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US president Biden signs a broad executive order on July 9, that is directed at promoting competitive behaviour in the American economy, and taking action against companies that have anti competitive behaviours. It also aims to limit corporate dominance that then can lead to anti competitive behaviours. These types of behaviours puts consumers, workers and small compoanies at a disadvantage. The Biden plan stretches from the smaller items such as hearing aids and baggage fees, to the task of putting in place the first antitrust regulation on tech companies Apple, Google, Amazon and others. Industries Biden sees as needing help are agriculture, healthcare, shipping, transportation, technology, and labor practices that limit wages and mobility. In making the executive order the White House says it "will lower prices for families, increase wages for workers and promote innovation and even faster economic growth." As each step is taken by the Biden administration to help workers, families, women and children, the situation is a reminder of the actions taken by Franklin Delano Roosevelt at another period of crisis in the nation's history. The July 9 executive order will create a Competition Council as proposed by Tim Wu, special assistant to the president for technology and competition policy in the White House National Economic Council. The Compeititon Council task will be to get federal agencies to take action to promote competitive behaviours for the first time since the 1980's when Republican presidents Reagan, Bush, and Democratic presidents Clinton, Obama, allowed such behaviours in some industries to get entrenched. In Biden's own words "the rise of monopolies weaken labor." In each industry agencies will now have the task of pushing back against anti-competitive behaviours already put in place by companies. In agriculture it will help small farmers, in pharmaceutical sector it will help the American people deal with a problem that has no end in sight of high drug prices and practices that support this. In all areas of the economy the Biden plan is for a new coordinated effort across all the agencies of the government and under the leadership of the president, to restore the vibrant economy to what it was before the long deterioration through anti-competitive behaviours. ...

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AstraZeneca PLC showed a net profit decline of 8.3% in fourth quarter 2011, on sales that remained stable at $8.66 billion compared to $8.62 billion in the prior year quarter. AstraZeneca is facing competition from low cost generics and cuts in government health care spending similiar to the rest of the industry. The company has announced new job cuts of 7,300 job for 2012, which brings total job cuts to 30,000 for the last 5 years. Most of the job cuts are in the U.S. and Europe. Hiring has continued in emerging markets leaving the net job cuts over the last 5 years at 9,600. Of the 7,300 job cuts planned for 2012, 2,200 will be in R&D departments, 1,350 in manufacturing and 3,750 in sales. AstraZeneca is changing the way it will do research and development with these changes. It will close the neuroscience research laboratories in Sodertalje, Sweden and in Montreal. It will have in its place "virtual" neuroscience units, small groups of 40-50 researchers working with academic groups and scientists outside to utilize the best science in the field. This is one of the most radical changes in R&D practices among pharmaceutical companies. In marketing the approach has shifted from having full time sales people call doctors offices to using online marketing tools and telemarketers. This approach is also being adopted for emerging markets....

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Treatment costs with Praluent for cholesterol control are extremely high at $14,600 a year.

