Our Racist in Chief

So interesting to see “Progressive” Democrat Congresswomen, who originally came from countries whose governments are a complete and total catastrophe, the worst, most corrupt and inept anywhere in the world (if they even have a functioning government at all), now loudly......

— Donald J. Trump (@realDonaldTrump) July 14, 2019

....it is done. These places need your help badly, you can’t leave fast enough. I’m sure that Nancy Pelosi would be very happy to quickly work out free travel arrangements!

— Donald J. Trump (@realDonaldTrump) July 14, 2019

“Not since Woodrow Wilson showed ‘Birth of a Nation’ in the White House has an American president been so flagrant in his racial messaging as this one.”  Chris Matthews

As if we needed a series of tweets that summed up the worst of America.  Leave it to our President to give us one.   A tweet displaying the racism, misogyny, xenophobia, Islamophobia, nativism, and fear mongering that has been unleashed to the nth degree in our current political climate.

For context, Trump is referring Democratic Representatives Alexandria Ocasio-Cortez of New York, Ilhan Omar of Minnesota, Rashida Tlaib of Michigan, and Ayanna Presley of Massachusetts.  All are women of color.  All are rising Representatives and all are on the more extreme side of the Democratic party. 

However, despite Trump’s indication, only Ilan Omar is an immigrant, whose family entered the United States in 1992 as refugees, fleeing the civil war in Somalia.  Ocasio-Cortez was born in the Bronx.  Rashida Tlaib was born in Detroit.  And Ayanna Presley was born in Chicago.  So their original countries "whose governments are a complete and total catastrophe, the worst, most corrupt and inept anywhere in the world?"  That's us, the good old United States.

Let's even give Trump the benefit of the doubt.  If we prescribe the best of intentions to Trump, does he really not know where these now prominent newsworthy representatives are from.  Is it really better if this is just from his ignorance?  Shouldn't we expect more of the president.

This goes beyond even dog whistle politics. Dog whistle refers to the practice of using code words and phrases to mean one thing to the general population, but to have an additional, different, more specific resonance for a targeted subgroup.  In particular, it has been used to refer to coded, racist language.  As explained by former Republican Party strategist Lee Atwater regarding the Southern Strategy, “You start out in 1954 by saying ‘Ni**er, ni**er, ni**er.’  By 1968, you can’t say ‘ni**er’ - that hurts you.  Backfires.  So you say stuff like forced busing, states’ rights, and all that stuff.  You’re getting so abstract by now, you’re talking about cutting taxes.  And all these things that you’re talking about are totally economic things and a byproduct of them is blacks get hurt worse than whites.  And subconsciously maybe that is part of it.  I’m not saying that.  But I’m saying that if it is getting that abstract, and that coded, that we are doing away with the racial problem one way or the other.  You follow me - because obviously sitting around saying, ‘We want to cut this,’ is much more abstract than even the busing thing, and a hell of a lot more abstract than ’Ni**er, ni**er.’" 

Trump's been accused of dog-whistle language before.  "There are good people on both sides."  Yeah, those Neo-Nazis are real good people.  

But here, we've blown way past that.  We've gone from the abstract to the blunt.  We've gone from the dog whistle to a megaphone. 

This is out and out blatant racism.  "Go back where you came from?"  Really?!?  That's a slur that has been used for decades against people who look different.  People of color.  People of different religions.  

This should offend and anger every American citizen.  Regardless of how you feel about the politics of Ocasio-Cortez, Omar, Tlaib, and Presley, they are all American citizens, and duly elected representatives of their districts.  Our President should be treating them accordingly.  With the respect their offices afford.  And every Senator and Representative, Republican and Democrat alike, should be calling out Trump for this tweet.

The Republican party has instead had several members circle the wagons.  Marc Short, Vice President Pence’s Chief of Staff said Mr. Trump was “not racist” because Mr. Trump as an “Asian woman of color in his cabinet.”  Ah, the old “I have a black friend” response.

Lindsey Graham at least did suggest the president should aim higher, but had to inject that Omar and her allies are “anti-American” politicians who “hate our country.”  “We all know that [Alexandria Ocasio-Cortez] and this crowd are a bunch of communists, they’re anti-Semitic…we don’t need to know anything about them personally, just talk their policies.”

Representative Andy Harris went as a far as to say the president’s comments were clearly not racist.  “They’re obviously not racist.  When anyone disagrees with anyone now the default is to call them a racist and this is no exception.”  He tried to even further explain “He could have meant go back to the district they came from - to the neighborhood they came from."

Trump for his part has doubled down on his comments, just now suggesting that the four should just leave America.

We will never be a Socialist or Communist Country. IF YOU ARE NOT HAPPY HERE, YOU CAN LEAVE! It is your choice, and your choice alone. This is about love for America. Certain people HATE our Country....

