The invisible graveyard of unseen victims of safe, effective, but unapproved drugs.

Unprepared: Government Failure at the CDC/FDA

Alex Tabarrok on the CDC and FDA’s ‘Failure of Historic Proportions’

College students who are assigned Tyler Cowen and Alex Tabarrok’s Modern Principles of Economics learn the twin concepts of market failure and government failure. To teach the former without the latter, as some textbooks do, is to present a lop-sided picture of the world and to romanticize governmental solutions that often do more harm than good.

Coronavirus is making this lesson tragically real, as federal agencies like the CDC and FDA have been caught off-guard by the outbreak and subsequently stoked the public’s fears while failing to provide solutions.

I was recently joined by Marginal Revolution blogger and George Mason University economics chair Alex Tabarrok. He explained how these agencies’ responses to COVID-19 has been a ‘Failure of Historic Proportions.’ Alex was recently interviewed by Reason’s Nick Gillespie on the subject, and elaborates in our interview on the urgent need for government to foster the conditions for markets to function.

Alex also talked about the hindrances to new drug approval per the framework he developed with FDAReview.org.

Watch Alex’s free online economics courses at MRUniversity.com and listen or read the transcript to understand how the economy can recovery faster with the help of better policy and the “invisible hand.”

TRANSCRIPT

Bob Zadek: Thank you so much for listening this rather strange Easter Sunday. For all of the economic and health destruction and disruption of this terrible period in our history, the experience our planet is going through centered around COVID-19 is also offering a masters if not doctoral level course in the relationship between citizens and their government — and an opportunity to rethink what that relationship should be.

What do we expect from our government and what has this experience taught us about the strengths and failings of government performance at all levels — federal, state and local — during this very difficult, unique time? It has an economic component, a health component, a civics component, and there will be so many lessons if we are smart enough to sort through all the noise to find them. We will be infinitely better off, with a deeper understanding of our relationship to government than we are now.

At times like this, I do my best to find thoughtful observers — the teachers, people in political life — to help us sort out these very difficult issues, and I certainly have succeeded with this morning’s guest. I’d like to welcome to the show Alex Tabarrok.

Alex is the Bartley J. Madden chair in economics at the Mercatus Center at George Mason University where he also teaches economics.

Alex co-writes a wonderful blog — mandatory reading every morning — it’s economics plus a lot more, called Marginal Revolution. I commend to everybody, do not start today before you check out the writings at the Marginal Revolution. Their thoughts and their links are seductive and astonishingly educational. You get smarter by the minute as you click on the links and read the thoughts of Alex and his co-author at Marginal Revolution.

He also is the cofounder of the MRUniversity, a thoughtful, rich-with-content online teaching platform. We’re going to discuss this morning the interaction between the economic and the health issues, which are raised by the COVID-19 epidemic.

Alex, welcome to the show this morning.

Alex Tabarrok: Well thanks Bob and thanks for that kind introduction.

Thinking Like an Economist: Implicit Trade-Offs in the Shutdowns

Bob Zadek: Now, Alex, I would like to start the show, just to set the tone and to tee up the issue, if you will, with a direct quote that I read only minutes before we went live this morning. It was a quote of Governor of New York, Andrew Cuomo. Focusing on the issue of the tension between the government’s duty to maintain our economic life and our physical life, Governor Cuomo said,

“You can’t ask the people to choose between lives lost and dollars gained. You cannot ask the people to choose between lives lost and dollars gained.”

Isn’t that exactly what all of us are being asked to choose? Or perhaps we’re not being asked to choose the choices being made for us. You have written extensively with great thought and with great passion about the economic and health effects of the virus on our country, on the cities and states, and you have stated that your standard is you want very little from government, but you certainly want competence.

How does your desire for competence apply to this decision between, in Cuomo’s words, “lives lost and dollars gained?” How does government make that decision between economics and health?

Alex Tabarrok: Right. Economists are often criticized because we do try to put a dollar value on life. We all make decisions all the time about whether to cross the road against the light or whether to take a risky job being a coal miner as opposed to doing something else, which implicitly involves a tradeoff of our lives and risk and money.

But the interesting thing is that the number you get is pretty high. So the number that is often used for the value of life is about $7 to $9 million. When the government is deciding how much to spend on fixing up the highways or improving safety in other ways, $9 million is a number which economists think is pretty good. That actually tells you that the value of life is so high that at this moment a lockdown is probably a pretty good idea.

