Why Is Nevada's Governor So Anti-Science?
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When I was in third grade, we learned to read using "readers"-- musty, hardbound books, with color illustrations, containing short stories about a multitude of subjects.
One of those stories was about a boy, in a foreign land (not sure which, if it was even identified, but I would guess it was in South America), who was caring for someone who was stricken with malaria. The story eventually leads to the boy curing the sick person using the bark of the chinchona tree.
It so stuck with me that every time I see a can or bottle of tonic water, I think of that story. Tonic water usta be called quinine water, because it contained quinine (which is what makes it bitter). I am reminded of all of this yet again because of the recent headlines related to chloroquine.
I am guessing that, though they seemed ANCIENT to us in 1965, the reading text books were likely published just after WWII, making them only about 20 years old at the time. And the story referenced above was probably included because, in 1944, scientists figured out how to synthesize quinine, thus signalling the beginning of the end of the celebrity status that the chinchona tree had enjoyed since it was first touted as a cure for malaria in 1653.
Fast forward to 2020 and we have idiots gobbling fish tank cleaner "because the POTUS told them to do so."
Just this past December, a New Jersey-based pharmaceutical wholesaler jacked up the price of two of their products: hydroxychloriquine sulfate and chloroquine phosphate. I accidentally discovered this by reading a site called News18.com. On that site is a news story headlined, "Donald Trump & Elon Musk Think Chloroquine is The Answer to Coronavirus, But What is it?" In the tenth paragraph of an eleven-paragraph story, we find this:
Incidentally, Rising Pharmaceuticals, a New Jersey-based drug company, had hiked the price of its Chloroquine phosphate tablets by as much as 98% between December 2019 and January 2020, according to data provided to STAT by the publishing and analytics company Elsevier. The unit price went from $3.87 to $7.66 for a 250-milligram tablet.
"Incidentally?" Tenth paragraph? What the hell is this? Who is News18.com?* (They seem to be concerned with India and cricket and Bollywood stars.) Why isn't this bigger news? Did I somehow miss this story when it was blasted by the mainstream media here in the US of A?
I searched the WWW for mention of Rising Pharma. I found a 1:06 clip from a CNN show that runs at 9 AM ET on Saturday, hosted by former Philadelphia radio talk host Michael Smerconish, in which he interviews an author, Gerald Posner, who wrote a book critical of Big Pharma. The piece, which ran on March 21, is the only mention of Rising Pharama's price change I can find in the legacy media.
On March 21, a site called RawStory.com (an "American online tabloid" according to Wikipedia), reported on the Rising Pharma story, embedding the Smerconish/CNN clip. I could only find two other "articles" about Rising Pharma--one from Yahoo Finance, and another on a site called Biospace.com.
Both of them were "rip-and-read" pieces, taken nearly 100 percent from a press release directly from Rising Pharma bragging about how the company was going to donate a million doses of the drug to help in the treatment of the virus.
"Rising Pharmaceuticals Responds to Pandemic by Lowering Prices and Donating Product," read both stories' headlines. No mention is made of Rising's chloroquine price shenanigans back in December.
And, "incidentally" (to borrow that handy weasel-word from News18.com), not only is the copy in the story identical to Rising's press release, the headlines on both items are exactly the same as the one on the press release.
Why is Rising Pharma's price gouging not a bigger story? I am puzzled by it. I am puzzled generally by the lack of appetite among mainstream media people (and alt media people as well) for providing their readers/listeners/viewers with good, solid information and data regarding what might be a drug that saves the world.
When the POTUS mentioned the concoction in a presser, CNN went the "Fact-Check" route. In a ten-graf story on the Thursday, March 19 conference, CNN framed the story thusly:
Fact check: Trump wrongly claims FDA 'approved' drug chloroquine to treat the coronavirus
The ensuing story is "true" in some sense, I suppose. As they truthfully recount, the president said:
"It's shown very encouraging -- very, very encouraging early results. And we're going to be able to make that drug available almost immediately. And that's where the FDA has been so great. They -- they've gone through the approval process; it's been approved. And they did it -- they took it down from many, many months to immediate. So we're going to be able to make that drug available by prescription or states."
And there is some truth to this. However, there is a legitimate question: Had the FDA "gone through the approval process?" No, not for this particular drug, for this particular application of this drug. U.S. physicians have always been free to prescribe it for "off-label" use, including its use for treating the effects of the COVID-19 virus. There was never any approval process needed.
