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.

A Barrage of Political Deceit, Sleaze & Lies

A small, partial list, there is also: 
I will show my tax returns
Etc.

The last 24 hours has been amazing and disgusting on a grand scale. No president other than this one would survive. American conservative politics clearly has moved from merely tribal to personality cult tribal. The New York Times reports on moves by the president to subvert the Department of Homeland Security for his own political gain at the expense of America’s national security:

“WASHINGTON — Top officials with the Department of Homeland Security directed agency analysts to downplay threats from violent white supremacy and Russian election interference, a Homeland Security official said in a whistle-blower complaint released on Wednesday.

Brian Murphy, the former head of the Homeland Security Department’s intelligence branch, said in the complaint that he was ordered this spring by Chad F. Wolf, the acting secretary of the department, to stop producing assessments on Russian interference and focus instead on Iran and China. That request, Mr. Murphy said, was routed through Mr. Wolf from Robert C. O’Brien, the White House national security adviser.

Mr. Wolf later told him not to disseminate a report on a Russian disinformation campaign to denigrate Joseph R. Biden Jr.’s mental health because it “made the president look bad,” said Mr. Murphy, who warned that the actions in their totality threatened national security.

In other instances, the department’s second-highest ranked official, Kenneth T. Cuccinelli II, ordered Mr. Murphy to modify intelligence assessments to make the threat of white supremacy ‘appear less severe’ and include information on violent ‘left-wing’ groups and antifa, according to the complaint, which was filed on Tuesday but released Wednesday by the House Intelligence Committee.”

In a different article, the NYT reports that in taped interviews with reporter Bob Woodward, the president admitted that he lied to the American people about how severe the pandemic actually was. The president was aware of the threat in February, but kept lying about it until March:

“President Trump acknowledged to the journalist Bob Woodward that he knowingly played down the coronavirus earlier this year even though he was aware it was life-threatening and vastly more serious than the seasonal flu.

‘This is deadly stuff,’ Mr. Trump said on Feb. 7 in one of 18 interviews with Mr. Woodward for his coming book, “Rage.”

‘You just breathe the air and that’s how it’s passed,’ the president told Mr. Woodward in audio recordings made available on The Washington Post website. ‘And so that’s a very tricky one. That’s a very delicate one. It’s also more deadly than even your strenuous flus.’

But three days after those remarks, Mr. Trump told the Fox Business anchor Trish Regan: ‘We’re in very good shape. We have 11 cases. And most of them are getting better very rapidly. I think they will all be better.’ A little less than two weeks later, he told reporters on the South Lawn that ‘we have it very much under control in this country.’”

The president claimed he lied to prevent a pubic panic. Regardless of his motive, very likely political self-interest, lies are lies and this batch of lies was not justified by the ‘public panic’ excuse. The ‘it was for the public’s own good’ is an excuse that politicians and rulers have used to justify lies when justification is needed. The historical records shows that very rarely are such lies justified.

In a third article, the NYT reports that postmaster General Louis DeJoy has hired a big gun GOP lobbyist to reach out to democrats in the House to try to get them to stop investigating his campaign finance felonies and his sabotage of the post office:

“Facing calls for his ouster by Democrats and a flurry of investigations on Capitol Hill, Mr. DeJoy informed postal officials that he had selected Peter Pastre, a former Republican congressional aide and insurance lobbyist, to act as a liaison for the agency with Congress and state and local governments, according to people familiar with the discussions.

The move came as the Postal Service was facing mounting political and operational crises. Mr. Trump has raised concerns about the security of voting by mail, and the independent quasi-governmental agency has struggled to overcome a delivery slowdown and a dire financial forecast — all while Democrats accuse Mr. DeJoy and the agency’s Republican-majority governing board of doing the president’s bidding.”

The AP describes Mr. DeJoy’s illegal campaign finance operation:

“Postmaster General Louis DeJoy is facing increased scrutiny as House Democrats investigate allegations that he encouraged employees at his former business to contribute to Republican candidates and then reimbursed them in the guise of bonuses, a violation of campaign finance laws. 

Five people who worked for DeJoy’s former company, New Breed Logistics, say they were urged by DeJoy’s aides or by DeJoy himself to write checks and attend fundraisers at his mansion in Greensboro, North Carolina, The Washington Post reported. Two former employees told the newspaper that DeJoy would later give bigger bonuses to reimburse for the contributions. 

Rep. Carolyn Maloney, who chairs the oversight panel, said in a statement Tuesday that if the allegations about campaign finance violations are true, ‘DeJoy could face criminal exposure — not only for his actions in North Carolina, but also for lying to our Committee under oath.’”

As always, the president’s best people include liars and felons. This time the sleazeball is Mr. DeJoy and us taxpayers are going to pay for this sleazeball lobbyist to defend DeJoy.

