There was a major update today in the Maintenance of Certification saga: the president of ASH (American Society of Hematology, which, oh what a coincidence, I mentioned just yesterday) wrote an open letter to the CEO of ABIM requesting to end MOC as we know it. In what is I am sure a completely unrelated announcement, the CEO of ABIM said he would step down in September 2024. He may want to reconsider that timeline.

A mural from the rust belt. Obscured by the gas-guzzlers in the bottom left corner is the slogan: “Without Labor Nothing Prospers”. Indeed.

A recent podcast episode and a recent blog post show how screwed up the American drug market is, and in how many different ways.

In his Healthcare Unfiltered interview focused on generic drug shortages, the FDA Commissioner Robert Califf blamed Group Purchasing Organizations for driving down the cost of generic drugs to below what’s economically feasible. The manufacturers don’t have an incentive to shore up their process, the fragile production line fails, and presto, you have a shortage. Which is fine if you are manufacturing a placebo, but in recent years the FDA’s Drug Shortages Database has been ever-growing, and as of today includes potentially currative cancer drugs like cisplatin and carboplatin, many antibiotics, and even some formulations of sugar-water. Not to be confused with placebo.

This all reminds me a bit of my childhood in Serbia back in the mid-1990s, when bread was dirt cheap and never available. But that was too much price regulation. Here, we have too efficient of a market leading to a shortage. Only, I am sure there will be hands raised wanting to tell me that — well, actually — this was a clear example of over regulation, since new factories can’t just pop up too meet the demand and make use of the temporary market inefficiency, being dependent as they are on pesky FDA regulations — like the ones about drugs being safe. If only we could price in the risk of death by sepsis, we’d be in great shape!

So, on one end we have Medicare/Medicaid paying through the nose for brand name drugs because it is forbidden by law from negotiating for a better price, and on the other private GPOs negotiating too well for generics, to the point of extinction, forcing payers to get those expensive brand name drugs. Heads, brand-name pharmaceutical industry wins, tails, payers loose.

It was encouraging to see some movement in the price negotiation area: the comically misnamed Inflation Reduction Act allows for CMS to negotiate the price of some drugs, and the list of those drugs was recently made availalbe. Ideal? Far from it — in an ideal world the federal government would not be involved in any of this; but it’s not the world we live in. This is where the blog post comes in: from Alex Tabarrok, about how we are bad at pricing drugs because of unknown externalities (true!) but also with a side-comment reframing measures the IRA takes allowing nogiation as “price controls”, linking to [a policy paper][10] which suggests yet another set of measure to mitigate the adverse effects of IRA’s proposed solutions to the drug pricing problem. ⊕ Efficient markets for me, but not for thee, as Tabarrok’s writing partner would quip. And so the measures pile up from both the pro- and anti-regulation side. Ad infinitum, I suppose.

See also: better drugs don’t cost more, and a list of a few earnest but misguided attempts at cost control.

After more than a month, I wrote something in Serbian. It is about my disdain for Serbian journalists and the only (let’s hope) TV appearance there, from a few years ago. The disdain would probably apply to many other countries, seeing as the profession revolves around online lurking and email exchange at best, manufacturing consent at worst. Though there are, of course, exceptions.

Continuing the daily cadence of one photo followed by a complaint about America’s most hated board of medicine, ABIM has once again shown its complete deafness of tone. While almost 10% of its customers — for we are not members of this private club — rebelling against its practices, it still sent out an automated extortion reminder threatening to remove certification if you don’t pay up. Well, I don’t think I shall.

The campaign to end mandatory maintenance of certification is, as of yesterday, at 20,000 signatures. This is just shy of 10% of the people affected; what are the other 90+ percent thinking? Still, it was enough to make the professional societies pay attention.

From the Department of You Can’t Make This Up: the face of D.C. pedestrian safety was hurt in a hit-and-run. And not just a little bit:

Stephen Grasty was placed in a neck brace and taken to George Washington University Hospital, where doctors treated him for a long list of injuries, including a broken leg, foot and vertebra. His C6 vertebra was “hanging on a hair,” Shelly Grasty said.

D.C. could be one of the most pedestrian and bicycle-friendly cities in America (just look at these lanes!), but you just can’t get away from out-of-town drivers. (ᔥAxios)

🏀 USA Basketball coach Steve Kerr after FIBA World Cup semifinal loss to Germany:

“This team is very worthy of winning a championship. We just didn’t get it done.”

Hic Rhodus, hic salta, if I may say so.

Also: Go, Serbia! (ᔥBen Golliver)

You don’t need to live in DC to appreciate Martin Weil’s delightful prose about its weather this weekend:

Both days, Friday and Saturday, innocent of haze and atmospheric moisture as they were, seemed to celebrate change and assure us that in coming days, humidity would cease to be a concern.

These two days seemed to embody the exhilaration that comes of seeing blue skies, and nothing but blue skies, everywhere we looked.

Of course, when it comes to weather reporting nothing can beat Kevin Killeen’s story on why February is the worst month.

Kevin Kelley’s 10-year-old list of The Best Magazine Articles Ever has three from The Washington Post that are in the top 25:

• The Peekabo Paradox (2006), about Washington’s preeminent child entertainer, the Great Zucchini, and also about virtue and vice.
• Pearls Before Breakfast (2007), about a master violinist playing a 1713 Stradivari violin incognito in front of L’Enfant Plaza commuters.
• Fatal Distraction: Forgetting a Child in the Backseat of a Car Is a Horrifying Mistake. Is It a Crime? (2009), about, well, that.

The first two in particular are better than anything that will come out this week in any magazine, least of all in the Post. (↬The Technium)