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      The Great Fever Misconception

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      Yes or no? On or off? Zero or one? Binary is simple, and simple is good. It facilitates decision-making, especially in a crisis like a pandemic. After all, either you have COVID-19 or you don’t. If you have COVID, then you are infectious and should isolate to avoid spreading it. On the other hand, if you don’t have COVID, you can’t infect anyone else, no matter how closely you associate with them. Of course, the tricky part is determining whether or not someone has COVID.

      The PCR test is the gold standard for determining if a person has COVID-19. It’s a very good test that gives us the yes-or-no binary information that we value so much for making decisions. Unfortunately, the test is not always readily available and it’s also expensive. And timing is critical. If you take the test too soon after you are infected, the virus may not have yet traveled to your nose where the sample is taken, and thus the result may be a false negative — you have COVID but the test indicates you don’t. Also, it often takes time in a laboratory to process the results — will you isolate or carry on while you’re waiting?

      COVID Failure: A Matter of Principle

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      Finally, what would prompt you to get a COVID test? Perhaps some event prompts you or requires a test by policy, but otherwise, you might take a test because you feel sick. If so, you already know you may be infectious. In that case, a positive COVID test merely confirms what you already suspect, and you normally get that confirmation a couple of days too late to do any good. Despite our heavy reliance on testing, it’s not as simple or as timely as we would like for deciding when to isolate.

      We’ve had another way to separate the healthy from the sick during the COVID-19 pandemic: symptoms. For example, if you have a fever, then you may be infectious. But temperature-based screening has not been very effective at all, and a big reason why is that the US government has historically defined fever as 100.4°F (38°C) or above. If a person’s body temperature is 100.3°F, then according to the government, that person does not have a fever. Does that make sense?

      Unfortunately, one of the distinguishing characteristics of COVID is the tendency of many infected people to have mild or even unnoticeable symptoms, including only slightly elevated body temperature, below 100.4°F. So, the government’s definition of “fever,” although simple and binary, has only confused the situation. Some people who were asymptomatic with COVID-19 took their temperature, found it to be below 100.4°F and assumed they did not have a fever. So, they carried on with normal day-to-day activities, often infecting others. Temperature-based screening systems typically use the government’s 100.4°F fever threshold, and, as a result, failed to prevent entry by many infected persons. Relying on the government’s 100.4°F fever definition has contributed to the spread of COVID-19. Where did this government standard come from, how can it be improved, and why has the US resisted change?

      © Douglas Dyer

      Origins of 100.4°F

      In 1868, a German physician, psychiatrist and medical professor named Carl Reinhold August Wunderlich published a paper describing his assessment that normal body temperature is relatively constant, varies from 97.9°F to 99.3°F (36.6°C to 37.4°C), and averages 98.6°F (37°C). He found that patients with a disease often exhibited a symptom of fever that he found to average at or above 100.4°F. He based these findings on 1 million temperature measurements for 25,000 patients.

      For the time, this scientific result was quite remarkable, and it changed medicine forever because it gave physicians the newfound ability to objectively assess the presence and severity of many diseases. However, Wunderlich’s patients were mostly German rather than being from different cultures, his thermometer may have been less accurate than those we have today, and people are a little different now than they were then.

      These are reasons to suspect that Wunderlich’s ideas of normal body temperature and fever are somewhat different today than they were in the mid-1800s. But, to be fair, Wunderlich observed differences in temperature based on many variables when healthy, and he advised that temperature averages have many “shades of gray.” In particular, Wunderlich noted that even smaller rises in temperature are cause for concern, and that there is no definite temperature threshold over which a person transitions from health to sickness. He said that any “elevation of the axillary [under the arm] temperature above 99.5°F (37.5°C) or any depression below 97.2°F (36.5°C) is always very suspicious.” He added: “But even when every precaution has been taken in making the observations, it is impossible to draw a hard and fast line to indicate by temperature the exact limits of health and disease.”

      © Douglas Dyer

      Today, clinical research suggests that Wunderlich’s findings should be revisited, that the normal temperature range varies by the individual, and that there is no arbitrary fever threshold that works for everyone. Yet, the US government and some medical experts still regard 98.6°F as normal body temperature and 100.4°F or above as a fever. For COVID019, this is simple, easy and, for most people, wrong.

      Improving on 100.4°F as a Fever Threshold

      If you’re interested in seeing if 100.4°F is an appropriate fever threshold for you, try taking your temperature. Use a normal, digital, under-the-tongue thermometer for at least 60 seconds. Make sure you haven’t consumed anything for 15 minutes — a hot or cold drink or food will change your measurement. Keep your mouth closed during the reading. Assuming you are healthy, if your temperature is below 98.6°F, then it’s a good bet that your fever threshold is under 100.4°F.

      If you were to take your temperature every day, preferably in the morning when you first wake, you would see that your normal temperature varies in a range of one degree or so. For example, in the image below is the normal temperature data for a person we’ll call JRDA5.

      © Douglas Dyer

      From this graph, we can see that JRDA5’s normal body temperature varies from 96.6°F to 97.4°F when healthy, and you can expect your own normal temperature to vary also.

      In modern medicine, a fever is understood to be a temperature elevation above a person’s normal range. This definition of fever is more accurate than an arbitrary fever threshold like 100.4°F that is based on population averages and data from 150 years ago. A person’s normal temperature range depends on many factors such as age, sex, nutrition and level of activity, and so different people will have different fever thresholds.