And CNN was right to call out that particular claim. But the story is upside down.
In the ninth paragraph, we learn that:
Pharmaceutical company Bayer announced on Thursday that it is donating 3 million tablets of its chloroquine phosphate drug, sold under the name Resochin, to the US government.
So, in the top of the story, we learn that the president "wrongly claims FDA approved drug." In the bottom of the story we learn that Bayer is dumping a warehouse full of chloroquine pills on us for free. And we learn further that the pharmaceutical giant's impetus for this charity is that, "New data from initial preclinical and evolving clinical research conducted in China, while limited, shows potential for the use of Resochin in treating patients with COVID-19 infection."
This CNN story uses the Inverted Pyramid wrong side up! The insignificant fact check is highlighted at the top. The most important (and OPTIMISTIC) fact is at the bottom. And between grafs one and nine? Blather from the FDA head about how chloroquine "would be tested through a 'large, pragmatic clinical trial' with coronavirus patients."
That's the ticket! People are dying, a simple, ubiquitous, relatively safe medicine is readily available, and the head of a large, lumbering regulatory agency advocates lengthy, cautious, CYA clinical trials. To paraphrase that expression the firearms enthusiasts like to affix to their bumpers, "When days count, the FDA is only months away."
Don't get me wrong, the FDA is one big reason that America doesn't eat pangolin scales purchased on a street corner. It's an agency that, quite literally, stands between you and death, illness and unregulated marketing and consumption of bat soup. It is charged with making sure that what goes into American mouths does not shoot out American butts at 120 miles an hour, sickening and possibly killing thousands.
But, in this case, it can't help itself. Lumbering bureaucracies gonna lumber! The FDA's affinity for "large, pragmatic clinical trials"-- and it's understandable insistence on proven safety and effectiveness-- are, for an agency of such size and scope, understandable (and perhaps laudable) but such tendencies are ill-suited for battling a fast-moving and sometimes deadly virus.
What is needed is decisive action. Bayer and the POTUS seem to be leaning in that direction, despite the FDA's wishes.
Chloroquine (or Plaquenil or hydroxychloroquine phosphate or chloroquine sulfate) are manufactured by at least ELEVEN different pharmaceutical manufacturers. It cures malaria--at least it used to. In 2018, there were more than 200 million cases of malaria reported worldwide. But it seems that chloroquine-resistant malaria is on the rise, so, while the pill is still used to cure malaria, it's efficacy in treating the parasites that cause that particular sickness is waning.
But the drug is still being manufactured in great quantities, perhaps billions of pills every year, because it helps a lot of people.
There are currently estimated to be 1 million lupus sufferers in America and 5 million worldwide. There are currently 25 million rheumatoid arthritis sufferers (I know one personally). Not all lupus patients take chloroquine. And not all RA patients take chloroquine. (It is not the most popular drug prescribed for RA, coming in second to a drug called methotrexate.)
It is right and good and necessary (and, I assume, profitable) to make and sell chloroquine and its cousins. And it has been for some time. And there are--in any analysis--millions who depend on it.
But even acknowledging all this, is there any reason at all to believe that there is any sort of looming shortage of this drug?
Even if we take as a given the total number of lupus and RA sufferers--worldwide--as being 30 million, and we also concede that all 30 million of them need the drug for relief, and we further stipulate that they take it daily, it is likely that those eleven drug makers are likely cranking out millions more units of the drug than are immediately needed--on a DAILY basis!
But, keep in mind that not ALL of those sick people use it. Still, with all the demand--for malaria, lupus and RA--there is no doubt an eye-popping number of pills needed, but the point still stands that the planet is awash in chloroquine pills. And earlier this month, I learned we have so much of the raw ingredient used to make those pills that we use it to cure that Ichthyophthirius multifiliis scourge that's currently threatening your nephew's fish tank.
If the number of COVID-19 sufferers needing or wanting the drug climbs to 96 million--just one "worst-case scenario" as reported by the Independent UK--the number of pills needed to treat them still would not rival the numbers currently made and consumed. And the increase in production wouldn't be so steep as to make it impossible or even difficult.
The "worst-case scenario" with regard to any chloroquine shortage is just that--a scenario.
As stated above, chloroquine is second to methotrexate in popularity in treating RA. It is used. A lot. It is used by itself and in a drug cocktail with chloroquine and a third drug. So nowhere near all RA sufferers use it or need it.
