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Susan Jaccoby brings up a major issue facing healthcare in America from personal experience. A third of the Medicare budget, she says, goes to the last year of life, and a third of this goes to the care in the last month. At the same time public opinion polls show Americans see the problem being too much medical intervention rather than too little. Especially when there is no hope except to prolong life for the patient with an highly deteriorated qulaity of life for a few months or a year, doing no service to the patient or future generations who may see their basic services cut when they most need it as a result of the unaffordable spiralling cost of Medicare. A Pew Research Center poll in 2006, shows 22 percent say a doctor should not always make efforts to save a sick person's life, and 70 percent believe that patients should be allowed to die in some situations, when it only prolongs life for a few months for instance and patients live in pain. The problem only gets worse in future years as an estimated 8.5 million Americans are expected to be over 85 years in 2030 with these same choices facing patients, their families, Medicare and the country....

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Quiet quitting has become a phrase that means workers are working hard and doing things the way they did before, except that they are not letting a work culture that may have gone astray because of bosses  who set the wrong rules guide their lives. Even as companies such as Stellantis are taking on a new culture because of a new respect for workers work-life balance and getting a lot more from them, other companies are following older set patterns that did not include work-life balance or rejected work-life balance outright without saying this openly. Stellantis, Europe's largest car company itself shows why this is dependent on who is the CEO and what he believes in. The previous CEO had poor health habits including frequent smoking and irregular long hours without a structure of any sort that led to this being carried over into the work culture. The CEO changes and new rules are set and soon it permeates who is hired at different levels that are consistent with his habits and sense of work life balance. A new culture develops over time and gradually you have new work ethic that respects the mental health and fitness of workers and of managers, and that of the CEO. This report in WSJ starts with the premise that workers should'nt feel bad because worker are "quiet quitting" anyway after the pandemic. But in reality the statement is a bad one, as it does not say there are better models out there few as they are, that need to take pre-eminent place after the pandemic rejecting the old ones that recklessly ignored health and mental health and were less motivating for workers, and leading to less productive culture in the workplace. At Stellantis a lot gets done in regular hours so that the time after 5 or 6 pm is devoted to workers getting into exercize taking a bike ride, doing things that revitalize and build a healthy body and mind so essential for productive and good thinking type concentration in work. Emails over weekends need not be replied till Monday, and bringing up work during the weekend is discouraged. And still a lot gets done, the company will take the leading role in EV vehicles in Europe and has aggressive plans for 2030 for new EV models. See the link to Stellantis to see how this new CEO runs a company of about 100,000 employees around the world. His name is Carlos Tavares and he took charge of Fiat, Peugeot, Chrysler combined operations called Stellantis in January 2021. This is important as it is the new trend that will take hold of the work culture after the pandemic only if workers and managers ask that it be so and as the word spreads that better more productive companies that can get a lot more done is the result of such an educated workplace that respects health and mental health, and the dignity of workers and families. Look, how can it not be so when the word still has to be spread on climate change in the business world? How can one take place without the other? There is a new sense of dignity in respecting the dignity of the environment, of water, soil, and air, how not so for the mind, the body and its connection to nature around it? And no better place than Stellantis and its CEO Carlos Tavares where the old CEO ran himself down with poor work and health habits and passed away while at work in 2018, to show a new way.  In Germany this new way of work-life balance based work culture is called by a more respectful term "Feierabend" than "quiet quitting" showing that what is wrong is with the work culture and bosses who do not grasp the importance of health, mental health, and what it means to be revitalized for truly productive and thoughtful work. Quiet quitting has that sense of workers having to feel a bit of guilt about this and still thinking it is right  doing it anyway. In Germany"feierabend" is popular and accepted, it means breaking away from work at normal times such as 5 pm or 6 pm when a workday ends so that one can go out and relax with a bike ride  or something that is good for health and fitness and rejuvenates. No email, no nothing so the mind can rest and revitalize. ...

