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      Week-end Wrap – Political Economy – August 25, 2019 by Tony Wikrent Economics Action Group, North Carolina Democratic Party Progressive Caucus Strategic Political Economy Give No Heed to the Walking Dead [The Scholar’s Stage, via Naked Capitalism 8-18-19] The People’s Republic of China is wealthier than any rival America has faced. Its leaders are convinced […]
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Apollo 11, West Africa and Eyelids

I lived in Pearl Harbor when Apollo 11 went to the moon and back.  They used slide rules to make calculations back then.  Those guys were launched into space while sitting on a giant firework.  They got to the moon, made it back in one piece…

…and spent three weeks in an isolation unit in Hawaii.  They were heroes.  They deserved a ticker tape parade.  And they waited patiently until they were cleared of any nasty moon germs before they got it.

I understand Anthony Fauci’s concern that a mandatory quarantine will discourage volunteer health care workers at a time of crisis in West Africa.  However, the problem is a cultural one.  Here in the US, workers get very few vacation days.  If you spend them all in an Ebola hospital in Monrovia, it is an unfortunate likelihood that your employer is going to be unsympathetic to your do gooder status when you get stuck in Newark for three weeks.  That’s why I think politicians need to move on protecting workers from losing their salaries and jobs when they come back.

Nevertheless, I think Cuomo, de Blasio and Christie have done the right thing by mandating a quarantine for a very limited number of people coming in from West Africa to New York and New Jersey ports.  That’s because the NYC-NJ megalopolis is the most densely packed area of the country and an outbreak of ebola there could have a devastating impact.  If health care workers are diverted to less crowded areas of the country to disembark in order to avoid detention in Newark, then the quarantine may have served its purpose.

(Update: DeBlasio and Cuomo have moderated their quarantine policy and I approve their changes.  They will allow health care workers that are high risk to remain at home during the isolation period.  They will be monitored by public health officials twice a day AND they will be compensated for lost income.  There’s a lot to like here.  The twice a day monitoring should help to keep the person off the streets, subways and buses.  The compensation for lost income should assure volunteers that they’re not going to be punished for doing good things.  Christie hasn’t changed his policy yet.  Not sure where Hickox is from but she might have to tough it out in Newark until she’s been cleared to travel on domestic airlines.  I’m betting that no American airlines wants to have another Frontier incident.)

It would be the equivalent of keeping ebola infected individuals out of Kinchasa or Lagos, as Michael Osterholm explains in the video below from Johns Hopkins Ebola Forum a week or so ago.  This video emphasizes why it is so important to contain the outbreak in West Africa and why it is almost too late to do so.  Well worth the viewing.  Not too nerdy or complicated.

Finally, this article from the New Yorker illuminates the problems with diagnosing ebola and protecting health workers.  Inside the Ebola Wars is a must read. (Also not too geeky) Here are some things I learned from it that makes me think that quarantining Kaci Hickox was probably not a bad idea:

  • The diagnostic test for ebola was developed on an old strain of the virus.  For the current two strains, it has become much less accurate and may be an unreliable confirmatory test for ebola.
  • Dr. Kent Brantly was symptomatic when he went into isolation in Africa and had his blood sent for confirmation of ebola.  The test came back negative.  A few days later, Brantly was much sicker and had a second test.  This one was positive.  So, if Kaci Hickox is making the case that she shouldn’t be stuck in Newark (well, who should?  I wouldn’t wish it on my worst enemy) based on her ebola tests, she’s full of s#*}.  There’s no way to know whether she is carrying the virus until she gets sick. That could still happen.  So, I’d stop giving the general public the idea that I’m imprisoned on false pretenses.  First, it’s not imprisonment and second, we don’t know yet and neither does she.  That’s the whole point of a quarantine.
  • There has been some speculation as to how some health care workers are getting infected in spite of their expertise with PPE.  A proposed route is that a tiny droplet of infected bodily fluid is getting trapped behind the moist eyelid of the health care worker.  How it got there is anyone’s guess.  Maybe it’s a chance encounter with an tainted gloved hand.  Maybe its aerosolization.  No one knows yet.
  • A single viral particle can kill you.  Well, it has to replicate like bunnies in your body but it only takes one.  And a single drop of blood or sweat contains billions and billions of viral particles.  Yep, think that over and now project that onto the map of New York City and New Jersey.  {{shudder}}

Still not panicking but I am relieved that there are people trying to prevent an outbreak.  This is not a Texas scenario and for that we should be grateful.

