Thursday, April 19, 2018

The Case of the Psychiatric Patient and Ex-Con Looking for Love

In a better world Ask Polly would not have responded to the letter sent by a woman who calls herself “I’m Still Here.” But, we do not live in a better world and Polly doesn’t know what she doesn’t know. Thus, Polly's willingness to address a woman who has an extensive history of psychiatric hospitalization and criminal incarceration becomes an excuse for her, yet again, to show us how little she knows. 

ISH was brought up in an authoritarian religious household. She married young, had four children and then had a breakdown. With the help of a therapist she has folded it all into a narrative of rebellion against oppressive forces. We do not know whether the therapist is a psychiatrist, whether ISH is taking any medication, and what her diagnosis is. We do not know whether her issues are psychological or physiological. We know very little. It does not deter Polly, but any serious therapist would need to know these things and would only treat this woman in coordination with a psychiatrist.

By that I mean that if ISH is suffering from bipolar illness, which is only treatable with medication, we would know that her therapist’s efforts to make it all into a coherent narrative, to fill it with meaning and to shift the blame away from her and on to her husband and parents, is a fool’s errand. Or better, it’s a form of indoctrination.

Now, some excerpts from the letter:

After more than a year of being told I wasn’t good enough, I broke down in the biggest, loudest way I knew how. I put on very public shows of self-harm, hysteria, panic, and despair. I threatened suicide, ran away, overdosed on medications, cut myself, and ended up in too many ERs, ICUs, and psych wards to count. In retrospect, I know I was begging the world to love me. I thought if I hurt myself enough, someone would save me.

My husband divorced me. Naturally, right? Like, who wouldn’t? I upped my level of commitment and put myself in a coma. A few weeks after I was released from the hospital, I put myself in jail.

Jail was a turning point, the degree of torture that it was. My searing terror of ever going back to jail moderated my actions, and it led me to find a therapist who knows her shit. I never thought I’d get to the point where death/escape doesn’t rule my every thought. I’m learning that I am good enough, I am worthy of love right here, right now, and always.

I got a job working with at-risk youth. I got my own apartment. I’m making actual friends for the first time. I’m working with my ex to spend more time with my kids, and I’m parenting them better than I ever have. Even though my time with them is limited, I’m busting my butt to be the parent I never had. I tell them every day how valuable they are and that I love them forever for one reason: THEY ARE MINE. I look at them, I listen to them, and I’m trying to love them with my whole heart.

I want to experience authentic romantic love, but I’m too paralyzed to do anything about it. I want to find a man who sees me — all the sparkly badass parts along with the steaming dungheap parts — and chooses me. A man who would find me sobbing on the couch and connect with me instead of criticizing me. A man I could have sex with because I want to, instead of doing it because I’m supposed to.

Might I say that finding true love is the least of her problems. She had a nervous breakdown and indulged in a spectacular series of self-destructive actions. As I say, she might have been bipolar, in which case she was not treated correctly or well. It does happen. She abandoned her children and her husband and is happy to blame her parents and her husband for her problems. Failing to take responsibility for her actions, she wants to live out the next chapter of the narrative that her therapist has taught her.

In the narrative she is not at fault. She now believes that she understands her problem and that she is ready for love. She still, however, can end up on the couch sobbing uncontrollably. Perhaps this signals an ongoing and untreated depression. Perhaps it's part of a bipolar disorder. If she thinks that love is going to solve it, she has bought the psycho world’s fiction and is about to be seriously disappointed.

Since Polly has no idea about what is going on here, she sounds especially mindless:

And it seems like we’re all destined to experience a private, intoxicating natural disaster that can usher us to the next level of happiness and understanding. But to get there, you have to bear witness to the disaster with every cell of your being. You have to let your emotions and your truest desires into the room instead of burying them deeper. Sometimes that feels a little bit like letting a monster loose.

A private, intoxicating natural disaster… huh? There was nothing private about ISH’s public spectacle. She fell apart in public. I suspect that in her community she has a reputation for bad behavior… and that this does not make her social life any easier. To imagine that her bad experiences can serve as a positive step toward happiness and understanding is absurd, stupid and dangerous.

