Cut drug lags with Free To Choose Medicine @annetterongotai @dbseymour @PeterDunneMP

Bart Madden and Vernon Smith outlined a brilliant proposal charted above to shorten lags in the availability of life-saving medicine based on reforms in Japan:

Recently, Japanese legislation has implemented the core FTCM [Free to Choose Medicine] principles of allowing not-yet-approved drugs to be sold after safety and early efficacy has been demonstrated; in addition, observational data gathered for up to seven years from initial launch will be used to determine if formal drug approval is granted. In order to address the pressing needs of an aging population, Japanese politicians have initially focused on regenerative medicine (stem cells, etc.).

Source: Give The FDA Some Competition With Free To Choose Medicine – Forbes via A Dual-Track Drug Approval Process.

This process would release the relevant data behind the drug including its clinical trials on a web portal so that patients and their doctors can work out whether a new drug is suitable to them given their genetic markers. Madden and Smith explain the operation of the web portal for Free to Choose Medicine (FTCM) as follows:

Doctors would be empowered to use their medical knowledge and in-depth knowledge of their patients similar to how they decide on off-label use for approved drugs, i.e., for uses that the FDA has neither tested nor approved but, in the opinion of doctors, are likely to be beneficial to patients. To gain early access, patients would purchase the drug from developers and consent to doctor and developer immunity from lawsuits except in the case of gross negligence or willful misconduct.

Off label use of medicines arises because the current Food and Drug Administration (FDA) process for drug approval has several phases. Phase 1 tests for the safety of the drug. Later phases are about whether the drug has its predicted effects. That should not be a concern of the FDA or its superfluous New Zealand equivalent Medsafe.

If a new drug isn’t better than the existing competition, that’s a problem for its investors for backing the wrong horse. It’s up to its investors and potential buyers to work out for themselves whether a new drug is more effective than the existing options. That’s a commercial decision, not a decision from regulators.

https://twitter.com/Carolynyjohnson/status/667696845615968257

Once a drug is approved by the FDA for particular uses, doctors and researchers often discover that a drug has other clinical applications.

Source: Pharma Marketing Blog 

Rather than go through another round of FDA approvals, doctors simply prescribe that drug despite the fact it is not approved by the FDA for that particular clinical use. This is what is called off label prescription.

A number of US states have passed hopelessly unconstitutional Right to Try legislation that authorises the prescription of new drugs not approved by the FDA.

The Free to Choose Medicine proposal is similar to Right to Try legislation. Free to Choose Medicine would allow doctors to make their own prescription choices for their patients as long as the new drug has been shown to be safe. That is, it has passed Phase 1 of the FDA drug approval process. Phase 1 is about drug safety.

In 1962, an amended law gave the FDA authority to judge if a new drug produced the results for which it had been developed. Formerly, the FDA monitored only drug safety. It previously had only sixty days to decide this. Drug trials can now take up to 10 years.

https://twitter.com/MaxCRoser/status/627581135355310080

Sam Peltzman showed in a famous paper in 1973 that the 1962 amendments to US Federal drug approval laws reduced the introduction of effective new drugs in the USA from an average of forty-three annually in the decade before the 1962 amendments to sixteen annually in the ten years afterwards. No increase in drug safety was identified.

Peltzman found that the unregulated market quickly weeded out ineffective drugs prior to the 1962 law change in the USA. The sales of ineffective new drugs declined rapidly within a few months of their introduction.

Doctors stop prescribing medicines that don’t work. Patients complain quickly about medicines that don’t work. What matters is they had the chance to try this drug.

If economists have a bitter drinking song, a battle cry that unites the warring schools of economic thought all, it would be “how many people has the FDA killed today”. Many drugs became available years after they were on the market outside the USA because of drug approval lags at the FDA. The dead are many. To quote David Friedman:

In 1981… the FDA published a press release confessing to mass murder. That was not, of course, the way in which the release was worded; it was simply an announcement that the FDA had approved the use of timolol, a ß-blocker, to prevent recurrences of heart attacks. At the time timolol was approved, ß-blockers had been widely used outside the U.S. for over ten years. It was estimated that the use of timolol would save from seven thousand to ten thousand lives a year in the U.S. So the FDA, by forbidding the use of ß-blockers before 1981, was responsible for something close to a hundred thousand unnecessary deaths.