      Almost always, a fever threshold defined as above your normal temperature range is below 100.4°F. Therefore, if we use this new definition, there is significant potential for identifying sick people using temperature-based screening. Relying on 100.4°F is insufficient for identifying mild, pre-symptomatic or asymptomatic cases of COVID-19.

      Why the Government Has Resisted Changing the Definition of “Fever”

      A pandemic is not the best time for complicated methods. Perhaps the US government chose to stick with 100.4°F for simplicity and consistency. But, in this pandemic, nothing has been simple. We’ve learned to take advantage of vaccines that need boosting, tests that need repeating and symptoms that keep changing. People can figure out their normal temperature range and their own personal fever threshold if that means effective screening. Having a fever or not is still binary, even if we define fever as above your normal range. It’s still pretty simple.

      Elevated temperature is not definitive proof you have COVID-19. We all like certainty, and the PCR test will remain the gold standard for COVID. But we don’t need certainty to make a decision to isolate. A fever should prompt isolation, even though it may not be caused by COVID. The next step is to get tested and then wait for the results. We can stop the pandemic if people isolate if they get a fever. Fever is the most timely indicator we may be infectious.

      Asymptomatic cases may not exhibit any elevated temperature, so we cannot depend on temperature screening anyway. It’s possible that there are some people infected with COVID-19 who do not have any fever, perhaps because their immune system doesn’t work at all. However, we know that many asymptomatic cases are accompanied by elevated body temperature lower than 100.4°F. We can catch those people using the more correct definition of fever. The perfect should not be the enemy of the good.

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      People hate change and the government is no different. It takes a lot to pass federal legislation and to modify federal regulations. But the government’s 100.4°F fever threshold isn’t working. The effort to change will help us control the pandemic.

      How Redefining “Fever” Helps

      Since the omicron variant of COVID-19 emerged, we’ve seen increased demand for testing, with many people standing in line for hours waiting to get a test. In the United States, the government has been ordering more tests to address the shortages. However, the demand for testing can evidently overrun our testing resources. By using a more accurate definition of “fever,” people will have a better idea of when they need to get tested. Today, about 75% of tests come back negative. We have clinical evidence that fever and other readily available health data can predict test results. By redefining “fever,” we can make testing more efficient.

      We can also monitor our health every day, conveniently, in our own homes. We can’t afford to give everyone a daily PCR test, and hardly anyone wants that anyway. In contrast, it’s easy, fast and affordable to take our temperature every day. It’s a smart, safe way to help keep our friends and family safe and do our part to fight the pandemic. A lot of people would self-monitor if they knew it would help.

      The coronavirus that causes COVID-19 evidently mutates easily, giving rise to variants, and we don’t expect that to change. It’s possible there are already variants that are not caught by current tests. Redefining “fever” can help identify cases that PCR tests miss. So far, fever is a symptom of all variants. More broadly, fever is a symptom of many other infectious illnesses, such as the flu. Isolating when you have a fever is appropriate for new variants and other viruses to help prevent the spread and keep everyone safer.

      It’s high time for the government to redefine “fever” as body temperature above a person’s normal, healthy range. With a more accurate definition, temperature-based screening can be a powerful new tool for fighting the pandemic — and one well-suited to use by anyone, at home and in time to make a difference. Americans want to help fight the pandemic. It’s about time the government helps them do just that.

