Medsafe Delenda Est

Excellent news out of the UK. Abrysvo, a vaccine for RSV administered to pregnant women, reduces infant hospitalisation by 80%. 

From the BBC:

A vaccine during pregnancy which protects newborns against nasty chest infections is cutting hospital admissions of babies by more than 80%, UK health officials say.

A virus, called RSV, affects many babies in the first few months of life and can leave them gasping for breath and struggling to feed, with more than 20,000 babies ending up seriously ill in hospital in the UK every year.

Since 2024, women have been offered a vaccine from 28 weeks of pregnancy to protect their newborns.

A new study analysing the impact of the vaccine shows it gives "excellent protection" to babies when they are most vulnerable to RSV, the UK Health Security Agency (UKHSA) says.

RSV (respiratory syncytial virus) is one of the main reasons young babies are admitted to hospital before the age of one.

The UK govt website provides a few more details (alas, the link to the paper is broken).

The vaccine here is going to have been Abrysvo; it's the one that England rolled out against RSV.

Last year, I noted Abrysvo in a Post column on the proposed Medicines Amendment Bill. 

I'd written:

New medicines are slow to be authorised for the New Zealand market.

Even if it a medicine has already been approved by many other trustworthy overseas regulators like those in Canada, the UK, Australia and the EU, Medsafe can take a very long time to evaluate a medicine.

But pharmaceutical companies are not quick to get their medicines into our approval process. New Zealand is a tiny market. We are not at the top of anyone’s priority list. Medsafe will not assess a medicine without an application.

Consider RSV – the respiratory virus whose name is utterly unpronounceable when it isn’t an acronym. It is highly contagious. Pregnant women, infants, and some young children are more at risk from it – at least according to the Immunisation Advisory Centre.

Vaccination against RSV is available for New Zealand’s elderly. But while 40 other countries allow access to Abrysvo, a vaccine administered to pregnant women to protect their infants, Medsafe’s database shows no evidence that its manufacturer has applied for New Zealand approval.

New Zealand researchers helped with the clinical trials that proved its safety and effectiveness. But the vaccine is not available here. Simply being good enough for 40 other countries and tested here isn’t sufficient.

I noted that the Bill's proposed fast-track approval process for medicines wasn't what had been promised in the Coalition agreements. Those promised automatic approval if at least two trusted overseas regulators had approved a medicine - regardless of whether anyone got around to applying for Medsafe authorisation. 

And I worried that the fast-track would not solve the problem if the underlying problem is pharma companies not seeing NZ approval as being worth the time. We're an afterthought. 

The FDA and EMA authorised Abrysvo in pregnancy, to protect infants against RSV, in 2023. 

When I made my submission on the bill last year, a search of the Medsafe database showed no evidence that application for NZ approval had been made. 

As of this afternoon, the same search yields the same result. 

If you're pregnant or are thinking of becoming pregnant, talk to your GP about s29 access to Abrysvo. It might be tough. There might not be anyone importing it. And a lot of doctors don't like using s29. 

It is approved in Australia. I don't know whether Australian doctors are willing to dispense for Kiwis willing to pay. 

This is so stupid. 

Medsafe authorisation stands between pregnant women and this vaccine, approved in dozens of countries, and well-proven in the UK. 

Fingers crossed that Pfizer is just holding off until the 'fast-track' verification process is live, and that it goes live fairly soon. 

A closing snippet from the BBC piece. Delays can be costly. 

The vaccine didn't come in time for Laine Lewis's son Malachi, now 12 years old. He developed a cold as a baby which deteriorated so much that he was taken to hospital, diagnosed with RSV and put on oxygen. Malachi later stopped breathing and a scan soon after revealed brain damage.

His mum has said it's important his story "doesn't scare people" because what happened to Malachi was very rare.

But she added: "I'd encourage people to take the vaccine for RSV because it will help their child."

Dr Watson said the vaccine could "make a big difference to keeping babies safe" through the winter.

"I would strongly encourage any pregnant woman to discuss it with their midwife, other health professionals, and be ready to have the vaccine at their week 28 appointment, or another vaccine appointment arranged soon after that."