— Donald J. Trump (@realDonaldTrump) July 15, 2019

I know I shouldn't be surprised anymore, but I continually find myself here.  Where is the bottom anymore?  How far down can we keep digging?

I'm not up for another five years of this.  I pray for wiser heads to finally prevail.

The Higher Price of Prescription Drugs and Those Who Fight To Keep It That Way

It seems Republicans may be willing to fight to keep prescription drug prices high.

The House Oversight Committee has been studying how drug companies set prescription drug prices.  Democratic Chair of the Committee, Elijah Cummings, requested information from twelve drug companies such as Pfizer Inc., Johnson & Johnson, and Novartis AG in January as part of a broad investigation into these practices.

Republicans, though, are warning drug companies not to cooperate with the congressional investigation.

In a report released yesterday, Republicans on the Committee have sent letters to the dozen CEOs of those major drug companies warning that the information they provide to the committee could be leaked to the public by Chairman Cummings in an effort to tank their stock prices.  Representatives Jim Jordan and Mark Meadows write that Cummings is seeking sensitive information "that would likely harm the competitiveness of your company if disclosed publicly."  They then accuse Cummings of "releasing cherry-picked excerpts from a highly sensitive closed-door interview" conducted in an investigation into White House security clearances.  "This is not the first time he has released sensitive information unilaterally."  Though they do say that they "cannot speculate about Chairman Cummings' motives," they relay that the committee should not pursue an investigation designed to impact stock prices.

The belief the investigation is focused on impacting stock prices seems to hinge on a quote from Cummings saying that he has three staffers he calls the "drug team" who work on the high cost of drugs and that their work has lowered drug company stocks.  The letter includes this quote from Cummings, offered at an appearance before the Committee on House Administration seeking an increase in funding for the Oversight Committee. "If you follow the headlines, we have already seen the impact they have had...on stock prices with regard to drugs.  I mean, it has been astronomical."

The letter, deceptively, omits the rest of the quote.  The full quote should read "I mean it has been astronomical saving the taxpayers money."  Without the last phrase, it seems Cummnings is bragging about the astronomical impact on drug stocks.  With the last phrase, it is clear Cummings is referring to the taxpayer savings.  Had Jordan or Meadows bothered to include more context, they would also see that Cummings said, just a minute later "Whatever you give us, we will give it back in savings by rooting out fraud, waste, and abuse."

All noble goals, and all things Big Pharma would rather not be revealed.

The impact of Big Pharma and its power over our lives is incredible.  It's reach is massively impressive:

• $1.05 trillion in total revenue for the global pharmaceutical market.  That's roughly one-quarter what the U.S. federal government will spend a year.
• $515 billion of that revenue comes from the United States and Canada, despite us making up only 7% of the total world population.  You have to wonder how that statistic can be true.
• $95.1 billion median revenue of the top drug channel companies (the drug delivery companies).
• $17.5 billion median revenue of the top twelve drug manufacturing companies.
• 21% - the 2015 profit margin for the healthcare technology industry, by far the most profitable industry of all, with major and generic pharmaceutical companies leading the way.
• Gilead Sciences leading the way with a profit margin of nearly 53% during the same time and a 480% stock return.
• $5.2 billion spent on prescription drug advertising in 2015, primarily for television advertising.
• $3.5 billion into lobbying interests from 1998 to 2016, 42% more than the second largest lobbying group (related insurance).
• $246 million alone in 2016.
• 1,378 paid lobbyists

And there are so many places to start here.

We could first talk about collusion and anti-competitive behavior in the pharmaceutical industry.  We could specifically talk about insulin, critical to more than 6 million Americans with Type 1 diabetes.  Between 2002 and 2013, drug makers Sanofi, Novo Nordisk, and Eli Lilly raised prices in lockstep.  Their insulin more than tripled in price to as much as $300 per patient, per month.  Closed-door negotiations between drug makers, insurance companies, and middlemen pharmacy benefit managers contributed to these outsize price increases.  This is classic price fixing, in violation of the Sherman Anti-Trust Act.

Then there's for the unproved medications with dubious benefits, like the prices for necitumumab, a lung-cancer drug. A study conducted before the FDA approval recommended that the drug ought to cost between $500 and $1,300 per treatment based on its likely benefit, giving patients only a few weeks of quality life.  Now approved, necitumumab costs $11,450 per treatment cycle.

Finally, there are also the rising costs on old proven drugs, like Acthar gel, a little known drug prescribed to treat everything from infantile spasms to the effects of Multiple Sclerosis.  The drug was approved by the FDA in 1952.  This drug increased from $1,650 to more than $24,000 per 5 milliliter vial overnight once the drug was acquired by Questcor in 2001.  By 2017, it was  $34,034 for the same amount. Acthar accounted for a staggering $1.3 billion in Medicare payouts between 2011 and 2015.

And that's just a sample.

