The Washington Post reports on a group of doctors who were testing lower dosages of an expensive blood cancer drug called Imbruvica to see if it was effective at lower doses. Then the companies that make Imbruvica hit back:

The researchers at the Value in Cancer Care Consortium, a nonprofit focused on cutting treatment costs for some of the most expensive drugs, set out to test whether the lower dose was just as effective — and could save patients money. Then they learned of a new pricing strategy by Janssen and Pharmacyclics, the companies that sell Imbruvica through a partnership. Within the next three months, the companies will stop making the original 140-milligram capsule, a spokeswoman confirmed. They will instead offer tablets in four strengths — each of which has the same flat price of about $400, or triple the original cost of the pill.

Just as scientific momentum was building to test the effectiveness of lower doses, the new pricing scheme ensures dose reductions won’t save patients money or erode companies’ revenue from selling the drug. In fact, patients who had been doing well on a low dose of the drug would now pay more for their treatment. Those who stay on the dose equivalent to three pills a day won’t see a change in price.

“That got us kind of p—ed off,” said Mark J. Ratain, an oncologist at the University of Chicago Medicine who wrote about the issue in the Cancer Letter, a publication read by oncologists. “We were just in the early stages of planning [a clinical trial] and getting it organized, and thinking about sample size and funding, and we caught wind of what the company was doing.”

I can’t believe I’m defending a pharmaceutical company, but what did these oncologists expect? Everyone knows that the price of drugs like Imbruvica doesn’t depend on the cost of actually manufacturing the stuff. Whether it costs a penny a pill or $100 a pill is irrelevant. These drugs are priced to recover their R&D costs based on the number of patients who are likely to use them. If the number of pills required was any kind of factor at all, they’d manufacture them in 10-milligram sizes and make people buy 14 or 28 of them.

You can argue about whether drug pricing is too high, but there’s really no argument that the price of a cancer drug should decrease if it turns out you can use less of it. That’s strictly a clinical judgment. The pharmaceutical company still has to recover its development costs, and that doesn’t change regardless of how big a dose is typically required.¹

¹Actually, the new pricing model for Imbruvica may be fairer than the old one. Should a 300-pound person pay more than a 150-pound person just because their body requires a bigger dose? Should people with higher cancer loads pay more than those with lower cancer loads? That’s not at all clear, is it?

This is how beloved Canadian health care is.Image Source/ZUMAPRESS

I got this email from a friend a few days ago and thought I’d share it:

I go to conferences which often have Canadian participants. Once I was speaking with a Canadian, who turned out to be extremely fiscally conservative. Thus, I steered clear of politics but we stumbled on healthcare because he mentioned that his spouse had suffered from two major cancer incidents. I mentioned that this must have been a financial disaster for him. He responded — very nonchalantly — basically along the lines of oh no that was mostly handled by our health care service. His out-of-pocket was fairly low under his supplemental insurance. Both times. Wife is doing well in remission. I asked — because I had heard it — whether treatment was delayed because of the limited number of doctors, etc. I got a weird bemused look in return and he just said no, there was no issue with it. That was really it. He didn’t praise or condemn the system. It was just a positive fact of his existence in Canada.

Then he complained at length about taxes, too much government intervention in all aspects of life, stifled innovation, etc. This guy was wealthy, successful in business, travelled, had houses, etc. And apparently still had a living spouse to share them with without risk or fear of bankruptcy. He reminded me of the many firebreathing Medicare recipients in the U.S. who despise the government, complain about bankrupting the nation, high taxes, welfare louts, but are highly defensive of Medicare — with no self-awareness.

It makes me kind of want to say to conservatives here that, it’s OK, you can totally be for national healthcare and still be a dick about it and everything else. It won’t turn you into a liberal. I’ve seen it!

Consider it said. Hey conservatives! You can totally be for national health care but continue to be a dick about it and everything else!

I’ve come this far, so I guess I might as well finish up:

Much of this is due to the Republican tax bill, of course, which has showered Wall Street with billions and billions of dollars. And why do we think that lower tax rates on big banks are going to improve their ability to lubricate the American economy? That’s a very good question, isn’t it?

Ed Kilgore draws my attention to a new PRRI survey which suggests that young people are becoming friendlier toward abortion rights.

Most Americans say their own views have not changed on the issue in recent years….The pattern among young Americans, however, is unique. Approximately one-third of young Americans say their views on abortion have changed in recent years, and nearly three times as many say their views have become more supportive of abortion rather than more opposed to abortion (25% vs. 9%).

This is good news, but I found myself a little dubious. I’d rather see a plain old trendline of young people’s attitudes toward abortion rights over time, but PRRI doesn’t provide that. Neither do most pollsters. But the biannual General Social Survey does, so I went there.

GSS asks questions about whether you support abortion in case of rape, in case of birth defects, etc. The closest we can get to a general question is whether you support abortion no matter why the woman wants one. However, the thing to look at here isn’t the raw numbers, which always depend strongly on question wording, but on the trend over time. Here it is:

The data is surprisingly variable and hard to read, but you can run a trendline through it. Here’s a summary of the trendline changes since 1980 in percentage points:

• Age 18-34: up +1 pp
• Age 35-49: up +6 pp
• Age 50-64: up +10 pp
• Age 65+: up +6 pp

There is, for some reason, a huge, decline and recovery in abortion support between 1995-2010 among the youngest age group, but in the end, virtually no change since 1980. It’s actually the older age groups that have changed the most.