Free to Choose Medicine is an excellent way to break the regulatory deadlock over drug lags. Free to Choose Medicine should be adopted in New Zealand. Any new drug that has passed the phase 1 drug safety part of regulatory approval processes in any one of the USA, UK, Australia, Canada or Germany should be lawful to prescribe in New Zealand. New drugs should not have to go through the superfluous processes of Medsafe.

The existing drug regulatory regime is based upon making the drug safe for the average patient. That has been swept aside by pharmaceutical innovation as Madden and Smith explain:

Today’s world of accelerating medical advancements is ushering in an age of personalized medicine in which patients’ unique genetic makeup and biomarkers will increasingly lead to customized therapies in which samples are inherently small. This calls for a fast-learning, adaptable FTCM environment for generating new data.

In sharp contrast, the status quo FDA environment provides a yes/no approval decision based on statistical tests for an average patient, i.e., a one-size-fits-all drug approval process. In a FTCM environment, big data analytics would be used to analyze TEDD [Tradeoff Evaluation Drug Database] in general and, in particular, to discover subpopulations of patients who do extremely well or poorly from using a FTCM drug.

Gender pay gap at age 25-29, OECD countries @GreenCatherine

The gender pay gap in New Zealand rounds down to zero for women in their mid-20s!

image

Source: Closing the Gender Gap: Act Now – OECD 2012.

Are Republican voters becoming climate alarmists?

Long-term political forecasts should not be based on demographics alone

Climate sceptics are so low that they must be smeared as libertarians

When the Twitter Left brands an opponent as a libertarian, I assume it’s a secret handshake among true believers trying to identify each other. You need time management counselling in your calling as a political junkie if you knew what a libertarian was until a few years ago. The only reason to change was the election of Senator Ron Paul.

The Twitter Left likes to smear opponents as libertarians despite the fact that certainly outside the USA and even within the USA few know what the libertarian means even with the help of scare quotes.

Only political junkies have an inkling of what a neoliberal is so why smear someone such an even more obscure label such as libertarian? Libertarian must be lower than a neo-liberal and should be hated even more by the Twitter Left must be the implication despite its poor marketing outreach value. I’m still puzzled as to why use such an obscure political label.

Today in the New York Times, a guide was published giving its readers the short answers to the key questions global warming. The author argued that most attacks on the science of global warming come from libertarians and other political conservatives who don’t like the implications of fighting global warming for growth in the size of government.

Source: Short Answers to Hard Questions About Climate Change – The New York Times via Environmental Economics: Short Answers to Hard Questions About Climate Change – The New York Times.

It is true that people attempt to discredit the arguments behind positions. Let he who is without sin cast the first stone.

“How to discredit an unwelcome report:

… Stage Four: Discredit the person who produced the report. Explain (off the record) that
1. He is harbouring a grudge against the Department.
2. He is a publicity seeker.
3. He is trying to get a Knighthood/Chair/Vice Chancellorship.
4. He used to be a consultant to a multinational.
5. He wants to be a consultant to a multinational.”

Sir Humphrey, The Greasy Pole.

As a professional economist, I am used to special interests as well as the Twitter Left arguing that economics is “just a theory” and its methodology is unrealistic along with various other attempts to avoid engaging with the actual advice put forward.

It is also true that scepticism about climate science has a partisan divide. In the USA, for example, Democrats are far more worried about global warming then independents or Republicans. (Independents is their name for swinging voters. They are called independents because if they register as one, they can vote in the Republican or Democratic primaries in many states).

Source: Republicans and climate change: Is it more about politics than science? – AEI | Economics Blog » AEIdeas.

I have argued in the blogosphere since 2011 that let the science be settled, only the economics matters because the economic cost of global warming is small.

Global warming, although real, is not apt to be severe. It will lower the level of GDP by maybe 2%. The loss of one year’s income growth! Courtesy of David Friedman’s reading of the report, this is what the most recent report of the IPCC said:

With these recognized limitations, the incomplete estimates of global annual economic losses for additional temperature increases of ~2°C are between 0.2 and 2.0% of income (±1 standard deviation around the mean)

I have also argued that the climate alarmists scored a great tactical victory in keeping the debate about the reliability of the science. By successfully baiting that trap for opponents, the climate alarmists have avoided having to discuss the costs and benefits of global warming.

