What is the quality of your intent?--Thurgood Marshall
I have other things I need to be doing. But I can't clear my head space. My goal isn't to politicize but to emphasize how important systems thinking is in our world of trillion dollar tax proposals, blockchain, net neutrality, and discussions of "Innovation" in healthcare. These are just a few topics in a bee's hive of activity in our modern economy.
I am unable to write about the calamity of Alzheimer's disease for example without consideration of upstream risk factors and potential influencers such as social determinants of health and funding of public programs. 50 million dollar investment in Alzheimer's disease: but can we disrupt the persistent paradigm? Should we allow ourselves to be gullible and believe a monotherapeutic cure is on the horizon in an ecosystem of toxic water, environmental assaults, climate change, agri-business, food policy, deregulation, and profound inequality? Think about the Blue Zones and their successes. Truly mind blowing.
I have recommended a documentary by Noam Chomsky, an American linguist, intellectual, philosopher, cognitive scientist, historian, social critic, and political activist. The trailer is below. The full documentary reminds us of the origin of our nation. If you read the constitution you can actually review James Madison's thoughts on the role of government, to protect "the minority of the opulent against the majority".
We all have subjective truths that model our perspectives and how we move in the world. The interesting part of all that is if we boil away the "fat" what remains is the foundational skeleton--a framework of sorts that can recalibrate our internal conversations and hopefully radiate out into the world--and offer possibility.
Our economy and political system were written in the white spaces of The Wealth of Nations by Adam Smith in 1776. There have been costume changes of course but the identification of Masters of Mankind as the power elite predates the current hateful rhetoric by at least 240 years.
A few modern notions from our complicated history
(brief points from documentary "Requiem for the American Dream")
1. We have 2 choices for our fundamental society. We can reduce inequality (think Aristotle and notions of a welfare state) or concentrate power in the hands of the wealthy, hereby reducing democracy (James Madison). This mirrors the nuanced differences between leading ideology of our two party system.
2. We have never had a financial crash during times of regulation
3. Most large corporations make more profits by manipulating markets and moving assets than selling goods or services.
4. If you don't know what regulatory capture is--you better google it.
5. 14th amendment? Corporations are people--undocumented workers are not.
6. A large electorate is too difficult to control by force--control their beliefs and attitudes. Create unfocused anger against each other and they will not democratize and drive real change.
We have seen the FCC walk away from Net Neutrality and we are days away from possible tax reform that still echoes the views of minority rule over the majority--to their benefit at our expense.
Yes we need tax reform. It has been 30 years since we have had a new tax bill but not in secret. Trillions of dollars and a colossal debt are part of this debate uninformed by experts or even the light of day.
Wednesday I attended the live meeting of U.S. Innovation by Reforming Patent and R&D Policy at the Brookings Institution. When challenged by Greg Ip, the Chief Economics Commentator from the Wall Street Journal about the sharp cuts in public investment in healthcare (Medicare, NIH funding, Medicaid expansion, ACA mandates), Kevin Hassett's (the chairman of the White House Council of Economic Advisors) reply was that most of these draconian measures--my words not his--would not be in final bill.
If that was supposed to reassure those of us paying close attention--It did not. The Brookings Institution's own document on innovation clearly states that public funding of healthcare research is necessary to drive innovation. The Brookings Private Sector Global Health R&D Project is worth a read for those wanting to remain objective in how we define "Innovation" and which companies are truly innovative.
The Access to Medicine Index 2018 Methodology Report is an important read for data-minded individuals defining measures and variables for analyses. I will be writing and discussing many of these analytic frameworks in future discussion. This report is emblematic of how definitions that are squishy, like "Innovation" can be mobilized for personal gain if not carefully designed with reproducible measurement. I use it to calibrate the end of year reports about innovation in healthcare that I am reading, writing, or discussion.
What is next? The second session, Promoting Energy Innovation with Lessons from Drug Development was particularly of interest. Modeling the FDA phased approvals to drive innovation in R&D in energy. I am curious if authors are familiar with The Public Utility Holding Company Act or PUHCA.
The Public Utility Holding Company Act (PUHCA) of 1935 is the only law that prevents utility holding companies from subsidizing unregulated business activities from profits obtained from their regulated business activities and captive customers. PUHCA requires that all side businesses be kept separate from the regulated business.
I am reading the full report made available at the meeting and here and will be discussing in future conversations. I often thought of the public utility model of providing affordable energy to everyone in the country as a model for US healthcare. I did not anticipate the opposite scenario and frankly I predict "Innovation" will lead to rate increases but I will do my research before a full scale jump to that conclusion--for now it is just a toe flick...
The authors propose three types of reform to the energy innovation system that build upon lessons from pharmaceutical innovation:
There are many lessons to be learned from FDA regulations. Stay tune...