president, the page count reached a&nbsp;staggering 95,894. Under Trump, the page count has fallen to less than 65,000, the&nbsp;<a href="https://www.federalregister.gov/uploads/2019/04/pagesPublished2018.pdf" target="_blank">lowest</a>&nbsp;page count in about a&nbsp;quarter‐​century. </p> <p>Economists often argue for deregulation in terms of money saved. But, once in a&nbsp;while, something more than the pocketbook is at stake. Every president since Reagan could have pushed the deregulatory envelope to save lives, but they didn’t. Well, Trump did it.</p> </div> Thu, 11 Jul 2019 10:19:00 -0400 Steve H. Hanke https://www.cato.org/publications/commentary/president-trump-delivers-lifesaving-deregulation