An finally, the outrage among outrages, it turns out that us idiot taxpayers will be paying for our scumbag president’s legal defense in a sexual assault case brought by one of the president’s many sexual assault victims. The NYT writes: 

“The attorney general argued that the intervention was routine but did not say why the department waited 10 months to step in.

The White House asked the Justice Department to replace President Trump’s private lawyers to defend against a woman’s accusations that he defamed her last year in denying her claim that he sexually assaulted her a quarter-century ago, Attorney General William P. Barr said on Wednesday.

The Justice Department’s intervention in the lawsuit means that taxpayer money will be used to defend the president, and it threatens the continued viability of the case of the plaintiff, the author E. Jean Carroll.

Mr. Barr defended the decision to intervene, arguing that it was routine for the department to take over lawsuits against federal officials — substituting the government as the defendant.

‘This was a normal application of the law,’ Mr. Barr said during a news conference in Chicago. ‘The law is clear. It is done frequently. And the little tempest that is going on is largely because of the bizarre political environment in which we live.’”

As usual, our corrupt Attorney General Bill Barre is subverting justice and lying to the American people. There is nothing normal about this. The president hired Barr to protect him from the rule of law. President Clinton did not use the DoJ to defend himself for his colossal stupidity and crimes in office. Barr is, among some other bad things, a liar.

And that is today’s roundup of lies, deceit and sleaze that surrounds our president.

Mindfulness vs. Mindlessness

 By Laura K. Schenck, Ph.D., LPC

https://www.mindfulnessmuse.com/mindfulness/mindfulness-vs-mindlessness

“Rejoice in the things that are present; all else is beyond thee.” – Montaigne

We are mindful when we are in a “mental state characterized by nonjudgmental awareness of the present moment experience, including sensations, thoughts, bodily states, consciousness, and the environment, while encouraging openness, curiosity, and acceptance” (Hofmann et al., 2010, p. 169).  This state of mindfulness is flexible, open to novelty, and sensitive to both context and perspective (Langer, 2005).

When we are operating in life from a mindful position, we are willing to open ourselves to all of the possibilities and nuances of our internal and external worlds.  We feel willing to invite whatever thoughts and emotions may come, because we are not rigid in fear that thoughts or emotions will overwhelm us.  Through this open stance, we allow ourselves to bear witness to thoughts, emotions, and external events without judgment.  Paradoxically, when we allow potentially negative thoughts or feelings to simply “be,” we take away the power that they have over us.  It is when we resist and deny our thoughts and feelings that they grow stronger.

A mindful stance welcomes whatever thoughts and emotions arise, examines them with curiosity and openness, and then lets them go.  There is no need to hold on to the disturbing thoughts and emotions.  From a mindful place, we are willing to experience them, calm in the knowledge that we are in the driver’s seat.  Thoughts and emotions have no power over us when in a mindful place.  When we experience fear, anger, or sadness mindfully, we take away the power of those emotions.  We do not deny or invalidate them, but we see them for what they truly are: feelings.

When we choose to adopt a mindful view towards our daily experience, we release the need to evaluate every thought, feeling, or action as “good” or “bad.”  Ellen Langer, author of the chapter “Well-Being” in the Handbook of Positive Psychology, notes that while “evaluation is central to the way we make sense of our world, in most cases, evaluation is mindless … A more mindful approach would entail understanding not only that there are advantages and disadvantages to anything we may consider but that each disadvantage is simultaneously an advantage from a different perspective (and vice versa).  With this type of mindful approach, virtually every unpleasant aspect of our lives could change.”

Much of what we are taught in Western societies involves the idea that when bad things happen, we just need to “hold on” and wait for them to pass.  Imagine the tension and fear involved in this mindset – knuckles white, breath held in, muscles tight.  When we shift into a mindful stance, we can begin to view the bad things that happen in life as being context dependent.  There is a deep awareness that with everything, there are both good and bad aspects, depending on our point of view.

When we are operating in a mindless way, we are choosing not to take in all available information – we select that which we pay attention to, even when it only increases fear or anger.  When living in mindlessness, we go through the day reacting to internal thoughts and feelings and external events, rather than responding. Mindlessness results in unawareness – we are limiting the full range of what we can experience.  There is understandable fear involved in the idea of “inviting” seemingly negative thoughts or emotions with open-minded curiosity.  We are taught to reject and suppress such negativity.

Reflect on how your own experience changes when you practice mindfulness in your daily routine.  The next time that an unpleasant thought or feeling arises, rather than stuffing it down and rejecting it, allow it to be. Practice sitting with discomfort. When we learn how to tolerate discomfort and distress in this way, we are providing ourselves with the chance to be freed from suffering.  Our emotional suffering persists when we deny it, ignore it, or rage against it.  Notice it, welcome it, observe it, and let it go.