Latest figures show around 64% of pregnant women in England are getting the RSV vaccine, but that falls to 53% in London.

Addendum: Nothing here argues a case for government funding. That would require its own more rigorous case. I do not know why anyone would read the above as arguing a case for funding. It is only arguing a case for authorisation, so those willing to pay can have that's choice, whether or not it would be sufficiently cost-effective to warrant funding. And remember that some medicines get pulled from Pharmac's evaluation queue for want of a NZ sponsor for Medsafe authorisation. 

Afternoon roundup

A closing of some of the tabs

First, a set from closing a pile of the week's accumulated stories from the Stuff papers. I wonder whether the people who complain about the absence of real journalism bother reading what The Post and Sunday Star Times have been putting out lately. 

• National's 'tax relief' won't be a tax cut "because the only real cut is a spending cut, anything else is just rearranging who pays what and in which generation."
• "If Health New Zealand can't find doctors, his iwi will." Some of the social services already being provided by Ngāti Toa.
• Andrea Vance asks "How did the cost of moving two schools blow out to more than $400m?"
• Promising work on methane vaccines for cows. Including great context from Dave Frame. [And here's Dave Frame and Adrian Macey over at Business Desk on methane]
• A path from John Birch through to anti-fluoride activism in NZ that runs through ZAP - a group I'd not heard of for at least a decade. Just great stuff from Charlie Mitchell here. 
• Poor response rates in the 2023 Census, and speculation that it might be the last census as we know censuses. 
• This one is just beautifully written. Joe Bennett on a walk up a hill.

  There’s a lot to be said for being a cattle beast. You live with friends. Your food is all about you. You own nothing but an ear tag. And castration frees you from the main source of worry and expense. Admittedly you make one bad journey in the end, but you don’t see it coming, and your mates go with you. And you’re spared the horrors of old age.

And the rest of the tabs. Or some of the rest. I'm drowning here but the computer needs to be rebooted.... 

• One hypothesis on why Google Search doesn't work as well as it once did.
• Another climate stress test, another finding of zero systemic risk justifying RBNZ's continued prudential excursions into climate issues. Unless prudential reg now is meant not to guard against systemic risk and instead starts from assuming that bank directors are idiots and that bank shareholders need to be protected against bad decisions.
• NZ's NPS-UD doesn't go hard enough. British Columbia's enabling apartments up to 20 stories near transit stations. 
• A new (to me anyway) metastudy on workforce diversity. Effects are significant and positive, "but insubstantial."
• "If the government believes making it more difficult to recruit offshore is going to get 50,000 people off the dole they are as deluded as all those who came before them who wanted to believe the same thing. I get the politics. I don't get the economics."
• RBNZ now investigating whether we should have a central bank digital currency.
• The Government really ought to push ahead with the Rule of Two for Medsafe Approvals. It would unlock access to RSV vaccines. Come on......
• Taiwan wants NZ to do more in supporting anti-authoritarianism. I wonder whether we ought to be doing more in supporting scholarships for promising students from the Islands to study in NZ.
• After my Insights column on the Christchurch Cathedral cost-benefit assessment, a reader pointed us to the business case for a major Tauranga city redevelopment project. I'd hope that, if central government is putting money into this, it pushed hard on checking whether the increases in tourism are plausible (and net national rather than within-country diversion). And whatever arguments one wants to have about appropriate discount rates for social projects as compared to infrastructure projects, expect infrastructure spending (like museums) to be portrayed as social investment where the lower discount rate allows a higher NPV for purported benefits. Bit of a Lil Lisa's Slurry problem here. 
  
  
  

Afternoon roundup

The tabs!

