Reasons for optimism - medicine

With a pandemic putting much of the world into lockdowns or quarantine, it might seem counterfactual for anyone to be optimistic about the future of diseases and the medical responses to them. Modern travel gives diseases that mutate and cross the species barrier from animals to humans the ability to spread rapidly, but modern medicine increases the speed and range of our responses to them. The development and testing of several vaccines against the coronavirus achieved within a single year a process that has usually taken 5 - 10 years. Humankind will emerge from the pandemic far better equipped to deal with new diseases when they appear than it was before. It has coped with Ebola, SARS, H5N1 bird flu, and MERS camel flu, and AIDS is no longer the death sentence it once was.

Of the diseases that ravaged previous populations, smallpox has been rendered extinct by vaccination, tuberculosis is treatable, and polio is on the verge of extinction in the wild. Even the ancient enemy, malaria, is within range as a variety of methods to combat it is being developed, and its extinction by mid-century looks very likely.

Heart disease used to be the big feared killer, but many cases of it are now treatable by drug therapy, angioplasty or bypass operations. This has led to various cancers taking its place as more people survive it. Cancers are increasingly more treatable than before, and it is likely that nanotechnology will give medicine the edge by locating cancer cells much earlier in the body, and targeting individual cancer cells to destroy them.

The resources and effort going into the early detection and treatment of the different forms of dementia and their reversal suggest that before long we will have a range of procedures to halt and reverse the build-up of the plaques and other conditions that induce it.

The principal cause for optimism about medicine in the future derives from work being done at the genetic level. Gene therapy and gene editing have brought the possibility of disabling or editing genes associated with inherited diseases, and even of editing genes to confer immunity against subsequent life-threatening conditions. Much of this type of procedure can be done in the womb, so the child will be born with the advantages it brings. Gene therapy might even offer ways of slowing down the process of ageing.

Despite the pandemic, medicine is continuing to advance at an increasing range, extending our ability to cope with the conditions that nature sends our way. To those who say the world will never be the same again, the best response is that this is correct. It will be better.

Let's not get silly about trade and Brexit

A report that we might be getting into a trade war:

The import of European mineral water and several food products into Britain could be restricted under retaliatory measures being considered by ministers over Brussels' refusal to end its blockade on UK shellfish.

The Telegraph can disclose that ministers are looking at proposals dubbed "Water Wars" which could see the UK end a number of continuity arrangements it has agreed with the EU.

Senior Government sources pointed to potential restrictions on the import of mineral water and seed potatoes, the latter of which the EU has secured a temporary agreement on until the end of June.

In a warning shot to Brussels, a Government source said: “There is thought being given to where we can leverage in other areas. We have continuity arrangements... we can stop these which means they won’t be able to sell their produce here.”

This is not just silly it is insane.

The value of trade is that we get to consume those lovely things made better, cheaper, faster, by Johnny Foreigner. Exports are merely the work we do to be able to afford them.

So, J. Foreigner decides not to eat our shellfish. Oh Well, Oh Dear, they are now without our lovely shellfish. To turn around and insist that therefore we will punish ourselves by not having their mineral water, or their seed potatoes, is that more than silly it is insane. Why are we punishing ourselves for their actions in denying themselves?

As the late, great, Joan Robinson pointed out:

Even if your trading partner dumps rocks into his harbor to obstruct arriving cargo ships, you do not make yourself better off by dumping rocks into your own harbor.

Do we want seed potatoes? Given that we like growing potatoes the answer is yes, obviously we do. So, why would we ban ourselves from gaining our seed potatoes from the best supplier? That Mr. Foreigner is barred from eating our shellfish is an entire irrelevance to the truth of this proposition and therefore an irrelevance to the decision.

Come along now people we’ve known this about trade for centuries now - it’s the imports that are the point. So why is anyone even dreaming of making this mistake?

Student unions should have nothing to do with policing speech

Universities are struggling to protect freedom of speech in the face of overzealous demands from a small but vocal mob of student activists.

These activists seek to sterilise life on campus. They have been particularly successful at toxifying student politics. Student unions now concentrate on a narrow “social justice” virtue-signalling political agenda focused on tackling alleged “structural oppression” against minority groups.

