Taking Note

Merck’s Cholesterol Drugs—Low Hanging Fruit?

If an expensive, name-brand cholesterol drug costs four times more than a generic but provides no clear clinical benefit, why do insurers—both public and private—continue to pay for it? The answer, in the case of Vytorin, a combination of two drugs designed to lower LDL or bad cholesterol, is that the influence of big Pharma in maintaining the status quo—even when unsupported by evidence—remains a formidable barrier. By suppressing negative studies, relentlessly pursuing positive trial results, and paying academic researchers to promote their therapy, Merck Schering-Plough has managed to hold onto a $4.6 billion market for a drug that has never been proven to be better than cheaper generics in preventing heart attacks or death.

Iraq’s Parliamentary Crisis - An Unexpected Constitutional Exit?

On November 8th, Iraqi legislators reached a compromise agreement over an elections law for the upcoming 2010 national parliamentary elections. The resolution to this bitter standoff −which centered on the disposition of Kirkuk in the electoral law and was part of a broader struggle to establish precedents over the city and other disputed territories−was hailed by Iraqi Prime Minister Nouri al-Maliki as an "historic victory of the will of the people." When Iraq’s Sunni Vice President unexpectedly exercised his constitutional prerogative to veto this hard-fought parliamentary compromise, it appeared Iraq was headed for a more serious political and, potentially, constitutional crisis. Without such a law, elections cannot be held, and the constitution mandates that the elections take place at some point in January 2010. With these further delays, it would appear that meeting this deadline will be logistically impossible.

Concern was heightened by the subsequent passage of what appears to be a retaliatory law that would potentially reduce Sunni representation based on the geographic allotment of seats. The law was rammed through the parliament on the basis of a Shiite-Kurdish bloc that hearkened back to the more crudely ethno-sectarian politics of the recent past. This polarizing action would appear to increase the odds for another Hashemi veto and a protracted stalemate if a three-fifths majority could not be stitched together to overturn a second veto. Such a scenario would further delay parliamentary actions, compounded by the fact that the parliament has recessed until December 8th for the ‘Eid al-Adha holiday.

The Future of Journalism

“The Future of Journalism” has been the subject these many months of conferences and confabs from coast to coast. Some experts and pundits seem to be omnipresent. The problems under discussion are certainly acute. The prescriptions focus on a mix of entrepreneurial and nonprofit models. Contemplation has its place. But the real tests will be in what actually gets done as journalism under force majeure is reinvented. I have just been reading the spring 2010 master of science curriculum at the Columbia University School of Journalism. What comes through is that students at Columbia and other leading schools are being trained in a variety of skills and a range of formats at a level of sophistication that assures the field will be much more broadly defined in the years ahead than the traditional notions of news gathering. Ultimately, the aspirants—at least as much as the prognosticators—will determine how journalism evolves.

As a practical matter, instruction at the “J” school, as it is known, was so elemental in the 1960s that graduates—of which I am one—emerged as full-fledged hunt-and-peck typists. Students mainly did reporting exercises. Secretaries were taught to take shorthand and touch type. Reporters were not. I see no evidence that typing with ten fingers is a requirement these days either. But the breadth of what is being offered is amazing, about which more in a moment.

Senate Bill Would Postpone Reform until 2014: The Political Implications

What if in 2012, unemployment remains relatively high, the recession continues, and voters blame President Obama, voting him and his Congressional supporters out of office?

Consider how that would affect health care reform. If the House bill prevails on the timing of reform, the Exchanges will open in 2013, subsidies will be available, private insurers will be regulated, and the Public Plan will be available to tens of millions of Americans. Conservatives elected in November of 2012 would have only two months to try figure  out how to derail the roll-out scheduled for January 1, 2013.

By contrast, the Senate legislation now under consideration would push reform forward to 2014. The Exchange, the public plan, the subsidies --none of the above  would be scheduled to become  a reality until one year after Conservatives took control of both the White House and Congress.  In a year, determined politicians could repeal and dismantle most if not all of the reform plan.

Public Resisting Conservative Slanders on Health Care Reform

Conservatives are putting up a last ditch effort to stop health care reform. They’re doing their level best to scare the public, telling them that passing health care reform will take the country down the road to socialism and ruin the economy, among other things. But the public, while it still has many questions and concerns about health care reform, just isn’t buying these scare tactics. Consider these findings from the most recent Kaiser Health Tracking Poll.

The public was asked whether the president and Congress passing health care reform would make “the country as a whole” worse off or better off. By 53-28, the public thought the country would be better off, rather than worse off.

