Don’t deprecate off-label drug prescribing

Is it questionable and suspicious for doctors to administer a medication that has not been proved effective for the use in question? Nope. It’s perfectly normal. I explain “off-label prescribing” in a new opinion piece at the Washington Examiner, the news hook being the recent flap about chloroquine/hydroxychloroquine as possible treatments for COVID-19. A related Twitter thread is here as well as here, and here’s our earlier coverage of off-label prescribing.

Also related, this recent line from Scott Alexander is so apt: “Just like the legal term for ‘not proven guilty beyond a reasonable doubt’ is ‘not guilty’, the medical communication term for ‘not proven effective beyond a reasonable doubt’ is ‘not effective'”.

Medical roundup

  • Telemedicine has become a crucial tool during the crisis. 2017 paper discusses the regulatory barriers that had constrained it [Shirley Svorny, Cato Policy Analysis; earlier here, here, and here]
  • “Wondered why it’s been so hard to ramp up production of surgical masks and respirators? Why haven’t private companies flooded into the market to meet peak demand? Because they are regulated medical devices and new versions require FDA approval which can take months to obtain.” [Paul Matzko thread on Twitter]
  • Asking former health care workers to “dust off their scrubs” and return for the emergency raises possible liability exposures [Lori Rosen Semlies, Wilson Elser] “Coronavirus could affect med mal rates: Experts” [Judy Greenwald, Business Insurance]
  • A closer look at certificate of need laws, which suppress hospital bed supply [Eric Boehm, related audio clip with Jeffrey Singer, earlier and more]
  • More on the relaxation of occupational licensure in medical jobs during the emergency [Michael Abramowicz, Jeffrey Singer, earlier]
  • Return with us now to those days not so long ago when public health specialists seemed to be in the paper every day inveighing against alcohol, dietary choices, and such like [Elaine Ruth Fletcher, Health Policy Watch last year on World Health Organization (WHO) rumblings against alcohol; JAMA on furious fight over red-meat recommendations]

Intellectual property law roundup

  • The ethics (and law) of emergencies: heroic efforts to shore up medical equipment on the run, such as using 3-D printing to supply a missing ventilator valve in an Italian hospital, can run into knotty problems of IP rights [Jay Peters, The Verge]
  • “Plaintiff recognizes that the community is in the midst of a ‘coronavirus pandemic.’ But Plaintiff argues that it will suffer an ‘irreparable injury’ if this Court does not hold a hearing this week and immediately put a stop to the infringing unicorns and the knock-off elves…. The world is facing a real emergency. Plaintiff is not.” [Lowering the Bar on federal Northern District of Illinois case]
  • As churches scramble to shift their worship services online, a gnawing question: are you sure you have the right to stream that song of praise? [The Gospel Coalition] Beating hasty retreat, Disney apologizes for having sought $250 licensing fine against arents at California school who’d screened “Lion King” video to entertain kids during PTA event [Nat Orenstein, Berkeleyside; Isabel McCormick, ScreenRant]
  • “It’s still early in 2020. But this is my vote for most annoying copyright complaint so far: a map (thin copyright!) shown (apparently only in passing; I haven’t watched yet) in the background of a movie that not only flopped but did so 8 years ago” [Zahr Said on coverage by Kyle Jahner, Bloomberg Law]
  • Jury awards $1 billion to music labels against cable and internet giant Cox, after claims it didn’t do enough to combat infringement by its users [Chris Eggertsen, Billboard]
  • “Newspaper Can Talk About ‘Derby Pies’ Without Infringing Trademarks–Rupp v. Courier Journal” [Eric Goldman; my Cato podcast on that subject with Caleb Brown back in 2016]
  • “Musicians Algorithmically Generate Every Possible Melody, Release Them to Public Domain” [Samantha Cole, Vice “Motherboard”]

Emergency state powers during an epidemic — and what happens after it’s over

The framers of American government were only too well aware of epidemics as a danger to human life (here’s a list of more than 30 such outbreaks that occurred between 1763 and 1783; Alexander Hamilton and his wife Elizabeth, after both contracting yellow fever and surviving, then underwent quarantine). And American constitutional law has from the outset recognized and countenanced a “police power” in state government during true emergencies to intercept the sorts of otherwise harmless movements and actions that can turn well-meaning individuals into vectors of physical harm to follow citizens. At the same time, as they also knew, freedom would count for little were these emergency powers to set the measure for what government can do to citizens in circumstances short of that dire urgency.

I’m grateful to Ingrid Jacques of the Detroit News for quoting me in her column on this subject yesterday:

“’We have no collective memory of going through this kind of thing,’ says Walter Olson, a senior fellow at the Cato Institute’s Robert A. Levy Center for Constitutional Studies. ‘It’s an invasion of rights we normally wouldn’t let the government get away with.’

“We’re all getting a crash course on what exactly the government can do in times of crisis. It turns out, it’s a lot….

“… Once the virus subsides, limited??government champions should watch whether all the regulations in effect during the threat go away, too.

“’The government must put away these dangerous weapons once the emergency is over,’ says Olson.”

For a sense of the sweeping powers governments sometimes assert in the name of quarantine, isolation and lockdown—definitely not meant as an endorsement—check this New York Times account. (It at least quotes a former NSC official who says “The American way is to look for better outcomes through a voluntary system.”)

