Carolyn Johnson reports that another cycle in the pharmaceutical outrage machine is building up:

Politicians are, once again, concerned that a drug company that plans to sell an old medicine for a very high price is taking advantage of the system. On Monday, Sen. Bernie Sanders (I-Vt.) and Rep. Elijah E. Cummings (D-Md.) sent a letter to the chief executive of Marathon Pharmaceuticals, arguing that the Illinois company is"abusing” government policies that encourage the development of treatments for extremely rare diseases, called orphan diseases.

“We urge you to significantly lower your price for this drug before it goes on the market next month,” they wrote. “Marathon’s apparent abuse of government-granted exclusivity periods and incentives to sell what should be a widely available drug for $89,000 a year is unconscionable.”

Unlike some of the other recent huge price increases that have been in the news, this one is for a so-called "orphan" drug that treats a rare disease. In this case, the rare disease is Duchenne muscular dystrophy, which afflicts about 15,000 people. That's too few for a pharmaceutical company to spend time on, so in 1983 Congress passed the Orphan Drug Act, which provides subsidies and patent incentives for developing orphan drugs and bringing them to market. It's worked fairly well:

The orphan drug at issue here is deflazacort, which has been available outside the US for a long time. However, nobody had bothered to conduct the clinical trials necessary for FDA approval in the US until Marathon did so. Having done that, Marathon now plans to charge $89,000 per year for a drug that formerly cost about $1,000 per year.

Is this outrageous? Sure. Is it also an effective way to bribe companies to bring otherwise unprofitable treatments to market? Sure. Did Marathon abuse the system, as Sanders and Cummings claim? Probably. The clinical trial of deflazacort was small and probably fairly cheap. Marathon could still make money with a lower price.

But here's the thing: the Orphan Drug Act was passed by Congress, and so was the TREAT Act, which speeds up FDA approvals of orphan drugs. The policy goal is to provide pharmaceutical companies with enough incentive to bring orphan drugs to market, but not so much that they're fleecing the public. If that balance is wrong, then Congress can change it. Just keep in mind that no system will ever be perfect. If we subsidize orphan drugs enough to make them profitable, there are always going to be cases where someone finds an unusually lucrative opportunity. If we lower the subsidies enough to eliminate these opportunities, we may kill off the orphan drug market altogether.

In other words: be careful. Maybe the Orphan Drug Act needs some updates, but don't kill the goose that laid the golden egg.

UPDATE: So how much did it cost Marathon to conduct the studies needed for FDA approval? Derek Lowe points us to John Carroll, who asked a couple of experts for an estimate based on a Marathon slide that outlines their research program. One figured the total costs at $65-75 million, while the other came in at $10-15 million. That's a pretty big difference, but probably not enough to change the math much:

If half of all US patients are put on Marathon’s steroid, that’s at least $405 million gross a year — $33.7 million a month — based on their lower $54,000 annual net price....Because the FDA gave them orphan status, Marathon has a 7-year exclusivity deal for deflazacort. Based on the company’s wholesale price of $89,000, that market is theoretically worth up to $12.6 billion in total through the full stretch.

That's gross revenue, which is considerably higher than net profit. Still, it suggests that $10 million vs. $65 million isn't a very big deal. Even a tenth of Carroll's lifetime estimate would make deflazacort a huge moneymaker for Marathon.

But if this is anything close to accurate, I have a question: if deflazacort is such a slam-dunk winner, why didn't some big drug company do this years ago?

Paul Ryan is doing his best to put lipstick on the Michael Flynn pig:

This is, of course, a falsehood untruth fib evasion flimsy lie. Three separate news organizations—the Washington Post, NBC News, and the AP—have confirmed that the White House was told about this at least two weeks ago. They did nothing. But when the Post made the story public, Flynn was fired within hours. That's all they cared about.

