Change is NOT in the air…

What’s something that everyone agrees we should change, but somehow it never changes?

And, why doesn’t it change?  What’s the problem??

 

Thanks for thinking about it and posting.  And recommending.

Regarding the Institute for Clinical and Economic Review

The Institute for Clinical and Economic Review (ICER) is an obscure but potentially critically important organization. (don’t let your eyes glaze over yet) The corny 2 minute video at their website (shown above) explains what ICER does and why it does it. Short answer made shorter: ICER evaluates the cost-effectiveness of new drugs, in part by comparing their cost-benefit profile with existing drugs to treat the same diseases.

Guess who hates ICER?
Hint: Pioneer (new) drug companies and the GOP
Answer: Pioneer drug companies and the GOP

Why? Money.

In an article, Special Report: Big Pharma wages stealth war on drug price watchdog, Reuters reports on how things are going with ICER:

“(Reuters) - As evidence grew this spring that the drug remdesivir was helping COVID-19 patients, some Wall Street investors bet on analysts’ estimates that its maker, Gilead Sciences Inc, could charge up to $10,000 for the treatment.

Then a small but increasingly influential drug-pricing research organization, the Institute for Clinical and Economic Review (ICER), said the treatment only justified a price between $2,800 and $5,000. Shortly after, Gilead announced it would charge about $3,100 for a five-day treatment and $5,700 for ten days - in line with the ICER recommendation.

The episode illustrates the growing power of the Boston-based nonprofit to hold down U.S. drug prices. Over the past five years, ICER has pressured drugmakers to lower the cost of nearly 100 drugs. It aims to play a similar role with emerging COVID-19 treatments and vaccines. Health insurers increasingly use ICER's fair-value analyses to limit access to expensive drugs or to negotiate steeper discounts with drugmakers. (For a graphic on drugs ICER has rated overpriced, click tmsnrt.rs/3hiYULv).

The industry has moved aggressively to combat the threat to its profits in two ways: With open criticism of ICER’s formula and with a stealthier campaign to undermine its credibility through proxies, including veterans’ groups and organizations that claim to advocate for patients but have ties to the pharmaceutical industry, Reuters found in a review of industry connections and funding among groups targeting ICER. 

Two such groups – the Partnership to Improve Patient Care (PIPC) and Value our Health – are led by employees of Thorn Run Partners, a Washington-based lobbying and public relations firm that counts nearly a dozen drugmakers as clients. PIPC denied it is part of a larger industry-financed proxy campaign to undermine ICER’s impact. Thorn Run declined to comment, and Value Our Health did not respond to inquiries.

As remdesivir gained momentum, PIPC complained to ICER in a June letter that its methodology, which examines how a drug improves patient quality of life, was unfair for COVID-19 drugs. It also held a webinar for patients criticizing ICER’s methods.

The group’s chairman, former U.S. Democratic Representative Tony Coelho, argued in the letter that ICER’s methods yield a flawed value assessment for COVID-19 drugs that could lead insurers or government programs to limit coverage to the elderly and people with disabilities because ICER’s formula attributes a lower value to their medicines than those for healthier patients. In a statement to Reuters, Coelho attacked ICER’s formula as a flawed “one-size-fits-all assessment.”

Gilead also pushed ICER for a higher price during its remdesivir review. The firm told Reuters that ICER’s assessment failed to consider savings from shorter hospital stays and underestimated how much insurers or the government would be willing to pay.

Remdesivir is the only COVID-19 treatment ICER has assessed so far. Steven Pearson, a Harvard academic who started ICER, said it will likely review more coronavirus treatments if they make it to market, including potentially those being developed by Regeneron and Eli Lilly and Co that use antibodies to generate an immune response. The two companies declined to comment.

ICER’s assessments are not used to deny care to patients based on their health, Pearson said. Rather, the formula helps insurers or government programs choose the most cost-effective treatment for a specific condition, based on its price and benefit in providing a better quality of life. Pearson pointed out that the formula has long been used in the health systems of countries including England, Canada, the Netherlands and Sweden.