Universities have a legal and moral duty to ensure that the freedom crucial to maintaining an atmosphere of discovery and debate are not buried under successive “safe space,” “inclusion,” and “liberation” policies.

It is encouraging, therefore, that the Government has set out a new set of proposals to protect free speech on campus — several of which were advocated in the recent Adam Smith Institute report, State of the Unions.

The greater legal protections for students and academics who have been penalised or removed for exercising their freedom of speech will make universities think twice about following the braying mob. After all, it has always been their policy to go down the path of least resistance.

The inclusion of student unions in the legal obligation to preserve freedom of speech should also be welcomed. Student unions pose the greatest threat to open debate on campus. Filled with puritanical ideologues, they pursue regressive bans on speech, dress, and even hand gestures. Examples of ridiculous student union bans, such as those on sombreros, are widespread.

While these latest steps are welcome, threats to freedom of speech on campus are unlikely to disappear. The Government must go further in enforcing free expression protection and disempowering censorious student unions.

The new rules mean that student unions will likely cease explicit ‘no-platforming’ of speakers. But the risk remains that they will impose substantial bureaucratic hurdles, such as requiring a student society to provide two months notice or pay security costs for a controversial speaker. These barriers are de facto censorship: relatively few student societies have the organisational capacity and monetary resources necessary to overcome these barriers.

Just this month Durham University Students’ Union decided that it would vet all “high-risk” speakers who wish to speak both on and off campus. If a speaker is deemed ‘controversial’ by the SU, then 4 weeks’ notice must be given, they may have to provide their speech in advance for approval, and if approved the SU may insist on adding additional speakers to provide “balance.” The SU’s definition of a high risk is someone who has “links to any person or groups connected with controversy.”

A recent paper on free speech produced by a number of student union officers and a lobbyist advocated the same approach. A risk assessment should investigate “the potential for the speaker’s presence on campus to cause harassment, alarm or distress to members of the student body.”

“The student union,” they said “also has a duty to think about how it can promote equality and minimise tension and prejudice between different groups on campus - and even where it facilitates events and debate, must consider the potential impact on students who may feel vilified or marginalised by the views expressed."

Of course lots of groups now claim that any criticism makes them ‘feel vilified and marginalised,’ so the SU officials propose that then a whole range of restrictions are applied, as in Durham. It will be necessary for the Free Speech Champion and the Office for Students to be highly vigilant against these tactics.

To prevent continuing attempts at censorship student unions should have nothing to do with controlling free speech on campus. SUs are completely unrepresentative institutions, elected by on average around just one-in-ten students, as the recent ASI report revealed. Most students regard the political activists who control SUs with absolute contempt. The free speech crisis on campus will only be effectively tackled once the wider problem of taxpayer-funded compulsory student unions is addressed.

In his introduction to the free speech proposals Gavin Williamson state that “some students’ unions have been granted inappropriate levels of control over which speakers can visit and how student societies can operate”. He is absolutely right. The appropriate level of control is zero.

Max Young is an Edinburgh University student who has served as Deputy Editor of 1828.org.uk and Free Market Conservatives. He is the co-author of the ASI’s report, State of the Unions.

Another thing about Mariana Mazzucato

That we disagree with near everything Mariana Mazzucato puts forward is not exactly a surprise to anyone. Her basic idea that government could and should direct the economy if only government were better at directing the economy fails, to us, on the grounds of how is government going to be better at directing the economy? Nowhere has really given us, nowhen, evidence that it can be after all.

But in more detail:

She is particularly critical of overseas takeovers that 'often come from foreign public institutions'. She regards this as 'hypocritical' in that 'we hear all this talk in the UK of needing more private sector and less state, then we sell if off to foreign states.'

We’d not want to make entirely too much of this point but it’s not as silly as she makes it sound.

When government runs something in the territory it is the government of it is subject to political as well as economic pressures. When government runs something in the territory of some other government it is subject only to those economic pressures.

For example, back when the British government did run the British electricity supply system what the workers were going to get paid was something decided - often enough - at Cabinet level. For union pressure, political pressure, made it so. Wages were politically decided. Or, another example, the nationalised steel industry. Famously, Callaghan was finally convinced that Steel plants needed to be of a certain size - economies of scale. So, the industry would and should be consolidated. At which point the political decision to award half of the one consolidated plant each to Scotland and Wales was taken. Meaning two sub-economic plants for political reasons.