      The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy. More

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      in US Politics

      Test to Treat: pharmacists say Biden’s major new Covid initiative won’t work

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      Test to Treat: pharmacists say Biden’s major new Covid initiative won’t workProgram to facilitate access to antivirals will have a limited impact because pharmacists are restricted from prescribing the pills A major new Biden administration initiative to facilitate access to Covid-19 antivirals will have a limited impact and fail to mitigate certain health inequities, major pharmacist groups argue, because pharmacists are restricted from prescribing the pills.Announced in Joe Biden’s State of the Union address, the “Test to Treat” program is meant to address the maddening difficulty Americans have had in accessing Covid-19 treatments. The administration will channel newly increasing stocks of antiviral pills to major retail pharmacies that have in-house clinics, providing one-stop testing and antivirals access.The program, which the administration aims to provide for free (in the face of fierce Republican opposition to new Covid-19 spending), is also slated to roll out in Veterans Affairs clinics, community health centers and long-term care facilities.Major participants include some 250 Walgreens stores, 225 Kroger Little Clinics and 1,200 CVS MinuteClinics. CVS clinics in particular are staffed by nurse practitioners and physician assistants, authorized by the Food and Drug Administration (FDA) to prescribe the two currently available Covid antivirals, Pfizer’s Paxlovid and Merck and Ridgeback Biotherapeutics’ molnupiravir.In a 9 March letter to Biden calling for pharmacists to be granted authority to prescribe these pills, 14 organizations representing pharmacies and pharmacists insisted Test to Treat’s impact will be compromised by the fact that such in-house clinics are relatively limited in number and largely in urban areas.“Unfortunately, rural and underserved communities are less likely to benefit from your test to treat approach because of this limitation,” the letter states.According to the Centers for Disease Control and Prevention (CDC), 90% of Americans live within five miles of one of approximately 60,000 pharmacies.“The FDA is still blocking us from leveraging the most accessible healthcare provider out there to make sure that these patients can get these drugs easily,” said Michael Ganio, a Columbus, Ohio pharmacist, senior director of pharmacy practice and quality at the American Society of Health-System Pharmacists, which is a signatory of the letter to Biden.“As far as expanding access,” said Ganio, Test to Treat is “not doing a lot”.The need for Covid-19 antivirals is likely to be greater in rural areas, at least on a per-capita basis. A recent CDC study found that through January, 58.5% of people aged five and older in rural counties had received at least one coronavirus vaccination shot, compared with 75.4% in urban counties.Paxlovid and molnupiravir are authorized for individuals at high risk of severe Covid-19, in particular unvaccinated people with certain medical conditions. Paxlovid was 88% effective at preventing hospitalization and death in its clinical trial. Molnupiravir proved just 30% effective. The FDA only authorizes its use when other treatments are unavailable or aren’t advised for an individual.Sufficient supply of Paxlovid will be key to Test to Treat. Since late December, the federal government has delivered a woefully inadequate 700,000 Paxlovid courses to states, the biweekly allotment increasing from 100,000 in January to 175,000 in March.The administration has claimed it will distribute 1m courses in March and 2.5m in April. A Pfizer representative would only state that the company plans to deliver a cumulative 10m courses by the end of June. The administration has agreed to purchase 20m courses, slated to be delivered by the end of September.In September 2021, the US Department of Health and Human Services amended a federal public health emergency law, the Prep Act, to grant licensed pharmacists the authority “to order and administer select Covid-19 therapeutics” – which at the time meant monoclonal antibodies and vaccines.But when the FDA authorized Paxlovid and molnupiravir in December, it explicitly restricted pharmacists from prescribing them.Authors of the letter to Biden say they submitted data to the FDA at the end of January, hoping to persuade it to grant pharmacists prescribing authority.These groups have also lobbied the federal government to ensure Medicare Part B would reimburse pharmacists for such prescribing – a move that would probably lead health insurers to follow.Prescribing Paxlovid safely can be challenging, because it may interact harmfully with other medications. Additionally, the FDA advises against providing the treatment to those with severe kidney or liver impairment. Experts have also raised concerns about molnupiravir’s potential toxicities. It cannot be prescribed to minors and is not advised for pregnant women.Chanapa Tantibanchachai, an FDA press officer, said the agency’s decision to forbid pharmacists from prescribing Paxlovid and molnupiravir “was based on several factors, including the drugs’ side-effect profiles, the need to assess potential for drug interactions, the need to assess potential kidney function problems (including the severity of potential problems), and the need to evaluate patients for pre-existing conditions” linked to severe Covid-19.Tantibanchachai said the FDA could revise the policy “as new data and information become available”.On 4 March, the American Medical Association said the “pharmacy based clinic component of the Test to Treat plan flaunts patient safety and risks significant negative health outcomes”. The AMA argued that by prescribing Covid antivirals at such clinics, providers may endanger patients for whom they lack a comprehensive medical history.The pharmacy groups insisted in their letter to Biden they have the expertise to prescribe these medications.In an email to the Guardian, Al Carter, executive director of the National Association of Boards of Pharmacy, stated: “Pharmacists have more complete access to the patients’ medication in comparison to physicians, especially since most patients have more than one prescriber, who don’t necessarily talk with each other.“Pharmacists spend their whole education focused on medications and their impacts on the body; whereas physicians take the minimal number of classes on pharmacology.”Katherine Yang, a clinical pharmacist at the University of California, San Francisco, said: “There are a lot of studies that show that when you increase services in community pharmacies, you improve care. In a lot of neighborhoods and rural areas, people may not have access to primary care, and pharmacists are the most accessible public health provider the patients can see.”TopicsCoronavirusBiden administrationUS domestic policyUS politicsPfizerPharmaceuticals industrynewsReuse this content More

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      in World Politics

      COVID Failure: A Matter of Principle

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      This is Fair Observer’s new feature offering a review of the way language is used, sometimes for devious purposes, in the news. Click here to read the previous edition.

      We invite readers to join us by submitting their suggestions of words and expressions that deserve exploring, with or without original commentary. To submit a citation from the news and/or provide your own short commentary, send us an email.

      March 10: True Toll

      In this month of March, the world is understandably somewhat reluctant to commemorate the second anniversary of the moment when the nations of the world unanimously declared COVID-19 a pandemic and began their largely concerted actions of lockdown. The story that unfolded afterward included a variety of traumatic episodes, including speculation about a diversity of possible preventive and curative treatments, sporadic outbreaks of revolt against enforced public policies and a scientifically successful campaign to produce effective vaccines. Despite their promise, the effectiveness of those vaccines nevertheless proved to be far from absolute.

      Pfizer’s Noble Struggle Against the Diabolical Jared Kushner

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      A group of over 100 public health, medical and epidemiology experts, after assessing the global results, has chosen this second anniversary to react and call into question the decisions taken by governments presumably capable of doing more. From the very early days, the scientific experts knew that, given the capacity of the coronavirus to mutate over time, any complication or holdup related to manufacturing and global distribution could undermine the entire logic of vaccines. They should have known that the biggest complication would come from a political and economic system that works according to principles that make it impervious to understanding the logic of a virus.

