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Culture War Roundup for the week of May 26, 2025

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I decided to go back to my saved comments on here, and found a great one on the FDA and progress that made me think. Here's the text:


Gleevec was approved to treat acute leukemia and was a major breakthrough

Okay? The FDA does not perfectly impede progress isn't a contentious claim. How about bromantane from my last link (An Iron Curtain Has Descended Upon Psychopharmacology):

My guess is the reason we can’t prescribe bromantane is the same reason we can’t prescribe melatonin and we can’t prescribe fish oil without the charade of calling it LOVAZA™®©. The FDA won’t approve a treatment unless some drug company has invested a billion dollars in doing a lot of studies about it. It doesn’t count if some foreign scientists already did a bunch of studies. It doesn’t count if millions of Russians have been using the drug for decades and are by and large still alive.

Does that count as impeding progress?

A generic EpiPen was approved in 2018 https://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-version-epipen

It only took them nine years! Congratulations to Teva Pharmaceuticals on their achievement.


I suppose it also comes down to the baseline we're discussing. Does the FDA impede progress relative to what, and by how much?

I think that the FDA impedes progress relative to a theoretical-within-punishing-the-elites pharmaceutical regulator, and the difference is enough to make a material impact on a decent fraction of people.


endquote

Anyway, the reason I bring this up is that I'm very curious how the Trump admin has been doing tackling regulation. There's a lot of things going on, and regulation seems to have lost the spotlight, but I'm very much hoping that we walk away from the next few years with dramatically reduced regulatory agencies.

Anyone have thoughts on how the promised regulation reduction is going?

Does that count as impeding progress?

No, because you can just go down to the store and buy fish oil for 30$? Not to mention eating fish oil isn't progress, we've been doing it for I don't know how many years. Lovaza is different in that it is manufactured in a GMP facility, with GMP protocols and supported (I presume, I don't follow the fish oil literature) by expensive clinical trials. Maybe you don't care when it comes to fish oil, but you probably care that your hideously complex chemo drug is both 1) effective and 2) safe.

Would the libertarians paradise where drug manufacturing and prescription was completely unregulated, and savvy consumers learned which manufacturers were reputable and which drugs were efficacious by word of mouth be better than what we have now? No idea, although it's worth noting that we effectively had that paradise in the era of snake oil salesmen and sulfanilamide killing over 100 people. We had thalidomide, we had SV40 contaminated polio vaccines, and other incidents I can't remember off the top of my head. I think it's reasonable to question whether the FDA in it's current state is net positive and how it can be reformed, but I'd wager that the vast majority of the 'FDA delenda est' crowd have no idea why this fence was built in the first place.

As some other anecdata, if you like, until recently many Chinese people prized medicine (and other goods!) manufactured in the USA. Largely due to the regulation and processes you dislike.

It only took them nine years!

Difficult for me to comment as I'm about up to date on epipens as I am on fish oils, but the rejection seems pretty opaque. Are you confident that the entirety of the issue here is the FDA just sitting on their application/dragging their feet, or were there actual major problems with the design?

I think that the FDA impedes progress relative to a theoretical-within-punishing-the-elites pharmaceutical regulator

What does 'theoretical-within-punishing-the-elites pharmaceutical regulator' mean?

Regardless, at the end of the day you face tradeoffs between safety and cost. The ideal number of pharmaceutical recalls/killed patients isn't zero, but it's hard to say what the optimal number is.

If you're curious, the Chinese have significantly deregulated. They also use a lot more 'phase zero' clinical trials that allow smaller biotechs to get clinical data much more easily and, as a result, are on a trajectory to wreck the US biotech ecosystem in the next 5-10 years. That said, I'd bet they've had some nonzero number of patients in clinical trials develop serious adverse events that were kept hush-hush in a way that's impossible to do in the USA.

Anyway, the reason I bring this up is that I'm very curious how the Trump admin has been doing tackling regulation. There's a lot of things going on, and regulation seems to have lost the spotlight, but I'm very much hoping that we walk away from the next few years with dramatically reduced regulatory agencies.

Well, he appointed an HHS secretary (who oversees the FDA) who fucking hates the pharmaceutical industry. As far as I can tell, the twin north stars of RFK Jr. are 1) pharmaceutical companies are evil and 2) COVID was manufactured in a lab and facilitated by NIH money. I don't think he's a man who wants to maximize the number of drugs large pharma companies can get approved. They've also (as far as I can tell) entirely cut off government grant money to at least Harvard, Brown, Columbia, Cornell, Northwestern and others which probably isn't optimal for progress. He's threatening to block government scientists from publishing in top medical journals and is instead promoting his personal weird one. Biotech in the US is probably dead in the water, and the future is Chinese.

I'm in favor of the libertarian paradise option.

There are two failure modes of the FDA:

  1. Letting bad drugs through that on net injure people.
  2. Slowing or stopping good drugs that on net help people.

The natural and personal and business incentives already heavily align towards getting good drugs out there, and not taking bad drugs.

You seem well informed, I'm surprised you even mention a drug killing a 100 people. I would shrug my shoulders at a thousand. FDA drug delays have estimated kill rates in the hundreds of thousands for some heart medications.


Optimal situation in my mind would be to switch FDA over to a certification regime rather than a licensing regime. This is basically the same thing I say about all government regulation, but I say it about everything because I think its a good idea. Certify that a thing is safe and not harmful, but do not require that certification for selling or consuming of the substance. Companies can submit their drugs to be certified, and the FDA runs those tests. They also run some number of public interest tests every year, like for fish oil or whatever.


And yeah, who knows wtf will happen with JFK at the helm.

And yeah, who knows wtf will happen with JFK at the helm.

Ok, that's it. I criticized the Democrats for hiding Buden's decline, so I can't, in good conscience, support Trump when he's appointing literal corpses.

I think he just sounds like a corpse but is relatively healthy. He has some voice condition.

Or did you mean he is a corpse because he is a Kennedy family member in politics?

RFK Jr. sounds like a corpse.

You said JFK. Barring some new information, he is a corpse.

I enjoy telling conspiracy theorists that JFK survived his assassination, donned blackface, and changed his name to Tupac.

No, it's just a silly joke based on you getting the first initial wrong. Unless I there's another Kennedy in the admin that I'm not aware of.

Ah whoops