Month: April 2014

In Manila today, after signing a military deal with the Philippines, President Obama once again attempted to assuage Chinese fears over his eastward “pivot”:

At a joint press conference in Manila, President Obama insisted the deal was not about thwarting China’s rise. “Our goal is not to counter China. Our goal is not to contain China. Our goal is to make sure international rules and norms are respected and that includes in the area of international disputes,” he said. …

China begs to differ. Locked in territorial disputes with the Philippines, Japan and others, Beijing sees U.S. involvement in East Asia as unwelcome interference. In an editorial published less than an hour after the agreement was officially signed, state-backed newswire Xinhua blasted the pact, calling the Philippines a “trouble-maker in the South China Sea” and warning the U.S. that its plans may backfire.

Ishaan Tharoor takes a closer look at how China has overshadowed Obama’s entire East Asia visit:

For decades, a Pax Americana, underpinned by U.S. naval supremacy, has authored the status quo in Asia. American military dominance is still a fact, but China’s aggressive military expansion over the past two decades — its defense budget grew more than 12 percent this year alone — calls into question the long-term balance of power. Last year, China commissioned 17 new warships, more than any other nation. It aims to have four aircraft carriers by 2020 and has developed a considerable fleet of nuclear submarines. In the next few decades, China’s ability to project naval power will extend deep into the South Pacific and Indian Oceans. …

China’s build-up comes alongside an increasing number of diplomatic spats between China and its neighbors over disputed territories, particularly islands in the South China Sea and East China Sea. Tensions with the nationalist government of Japanese Prime Minister Shinzo Abe over the Senkaku islands, known by the Chinese as the Diaoyu Islands, have flared dangerously in the past year, with Japanese and Chinese aircraft and vessels engaging in dangerously provocative maneuvers. Calming Asia’s troubled waters is no easy task, especially for an administration that wants to buttress traditional allies but remains fearful of antagonizing Beijing. Obama’s mixed messaging in Tokyo was evidence of the awkward diplomatic tight rope he has to walk.

Previous Dish on Obama’s trip here and here.

Matthew Vines’s new book, God And The Gay Christian: The Biblical Case in Support of Same-Sex Relationships, has gotten a lot of blowback from gay-unfriendly evangelicals. In a hostile review, Andrew Walker explains why the book has struck a nerve:

What makes Vines’ book unique is that Vines does not consider himself a theological liberal. He proudly brandishes the identity of a conservative evangelical, claiming to uphold the authority of Bible, affirming its full inspiration and authority. Throughout the book, he quotes John Piper and Tim Keller, thus signaling his evangelical bona fides.

In the marketing materials for God and the Gay Christian, Vines is a theological wunderkind having found the formula for making biblical authority and homosexuality compatible. Vines no doubt believes the authenticity and sincerity of his interpretation and indeed, that is where the heart of this book resides. As the reader soon discovers, Vines doesn’t believe the error in understanding homosexuality is found within the Scriptures, but in our interpretation.

And so naturally the Christianists are getting antsy. The head of the Southern Baptist Theological Seminary, Albert Mohler, Jr., responded to Vines on his site – and also with a 100-page eBook (pdf), including essays from a number of conservative evangelicals – claiming that Vines wants “to overthrow two millennia of Christian moral wisdom and biblical understanding”:

God and the Gay Christian demands an answer, but Christ demands our obedience. We can only pray — with fervent urgency — that this moment of decision for evangelical Christianity will be answered with a firm assertion of biblical authority, respect for marriage as the union of a man and a woman, passion for the Gospel of Christ, and prayer for the faithfulness and health of Christ’s church. … The church has often failed people with same-sex attractions, and failed them horribly. We must not fail them now by forfeiting the only message that leads to salvation, holiness, and faithfulness.

Matthew Paul Turner has more on Mohler and company’s pushback:

In an email exchange with Vines, the author explained that “most books written on this subject in the past have come from a more progressive or moderate theological bent, so they haven’t found an audience among conservative Christians. But given that my book takes a conservative theological approach, it is much more likely to gain a hearing from evangelicals.”

And that is what scares Mohler about this book, and ultimately, it’s what led him to congregate a few of his theology buddies together to craft an official response to it in the form of a free, anybody-can-download ebook called God and the Gay Christian? A Response to Matthew Vines.