      Embed from Getty Images

      On March 9, the group of experts addressed a letter to the Biden administration to express their frustration with a situation that has evolved very slowly and largely inadequately outside the wealthy nations. This is not the first time concerned experts have urged “the administration to share Covid-19 vaccine technology and increase manufacturing around the world,” Politico reports. For the past two years, they have regularly been rebuffed, as governments preferred to pat themselves on the back for the short-term efforts they were making to protect their own populations, while creating the conditions that would allow the virus to mutate and gain strength elsewhere before returning to provoke new research and the promise of further commercial exploitation with boosters and new treatments.

      Principles vs. Ideals

      The experts should have realized by now that there is a principle at work that overrides every other scientific or medical consideration. It was established early on by the coterie established around Bill Gates, big pharma executives and other important influencers sharing their industrial mindset. It can all be traced back to the wisdom of Milton Friedman, who loved to repeat the slogan, “There’s no such thing as a free lunch.” The principle is self-explanatory: In a competitive world, the idea of sharing simply cannot compete with the idea of competing. If you can’t afford lunch, you’ll just have to go without eating. That works when the only outcome is seeing people starve. It doesn’t work when the effects of their starvation are somehow transmitted back to those who have a permanent place at the banquet.

      US culture has cultivated the idea that life itself is a competitive race for advantage and the promotion of self-interest stands as the highest of virtues. Health like wealth must play by the rules of the competitive game. That same culture insists heavily on a form of discipline based on the idea of respecting “principles,” which it sometimes perversely confounds with “laws of nature.” The divinely ordained requirement to solve all problems through competition is a prominent one, but not the only one. 

      The problem with such principles that are taken to be universal laws is that once you believe it is a law, you no longer need to reflect on its appropriateness or assess its very real effects. We are witnessing an example of it today in the Ukraine conflict. The United States has invoked the defense of the sacred principle of “sovereignty,” reformulated as the right of a nation to determine its own foreign policy, including the choice to join a distant empire. That may be a principle, but is it a law? Insisting on it instead of reflecting and debating the question has provoked a disastrous and increasingly out of control war that, like the COVID-19 pandemic, has already had severe unintended knock-on effects, wreaking havoc on the global economy as well as destruction in Ukraine itself. 

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      Every culture must realize that its own principles may not be universally applicable, that they may not be perceived as others to have the status of laws. Any attempt to apply them as universal truths may cause immense human suffering. And that reveals the very dimension of the problem the health experts are pointing to. A potentially criminal complacency exists when the suffering caused by the inflexible application of the principle is directed toward others, at the same time when the purveyors of the principle take measures to protect their society and their environment. The principle of Ukraine’s sovereignty is already damaging not just Ukraine itself and now Russia, thanks to the application of the principle, but also Europe, the Middle East and Africa, which will be cut off from vital supplies of energy, food and fertilizer.

      For the past two years, the concerted defense of the ideal of competition by the pharmaceutical companies in their supposed combat to defeat COVID-19 has clearly aggravated the effects of a pandemic that might have been contained if the idea of sharing had been elevated to the status of principle. But sharing doesn’t deserve to be regarded as a principle. For Americans, it is based on soft ideas like empathy and compassion rather than hard reasoning about what might be financially profitable.

      Reflecting on two years of struggle, the group of experts noted “that the development of U.S. vaccines was largely successful, bringing protection to the public in record time,” Politico reports. That’s the good news. And now for the bad news: “But getting shots in arms in low- and middle-income countries has been a ‘failure.’”

      Out for the Count

      No precise statistics can account for the difference between the damage actually done by COVID-19 and what might have happened had governments effectively managed the global response in the earlier phases of the pandemic. “The true toll of this failure will never be known,” the experts explain, “but at this point almost surely includes tens of millions of avoidable cases and hundreds of thousands of deaths from Covid.”

      The “true toll” they cite reminds us of John Donne’s meditation on the bells rung for the dying in a time of plague. The poet and dean of St Paul’s affirmed that “any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee.” Might we hope that 400 years after Donne wrote these words, pharmaceutical companies and politicians could, for once, take them to heart?

      But there is yet another much more concrete  meaning of “toll,” as in “toll road.” It is the price humanity is expected to pay, in dollars and cents, to the pharmaceutical companies that have so diligently used their patents to protect their exclusive rights to exploit and enrich themselves thanks to the global potential for suffering of others.

      Embed from Getty Images

      The final and fundamentally political irony of this sad tale relates to the fact that to do what the experts insist needs doing requires “more funding from Congress.” At a time when prominent members of Congress have become obsessed by the threat of inflation, while at the same time unabashedly inflating military budgets and responding urgently to the “sacred” needs of NATO in times of peril, the likelihood that Congress might suddenly address a global problem it has avoided addressing for two years seems remote.

      One of the experts, Gavin Yamey, suggests that COVID-19 “could follow the path of diseases like HIV or tuberculosis: become well controlled in wealthier countries but continue to wreak havoc in poorer nations.” Geopolitics in this increasingly inegalitarian world appears to be following a trend of domestic demographics in the US, marked by the separating of society itself into two groups: the denizens of gated communities and the rabble, everyone else out there.