When the French government - just as a speculative example - runs British power stations that domestic, British, political pressure doesn’t apply to the government decisions. No Briton does vote for the French government after all. So, decisions are taken on a more hard-headed economic basis.

Of course, part of the distaste for privatisation itself, let alone to foreign state actors, is that politics is taken out of the decisions making process. Even as we applaud that taking out, others insist that it should remain - that’s part of the base difference of opinion.

But foreign state economic actors are going to be, at the very least, freer of those contradictory domestic political pressures. Which is what makes for the greater economic efficiency of them. Precisely, that is, that foreign state actors think of shareholder, rather than stakeholder, primacy is what makes them desirable.

People aren't thinking about these recovery bonds

The latest suggestion is that there’s a huge great big pile of saved money just sitting around doing nothing. So, why not issue bonds and the government can get on with spending that money on useful stuff:

Starmer’s plan for British Recovery Bonds to encourage those savings to be invested securely in local communities, jobs and businesses looks like a far better substitute.

Households have indeed saved £125 billion so why not?

The mistake is to think that this £125 billion is currently doing nothing. Some portion of household savings will be under the mattress and that is indeed doing nothing. But then we don’t record as savings what is under the mattress, we don’t in fact know how much is there. Our records are of what is in banks. And banks do not just shovel money into the vault and leave it there. That’s just not how banking works.

Instead that money is lent out.

Yes, we can all shout that banks just create money when they lend and they don’t actually lend out deposits. But by 4.30 every afternoon they must finance their lending. If this were not so then no bank could ever go bust as a result of a bank run and we know they can therefore it must be true that a bank must finance a loan. Deposits finance lending even if the financing comes after the lending.

Thus that £125 billion in bank accounts is already being used.

The proposal is therefore not to mobilise the savings because they are already mobilised. It is, rather, to change the manner in which they are mobilised.

Some will say that government spending the money on lovely local things will be better than fructification in the pockets of the populace. We don’t think so and we do have - given the usual examples of how carefully government does spend money - reality on our side.

The idea that such savings are currently not being deployed depends upon the idea that there are those vaults of unused money. It ain’t so - Scrooge McDuck is a cartoon, a jest, not a guide to public policy.

Recovery bonds will change what those savings finance but that’s all. And the argument to be won is that the new deployment will be better than the old - a difficult task we insist. The idea that those mountains of cash are currently doing nothing is just Disney economics and that might be the way to run the Magic Kingdom but it’s of as much relevance to real life as a duck in a sailor suit.

MI5 reports PM ensures closer Cabinet working

Downing Street 

SW1 

“Good morning, Humphrey.” 

“Good morning, Prime Minister.” 

“What’s that lorry doing outside?” 

“It’s delivering another chair for the Cabinet room. You will now have 23 round the table, Prime Minister, as well as those who sit around the walls.” 

“Golly, it’s getting a bit squashed.” 

“We refer to it as ‘working more closely’.  It also provides more opportunity for the streamlining of government you have long promoted.  There will be more heads to roll, Prime Minister.” 

“I wondered why Michael was looking a bit peevish when I saw him on my run this morning.” 

“I thought I should forewarn his staff last evening. The trouble seems to have originated because Mr Gove considered Lord Frost to have lost out to Monsieur Barnier in the Treaty negotiations and to be responsible for the mess that has followed. Given your promotion of our chief negotiator to the House or Lords, that was considered to verge on the disloyal.” 

“Well actually, Michael is probably right about that.  I remember saying that the Northern Ireland protocol would only affect goods intended for onward transit to the south. Goods staying in the north would just be waved through.  Now it turns out that everything is buggered up.” 

“Yes indeed, Prime Minister, but Lord Frost had to placate the Brussels view that the UK could not be trusted to distinguish one from the other.  Monsieur Barnier says they are only doing this to protect the Good Friday Agreement.” 

“That’s balderdash.  There’s nothing in the Good Friday Agreement about customs because Brexit was not even on the horizon when we agreed it.” 