Polly gets worse, imagining that ISH is an angel of light:

But now your monster has transformed into a gorgeous being of wisdom and light, one that’s anxious to share that light and that joy with others. Even though you feel fearful, I don’t think you have much to fear from love, because you’re resilient, you know your own heart, and you trust yourself. As long as you know that the steaming dung-heap parts of you are all tangled up with the sparkly badass parts, as long as you understand that you are that rare and precious species of angel-monster that has the power to inspire and give generously to others, you have nothing to worry about.

Unfortunately, this is not a joke. Again, Polly does not understand that this woman’s reputation is probably well known where she lives. Her problem is restoring her good name, not finding some form of redemption through true love. Have you noted that our seriously professional credentialed therapists are trafficking in a secular religion? In the name of science.

It gets worse. Polly tells this woman, whose instincts and gut feelings led her into this impasse that she should trust her instincts. When she tried to kill herself, she was following her instincts. When she overdosed she was trusting her instincts. Whatever she did to merit incarceration involved failing to control her instincts:

I just want to remind you that you can trust your instincts. Even though things might feel frightening and uncertain, you know that you’ll be okay. You’ve been through the fire and you can survive. You have to remind yourself, even as you feel fearful, that it’s thrilling and good to feel vulnerable to love. You’re strong enough to feel fear and still be brave in spite of your fear.

Polly next descends into cheerleader mode:

This is a great moment for you, because you get to ask for exactly what you want for the first time in your life! That’s how I feel, too. I can ask for what I want, even when I think it’s a little much. And I can accept when some people aren’t cut out to give me what I want.

This is pathetic. The notion that this seriously damaged women can now live out Polly’s adolescent fantasies is pathetic. Asking for what you want means very little if you are not the person, if you do not have the character and reputation, to obtain it. Polly is setting her up for disappointment.

Of course, we do not know what ISH's therapist thinks about this quest for redemptive love. And we do not know why, when ISH loves her therapist, she is writing to a magazine advice column.

Polly has no idea about what this women is thinking, how she thinks or her belief system. This does not prevent her from telling ISH that she is a great thinker and is fully capable of loving:

But I think it’s even more important to understand the unique, hidden strengths you have that lie in your belief system and in your clear, hard-fought ideas about what it means to be alive and to honor another human being with your love.

Because here you are, living an inspired, engaged life that you can really FEEL for the first time. Savor this. Don’t rush past this moment. Don’t let your interest in true love take you out of the enormous joy of this day, and the next. Don’t obsess. Give yourself time and space to figure out how you want to live and what makes you happy.

You and I know that once ISH goes out to find true love she will most likely be used and abused by men. Surely, her judgment is seriously distorted and her instincts are defective. If she imagines that with her newfound therapy-induced insights she is going to overcome all that, she is smoking the wrong kind of cigarettes. As for Polly, she is being completely irresponsible. She is aiding and abetting what looks to be a looming calamity.

Everyday Life in Multicultural Sweden

Germany has solved its Muslim migrant crime problem: whenever a Muslim migrant commits a crime the police mark it down as right-wing violence. In the meantime the country is being overrun by Middle Eastern criminal gangs. There, that’ll teach them.

On a per capita basis Sweden surpassed even Angela Merkel’s Germany in opening its arms to Muslim migrants. How’s that working out? Politico reports the bad news:

Sweden may be known for its popular music, IKEA and a generous welfare state. It is also increasingly associated with a rising number of Islamic State recruits, bombings and hand grenade attacks.

In a period of two weeks earlier this year, five explosions took place in the country. It’s not unusual these days — Swedes have grown accustomed to headlines of violent crime, witness intimidation and gangland executions. In a country long renowned for its safety, voters cite “law and order” as the most important issue ahead of the general election in September.

Sweden is paying a price for its multiculturalism, for its willingness to sacrifice the lives of its citizens to a dumb idea. In another place and time it would have been called human sacrifice:

Gang-related gun murders, now mainly a phenomenon among men with immigrant backgrounds in the country’s parallel societies, increased from 4 per year in the early 1990s to around 40 last year. Because of this, Sweden has gone from being a low-crime country to having homicide rates significantly above the Western European average. Social unrest, with car torchings, attacks on first responders and even riots, is a recurring phenomenon.