And it may well be that all 5 million lupus sufferers on the planet use it daily.
But for those infected with the coronavirus, only the sickest among them will be administered the drug, at least as matters currently stand. In the near term, many doctors, nurses and other health workers will most likely take it prophylactically. But if we take the combined numbers of both groups--patients plus medical workers--then add them to the current group who depend on the drug, the figures still do not suggest that the makers of the drug might have any trouble adjusting to the new demand.
As we speak, Novartis, Teva, Bayer, Merck, Sanofi and Pfizer have committed to manufacturing and donating (literally) TENS OF MILLIONS of the pills--for free--to the U.S. (and, I assume, the world) to fight this ailment. Just yesterday, Greek pharamaceutical manufacture Uni-pharma-SA announced that they would be donating 24 million pills (!) to Greek hospitals.
If all of them combined donate 60 million pills, that's enough to treat tens of thousands of ill COVID patients and frontline doctors, nurses and caregivers. Probably for months!
And, keep in mind, I did not read--in ANY of these stories--that the manufacturers would halt production and distribution of the drug for use in treating lupus or RA (or even malaria). These pill donations, this ramping-up in production, is--any sensible person should assume--IN ADDITION to their current output.
Just as we speak of "excess deaths" when seeking to put this scourge in perspective, we should also seek to estimate just how many "excess pills" we might need in battling the virus.
If we go with the Imperial College doomsday scenario, the number of those infected who might need chloroquine--doctors, patients, nurses--would be maybe 20 million people. (But that is the upper limit. And, as we all know, even the author of that study has since revised the numbers downward.) In such a scenario, drugmakers would have to ramp up their collective output of chloroquine by 67 percent! (Assuming ALL 30 million lupus+RA sufferers take the drug--which they don't--and that the drug makers only make enough each day to satisfy that day's demand--which they don't.)
Let's be generous and say that only half those 30 million lupus/RA folks need chloroquine. Let's further assume that we're only looking at a HALF-doomsday scenario of 10 million doctors, nurses and patients needing it. A rough estimate means drug makers will need to ramp production up by a third.
One doesn't need to be an expert on supply chains or manufacturing cost estimation or raw materials sourcing to believe that such a feat is, while difficult, probably do-able. Especially in a crisis!
I'm sure that Novartis and the others also have to maintain manufacturing lines of other critical drugs. They're drug companies and tens of millions depend on them for relief and, in some cases, survival.
And, though they may act swiftly, there may be some minor interruptions to the supply, but ask yourself this question: Is there any real possibility that the number of corrupt doctors and pharmacists here in the U.S. could prescribe (or hoard) so many of these pills that it would result in any significant change in the supply of the drug? Or that any such shortage would cause any real harm to the patients currently depending on the drug?
And just where is all this hoarding going on? I have seen zero firsthand reports of fraud or abuse, or reports of prosecution of such abuses. Were there any real incidents of hoarding, it would no doubt lead all the major broadcasts and be above the fold on page one of the five or six newspapers left in America. (/s)
The "cure" for COVID-19 calls for TWO 500mg pills per day (along with zinc and Zpak). Repeat for 6 days if necessary. And, IIRC, the prophylactic use recommends ONE a day for those on the front lines.
Even if there were an evil doctor on every corner hoarding the pills for himself and his family--and two evil pharmacists for everyone one of those evil doctors setting aside a dozen pills for himself and his family and friends--we're still not talking numbers that are all that large.
Now, conduct that experiment using Nevada. I can't find out how many pharmacists there are in Nevada. I do know that there are approximately 67,000 pharmacies in America. Nevada, however, has a population of 3 million, which is 1/100th of the country's population. So, evenly divided (which it probably isn't, but work with me), Nevada has 670 pharmacies. Let's say that each one has at least one pharmacist. Let's be generous and say that each has 3! That's ~2,000 pharmacists in Nevada. Let's assume that every one of them is thoroughly contemptible and corrupt and cowardly and they've set aside pills for themselves and their loved ones. And let's assume that Nevada also has 10,000 doctors, each with the ability to prescribe pills, each thoroughly corrupt and willing to coerce their corrupt pharmacist friend to help with hoarding pills. THAT is a problem.
But the number of people willing to risk censure and ruination in order to hoard pills is likely small. And the likelihood that any significant number of them could or would hoard pills is likely small as well.
