A thought experiment: If Virus Tests Were Sodas

Originally published at: https://boingboing.net/2020/05/04/a-thought-experiment-if-virus.html

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After some sleuthing, I have found what this is quoting. Here is a direct link: https://paulromer.net/if-tests-were-sodas/

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Ugh, this is a BAD TAKE.

keep total costs from running out of control, insurance companies, health care providers, and government regulators have cobbled together a system that limits access to soda

The primary purpose of the system is to ensure that the soda doesn’t harm you, kill you, or–since we’re engaged in a false equivalence to diagnostic tests–mislead your doctor as to your health so that they can’t help you make safe decisions.

  1. Not all tests are equal, not from a chemical standpoint and not from a diagnostic utility standpoint. Test sensitivity and specificity are hugely important. If we don’t understand those parameters before we deploy a test, we can’t actually say how useful it is.

  2. We’re careful with the ingredients used in an assay because they can affect the final result. If we add other variables, like a different swab, to the mix, then we need to understand how those variations affect the accuracy of the final result. Otherwise we can’t compare 2 tests, either between patients or between time-points for the same patient.

Those are just the 2 biggest flaws with this comparison. There’s a lot of other really problematic issues in Paul’s post, including unsourced claims labeled as facts. There are fair critiques that can be made of the FDA’s actions in this pandemic–I’m not claiming that they’ve been perfect–but this critique is not one of them. @frauenfelder if Paul’s a friend, help him be less wrong online.

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Oh good. I’m not the only one who didn’t think this comparison made sense.

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In fact, I’d like to see a little more limit on the access to soda!

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The analogy is glib propertarian bullshit.

It tries to deflect the real problems of ensuring the safety of tests, the accuracy of tests, the production of tests, administering the tests properly, performing the labwork associated with tests, distributing the results of the tests, and acting those results of those tests by turning it into a neat little economic fairytale where regulation is bad.

That’s the thing about fairytales. they’re comforting little stories that are completely made up, and only children believe them.

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Yeah, uh, I mean this nicely, but… what the fuck? Food isn’t medicine. The idea that info inserts are driving health care costs anywhere is not smart. Is author suggesting the disclosures in those inserts should be optional? Skipped? Non-binding? Like, what’s the actual critique here?

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The actual critique here is the author is trying to get people to think that the bad nasty drug companies and the evil empire government bureaucrats are colluding to artificially limit the availability and thereby maintain the price of something that everybody wants and needs. And the article he chose for the object of this transparent bit of Randist propaganda isn’t even food - it’s anti-food. It’s a totally unnecessary luxury item that NOBODY actually needs and which in fact performs the exact opposite of the medical item it’s supposed to stand in for here. Soda has a harmful effect on the human body, and unlike Covid-19 testing materiel, the absence of it would actually improve the overall health of the human race. The author of this woefully misguided screed thinly disguised as a “thought experiment” has written a real masterpiece of twisted illogic.

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What’s more, soda cans are in fact required to list the ingredients, the nutritional contents, disclosures about potential allergens and so on. It will also typical list the package material for recycling purposes. There has to be testing and quality control to back up the documentation, and instruments used in production need to be regularly calibrated. None of that keeps beverage companies from selling diabetes-in-a-can for pennies.

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One part of this system is an expensive regulatory process…

An infinitesimal, yet incredibly necessary, part of this system is the “expensive” regulatory process that slows corporations from killing people for profit.

It is a thought experiment, but some thoughts are best kept in one’s head.

ETA: now that I have found and read the full un-linked source, I think the point was perhaps just poorly summarized. Still, the system being onerous does not mean the solution is wild West. Perhaps one solution is to maintain a pandemic task force which can prepare for and overcome otherwise necessary regulatory hurdles in a timely manner by thinking about them before the need is immediate.

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I think the article misses that we have bulk production in tightly controlled pharmaceuticals already. Advil is reasonably priced, non prescription, produced in huge quantities but bound by most of the rules he is complaining about. The problem with cheap scalabale covid testing is that it is a product that no one needed, at all, a year ago and everyone on the planet needs now. If he thinks Coca Cola could scale their production from zero cans to a few billion over the course of a few months, even completely free from regulation, he’s missing the mark.

