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Welcome to October. Here's everything that happened this week in health.
The stolen summer is over, and there’s a nip in the air. Everyone's dusting off the old cardigans under their beds, sipping Bud Light pumpkin spice seltzer, and adding vaccination status to their resumes. People are once again united by a common enemy, Jonathan Franzen, and coming together to roll their collective eyes about his new novel (the first part of a trilogy!) while discreetly pre-ordering it. The moon is playing it safe and gradually, non-confrontationally backing away from Earth.
We’re now three months into this newsletter experiment. Thanks for sticking through the figuring-out stages as the platform comes together. How’s it going so far? For newer readers: I’ve been trying different approaches week to week—sometimes interminable screeds on a single topic, and sometimes a panoply of shorter updates on the week’s news. I appreciate your feedback, requests, and scathing critiques along the way. It’s a new form, and I want to make this useful to you. And ideally fun. But never both.
My initial reaction is that does seem great. Of course, I also have questions. And I can't wait til "game-changer" is over. (Game's the same.)
This is probably good news, but we also shouldn't get ahead of ourselves again. The drug won’t (and doesn’t claim to) stop people from getting COVID, but it does seem to help make the disease less severe if taken early on. Assuming that people are willing to take it.
I’m not being glib in suggesting that; it’s an unknown, and I'm taking nothing for granted at this point in the pandemic.
Merck also makes ivermectin, for example, and the company urged people not to take its product to fight COVID because there was "no scientific basis for a potential therapeutic effect" and "a concerning lack of safety data." People took it nonetheless. And when they couldn't get a prescription, they bought a veterinary version. Now the horses can't get their medicine, and some horse owners are apparently worried about the stigma of attempting to procure it. Weird times.
In any case, I thought the vaccines would change the proverbial game when they were authorized last November. They helped a lot of us. But also, now, almost a year later, September 2021 was the fifth deadliest month of the pandemic in the U.S. Some 58,000 Americans died, almost all of them having chosen not to get vaccinated. And now Merck seems to have an effective drug, and will be recommending it, along with doctors and federal agencies (presuming it's authorized by FDA shortly). So I'm also mindful that this urgent, unanimous institutional support is precisely what turned some people against vaccination.
The drug is also, it's worth noting, not as effective as being vaccinated. And far more expensive (more on that later).
Its existence is absolutely not a reason to forego vaccination. If people believe it is, there could be a paradoxical decrease in vaccination rates. In the process, more people would be leaving themselves open to spreading the virus to others.
But maybe this drug will exist in a middle ground that appeals to a segment of the population that doesn’t feel comfortable preventing COVID entirely but would seek medical treatment at the onset of mild symptoms—and take 4 pills every 12 hours for 5 days, even if they start to feel better after two or three. (Antibiotics have taught us that people very often stop taking things as soon as they feel better.) That sort of regimen would likely work well for patients who seek treatment early and take medical advice very seriously. Which patients are also likely to have been already vaccinated.
Being sick has a way of making people suddenly less skeptical of medical science. Maybe this drug will supplant horse paste in the popular imagination and unvaccinated people will take it in evidence-based regimens and doses, even despite emphatic recommendations of doctors that they do so.
That's key, because it doesn't work if people wait until they're gasping for air. The big caveat is that the drug won’t help if you’re already very sick. If you wait too long, the virus just isn’t the issue, as ICU doctor Darren Markland this week described in a [emoji of a thread] about what it’s like to be treated then, where you’re unable to speak and hurdling towards death, unconscious and being constantly infused with myriad medications to which you can't even consent because you didn’t trust a 0.3 milliliter shot:
Truly, I hope this medication helps people before they get to that point. It clearly seems to have the capacity to. Whether we let it is up to us.
Human behavior has been the only real variable in this pandemic, and no one seems able to predict, explain, or understand it. I've never presumed to begin to.
The cost of prescription drugs is one of the few problems that almost everyone still agrees is a problem. Trump and Biden both promised to address it, and both proposed mild-to-moderate measures. Leaders in both parties say they want to move closer to, among other things, allowing Medicare to negotiate with pharmaceutical companies rather than paying whatever price the drug companies demand. But now it seems that won’t happen.
The invisible hand of the free market has determined that if an industry has enough money they can lobby effectively enough to avoid being subject to the invisible hand of the free market.