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Garlic, ginger, turmeric and similar products are vital for healthy living and healthy food. So it is surprising that so little has been done before the Trump tariffs on Chinese food dumped in the U.S. This BBC report by Pamela Parker says 1994 was when the U.S. confirmed dumping by China of garlic yet the tariff that was placed was of an ineffective type that could be circumvented. As a result the U.S. producers such as Vessey in California that produced garlic for 100 years and 5 generations decided to not produce it beside cauliflower and cabbage. Of the surviving producers one producer today in California produces 100 million pounds of this product that has value way beyond the actual dollars as vital for healthy food supplies in the U.S. In fact after reports of contaminated water supplies in China imports of ginger and other such food products have been shifted away from China.  It is well known that the industrial revolution in China came too quickly and at a large cost to the environment after 1990 including contamination of the water, rivers. For this reason it is stunning that the people setting trade policy in Washington could have ignored the vital need of U.S. meeting food needs for healthy living out of its own soil and trusted farming community. To not have done so and let producers of garlic or ginger or other such vital food products to sustain health to go out of business is nothing less than a part of the growing calamity of self inflicted wounds that have happened so far. At no time more compelling an issue as today in the pandemic. The truth is that when it comes to healthy food supplies it is vitally important, as important as national security. And local supplies grown in one's own state or country particularly for vegetables, herbs, and fruit, are very critical. There is no way to even compare product grown locally to product grown in any country where water supplies may be contaminated by rapid industrial growth. ...

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2.9 million Americans live in vans for most of the year down 6% in 2023, according to one estimate. It is'nt easy as it means finding places to park for the night and doing this day for long periods. Many as shown in this report are young people, some leave their state for travel, some are photographers, some have decided to explore the world outside after being stuck in one place. Others are people who have difficulty finding housing with costs beyond their reach as this engineer in Brooklyn, NY. 

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The lockdowns and remote work have led to men spending more time taking care of children at home. The stereotype of the hapless dad as a second grade caregiver is now out of date. Dads have learned a lot during the pandemic.

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On one hand Chinese environmental officials are aware of the pollution problems in Beijing and Shanghai and other cities. Levels of nitrogen dioxide in Beijing exceed the WHO clean air guidelines by 78%. On the other hand the newly emerging middle class is seeking car ownership, and the local government officials need growth in the car industry to show good GNP and GDP growth numbers on which their performance is judged. Beijing and Shanghai and Anhui province local governments are part owners of some auto companies. About 416,000 people are employed in the Shanghai area auto industry alone and the auto industry in Shanghai pays about 900 millon dollars in taxes, according to government figures. At seven cars per 1000 population car sales are just beginning to take off. And with China's population its clearly not going to be possible to have the same level of ownership as in the US. The same is true for India. This would increase by many times the current demand for crude oil and increase emissions to the point of creating a disaster. And even today because of lax enforcement, and older models on the road, about 40% of vehicles in Beijing have no pollution controls and the other 60% have varying degrees of pollution controls. Experts say changes to the subsidized oil price policy, refineries that produce cleaner gasoline, policies to build more mass transit which has lagged behind in China as car sales took off (and probably more GNP impact from car plants than mass transit which act as inducement for local officials), and stricter fuel efficiency and auto emissions standards are needed....

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It is important to know the cause of 0.3% contraction in first quarter 2025 for US economy. It is says WSJ because of a 5% hit from net exports, the difference between exports and imports, as importers rushed to import more before a tariff deadline. Imports by the US increased by 42% in first quarter 2025. Some include MIchigan Governor Whitmer who supports the tariffs as a way to take back America's industrial base, build factories in the US, say the uncertainty of the way tariffs were implemented is damaging confidence in the economy. For instance could the US have excluded the EU, Japan, UK, India as allies, and focused on China.  The problem with that approach is that it would single out China. It means other nations Japan, South Korea, Germany are not investing in the US, also have used trade for unfair advantage, are not called out. This would put China in an odd position. It is better to call out all who benefited from unfair advantage including China, Germany, Japan South Korea, Taiwan, because this has more credibility, giving all a honest and fair picture that they could then look at themselves in the mirror and correct. In the short run it looks messy, the tariff methods look erratic and back and forth increasing tariffs is also messy and unruy. Yet when every major trading nation knows deep inside that US is only saying it like it is asking only for fairness in trade, it will lead it to negotiate a fair trade agreement with US. ...

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See the link about an aging USA airline fleet and fewer orders to Boeing and Airbus from US airlines. Well here are some of the remarks and comments from employees who interact with customers every day and know their unhappiness and their trouble on planes in direct telling it like it is manner. At US Airways Doug Parker the CEO wants to hear what employees have to say and here is some of it.