The point of shrugging off the Flynn affair is to head off calls for further investigation. Jason Chaffetz, who never met a Hillary Clinton rumor that he couldn't spin into months of congressional testimony, says blandly that the Flynn affair is "taking care of itself." Chris Collins says Republicans are staying quiet about Flynn because it's Valentine's Day. Seriously. Donald Trump himself says the "real story" is that there's been so much leaking about his administration.

Nope. The real story is what Trump knew and when he knew it. And not just about Flynn, but about the entire Russian hacking affair. If congressional Republicans really believe there's nothing there, they should be eager to investigate in order to clear the air. Obviously, that's not what they believe.

David Corn has more here on why the Flynn story isn't done—and neither is the need for an investigation of Flynn and his contacts with Russia.

UPDATE: Not everyone is taking such a lackadaisical approach to this story:

The strongest support for Flynn came from Moscow on Tuesday morning. Konstantin Kosachev, chairman of the Russian foreign affairs committee, said he did not deserve to lose his job and lashed out at Trump for allowing Flynn to resign. “Either Trump hasn’t found the necessary independence and he’s been driven into a corner,” he said. “Or Russophobia has permeated the new administration from top to bottom.”

It's good to see that Flynn still has some friends left.

The Washington Post tells us today that ISIS knows it's doomed and has already begun preparing a strategy for survival as a purely virtual organization:

[The Islamic State], now confronting its own eventual fall, is devising a modified survival strategy that may involve surrendering control of its “caliphate” in Iraq and Syria but seeks to preserve a virtual version of it online.

....The plan reveals a level of desperation for a terrorist organization that has seen its territory shrink rapidly over the past year....Beyond losing territory under military pressure from the United States, Turkey, Russia, Syria and Iraq, the Islamic State has seen the flow of foreign fighters into its ranks plummet — from as many as 2,000 a month two years ago to as few as 50, according to recent assessments.

The group began altering its propaganda themes last year to prepare followers for the collapse of the caliphate, depicting its mounting battlefield losses as ­noble and inevitable struggles, in contrast to the triumphant messages that had previously dominated its output.

This future strategy is outlined in "Media Operative, You Are a Mujahid, Too," published by ISIS last year and described by Charlie Winter here. Winter's goal is to warn us about what's happening and to make recommendations about how to respond to this future incarnation of ISIS. But it's also worth noting the obvious: If ISIS understood last April that its battlefield position was hopeless, that means the US military strategy was working pretty well.

Donald Trump will inevitably take credit for the eventual destruction of ISIS. I hardly even blame him for that. But the truth is simpler: Barack Obama's approach was the right one. His goal was to win the war against ISIS slowly, inexorably, and with a minimum of US involvement. It took him about five years after he was first elected, but he eventually learned that heavy US involvement in Middle East wars was not only futile, but often counterproductive. It turns the residents of the battlefield against the US; leaves a gaping hole when US forces eventually leave; and tests the patience of the American public.

The war against ISIS leans on those lessons. Iraq is taking the lead, which forces them to get battlefield experience that will stand them in good stead when the US leaves. Residents are angry at the brutality of ISIS, not US forces. And the American public is willing to be patient as long as US casualties are low. The end result is a longer war but a more effective one. When ISIS is finally defeated, Iraq will be in good position to keep it from rebuilding itself. ISIS understands this, and that's why they're preparing for their eventual defeat in the physical world.

The intelligence community has transcripts of Michael Flynn's conversations with the Russian ambassador. Will someone please leak them? Surely we all deserve to know just what Flynn "inadvertently" failed to mention to Mike Pence and Reince Priebus? And please don't try to pretend that releasing Flynn's conversation would harm national security. It would embarrass the Trump administration, and that's it.

Meanwhile, Hillary Clinton's former deputy for communications at the State Department, Philippe Reines, had this to say to Flynn:1

Hillary Clinton herself is on board:

Hillary Clinton has spent her entire career having to be buttoned up. I would love it if she'd loosen up and do a bit more tweeting like this. After all, both Reines and Clinton have more than enough reason to hate Flynn's guts. Details here if you've forgotten.