For example, the U.S. government long ago agreed to buy $1.2 billion worth of the above Merck drug (molnupiravir) at a cost of around $700 per course of treatment, even before we knew if it would work. That means it’s roughly 15 times more expensive than getting vaccinated. It’s also less effective and doesn’t prevent you from getting sick. So you might think there would be grounds to negotiate that price. But no. We had to agree to buy it, even if it didn't work, just to incentivize development of the drug.
You also might think the government could negotiate a price like that, especially because the basic science behind the drug’s development was also funded by taxpayers. Yet, as with the Moderna vaccine, we’re paying for this drug twice.
In harrowing times like these, it's tempting to feel grateful that the pharmaceutical industry has really come through for us. They will demurely accept the gratitude. But when legislators propose reforms to make drugs more affordable, the industry will insist that the only reason they do things is because of the promise of billions of dollars in profit. If you take away their monopolies and ability to dictate price, there would be no innovation at all.
This is false. The truth is that the vaccines we have, and this new drug and others, were born of years of forward-thinking research that no drug company would invest in until enormous profit was almost certain. Which may be smart business, but isn’t how you stay ahead of pandemics. Or anything else.
It’s also the time of the season where we make predictions about future pandemic seasons. Lots of projections about fall and winter are looking optimistic because there’s just no one left to be infected. At the same time, that’s what I thought would happen this summer, and then delta gave us another wave. I remain cautiously optimistic. It’s a welcome change from last fall when I was more ... despondently pessimistic.
Whatever happens, I’m reminded, we’ll find something to worry about.
I’m not quite ready to go back to engaging in the fat-versus-carbohydrate wars again, but the Times is. They're also back to debating the health effects of social media. In both cases, the consequences are clearly substantial, but the solutions are not simple. As for social media platforms, debates usually return to the same old "good or bad" binary that defines so much in health. It's never so simple. Except in the case of Bud Light pumpkin spice seltzer.
Some will blame the evils of social-media platforms while others blame human users, arguing that social comparison, fighting, lying, and scamming would happen anywhere, as they have since the beginning of time. In the former category, Senator Blumenthal asked Facebook to commit to abolishing Finsta, and the scene is worth watching, if you missed it.
Like most of you, I have a love-hate relationship with all platforms. I appreciate products that cater to my interests and preferences, and then I resent them when they do. (This is also how human relationships work.)
The health effects of social media are both serious and complex, and I'm still not sure of much in terms of regulation. Killing companies and banning platforms is still a reflexive suggestion that feels like playing Whac-A-Mole. (If you're new here and coming from Twitch, Whac-A-Mole was a game developed in the 1970s where innocent children were implored to smash animatronic mammals with an enormous mallet before they could return to their homes in exchange for paper tickets.)
Bans are politically simpler than creating a system where people have ready access to comprehensive health care. But banning also rarely comes to pass. We can’t even manage to ban cigarettes or 96-ounce sodas or guns (outside of a well-regulated militia which of course is necessary to the security of a free state).
I'm old enough to remember when we worried that Google was making us stupid, and the answer was yeah but it's easy and I like it so meh ... sorry what were we talking about? Ultimately we kept using it because no one wanted to use Bing.
And when we do manage to ban things, like marijuana or (briefly) alcohol, new problems arise. (Mass incarceration makes us all sick.) Though I get the impulse. My immediate reaction upon seeing that Bud Light was launching a pumpkin-spice seltzer was to yell for it to be banned (to myself, alone in my office).
But it won’t be banned, and people will drink it ironically, and then the irony will fade and they’ll just be drinking it. No good will come to anyone, and we'll act like there's nothing to be done about it. MarketWatch will ask if this product needs to exist, and the answer will be a resounding no. If you really watch the market, MarketWatch, you'll notice that the abiding interest is profit. Products don’t firstly exist because they’re needed; it's just a nice bonus when they are. More often, the sense of need is artificially created by the invisible hand of marketing and advertising.
If we were guided by organic need, we'd have had coronavirus vaccines ready years ago, after SARS and MERS made clear to us that it was only a matter of time before the next coronavirus pandemic. Instead, products exist because someone profits from their existence. In the case of legal drugs, we bend over backwards to create that profit incentive for our pharmaceutical companies. Then they insist on maximizing that at all costs, because it is their nature, and we do not learn.
One of the clearest lessons of this pandemic—as we look toward the next one—is that this system of creating, making, and buying is an enormously costly vulnerability. It's like waiting to build tanks until war has broken out, and then letting the tank makers (tanksmiths?) name their price. The approach is unsafe, untenable, unjust, and almost everyone dislikes it. We could take disease preparedness as seriously as we do military preparedness. But apparently it's not going to change.