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As president Jinping begins a second five year term his focus is on the small communities like Chashan, only a 6 hour drive from Beijing, that were neglected in the rush to industrialization. He has vowed to get rid of poverty in China by 2020. About 43 million people live in rural communities that have mostly older people and live on 95 cents a day. There is another challenge say experts which is the much larger popuation that lives in rural and urban areas- including urban migrants without property and residence rights- who live on less than $5.50 per day, $165 a month, according to the World Bank. This is about 1070 yuan per month, or in Indian rupees for a comparison with India- which was at a similar stage of development in 1990- of Rs 10,000 per month. About 40% of China's population or 560 million people are in this group. With a rapidly aging society as a result of the earlier one child policy, China faces the risk of not advancing from the level of a middle income country, in the way that South Korea and Japan have moved to levels similar to Western Europe and the U.S. As China's growth level slows and with an aging society this remains a major challenge. As this report shows there is great pressure on local officials to eliminate the poverty level of people living below $30 or about 200 yuan a month, as targets are set at local levels and corruption weakens the effort. There is concern at the lack of an effort to improve the living conditions of the 200 million rural migrants living in cities, who under China's "hukou" system are not considered residents and are not getting education and health benefits. ...

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Boris Johnson was never for austerity and says this in his new book, yet he failed to make the major investments in the British economy in the way Biden has done in the US, and in some ways has left Labor's Starmer with difficult decisions with the strained budget finances of Britain. Of the investments he protected from John Osborne and his austerity plans as chancellor under Cameron Boris Johnson says- “Those big investments – Crossrail, the Olympic site, the Westfield Centre at Shepherd’s Bush – were fortuitously timed for London: vast counter-cyclical programmes that kept the spades going into the ground and people in work.” This was as Mayor of London in 2016. Of Osborne and Cameron so little is left, and so little came out of the period of austerity other than the failed investments Britain failed to make, simply a lost decade for Britain. And the diversion of Brexit under Johnson not taking Britain to a good place for the standard of living of the British people. Of the intraparty conflicts in the Tories he says Sunak's resignation as chancellor should never have happened calling it "worse than a crime," and a mistake for Sunak, the party, and the country. Johnson says that many days as PM he would come back to No.10 flat, exhausted and working into the evening when he should have been talking to colleagues, MP's to keep them all together. After Sunak's resignation from Boris Johnson's cabinet the Tory Conservatives split further apart, this time in the Boris Johnson faction of the party. Sunak's elevation to prime minister was short lived ending up with the Tories going downhill from there.  On the singular goal that led to the splits- that of Brexit- Johnson has little more to say than that in his travels he had found people wanted more Britain. ...

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This WSJ report on critical analysis of coronavirus data has a very useful chart of Estimated Range of Symptomatic Cases Reported by Country. Complete coronavirus data for all symptomatic persons who have the coronavirus infection is lacking in most countries. Many people in large populations have symptoms and are positive but are not reflected in the official data collection. This is a big problem as the total number of cases are understated by a magnitude of twice to five times the numbers reported in official tally.   South Korea has done a good job of getting more of the symptomatic people with the infection in its data, as about 53% to 90% of such persons are reflected in official data. Next comes Germany at a range of 38% to 55%.  China comes third and has about 28% to about 38% of such persons reflected in its data, the U.S. currently on April 4 at about 14% to 19%, according to this chart in the WSJ. The source for this is Mathematical Modeling Center at the London School of Hygiene and Tropical Medicine. What this means is that the US. number of cases at 278,000  reported infected people with symptoms (April 4) is only 14% to 19% of the true number. Another way to say this is that the actual infected persons with symptoms is about 5 times what is reported, or over 1 million not the 278,000 reported.  As happens for China data collection agencies may never get the true number. To be comparable to the Chinese numbers, as the U.S. is a large country, the figure closer to the true numbers would be twice the 278,000 reported or over half a million symptomatic infections of coronavirus in the U.S. Why is this data important. With widespread testing as in South Korea one gets data that tells one how many people are infected (the size of the problem) and therefore the resources needed and the point of greatest impact. Also it tells one the typical transmission rate per person, and it helps hospitals in each area know what to expect and what resources are needed to prepare- not find people suddenly turn up in the E.R. in unpredictable numbers. The lack of widespread testing and better reporting in the data to get a grip on the pandemic is shown in this chart for countries hardest hit, less than 5-6% for Italy and Spain. The UK and France at 5-8%.   ...