Shootings in the country have become so common that they don’t make top headlines anymore, unless they are spectacular or lead to fatalities. News of attacks are quickly replaced with headlines about sports events and celebrities, as readers have become desensitized to the violence. A generation ago, bombings against the police and riots were extremely rare events. Today, reading about such incidents is considered part of daily life.

The rising levels of violence have not gone unnoticed by Sweden’s Scandinavian neighbors. Norwegians commonly use the phrase “Swedish conditions” to describe crime and social unrest. The view from Denmark was made clear when former President of NATO and Danish Prime Minister Anders Fogh Rasmussen said in an interview on Swedish TV: “I often use Sweden as a deterring example.”

Of course, the weak-kneed Swedish government is attacking the problem. Which problem is it attacking? Certainly not the crime problem. It is attacking its PR problem. It is trying to quash its reputation for being the rape and crime capital of the Western world by ramping up its PR budget. You can’t make this stuff up:

In response, the Swedish government has launched an international campaign for “the image of Sweden” playing down the rise in crime, both in its media strategy and through tax-funded PR campaigns. During a visit to the White House in March, Sweden’s Prime Minister Stefan Löfven admitted that his country has problems with crime and specifically shootings, but denied the existence of no-go zones. Sweden’s education minister, Gustav Fridolin, traveled to Hungary last week with the same message.

Of course, it’s just another big lie:

In March, Labor Market Minister Ylva Johansson appeared on the BBC, where she claimed that the number of reported rapes and sexual harassment cases “is going down and going down and going down.” In fact, the opposite is true, which Johansson later admitted in an apology.

And another big lie:

But the reality is different for those on the ground: The head of the paramedics’ union Ambulansförbundet, Gordon Grattidge, and his predecessor Henrik Johansson recently told me in an interview that some neighborhoods are definitely no-go for ambulance drivers — at least without police protection.

And another big lie:

Similarly, in an op-ed for the Washington Post, former Prime Minister Carl Bildt described the country’s immigration policy as a success story. He did not elaborate on violent crime. After repeated attacks against Jewish institutions in December — including the firebombing of a synagogue in Gothenburg — Bildt took to the same paper to claim that anti-Semitism is not a major problem in Sweden.

When the Times of London reported on migrant crime in Sweden, local authorities were outraged that someone could be telling the truth about their country:

Sometimes it takes an outsider to put things in perspective. A recent piece by Bojan Pancevski in London’s Sunday Times put a spotlight on immigration and violent crime. The article caused a scandal in Sweden and was widely seen as part of the reason why the British and Canadian foreign ministries issued travel advice about the country, citing gang crime and explosions. “They make it sound as if violence is out of control,” said Stefan Sintéus, Malmö’s chief of police.

It didn’t seem to occur to the police chief that both the travel advice and the article could reflect the same underlying reality. After all, only a few days earlier, a police station in Malmö was rocked by a hand grenade attack. Earlier the same month, a police car in the city was destroyed in an explosion.

Officials may be resigned to the situation. But in a Western European country in peacetime, it is reasonable to view such levels of violence as out of control.

We conclude that in multicultural Sweden, run by and for feminists, rape is rampant, migrant crime is rampant,violence is rampant and dozens of neighborhoods are no-go zones. The Swedes might feel especially virtuous about their high ideals, but their migrant population sees things more clearly and is happy to exploit its manifest weakness.

Wednesday, April 18, 2018

NYU Asserts Authority, Stops Disruptive Protest

Here’s some good news to brighten your day. It comes to us from New York University, one of the most respected and most expensive schools in the nation.

What happened at NYU should be an object lesson for universities around the country. Kyle Smith reports on a student protest that took place in the Kimmel Center for University Life. The “woke” protesters declared that they would shut down the center until their demands were met. You can guess what they were demanding. I do not need to rehash them here.

What happened next, Smith reports, showed how best to deal with such adolescent antics. University administrators took to the phones… and placed calls to the parents of the protesting students. They informed said parents that their children risked being suspended from the university and also risked their financial aid. Quickly, the assembled group of activists disbanded.

