Drugs, War and Deadly Bureaucratic Blunders
President Harry Truman famously asked to be send to a one-armed economist, having been frustrated by economists saying ” on the one hand” and “on the other hand.”
Truman might not have liked to hear the pros and cons of various economic propositions and legislative actions, but in asking for a one-armed economist he was asking for a second-rate analysis, asking to be told only part of the expected consequences of proposed Congressional and presidential initiatives, only a fragment of the outcomes that would likely be generated by proposed changes in public policy.
Taking, for instance, a two-armed approach, one might argue on the one hand that a guaranteed annual income provided by the government, by taxpayers, would reduce poverty, but on the other hand such a universal income entitlement might unintentionally lower incomes in the longer run, particularly in low income quintiles, by increasing school dropout rates, reducing work ethics, and lowering workplace productivity.
“The concept of unintended consequences is one of the building blocks of Economics,” explains Rob Norton, former economics editor of Fortune magazine, in The Concise Encyclopedia of Economics.
American Enterprise Institute scholar Mark J. Perry, a professor of economics at the University of Michigan, stated in a summary of an unintended consequences at the U.S. Food and Drug Administration: “The lengthy and costly FDA approval process might be causing more, not fewer, deaths.”
In his article “Drug Approvals and Deadly Delays” in the Journal of Physicians and Surgeons, attorney Sam Kayman highlighted the estimated number of U.S. deaths due to the “FDA’s incredibly long delay in approving beta-blockers to reduce the risk of second heart attacks.”
By the mid-1970s, reported Kayman, the effectiveness of beta-blockers in lowering these types of heart attack risks, as documented in clinical trials, resulted in a number of beta-blockers being approved in Europe for this use.
“But in the U.S., the FDA imposed a moratorium on beta-blocker approvals due to the drugs’ carcinogenicity in animals,” explained Kayman. “In effect, the FDA was denying needed cardiac drugs to people at high risk of heart attacks because of the unproven possibility that those drugs might cause cancer years in the future. Finally, in 1981 the FDA approved the first such drug, boasting that it might save up to 17,000 lives per year. That meant, of course, that as many as 100,000 people may have died waiting for FDA to act.”
In terms of media coverage and corresponding public knowledge, the victims of a drug that caused death by mistakenly being approved by the FDA receive front page attention. In contrast, those who die because of the FDA’s lengthy approval process generally remain invisible.
The aforementioned deaths resulting from the lengthy delay in this single instance of beta-blocker approval totaled an estimated 100,000 deaths, a body count 41,780 higher than the total 58,220 U.S. military fatal casualties in the Vietnam War, November 1, 1955 – April 30, 1975.
As stated succinctly by former Secretary of Defense Robert McNamara in his 1995 memoir, a chief architect of the Vietnam War and a major force in urging the escalation of American involvement, “We were wrong,” – a concise acknowledgement of a deadly blunder, 19,407 American body bags per word, said with more truthfulness, brevity, and straightforwardness than was evident in the U.S. management of the entire Vietnam War.
Ralph R. Reiland is Associate Professor of Economics Emeritus at Robert Morris University in Pittsburgh.
Ralph R. Reiland
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