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Zweig gives the example of Palm Pilot IPO shares in March 2000, which the parent company 3Com priced at more than 1,350 times net earnings for the Palm shares. He cites George Akerlof, who writes about identity economics, and points to the fact that users of a product can be so fanatically devoted to it so as to drive up the price for an extended period of time. In the case of Palm Pilot its users were fanatically devoted to the product. This appears to be true for Facebook with users who see their identity enhanced as they put up pictures of themselves and share with friends. Over time users may realize that it is their private information that Facebook is using to generate revenue. It also sets up the shares for a sharper reversal over time.

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France joins Britain in requiring masks in indoor space. The number of new cases in France are now dropped down to a few hundred each day compared to several thousand before. This month in July the reproduction rate passed 1 suggesting need for caution as social distancing rules, avoiding French custom of kiss in greeting, and mask wearing are now being less strictly observed. Anyone not wearing a mask after August 1 would be fined $125 or 100 euros.

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Finance professors and experts on internet IPO's, Ritter at the University of Florida and Aggarwal, are skeptical that average investors would make money on the Facebook IPO. Ritter's information base shows that from 1980 to 2009, the average IPO's would jump 18% on the first day and 21% in the next three years, showing that hype and marketing with restricted supply of shares relative to demand created can artificially increase the price on the first day. As average investors get to invest after the opening day and on less favorable terms than the insiders and bankers doing the IPO, its not such a good deal for the average investor. Google performed well for the average investor, but this could be the exception rather than the rule. Google operates in a space, namely "search" engine, that is an essential part of the functioning of the internet space, which accounts for its continued growth. This may not be true for game firms such as Zynga, group discount sites such as Groupon, and social network sites such as Facebook, because their growth could stall suddenly. As Jason Zweig points out in the Journal, another factor is the starting price. At a high enough starting price the risk for investors could be high and returns may be no higher than the average 6-7% range....

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FDIC program for loan modification at IndyMac Bank. About 3500 loans were modified, and 15,000 borrowers contacted in recent weeks with offers for lower affordable monthly payments. FDIC's innovation is to create a comprehensive program with clear guidelines so that a lot of loans can be modified without doing it on a case by case basis which would take too long. Loans are modified by reducing interest rates and the principal amount so that the payments are affordable each month, and the FDIC has come up with 38 to 40% of the previous monthly payment as about the right amount. It also looks at tax information to verify earnings. There have been complaints about the responsiveness of FDIC Indymac call centers which may have inadvertently turned down some homeowners looking for help. A big problem is that the FDIC can do little for loans sold to other investors so that out of 653,000 loans serviced by Indymac Bank only about 47,000 are eligible for FDIC modification program. ...

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In 2023 there are 4.3 million electric vehicles on American roads and 150,000 public charging ports. President Biden's goal is for 50% of cars to be EV's by 2030 with 500,000 public charging ports. The National Renewable Energy Laboratory affiliated with DOE forecasts need for 1 million charging ports. Ohio and Pennsylvania are leading the way in a slow start with other states joining in. A single public charging port can cost about $150,000. It will cost $31 billion to $55 billion to build the public portion of a national charging network. About $24 billion is planned investment.

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Hangzhou, hard hit by closing export focussed factories, is trying a$100 million voucher program to increase spending. Since January, a fifth of the residents of this city have received $30 vouchers, and more vouchers are being issued. Taiwan just tried a voucher program with $102 going to each Taiwanese citizen. Taiwanese President Ma says 50,000 retailing jobs were saved and about two-thirds of one percent addded to GDP. The problem in China is the lack of a safety net and poor access to health care, that is making average Chinese to save over one fourth of incomes. Consumer spending is 35% of GDP. The government has focussed on exports, and used export generated revenues for huge infrastructure spending. With exports down by over 25% in January, the export model is fading away quickly. Japan and Taiwan have seen much higher drops in exports, and China should see even more deceleration in exports, with a lag of some months, as a lot of products made in China use parts made in countries like Japan and Taiwan. The China Development Research Foundation says one fourth of the population have no health insurance at all. Though by some estimates this number may be about two thirds of China's 1.3 billion people. Hundreds of millions of people have huge bills for treatment of serious illness that are not covered by even the most basic insurance. Public pensions cover less than one third of the workers. And an estimated 130 million migrant workers have no unemployment insurance. Even payments to the poor reach only a fraction of people eligible. The government has only tentatively moved to correct his. And outside economists say that something needs to be done in abig way to build this safety net. The government has announced a $123 billion 3 year initiative to deliver basic, universal health care and health insurance. This follows a 3 year drive to provide compulsory and free education to students through 9th grade. David Dollar, the World Banks's country director, described ameeting with Finance Ministry officials, and wrote in areport on the Bank website that the government had the resources to expand these programs quickly. Instead the government has taken a piecemeal approach when action on a large scale is needed. One of the problems may also be that to make universal health insurance, the current health system may need to be examined and rebuilt, so that economical cost effective treatments are encouraged and costs are managed effectively. This would make universal health care affordable by keeping costs manageable, in the same way that the Obama administration is trying to do in the USA. ...