1In case you don't get the reference, Flynn's son was a big proponent of Pizzagate, the bizarre claim that Hillary Clinton and her pals ran a child sex-trafficking ring from the basement of the Comet Ping Pong pizza shop. This eventually led to a North Carolina man entering the shop and pointing a gun at an employee. He later started shooting, and after he was captured he told police he was "self investigating" the conspiracy theory.

Michael Flynn Sr. didn't traffic in Pizzagate, but he did pass along quite a few other weird conspiracy theories.

My previous post ("Michael Flynn Is In Big Trouble") was either an example of spectacularly good timing or spectacularly bad timing. I'm not sure which. In any case, just as I clicked the Publish button, an alert popped up on my screen telling me that Michael Flynn had resigned. Thank God. The man was a paranoid nutcase, and National Security Advisor is the last place in the world for a nutcase.

The real reason Flynn resigned, of course, is that he lied about his conversations with the Russian ambassador. There's no official reason yet, though. I imagine it will be something like I'm confident I did nothing wrong, but I don't want to be a distraction during this critical time.

Question: Will the investigation continue? There's still plenty of suspicion about whether Trump knew what Flynn was doing, after all. Second question: Where will Flynn end up? The Heritage Foundation? Infowars? Working for RT? At CNN as a national security analyst? We'll have to wait and see.

UPDATE: Here is Flynn's resignation letter. No real reason given except that he "inadvertently" provided Mike Pence with "incomplete information" due to "the fast pace of events." Really? A National Security Advisor who has a hard time handling the fast pace of events? That's really not a position for someone who's easily flummoxed.

The Washington Post has the latest on Flynngate:

The acting attorney general informed the Trump White House late last month that she believed Michael Flynn had misled senior administration officials about the nature of his communications with the Russian ambassador to the United States....It is unclear what the White House counsel, Donald McGahn, did with the information.

Well, within a few days Trump had fired Yates for not defending his immigration order. At that point, I imagine no one in the White House felt like approaching the boss with any other bad news she had passed along. In any case, the issue here is threefold. First, did Flynn talk with Russian Ambassador Sergey Kislyak during the transition to assure him he shouldn't worry about Obama's sanctions for interfering with the election? Second, was Flynn in touch with Kislyak before the election, while the Russian interference was actively taking place? And third, did he lie about it?

In the waning days of the Obama administration, James R. Clapper Jr., who was the director of national intelligence, and John Brennan, the CIA director at the time, shared Yates’s concerns and concurred with her recommendation to inform the Trump White House. They feared that “Flynn had put himself in a compromising position” and thought that [Vice President Mike Pence] had a right to know that he had been misled, according to one of the officials, who, like others, spoke on the condition of anonymity to discuss intelligence matters.

A senior Trump administration official said that the White House was aware of the matter, adding that “we’ve been working on this for weeks.”

....Kislyak, in a brief interview with The Post, confirmed having contacts with Flynn before and after the election, but he declined to say what was discussed.

So: the intelligence community concurred that Flynn had spoken to Kislyak about sanctions; he "misled" Pence about this; the Trump White House has known about this for weeks; and Flynn was indeed in contact with Kislyak during the campaign. It's no wonder that the White House has declined to stand behind Flynn and now says they are "evaluating the situation."

The New York Times has more details:

The Justice Department had warned the White House that Mr. Flynn...could be open to blackmail by Russia, said a former senior official....The White House has examined a transcript of a wiretapped conversation that Mr. Flynn had with Sergey I. Kislyak, the Russian ambassador....The conversation, according to officials who have seen the transcript of the wiretap, also included a discussion about sanctions imposed on Russia after intelligence agencies determined that President Putin’s regime tried to interfere with the 2016 election on Mr. Trump’s behalf.