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Imagine a world (a single country that steadfastly insists that what others can be observed to be doing is impossible) in which the only way to get a soda is to get your doctor to write a prescription. It costs $20 per can. Your insurance company pays. The economy produces about 100,000 sodas each day.

It strikes me that he walks into a glaring contrafactual even before getting to the soda. We don’t live in a world where virus tests are scarce, expensive; and dysfunctionally allocated; we live in a country where that is the case; and in looking at the places doing a better job it’s not, on the whole, a long list of libertarian utopias that boldly deregulated their virus test markets faster than we did.

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C’mon, if Coca Cola were handling things they could have stopped producing New Covid™ and gone back to Covid-Cola Classic™ pretty quickly once the sales numbers demanded it…

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Reading the full thought experiment, I see what Paul Romer is getting at. The barriers to innovation are unnecessary and harmful to people. If we were to just remove some red-tape, we’d be able to get these tests out faster and help more people.

It sounds great, but much of this red tape is there for a reason. We won’t really know how effective these tests are until we do large-scale trials. These are expensive and take time. There’s no getting around that. I’m not up to speed on all the research as to how effective these alternative tests are, but I’m sure there’s a lot we don’t know.

We could roll the dice and go with something that we are pretty sure works. But, is that a chance we really want to take? That would be more devastating than going with the tests we have.

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Well, it certainly has many unintended side effects, and is heavily shaped by industry (insiders that do very well from the current regulatory framework). Regulation is not bad per se, but something I’ve observed from working in medtech is that it doesn’t necessarily achieve the quality desired.

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Not all regulation is science-based. Some of it is to discourage malice or stupodity.
Or bad spelling.

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You fucking commie! /s

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I second most of the critique above, and I think this is dangerously misleading.

@frauenfelder, would you consider placing at least a note of caveat on the quotes? I see you did not provide a link. If you do, please urge people not to jump onto those conclusions.

I am by no means an expert on epidemiology or virology, but as a scientist (biologist) I do understand a bit of what virologists and epidemiologists continue to explain during the pandemic.

The author surely picked up some of the dismay about the very centralised and difficult testing efforts in the US. His intention is surely good, but he is no expert, and his simile with soft drinks is silly at best. His spin, however, is outright bullshit. And his conclusion is by far to condensed to be right:

As long as labs provide tests that do what a test is supposed to do, let them worry about the details.

Sorry, that’s just bullshitting for page views.

The problem is much, much more nuanced.

Have a go here, for example. Published a month ago, in Nature, no less:

https://www.nature.com/articles/d41586-020-01068-3

One (!) money quote:

One problem is that US hospitals use a range of software platforms for electronic health records. Many also have strict administrative procedures for setting up accounts with labs, exchanging samples and handling billing, adds Pride. For this reason, several hospitals chose to stick with the commercial labs they’re already working with, say researchers.

Less than a week later, in PNAS:

Again, just one (!) money quote:

Now, [in California] laboratory personnel “who demonstrate molecular biology polymerase chain reaction (PCR) experience” can legally run COVID-19 tests if they are supervised by a licensed physician or PhD with related lab experience, according to the proclamation (5). […] Even without special legal allowances, molecular biologists are finding ways to pick up pipettes to aid coronavirus testing.

[Edited very slightly for clarity.]

Seriously, the US did quite a lot to catch up. While their jump-start after the first problems isn’t without problems, the bullshit simile with soda is just confusing everything and everyone. It is contributing to public outrage in a very misplaced way. Paul Romer might be a lauded economist, but he sure as hell has no idea about virology, lab work, and life science in general.

My opinion: this is not the time to listen to economists, and giving them a platform, when discussing how to do things in other specialised fields under pressure.

Just FTR: we have our very own economists spreading extremely dangerous bullshit in Germany. Romer is not as bad, but if you ask me: don’t give him your attention. Please.

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Why aren’t they making Coca-Cola with cocaine in it again?

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Paul Ryan, Rand Paul, and Ayn Rand go into a bar. They drink unregulated poison whiskey and die.

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