Smith has the story:

NYU administrators showed little patience for the activists disrupting the proceedings at the Kimmel Center for University Life. But how to dissolve the protest? It turned out that there was no need to bring in the police. Ringing up the students’ parents was all it took. The phone calls advised parents that students who interfered with campus functions could be suspended, and that suspensions can carry penalties of revoked financial aid or housing. The students “initially planned to stay indefinitely,” notes the Voice’s report. “Instead, the students departed within forty hours.”

The university administration did nothing more than to assert its authority. Remember that we have all been told that exercising authority is a bad thing. In the past university administrators have tended to back off, to bend over, to refuse to punish any students who disrupted speeches.

Smith explains:

Higher ed’s decades-long policy of backing away from acting in loco parentis was, at least momentarily, reversed. What else might happen if other universities and colleges rediscovered the positive effects of asserting authority rather than recoiling from it? What if, for instance, Middlebury had withdrawn financial aid and/or housing from dozens of students for disrupting the speech of an invited scholar, Charles Murray, last March? What if Middlebury had even hinted at the possibility it might do so? Middlebury would almost certainly become a much more welcoming place for the free exchange of ideas, hence almost certainly more in line with its supposed ideals as an institution of learning. Instead, after the debacle in which Murray was subjected to (in the words of PEN America) a “lawless and criminal attack” that “marks a new low in this challenged era for campus speech,” the college merely issued a meaningless pile of paper reprimands ranging from probation (just the ordinary kind, not even the double-secret variety) to disciplinary letters being placed in the students’ files.

Universities that demonstrate courage set limits and boundaries. Students respond appropriately. Smith concludes that NYU has taught students a good lesson in how the real world works:

NYU shows us that it’s possible to maintain order on campus, even in the face of the strenuously aggrieved, with a tactic as simple as a phone call. If it disabused the protesters of any notion that the world must stop and listen to them any time they’re feeling feverish with injustice, it did them a favor. Undergraduates often joke about how ill-prepared they are for life after graduation, “out there in the real world.” Colleges and universities should seize the opportunity to teach the real-world fact that being woke is not a license to interfere with other people’s business.

Has Trump Brought Peace to the Korean Peninsula?

Compared with James Comey’s prattle about golden showers and porn star Stormy Daniels’ heartfelt complaints about how people don’t respect her, the possibility of an end to the conflict on the Korean peninsula seems, to the television pundits, like a triviality. The New York Times, to its credit, gave the story major space on page 1,

But, the news is momentous and deserves some note. Don Surber’s blog (via Maggie’s Farm) quotes the CNBC report:

"North and South Korea are in talks to announce a permanent end to the officially declared military conflict between the two countries, daily newspaper Munhwa Ilbo reported Tuesday, citing an unnamed South Korean official," CNBC reported.

"Ahead of a summit next week between North Korean premier Kim Jong Un and South Korean President Moon Jae-in, lawmakers from the neighboring states were thought to be negotiating the details of a joint statement that could outline an end to the confrontation.

"Kim and Moon could also discuss returning the heavily fortified demilitarized zone separating them to its original state, the newspaper said.

We recall the times that media commentators were gnashing their teeth in terminal anguish over the nuclear war that was about to erupt over the Korean peninsula. We recall the insults directed at Donald Trump when he spoke to the South Korean parliament. And we know that he will receive very little credit for what is currently taking place:

Remember when he addressed the South Korean parliament in November? The American press said Trump used it to promote his golf course. I read the speech. He told parliament in not so many words that all was right, and that a peaceful end was near.

As noted on this blog, the man who, along with Trump, is most responsible for this turn of events is Chinese president Xi Jinping. We recall that Trump said that he had developed a good relationship with President Xi. And we recall that Kim Jong-un was recently welcomed in Beijing with all due pomp and ceremony. The Chinese government was giving him face and was probably guaranteeing his survival. The American president had done the same when he agreed to meet with Kim face-to-face. The meeting between Kim and Mike Pompeo over the Easter weekend moved the negotiations forward.