Still, current and former administration officials familiar with the call said the transcript was ambiguous enough that Mr. Trump could justify both firing or retaining Mr. Flynn....Former and current administration officials said that Mr. Flynn urged Russia not to retaliate against any sanctions because an overreaction would make any future cooperation more complicated. He never explicitly promised sanctions relief, one former official said, but he appeared to leave the impression that it would be possible.

The AP's Julie Pace confirms that the White House has been aware of this for weeks. The Times claims that Mike Pence is especially peeved at Flynn and has taken his concerns directly to Trump. They also say that White House officials have already started "discussing the possibility of replacements."

The other big question here is, inevitably, what did the president know and when did he know it? Was Flynn freelancing the whole time? Or was he acting with Trump's blessing? A few days ago David Corn asked what had become of the big Russia scandal, which seemed to have disappeared from view, and now we know. It was just waiting for the right moment to rear its ugly head again.

Let us engage in some civil conversation with our friends across the aisle. First, here is David French on terrorism:

There are a few terror-related memes that crawl all over the left side of the internet — all of them designed to minimize, to downplay, the jihadist threat. “Bathtubs are more dangerous than terrorists.” “Toddlers are more dangerous than terrorists.”...One needs to consider capacity and intent. My bathtub isn’t trying to kill me. I don’t need the government to protect me from my furniture or my firearms. I can be a responsible gun owner. I can step gingerly around my allegedly dangerous furniture and learn to keep my head above water in my deadly bathtub, but the average American can know next-to-nothing about ISIS’s next terror plot.

This meme annoys me too. Unlike French, I think it's pretty obvious that the threat to Americans from terrorism is objectively fairly small. But bathtubs don't fight back or change their tactics. Terrorists do. This means that a few minor regulations can make bathtubs safe forever, but keeping terrorism from metastasizing really does require vigilance. We may disagree about how much vigilance, but the comparison to lightning strikes and shark attacks is kind of silly. We should knock it off.

(On the other hand, it's a little rich for French to count "60,000 casualties in the struggle against jihad" by including 3,000 from 9/11 and 57,000 from the Iraq War. If there were ever a poster child for the danger of overreacting to fearmongering about terrorism, the Iraq War is it.)

Next up is David French on this week's episode of Saturday Night Live:

While the attacks on Trump got all the press, there was one skit this weekend that actually took aim at progressive pieties. How did this send-up of sappy leftist commercials make it through quality control? Watch and enjoy:

There's nothing unusual here. Liberals have a long and rich history of making fun of their own excesses. Here are a few famous examples from past decades:

You can find thousands more like this with little effort. But you won't find many examples of conservatives making fun of their excesses. I don't quite know why this is. Maybe conservatives take themselves more seriously than liberals do? Or they're afraid of their most extreme faction while liberals aren't? Or mockery just doesn't appeal much to conservatives regardless of topic? I dunno.

POSTSCRIPT: Yes, this whole post is mostly just an excuse to put up a few funny comedy bits. Guilty as charged.

I'm jumping the gun a little here, but I'd like to remind everyone that during his first month in office, Barack Obama:

  • Signed the Lilly Ledbetter Fair Pay Act.
  • Banned torture.
  • Signed a $787 billion stimulus bill.
  • Sent 17,000 additional troops to Afghanistan.
  • Ended the month with a net job approval rating of +27 percent.

Donald Trump still has a few days to go, but so far he has:

  • Signed no legislation.
  • Mostly signed executive orders that are either routine (pay freezes, a halt to new regulation, reversing the Mexico City rule) or little more than PR messages to his base (cracking down on drug cartels, financial regulatory reviews, rebuilding the military, etc.).
  • Signed one executive order that was important, but rolled it out so incompetently that it caused massive chaos and was promptly overturned by the courts.
  • Sat idly by at dinner while aides discussed a North Korean missile launch and then failed to respond in any way at all.
  • Has presided over a White House so epically leak-prone and amateurish that people are already taking bets about which senior officials will get fired within the next few weeks.
  • Ended the month with a net job approval rating of about -8 percent.