So much for taking the country down the road to socialism. What about ruining the economy? Over the long term, the public believes, by 49-37, that passing health care reform will actually help the nation’s economy.

New Mammography Guidelines Hit the Wall of Public Opinion

The new recommendation from the U.S. Preventative Services Task Force that women under 50 should not undergo routine mammography is generating a lot of controversy—it is a direct challenge to the strong message women have been receiving for two decades that they should have yearly screening starting at age 40. The task force also recommends that women age 50-74 have a mammogram every two years (rather than yearly) and finds that there is little benefit in screening women over 74 at all.

To the experts who have been questioning the benefits of mammography for several years, these recommendations are no surprise—and they are welcome. The World Health Organization, and many European countries where the government pays for routine mammography screening, already follow these guidelines. But how is this news playing in Peoria?

The Aftermath of Soviet Hegemony

A couple of years after the collapse of the Soviet empire, I asked Adam Michnik, one of Poland's leading dissidents who had founded a major new newspaper, how he thought the country was doing. "Terribly," he said, describing factional squabbles among the emerging political parties and his growing disdain for Lech Wałęsa, who had become Poland's president. He called him "Piłsudski without a horse," invoking the country's strongman of the 1920s and 1930s, a brief era of Polish inter-war independence ending with the Nazi invasion.

"But what about the defeat of the Communists?" I asked. "Oh that," he said, dismissing decades of subjugation to the Kremlin as so much historical detritus, of which Poland has accumulated a great deal.

Our exchange came to mind the other day when I read an interview in the Wall Street Journal with Michnik, still a leading intellectual voice in Poland. Asked to describe the country's situation today, he replied, "fantastyczne," the exact opposite in Polish of his assessment to me all those years ago. It's been a while since I was in Poland, but Michnik's view strikes me as a good place to begin measuring what is happening there and elsewhere in the former Soviet empire in this season of the twentieth anniversary of the fall of the Berlin Wall, the symbolic implosion of Moscow's hegemony in the region. The spectrum of development is broad; from the autocratic kleptocracies of Central Asia, the wars in the Caucasus, the political stalemates in Ukraine and Byelorussia, and the burst economic bubble of the Baltics to the differing but essentially positive trends in Hungary, the Czech Republic, Slovakia, Rumania, and Bulgaria, with Poland probably the best off for now. Germany, the land of the wall itself, seems to have integrated its halves well enough to be comfortable with the kitsch status of Ostalgie, a peculiar yearning for simple life styles in the Democratic Republic.

Does Obama Believe in School Integration?

Over the past 10 months, we’ve heard a great deal about the Obama Administration’s support for charter schools, education standards, and performance pay for teachers.  But what does the Administration think of racial and socioeconomic school integration?

On Friday, a slew of major civil rights organizations held a national conference at Howard University Law School and invited several key Obama Administration officials to speak, including Carmel Martin, Assistant Secretary for Planning, Evaluation and Policy Development at the Department of Education;  Russlynn Ali, the Education Department’s Assistant Secretary for Civil Rights; and Derek Douglas, Special Assistant to the President for Urban Affairs in the Domestic Policy Council.  The event, a portion of which was broadcast on C-SPAN, was marked by “respectful tension,” as Ohio State University’s john powell noted.

Public Backs Abiding by International Law

In the bad old days of the Bush administration, our nation’s leaders did not seem too interested in abiding by international law and, in fact, seemed to take some pride in asserting our right to ignore it. Under the Obama administration, that attitude has changed and it is good to see some polling evidence—from a WorldPublicOpinion.org poll, conducted by Knowledge Networks—that the public is simpatico with this shift. American respondents to this poll—which included people from 20 other countries —said “our nation should consistently follow international laws” (69 percent) rather than feel free to ignore those laws if they are not deemed to be in our nation’s interest (29 percent). Moreover, respondents expressed confidence in the decisions of the World Court, an institution the Bush administration was quite skeptical of. Fifty-seven percent said they would be very or somewhat confident that a World Court decision involving the United States would be fair and impartial, compared to 42 percent who were not very or not at all confident.

Iran’s Opposition Demands Obama Take a Stand

This week at insideIRAN.org: The debate over whether the United States has shown enough support for Iran’s opposition movement has intensified since protesters in Tehran last week shouted, “Obama, Obama! Either you’re with them, or with us.”

Joining the opposition chorus is a growing line-up of parties worldwide, all calling on Obama to broaden his strategy from one narrowly focused on making an acceptable nuclear deal with Iran to one that also includes demands to allow the opposition to freely express itself: the government of France; members of the U.S. Congress; international human rights organizations; and much of the active Iranian diaspora.