PHONY GRASSROOTS CAMPAIGN 

The industry has followed the same playbook before: soliciting criticism from outside groups - some of which it finances or staffs - to create the impression of a broad-based patient uprising against ICER’s pricing assessments rather than an industry push to protect profits. 

Last year, ICER invited input as it revamped its assessment methods. Two of more than 50 comment letters came from six California veterans’ groups, who blasted an ICER contract with the U.S. Department of Veterans Affairs (VA), saying its formula denies veterans care and “inherently discriminates” against people with disabilities.”

If it sounds like doing what ICER does is a no-brainer good thing, that is because it is a no-brainer good thing. What is a brain exploder is the fact that this kind of analysis is not being done by the federal government to inform the public about when they are being price gouged. Once again, lobbyists backed by special interest campaign contributions and a corrupt two-party political system serves special interests at the expense of the public interest.

The industry response: Lies & insulting irrationality

The Remdesivir company complained that ICER’s assessment (1) failed to consider savings from shorter hospital stays, and (2) underestimated how much insurers or the government would be willing to pay. Both complaints are either irrational or a lie. First, ICER is fully aware of benefits from shorter hospital stays and any other source from drug treatments. Their analyses ignore no known benefits, otherwise it would not be a “cost-benefit” analysis. That assertion is a lie.

Second, it is irrational to argue that what insurers are willing to pay is completely irrelevant to a cost-benefit analysis. Whatever insurers are willing to pay will be paid by consumers one way or another, e.g., higher insurance premiums or no access to drugs at all (‘extreme health care rationing’). Cost is cost. This argument is insulting in its irrationality and intent to deceive the public.

Also insulting and irrational is the industry tactic of its sleazy, deceptive phony grassroots campaigns.

Lies, insults and irrationality are all legal and just business as usual, i.e., money talks and the public interest walks.

ICER'S TEN LEAST COST-EFFECTIVE DRUGS
ICER’s recommended price based on a cost effectiveness threshold of 

$100,000 per quality year of life gained from the drug

Book Review: Rage

Fauci: Trump’s “attention span is like a minus number”

This is a portion of a book review the Washington Post published yesterday. It was written by Rosa Brooks, a Georgetown law professor. The book was written by reporter Bob Woodward and is about his interviews with the president earlier this year. Some of the interviews were taped so the president cannot simply deny what Woodward reported. Instead, he has to explain away his lies and deep immorality. Brooks writes:

What new insights does Bob Woodward’s latest book, “Rage,” offer? We learn that President Trump is not the sharpest tool in the shed; members of his Cabinet consider him a narcissistic fool, devoid of empathy and incapable of distinguishing between truth and falsehood. Trump blithely minimizes the lethality of the coronavirus because he doesn’t want to look bad. He takes no responsibility for anything, boasts repeatedly about his wealth and genius, and shows nothing but contempt for those who happen to get in his way.

But we knew all this already, didn’t we? We already knew that Rex Tillerson, Trump’s former secretary of state, told colleagues that the president was “a moron” and that John Kelly, Trump’s former chief of staff, often referred to him as an “idiot.” We knew that other senior officials have decried Trump’s “amorality” and “erratic behavior,” and that Jim Mattis, his former secretary of defense, was “angry and appalled” by what he saw as Trumpian behavior that made “a mockery of our Constitution.” We knew about Trump’s repeated assurances that the coronavirus would soon “disappear . . . like a miracle” and about his “perfect” phone call with Ukrainian President Volodymyr Zelensky, which led to his impeachment. We even knew that Trump considers America’s war dead “losers” and “suckers.”

The Age of Trump has been characterized by “shocking revelation” after “shocking revelation,” with the occasional “stunning revelation” thrown in for variety. Each new revelation is claimed to be the one that will end Trump’s presidency; each time, Trump blithely skips away from accountability, and his base remains loyal as ever.