According to Vines, somebody from Mohler’s camp requested an early copy of God and the Gay Christian, but Vines didn’t learn of the ebook until last Tuesday, the day that both books released. Yes, that’s how afraid of Matthew Vines they really are, so scared that they’re fully willing to purposefully sabotage not only the success of Vines’s book with a rush-to-press response but also the conversation he’s hoping to spark.

Jonathan Merritt of Religion News Service brought Mohler and Vines together to discuss the controversy:

[Religion News Servic]: Many note that Christians for millennia have held to a traditional view on this issue. But the church also held to certain positions on matters of race before some challenged prevailing and accepted interpretations of scripture. How does Church history and tradition factor into your thinking?

[Albert Mohler]: One of the key insights of the Reformation is that the church must always be reformed by the Scriptures. We must test everything by the teachings of the Bible, and correct our beliefs and practices when these are found to conflict with what the Bible teaches. The Christian church has had to do this regularly, on matters great and small. But I am confident that the church has not misread the Bible for 2,000 years on this question, and that the normalization of same-sex sexuality and same-sex marriage cannot be justified in any way by an honest reading of the Scriptures.

[Matthew Vines]: I think the most instructive analogy from the Christian tradition on this issue is the question of heliocentrism. For the first 1,600 years of church history, every major theologian and church leader believed both that the earth stood at the center of the universe and that the Bible taught this. With the advent of the telescope, Galileo and others obtained new information, which ultimately led Christians to reinterpret Scripture’s statements about it. I think we’re in a similar situation regarding sexual orientation. Until the past 50 years, Christians didn’t think about homosexuality in terms of orientation. They thought about it simply in terms of excess—along the lines of gluttony and drunkenness. Consequently, there really is no Christian tradition on the specific issue we face today: gay Christians and their committed relationships. Just as with heliocentrism, we don’t need to degrade the wisdom of our predecessors. We simply need to acknowledge that we are in a new interpretive environment, faced with an issue our forefathers were not faced with, and that fact requires us to look at Scripture anew.

Julie Rodgers, who describes herself as “a gay Christian who affirms the church’s historical teaching on marriage,” nonetheless agrees with certain parts of the book. She elaborates on the argument Vines makes above:

Matthew says we now have a more advanced understanding of sexual orientation than they had when the Bible was written. Because we now believe a gay orientation is fixed and unchosen, and the biblical authors were writing to a culture that only understood homosexual behavior in the context of their patriarchal society that viewed gay sex as excessive lust, we have to acknowledge the gap between Scripture’s context and ours, admitting Scripture doesn’t speak to the idea of loving, monogamous same sex relationships. Biblical condemnation of homosexual behavior is primarily related to gender hierarchy in a patriarchal context (rather than gender complementarity), and since we no longer live in such a context then we should reconsider the commands that were written to that specific culture for that specific culture. By imposing the same commands in our current context, the church is mandating celibacy for all gay Christians and forbidding an avenue for them to sanctify their sexuality in the context of a Christian marriage, causing tremendous damage that results in the “bad fruit” of isolation and self-hatred for gay men and women made in the image of God.

Terence Weldon defends the book, citing another aspect of Vines’ approach:

One of the most useful passages in God and the Gay Christian is Vines reflection on the biblical verse, “by their fruits you shall know them”. In his own life, and that of others he was able to observe, he noted that for naturally gay and lesbian people, the fruits of acknowledging honestly the truth of their natural orientation was positive, leading to what in natural law is termed “human flourishing” – and the fruits of denial, for example in the attempts of ex-gay organisations at conversion therapy, were frequently downright tragic.  (Jeremy Marks, who once led an ex-gay ministry in the United Kingdom, aptly described this with another apt biblical phrase, “Exchanging God’s Truth for a Lie”).

Previous Dish on Vines and the speech that gave birth to his book here and here.

Christopher Ingraham shares a chart on Obama’s clemency record thus far:

Emily Bazelon fears that the clemency reforms the administration announced last week won’t go far enough:

This sounds like the swing Holder took last summer at harsh sentencing, when he directed federal prosecutors to stop specifying the quantity of drugs for certain offenders so as to avoid triggering a mandatory minimum sentence. Then as now, it’s not clear how a grand pronouncement plays out on the ground. Traditionally, pardons have often turned on whether prisoners significantly cooperated with the prosecution, were seriously ill or elderly, or simply serving an unduly severe sentence. The key limiting factor on Cole’s new list of standards is the requirement that a prisoner would have done much less time if sentenced today. That could be a narrow category: drug offenders sentenced to long terms before the Fair Sentencing Act of 2010, which reduced the disparity between sentences for crack and powder cocaine.

