Last note to @ATabarrok & @ezraklein. We got lucky w/ vaccines. Many other decisions @US_FDA are made at margins & the push from libertarian right to further weaken the approval process serves no one. We know less & less about what we put in our bodies, pay more & more for it. 1/
We just don't "figure it out later." As @VPrasadMDMPH, @jsross119, @akesselheim have noted evidentiary basis for drugs, etc. is getting weaker. There are opportunity costs, real human dangers about letting ineffective, poorly tested agents out on market. 2/
No one was going to suggest delaying vaccine EUAs w/ the data we saw emerge. Frankly, the process worked. It almost failed w/ hydroxychloroquine because of political pressure, notion that there were few downsides to putting the drug out there for a new indication w/o evidence. 3/
The lesson of #COVID19 isn't that we need a weaker FDA, with looser standards. We need a more independent agency which manages access and answers, balances need for both, without interference from politicians and the industries it regulates. 4/
And don't "people are dying" at me. I went through the height of the AIDS epidemic in the US, we made the "FDA is killing us," argument early on, before you did, but quickly learned that evidence matters, otherwise we're flying in a data-free zone. 5/
And yes, FDA screwed up on tests. But if you take a more comprehensive view of this history of the agency, regulation, it has bent over backwards to move products to market w/o any evidence of clinical benefit with increasing regularity. 6/
Read Daniel Carpenter's book, Reputation and Power: Organizational Image and Pharmaceutical Regulation at the FDA, to get a good sense of where we are, where we came from. 7/ press.princeton.edu/books/paperbac…
There will be other pandemics, other health crises. We undermine the FDA at our own peril. Move fast and break things may be the entrepreneurial way, but it's a disaster for public health. end/

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More from @gregggonsalves

3 Apr
@samhorwich @ezraklein I was first relieved that there at least was some pushback in the piece and it wasn’t 100% libertarian BS. But after a re-read realized it was a capitulation out of ignorance letting a purely ideological view of the regulatory state drive the narrative. 1/
@samhorwich @ezraklein The main tell here? People like Alex will always say less regulation as the answer to every question. Anyone who knows FDA, the history and politics, will realize the agency has drifted towards appeasement of its critics since the 1980s. I should know. I was one of them. 2/
@samhorwich @ezraklein Did FDA make mistakes over the past year? Surely, but in the larger context, these missteps (and even the agency’s better decision) are now being pitched by Goldwater Institute and others that it‘s now time for guess-what? More deregulation. Ezra walked straight into it. 3/
Read 27 tweets
1 Apr
Our roads & bridges are crumbling. Our transportation network: a joke. I've seen better airports in countries the size of Utah. @POTUS isn't betting on big government as @SangerNYT says. 1/ nytimes.com/2021/03/31/us/…
This framing makes it partisan, as if the key question is how big would you like your government? I'd like a 21st century nation please. With basic infrastructure up to code. Write that article. 2/
I mean for god's sake, the Mies-Van-Der-Rohe less-is-more minimalist ideology of government has ruined us. Infrastructure crumbling, public health so weak, education sub-par, inequality so deep. This is not a sign of a healthy nation. 3/
Read 13 tweets
26 Mar
So there are some ghouls on Twitter crowing that "other" states are seeing increases in #COVID19 cases this week, some substantial. The implication is look how good we're doing, compared to those "other" states. 1/
It doesn't matter who is doing it. We should not be heralding the deaths of fellow Americans as if this is some contest. 2/
Some aspects of what has happened are predictable, some are not, but to look at the differences in COVID19 rates right now and use it as a political cudgel to undermine our national response, sound public health practice is gruesome. 3/
Read 7 tweets
22 Mar
I am sympathetic to this case & know some of the authors here, but frankly people from around the world have been saying this for months now. It's largely been coming from the global South, not asking for handouts but transfer of know-how. Great to have these people on board. 1/
But let's not obscure the fact the delays in American leaders speaking out like this has cost lives. We could have had a global plan for scale-up, not a solely domestic one from the start. 2/
Now let's get down to business. @POTUS needs to tell the companies that the USG will underwrite tech transfer, scale-up of production, mobilization of precursor commodities and chemicals, now, today, not this summer. 3/
Read 13 tweets
20 Mar
.@GovRonDeSantis is a @Yale and @Harvard grad. He knows exactly what he's doing in embracing quackery & pseudo-science. It is a calculated, cynical, political move. 1/
It's an embrace of anti-scientific thinking because he thinks this is the way to power. This is his only rationale, his only desire. 2/
This man is dangerous. He would do anything to advance his career. He belongs no where near the Florida Governor's mansion, let alone the White House. He is emerging as a worse, even more scary version of Trump. 3/
Read 6 tweets
19 Mar
No @GovRonDeSantis. You got lucky. And now you're dancing on the graves of the dead. Why don't you go visit the relatives of the 32,000 dead in your state? Those among the 2M infected who will live with long-term effects of #COVID19. 1/
You miserable fuck. Never let a crisis go to waste. You see a way to profiteer from the pandemic for your political future and you're all in. 2/
Sound public health measures still apply. Widen out the lens & you'll see overall, some countries went all-in w/ containing #COVID19 in Oceania/East Asia, while many in the Western Hemisphere & Europe couldn't get it together to do that. Result? They fared better than we did. 3/
Read 11 tweets

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