Bob Zadek: So actually, what you are saying is that government does and indeed probably has to or else there’s no way to make the decision between the proverbial apple and orange. If you don’t assign a value to human life, then it is impossible for anybody to make a decision about to what extent we should surrender economic losses in favor of hopefully gaining human lives.

So while many people out there who haven’t thought about this issue that much would wince in pain — and you will hear people saying, how can you assign a value to human life? — well, that’s kind of naive because, Alex, unless you do that, decision-making becomes impossible, doesn’t it? There is no alternative to assigning a value.

Alex Tabarrok: Trade-offs are everywhere. You can’t make rational choices without making trade-offs. So we can do one of two things: We can close our eyes and pretend that the tradeoffs don’t exist and then implicitly make some judgment. I.e.,we have to decide how many ventilators are we going to buy.

How big should our medical care system be?

How close does the firetruck have to be?

How many firetrucks do we need?

How many ambulances do we need?

We can do it implicitly and just kind of throw up our arms and take a guess, or we can do it seriously. The hard-nosed economic way puts a value on human life and then figures out, “Well, given that value, what’s the optimal distancing for the fire department?”

I’m much more of the hard-nosed person who’s willing to put a number on life. In this case when the number turns out pretty high, then that says we ought to be willing — in a rich society like the United States — to give up some wealth in return for life.

Bob Zadek: Your first examples — crossing the street or undertaking a dangerous job — were two individual choices that all of us make all the time. We don’t do it with a calculation — with life expectancy tables in front of us — but all of us decide whether the risk on a personal level is worth the benefit? The benefit might be economic, it might be emotional, it might simply be a gain in happiness, but we make those decisions. So that’s not a foreign decision. Part of being a human is to make that calculation.

Sometimes it boils down to kind of the view of the “left versus the right” and the left would like to believe they don’t assign a value to human life. But of course, even if we go to something like Medicare for All, you cannot run government health insurance unless you make the calculation, because you have to decide how much health care to give somebody. That has to be an economic decision.

Help us understand that calculation is essential in every government program — even those that are promoted by the left.

Alex Tabarrok: Oh, absolutely. If we have free medical care then the demand is going to be infinite. So any country which has a national healthcare system imposes limits on what they’re going to buy. And that’s not unreasonable, but unfortunately it does mean that sometimes we get “one choice rules all,” and that’s not very efficient either.

“[T]he government is not good at it making subtle tradeoffs, which individuals are much better at.”

Although I agree with the lockdown at the present moment in time, we are going to have to get more subtle think about starting the economy up again. But what kind of protocols should we be taking to do that?

Who should be going back to work?

Who should be staying at home? How are we going to manage our work life?

Are we all going to be wearing masks? I think that’s a good idea for until we reach a vaccine time. So the government unfortunately just is good at making a clampdown decision — one decision, everyone has to follow it.

For some individuals — i.e., young people — it’s much going to be much safer for them to go back to work than it is for older people. We need to start allowing or to think about how we’re going to allow these more subtle trade-offs to be made by individuals and firms.

But the government is not good at it making subtle tradeoffs, which individuals are much better at.

Essentials vs. Non-Essentials

Bob Zadek: Even though we all have used the expression “total lockdown” there are obviously huge swaths of the economy that are not in lockdown. The healthcare part of the economy is functioning. Manufacturing in many areas is functioning. Somebody is making the masks and the ventilators and preparing the food and growing the food. There are huge segments — somewhat invisible perhaps of the economy –that are functioning. We always have made the decision about the trade-off.

We are not now by any means in a total lockdown. The economy is just functioning differently, and perhaps we have closed up too much, perhaps just the right amount. We have this kind of silly false dichotomy of “essential or non-essential,” left to local administrators and states. But by making this phony excuse of “essential” and “non-essental” we are really in far less than a total lockdown right now.

Alex Tabarrok: Yeah. I agree with you that this nonsense about essential and non-essential — it’s giving government an excuse to do what they always like to do, which is to make these broad-based rules and to decide from their armchairs what’s going to be allowed and what’s not.

In Michigan you can’t buy seeds if you want to grow a garden, which is crazy.

“At first the government ignored the threat and now they’re getting a little bit out of control in the clampdown.”

WalMart has to close off certain aisles because whatever’s on those aisles is deemed non-essential. This to me is ridiculous. I think instead what we need is what Walmart was doing already, which was to have temperature checks for their employees, to disinfect the stores every night, and to have more social distancing, so to have fewer hours so that we can disinfect more and to have one way aisles, for example. If you have a one-way aisle, then you can social distance much more than if you have people going both ways. Now that’s a very simple thing. But it allows much more flexibility and it doesn’t sort of tell people, “Well, you can’t buy this. You can’t buy that. Oh, no, you can’t do that. That’s not essential.”