• “Is it unfair on everybody else that has paid for that road and doesn't use it? I mean, this equity stuff's bollocks, this is about traffic. ...Consultation’s bollocks as well.” Mayor Brown ain't wrong.
• Predictions that Labour and Te Pati Maori will strike a deal where TPM seeks only the electorate votes in Maori districts and Labour seeks only the party vote in those districts. Biggest question is why MMP has avoided these kinds of rorts so far. They're the obvious play. 
• Good time to be a liquidator.
• 35 kilograms seems like a lot of cocaine to seize in one go for a country of 5m people. Are there reasonable measures of demand elasticity? One could perhaps work out the size of the market based on price movement. If the price doesn't move much, either the market is huge or suppliers are able to quickly plug even a 35kg hole. If it moves a lot and stays high for a long time, less so.
• My normal drill on carbon forests and biodiversity is that if you want more biodiversity, don't screw up the ETS accounting - use a separate policy instrument. But if this is right, then biodiverse forests sequester more carbon. And if it also applies to NZ forests, then making sure the settings accurately reflected sequestration would encourage greater biodiversity. 
• Don't envy Shane Reti this hospital pass. The health system is not in good shape. 
• Works in Progress on Upzoning NZ
• Maybe post-prison half-way houses should be next door to judges' primary residences. Skin in the game and all that.
• NZ needs a dedicated agency whose only task is infectious disease. Indeed.
• Andrew Norton on Australian attempts to centrally plan higher ed.
• Why We Need Taiwan.
• Mercatus on cutting zoning down to size. Tons of good stuff in here on problems with single-family zoning. 
• Good News! New Zealand is at less of a competitive disadvantage relative to Australia! Bad news: it's because they dropped by more than we did.

The only thing you'll be nursing is your whisky

Either New Zealand has no shortage of nurses, or New Zealand is a fundamentally silly country. 

Look on, ye voters, and despair. 

A new nurses' training school is ready to train, but has to sit empty. Why?

Here's the bit in BusinessDesk: 

Instead, bureaucracy and an absence of pragmatism is coming before both the pressing workforce crisis and urgent patient needs.  

The delays all come down to an historic technicality requiring education providers to offer a Bachelor of Nursing programme before they can offer an Enrolled Nursing programme.  Yet enrolled nurses trained by UP Education in Australia are able to live and work in NZ using this exact diploma. 

They’re high-quality nurses who make essential contributions in hospitals, private practices and aged-care facilities. 

Let’s repeat that. This qualification is a cornerstone of the Australian healthcare system. Those who hold it can work immediately in the NZ healthcare system. Yet it is not allowed to be taught as a standalone qualification in this country.  

This outdated standard is likely why the NCNZ, the nurse training regulator, originally agreed to consult with its members on the removal of this standard.  

However, the NCNZ has since decided to bundle this specific review of a single technical clause into a much wider review of sector-wide nursing competencies across the country’s entire nurse training sector – for enrolled and registered nurses. A technical standard that could have been reviewed and removed in a matter of weeks has snowballed into a review requiring consultation across the whole health sector beginning late this year or early 2024, potentially delaying our nursing programme a further 12 to 18 months. 

Newsroom covers it too:

Rivera said she had been told the registered and enrolled nursing scopes would be wrapped together from early 2024.

“Then there’s the consultation on what the actual education standards might look like, so I said to [Nursing Council chief executive Catherine Byrne] that this sounds to me like a 12-18-month delay.

“I didn’t get a reply, but that is my assumption given how consultation processes work with the Nursing Council.”

At the extreme end, Rivera’s estimated timeline could push the opening schedule to early 2025.

The facility, which got $370,000 in taxpayer funding through the Tertiary Education Committee, will sit empty until the consultation comes to an end.

“I have staff hired and ready to go, but luckily we're quite nimble and I've got them working on other health qualifications, so they are doing other things.

“The broader issue is we thought we could be part of a solution to a problem, and the bureaucracy around it is astonishing. There's just no movement.”

Rivera accepted the scope of practice needed to be looked at. “But it shouldn't mean that when there's a crisis, everything grinds to a halt and no new player is allowed in the market.”

 

Certified

If a drug or medical device has already gone through the regulatory gauntlet at the FDA and Australia, or in the UK and Canada, or the EU and Taiwan, or Switzerland and Singapore, does it seem all that likely that Medsafe's going to find anything that everyone else missed?

Sure, Medsafe has 'expedited' processes for drugs already approved elsewhere. But those processes still impose cost - particularly time cost on pharmaceutical companies' regulatory affairs teams. 

