Monday Reads

Good morning!

So, I had a rather uneventful weekend.  I spent a lot of time grading stuff for my International Finance class and getting ready for my Security Analysis Class.  I am still getting used to teaching MBAs and graduate students instead of undergrads. Plus, I teach Finance now with very little Economics so I feel mercenary.  I tell myself that it keeps me in the kathouse and in red wine.  But, it’s difficult at times because teaching economic literacy is more of a calling to me.  Finance is much more utilitarian so I try to look at it as giving some one a life skill but it’s not quite the same.  I used to be appalled that undergrad students could get through high school knowing so little and now I have learned that you can get an undergrad degree and come out with bad skills too.  Color me jaded. At least I am not training predators.  I am training people that are just trying to survive in a world of predators.

Anyway, I did watch a few things over the weekend that helped me cope with the ordeal of reading so many cut and pastes from the internet instead of original thoughts.  AMC ran White Zombie.  I had never seen that.  I learned how little Lugosi made for the movie and was rather shocked.  I guess he was worried about loosing his career to Boris Karloff at that point and was taking all offers.  Then, I spent some time with Front Line which has a special place in our hearts here since Boomer’s brother is a cinematographer there.  The topic also figures predominantly in my life and JJ’s since it dealt with antibiotic resistant bacteria.

I’ve battled a MRSA (antibiotic resistant staph infection) for several years. You may remember one of them put me in the hospital and doctors were worried about me losing my eye sight. Thankfully, there’s one last drug that works for me. But, it will lose its efficacy eventually.  My doctors now trust me to rush to the pharmacy and get antibiotics when it gets out of hand. I have a topical lotion that seems to control anything that looks suspicious. I really try to not use the oral antibiotics unless it doesn’t respond to the topical and it looks like I’m in trouble.   Trouble means it doesn’t go away and the entire site begins to swell like a balloon even when I drain it, clean it, and douse it with the topical stuff.  At that point, waiting to see the doc even is dangerous.   I imagine that one day that routine won’t work.

That seems to be the message of the episode and of some eecent articles with warnings from the CDC. There are some bacteria that no longer respond to anything and that list is growing.  Dr. Arjun Srinivasan of the CDC says “We’ve Reached The End of Antibiotics, Period”.

For a long time, there have been newspaper stories and covers of magazines that talked about “The end of antibiotics, question ma?” Well, now I would say you can change the title to “The end of antibiotics, period.”

We’re here. We’re in the post-antibiotic era. There are patients for whom we have no therapy, and we are literally in a position of having a patient in a bed who has an infection, something that five years ago even we could have treated, but now we can’t. …

…I wonder if you can reflect a little bit and describe how the MRSA phenomenon, this resistant bacteria, changed public awareness about the problem.

So methicillin-resistant Staphylococcus aureus, or MRSA, for a lot of people is the first time that they had really encountered one of these highly drug-resistant bacteria. …

Literally for decades it’s been something that’s been difficult to treat. There were, up until recently, limited treatment options for MRSA. There is really one antibiotic that was available to treat it.

Was it that bad? Did people die from it?

People did die from it. It caused very serious infections. … MRSA was something that if you asked any doctor or nurse about MRSA, they would tell you, “Oh, yes, it’s a very serious issue. We struggle with it in our patients, in our intensive care units,” but if you asked the average person outside of hospitals about MRSA, they probably would never have heard of it. That all changed maybe about a decade or so ago.

What changed?

We began seeing MRSA infections outside of health-care settings. …

We were seeing it in young people who were athletes, who were young football players who had serious infections, who died of these MRSA infections which had previously been limited to hospitals.

We saw outbreaks in schools. We saw outbreaks in health clubs. And what most of these people were getting was something very different from what we saw in hospitals.

I guess nearly every one in New Orleans that spent some time in the post-Katrina environment now harbors MRSA if you believe the Doctors who deal with my outbreaks.  I had read about Super Bugs some years ago but it wasn’t something I kept at the front of my mind.  The biggest problem now is that it’s not really a good investment for pharmaceutical companies to do research in future antibiotics because they are only one shot drugs instead of drugs used perpetually.  Therefore, there is a distinct need for the Federal Government to step in and fund the research.  That, of course, is not really happening in this country of course.  There is also this ghoulish term of “nightmare” bacteria that sounds like something from a horror movie. The man who was interviewed by Frontline and was a major researcher for antibiotics passed away last week.  This adds to the story that sounds like a human disaster in the making.

We wanted to share the sad news that John Quinn, a veteran Gram-negative researcher featured in Hunting the Nightmare Bacteria, passed away last weekend. We knew him only briefly but in that short time he made an enormous contribution to our efforts to understand the importance of this subject and why major pharmaceutical companies have been pulling out of antibiotic development.

We knew companies had been abandoning antibiotic drug development and wanted to help viewers understand what that looked like from the inside. The story of Pfizer soon became an obvious example because the company had such a long history in developing antibiotics and had, until recently, been one of the stalwarts that remained involved in seeking a cure for Gram negatives.

But finding someone who was able to talk about the company and its decision to close down its antibiotic research efforts proved more difficult than we’d anticipated. Though we reached out to many researchers and scientists who had worked at Pfizer, they were all reluctant to speak on camera about the program.

That is until we found John Quinn. Quinn was a doctor by training and had been working in academia on Gram-negative resistance before it became a major public health concern. He watched first hand as resistance grew and doctors he worked with had few options to treat patients. “I’d seen [Gram-negative bacteria] kill patients,” Quinn told us. “I had, you know, seen the drugs that we were using cause kidney failure.  So I was acutely aware — personally aware, professionally aware — of the need to make progress in this space.”