One notes that Pompeo, surely the smartest and most capable member of the Trump foreign policy team was entrusted with the task of negotiating with the North Korean leader. One also notes, with chagrin, that a couple of Republican twerps have declared that they cannot vote for him for Secretary of State.

Be that as it may, Roger Simon takes the measure of the Trump foreign policy this morning and compares it with the Obama foreign policy. As you know, there is no comparison.

It is good to examine the record… all the while understanding that Trump has only been in office for fifteen months.

Simon first summarizes the Obama record:

Obama's foreign policy was a disaster, beginning with the peculiar apology tour that mystified much of its Middle Eastern audience, through the yet more peculiar (misspelled) reset button with Russia that further mystified Sergei Lavrov, on to Obama's overheard whisper to Medvedev telling Putin he would be more accommodating on missile defense after the election (imagine the apoplectic reaction of our media if Trump did that!) to the Libyan war leading to the assassination of Qaddafi (the only Arab leader to voluntarily denuclearize) that created a failed state and a raft of refugees to Italy and elsewhere, and, of course, the rapid exit from Iraq that gave rise to ISIS.

And this omits the equally egregious examples - the failure to enforce the red line on Assad's use of chemical weapons, about which he naively believed Putin, and the never-signed, never published Iran Deal itself, which has done nothing but enrich the mullahs who wreak havoc from Venezuela to Yemen.  This duplicitous and unverifiable non-agreement prolonged the monstrous Syrian civil war, causing the greatest refugee crisis since World War II and changing the character of Europe possibly forever.

The Trump record is a work in progress, but here are a few highlights:

To begin with, there's the near-annihilation of ISIS.  Then there's the renewed alliance with Saudi Arabia and the Gulf States without, miracle of miracles, the ostracism of Israel.  Indeed, while announcing the move of the US embassy to Jerusalem (with little protest by ME standards), the Israeli-Saudi alliance has flourished.

And also:

And then there is the North Korea situation.  Not one American president made a dent in it.  There are no guarantees, but Trump seems to be on the brink of.... something. It's exciting to watch because there is actually a possibility of real peace in a part of the world that has not seen it in well over half a century.  Trump, the peacemaker, balancing North Korea, South Korea, China and Japan?  Who would have thought it?  Not our media.  They hate him so much if he cured cancer they would think it was a trick - or a clever way to sabotage Obamacare.

And then there’s the threat of a trade war. Every sensible commentator has opposed the Trump approach to tariffs. And yet, Simon offers a counterargument:

Our media and some of our business people and the knee-jerk political opposition went into paroxysms when Trump threatened tariffs with China.  But how else could a rebalancing of our trade with our greatest competitor ever be effectuated?  Certainly not by the jawing of stodgy trade officials who have been at it for decades with no results and little incentive to have any.  Now it looks as if it may succeed. (What's surprising is that our media didn't get what Trump was up to in the first place, negotiating.  Scratch that.  They probably did.  They just couldn't stand it because it was Donald doing it.   That's how stunted they are.)

Simon believes that the tariffs were a negotiating strategy, gamesmanship more than a declaration of war. We shall see.

Simon suggests that Obama’s idealism, his inability to engage in balance-of-powers diplomacy for a nation he believed to be corrupt, made it impossible for him to be an effective world leader.

On the contrary, Simon believes that Trump is not just pragmatic in terms of trying to find out what works, but that he has managed to develop good personal relationships with world leaders while also playing hardball in the arena. The salient point, as I see it, is that Trump understands that with good relationships, with Xi and even with Putin, he runs less of a risk that his opponents will misinterpret American strength as an invitation to war:

This partly explains Trump's two-tiered approach - criticizing a country's actions while seemingly being softer or even too soft on their leaders (Putin, Xi).  The president wants to get things done and realizes, from business, that is the effective way. You might insult the leader for a while, as he did with Kim, but eventually you stop in order to get your way.  You don't alienate the boss who has to make the final decision or it won't get made - unless you want to completely annihilate him, but Trump, despite what his critics says, has not indicated that he does.  In fact, the reverse is true. Consequently, Trump, as he has demonstrated, has little use for ideology or even consistency. In a constantly changing world, he may be right. Those who are looking for some sort of Trump Doctrine may be looking for something that is actually outmoded. So far he is being more successful than Obama and all the neo-Marxist works of Marcuse, Gramsci, etc. combined.