And five million middling-income people at the far end of the world just don't hit the priority queue.

Alex Tabarrok talks about the FDA's invisible graveyard: all the people it has killed by being too slow to approve safe and effective drugs. How should we think about New Zealand's, when New Zealand insists on running a separate process for drugs already approved elsewhere?

In August, Pharmac dropped a pile of drugs from funding evaluation. Why? In twenty-four cases, Pharmac said, "We understand there is currently no Medsafe approved product available in New Zealand. We are not aware of any supplier willing to pursue Medsafe registration."

The government here likes to say the problem is the pharmaceutical companies, and that Medsafe would be happy to process their applications if only they'd apply. The real problem is that we have this process at all for drugs already approved elsewhere.

ACT yesterday announced that it would require Medsafe to automatically approve any drug or device already approved by at least two other trustworthy regulators, unless Medsafe had extraordinary reason not to approve it. 

ACT says if a drug or medical device has been approved by any two reputable foreign regulatory bodies (such as Australia, United States, United Kingdom), it should be automatically approved in NZ as well within one week unless Medsafe can show extraordinary reason why it shouldn’t be. 

This simple change would significantly improve access to medicines that have already been subject to rigorous testing and analysis through other regulatory regimes.

The Strategy would include a working list of international regulatory regimes that have comparable or more robust systems compared with New Zealand. It will also include an analysis of areas where international analysis might not be directly relevant to the New Zealand population: for example, if there are significant differences in population makeup that would distort medical efficacy.

National's policy isn't far from that.

4.2 Faster approvals for new medicine

New Zealand’s slow approval process for medicines means Kiwis wait much longer than people in other countries to access potentially life-saving treatments. While it is essential that medicines and other treatments are subject to stringent scrutiny to ensure they are safe, there is no reason why New Zealanders should have to wait for our domestic medicines regulatory body, Medsafe, to conduct its own cumbersome process from scratch, when countries with health systems we trust have already gone through this exercise.

National will

• Legislate to require Medsafe to make decisions on approval for registration for all medicines within a maximum 255 days, to align with Australia,
• Require Medsafe to implement even faster approvals processes for any medicines for use in New Zealand that have already been approved by at least two regulatory bodies that we currently recognise, including Australia, the EU, Singapore, the UK, Switzerland and the US.

I've long wanted this kind of policy. And there's some hope that the general congruence of the two parties' policies could mean it gets done in the event of a National-ACT coalition.

Excellent.  

Afternoon roundup

The tabs...

• Earthquake strengthening costs on one Wellington performance venue have increased from $90m to $182m and now to $329m (Dom, Herald). We have no clue what strengthening the recently quake-designated Michael Fowler Centre and Opera House might cost. Would it be crazy to expect a billion dollars across all three? After $100m more than necessary on a library? All for a town of about 200,000 people where the water pipes are a century-old collapsing mess? It's a good thing Wellington's pretty...
• Mothers of underweight babies below a cut-off get substantial US government support; those just above the cut-off don't. Run the RDD and find no effects of funding on outcomes. 
• NZ's National Party promises non-finance spending two percentage points of GDP higher than Ardern promised in the 2019 Wellbeing Budget. 
• Devastating New Yorker piece on the Ariely / Gino mess. Harvard's Business School is not a serious place. 
• Admin staff at the Auckland Uni law school are substantially happier than faculty. I keep wondering when somebody might set up a union that represents only academic staff. 
• Superb BusinessDesk piece on Sean Colgan, who backed Rako in its fight with the Ministry of Health. And has leant David Seymour a plan for the election campaign. 
• My piece in this past weekend's Stuff papers covers two recent NBER working papers on zero-sum thinking. 
• California's math curriculum is nuts. Unfortunately, this kind of nuttiness is also infecting New Zealand.
• A lot of US voters are confused about whether Robert F Kennedy Jr is Bobby Kennedy. They identify the picture of Bobby Kennedy from the 1950s, the father of Robert F Kennedy Jr, as being Robert F Kennedy Jr. He's aged remarkably well if so; the father would be turning 98 later this year. Every time you learn a little bit more about voters, just be amazed that the world isn't even worse. 
• For six years, NZ had a government that expressed commitment to wellbeing as its highest goal, and yet this. 
• So Sanitarium ran into some supply issues and cut supply to The Warehouse before either Foodstuffs or Woolworths. Which seems more plausible: that the whole thing is a stitch-up by the big supermarkets to get Sanitarium to cut out a low-price potential competitor, with a new grocery regulator watching? Or that the big supermarkets have longstanding contracts where they pay a bit more to have clauses providing greater security of supply? I'd bet on the latter, but nobody else seems to have considered that possibility.