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This review of Acemoglu and Robinson in the MIT News is relevant to the situation faced today. The two professors at MIT and University of Chicago, have provided two books relevant to today's crises, the first "When Nations Fail" in 2012 about the need for inclusive nations, and the second "The Narrow Corridor" about the importance of the role of individual and society in sustaining democracy. Their point in the first book "When Nations Fail" in 2012 coming after the financial crisis caused by banking excesses stated that the nations fail when they are not inclusive.  In practice it is about " the system being rigged" to favor some groups as the Republican party and Mr. Trump say has happened. The banks and lobbyists, pharmaceutical industry and lobbyists, tech industry and lobbyists, leading to a system where individual and society are pushed into a corner. Social theorist and economists fail to look at things in practice such as profit seeking behaviours and unethical behaviour that goes unchecked, which continued after the financial crisis into the election of 2016, with charges of rigged systems.  This week Germany's DW.com oped pages covered New York with the statement that treatment in New York costs $15,000 for coronavirus infection illness yet many New York residents in the worst affected neighborhoods would find a $500 expense difficult to bear. Early closing of schools to control infection rate was resisted by Mayor De Blasio of New York because many parents depended on schools for lunches for their kids. The situation had been allowed to deteriorate to that level.  In their second book the MIT authors are saying that the role of the individual and society are important to check that of the state (for example if it is perceived as being rigged by the influence of lobbying of legislators and politicians as the Republican party and Mr. Trump have maintained). It is only when it is checked and there is some tension is there the possibility of democracy and democratic processes, say the two MIT authors. In the absence of this the states and elites of politicians and business interests supporting the leaders and their common behaviours, become a perpetual state, in effect a one party rule of two parties with similar behaviours and interests in the state. A situation that allowed the outshoring of American manufacturing and European manufacturing to China including critical infrastructure, essential infrastructure over 2 decades even over the protests of Mr. Lighthizer since 2010. As the twin crises evolved in Europe of austerity policies after banking excesses in Europe, and the migration crisis of migrants coming from North Africa and the wars in the Middle East, a similar situation began to develop in Europe as the political elites entrenched in Germany, France, and Spain faced new voices. The tensions that arose were constructive bringing in the role of society and individual that the MIT authors say are so necessary for the narrow corridor of democratic process to function. New parties emerged in France with Macron's La Republique En Marche, Podemos and Ciudadanos in Spain, and in Germany with the SPD and CDU shrinking till the revival of Merkel for her handling of the pandemic. Coming from an intuitive way born from experience in East Germany, Germany's recent president Joachim Gauck, civil rights activist  came up with the same ideas. He is a Lutheran pastor in former East Germany who struggled against the government of the German Democratic Republic (former communist East Germany) for a role for individual and society against the state. We profiled and quoted him in "The Way Forward"  column in Lyrarc.com. Gauck's point was that  having diverse groups in the conversation is important, not excluding others from outside in the conversation is important. Gauck called  debate "the oxygen of democracy,"  that needed to be maintained.  Genuine democratic process is hard to sustain, it happens only when the role of individual and society is given prominence, so that only a narrow corridor exists for democracy, a narrow space in which can be sustained only if the effort is there, the goodwill is there, and the grace of Divine Providence.  It is fragile and it is critical to sustain.   In this sense the sometimes heated debate in the U.S. and Europe, Asia and Latin America about words such as- austerity, community, solidarity, migration, New York Mayor De Blasio's choice between school lunches and infections, about infrastructure, pharmaceutical prices, infrastructure, outshoring, jobs sent overseas, manufacturing locally, made in USA or made in India or made in France, Atmannirbhar Bharat, misallocation of capital starving health and public services, are all relevant and essential for democracy. This includes the discussion to avoid use of the military in protests in American cities in the middle of a pandemic which just crossed the 2 million mark in cases in the U.S., that was taken up by Defense Secretary Esper. In it lies the hope for democracy and many voices. Der Spiegel recent look at the pandemic how it happened in China, closes with the line- you need more than one voice in society. A constant reminder that many voices be heard, counseling patience, but also that wise choices be made with divine providence.           ...

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While communities with high unemployment and depressed areas like Rocky Mount in N. Carolina, with 14% unemployment -and many customers skipping prescriptions because they can't afford them- are the worst off, the national picture shows many similiarities. Even with Medicare drug benefit, lowcost generics, and Walmart type low cost drugs, many Americans cannot afford prescription medications for life threatening illnesses. Nationally a third of respondents say they are not complying with prescriptions as they cannot afford them, compared to a fourth three years ago.

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Drug companies spent $168 million on lobbying in 2007, up 32% from 2006, according to the Center for Public Integrity. The biggest spender is the Pharmaceutical Research and Manufacturer's Association of America which paid $23 million, a 26% rise from ayear earlier. Amgen was first among drug firms at $16.2 million, Pfizer at $13.8 million, Roche at $9 million, Sanofi-Aventis at $8.4 million, GlaxoSmithKline at $8.2 million, and Johnson & Johnson at $7.7 million. In 2006 Democrats received 31% of the industry lobbying funds, now with Democrats controlling Congress the shift is to more money given to Democrats.

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The NYT Editorial Board on efforts in the U.S. Senate by lobbying groups to have the 2.3% tax on medical devices- to pay for medical coverage of the uninsured in the Obama health Care law- repealed.