So it is rather curious that climate sceptics are playing to the strength of the climate alarmists rather than their weaknesses. Those weaknesses are the economics of global warming and the public choice economics of international climate agreements.

Source: Richard Tol.

Not only is the economic cost of global warming small, the chances of supplying an international public good such as a treaty to reduce carbon emissions is minimal.

The New York Times today in its Q&A guide did not quantify the costs and benefits of global warming. That makes their guide deeply misleading. This is because such estimates of the cost of global warming as a percentage of GDP are available from the IPCC. Which is worse? Being a libertarian or a misleading, low rent journalist?

Source: Short Answers to Hard Questions About Climate Change – The New York Times via Environmental Economics: Short Answers to Hard Questions About Climate Change – The New York Times.

What is even more bizarre in the guide today in the New York Times is the claim that politicians are finally taking climate change seriously. Anyone who claims that a climate change treaty will come out of Paris that is in any way binding is simply not paying attention to the last 5 years of politics and who controls the U.S. Congress. They cannot be taken seriously as a political commentator.

Obama gave up on a climate bill passed by the House of Representatives in 2010 despite the fact that he had the numbers in the Senate to break a filibuster. There were 5 Republican senators who would have voted for cap and trade in April 2010: Lindsey Graham, Susan Collins, Olympia Snowe, Scott Brown, and George LeMieux. There were 57 Democrat Senators. It takes 60 votes to break a filibuster.

Obama gave up because he didn’t want the additional political flak of passing a climate change bill in the aftermath of the political costs of passing Obamacare. President Obama could have fought harder to get the Bill the House passed through the Senate but he did not.

Concern about global warming fads away when it becomes a hip pocket issue. Rather than blaming vast right-wing conspiracies, using Google searches for “unemployment” and “global warming”, Kahn and Kotchen found that:

  • Recessions increase concerns about unemployment at the expense of public interest in climate change;
  • The decline in global-warming searches is larger in more Democratic leaning states; and
  • An increase in a state’s unemployment rate decreases in the probability that Americans think global warming is happening, and reduces the certainty of those who think it is.

As Geoff Brennan has argued, CO2 reduction actions will be limited to modest unilateral reductions of a largely token character. There are many expressive voting concerns that politicians must balance to stay in office and the environment is but one of these. Once climate change policies start to actually become costly, expressive voting support for these policies will fall away, and it has.

The minimum wage as % of the median wage and the gender wage gap at the bottom of the U.S. labour market

When feuding with strangers on Twitter about the gender wage gap, a common explanation for the much smaller gender wage gap at the bottom of the labour market is the power is the minimum wage to uplift women’s wages and with it narrow the gender wage gap at the bottom of the labour market.

Below I have plotted the minimum wage as a percentage of the median wage for the USA along with the gender wage gap for the bottom 10% of the U.S. labour market. Both are expressed as percentages of the median wage.

Source: OECD Employment Database and Data extracted on 30 Nov 2015 04:03 UTC (GMT) from OECD.Stat.

From what I can make of the above chart, the gender wage gap at the bottom of the labour market was closing rapidly when the minimum wage was falling as a percentage of the median wage. That gender wage gap then stabilised when the minimum wage stabilised as a percentage of the median. The gender wage gap increased when the minimum wage increased as a percentage of the median wage for full-time employees.

Should not this relationship between the minimum wage and the gender wage gap be the other way around if the minimum wage is a force for closing the gender wage gap at the bottom of the labour market?

 

Partisan advantage by date of birth

Fact checking @Bernie Sanders latest presidential debate

An example of American gerrymanders

Has @Noahpinion pivoted on minimum wage rises and unemployment?

Source: Most of What You Learned in Econ 101 Is Wrong – Bloomberg View.

The incentive effects of the living wage and a carbon tax @BernieSanders

@Noahpinion can the @LivingWageNZ model close the 30% wage gap with Australia? @arindube

Noah Smith overnight argued that increasing the minimum wage to $15 an hour in the USA will induce innovation that will, in time, mitigate much of the costs of the minimum wage increase to employers:

So minimum-wage laws, by forcing us to abandon low-skilled labour, might actually increase technological innovation. Some people even speculate that this effect might have started the Industrial Revolution itself! Economic historian Robert Allen has argued that the Industrial Revolution began in Europe, rather than in China, because European employers were forced to pay more for labour. Since labour was more expensive, companies invested in technology, which then raised productivity so much that it boosted wages even higher, forcing companies to invest more in technology, even as their increased incomes allowed them to make those investments. A 1987 theory by growth economics pioneer Paul Romer operated on a similar principle — expensive labour causes an upward spiral of technological improvement. 