“You are, as ever Prime Minister, absolutely right but we do not want to embarrass the EU by pointing out the obvious. In a negotiation, it is very important to maintain good relations.” 

“Be that as it may, if Ursula can break it, so can we. Bear in mind, Humphrey, forsan et haec olim meminisse iuvabit. I asked Michael to sort out the Northern Ireland Protocol.” 

“Well that’s my point.  Brussels likes Lord Frost but they do not, and I am sorry to say this, have much affection for Mr Gove.  They regard him as ‘difficult’.” 

“Are you telling me the same thing applies to all the other cock-ups? We cannot export fish to the EU but they can catch the same fish in our waters and send it to us with no documentation.  We cannot send our pigs to the EU so East Anglia is over-run with pigs they cannot afford to butcher.  Furthermore, China has banned EU pigs so they are now sending them all over to us with no let or hindrance. We gave the EU six months to adjust to British import paperwork with no reciprocal agreement – I could go on. In absentia lucis, Humphrey, as you well know, Tenebrae vincunt.” 

“Please don’t remind me, Prime Minister. You are simply underlining the reasons why Brussels has asked to deal with Lord Frost rather than Mr Gove. You have been urging us to improve our relations with our largest customer and this is an important step in that direction.” 

“Humphrey.  That’s all very well but being the errand boy to Brussels does not really justify a Cabinet seat.” 

“We have thought of that, Prime Minister. We will announce that Lord Frost will “also be in charge of dealing with post-Brexit trade problems as well as overseeing domestic reform to “maximise” the opportunities of having left the EU.’”

“Does that make him Secretary of State for Trade as well? And Foreign Secretary?” 

“I have had a word with her Permanent Secretary, and I gather Ms Truss will be delighted to have the benefit of Lord Frost’s wisdom and guidance. Mr Raab likewise.” 

“Just as well we have lots of other things for Michael to do.” 

“Yes indeed, Prime Minister. Our media announcement will say Mr Gove ‘will continue to be in charge of civil service reform and liaising with the devolved administrations. The prime minister has put him in charge of a committee to address NHS waiting times, backlogs in the courts and other effects of the pandemic on public services.’” 

“Humphrey, you must be joking. We already have Secretaries of State for Scotland, Wales and Northern Ireland and they’re twiddling their thumbs because the devolved administrations of those nations are dedicated to keeping them in the dark.  This month, Edinburgh has come up with a plan for adult social care, which is more than we’ve been able to do, and they did not even ask for our advice.”

“Indeed.  And it will add 20% to the social care bill which, doubtless, they will expect us to finance.” 

“Well actually, Humphrey, they say social care provides ‘estimated financial value to Scotland’s economy of £3.4 billion’ or presumably £4 billion after the 20%.  In other words, it isn’t a cost at all but an income, so they won’t be asking us for a contribution.” 

“Sometimes I am glad I am not an economist. And before you ask, his Permanent Secretary assures me that Mr Hancock will appreciate Mr Gove’s chairmanship of the committee to address NHS waiting times.  He had been considering leaving that to Sir Simon Stevens but he does not want Sir Simon to take the credit when it should be all hands to the pump.” 

“I suppose you are going to tell me, Humphrey, that Mr Buckland, the Chancellor, Mr Kwarteng and all the other Cabinet ministers involved in this committee are equally pleased?” 

“’Equally’ is indeed the mot juste. You really have devised a brilliant plan.  The new Cabinet will not have 23 members at all – just you, Mr Gove and Lord Frost.  All the others will be redundant.  And almost all of their civil servants can go with them.  If I may say so, Prime Minister, you are a genius.” 

“Humphrey, you are too kind. Alea iacta est. Thank you.” 

The next day

“I’m sorry Prime Minister but the media have got the wrong end of the stick. They have the impression, extraordinary as it may seem, that Lord Frost lost all those points in the negotiations and Mr Gove is the hard man trying to correct them.”

“Extraordinary!”

“We must justify Lord Frost’s appointment to the Cabinet by making it clear that he is the hard man and Mr Gove is the softy.”

“Isn’t that ‘spin’. Humphrey?”

“No Prime Minister. It is realpolitik. And Lord Frost does indeed talk a hard game which adds a little verisimilitude.”