At first the government ignored the threat and now they’re getting a little bit out of control in the clampdown.

Bob Zadek: Before we leave this almost amusing dichotomy between essential and non-essential. In the San Francisco Bay Area in California, all construction was halted as being non-essential except for, I don’t know if you heard this, Alex, low-cost housing, affordable housing is essential and that’s continuing.

Also in the Bay area there was a discussion of banning gourmet foods. If food is labeled “gourmet,” it’s inessential. However, baked beans, my favorite, and macaroni and cheese — being the opposite of gourmet — you can sell all you wanted. So that’s government at its very worst. I don’t know if you’ve heard those stories. I found that quite amusing.

Alex Tabarrok: I wonder if San Francisco will make an exception for arugala.

Bob Zadek: I hope not. Lettuce is supposed to be green. No other color is acceptable to me. It’s supposed to be green and tasteless.

Alex Tabarrok: Yeah, the construction thing is crazy. One thing I pointed out is actually now would be a great time to fix the roads because there’s no one on them. Construction work is a job where you can social distance quite well. Many of them are already wearing masks — they can disinfect the tractors and the diggers and so forth. So actually now is a great time to improve the rest of the system at low cost.

Bob Zadek: Perfect idea, Alex. You should be working with Department of Transportation instead of wasting your time over there at Marginal Revolution.

Flattening the Curve

Bob Zadek: This issue about flattening the curve raises the choice which many governments felt they had to consider, which is to close down the economy so that not so many people get sick at one time because the healthcare infrastructure simply didn’t have enough beds. Therefore you eliminate or mitigate the spread of the virus. But that has as a negative trade off that once you start to flatten the curve and you send people out from under out from their homes back into society, you haven’t developed the herd immunity we’ve read so much about. Then the virus may very well come back.

This is as opposed to not shutting down the economy, having a very high pointed Mount Everest kind of a curve, but at the other side of it, you’ve eliminated the virus. That has an economic component, and it struck me that the decision was made not based upon science and not based upon economics, but based upon the practicality of simply how many beds we have.

Was the thinking correct on that? Any thoughts on this flattening the curve versus powering through it in a Mount Everest kind of curve?

Alex Tabarrok: I think flattening the curve is a little bit misleading. This was the term which got out there early on to kind of save the healthcare system. I actually refer to the curve and the reasoning behind flattening the curve or the lockdown or social distancing is that the virus can’t survive if it doesn’t find hosts. So we can kill off the virus, stop it from replicating and a couple of different ways one is developed, you know, a vaccine or a to develop, you know, herd immunity.

But the other is the social distance and to hide. We’re basically hiding from the virus, cause if the virus can’t find us, it can’t replicate and it will die off. So what we’re in now is this first part of the plan, which is like the suppression or the lockdown part to kind of kill off some of the virus and get control.

Once we have, we’ve bent the curve. Once we’ve got the number of deaths going down, then I think that we can start to talk about how to get the economy going again and who should go back to work and how, and what sort of safety protocols we need. But I do agree that the first step I think is necessary and that is to suppress and to crush the virus, to attack the virus. But what we’re not doing yet is investing huge amounts in our testing capacity. That is what is going to drive us in the second part of the plan.

“We basically need a Manhattan Project for testing and that’s doable.”

We had this huge relief bill two point — $2 trillion. There’s nothing in there for building new testing machines. We really needto have so many tests that we can basically test people every couple of weeks. We need millions of tests a day. This is the most ingenious country in the world. We can scale this up. We can invest a few billion dollars in these machines and then start testing. That would be a much cheaper of addressing this crisis than the lockdown. So far I’ve seen a lot of private initiative in this area, but the government has not gotten behind this in any big way — they’re behind. We basically need a Manhattan Project for testing and that’s doable.

Bob Zadek: Of course nobody could disagree on the issue of testing, but since it has been so widely written about and commented by so many people, including yourself and your colleagues over at Marginal Revolution, can you help us understand a bit about why such an obvious obvious need is not being met? It’s not like it’s not known. Is there something about the decision-making in government? Is there something structural about our economy that mitigates against the all hands on deck needed for testing?