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Schools, shops, restaurants, cafes and offices are reopening and people are getting back to work and outdoors. What are the ways to reduce chances of getting the coronavirus and what is the latest advice from public health experts.  More attention is now being given by CDC and other experts to the aerosols, the smaller particles that are airborne that can spread the virus to people unawares in breathing, talking and singing activities. larger droplets come down to the ground, smaller droplets can be airborne for hours. This makes masks wearing very important, call it essential protection. Air filtration and proper ventilation is also important. What about social distancing? Experts now say 6 feet is good, 10 feet is better. This is from Joseph Allen director of the Healthy Buildings program at Harvard School of Public Health. No magic number but 6-10 feet or more is good for safety. Can one start expanding one's social circle? The fewer contacts the better says Dr. Allen. You can he says expand the circle but this depends a lot on how serious the other family is in taking precautions. Are elevators risky? If one can one should take stairs but do not board a crowded elevator unless the lobby is more crowded. Do not touch buttons, if you do use elbow or use sanitizer from your shirt pocket after pressing. This is where mask is essential. Here a tip is useful. Talking does not help as talking emits 10 times the particles than when you are quiet and this is true for small spaces such as elevators. Continual talk is not a good idea such as a long time spent talking, here watch that habit of getting into long conversations face to face.  Is it good to take a summer vacation. Here the answer is yes, as no one really knows how the winter will be. And remember outdoors is good for renewal of health, and one can look for places that are not crowded where the 10-12 feet or more can be easily done. One tip here is to take your own food and supplies from home so there is no need to go to crowded restaurants. Swimming in a lake or ocean is fine. Camping outdoors is fine and actually a good idea if you are with your own family. Try to use an empty restroom and one that is clean and wear the mask. While camping keep the 6-10 foot rule with people outside your immediate family, do not share food and drinks and try not to touch each other's supplies, and sanitize your hands or wash if you do. When hiking keep the mask in your pocket so you can wear it when you see others passing on trails. In hotels skip the cleaning service, in a rented property ask the owner to keep the windows open before you arrive, and put a day or two between your coming and the last person who rented the place. Renting a car is tricky allow a couple of hours to elapse between you and the last rental, open windows. Public restrooms. Always wear a mask many are poorly ventilated. Open the door without use of hands if possible,or use a paper towel to open and discard. Do not use air dryers. Is it safe for your house cleaning person to return. Keep the windows open to let in fresh air. Make sure your cleaner wears gloves. And all should wear masks. How to visit grandparents? Experts advise keeping visits outside and wearing masks when not 6-10 feet apart. Anyone not feeling healthy should avoid the visit. And bathrooms should be sanitized after people leave even wait a day if there is another bathroom. Experts advise against sharing food and buffet type meals. Ten feet distance is better than six feet. Can one use a gym? Here the advice is to exercize outdoors or at home if one can. It says be cautious unless your gym is limiting the number of people or spacing the equipment adequately. Ask about open windows, air filtration systems, ventilation.  This is excellent advice from experts with the latest information. Over the last few months from March to May most of the information was during lockdown, and a lot can be forgotten or seen as not necessary as things return to normal, as shops schools and cafes, office reopen, and cases remain steady and under control. Being vigilant is good for safely navigating this period through the summer and into winter till a vaccine is found. It is also about being a good civic minded person aware of one's own responsibilities, as when all take safety seriously and practice it everyday, it builds another layer of protection for everybody- because it creates a safer environment for all.     ...