Morning roundup

The morning's worthies:

• NZ alcohol policy basically gives a veto over licensing to the Medical Officer of Health and to the Police. Sucks when you get a prohibitionist in charge of either. And why are so many NZ prohibitionists named Palmer anyway?
• Josh Gans on copyright status of AI-created works. 
• Grimes set up an AI trained on her own work. It tweets. Grimes notes, "The degree to which this bot has mastered my internal monologue is terrifying to me"
• Michael Reddell on RBNZ forecasting. I think it's a damned shame we didn't get NGDP markets for NZ; Simon Bridges murdering iPredict may have cost us considerably. Thanks again Simon. 
• A reminder that it was Don Lavoie who coined the term "knowledge problem" for Hayek's fundamental insight, not Hayek himself. Even if you think you're familiar with the term, please read this. 
• Immigration NZ continues to be an absolute mess. It's only partially the bureaucracy's fault. They'll have had whipsawing policy directives from the Ministers. First it's clamp down and don't process visas because Labour hates immigrants. Then the inevitable bad consequences from blocking migration, so they get told to stick every employer into the high-trust accredited employer visa programme to speed up processing - which pushes actually trustworthy employers into the same queue with a bunch that really really aren't. And the inevitable consequence of that. Absolute mess. Herald, Stuff. The Stuff piece is particularly good. 
• RBNZ figures that migration might now be reducing inflationary pressure rather than adding to it - easing labour supply bottlenecks.
• In today's edition of "China is actually a more stable and reliable trade partner than the US," Trump promises 10% across-the-board tariffs if elected. Shouldn't US foreign policy aim at encouraging deeper trade links with the US and reduced reliance on China?
• Action on Smoking and Health is getting fed up with BS coming from Health Coalition Aotearoa.

Afternoon roundup

The tabs do pile up. A few days out at the NZAE meetings, a couple days leave, and then digging out from under the pile...

• If the government forbids asylum seekers to work, it ought to be providing them income support. Instead it bans them from working and requires them to live off of any savings they might have, and charity. It really is a kind of administrative evil. 
• Anton Howes with some fun history of freight infrastructure
• Paul Walker with some fun history of the firm
• “You’ve got this cool thing that will get you the youth market and make you look innovative. But if there’s even the tiniest chance it will lead to a big fraud investigation or AML problems, you have really stuffed up. And you can never prove something 100 percent won’t go wrong.”
• Christchurch is pretending that its sun is different from the sun elsewhere as an end-run around MDRS rules. It'll be a test of how government responds to these kinds of shenanigans. 
• Industrial and process heat is covered by the ETS. Nevertheless, central government requires councils to consider climate change when consenting industrial process heat. An ETS means councils shouldn't have to think about this. 
• National has proposed a third medical school. But it won't do a lot of good without expanding the number of supervised practice positions at hospitals. Right now, there are international doctors who could practice here, in a desperate doctor shortage, but there aren't enough of those slots, and those slots are mandatory. Some catch, that catch-22.
• There has now been an increase in clinical practice positions so that we can get more nurses. Three years into the pandemic, but better late than never. 
• The great thing about carbon prices is that people really don't have to understand what actions are associated with reducing global warming. Prices give them all the guidance they need. Good thing, because a survey of Kiwis had 'rallying behind recycling' as doing the most good for the climate. Recycling has negligible effects on GHG. But it doesn't matter, because waste is in the covered sector... 
• StatsNZ isn't likely to hit census response rate targets.
• "Since when are monopolies for private companies a good thing?" Well, they can be. But they're less likely to be when granted by statute, as they are here...
• The pharmacy guild advances implausible arguments for maintaining guild restrictions on pharmacy ownership. 
• Me, in Newsroom, with a reminder about Alchian's shipping the good apples out. 
• Police response-time targets have been curved...
• Willie Jackson wants to have a big nationalistic fight with Big Bad International Platforms to take to the election. Only sensible way of reading this. 
• Tech to reduce nitrogen runoff from fertilizer. Neat. 