Viewed in this context, “Rage” offers some fresh details and confirmation of old assumptions, but little that is likely to surprise anyone or change any minds. These incidents have lost their power to shock. What makes the book noteworthy is Woodward’s sad and subtle documentation of the ego, cowardice and self-delusion that, over and over, lead intelligent people to remain silent in the face of Trumpian outrages.

Woodward offers a detailed portrait of the president and some of his top aides. He tells us, for instance, that Mattis viewed Trump as “dangerous” and “unfit” for office, and ultimately resigned when he thought that Trump’s directives had shifted from merely stupid to “felony stupid.” For his part, Trump told White House trade adviser Peter Navarro that he considered his “fucking generals” to be “a bunch of pussies.” Meanwhile, Woodward reveals, former director of national intelligence Dan Coats took seriously the possibility that Trump was “in Putin’s pocket” and “suspected the worst” of the president. Trump, Coats reportedly told Mattis, “doesn’t know the difference between the truth and a lie.” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, was no more complimentary, commenting privately that Trump’s “attention span is like a minus number.”

Brooks is correct to surmise that none of this will faze the president’s supporters. They are long past the point of concerns about the president’s lies, incompetence, blatant corruption, immorality, mental unfitness for office, and apparently, almost anything else bad. They are in full-blown personality cult tribal mode and living the alt-reality it confers on them.

Some Thoughts on Conspiracy Theories

Belief that the Earth is flat can reasonably be considered to be a debunked conspiracy theory. That belief requires the believers to also believe that there has is a massive conspiracy involving billions of people all over the world lasting for centuries. That is a bit of a stretch, to put it mildly.

In general, once a person is convinced about a big conspiracy, then believing anything becomes easier. Facts, expertise, sound reasoning can all fade in significance, or even disappear completely. One appeal of conspiracies is that they give permission to accept or reject out of hand, any claim, fact or reasoning. The conspiracy theory mindset tends to create a freedom to construct reality as a person wants. That allows believers to side-step the hard part of having to deal with actual reality and sound reasoning.

What about Qanon?

The conspiracy: The Q conspiracy says that Hillary Clinton and other powerful democrats are part of a world-wide cadre of Satan-worshiping cannibalistic pedophiles who are secretly taking over the world. In that crackpot narrative, the president is secretly a genius working behind the scenes with Mueller, and in some versions also with JFK Jr. who is secretly still alive, to uncover this evil cadre and bring them to justice. The justice bringing event is called the “Storm” in the Q narrative. Once the Storm is over, the president will usher in a new golden age.

Wot?: That all sounds right to me. (not really)

This is not mostly a matter of low IQ or naive gullibility. It is mostly a matter of a certain cognitive style that some people have. Science Daily discussed research published in 2018 in the Journal of Individual Differences comments:

“These people tend to be more suspicious, untrusting, eccentric, needing to feel special, with a tendency to regard the world as an inherently dangerous place. They are also more likely to detect meaningful patterns where they might not exist. People who are reluctant to believe in conspiracy theories tend to have the opposite qualities. Our results clearly showed that the strongest predictor of conspiracy belief was a constellation of personality characteristics collectively referred to as ‘schizotypy.’ The trait borrows its name from schizophrenia, but it does not imply a clinical diagnosis.”

Other research finds that conspiracy believers tend to have a relatively intuitive style of thinking, while an analytical style seems to hinder conspiracy thinking. This does not necessarily relate to intelligence. It is possible that being more intelligent may lead to greater susceptibility to conspiracy theories because those people are better able to rationalize nonsense into sense. Intelligence is complicates and multi-faceted. People who believe the QAnon (or flat Earth) narrative may be lacking some intellectual resource, but it not may be what we think of as intelligence.

Interestingly, a 2010 study found that when a charismatic leader aligns with what people tend to believe or their ideology, the critical thinking part of their brain turns off. Some other research suggests the same thing. Humans are a combination of multiple tendencies and cognitive abilities. The activity of such factors varies in different personal and social situations. Thus a person who is technically brilliant and normally astute could become a conspiracy believer under the right circumstances.