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Requests, consensus, and social pressure played a bigger role than just strict rules and penalties in controlling the virus in Japan. By contrast in Germany states imposed strict rules and fines, some consensus, a better equipped hospital system, added contact tracing, to limit the spread. More than 100 industries in Japan have drawn up new guidelines for reopening to minimize risks. Prime minister Abe said recently " Now we are going to venture into a new arena. Therefore we need to create a new lifestyle from now on. We need to change our way of thinking." The new social consensus on the best way to behave outdoors and at work is the way Japan is tackling reopening.  The effort is focused on avoiding high risk situations the 3 C's crowded, closed spaces, and close contact, close conversations. Japan started with a fumbled response but gradually the right spirit and social distancing caught on. The universal health care system helped Japan detect cases early, even in the remote rural areas. ...

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Krauthammer says there is reason for optimism that the super committee of the August 2 Debt Ceiling and Deficit bill can achieve major results. The reason he says is that much of the work in key areas has already been worked out by the Simpson-Bowles Commission. This has also received extensive public scrutiny and discussion. Its now upto the committe to make some choices for tax reform. For the sake of efficiency and fairness this needs to be done. Efficiency is gained by closing the loopholes and the tax exemptions for mortgage interest deductions, health-care exclusion, and subsidies such as the one for ethanol. And in its place moving to lower tax rates, the 23% envisaged by Simpson-Bowles, or the 28% from the Reagan days, down from the 35% today. Fairness is gained by removing tax breaks for special interest groups that do much of the lobbying. The mortgage interest deduction can be phased out starting at $500,000 in the inital phase or using the plan for tax expenditures proposed by Martin Feldstein. Feldstein's proposal outlined in the New York Times on May 4, 2011, (see group for Feldstein) was to limit the reduction in taxes from deductions and exclusions to 2% of the person's AGI or adjusted gross income. The other part of the Committee's focus would be the structural changes to Social Security and Medicare- raising the Social Security and Medicare ages and changing the inflation formula, and means testing Social Security. Obama has already considered the raising of the age for Social Security and changing the cost of living formula....

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The Republican tax law of 2018 is unpopular, according to a new NBC/WSJ poll in April 2018. Only 27% of people in the poll view the tax law favorably, 36% view the tax law unfavorably. About one third or 32% say they have no opinion, possibly because they have no clear idea of how it will impact them or the country. On trade and other economic issues the Republican Party is viewed more favorably, including for its tougher stance to give the U.S. a level playing field. Even though the Republicans are not viewed so favorably on taxes, the poll findings show the Democrats are not seen as better on taxes and economic issues. The poll also shows the Democratic Party better able by large margins to handle issues such as gun violence, sexual harrassment and health care. This shows that under an aging Democratic leadership of Pelosi, Hoyer and Schumer, and the failure of Hillary Clinton, the younger Democrats with a more Progressive tendency are having to make their own case with people not clear how the Democrats can offer a better alternative. ...

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On the Matterhorn mountain at night the messages "Stay at Home,"  "Hope," and the Swiss flag are beamed on snowy slopes, as Switzerland enters the 11th day of quarantine. It is about working hard at following simple rules and staying at home, an appeal to Swiss people who believe in working hard and being sensible.

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This report in DW.com show the level shopping spree has reached in China. A 24 hour Singles Day on November 11 is a day for online shopping spree in China. It was started in 2009 and reached about $18 billion in 2016. About half of China's population has mobile phones and 90% of sales are on mobile.

