This is a new and experimental part of the blog. As you may have noticed, we stopped posting a while ago. We tried to restart but life got in the way. What we’re thinking about today is an experiment to get us posting more. We’ll share comments and thoughts about things we read and ideas we encountered, some distinctly outside of our wheelhouse of expertise. Some thoughts will probably be half-baked. Others we might turn into full products either on the blog or in other outlets. As always, reach out or comment–thinking is best done with others.
May 13, 2021: Regulation, basic science, and competition with China
– Nich Weller
1 – Regulation, innovation, and healthcare systems
Spent the morning watering my garden and listening to Tyler Cowen’s podcast interview with Daniel Carpenter, an expert in regulations and the FDA at Harvard. The interview covered lots of ground and it’s worth a listen or read. Two parts stand out: Cowen’s questions about a more laissez faire approach to drug approvals and Carpenter’s fascinating discussion on petitions to legislatures as a method for democratization.
On the FDA, Cowen asked Carpenter about relaxing FDA regulations for approving drugs so that FDA approval was more like a stamp of approval from Better Housekeeping. Cowen argued that getting drugs and vaccines more widely available sooner would be a net positive. I have some sympathy for this argument, but I also think it overlooks some important and complex dynamics in our regulatory and healthcare system. But more basically, I thought to my own difficulties in making decisions about healthcare. Is that sharp pain in my lower abdomen an urgent case of appendicitis, a muscle injury, or just bad Mexican food? Decisions about medicine and health can inflict a lot of stress on people and families, not too mention the financial costs or associated health issues due to stress and costs. Wading through information on drugs is difficult and confusing, even for people with technical backgrounds. Doctors and other professionals help sort information and inform decisions, but a more robust FDA approval processes helps reduce the amount of time, resources, and stress one may have to dedicate to understanding a drug, its effectiveness, and its safety.
Our system of healthcare delivery and how we pay for it is important here too. With fewer barriers to distribution, would it be easier for the pharmaceutical industry to encourage doctors to prescribe certain medications with the potential for little health improvement but lots of sales? Cowen notes that the UK’s approval process for COVID-19 vaccines was quicker to approve the AstraZeneca vaccine. But perhaps the UK can be looser with regulatory decisions because British citizens generally like the National Health Service and trust it, which many Americans can’t say about their healthcare regime. Regulatory decisions and arguments about their stringency can’t be cleanly separated from larger health care system dynamics, including trust and feelings and measurements of efficacy.
2 – Petitions and democracy
Staying in the Cowen-Carpenter podcast. Carpenter proposes bringing back petition days to state legislative bodies as a way of infusing more democratic mechanisms into policy making while avoiding the downsides of plebiscite-type referenda. He notes that plebiscite referenda can lessen deliberation, compromise, and other desirable qualities of small-r republican mechanisms. This jives, I think, with how I’ve thought about referenda in Arizona, where they are largely dominated by existing interests, they are used by the legislature to offload the politics of a tricky issue, or they water down deliberation and compromise (see our blog post about Arizona’s Prop 127 from the 2018 election). I’m less familiar legislative petition mechanisms. Guess I need to buy his book.
Shout out to Zach Pirtle for recommending the podcast episode.
3 – Basic science and the National Institutes of Health
A new research nonprofit, New Science, aims to build new institutions of basic science that avoid the pitfalls of academia. The argument on the group’s website critiques academia and entities like the NIH for failing to invest in ambitious, creative researchers and becoming too conservative in their approach. I think there’s something to their arguments and I’m curious how their programs will play out.
What stood out to me is the assertion that NIH/NSF/academia is failing to truly support basic science. I think about and encounter the reverse critique more frequently: That NIH/NSF/academia focus too much on a basic science-driven model of innovation whereby investments in research eventually (but unpredictably) lead to outcomes that improve lives, contribute to new technologies, or strengthen economic competitiveness. The NIH and advocates for it, for example, laud investments in NIH by Congress as the input that generates health-related breakthroughs by investing in the self-governing (via peer review) institution of science. Patient advocate groups have–I think rightly–noted that this model distracts from outcomes that matter to patients.
The New Science group, by my very initial reading, shares some critiques about NIH and NSF with critiques advanced by folks that study science and science policy. But the intervention New Science plans to implement doubles-down on curiosity-driven research untethered to academic goalposts. Others who might share their critiques argue for better linkages between research and outcomes.
Hot take: Trying to “do to science what Silicon Valley did to entrepreneurship” might be problematic or misguided given what we know about how Silicon Valley functions and the technologies its brought to fruition.
4 – Science and competitiveness with China
The Endless Frontier Act and the NSF for the Future Act both aim to reinvigorate American science and technology. Testimony on both bills referenced economic competitiveness with China and related national security issues. Some members of Congress noted that we shouldn’t replicate what China does because the American approach to innovation is better. What’s not clear to me are the differences between China’s approach and say the approach of the U.S. in the post WWII era, when close connections between government investment, technological development, and industrial capabilities led to substantial breakthrough technologies and advances (and, of course, Eisenhower’s warnings about the military-industrial complex). Though I’m less steeped in China’s approach to S&T, there’s at least some indications to suggest their replicating innovation approaches from the US but with a much more robust manufacturing base. My point here is that we shouldn’t be so quick to dismiss China’s approach without some consideration of parallels between China’s approach and the history of US innovation.
After watching some congressional testimony on the topic, I thought of a presentation I watched at the US embassy in Beijing in the summer of 2016. After someone from the NSF shared slides showing China’s growth in various S&T-related metrics, a young State Department staffer presented on China’s approach to science. He stated that Beijing couldn’t replicate the dynamism of places like Silicon Valley and thus concluded that worries about China overtaking the US in S&T sectors and innovation were overblown. At the time, I thought his argument was patently ridiculous and I still do. It ignored a great deal of history about how the American innovation system came to be.
More on these bills:
- Michelle and I, along with Mahmud Farooque and Leah Kaplan, shared our thoughts on the Endless Frontier Act last summer when it was first proposed.
- Mahmud shared his perspective on the NSF for the Future Act during a recent congressional hearing.
Muddling Through Science, Policy, and Politics 