Alex Tabarrok: To be honest, I don’t understand why we are not pursuing this path 110%. I could understand in the early days,the CDC completely botched the first test and the FDA — following their usual slow bureaucratic procedures — did not allow private and state labs to run their own tests. It was a very costly mistake. The CDC and the FDA have really botched it and are essentially responsible for thousands of deaths, which could have been prevented had we acted earlier.

Although they made this huge error, I can understand it. They were sort of following the usual playbook, which was the risk averse “Go slow.” But at this stage in the game, I don’t understand what is going on. I don’t understand what Trump is thinking. I don’t understand. For example, he’s still talking about creating a task force with Ivanka but she has no no capabilities in this area whatsoever.

Let’s get somebody who’s been thinking about this for some time. Let’s get a noted epidemiologist. Let’s get Bill Gates. The fact that Bill Gates is doing more than the government is an absolute crime.

Bob Zadek: Well, that shouldn’t be a headline. Bill Gates has always done more than the government more effectively, ever since Bill Gates was a teenager. We’ll explore that a little bit more after the break. When we come back from break, I want to explore more the operations of the FDA. Alex has complained that the FDA is risk averse. I have a somewhat different. We’ll explore it in detail.

FDA’s Institutional Weakness: Risk Aversion & the Invisible Graveyard

Bob Zadek: You have used the label quite often that the FDA is “risk adverse.” As we all know, the FDA was horrible in its decision-making. It turns out that the decisions they made were, as it turns out, the most risky. So they might have thought they were being risk adverse, but in reality they were being very much risk takers. I say that because they chose an alternative that was horrible. So let’s explore a little bit about the decision-making of the FDA.

What is their mission and what is their structure? I’m not looking to point fingers at any politician or any single bureaucrat. I like to focus on structure to see what we can learn from a faulty governmental structure.

Alex Tabarrok: That’s an excellent point about risk-taking, Bob. I agree with you. And that is due to the detrimental nature of this virus–if unchecked, it doubles about every three days. That means that you start with a thousand people who are infected and in 30 days that’s 10 doublings — you’re up to a million people. That’s the nature of an exponential curve. When you’re dealing with an exponential process like this, then acting early is absolutely critical because that last doubling — when you go from the ninth to the 10th doubling is an increase of 500,000 people becoming infected. If you act early and reduce just one doubling, then you save 500,000 people from being infected.

Why was the FDA so slow? Well, they don’t usually deal with exponentials and their usual procedure is “if we make a mistake and we approve a drug which turns out to have some bad side effects, then we’re going to be in trouble. People are going to come knocking on our door. People are going to die and then they’re going to complain, of course, and there’s going to be congressional oversight and we’re going to be in trouble.”

On the other hand, if during a usual time period the FDA says, “Well, let’s delay. Let’s take some more time. Let’s do another test,” that also kills people because people would have lived had that new drug been available sooner. They still die, but it’s what I call an invisible graveyard. The relatives don’t know that if this drug had been available sooner this person — my loved one, my father, my brother, my sister — would have lived instead of died. So they’re buried in this invisible graveyard. Most of the time the invisible graveyard doesn’t cause the FDA any problems.

“The relatives don’t know that if this drug had been available sooner this person — my loved one, my father, my brother, my sister — would have lived instead of died. So they’re buried in this invisible graveyard.”

What does cause the FDA problems is the visible graveyard when they approve a drug, which turns out to have some bad side effects. So they’re much more concerned about approving a bad drug than they are about delaying a good drug. And that has bad consequences for us. It means that more of us actually ended up dying than should. But you can understand the FDA’s incentives even though they are very biased.

Bob Zadek:That was observed by Frederick Bastiat when he wrote about the unseen. There are, in any matter of governmental policy, the visible effects of that policy, and then there are the unseen. If you are afraid of being criticized, all you care about is if I make a mistake, let the mistake harm larger numbers of unseen so I will not be criticized. Public choice theory comes into play here. So it was the issue as Bastiat pointed out of the unseen — unseen consequences are never a problem if you’re seeking to hold onto your job. You light a candle every morning and say, “if there’s a God in heaven, no one’s going to know that I messed up,” and that’s Bastiat’s unseen. So structurally then it’s the natural behavior. Nobody wants to be exposed as being bad at their job.

So the problem with the decision-making at the FDA was they made a decision, even though the harm caused by the decision might be greater, they made that decision, as Alex pointed out, because it’s unlikely people will know and will know that these additional deaths are at the feet of the FDA.