Because courts applying constitutional law tend to treat government power as at its legitimate zenith during a “hot” emergency, and (this is nothing new) grant maximum short-term deference to the authorities at such times, ordinarily robust constitutional rights bend at least until the immediate threat to life has passed.

Freedom to assemble and freedom to worship are central to the First Amendment, yet courts have upheld and would uphold bans on religious and political assemblies in times of epidemic. Second Amendment rights that courts would ordinarily enforce, such as to operate a gun store or get processing for a required permit, may also be suspended without a short-term judicial remedy. Indeed, the judicial remedy needed to enforce any right may fail if the courts are closed owing to an epidemic.

True emergencies do not last. When this is over, as it will be, both the courts’ vigilance and ours must be directed toward making sure the government promptly and fully relinquishes whatever emergency powers it has flexed. We will face a body of opinion intent on pressing that exact advantage, as in this Chicago Sun-Times column from Friday:

If we can fight a war against an enemy we can’t see or touch, we certainly could use draconian measures to fight the gun violence in our neighborhoods as well.

Watch out for this kind of thinking. We’re going to hear a lot more of it.

[cross-posted from Cato at Liberty]

The groaning Christmas tree that is the virus economic response bill

Omnibus legislation laying out a federal response to the economic crisis brought on by the COVID-19 pandemic has been stalled because of demands to add a variety of provisions including pro-union revisions to labor law, relief for owners of cruise lines, clean energy subsidies, and much more. Ted Frank has screenshots on “pay equity” and corporate board quotas provisions and also discusses the anti-stock-buyback campaign, while Rachel Bovard has screenshots on provisions on same-day voter registration, airline greenhouse gases, wider use of minority-owned banks and credit unions, a Post Office bailout, and requirements that beneficiary companies incorporate diversity offices into their management. David Boaz of Cato writes: “This is emergency legislation to deal with an extraordinary and unprecedented situation. …Congress should insist on a bill narrowly tailored to address the current crisis, not another sprawling lobbyists’ spectacular.”

Also related to the COVID-19 pandemic and its economic impacts, here is a very fine new piece by Arnold Kling, an economist who understands both cost-benefit analysis and exponential contagious spread. And Alex Tabarrok argues that despite demands that the President invoke the Defense Production Act, the best course is to work with markets to meet medical supply needs rather than attempt a switch to command and control.

COVID-19 pandemic roundup

  • Get the truckers what they need: reversing itself, Pennsylania agrees to reopen all 17 closed turnpike service plazas, heavily relied on by truck workforce [Ashley, CDL Life]
  • No, Senator, Medicare for All would not have kept us safe: “An Epidemic Big Enough to Accommodate Everyone’s Wish List” [Jacob Sullum] Has spending on the federal Centers for Disease Control and National Institutes of Health been squeezed, gutted, etc.? My colleague Chris Edwards checks the numbers;
  • This is not the first time epidemics have interrupted the Supreme Court in its work [ABA Journal]
  • Medical supplier, speaking anonymously “for fear of FDA retaliation,” says it has large quantities of protective masks ready that cannot be used or even unpacked until FDA gets around to inspection [Tom Rogan, Washington Examiner] As part of liability protection, new bill will allow masks manufactured for industrial uses to be put into health care service [Jeanne Whalen, Washington Post; earlier here and here]
  • Good luck and renewed health to David Lat, founder of Above the Law and longtime friend of this site, who’s on ventilation in a New York hospital with a COVID-19 diagnosis [New York Law Journal, his Twitter and Facebook posts]
  • Emergency measures have a way of bleeding into later policy: “Politicians Declare Eviction Moratoriums To Combat Coronavirus. Will They Give Up That Power After the Virus Fades?” [Christian Britschgi]

We’ll pay in lives for the testing debacle

“Between early February and mid-March, the U.S. lost six crucial weeks because regulators stuck to rigid regulations instead of adapting as new information came in. While these rules might have made sense in normal times, they proved disastrous in a pandemic.” [Alec Stapp/The Dispatch] When it’s all over, the CDC/FDA testing fiasco is going to go down in the history books, and not in a good way. “We only need to take a look at South Korea to see how we could have been in a better position if we’d let private industry play a larger role in testing.” [Jeffrey Singer/NBC News] “People have talked about ‘drug lag’ but here is a highly quantifiable measure of ‘diagnostic lag’: the excess deaths and hospitalizations the US will suffer thanks to CDRH [the FDA’s Center for Devices and Radiological Health] blocking a standard test. The sheer cost of what the FDA has done is now universally perceptible, undeniable.” [Balaji Srinivasan; earlier here, and this at Cato]

Two on police surveillance

Matthew Feeney joins Caleb Brown to discuss aspects of police surveillance and privacy in two Cato Daily Podcasts. The first arises from the rapid advance of facial recognition technology and databases: a tech company is now promising to link up photos of unknown people with their presence on the web for private clients and police.

The second inquires into where we are headed with the new electronic neighborhood watch: Amazon’s Ring provides handy surveillance of the front porches of many American homeowners, but acquires a new dimension when localities partner with the company to make it easier for cops to get its footage.