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Novartis is taking a new approach to drug research and drug discovery. The old one which was popular in the drug industry was to go directly for blockbuster drugs for large numbers of users, with a long time in the research pipeline because the area of research was largely an unknown. This was costly and becoming less and less productive. Dan Vasella who heads Novartis, is taking a different approach which comes from his understanding of medical science as a physician, in an industry run by accountants, lawyers and business people. This is to go after wellknown molecular pathways identified by Dr Fishman at Harvard in his research, and do this by taking on problems in diseases that afflict small numbers of people. These drugs have some established medical science to work with, and the research work takes a shorter period. Once the drug proves its effectiveness in one illness, it is tested for other illnesses that afflict a large number of people but which shares some of the same underlying phenomena that cause the disease in the two situations. Dr Vasella stumbled on this approach after the development of the drug Gleevec by Novartis. Gleevec was originally approved for a rare blood cancer, but has now shown to be effective against six other dieases. Gleevec brought 3.7 billion in revenues in 2008 for Novartis. In 2002 Vasella made a bold move to discard the old drug development model. The basis of this approach was to go after new drugs that were desperately needed and where the genetics of the illness were well understood. Whereas pursuing rare dieases is considered foolhardy by most drug company leaders, Vasella's idea is to use the common genetic underlying arrangements for that drug to go after other diseases that would be good prospects for the now proven drug. The known genetics makes it possible to complete the research in a shorter time. In 2009 Novartis has 93 drug candidates in the pipeline, 40% more than 3 years ago and 80% of Novartis' drugs last year made it from early testing to late stage development. This was a 60% improvement over 2005. The new approach fits the current regulatory climate, with regulators concerned more about safety, and Medicare and Medicaid and other payor less willing to pay for treatment with modest benefits or with uncertain outcomes. The approach had to be executed in terms of organization and staffing. Vasella moved the R&D global research operation from Basel to Cambridge, Massachusetts, and spent $4 billion on the move. He recruited a renowed researcher and cardiologist at Harvard University, Dr Mark Fishman, who had done research on the genetic mutations in the cardiovascular systems, to run the center and set the new direction for global research. Fishman convinced Vasella that medical research should focus on a small number of molecular pathways- the complex suquences of interactions among chemicals, proteins, and larger cell structures in the body that are behind all illnesses. Says Fishman, there are 24,000 genes in the genome, but only a few dozen pathways conserved through evolution. Fishman's theory is that you find all the links in a pathway and then locate the signals that can turn the genes on or off to develop medicines for illnesses. Bercause disease after disease share a common pathway, the knowledge gathered can then be applied across that region with more accuracy and directly, to address a range of illnesses. Fishman's approach means marketing and sales no longer make the decisions. There is a new method for doing things. Fishman focusses on clinical data and insists that commercial analysis comes after sufficient clinical data. A major restructuring in 2007 led to shedding 1260 sales and marketing jobs, as clinical science now takes precedence and medically trained scientists take senior leadership positions. The new approach is being used for a drug developed for Muckle-Wells syndrome. Computer simulations are shortening the time to late stage trials. The drug has applications for Type 2 diabetes and severe arthritis. The whole process will take many years, as its a sea change for the industry and for Novartis, a fresh approach when the approach used by the pharmaceutical industry for so long is failing. An oral drug treatment for multiple sclerosis is being developed along these lines. Afinitor. approved by the FDA for kidney cancer in March shows potential in six other diseases, including lymphoma where Afintor shrank tumors by 50% in one third of the patients in a trial. ...

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A new West Coast Model is emerging with ballot measures in the states of Washington, California and Oregon. The model is to make up for decades of faulty income distribution which favored tech communities in west coast states leaving behind people from minority communities and the working class outside tech hubs such as San Francisco, San Jose and Seattle. During this period budgets for education and healthcare, social services and essential infrastructure suffered as budgets were squeezed for local governments. Minimum wage also lagged behind and communities struggled to keep up. Washington votes for a ballot measure that raises the minimum wage to $13.25 statewide and mandate paid sick leave for workers. In California a ballot measure makes permanent an income tax surcharge on millionaires to use these funds for education. In Oregon measure 97 places a gross receipts tax on corporations with annual sales in Oregon over $25 million, raising $3 billion a year for schools, health care and other programs. The California and Washington measures are likely to pass, Oregon uncertain, say experts. And even in Oregon supporters have learned from the experience to put forward new proposals on the ballot. The Washington measure is supported by Nick Hanauer, and Zach Silk, president of Civic Ventures in Seattle, who say it is essential to put more money in workers wages to increase growth and to bring better lives outside the tech hub areas. Most of the tech booms of the last two decades have not touched the areas outside tech hub metropolitan areas. The conservative approach adopted in Louisiana and Kansas of reducing taxes first and then when holes in state budgets developed to cut education, health and other service expenditures has not worked, and it has led to the backlash in the form of the new West Coast Model, which is expected to be brought up in other states in the east and midwest. The tech hub areas have grown with the boom in tech but this has largely ignored the rural areas, communities just outside of the tech cities, and led to uneven and distorted growth shortchanging the working class and the middle class, and hurting investment in education and healthcare across each state. Bill Whalen, a research fellow at Stanford University's Hoover Institution conservative think tank ,says that its hard to deny that the balanced growth for all communities across the state has lagged far behind as the tech booms boosted growth in the economies of California, Oregon and Washington. An article in the German online site Zeit on Silicon Valley described this vividly showing how this can happen in communities sitting side by side in the San Jose area, with minority Hispanic communities and working class communties seeing very little of the benefits of growth. ...