Tuesday, April 17, 2018

The Case of the Nagging Girlfriend

It’s so easy that even Carolyn Hax will see it clearly. So I thought to myself after reading a letter written to the Washington Post advice columnist. As rarely happens, I was wrong. Hax, who is considerably more woke than your humble blogger, whiffed on the question. I’ll present the letter and you will see whether you can do better than she did.

Here goes:

I have been seriously dating my boyfriend for over two years, and we live together. I have expressed more than once that I want to be married, and that it is something I value and want in life, and we had a lengthy conversation about it a couple months ago. He always tells me he's "not ready, but maybe one day," and says the same thing about having kids.

We've had our ups and downs, and lately I feel as though he doesn't actually want to marry me or make any big commitments. I am almost 30, and don't want to wait around forever for him make up his mind. It took about nine months for him to just call me his girlfriend.

I've also written him notes to fully articulate my feelings without him interjecting, and he doesn't usually write much back. It is either defensive, or he will say something like "thanks for sharing." Truly, I don't know where most of his feelings lie about any of this, and I am being very transparent.

Should I just start to accept that we in fact do not want the same things?

What does Hax say? Of course, she mumbles about a lack of intimacy, about a failure to commit, and an inability to communicate. In short, she blames the boyfriend.

In these words:

Or accept that even if you do want the same things, you won’t know that because he doesn’t talk to you. Except, apparently, either to interrupt you while you’re trying to talk or to be dismissive of what you take the trouble to write down.

What you describe isn’t the absence of an engagement or of common goals — it’s an absence of intimacy. Intimacy takes two people who are being transparent with each other about their feelings for each other, and about their hopes, goals, fears, doubts and frailties. So if it’s intimacy you want, then this isn’t the person you want for a life partner, even if he proposes to you today.

Of course, this is psychobabble. It fails to address the problem. 

Hax continues:

But judging from your letter, you’re pressing to formalize a relationship that flat out isn’t working in some fundamental ways — “thanks for sharing”? seriously? — and this says you’re due to revisit your principles on commitment.

Yes, but why isn’t the relationship working? Has it crossed your mind yet—it certainly hasn’t crossed Hax’s—that the letter writer has become a nag? She nags her boyfriend all the time about marriage and he has shown her that, if she really wants to get married, she should shut up about it.

Surely, you recognize that this poor woman has imbibed therapy culture wisdom. She expresses her feelings, all the time, orally and in writing. She has learned to lean in. She says what she wants, clearly and unambiguously, and she assumes that because she keeps nagging about it, her boyfriend is going to accede.

She thinks that she is a modern woman. She has overcome the old habit of waiting for a man to propose. She thinks that she can nag him into proposing, and that if he doesn’t, it means that he does not want to marry and does not respect her words. Hax thinks so, so it cannot possibly be true.

Here’s the bottom line: her rhetorical infelicities have made it impossible for him to propose marriage without feeling that he is giving in to pressure, that he is being controlled and manipulated by her, that she wants to push him around. She’s pushing him around, so he pushes back. Her nagging has deprived him of initiative. Thus, he must first save face, even if that means dismissing her concerns as so much nagging. If he gives in, he will manifest weak character. If his character is weak he will not be very much of a husband.

So, the solution to her problem is: to shut up about marriage. Even to say that she is not clear whether or not she wants it. Her current strategy, designed and sold by feminist leaders, is not working. She can blame the man or she can take some responsibility and change strategy, to shut the fuck up about marriage.

The Future of Gene Therapy

People were scandalized, but they should have known better. Medical science and the pharmaceutical industry are businesses. They exist to make a profit. If they did not make a profit they would not long be in business. And they would not be doing the groundbreaking research that has given us gene therapy.