Smith is confusing induced innovation with standard substitution effects and offsetting behaviour. When you make something more expensive, buyers look for cheaper alternatives including technologies that were previously unprofitable to employ.

Up until the minimum wage increase, these labour saving technologies were not profitable investments because the best available choice was still lawful to employ, which was low skilled labour. A minimum wage increase makes it unlawful to employ the best available alternative. As Modeled Behaviour explains better than me:

If throwing the costly challenges of artificially expensive Labor at businesses drives economic growth, then perhaps we should have an Office of Government Hurdles that is designed to generate arbitrary restrictions for businesses. After all, if this innovation is a driver of economic growth it should have value by itself and not simply as a by-product of some other regulatory goal, e.g. keeping out immigrants or raising wages. Consider a law that banned bending over in the workplace. Is there any doubt that this would spur innovative products that aided in grabbing without bending? Or consider a law that mandated everyone work from home. This would spur massive investment in broadband and telecommunications. But there is no doubt we would be poorer from both of these regulations.

One of the reasons demand curves slope downwards is as the price of the good increases, buyers have other options so they stop buying and pursue these other options which include innovation.

Smith also falls for the standard labour market policy response in a crisis, which is to send them on a course:

And as workers raise their own skill levels, that new technology would raise their wages as well. The entire economy, including any workers who temporarily lost their low-wage jobs, would benefit in the long run. Of course, this theory is fairly speculative — theories that play out over years or decades are hard to test with real-world data. But it’s a potential benefit of the minimum wage that is worth thinking about.

Whenever there is a crisis in the labour market, the standard policy response is send them on a course. That makes you look like you care and by the time they graduate, the problem might have fixed itself. I encountered this policy response to labour market crises to repeat itself over and over again while working in the bureaucracy.

Clever geeks such as yourself sitting at your desk as a policy analysis, public intellectual, politician, activist or minister did well at university. University graduates succumb to the fatal conceit when they assume others will as well, including those who have neither the ability or aptitude to succeed in education.

Educational romanticism will not solve the disemployment problems of a minimum wage increase. People don’t go on from high school to higher education for a range of reasons that include a lack of motivation to study or a simple lack of ability no matter how hard they try.

Charles Murray believes many students make poor investments by going to college, in part, because many don’t complete their degrees:

…even though college has been dumbed down, it is still too intellectually demanding for a large majority of students, in an age when about 50 per cent of all high school graduates are heading to four-year colleges the next fall. The result is lots of failure. Of those who entered a four-year college in 1995, only 58 per cent had gotten their BA five academic years later

Murray does not want to abandon these teenagers:

…Too few counsellors tell work-bound high-school students how much money crane operators or master stonemasons make (a lot). Too few tell them about the well-paying technical specialties that are being produced by a changing job market. Too few assess the non-academic abilities of work-bound students and direct them toward occupations in which they can reasonably expect to succeed. Worst of all: As these students approach the age at which they can legally drop out of school, they are urged to take more courses in mathematics, literature, history and science so that they can pursue the college fantasy. Is it any wonder that so many of them drop out?

Charles Murray is frank about educational romanticism. Half the population is of below average IQ. That is before considering the necessary personality traits to be a successful student. Asking people without the necessary IQ and personality traits to waste their time with up skilling insults them.

Carrying that send them on a course educational romanticism over to the minimum wage and living wage debates is to use the low skilled as lab rats in the social experiments that are bound to fail as they failed in the past.

One of the purposes of applied price theory, the study of economic history and even labour econometrics is to spare us policy experiments we already know will not turn out well.

We do know what will happen if the minimum wage is raised to $15 per hour. Some people will lose their jobs. More importantly, there is a reduced incentive for the low paid to invest in skills to improve their earning power because the minimum wage is already delivered that assuming they still have a job. Human capital effects of minimum wage increases is under discussed.

