Etiquette



DP Etiquette

First rule: Don't be a jackass.

Other rules: Do not attack or insult people you disagree with. Engage with facts, logic and beliefs. Out of respect for others, please provide some sources for the facts and truths you rely on if you are asked for that. If emotion is getting out of hand, get it back in hand. To limit dehumanizing people, don't call people or whole groups of people disrespectful names, e.g., stupid, dumb or liar. Insulting people is counterproductive to rational discussion. Insult makes people angry and defensive. All points of view are welcome, right, center, left and elsewhere. Just disagree, but don't be belligerent or reject inconvenient facts, truths or defensible reasoning.

Monday, October 23, 2023

Health news bits: Drug industry fights drug price negotiation; Drug industry fights low-cost drugs

A WaPo opinion discusses intense industry opposition to negotiating drug prices for Medicare:
In recent months, drug manufacturers and their allies have filed 10 lawsuits attacking one of the Inflation Reduction Act’s core health policy achievements: its plan for Medicare to negotiate drug prices. Applying to a select number of especially profitable drugs that have been on the market for at least nine or 13 years, negotiation is intended to arrive at a fair price — at least 25 percent less than the manufacturer’s price — based on the drug’s proven clinical benefits. Manufacturers set prices without meaningful constraint, and the Inflation Reduction Act’s negotiation, the first round of which will begin next year, is predicted to save Medicare $100 billion by 2031. Now, the pharmaceutical industry is attempting to achieve through the courts what it could not through the legislative process — maintaining unreasonably high brand-name drug prices at the expense of the American public.

At their core, the complaints argue that giving Medicare the power to negotiate infringes the rights of pharmaceutical manufacturers to sell prescription drugs at any price they set. Their arguments rely on the untenable premise that for-profit companies have a constitutionally protected right to receive taxpayer dollars. Even more alarmingly, they assert that the unmatched profitability of the pharmaceutical industry is itself a public good that should be judicially guarded at the expense of patients and taxpayers. Courts and the public must reject these claims.  
First, the manufacturers argue that the plan violates the takings clause of the Fifth Amendment, which prohibits the government from taking private property without just compensation. Manufacturers may have a right to own and sell their drugs. However, they do not have a right to any particular level of Medicare reimbursement. Courts have agreed that private health-care entities can’t set their own payment rates, or expect to participate in voluntary programs such as Medicare without conditions.  
Second, manufacturers claim a violation of the Fifth Amendment due process clause, which prohibits the deprivation of liberty or property without due process of law. Courts have recognized due process rights in the context of certain public benefits, such as social security for those with disabilities. But Medicare is not a benefit program for drug manufacturers. Rather, Medicare’s intended beneficiaries are the American people, many of whom cannot afford the cost of drugs at the rates manufacturers have set.
Once again, the thinking and morals of American plutocrats is quite clear. They don't care about us or social well-being. They care about themselves and profit. The audacity of arguing that the unmatched profitability of the pharmaceutical industry is itself a public good is a lie on the scale of the authoritarian radical right's colossal stolen 2020 election lie. 

One can see the plutocratic, government-hating USSC siding with the drug industry on this one.
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Why low-cost ketamine is still inaccessible to many with severe depression

Patients with treatment-resistant depression are missing out on potentially life-changing treatment with ketamine because systemic barriers in the public health system have made it unaffordable.

The researchers drew attention to the fact that it is now more than 20 years since the first indications that generic ketamine was effective, but public funding to support research and patient access has been slow, uncoordinated and underfunded. They also say there have been insufficient commercial incentives to conduct the research and development of generic ketamine, nor any schemes promoting public-private partnerships.

There is now a stark disparity in the accessibility and cost of ketamine-based depression treatments. The patented, intranasal s-enantiomeric ketamine formulation, Spravato, is priced at around $500 to $900 per dose, whereas generic ketamine stands at about $5 to 20 per dose. This high cost has led to Spravato being rejected for public reimbursement three times and thus it remains largely inaccessible for Australian patients.

This narrative is not unique to ketamine, as the article foresees a similar fate for upcoming psychedelic-assisted psychotherapy treatments, which are on the verge of entering the mental health treatment arena. The article suggests that without systemic interventions, the cycle of underutilizing low-cost effective solutions is set to continue, leaving patients unable to access treatments while threatening to blow out health care costs.
US prices for ketamine range from ~$200 to ~$12,000 depending on what the drug is being used for, e.g., pain, depression, anesthesia, etc. 