      Why Monitoring Language Is Important

      Language allows people to express thoughts, theories, ideas, experiences and opinions. But even while doing so, it also serves to obscure what is essential for understanding the complex nature of reality. When people use language to hide essential meaning, it is not only because they cynically seek to prevaricate or spread misinformation. It is because they strive to tell the part or the angle of the story that correlates with their needs and interests.

      In the age of social media, many of our institutions and pundits proclaim their intent to root out “misinformation.” But often, in so doing, they are literally seeking to miss information.

      Is there a solution? It will never be perfect, but critical thinking begins by being attentive to two things: the full context of any issue we are trying to understand and the operation of language itself. In our schools, we are taught to read and write, but, unless we bring rhetoric back into the standard curriculum, we are never taught how the power of language to both convey and distort the truth functions. There is a largely unconscious but observable historical reason for that negligence. Teaching establishments and cultural authorities fear the power of linguistic critique may be used against their authority.

      Remember, Fair Observer’s Language and the News seeks to sensitize our readers to the importance of digging deeper when assimilating the wisdom of our authorities, pundits and the media that transmit their knowledge and wisdom.

      The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy. More

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      Pfizer’s Noble Struggle Against the Diabolical Jared Kushner

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      These days it’s rare to read in the media a story with a happy ending designed to comfort our belief that, at least occasionally, we live in the best of all possible worlds. Forbes has offered such an occasion to a self-proclaimed benefactor of humanity, Dr. Albert Bourla, the CEO of Pfizer. (Disclaimer: Pfizer is a company to whom I must express my personal gratitude for its generosity in supplying me with three doses of a vaccine that has enabled me to survive intact a prolonged pandemic and benefit from a government-approved pass on my cellphone permitting me to dine in restaurants and attend various public events.)

      The Contradictory Musings of Biden’s Speculator of State

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      The Forbes article, an excerpt from Bourla’s book, “Moonshot,” ends with a moving story about how Pfizer boldly resisted the pressure of the evil Jared Kushner, Donald Trump’s son-in-law, who had no qualms about depriving the rest of the world — even civilized countries such as Canada and Japan — of access to the COVID-19 vaccine to serve the US in their stead.

      “He insisted,” the good doctor explains, “that the U.S. should take its additional 100 doses before we sent doses to anyone else from our Kalamazoo plant. He reminded me that he represented the government, and they could ‘take measures’ to enforce their will.”

      Today’s Weekly Devil’s Dictionary definition:

      Take measures:

      Go well beyond any measured response in an act of intimidation

      Contextual Note

      Bourla begins his narrative at the beginning, before the development of the vaccine, by asserting his company’s virtuous intentions and ethical credentials that would later be challenged by bureaucrats and venal politicians. “Vaccine equity was one of our principles from the start,” he writes. “Vaccine diplomacy, the idea of using vaccines as a bargaining chip, was not and never has been.”

      Embed from Getty Images

      Some readers may note that vaccine equity was only “one” of the principles. There were, of course, other more dominant ones, such as maximizing profit. But Bourla never mentions these other principles, instead offering a step-by-step narrative meant to make the reader believe that his focus was on minimizing profit. That, after all, is what a world afflicted by a raging and deadly pandemic might expect. A closer examination of the process Bourla describes as well as the very real statistics about vaccine distribution reveals that, on the contrary, Pfizer would never even consider minimizing profits. It simply is not in their DNA.

      Bourla proudly describes the phases of his virtuous thinking. The CEO even self-celebrates his out-of-the-ordinary sense of marketing, serving to burnish the image not only of his company but of the entire pharmaceutical industry. “We had a chance,” he boasts, “to gain back our industry’s reputation, which had been under fire for the last two decades. In the U.S., pharmaceuticals ranked near the bottom of all sectors, right next to the government, in terms of reputation.”

      Thanks to his capacity to tone down his company’s instinctive corporate greed, Bourla now feels he has silenced his firm’s if not the entire industry’s critics when he makes this claim, “No one could say that we were using the pandemic as an opportunity to set prices at unusually high levels.” Some might, nevertheless, make the justifiable claim that what they did was set the prices at “usually” high levels. A close look at Bourla’s description of how the pricing decisions were made makes it clear that Pfizer never veered from seeking “high levels,” whether usual or unusual, during a pandemic that required as speedy and universal a response as possible.

      Thanks to a subtle fudge on vocabulary, Bourla turns Pfizer’s vice into a virtue. He writes that when considering the calculation of the price Pfizer might charge per dose, he rejected the standard approach that was based on a savant calculation of the costs to patients theoretically saved by the drug. He explains the “different approach” he recommended. “I told the team to bring me the current cost of other cutting-edge vaccines like for measles, shingles, pneumonia, etc.” But it was the price and not the cost he was comparing. When his team reported prices of “between $150 and $200 per dose,” he agreed “to match the low end of the existing vaccine prices.”

      If Pfizer was reasoning, as most industries do, in terms of cost and not price, he would be calculating all the costs related to producing the doses required by the marketplace — in this case billions — and would have worked out the price on the basis of fixed costs, production and marketing costs plus margin. That would be the reasonable thing to do in the case of a pandemic, where his business can be compared to a public service and for which there is both a captive marketplace (all of humanity shares the need) and in which sales are based entirely on advanced purchase orders. That theoretically reduces marketing costs to zero.