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In which I differ with Derek Lowe over NIH funding

Typical private industry lab circa 2014

Derek Lowe, blogmaster over at In the Pipeline, took issue with NIH Director Frances Collins contention that if the NIH budget hadn’t been cut in the past decade, we might have had an ebola vaccine by now.  I remarked on the Vox article about this very same topic last week.  However, I’m siding with Collins on this topic.  True, he might be using the very scary disease of ebola to make his point but it is a valid one.

To get an idea of what the NIH has been up against, I recommend that readers review the congressional testimony on the ebola outbreak from last week.  I believe it was Anthony Fauci who laid out the problem.  It goes like this:

  1. The NIH identified the need for an ebola vaccine about a decade ago.
  2. (This is the crucial part) The NIH is engaged in basic research.  We are talking very, very basic research.  Like, identifying the genes and sequences and making them available to other researchers, or studying how the virus works and propagates, or figuring out which enzymes chop up the viral proteins, or how the viral proteins are exposed to the rest of the body.  That’s the kind of research the NIH does.  And sometimes, the research is so preliminary that there are mistakes that get published that industrial labs have to figure out when they try to replicate the results in the lab.  Not a criticism.  It happens.  You only have so much money to do the research and sometimes, it’s not enough to double check your results.  I get it.  But it does make it harder for your private industry partners to figure out what’s going on and sometimes means that projects need to take detours to unpack mechanisms and rerun assays and such.  In other words, REAL RESEARCH.  That’s just the way science works, much to the finance industry’s chagrin.
  3. So, the NIH tried to get a private industry partner to help finish the research on the vaccine and develop it.
  4. But during the same decade, private industry was going through a chaotic destructive process brought on by the “patent cliff”.  That is, the blockbuster drugs that fueled industry research suddenly went off patent.  In response, the shareholders who were not about to take a haircut just so some lab rats could continue to do research for them, decided to take the money and run.  That precipitated Pharmageddon, where I and my colleagues got tossed out of corporate labs by the hundreds of thousands.
  5. The NIH couldn’t find a private industry partner until the last couple of years when Glaxo Smith Kline (GSK) decided it would take a risk and start working on one.
  6. In the meantime, in the last couple of years, the Republicans have lost their freaking minds over the budget and would rather let every government institution rot in hell before they would approve any funding.  This is about the same time we wrote a blank check to AIG, and other lords of the finance industry (see Neil Barofsky’s book).  Then the Democrats came up with this great idea of a sequester, you know, to call the Republicans bluff.  And the raving mob that calls itself the Republican party took the deal and slashed NIH funding by 20%.  The Democratic leadership that came up with the boneheaded, backfiring sequester idea should be kept away from sharp objects for their own safety.
  7. So, to recap: NIH needed a vaccine but couldn’t find a private partner for nearly a decade.  Private industry contracted at a time when additional research and development is crucial.  Regular NIH funding is not sufficient for it to develop a vaccine on its own.

This would probably be a good time to insert some Paul Krugmanesque graph that shows the equilibrium between private and public investment in scientific research.  This one should show that when private industry stopped funding research, the corresponding expected increase in public spending was notably absent.