If that’s all the proposed reform adds up to, it’s too minor a tweak to the system.

It might not even address some of the most sympathetic cases—people who say they played unknowing or peripheral roles in a larger drug ring. People like Stephanie George, who said she didn’t know about the lockbox full of cocaine her boyfriend had hidden in her attic. The judge in her case 17 years ago said he had no choice but to sentence her to life, even though he saw her as “a girlfriend and bag holder and money holder but not actively involved in the drug dealing.”

Abby Rapoport is more optimistic:

[T]he biggest news for criminal-justice reformers has been the administration’s appointment of a new pardon attorney to oversee the program: Deborah Leff, who spent her years at DOJ working on the Access to Justice Initiative, an agency meant to help low-income defendants get a fair hearing in court. “Poor people often do not have access to counsel, and when they do get an attorney, that lawyer is often overworked, undertrained, undercompensated, and placed in a system that encourages a quick plea bargain and discourages carefully listening to the needs of clients,” she wrote in an article with Melanca Clark for the American Bar Association. Those who come from the prosecutorial side of things—which is most everyone at the Department of Justice—tend to be more skeptical of the idea that convicted criminals can be reformed. But Leff’s background makes her more likely to be sympathetic to requests for clemency.

A reader writes:

I’m a pediatrician with a background in healthcare consulting prior to med school, and I’m with you on drug costs. People take this view like it’s “blood money” because the companies sell it for $10 in Egypt. That’s not blood money; that’s charity.

For all the innumerable flaws in our healthcare economic model, we are the engine of pharmaceutical development. The fact that the US market will bear those costs drives funding for essentially everything, such as, for instance treatment for Hep C (which is not really a disease of the rich and famous, and will never have much sales volume in the US).

They come up with these drugs, and price them (often highly, I’ll admit) based on what the market will bear. They then essentially give it away in countries where the market will not bear that (Egypt) or sell it in bulk volumes to healthcare systems who negotiate a better rate with their size (Europe). It’s only our fractious and ridiculous healthcare system that prevents us from negotiating better rates a la Canada and our Euro friends.

Then people like to heap abuse on Pharma for coming up with boner bills and hair regrowth formulas. They do this in utter ignorance of HOW those drugs were discovered. For example, Viagra?

Anti-hypertensive research, erections being a unanticipated side effect. Rogaine? Anti-hypertensive research (hair growth is a side effect). Latisse? Glaucoma treatment (with a side effect of sexy eyelashes).

These drugs came out of treatment research, and have the added benefit of making people happier. There is almost no original research (only refinement) going into any lifestyle drug besides male birth control (which I would argue is a FANTASTIC public health drug) and female arousal (which is a bit more ambiguous).

Sure, the prices look like highway robbery. But so many of these drugs fail miserably, either not working, or for less tolerable side effects than glorious eye lashes. And they all cost insane amounts of money to research, and even the failures advance science. Not to mention the financial awards really incentivize research into practical applications of new discoveries in university and public labs. It’s a lot easier to take a risk in an academic setting with the possibility of a pot of gold at the end of the rainbow.

Another refocuses on the pill that started the thread:

A little context on Sovaldi, as I happened to be discussing this last night with a friend who works at Gilead in San Francisco (the same company that makes Truvada). Gilead paid $11 billion to Pharmasset just for the molecule that the Sovaldi drug is based on. That was before developing and marketing the drug, getting FDA approval, and everything else that goes into making a drug fit for distribution. An eleven figure outlay just to start the process of hopefully developing a drug.

Another reader:

The issues around drug pricing are real. However, Sovaldi is a relatively poor place to pick a fight. The drug will make a significant and legitimate impact on the Hepatis C virus (HCV). The clinical data have been impressive, and it has already spurned on competition from other pharmas. For example, a collaboration between AbbVie and Enanta has yielded a regimen that is as impressive as Sovaldi (and arguably a tick better in certain subsets). They are filing for approval and expected to be on the market. They’ve also signaled that they will undercut Sovaldi’s price tag. In this situation, the market is working as it should, triggering competition, innovation, and pricing pressure.

Also, for these types of small molecules (rather than biologics), I wish that those outraged by the prices would acknowledge one long-term outcome: these drugs will eventually go generic. When they do, the cost of “curing” HCV for the population as a whole will drop significantly. That’s a good place to be, in my opinion. Gleevec, a relative wonder drug for a form of leukemia, is due to go generic very soon. The only impact on society will be a decrease in costs.