As for investing in up skilling, active labour market programs that invest heavily in upskilling the unemployed have a dreadful record. This dreadful record is when there are subsidies direct to the unemployed going on prearranged courses focused on work skills. We’re not talking about indirect incentives such as raising the minimum wage and hoping for the best regarding their upskilling both on the job or while on the unemployment benefit.

Back to Noah Smith. He admits that increases in the minimum wage reduce employment. He tries to ride out on the conclusion that that increase in unemployment after a small minimum wage increase isn’t much.

Obviously the teenagers and adults thrown onto the scrapheap of society by the increased minimum wage don’t count in the brutal utilitarian calculus employed by Noah Smith and other champions of the low paid.

Smith is now trying to fortify his argument by arguing that minimum wage activists have spotted an untapped innovation right under the noses of entrepreneurs who profit from exploiting gaps in the market faster than the rest. Bureaucrats and politicians notice these gaps in the market before those who gain from superior entrepreneur alertness to hitherto untapped opportunities for profit do so and instead leave that money on the table.

What is even richer in this induced innovation hypothesis of Noah Smith and others is many of these minimum wage workers are in the services sector. Services suffer from Baumol’s disease: the limited ability to innovate in labour-intensive areas.

The optimal timing of innovation spawned a vast literature. So has offsetting behaviour to regulation. The former innovation is welfare enhancing. The latter is mitigation of the dead weight social losses of regulation.

What and where to innovate is a process of market discovery. The life cycle of many industries starts with a burst of new entrants with similar products and production processes. These new or upgraded products and the different ways of making them often use ideas that cross-fertilise.

In time, there is an industry shakeout where a few leapfrog the rest with cost savings and design breakthroughs to yield the mature product (Boldrin and Levine 2008, 2013). Fast-seconds and practical minded latecomers often imitate and successfully commercialise ideas seeded by the market pioneers using prior ideas as their base.

This entire dynamic market process of competitive selection, competition as a discovery procedure, trial and error and leapfrogging is distorted if one or more of the contending entrepreneurs as their hand forced by regulation on labour imports rather than because of competitive merits. The government cannot enable this process because neither the outcome nor even the direction of the competitive struggle for survival is known in advance. To quote Thomas Babington (1830):

The maxim, that governments ought to train the people in the way in which they should go, sounds well. But is there any reason for believing that a government is more likely to lead the people in the right way than the people to fall into the right way of themselves?

The firms that survive and grow in competition with rival ways of doing business are the more efficient simply because they survived. What will survive in market competition will not be known in advance to politicians and activists when they decide to make one specific input more expensive. The results of the competitive market process that weeds out the less efficient firm are known at the end of this long race, not at the start.

Knowing that innovation is induced by changing relative prices and wages doesn’t help wise bureaucrats and farsighted politician know which one of those relative prices or wages will be decisive in determining the direction of innovation. As Alfred Marshall explains in The Social Possibilities of Economic Chivalry (1907):

A Government could print a good edition of Shakespeare’s works, but it could not get them written… I am only urging that every new extension of Governmental work in branches of production which need ceaseless creation and initiative is to be regarded as prima facie anti-social, because it retards the growth of that knowledge and those ideas which are incomparably the most important form of collective wealth.

What is not explored adequately in this debate by either Noah Smith or the New Zealand Living Wage Movement is why limit the efficiency wage and induced innovation hypotheses to low skilled workers.

Why not increase the wages of all workers by 20-30%? There will not be a large disemployment effect and the induced innovation will mitigate the costs, if Noah Smith and his efficiency wage and induced innovation hypotheses are to be believed.

30% would be a good number for increasing all New Zealand wages was that is about the wage gap with Australia. Let’s go for broke. What’s the risk other than massive unemployment and economic chaos?

The living wage sought in New Zealand and the fight for $15 campaign in the USA presuppose massive offsetting labour productivity gains. A doubling in labour productivity overnight in low-paid service and other jobs or at least within a few years because of higher work morale.