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Two of Amgen's drugs that treat anemia in cancer and kidney-failure patients have questions raised about their safety and marketing. The two anemia drugs Epogen and Aranesp generate about half of Amgen's sales. THey now have ablack box warning placed on them by FDA requirements.

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A study by AARP of 514 brand name and generic drugs between 2005 and 2009, shows that generic drug prices went down an average of 31% during this period, and brand name drug prices went up by 41%. One of the authors of the report says that it is important to look at individual drug prices and not studies showing total spending on drugs, because this is a significant cost for people paying out-of-pocket, It drives up insurance premiums, and pushes retirees into coverage gaps in Medicare Part D drug program. Analysts indicate pharmaceutical companies are increasing prices on drugs before patent expiration to get as much profit before the patents expire.

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A report by pharmacy benefits managing company Express Scripts shows a 13% increase in the price of branded drugs in the U.S. from Sept 2011 to Sept 2012. Generic drug prices declined by 22% in this period. The report also shows that growing spending on specialty drugs for cancer, MS and other diseases is a big reason for the increase in prices of branded drugs. This report is from a random sample of six millon Express Scripts members using prescription drug coverage. Prof. Schondelmeyer of the University of Minnesota, who manages the drug benefits program at the university and conducts a similiar price report for AARP, says the potential benefits for these specialty drugs are not that good to justify the high prices.

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Lobbying by the American pharmaceutical industry and the Obama administration. Emails showing the negotiations between the administration and the pharmaceutical companies.

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Are high prices for pharmaceutical products and healthcare services putting a severe burden on U.S. finances and defunding education, infrastructure, R&D in new technologies, which provide the underpinnings for future U.S. competitiveness? Yes say experts. In 2009 Americans per person cost of healthcare was $7,960. By comparison Canada was $4,808, Germany $4,218, and France $3,978. And without necessary efforts for educating people about caring for health and preventive care, the health conditions of Americans are no better than these countries, and poorer in some dimensions. Klein says deficits would not be a problem for the U.S. if prices for pharmaceutical products and healthcare services in the U.S. were similiar to that of the largest developing countries. Experts say the Obama healthcare law simply postponed the addressing of this problem.

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Abbott Laboratories agreement to pay $1.6 billion in civil and criminal fines for promoting unapproved off label uses of the neurologic drug Depakote, to sedate older patients in nursing homes. The acting associate attorney general, Tony West, said: "Not only did Abbott engage in off-label promotion, it targeted elderly dementia patients and down played the risks apparent from its own clinical studies." Abbott aggressively promoted its use in nursing homes. It also aggressively promoted the use of the drug for schizophrenia between 2001 and 2006. In 1999 Abbott had to discontinue a clinical trial testing Depakote's effectiveness against dementia after results showed increased incidence of anorexia, drowsiness and dehydration.

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According to the General Accountability Office inquiry, 28 drug products had price increases over 100% in 2000, in 2008 71 drug products had such large increases. Medicines like Adderall for attention deficit disorder, Inderal for chest pain, Sumycin for infections were in the list of 416 brand name drug products where makers or distributors raised prices at least once by 100% or more for period 2000-2008. As large pharmaceutical companies sold their marginally profitable drug products or small selling products to smaller companies, these smaller companies would immediately increase prices to recover the money they paid to the large pharmaceutical companies. 26 of the brand name products saw prices raised 10 fold. A third of the drugs with large price increases treat depression and disorders of the central nervous system.

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The FDA sets a pathway for developing "biosimilar" drugs in the U.S. Biosimilar drugs are cheaper versions of higher cost biotech drugs. Europe has moved further ahead in this area.

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White House visitors database shows lobbyists have frequent access to the White House. On one January day, Jan. 17, 2012, lobbyists came with the CEO's of their companies to 1600 Pennsylvania Avenue at 9 am for roundtable with President Obama. The CEO's are on the president's Jobs Concil. At 1 pm representatives from the meat industry arrive. And at 4 pm a lobbyist from Goldman Sachs comes for a meeting with Alan Krueger, chairman of the Council of Economic Advisors. Its a fairly routine day.