As usual, I’ve already found a response that really seems to misunderstand the problem by a writer in the National Review.  It really isn’t the patent issue that thwarts the development of antibiotics by Big Pharma.  It’s the fact that antibiotics should be used sparingly, rarely, and basically for one illness.  The lack of ongoing cashflow to return to the original investment is the issue.  Granting patent extensions isn’t going to solve this problem at all.  It seems clearly to be an area that requires nationalization from an economic standpoint and the standpoint that it clearly will become a national health issue.

Before we get too upset with the evil pharmaceutical industry, remember that it can take billions to develop a new drug. And, we have restricted the patent time for the drugs they successfully develop to permit less expensive generics to be manufactured.

It seems to me that if we want new and better antibiotics–we should ensure that the financial risk taken has the potential to lead to a substantial financial gain by extending the patent life for new antibiotics an extra ten years from the time it receives formal approval. Then, maybe, drug companies will more energetically jump into the research for new antibiotics.

We could also have the NIH fund more research into antibiotics and make the results available to everyone. But that would mean making antibiotics a priority over other areas of research. I’m not sure the politics would permit such an explicit triage.

Is our political system so fraught with ideology that we can’t even deal with an oncoming plague?  This is a typical economic problem of “the commons”. We’ve had an overuse and a large abuse of antibiotics.  This is especially true in food production where antibiotics typically are used without cause in animals raised for food.

A big part of the trouble is that the gains from the overuse of antibiotics are private, whereas the losses are public. Problems such as these are rarely soluble without outside intervention. Ramanan Laxminarayan of Princeton University, who has been thinking for many years about how to deal with the question of resistance, suggests the answer is a mixture of incentives and scourges. Prize funds, or guaranteed-purchase arrangements for new drugs and the rapid-diagnostics systems that would allow them to be deployed appropriately, would help overcome the financial problem of antibiotics being cures, rather than just treatments. Stricter dispensing guidelines for doctors and pharmacists might help deal with the moral hazard of overtreatment.

A bit of realism would be good, too. Derrick Crook, a consultant microbiologist at Oxford, where Florey and Chain once worked, observes, “It is hard to massively restrict the use of antimicrobials when they are doing good. It is possible that the enormous use in Asia is a good thing for a short time in a given country.” That, combined with ignorance about precisely how much the unnecessary use of antibiotics contributes to increasing resistance, makes restriction highly controversial.

So, wow.  I took a lot more time on this subject than I thought I would.  Here’s some other links you may want to look at today!

Charles M Blow writes about Billionaires’ Row and Welfare Lines

Forbes’s list of the world’s billionaires has added more than 200 names since 2012 and is now at 1,426. The United States once again leads the list, with 442 billionaires.

It’s a great time to be a rich person in America. The rich are raking it in during this recovery.

But in the shadow of their towering wealth exists a much less rosy recovery, where people are hurting and the pain grows.

This is the slowest post-recession jobs recovery since World War II. The unemployment rate is falling, but for the wrong reason: an increasing number of people may simply be giving up on finding a job. The labor force participation rate — the percentage of people over 16 who either have a job or are actively searching for one — fell in August to its lowest rate in 35 years.

David Gregory spends his Sunday Show concern-trolling Obama Care.

But David Gregory has never come across a Republican talking point that he didn’t love, embrace and swallow up whole to faithfully regurgitate to the masses. So he dutifully confronts Blue Cross and Blue Shield of Florida CEO Patrick Geraghty about the news that 300,000 Floridians have found their policies dropped because they fall below the minimum standards of coverage set by Obamacare. Problem was, Geraghty wasn’t going to playGregory’s gotcha game with people’s healthcare:

“We’re not cutting people,” Geraghty said. “We’re actually transitioning people. What we’ve been doing is informing folks that their plan doesn’t meet the test of the essential health benefits; therefore, they have a choice of many options that we make available through the exchange. And, in fact, with subsidy, many people will be getting better plans at a lesser cost. This really is a transition. In fact, the 300,000 figure is the entire year. So it’s really 40,000 people for January 1, and we’re walking them through that transition.”

Now, it’s absolutely true that there will be a fraction of people who find that their costs have gone up, the specific number and amount is still up for debate. And if they don’t qualify for subsidies, that will mean a higher out-of-pocket cost, at least in the short term. However, short-term partisan gains notwithstanding, the program will factor in long-term the inclusion of healthy, young people on the exchanges, which will help mitigate the ailing people who rushed for the initial coverage. Specifically, the re-insurance tax is being levied for the first three years is intended to help smooth that transition to allow for the long-term sustainability of the program.

More than 60 women took to driving cars to defy the ban on women drivers in Saudi Arabia.

Brushing off threats from the government, more than 60 Saudi women got behind the wheel on Saturday in a bold protest of the nation’s de facto ban on women driving.

Sara Hussein, a Saudi woman involved in the effort, drew parallels to the U.S. civil rights movement: “Think back in history — Rosa Parks was the only person who sat down on the bus, wasn’t she? And then it started to happen gradually. It does have to start with the few brave people who are willing to risk whatever there is to risk.”

Many women documented the act of civil disobedience on social media, even posting videos to YouTube. The most popular video, which has already been viewed nearly 100,000 times, was posted by May al-Sawyan, a 32-year-old economics researcher. She drove to the grocery store.

So, that’s it for me this morning!  What’s on your reading and bloging list today