So now tell us a little bit more about that wrongful decision-making, and ultimately riskier decision they made, hoping nobody would find out. The die was cast pretty early in the game by the wrongful decision making of the FDA, wasn’t it?

Alex Tabarrok:Correct. First the CDC messed up and their entire job is to prepare for pandemics. I mean, that is their raison d’etre. Right? They had more time than anybody to prepare for this, because it was obvious what was going on in China. China should have been a wakeup call to many more people. This was when I first started getting interested in the issue.

I’m not an epidemiologist, but when I saw what China was doing, the lengths to which they were going to combat this virus… China is not shutting down their economy lightly. Right? The Communist Party of China relies on high growth rates to stay in power. So when you see a government like that closing down and locking down entire cities and closing its economy, you know this has got to be serious. The Chinese aren’t stupid.

So we had lots of time to prepare for this, but the CDC utterly failed. The first produced a botched test, which didn’t work. Then the FDA enhanced that failure by not allowing private labs to run their own tests. And this is where the ordinary bureaucratic behavior of the FDA came into play because they were used to being risk averse.

They were used to thinking, “We must wait for safety protocols. We must wait for efficacy testing. We need to test the private labs. We can’t just say, go ahead and take this test. We need to check out the test out ourselves.”

There were all kinds of ridiculous things like to get a test approved, you had to mail to the FDA a CD-ROM with your test results and the printout. This has been highly crazy when you’re dealing with a super-fast-moving process. It was only weeks later that the FDA finally let up and allowed the private labs to start making their own tests. And that’s when our testing capacity began to increase. It’s not enough, but that’s when things began to happen when we unleashed private forces.

Bob Zadek: You have written quite a bit about the FDA and have questioned their basic mission. What is the FDA’s current mission? Safe and effective is of course the phrase that’s relatively new. You have written that the FDA is given the wrong mission and ought to be recast to behave differently. So tell us how the Alex Tabarrok-structured FDA would look different from its current mission?

Alex Tabarrok: One interesting thing about this crisis is that everyone is feeling the effects of FDA delay, while before the crisis, it was only people who were sick, who felt the effects of the FDA delay. If you had cancer or AIDS or heart disease before the crisis, you also could be pretty angry at the FDA for being so slow and bureaucratic because you felt those effects. I’m hopeful now that people will think a little more when they come to evaluate the FDA.

Now what should the FDA be doing? What do they think they’re doing? Well, basically they have put themselves up as the gold standard — as “We’re not going to allow a drug onto the market until it is both safe and effective.”

They’re the ones who are doing the evaluating and the basically give a permit. “Okay, here’s your permit. You can’t produce a drug until you have a permit.” Now what I think should be going on is actually much more of what I call a Consumer Reports model. Consumer Reports evaluates products, tests products, they rank products, they rate products, but they don’t tell you cannot buy this one. Right? They provide consumers with information and that is an extremely useful thing to do. I’m very glad that they do that and I’m glad when the NIH does tests on drugs and says, “Listen, here’s a randomized controlled trial. These are the effects of these drugs.”

I think the FDA should be much more like a Consumer Reports agency. It should be providing information to physicians and to patients, but it shouldn’t be permitting. It shouldn’t be allowed simply to say “You’re not allowed to produce this drug. You’re not allowed to sell this drug.” It should provide information and then let physicians and patients make their own choices about what trade-offs are reasonable.

“I think the FDA should be much more like a Consumer Reports agency. It should be providing information to physicians and to patients, but it shouldn’t be permitting.”

Right to Try & the Right to Medical Self-Defense

Bob Zadek: The related issue which comes about here is “right to try” — a very important issue for libertarians. Under today’s regime, absent a compassionate use doctrine (we don’t have to get into), the FDA does not allow an unproven drug to be tried. The force of government prevents somebody with a fatal disease — who will have a very short life — from taking a drug that may save their life. Now what’s the danger to somebody who is fatally ill? They are dying anyway. To protect them from a bad drug is utterly absurd, and what if that drug would help them? Isn’t it the individual’s right to say, “I want to take a chance. I have no hope otherwise”?

Alex Tabarrok: I think about this like the right to self-defense. There should also be a right to medical self-defense — that is to take whatever actions you and your physician deem necessary to protect your life in a medical situation where you are being threatened. If somebody breaks into your house and threatens you, you have the right to self-defense. I think if a virus, or a bacteria, or a cancer, break into your body, you have also have a right to medical self-defense, which is to use whatever tools are available to fight back. The FDA stands in the way of doing that.