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      But Bourla wrote the book to paint Pfizer as a public benefactor and himself as a modern Gaius Maecenas, the patron saint of patrons. Once his narrative establishes his commitment to the cause of human health and the renunciation of greed, he goes into detail about his encounter with Kushner. After wrangling with the bureaucrats at Operation Warp Speed created to meet the needs of the population during a pandemic, Bourla recounts the moment “when President Trump’s son-in-law and advisor, Jared Kushner, called me to resolve the issue.” That is when Kushner, like any good mafia boss, evokes his intent to “take measures,” a threat the brave Bourla resists in the name of the health of humanity and personal honor.

      That leads to the heartwarming, honor-saving denouement, the happy ending that Bourla calls a miracle. “Thankfully, our manufacturing team continued to work miracles, and I received an improved manufacturing schedule that would allow us to provide the additional doses to the U.S. from April to July without cutting the supply to the other countries.”

      Historical Note

      Investopedia sums up the reasoning of pharmaceuticals when pricing their drugs: “Ultimately, the main objective of pharmaceutical companies when pricing drugs is to generate the most revenue.” In the history of Western pharmacy, that has not always been the case. Until the creation of the pharmaceutical industrial sector in the late 19th century, apothecaries, chemists and druggists worked in their communities to earn a living and like most artisans calculated their costs and their capacity for profit.

      The Industrial Revolution changed all that, permitting large-scale investment in research and development that would have been impossible in an earlier age. But it also introduced the profit motive as the main driver of industrial strategy. What that meant is what we can see today. Pharmaceutical companies have become, as Albert Bourla himself notes, “ranked near the bottom of all sectors.” They exist for one reason: to make and accumulate profit. Industrial strategies often seek to prolong or extend a need for drugs rather than facilitate cures. Advising a biotech company, Goldman Sachs famously asked, “Is curing patients a sustainable business model?” The implied answer was “no.” The greatest fear of the commercial health industry is of a cure that “exhaust[s] the available pool of treatable patients.”

      Embed from Getty Images

      In any case, COVID-19 has served Pfizer handsomely and is continuing to do so. In late 2021, the Peoples Vaccine Alliance reported “that the companies behind two of the most successful COVID-19 vaccines —Pfizer, BioNTech and Moderna— are making combined profits of $65,000 every minute.” Furthermore, they “have sold the majority of doses to rich countries, leaving low-income countries out in the cold. Pfizer and BioNTech have delivered less than one percent of their total vaccine supplies to low-income countries.”

      At the beginning of the COVID-19 “project,” Bourla boasts, “I had made clear that return on investment should not be of any consideration” while patting himself on the back for focusing on the needs of the world. “In my mind, fairness had to come first.” With the results now in, he got his massive return on investment, while the world got two years and counting of a prolonged pandemic that will continue making a profit for Pfizer. At least he had the satisfaction of putting the ignoble Jared Kushner in his place.

      *[In the age of Oscar Wilde and Mark Twain, another American wit, the journalist Ambrose Bierce, produced a series of satirical definitions of commonly used terms, throwing light on their hidden meanings in real discourse. Bierce eventually collected and published them as a book, The Devil’s Dictionary, in 1911. We have shamelessly appropriated his title in the interest of continuing his wholesome pedagogical effort to enlighten generations of readers of the news. Read more of The Fair Observer Devil’s Dictionary.]

      The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy. More

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      Arkansas officials praise doctor accused of giving inmates ivermectin without consent

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      Arkansas officials praise doctor accused of giving inmates ivermectin without consentDespite lawsuit filed against Dr Robert Karas by four inmates, local officials have praised him for a ‘job well done’ An Arkansas doctor accused of prescribing ivermectin to inmates in his state without their consent has been praised by local officials for a “job well done” despite widespread outrage at his actions.In January, the Arkansas chapter of the American Civil Liberties Union (ACLU) sued Dr Robert Karas, the physician at Arkansas’s Washington county detention center, on behalf of four inmates who said they were given ivermectin to treat Covid-19 as a form of “medical experiment”.“Plaintiffs ingested incredibly high doses of a drug that credible medical professionals, the FDA, and the Centers for Disease Control and Prevention (CDC), all agree is not an effective treatment against Covid-19 and that if given in large doses is dangerous for humans,” the lawsuit said.According to the lawsuit, Karas told the inmates that the prescribed drugs “consisted of mere ‘vitamins’, ‘antibiotics’ and/or ‘steroids.’”The CDC, as well as the Food and Drug Administration (FDA), have put out advisories warning against using ivermectin for Covid-19, though it is a cause celebre for some rightwing figures and anti-vaxxers.Despite the lawsuit, some prominent local leaders of Washington county have lauded Karas for his Covid treatment efforts.On Monday, Patrick Deakins, a Washington county justice of the peace, introduced a resolution to a local quorum court’s jail and enforcement committee to praise Karas for his handling of the pandemic in Washington county jail.“I don’t know the science behind Covid and I’m not so sure anybody does. I’m certainly not a doctor and I’m certainly not a virologist, and none of us on this panel are,” Deakins said.He went on to add, “I don’t know the value of one treatment or the appropriateness of it is. I don’t know the efficacy of ivermectin and I don’t know the most useful ways to treat any one individual, and those are not the debate of this resolution, I just want what’s best for the health and safety of the county.”“While over 850 cases of the infection have been recorded in the Washington county detention center, Dr Robert Karas and Karas Correctional Health have effectively treated those cases which have resulted in zero fatalities from the virus,” the resolution said.According to the document, Karas provided “exceptional medical care” to inmates and that the “Washington County Quorum Court commends Dr Robert Karas and Karas Correctional Health for a job well done despite the unique challenges.”Despite the resolution getting passed by the committee, other local officials pushed back against Karas.“If you talk to individuals at our local hospitals that are treating patients after Dr Karas has treated them, they are very ill,” said justice of the peace Eva Madison. “The reality is that he doesn’t know … He can’t possibly know what the side-effects are of the treatment that he has given,” she added.“How can we tout nobody died when the individuals in this lawsuit claimed health consequences from what he did to them,” Madison said in reference to the inmates. “You can agree or disagree with the lawsuit, Dr Karas, but why in the world would this body endorse a practice that’s being challenged in court?”In the lawsuit filed by ACLU last month, inmates complained that they suffered from various side-effects after ingesting ivermectin, including vision issues, diarrhea, bloody stools and stomach cramps. The inmates were also subject to payment of fees for medical examinations that they sought after experiencing the side-effects.Karas, who has had numerous lawsuits filed against him over the years for allegedly providing inadequate and poor medical care to inmates, has filed a motion to dismiss ACLU’s lawsuit against him.TopicsArkansasCoronavirusUS politicsnewsReuse this content More