“Oh very well, Humphrey, but you’d better get Michael to back it up.”

Just a little observation about being a nation of fat porkers

Much is made these days about how we’re all obese and falling over like weighty flies at great cost to the NHS. So much so that supermarkets offering us a deal on food prices must be banned from doing so.

As we’ve noted before we don;t in fact believe all of this. Obesity saves the NHS money anyway and it’s up to each one of us how we live our lives and meet our end. The restrictions aren’t justified and shouldn’t be justified that way anyway that is.

Some of the evidence called into play doesn’t quite make sense:

What would most surprise a time traveller from a hundred years ago about an affluent 21st-century society like ours? Cars would hardly be a shock: the Ford Model T began production in 1908. Similarly, tower blocks and skyscrapers were already becoming familiar a century ago: Chicago’s Home Insurance Building, considered the world’s first skyscraper, was built in 1885. No, the most striking change would be the people themselves. The physical appearance of the average person today is radically different to the average person of 1921. We are much fatter now.

That’s true of the great bulk of us, yes.

We are so accustomed to our prejudices against fat people that it’s easy to forget they are the accidents of a particular cultural moment. The two oldest carvings of human beings (the Venus of Hohle Fels from about 35,000 years ago and the Venus of Willendorf from about 25,000 years ago) depict women who would now be classified as obese. Even if, as archaeologists suggest, these statuettes were not intended as portraits of ideal beauty, they were evidently symbols of power. The paintings of Rubens are almost a cliché of changing beauty standards but they also represent different social attitudes. It was not just Rubens’s nymphs and pagan goddesses who were fat: his Virgin Marys and even his Jesuses were too. Fatness suggested authority and moral solidity.

Not just the moral solidity. Fatness suggested being rich. Because only richer people were gaining that sustained excess of calories to make them so.

Which tells us something important about this past century. This is the first time in human history that the majority of the people have been rich - because this is the first time in human history that the majority of the people have been able to have that sustained excess of calories to be fat.

We can indeed mutter all sorts of things - about swimsuit design perhaps - over the problems that generalised obesity brings to us as a society. But we really do have to remember that this is a victory, that it’s even possible.

For that we are all fat may or may not be a problem but that we all can be is indeed that victory of technological advance over Malthusian constraints.

Reasons for optimism - education

The grounds for optimism concerning UK education at both school and university levels are based on the assumption that it will change. Critics have not been short of ammunition, pointing out that children from East Asian countries regularly score well ahead of their UK peer group in ‘hard’ subjects such as mathematics, physics and engineering.

There has been concern that the measures which purport to show a higher percentage passing with higher grades are in fact measuring grade inflation, and that the subjects have been dumbed down to make high scores easier to attain. There is concern, too, that a typical UK university is no longer what Disraeli called “a place of light, liberty and learning,” but a place that will not tolerate the expression of views that might offend some people. Critics also allege that in a scramble for diversity, political correctness and equality, universities have lost sight of quality.

There are, however, indicators that suggest these criticisms may soon be met. Every year more schools choose to be self-governing as ‘free’ schools or to attain ‘academy’ status. This combines with the parental choice that has become widespread to create a situation in which parents can put pressure on the system by preferring schools with rigorous academic standards rather than ones which pursue a ‘woke’ agenda of social and diversity awareness instead. Since the schools’ revenue from the state is based on enrollment, the choices of parents will increasingly lead schools to follow the preferences of parents and students or risk closure.

An important technological development will speed the process of change. The application of artificial intelligence to education makes it possible for each child to have an individual electronic tutor that can teach them at the pace they are capable of attaining. These will be accessible outside the classroom as well as within it, and will transform the way children are taught. Teachers will no longer have to attempt to lead a class forward all at the same pace.

Further grounds for optimism about the future of education spring from the fact that variety will increase as both schools and universities have the option of specializing in particular disciplines. Some will choose to become centres of excellence in subjects such as mathematics or music, and as they acquire that reputation, will attract the brightest and the most promising students in those subjects to their doors.

University education has become increasingly international, and will almost certainly continue to do so. UK universities have many students from other countries studying at them, and increasing numbers of UK students are choosing to study at foreign universities. This enables students to choose the institutions and courses best suited to their needs and abilities.