Derek has a libertarian streak and works for one of the last small molecule drug discovery companies in Cambridge.  That’s not necessarily a bad thing but it does skew his perspective just a tad.  Not only that but Derek is operating in the old world order when we tested every therapeutic treatment to death.  That’s clearly not happening with the ebola treatments.  Those suckers have been fast tracked like nobody’s business.  We are treating ZMapp like it’s a cure for ebola when it’s nothing of the sort.  It’s just that it’s the only thing we’ve got.  ZMapp is so early in development that back in the old days of real drug discovery, it might have been killed in a project portfolio review before it ever made it to development.  And the vaccines?  Well, normally, they’d go through many stages of development and testing for safety, efficacy, and side effects with an expanding number of trial recipients at each stage before it was approved by the FDA.  Forget that.  In this epidemic in West Africa, with number of exposures increasing exponentially, no one has time for these niceties (though I can just see some lefties screaming about how we killed West Africans with an untested vaccine that triggered a cytokine storm or autoimmune disease.  Wait for it.  You know it’s going to happen.  There will probably be a movie about it featuring some ruggedly handsome Liam Neesom type and a earnestly beautiful lady scientist detective out to uncover the awful truth of corporate exploitation of poor third world citizens.).

The real world is not so simple but there definitely is money at the bottom of this mess.

I’ve worked on both sides of the problems in both industry and in academia, if only briefly.  But I got a good look at what it’s like to do research on NIH grant money and it’s not pretty.  Most of a principal investigator’s time is spent preparing grant applications.  It’s very bureaucratic and, I suspect, very political.  If there isn’t a retrospective analysis on the amount of grant money that goes to the Ivies that leave the rest of the academic labs starving for funds, there really should be.  Not every breakthrough has to happen at Harvard.  The polio vaccine, for example, was developed in Pittsburgh.  Oh, yeah, how many of you knew that Jonas Salk worked for the University of Pittsburgh? True story.

And yet, it was about a year ago that I got a call in my office at Pitt from a researcher in the immunology group who had just lost her job because of the sequester.  It was last year at about this time that we had to cut back sharply on ordering chemicals and lab supplies for my lab because grants were on hold, also due to the sequester.  Even today, I see positions at Pitt for the kind of work that I used to do but the hours are part time.  Really??  You expect scientists to do protein production, extraction and crystallization experiments on a part time basis?  That’s the craziest thing I have ever seen.  You can’t just interrupt an experiment half way through the week because you’ve run out of hours.  That makes me think that the people posting the positions aren’t serious about how many hours they expect the researcher to be available.  It’s deceptive and weird and unrealistic.  But that’s life on soft money.  Here today, gone the next.  Yet the cells still need to be fed, lysed, protein collected, spun, purified, etc, etc, etc.

Friends, Americans, countrypersons, this is no way to run a research infrastructure.  Ok, sure, it’s the way to run a research infrastructure if you don’t want to do it like Americans used to do it.  If you are content to run a research infrastructure like Bolivians do it, fine, do it this way.  But don’t complain later that nothing of significance happened on the science front from 2008 onward.  Don’t complain that the NIH is not telling the truth about funding.  It can’t be all things to all people without a steady funding mechanism that isn’t going to be subject to violent shocks brought on by crazy people who get elected to Congress.

Here’s the bottom line.  If liberals expect the NIH to do all of the things that they *think* it already does, it needs more funding.  It needs waaaaaaaay more funding than it already has.  It needs as much funding as private industry used to pump into its own research coffers but no longer does.  It needs billions and billions more.  It has to become what private industry used to be but no longer wants to be.

And if Republicans are committed to free enterprise at all costs, it’s going to have to get tough with private industry drug discovery and force it to take on research that it sees as unprofitable.  It needs to have a serious talk with the bonus class and shareholders about greed at the expense of public health.  Isn’t that what the GOP is all about?  Morality?

That’s just the honest truth.  The NIH is not private industry.  If we want the NIH to replace private industry, which has abandoned certain, critical research areas because it can’t make the kind of profits that shareholders demand nowadays, we need to put more money into the NIH and fund researchers properly and seriously.  That is the point that Frances Collins has been trying to make.

Liberals have a complete misunderstanding of what the NIH does or is capable of doing.  Libertarians have an inflated view of what private industry can do, sometimes because they are living in one of the last holdouts of productive private industry drug discovery (that could end at any time, so don’t get too comfy, Derek).  But once you have lived in both worlds, you can see what a shambles the whole system is.  It’s unsettling and alarming.