I’d like to see a whole bunch of rules, because there’s also a drug lag. It takes the FDA time to approve these drugs.

There’s also a drug loss, which is all of testing which the FDA requires manufacturers to do is expensive, and if the patient population is not that big, it just may not be worthwhile going through all of those — all that time and all of that expense to research and develop a new drug. It takes over a billion dollars, over $1 billion to get a new drug on the marketplace. If the market isn’t big enough, then a firm is just going to decide, “Well, it’s not worth it,” and they’re not even going to research and develop the drug to begin with. Both drug lag and drug loss are concerning.

Bob Zadek: Much of the problem would be eliminated if we took away two words fromthe FDA mission, which is “and effective.” If the FDA would just make sure it’s safe — in other words, apply the same standards to drugs that you do to food. Make sure it’s not going to kill somebody. Make sure it is safe but, “and effective” is meaningless. You can tell people the FDA has not found this to be effective. Just like nobody believes that Cheerios is going to cure cancer, but because Cheerios is ineffective at curing cancer, doesn’t mean it can’t be sold.

The FDA is performing a valuable, perhaps unique, public service so long as they are objective and competent — Alex’s word competent — but let them do that. Tell us it’s safe, but, and tell us it’s not proven to be effective. After that, anybody on this planet can make an informed decision whether to spend money and time taking a drug or a food, and we have dominion over what goes into our body. So wouldn’t that do it?

Alex Tabarrok: Yeah, that’s absolutely correct. It was only added after 1962. I think overall that would be better. Now, let’s be honest — we’re talking about tradeoffs. We would get more ineffective drugs. But the advantage is that you would have drugs on the market sooner and you would have more drugs available. I think the advantages overcome the disadvantages.

Simpler Fixes: Automatic Cross-Country Drug Approval & Ending State Medical Licensure

Alex Tabarrok: Moreover, there are even simpler things we could do at least to start. Here’s one idea which I have proposed. It just seems blindingly obvious to me. I haven’t got the FDA and the government to agree yet, but here’s my blindingly obvious idea. Any drug which has been approved by a major developed country, whether that be Japan, the European Union, Canada, Germany — whatever — any major developed country which approves a drug drug ought to be automatically approved within the United States as well.

This is very simple. Suppose you’re in Germany and the German physician says, “I’m prescribing this drug for you.” Do you ask your German physician, “But has it been approved by the FDA?” No, of course not. Germans trust the European medical system and if the physician approves, you’re probably going to take it. “Well, if it’s good enough for Germans, it’s good enough for me.”

Bob Zadek: I have such incredible optimism in general, but specifically on the other side of this epidemic. I’m sure it’s easy for you (as well as myself) to see all of the obnoxious policies that we have acquired in our country that have been set aside — the regulations to deal with the virus. I allow myself to be optimistic that these temporary suspensions of regulations will become permanent because I’m an optimist.

In the few minutes we have left tell us, on the positive side, what changes in our daily lives in the regulations do you see resulting from what we have learned, such as tele-medicine?

Alex Tabarrok: The silver lining is that we now are allowing more doctors to practice across state lines. This is always crazy — it’s one thing to say, “Well, I don’t want a doctor from South Korea. They might not have as good a medical system as ours. So they can’t practice here, unless they’re approved here.” But to say in New York that I don’t want a doctor from California working on me? It’s completely insane. Yet that is the position that we have had — 50 different approval systems for physicians. I think that’s going to go away, but I do think telemedicine is going to have a more permanent role.

We have hobbled it with this crazy HIPAA privacy regulations. But your doctor can’t even email you unless it’s a secure email system and so forth. I do think most of the time the doctor can evaluate you over Skype. So I think that’s going to be a permanent change.

Online education — I think we’re going to do more of that. I’m actually a big proponent of that, so I think it’s not great now because people are having to do it very quickly on the fly. But overall I think that will be a positive trend.

Bob Zadek: Also, we’re not breaking up big tech anymore. No one’s going to complain about breaking up Zoom or breaking up Amazon. I think those will go by the board since it is big tech that is keeping our country alive during this process. There’s so much to learn. We could have a profound effect upon economic and medical life in this country as a result of, dare I say, the experience of the COVID-19 virus.

Alex, thank you so much for giving us an hour of your time this Sunday morning. Your wisdom is always welcome. And once again, I commend our listeners to read every morning Marginal Revolution. It’s there every morning, reliable as can be. The links are wonderful, and check out Marginal Revolution University. It is a wonderful teaching tool.

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