So why did Gov. Sisolak of Nevada issue an emergency order regarding prescription of chloroquine?
On March 24, a press release from the governor's office stated that he would not allow doctors to prescribe the drug to help patients infected with coronavirus. It states, in no uncertain terms, that:
"The regulation prohibits the prescribing and dispensing chloroquine (sic) for a COVID-19 diagnosis, requires an ICD-10 code on prescriptions for the drugs and limits the prescription to a 30-day supply for the drug."
Earlier in the release is the justification for the order: "...there is no consensus among COVID-19 experts or Nevada's own medical health advisory team that the two drugs provide treatment for COVID-19 patients. The emergency regulation is aimed at preventing hoarding of the drugs." Further down, it claims the emergency regulation will "ensure access for Nevada patients to chloroquine and hydroxychloroquine for legitimate medical purposes." This implies that use of the drug for COVID-19 is illegitimate.
His "chief medical officer for the state Division of Public and Behavioral Health" helpfully chimes in that this is "a strong step in protecting patients" and that "we must deal with facts, not fiction." Which implies that claims of the drug's efficacy in treating COVID-19 is "fiction."
To review: Sisolak claims that there is "no consensus" regarding the drug's usefulness in treating COVID-19. He claims also that this order "protects Nevadans who needs (sic) these drugs for legitimate medical purposes." He implies that COVID-19 patients not hospitalized do not need them. He further opines that "the best way to prevent the spread of COVID-19 is to stay home for Nevada, not to stockpile these drugs," setting up an either/or situation that is just plain unrealistic and unnecessary.
Within minutes, Sisolak was dragged on social media for insinutating himself between doctor and patient. And within a few more minutes, he was compelled to "clarify" the order, claiming that he never meant to ban use of the drug for hospitalized patients. In contradiction to the press release.
The local papers dutifully corrected the initial stories to reflect the walkback. In one such story, the Sun helpfully informed us that, "The governor’s rule comes a day after a Phoenix-area man died and his wife was in critical condition from taking an additive used to clean fish tanks known as chloroquine phosphate, similar to the drug used to treat malaria." This, of course, implies that Sisolak's order is in response to that incident.
We're not sure why this isn't just a police matter. Surely, there are sanctions against "hoarding" pills. And there is, no doubt, law enforcement officials who closely monitor any such activities. And it may well be that they move so slowly and/or methodically that their sanctions and enforcement might be less than efficient when a hyper-contagious bug is threatening to overwhelm our hospitals. But leaning on honest doctors and telling them what they can and cannot do is perhaps not the best compromise.
Lastly, I haven't been able to find the actual emergency order, so the press release is all I have to go on when judging whether the governor's action was based in science or politics. Inspect it for yourself. It offers three different rationales for the order. No consensus? (Who cares? We're all dying, last time I checked.) Stop stockpiling! (Has anyone presented any proof that stockpiling is happening? Or, if it were, that those who need it can't get it?) Not legitimate! (Tell that to Gov. Cuomo, Dr. Zelenko, Dr. Raoult and those who are about to expire in Greece, Madrid and NYC. How do you define "legitimate" in the midst of a worldwide scourge, anyway?) Facts, not fiction? (Respectfully, where are you getting these "facts?" And what, in particular, are you calling fiction?)
If the "hoarding" storyline was so clear, why did he clutter up the script with dubious science claims and bizarro rhetoric about facts and fiction and legitimacy? And has American innumeracy gotten so bad that we can't figure this stuff out on our own? I might be way off on these figures, but, even without them, something doesn't add up.
Full disclosure: I turn 63 this summer. And, although I have no "underlying conditions" (and can run a sub-9-minute mile on my good days), I do not fancy living in a state in which doctors have one hand tied behind their back in the middle of a once-in-a-century pandemic. If I exhibit signs of the flu, the wife has been instructed to load me into the car and drive me to Utah.
* If you scroll down to the very bottom of the NEWS18.com website, you see this:
"CNN name, logo and all associated elements ® and © 2020 Cable News Network LP, LLLP. A Time Warner Company. All rights reserved. CNN and the CNN logo are registered marks of Cable News Network, LP LLLP, displayed with permission. Use of the CNN name and/or logo on or as part of NEWS18.com does not derogate from the intellectual property rights of Cable News Network in respect of them. © Copyright Network18 Media and Investments Ltd 2020. All rights reserved."
I did NOT see that coming.