As for the view that these companies are gouging patients and society through drug prices: perhaps, as I can’t necessarily confirm or deny. However, I do believe that society is willing to accept high prices initially, provided that they are part of a pact wherein the manufacturer uses the profits for new and novel initiatives. In the case of Sovaldi, the drug maker Gilead has not violated that pact. As you know, they’ve been a long-time leader in the development of novel HIV drugs. And now they appear to have taken those profits and made a large impact in the lives of those with HCV.

But another proposes a different means of innovation:

Why can’t we have an medicinal X-Prize?  Granted, the sums required would be much larger.  But how hard would it be for our own government, or preferably a consortium of developed countries, to pitch in and structure a competition along the lines of “first company to develop a cure for ___ disease will receive a lump sum payment of $5 billion, and the second company will get $2 billion.  Entry into the contest requires developing company to release into the public domain any and all patent rights associated with the treatment.”

Now, those numbers are huge. But let’s say it costs $10 billion in prize money to get that Hepatitis C drug.  Considering that 350,000 people a year die of the condition, that’s about $14,000 per life saved. In just a year. Even in the United States, the number is 15,000 annual fatalities with an estimated 2% of the population carrying the virus (according to the Wiki machine).  What is the cost to our healthcare system of a couple million people needing decades of medical surveillance and intervention for an untreated condition?  What is the cost to our economy of many many people being less able to work and contribute?  Somebody smarter than me could run the actual numbers, but even if we just focused on the costs to the US economy and let the rest of the world ride for free, I’d be surprised if the ROI wasn’t massively positive.

Another adds:

After paying out the prize money, the U.S. government would demand any other country that wanted to use the drug pay a % of the prize equal to the country’s percentage of GDP.  At a quarter of the world’s economy, the U.S. could end up paying as little as $5 billion of the $20B prize.

(Photo: A Solvadi pill)

Sam Stein summarizes a new poll on the ACA:

The poll, which was conducted by Democracy Corps in battleground congressional districts and shared in advance with The Huffington Post, shows 52 percent of respondents want to “implement and fix” the 2010 health care reform law versus 42 percent who want to “repeal and replace” it. Those numbers were 49 percent to 45 percent, respectively, in the firm’s December poll.

The favorable trend toward Obamacare has been witnessed not just in Democratic districts but also in Republican districts.

YouGov also finds that opinion of the law, though still negative, is improving:

Although nearly half the public still believes the Affordable Care Act is mostly a failure, in this week’s poll more than ever before, 25%, are willing to say it is mostly a success, capping what has been a clearly rising trend line in positive assessment of the law.

Cohn describes Obama as “trolling the GOP” on Obamacare:

[P]revious surveys have suggested a majority of Americans simply want to move on to other issues. In the March Kaiser tracking poll, which is different from the survey Kaiser ran with Upshot, 53 percent agreed with the statement, “I’m tired of hearing about the debate over the health care law and I think the country should focus on other issues.” Just 42 percent said it was important to continue debating about the law.

Political strategy isn’t my speciality. I’m a policy guy. But in this environment, it seems to me, the most sensible approach for Obama and Democrats is to defend the Affordable Care Act aggressively—as they are increasingly doing—while trying to promote other causes, like a higher minimum wage and immigration reform, where Democratic positions are more popular. The more Republicans insist that the big debate over Obamacare is not over, the more they look like obstructionists whose agenda consists largely of trying to undo what Obama has done.

Chait explains why Republicans want so badly to run against Obamacare:

In gaming out the Party’s likely course, one factor that must be considered is the sheer burning desire to run against Obamacare as an end in and of itself rather than as a means to win votes. The law has crystalized right-wing resentment against the president, and as his largest domestic achievement, symbolizes the success or failure of the Obama presidency itself. The success of Obamacare would hand Democrats not only a generational policy triumph, but also nullify the Republicans’ campaign to brand him a failure.

One of the deepest regrets harbored, and often expressed, by conservatives is that the nomination of father-of-Obamacare Mitt Romney robbed them of their chance to run the kind of obsessive health-care campaign they have longed for since 2010. The midterms — the first election after the law has taken effect — give them their best chance to claim a kind of popular mandate against its implementation and breathe new life into the cause of repeal. They may have to choose between strategy and rage.