This comparison extends to the new Republican Congress too. Obama's Congress was busy immediately with serious legislation. Trump's Congress is struggling to confirm cabinet nominees; is completely at sea about how to tackle Obamacare; and can't seem to agree on how to handle corporate taxes and tariffs. I assume that big tax cuts for the rich are still on the agenda, but it's not yet clear what else is.

Obviously Trump has done some genuine damage already,1 and both Trump and Congress have plenty of time left to wreak a tsunami of even more. But for a guy who was elected to shake things up, he sure hasn't done much real shaking yet. Just a lot of big talk.

1In other words: don't let your guard down. That's not what I'm suggesting here.

This was the scene at Mar-a-Lago as news came in that North Korea had conducted a missile test. The public is all around. Classified documents are lying on the table. People are on the phone where anyone can overhear them. There is no operational security at all. This picture was taken by some random guest from a few feet away. Trump himself just looks bored by the whole thing. Facebook

John Schindler got a lot of attention over the weekend for his Observer article, "The Spy Revolt Against Trump Begins." Here's the bit that raised the most eyebrows:

A new report by CNN indicates that important parts of the infamous spy dossier that professed to shed light on President Trump’s shady Moscow ties have been corroborated by communications intercepts....SIGINT confirms that some of the non-salacious parts of what Steele reported, in particular how senior Russian officials conspired to assist Trump in last year’s election, are substantially based in fact.

....Our spies have had enough of these shady Russian connections—and they are starting to push back....In light of this, and out of worries about the White House’s ability to keep secrets, some of our spy agencies have begun withholding intelligence from the Oval Office. Why risk your most sensitive information if the president may ignore it anyway? A senior National Security Agency official explained that NSA was systematically holding back some of the “good stuff” from the White House, in an unprecedented move.

....What’s going on was explained lucidly by a senior Pentagon intelligence official, who stated that “since January 20, we’ve assumed that the Kremlin has ears inside the SITROOM,” meaning the White House Situation Room, the 5,500 square-foot conference room in the West Wing where the president and his top staffers get intelligence briefings. “There’s not much the Russians don’t know at this point,” the official added in wry frustration.

"Inside" reporting about the intelligence community is notoriously unreliable, so take this with a grain of salt. Maybe it's true, maybe it's not. But just the fact that stuff like this is getting a respectful public hearing is damning all by itself. For any other recent president, a report like this would be dismissed as nonsense without a second thought. But for Trump, it seems plausible enough to take seriously. Stay tuned.

Steve Jobs may be dead, but his reality distortion field lives on:

The speculative frenzy that always precedes a new iPhone has been supercharged in anticipation of the 10th-anniversary release expected later this year. Analysts in research reports have predicted the phone will be one of Apple’s most revolutionary, with some suggesting it will come in three sizes instead of the usual two, with a case made almost entirely of glass and possibly wireless-charging capability.

At least one of the anniversary phones is expected to have an OLED screen, technology that would make the device thinner and lighter. The display, on top of its being an anniversary edition, has led to speculation that Apple could charge record prices for it, said Steven Milunovich, an analyst with UBS.

Three sizes! Wireless charging! An OLED screen! All for a mere thousand dollars.

The sleazy marketing part of me admires the hell out of Apple. They have somehow built up a customer base so loyal that they can explicitly follow a strategy of staying two years behind everyone else and then incorporating whatever features turn out to be popular. Their loyal customers are, apparently, OK with paying astronomical prices for the privilege of always lacking the latest and greatest features. Because it's Apple.

When I switched from an iPhone to an Android phone several years ago, it took me literally no more than a day to get accustomed to the new UI. Phone interfaces, after all, are designed to be super simple, and the iPhone and Android UIs aren't really all that different to begin with. But iPhone users remain fanatically loyal for reasons that escape me. I wonder if this bubble is ever going to burst?