In the UK, where there are drug price controls based on cost-benefit analysis, England's influential cost watchdogs rejected J&J's ketamine depression drug Spravato (nasal ketamine spray). The US does not rely on cost-benefit analyses like the European Union and the UK do for drug pricing. The reason for that is obvious - the drug industry has corrupted the US government.

Once again, the thinking and morals of plutocrats is clear. They care only about themselves and profit.

In a world filled with angst, is there really any hope for mankind?

 I just want to leave this thought out there:

I am not referencing any source or news outlet, I am only referencing my own internal thoughts.

Even up here in Canada, we are feeling the tension, but nothing like the tension that is exploding south of the border. When talking politics with friends and family back in the US, it seems to be ALL gloom and doom.

AND many believe we are at a inflection point. WWIII could erupt over the Israeli conflict. It could erupt over the Ukraine conflict. It could erupt if China invades Taiwan. 

There is also a growing trend towards Nationalism. We all know about it in the US. There is a rising tide of that in Germany while Italy elected a far-right government. Ditto with places like Finland and Greece.

Then there is the growing and very real climate crisis. Almost forgotten in the political upheaval. Global emissions actually rose in 2022. I doubt they will have shrunk by the end of this  year. 

So, despair and angst now rule our collective psyche. Well, to be honest, not MY psyche, but we can't all be Snowflakes. But yes, it is happening. Around the dinner table, online discussions, everyday gatherings. Even here in Canada. 

AND TO ME, THERE IS THE RUB! People, as they become more anxious, tend to want to protect their own. And become MORE bitter about who is responsible for our pending doom. It's all the Israeli's fault - or all Hama's fault, or all Iran's fault, or all Trump's fault, or all Russia's fault, or all the fault of those damn Christian extremists or damn Muslim extremists, or ............. it's ALL the fault of the media, particularly social media.

It is NEVER our own fault. 

So, back to the original question: Is there ANY hope for mankind? I am asking not only in context of what is actually happening in the political arena, BUT in context of how we are responding to what is happening out there. Have we (not each one of us individually, but the universal "we") given up on mankind?

Sunday, October 22, 2023

Israel war update

Reporting from today indicates that the changes described in my last comment are only picking up momentum and getting more extreme. Authors and journalists in Israel are describing Israel now as a country that is becoming fascist, and the war as a genocide. Below are 2 stories from the Middle East Eye. Israelis with guns (some supplied by members of the National Religious Party) are injuring and sometimes shooting Arabs. Palestinian citizens of Israel are lying low and avoiding use of their language in public using Hebrew or English. 

Some disturbing video footage, and apparently many of those behaving and talking like bigots are former liberals who have now freaked out after the Hamas attack on 10/7. Even some liberal academics have caught the bug. I already saw this beginning to happen days ago. A newspaper editor in an interview with Ian Bremmer couldn't stop repeating the need to get rid of Hamas "once and for all" even if innocents are killed in the process. Asked by Ian Bremmer, "But what then? What's the end? What would you do with Gaza? Who would administer the territory? Are you prepared to deal with insurgents that may be more radical than even Hamas?" etc. etc. He just kept repeating, "These are not important questions right now. The thing is to destroy Hamas NOW! Everything else must wait until later." That's a prevalent frame of mind now. The distinction between Hamas and Palestinian has become blurrier by the day. In the act of killing, the perpetrator fast becomes desensitized. Humanity is lost.

The US isn't quite as bad, but the trends after this attack are here as well. Arabs and Palestinians here are also beginning to live in fear, and ethnic racism appears to be gaining ground. People here mostly support what is clearly a genocide. Israelis and Biden announced some deal with "humanitarian assistance" that was supposed to arrive today. It's not clear it will. 

But unreported here is the fact that the deal conspicuously leaves out fuel/energy. Without that, all hospitals will run out of juice killing many more than that bomb that got so much attention. At least 1200 of the 4000 killed in Gaza now were children. Without fuel, the drinking water (which relies heavily on desalination equipment) will dry up.