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      The big idea: are we really so polarised? | Dominic Packer and Jay Van Bavel

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      The big idea: are we really so polarised? In many democracies the political chasm seems wider than ever. But emotion, not policies, may be what actually divides us In 2020, the match-making website OkCupid asked 5 million hopeful daters around the world: “Could you date someone who has strong political opinions that are the opposite of yours?” Sixty per cent said no, up from 53% a year before.Scholars used to worry that societies might not be polarised enough. Without clear differences between political parties, they thought, citizens lack choices, and important issues don’t get deeply debated. Now this notion seems rather quaint as countries have fractured along political lines, reflected in everything from dating preferences to where people choose to live.Sign up to our Inside Saturday newsletter for an exclusive behind the scenes look at the making of the magazine’s biggest features, as well as a curated list of our weekly highlights.Just how stark has political polarisation become? Well, it depends on where you live and how you look at it. When social psychologists study relations between groups, they often find that whereas people like their own groups a great deal, they have fairly neutral feelings towards out-groups: “They’re fine, but we’re great!” This pattern used to describe relations between Democrats and Republicans in the US. In 1980, partisans reported feeling warm towards members of their own party and neutral towards people on the other side. However, while levels of in-party warmth have remained stable since then, feelings towards the out-party have plummeted.The dynamics are similar in the UK, where the Brexit vote was deeply divisive. A 2019 study revealed that while UK citizens were not particularly identified with political parties, they held strong identities as remainers or leavers. Their perceptions were sharply partisan, with each side regarding its supporters as intelligent and honest, while viewing the other as selfish and close-minded. The consequences of hating political out-groups are many and varied. It can lead people to support corrupt politicians, because losing to the other side seems unbearable. It can make compromise impossible even when you have common political ground. In a pandemic, it can even lead people to disregard advice from health experts if they are embraced by opposing partisans.The negativity that people feel towards political opponents is known to scientists as affective polarisation. It is emotional and identity-driven – “us” versus “them”. Importantly, this is distinct from another form of division known as ideological polarisation, which refers to differences in policy preferences. So do we disagree about the actual issues as much as our feelings about each other suggest?Despite large differences in opinion between politicians and activists from different parties, there is often less polarisation among regular voters on matters of policy. When pushed for their thoughts about specific ideas or initiatives, citizens with different political affiliations often turn out to agree more than they disagree (or at least the differences are not as stark as they imagine).More in Common, a research consortiumthat explores the drivers of social fracturing and polarisation, reports on areas of agreement between groups in societies. In the UK, for example, they have found that majorities of people across the political spectrum view hate speech as a problem, are proud of the NHS, and are concerned about climate change and inequality.As psychologist Anne Wilson and her colleagues put it in a recent paper: “Partisans often oppose one another vehemently even when there is little actual daylight between their policy preferences, which are often tenuously held and contextually malleable.”This relative lack of divergence would, of course, come as a surprise to partisans themselves. This is the phenomenon of false polarisation, whereby there is widespread misperception of how much people on the left and the right are divided, not only on issues but also in their respective ways of life. When asked to estimate how many Republicans earn more than $250,000 a year, for example, Democrats guessed 38%. In reality it is 2%. Conversely, while about 6% of Democrats self-identify as members of the LGBT community, Republicans believed it was 32%. New research from Victoria Parker and her colleagues finds that partisans are especially likely to overestimate how many of their political opponents hold extreme opinions. Those overestimates, in turn, are associated with a disinclination to talk or socially engage with out-party members, avoidance that is likely to prevent people from forming more accurate impressions of the other side.What drives these misperceptions? And why do citizens so dislike one another if they aren’t necessarily deeply divided on policy matters? Politicians certainly have incentives to sharpen differences in order to motivate and mobilise voters, rallying support by portraying themselves as bulwarks against the barbarians on the other side. Divisiveness also plays well on social media, where extreme voices are amplified. Moral outrage is particularly likely to go viral.In a recent project led by Steve Rathje and Sander van der Linden at Cambridge University, we examined more than 2.5m posts on Twitter and Facebook. We found that posts were significantly more likely to be shared or retweeted if they referenced political opponents. Every word about the out-group increased the odds of a post being shared by 67% – and these posts were, in turn, met with anger and mockery.In this increasingly toxic environment, reducing false polarisation and affective polarisation are major challenges. It is often suggested, for example, that if people were only to expose themselves to perspectives from the other side, it would breed greater understanding and cooperation. Yet this intuition turns out to be flawed.The big idea: Is the era of the skyscraper over?Read moreSociologist Christopher Bail and his colleagues offered sets of Democrats and Republicans money to follow a bot that would retweet messages from politicians, media companies and pundits every day for a month. Importantly, the messages always came from the other side of the political spectrum. Far from promoting harmony, it backfired. After a month of being exposed to conservative talking points, Democrats’ attitudes had become, if anything, marginally more liberal. And Republicans became more conservative following their diet of liberal views. When what you see from the other side strikes you as biased or obnoxious, it doesn’t endear you to their perspectives.In this regard, the behaviour of elites matters. Political scientist Rasmus Skytte showed people messages from politicians that were either civil or rude. Interestingly, aggressive and unkind messages didn’t reduce trust in politicians or increase affective polarisation. It seems that incivility is what people have come to expect. But when they saw polite and respectful messages, they subsequently felt more trust towards politicians and became less affectively polarised.These results suggest that we should expect better from our leaders and those with large platforms. Don’t reward divisive rhetoric with “likes”. Instead, follow politicians and pundits who embody norms of respect and civility, even when they disagree on policy matters. In fact, many of us might be better off if we took a break from social media altogether. When economists found that whenpeople who were encouraged people to disconnect from Facebook for a month spent less time online and were less politically polarised. They also experienced improved psychological wellbeing.No one these days is worried that our societies are insufficiently polarised. But because so much of the polarisation is about emotions and identities rather than issues, it is still not clear that citizens are presented with good choices or that important issues are being deeply debated. Here again, we must expect better. Demand that politicians and pundits get into policy specifics. Let’s focus more on actual ideas for solving actual problems, where we, as citizens, may well turn out to agree on more than we realise. Dominic Packer and Jay Van Bavel are psychologists and the authors of The Power of Us. To support the Guardian and Observer, order your copy at guardianbookshop.com. Delivery charges may apply.Further readingUncivil Agreement: How Politics Became Our Identity by Lilliana Mason (Chicago, £19)Breaking the Social Media Prism: How to Make Our Platforms Less Polarizing by Chris Bail (Princeton, £20)The Wealth Paradox: Economic Prosperity and the Hardening of Attitudes by Frank Mols and Jolanda Jetten (Cambridge, £19.99)TopicsBooksThe big ideaSociety booksSocial trendsSocial mediaDigital mediaPsychologyUS politicsfeaturesReuse this content More