The greatest improvement will come from the change in which the state no longer provides education, but guarantees access to education instead. The state will provide most of the money for education, but it will be directed to independent, self-governing institutions rather than to state-owned ones. This leads to competition between providers of education, and will raise standards accordingly.

We're afraid we just don't trust the Fabian Society

That the Fabian Society is always going to insist that Tories bad and spending more - much, much more - of other peoples’ money good is just obvious. To have a report that says that not spending more - much, much, more - of other peoples’ money is going to cause civilisation to collapse in a heap is thus just part for the course.

We can argue against such claims, of course we all can. That special measures introduced for the pandemic get un-introduced at the end of it seems sensible to us, just as the one example. That the special welfare provisions put in place end seems to us no more remarkable than that the pubs are allowed to - eventually - reopen. Special times do indeed lead to special measures and normality is accompanied by the reversal of them.

This is not the Fabian way:

Government failure to maintain the £20 a week Covid top-up payment for universal credit will overwhelmingly hit the incomes of working and disabled people, and put more than 700,000 into poverty, according to a study by the Fabian Society.

That Fabian way being that any increase in spending must become permanent because more spending of other peoples’ money is good, d’ye see?

The thing is we just don’t trust them. From their actual report:

Poverty is measured as 60 percent of median contemporary income, after adjusting for housing costs and size of family. Note this is a different measure than we used in our previous report Double Trouble (for that study we used a fixed-line measure of poverty rather than a poverty line based on changes in median income, to avoid the perverse situation where rising unemployment leads to a fall in the cash value of the poverty line).

The reason we don’t trust them? They change their definition of poverty according to what best suits the insistence that more must be spent. Always.

When it is convenient, as in this report, to use a measure of relative poverty to argue for more tax and spend then they do that. When a relative measure would lead to less tax and spend - this being their complaining above about perversity, that when median incomes fall this means that fewer are in relative poverty, or that the relative poverty line falls - then they switch to an absolute measure of income.

This is intellectual casuistry and no, we shouldn’t trust people who do this. Humpty Dumpty is meant to be a joke in a children’s book, not a blueprint for the design of national policy. Sadly, so too is the Queen of Hearts and her efficient manner of dealing with such behaviour only a joke.

The first rule of economics - incentives matter

There is indeed a problem with the development of antibiotics. Far too many bugs are gaining immunity to the ones we use - largely because we use them and evolution happens. Far too few new antibiotics are being developed. This is a problem we’d like to solve because we’d really not want to return to a world in which sepsis is the likely outcome of any surgery.

The problem is one of incentives. It costs hundreds of millions to billions to develop a new antibiotic. The patent which allows that cost to be recouped lasts 20 years from filing, usually about 10 years from approval. But the entire point of having this new antibiotic is that we’ll use it very sparingly as the last resort. Only those infections that don’t succumb to our extant supply will be treated with it. Further, we really don’t want widespread use because that would just encourage that evolution thing to make it not work again.

A system based upon volume sales therefore doesn’t work as a development incentive for new antibiotics.

The answer is, obviously, change the incentives. Some say that therefore drug development, or perhaps just antibiotic, should become a government function. The recent success of that in the development of coronavirus vaccines might show that not to be the path to take. Changing the incentives for the system we know works, those private developers out there, seems more sensible:

And the UK is experimenting with a new subscription-style payment model that pays drug companies upfront for access to novel antibiotics, so decoupling profit from volume sold.

More detail here:

The NHS is offering 2 contracts to pay pharmaceutical companies at the start of their work for access to innovative antibiotics, incentivising them to bring new classes of the drugs to patients across the UK for the first time in almost 30 years.

Of particular interest are antibiotics that can provide alternative treatment options for serious infections, such as bloodstream infections, sepsis and hospital-acquired pneumonia.

The high cost and low returns associated with antibiotic research and development makes it commercially unattractive. This is why the drugs will be paid for by the world’s first ‘subscription-style’ payment model for antibiotics and will be made available to UK patients as soon as possible, potentially as early as 2022.

We do not say that scheme will be perfect - human design never is in this vale of tears. Rather, that the development of antibiotics faced an incentives problem. The answer is to change the incentives. Because, you know, incentives matter.