Evidently, they make more money from extended treatments than from one-shot miracle cures. Recently, the New York Times reported that some people might have to take anti-depressants for life, At least, SSRIsy are presumed to provide a therapeutic benefit. Psychoanalysis, on the other hand, does not produce any real therapeutic benefit, but has parlayed its failures into endless treatment. It may not be good for you, but it is a good business model.

Similar questions are now being raised about gene therapy. When a Goldman Sachs analyst asked whether one-shot cures for extremely rare genetic conditions could make for good business, people were horrified. They did not know that many pharmaceutical manufacturers choose to dedicate their research efforts to diseases that afflict more, not fewer people. This feels reasonable and caring. Why cure two people when you can find a drug that cures two million.

But it also assumes that we cannot do everything. Yet, if your child is one of two people with a genetically based illness, I doubt that you will feel consoled by the fact elementary economics tells us that we must choose where we put limited research dollars.

Anyway, the truth, as reported by the MIT Technology Review (via Maggie’s Farm) is that pharmaceutical manufacturers either avoid new gene therapies or price them at millions of dollars a treatment—passing the buck to insurance companies. And thus, dividing the risk. After all, if treatment costs millions, and if only three patients need the treatment, insurance companies will probably not have too much trouble paying it out. If it costs millions of dollars and millions of people have the illness, it’s a different story.

And yet, for the pharmaceutical manufacturer, spending millions to develop a treatment for an illness that afflicts a half-dozen people is not good business, no matter who is paying for it, and no matter how much they charge.

The Review explains a recent decision by GlaxoSmithKline:

Just today, we saw GlaxoSmithKline sell off its pipeline of gene therapies for rare disease to a London startup called Orchard Therapeutics for a 20 percent stake in the young company.

The treatments Glaxo didn’t want were bona fide miracles: one-and-done cures that replace a broken gene and save a life.

One was Strimvelis, a therapy for a rare immune deficiency that’s been curing kids outright.

Another, still in development, is a DNA fix for a devastating childhood disorder called metachromatic leukodystrophy, which affects the brain. Victims lose their ability to talk, walk, and think before losing their lives.

The economic problem is that companies can run out of patients as they’re cured. Or they may not have enough of them in the first place, if the gene therapies treat exceedingly rare diseases.

For instance, only a couple of dozen kids each year in the US and Europe are diagnosed with the type of “bubble boy” disease that Strimvelis treats, called ADA-SCID. So even at a price of $665,000, Glaxo didn’t see that the drug was going to be much of a business.

Or else, consider the case of Novartis:

Other gene cures could be made more valuable if prices are a high enough. On April 9, Novartis said it would pay almost $8.7 billion to acquire AveXis, owner of a gene therapy that’s been curing kids with spinal muscular atrophy.

That disease is 20 times as common, so there's a larger market. Yet Novartis’s projections that the treatment could bring in several billion a year in revenue also suggest that the company might charge unheard-of prices, perhaps $2.25 million according to Wall Street bankers.

Should we consider it fortunate that spinal muscular atrophy is 20 times more common than “bubble boy” disease? It’s a grim calculus, made even more grim by our knowledge that a large part of medical expenses today involve end-of-life care.

Recently, we learned that Barbara Bush had decided to forgo any further medical care in favor of comfort or palliative care. And we recently reported on Barbara Ehrenreich’s new book, wherein she suggests that she is done with preventative tests.

The treatments provided in the last six months of life extend life a little and perhaps make it more livable… even though many of these treatments do not even do that. And now, we spend fortunes on everyone’s grandparents and are wondering about how we are going to pay for an expensive treatment for an illness that afflicts a dozen children. It seems easy until you ask: how many diseases afflicting a very small number of individuals exist?

It feels like an easy question, but it is likely more difficult than we think. At the least, it’s worth raising.

Paul Krugman's Greatest Prophecy

In 1998 famed stock market prognosticator Paul Krugman gazed lovingly into his foggy crystal ball and saw the future of the internet:

The growth of the Internet will slow drastically, as the flaw in ‘Metcalfe’s law’—which states that the number of potential connections in a network is proportional to the square of the number of participants—becomes apparent: most people have nothing to say to each other! By 2005 or so, it will become clear that the Internet’s impact on the economy has been no greater than the fax machine’s.