The labour productivity increase required to offset even some of the costs of the double-digit living wage increases proposed at home and abroad are large, very large:

Looking first at the 2016 position, the proposed wage floor increase would require productivity growth of around 11% between 2015 and 2016. By 2020, the cumulative productivity gains from 2015 would need to rise above 37%, implying an average annual increase of 6.6%… the pace of productivity growth implied by our thought exercise is unprecedented: the annual average increase during the economic growth years of 1991-2008 was 2.2%. That points to two conclusions. First, firms are likely to need support in meeting the productivity challenge. And second, any productivity plan should look beyond the obvious forms of high-tech wizardry in high value-added sectors to encompass new forms of organisational approaches and business models in our most labour-absorbing industries.

What is missing in most discussions of the efficiency wage hypothesis and the latest discussion of induced innovation and wage increases is, as the Washington Centre for Equitable Growth notes is the upper limit on the wage increase that carries only minimal disemployment risks:

Many activists and policymakers across the country are vigorously pushing for an increase in the minimum wage at the federal, state, and local levels. Of course, while many people agree that the minimum wage needs to be higher, that still leaves the question of how high it should be… The trouble, however, is taking that research and applying it to potential minimum wage increases that would be outside the range of previous hikes. For example, raising the current federal minimum wage from $7.25 to $15—more than doubling it—would be significantly larger than prior increases.

That upper bound discussion is a small hole in their arguments compared to their failure to advocate massive efficiency wage increases and massive induced innovation wage increases across the entire economy. Why is the efficiency wage and induced innovation hypotheses only extended to the low paid? Why not hire wages for everyone?

One of the reasons for the high labour productivity in Western Europe is their minimum wages, employment protection laws and high taxes made it unprofitable to employee low skilled service workers.

European consumers innovated in the face of these high costs of taxes and regulation by doing for themselves what Americans buy on the market be it anything from takeaways to home help. That is well known as Richard Rogerson explains:

The empirical work establishes two results. First, hours worked in Europe decline by almost 45 percent compared to the United States over this period [from 1956 to 2003]. Second, this decline is almost entirely accounted for by the fact that Europe develops a much smaller market service sector than the United States… relative increases in taxes and technological catch-up can account for most of the differences between the European and American time allocations over this period.

The phenomena that developed in Europe as the result of the additional costs of taxes and labour market regulation is known as Eurosclerosis, not a productivity breakout through efficiency wages and induced innovation.

Eurosclerosis, Swedosclerosis, the British Disease and rising inequality harming economic growth

The Washington Centre for Equitable Growth have joined the Wall Street Journal in falling for that dodgy OECD hypothesis about rising inequality holding back economic growth.

The chart below shows stark differences between egalitarian Sweden and France, and the more unequal UK since 1970 in departures from a trend growth rate of 1.9% in real GDP per working age person, PPP.

image

Source: Computed from OECD Stat Extract and The Conference Board. 2015. The Conference Board Total Economy Database™, May 2015, http://www.conference-board.org/data/economydatabase/

In the above chart, a flat line is growth at the same rate as the USA for the 20th century, which was 1.9%  for GDP per working age person on a purchasing power parity basis. The USA’s growth rate is taken as the trend rate of growth of the global technological frontier. A falling line in the above chart is growth in real GDP per working age person, PPP, at below this trend rate of 1.9%; a rising line is above trend rate growth for that year.

  • Sweden really had been the sick man of Europe until it turned its back on high taxing, welfare state socialism in the early 1990s.
  • France has been in a long decline so much so that the global financial crisis is hard to pick up in the acceleration in its long decline in the mid-1990s.

Britain did very well, both under the neoliberal horrors of Thatcherism and the betrayals by Tony Blair of a true Labour Party platform. The UK grew at above the trend annual growth to 1.9% for most of the period from the early 1980s to 2007.

Neither France or Sweden, despite their egalitarian economies, kept up with the US growth rate since 1970. Under the OECD’s hypothesis, if France and Sweden had been more unequal, their trend growth rates would have been even more appalling since 1970.

How the USA evolved

https://twitter.com/LearnSomethlng/status/655941471204339713

27 unarmed whites killed by police since 1 January 2015 by threat level

I did some recoding again because the Washington Post categorises people as not attacking when they are reaching inside their jacket or a car when challenged not to do so or charging armed police. The Washington Post counted 13 whites as no attack in progress. I count six. The three killed in crossfire were a six-year-old, a woman shot when police were aiming at her dog, and a passenger in a fleeing car.

Source: Investigation: Police shootings – Washington Post.

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