Some Palestinians in Gaza are already drinking saltwater and/or dirty water in desperation. Middle East eye and 972 are both good online magazines to keep up with events most media outlets don't report . A common (probably accurate) perception of those writing there is that they are facing a second Nakba, which is their traumatic "catastrophe" in the 40s, something that shapes collective memory and world view for most Palestinians.

Two articles are relevant. One is about America's unwavering support of this ethnic destruction and the other on what appears to be an emergent fascism or something close taking shape in Israel since 10/7. I don't use the word fascism lightly, but now we ARE seeing eliminationism in rhetoric and policy. The rate of ethnic elimination or genocide, in my view, is already much more rapid than anything Nazis did in the early and mid 30s. They have trapped 2.3 million people into a ghetto concentration camp setting of their devising (with no escape open, all gates closed). They subject them to slow death by starvation and cut the energy needed for everything including functional hospitals. They tell them to move south, then they bomb them in transit and in the places they told them to evacuate to, such as Khan Younis and other places in the south. 

In the nearly two weeks since a devastating Hamas rampage in southern Israel, the Israeli military has relentlessly attacked Gaza in response. Even after Israel told Palestinians to evacuate the north and head to what it called “safe zones” in the south, strikes continued across the territory overnight and Palestinian militants continued firing rockets into Israel.

A residential building in Khan Younis, a city in southern Gaza where hundreds of thousands of Palestinians had sought shelter, was among the places hit. Medical personnel at Nasser Hospital said they received at least 12 dead and 40 wounded.

The bombardments came after Israel agreed Wednesday to allow Egypt to deliver limited humanitarian aid to Gaza, the first crack in a punishing 11-day siege. Many of Gaza’s residents were down to one meal a day and drinking dirty water.

Another article focuses on Israel's urge for revenge being aimed at all Palestinians:
When you walk the streets of Jerusalem, you don’t see people anymore. You see police and private security forces.

Increasing numbers of civilians have been carrying guns in the streets, and even in shopping malls, where some Israelis were armed with M16s. This comes after National Security Minister Itamar Ben Gvir decided to hand out thousands of guns and to ease the conditions for purchasing weapons.

In one case, a group of armed Israelis stopped a Palestinian man, ripped a baby seat from his car and dropped it in the street, and then searched his vehicle. The Israeli state has given them implicit permission for this type of harassment.

The Moral Rot Files: On the perversion of philanthropy

Axios comments on how some modern billionaires see philanthropy -- it's not pretty:
1 big thing: Silicon Valley's perversion of philanthropy

Under the new conception of philanthropy, the act of making the fortune itself is the philanthropic act. There's no need to give any money away — feel free to go ahead and drop more than $220 million on Malibu property if you're so inclined. Just by dint of getting rich, your philanthropic work is largely done.

This vein of thinking is now solidly in the Silicon Valley mainstream.

Google founder Larry Page said in a 2014 interview that the most philanthropic thing he could do with his fortune would be to give it to Elon Musk. As New York magazine's Kevin Roose explained, Page was "saying that companies like SpaceX and Tesla are themselves philanthropic organizations, and that supporting those companies financially is preferable to supporting charitable causes in the traditional way."

PayPal and Palantir founder Peter Thiel said in 2016 that seeking revenge on Gawker by bankrolling legal cases against the company was "one of my greater philanthropic things that I've done."

Amazon founder Jeff Bezos was asked in 2018 how he could "do good with" his fortune. His answer was that "the only way that I can see to deploy this much financial resource is by converting my Amazon winnings into space travel" — something he described as his "most important work."

OpenAI founder Sam Altman decided this year that his organization's philanthropic mission would be best served by converting it from a nonprofit to a for-profit. 
Billionaire venture capitalist Marc Andreessen's techno-optimist manifesto, published this week, generalizes such thinking. "Technological innovation in a market system is inherently philanthropic, by a 50:1 ratio," he writes. In other words: Every dollar an innovator like Andreessen makes for himself equates to a $50 philanthropic donation to society at large. Why even bother giving away the dollar, if that's the case.

Well, there we have it. Delusional (or mendacious) billionaires drink their own Kool-Aid. That's how they get delusional. And jaw-droppingly arrogant. Every dollar a billionaire makes gives $50 to charity. I can feel the love now!