Further, we also have to look at how many in Washington are in the pocket of Big Pharma, especially many Republicans.  We can look back at the issue in 2016 surrounding imatinib and Colombia's attempts to approve a generic version.  Imatinib is manufactured by Novartis.  In Colombia, the drug is marketed as Glivec.  The World Health Organization's List of Essential Medicines last year suggested that the drug was a treatment not only for chronic myeloid leukemia, but also for gastrointestinal tumors.  Currently, the cost of an annual supply is over $15,000, or about twice the average Colombian's income.  The Colombian Minister of Health Alejandro Gaviria announced plans that would eventually result in a generic production of the drug, potentially lowering the cost by 30%.  As a result, Andres Florez, deputy chief of missions as the Colombian Embassy in Washington, D.C. wrote letters about concerns of U.S. retaliation for such a move.  In fact, after a meeting with Senate Finance Committee International Trade Counsel Everett Eissenstat, staffer under Senator Orrin Hatch, R-Utah, Florez wrote that Eissenstat said that authorizing the generic version would "violate the intellectual property rights" of Novartis and that if "the Ministry of Health did not correct this situation, the pharmaceutical industry in the United States and related interest groups could become very vocal and interfere with other interest that Colombia could have in the United States."  Blackmail on behalf of Big Pharma.  Florez further worried "this case could jeopardize the approval of the financing of the new initiative 'Peace Colombia,'" an Obama administration era program seeking to bring together rebels and the government to end decades of fighting that resulted in the deaths of hundreds of thousands.

How about US congressman Tom Marino, who was forced to withdraw his nomination for Trump's drug czar when a report by the Washington Post and CBS's 60 Minutes highlighted his role in forging legislation that hindered the DEA's ability to move against drug distributors or pharmacies recklessly dispensing opioid painkillers?

Again, that's just the beginning.

Sadly it's not the most troubling aspect.  Now is the time for the question raised earlier.  Why do we account for 49% of the global pharmaceutical revenue despite only accounting for 7% of the population?

Because our country is specifically setup right now to benefit the pharmaceutical industry, especially in comparison to other industrialized countries.  The global average for prescription drug cost savings is 56% outside the United States.  We pay twice as much as other countries do.  That's the average.  For specific medications, the savings are even more extreme.  This has led 19 million American adults to import medication to save money.  That's 8% of the population.

Let's take for example a blood pressure medication.  One pill the doctors wanted me to take was Bystolic.  In the United States its $4.71 a 10 milligram pill.  In Canada, it's $2.36.  Still high, but much less expensive.

Why does this disparity continue?

Unlike in most industrialized countries, the United States government has no ability to negotiate drug prices with pharmaceutical companies.  The FDA is tasked with approving medicines based on safety and efficacy, but cannot consider cost or value in its approval process.  Further, there is no post approval process for negotiating or setting drug prices either.  Medicare was forbidden from negotiating prices staring in 2003 as part of the government's compromise with the pharmaceutical industry to get the Medicare drug expansion plan passed.  And unlike other countries, the United States government has taken no steps to interfere with the free pricing system.  In Europe, the government often sets drug prices with those prices dropping over time.

This leaves consumers unprotected, with big pharma possessing patent monopolies on drugs critical to patients' lives and health.  The companies then collude and engage in outright price fixing to set their profits as high as possible, and they're able to charge Medicare whatever they want.

The numbers bear this out.  Spending on prescription drugs has risen rapidly over the past decades, with new drugs and new specialty drugs in particular driving the spike.

Branded drug prices have risen by over 60%.  Commonly used specialty drugs in particular have increased 57% since 2014.

You might say the hope is generic drugs.  After all, prices for generic drugs have dropped 37% since 2014.  And patents generally only provide a monopoly for 20 years (give or take with the Hatch-Waxman Act).  However, even some older generic drugs are becoming very expensive, owing to factors including drug shortages, supply disruptions, and consolidations in the generic-drug industry leading to outright monopolies.  One such generic had a 2,800% increase in price according to a perspective in the New England Journal of Medicine.

So, where do we go from here.

Thankfully, the fights have started.  The federal legislature has been looking to lower prices of prescription drugs.  Even President Trump has recently indicated that he is willing to work with Democrats to lower drug prices.  State level lawmakers are also working to lower prescription prices at their level.  And thankfully we have action in the courts, cases on insulin price fixing.

But we know that pharma will fight each of these measures and will fight hard.

"Does that surprise you?" former Pharmaceutical Research and Manufacturers of America (PhRMA) CEO Billy Tauzin told NPR in a report entitled "In Election Year, Drug Industry Spent Big To Temper Talk About High Drug Prices."  When government responds to voters' cry for lower drug prices, Tauzin state "PhRMA has always responded by increasing its resources."

We can only hope all our representatives will finally put their constituents above their pocketbooks.