In Flint, 4.9 percent of children tested for lead turned out to have elevated levels. That’s inexcusable. But in 2014 in New York State outside of New York City, the figure was 6.7 percent. In Pennsylvania, 8.5 percent. On the west side of Detroit, one-fifth of the children tested in 2014 had lead poisoning. In Iowa for 2012, the most recent year available, an astonishing 32 percent of children tested had elevated lead levels.
.. Across America, 535,000 children ages 1 through 5 suffer lead poisoning, by C.D.C. estimates.
.. Researchers soon found that early exposure to lead impairs brain development and is strongly associated with later violent or criminal behavior.
.. Yet the lead industry ferociously fought attempts at regulation. It wasn’t until the 1970s and ’80s that lead was largely removed from gasoline, and until 2008 that a regulation reduced lead in paint to a reasonable level. Millions of children continue to suffer brain impairment because of the greed of the lead industry.
A disturbing report from the front lines of the war on cancer.
“The Death of Cancer” is an angry book, in which one of the critical figures in twentieth-century oncology unloads a lifetime of frustration with the obduracy and closed-mindedness of his profession. DeVita concludes, “There are incredibly promising therapies out there. If used to their fullest potential for all patients, I believe we could cure an additional 100,000 patients a year.”
.. Baffled, he asked one of the hospital’s leading oncologists, Barney Clarkson, to explain exactly how he was administering the MOPP protocol. Clarkson answered that he and his colleagues had decided to swap the nitrogen mustard in DeVita’s formula for a drug called thiotepa. This was a compound they had developed in-house at Memorial Sloan Kettering and felt partial to. So MOPPwas now TOPP.
.. “Why in God’s name have you done this?” he asked.
A voice piped up from the audience. “Well, Vince, most of our patients come to us on the subway, and we don’t want them to vomit on the way home.”
Here were physicians at one of the world’s greatest cancer hospitals denying their patients a potentially life-saving treatment because their way felt better. Stories like this are why DeVita believes that a hundred thousand cancer patients in the United States die needlessly every year.
.. The angriest chapter of “The Death of Cancer” is devoted to the Food and Drug Administration, because DeVita believes that it has fundamentally misunderstood the trade-off between diffusion and innovation. The agency wants all new drugs to be shown to be safe and efficacious, to be as good as or better than existing therapies (or a placebo) in a randomized experiment involving the largest possible number of patients. For example, the F.D.A. might ask that patients getting an experimental treatment have better long-term survival rates than those receiving drug treatments already in use. The F.D.A. is the country’s diffusion gatekeeper: its primary goal is to make sure that good drugs get a gold star and bad drugs never make it to market.
.. A given tumor, for instance, can rarely be stopped with a single drug. Cancer is like a door with three locks, each of which requires a different key. Suppose you came up with a drug that painlessly opened the first of those three locks. That drug would be a breakthrough. But it can’t cure anything on its own. So how do you get it through a trial that requires proof of efficacy—especially if you don’t yet know what the right keys for the two remaining locks are?
.. Drugs are now approved not for a specific cancer or for general use in a variety of cancers but for a specific stage of a specific cancer and specifically after and only after patients have had all current treatments, which are listed drug by drug, and the treatments have all failed. Doctors risk F.D.A. censure if they use an approved drug under any other circumstances, and patients are penalized because insurance companies won’t pay for treatments not approved by the F.D.A.
The vital insight gained by using an approved drug in a different way for a different tumor has been lost.
Wall Street Is Using the Power of Dodd-Frank Against Itself
Rent-seeking tends to be a force against innovation and for stagnancy, in large part because its focus is on the past — on maintaining power and influence gained long ago, often at the expense of innovation. Businesses built around rent-seeking don’t try to increase the size of the pie; they just want to make sure they get a bigger slice. (If a company doesn’t seem to care about your opinion of it as a customer, there’s a good chance that it is seeking rents.)
.. The depth of the inquiry was notable because the school is generally thought of as a Wall Street-friendly training ground for future bankers. One of the most striking findings was that between 1980 and 2000, the large banks in America had significantly moved away from productivity enhancement and toward rent-seeking.
.. To fight rent-seeking, we would need banking laws made up of straightforward rules that educated laypeople could understand. They would have to eliminate our maddeningly complex regulatory infrastructure. There would be trade-offs: The financial system might not perform as efficiently, and the economy might not grow as quickly during boom times. But if done right, an overhaul of banking regulations could create a political context in which rent-seeking self-enrichment by banks is no longer the norm. We might even come to call it what it is: corruption.
The Death of the Comcast Deal
Sure, they might be near-monopolies in many parts of the country, but the deal was simply about linking up regional monopolies, not increasing them.
.. the Justice Department decided, conceptually, to turn things around, and in economic jargon, to look at the other side of the “two-sided market.”
.. Stated differently, anyone who wants to reach one of Comcast’s customers—like Netflix delivering a film or Spotify delivering a song—has to go through it, and it alone. Looking at the deal this way forced the Justice Department to think about Comcast as something much more than just a regional cable company.