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      Nine percent of New York City workers still unvaccinated after Friday deadline

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      New YorkNine percent of New York City workers still unvaccinated after Friday deadline
      Last-minute rush of jabs boost vaccination rate to 91%
      Fox News host gets death threats for vaccinations plea
      Victoria Bekiempis in New YorkSun 31 Oct 2021 13.02 EDTFirst published on Sun 31 Oct 2021 08.30 EDTNine percent of New York City’s municipal workforce remains unvaccinated following a Friday deadline to demonstrate proof of receiving at least Covid shot, officials said.‘They broke my heart’: sculptor laments Central Park Covid monument removalRead moreHowever, the percentage of city workers with at least one dose rose considerably as the deadline loomed.Opposition to vaccine mandates fueled by rightwing politicians and media figures led to protests in New York this week. But on Saturday night, authorities said 91% of city workers had received at least one dose, up from 83% on Friday and 76% on Thursday.Workers who did not abide by the requirement were still due to be placed on unpaid leave from Monday, potentially spurring staffing shortages in the police, fire, emergency medical services and sanitation departments.The New York police department vaccination rate stood at 84%, officials said. Asked about the plan for dealing with a potential staff shortfall, an NYPD spokesman said in an email: “We will be prepared for any changes in personnel due to the mandate.”City data indicated that 78% of fire department workers, and 79% of sanitation department workers, had received at least one dose as of Saturday.Those agencies also said they were preparing for staffing shortfalls.Fire officials said they were prepared to close up to 20% of fire companies and see 20% fewer ambulances in operation.The department planned to change schedules, cancel vacations and seek out non-fire department EMS providers.The fire commissioner, Daniel Nigro, slammed some firefighters who took paid sick leave in advance of the vaccine deadline.“The department has not closed any firehouses,” Nigro said. “Irresponsible bogus sick leave by some of our members is creating a danger for New Yorkers and their fellow firefighters. They need to return to work or risk the consequences of their actions.”The New York City mayor, Bill de Blasio, recently said the sanitation department would implement 12-hour shifts rather than the normal eight-hour shifts, and start working on Sundays so garbage did not accumulate amid staffing shortages.The Associated Press contributed to this report.TopicsNew YorkCoronavirusVaccines and immunisationInfectious diseasesUS healthcareUS politicsnewsReuse this content More