Perhaps this is on the cusp of changing, but given the long-term trends and the year-to-year variability of opinions, I’m sort of skeptical. If I find more data that directly shows abortion attitudes by age group, I’ll pass it along.

I was just at CVS. When I went to pay, I noticed all the baby formula was behind the counter, like Sudafed and cigarettes. Why? “Because poor people steal it a lot,” the clerk told me.

Am I the last person in America to know this? Maybe. But what a goddamn statement about our country.

Over the last year I’ve taken several long-exposure photos of rivers and waterfalls. I have a soft spot for them, but I admit that I also sort of enjoy tweaking all of you who think this kind of thing is about on a level with clowns painted on black velvet. However, this picture I really and truly like. I took it at Yosemite, on the Vernal Fall footbridge, and I was quite taken with the color of the rocks, its harmony with the color of the water, and the lovely effect of the water swirls. Needless to say, your mileage may vary.

I figured I should keep everyone up to date on the travails of Wall Street’s biggest banks in the brutal Dodd-Frank environment they have to compete in now. Only one bank to go!

Here’s the latest from our president:

Russia and China are playing the Currency Devaluation game as the U.S. keeps raising interest rates. Not acceptable!

— Donald J. Trump (@realDonaldTrump) April 16, 2018

Hmmm. Here’s what his Treasury Secretary had to say about China a few days before:

Over 2017, the Chinese currency generally moved against the dollar in a direction that should, all else equal, help reduce China’s trade surplus with the United States….More recently, since the beginning of 2018, the renminbi (RMB) has continued to strengthen against the dollar, up 3.7 percent as of end-March.

….China does not publish its foreign exchange market intervention, but Treasury estimates that Chinese authorities significantly curtailed intervention in the second half of 2017 that they had been undertaking to support the value of the RMB. Foreign exchange reserves sold in the second half of the year are estimated at $6 billion, a significant decline compared to estimated sales of close to $250 billion during the second half of 2016.

Here it is in chart form. First, the exchange rate:

And market interventions to prop up the renminbi:

In other words, according to Trump’s own Treasury Department, the value of China’s currency has increased and the level of intervention has been nearly zero during Trump’s entire term in office. In the grand scheme of things, perhaps this doesn’t really matter. Still, WTF? Does Mnuchin even talk to his boss about this stuff?

My Twitter feed is glutted with Michael Cohen snark right now, and he is undoubtedly the most entertaining news of both today and the past week. But I don’t have anything nonobvious to say about him, so let’s talk about something else. Last week I promised to write again about the latest NAEP scores, and today Bob Somerby reminds me to do that. Bob and I may have a fraught relationship, but one thing we agree on is a tiredness over the knee-jerk narrative that interprets all test scores at all times as evidence that American schools are failing. So let’s take a look.

Over at the Atlantic, Natalie Wexler has a piece titled “Why American Students Haven’t Gotten Better at Reading in 20 Years.” Her theory is that it’s related to the way we teach reading, and I had it open in a tab over the weekend but eventually closed it because I don’t have any special knowledge of how best to teach reading. However, Bob points out that the first order of business is to see if it’s even true that American students have flatlined over the past 20 years, as Wexler claims. Here’s the NAEP data:

For those of you too lazy to do your own arithmetic, here’s the comparison between 1998 and 2017:

• Asian: +15 points
• White: +5 points
• Hispanic: +10 points
• Black: +5 points

There are a number of points you can make with this data, but one point you can’t make is that kids haven’t gotten better at reading.¹ Using the usual rule of thumb that 10 points equals one grade level, black and white kids have improved half a grade level; Hispanic kids have improved a full grade level; and Asian kids have improved 1½ grade levels.

That’s not too bad in the space of only 20 years, and it comes on top of similar improvements between 1975 and 1999. So here’s my question: how fast should reading scores be improving? For that matter, is there any special reason that reading scores should be improving at all? Poverty hasn’t changed much. Average incomes haven’t changed much. The phonics wars have been raging for decades, but I’m not sure that reading pedagogy has really changed very much down on the ground.

So why do we expect reading scores to be skyrocketing in the first place? Why do we almost universally refuse to acknowledge that scores are up at all, let alone up a fair amount? Why are we so determined to believe that kids in the past were better educated than kids today, even though the evidence says nothing of the sort? It is a mystery.²

¹And before anyone asks: if you restrict yourself to public schools only, the 20-year gains have actually been a little higher.

²The usual dodge at this point is to suddenly decide that NAEP scores don’t matter, and the only important thing is how our kids compare to kids in other countries. That, however, is an extremely tricky subject on a variety of levels, and it’s genuinely not clear what the limited data tells us. In any case, I’m not willing to even discuss this with anyone who lacks either the math skills or the intellectual honesty to first acknowledge the steady and significant score gains among American kids over the past few decades.

In the cities, uniforms for Irish schoolgirls generally run toward the usual knee-length skirts. Out in the country, as you can see, they don’t put up with such immodest notions. This picture was taken in Killaloe, County Clare, a village of about a thousand people that boasts of being home to some of Ronald Reagan’s ancestors. Across the river is Ballina, County Tipperary, which boasts of being home to some of Kevin Drum’s ancestors.