Afternoon roundup

The worthies, on the closing of the browser tabs

• I still have great difficulty understanding why it is worse to draw up to 5000 cubic meters of water per day from an aquifer to put into bottles for people to drink than it is to run the same amount of water through cows.


• We have a desperate shortage of nurses. Meanwhile, the Nursing Council is blocking a nursing school from training new nurses. It's just nuts that ComCom is likely going to waste its next market study on a populist beat-up on bank mortgage interest rates. The opportunity cost is high.


• Lianne Dalziel on the review into the Auckland cyclone response. Good thoughtful piece from someone who's been there [should ungate tomorrow by removing the /pro from the URL]. 


• Transpower's increased the expected amount of solar generation coming onto the grid by 2030. In 2020, they expected about 1 GW by 2030. Now they expect over 7 GW. Wow. 


• Ice cream is associated with lower risk of diabetes. Unsurprisingly, the NZ public health people aren't having a bar of it - their latest recommendations on diabetes stick to the ban-and-tax stuff. Why not make ice cream part of school lunches? 


• Good summary from Pattrick Smellie on the work that Robin Oliver commissioned from Sapere looking at effective tax rates (average and marginal) across different income bands and family situations. I had a chat with Robin about that work yesterday. 

Afternoon roundup

It's been a while since last posting. The tabs...

• Gita Gopinath on Covid's lessons for inflation and central banking


• Long-Covid and labour markets. There is still far too little data on this. 


• Expect it to get weirder


• Be careful about audit studies that use racially-loaded names to signal race. They can signal other stuff at the same time. And they aren't perfect signals on race either. 


• Matt Levine on Silicon Valley Bank


• Very strong NZ public support for incentive payments to local councils. Good.


• Ian Powell on some of the messes in health system reforms. There will not be the back-end efficiencies the government may be looking for. Ian McCrae suggests these reforms for the next policy bonfire.


• Pattrick Smellie on lame government industry transformation plans


• I expect a NZ version of this would find similar results: the decline in marriage and the rise in social problems. 


• Doesn't it make more sense to finally deal with the messy problem of setting FBT on employer-provided parking than to try to FBT-exempt every single possible substitute for driving? Should sneakers be FBT-exempt for those who walk to work?


• Electricity generators warning that proposed Resource Management reforms are going to completely screw up building new power generation. 


• Rebecca Macfie argues that a pile of contractors wind up working for less than minimum wage and so contractor law reform was needed. I have difficulty squaring the assertion about low low contractor wages with the fact of very tight labour markets where hospitality and retail are having to pay margins above the minimum wage even at entry level. Is it illegal for these workers to just go and find a different job?


• 72% of Kiwis think that farmers should be allowed to use genetically modified grasses that reduce methane and nitrate emissions.


• It really looks like the guy running NZ's newly merged polytechs hasn't got a clue about academic freedom.

Afternoon roundup

Oh the tabs. 

• Chris Quin is CE of Foodstuffs North Island. His chat with Morning Report on what they've been doing to get groceries through to Hawke's Bay, including helicopters....
• The nastiness is intrinsic to Dahl's work. Erasing it is a mistake. I still think that when rights-holders abandon the original works by making them unavailable, those works should enter the public domain. Especially if the author is already dead. 
• Looks like business-as-usual continues on at least one front. Government is set to impose a pile of compliance regulations on incorporated societies and there just isn't time to let them look at the regulations before they take effect. Government, despite the change at the top, is still trying to do too many things at the same time and risks making serious messes. 
• Dileepa Fonseca also points to government capacity constraints. "...Wellington's workforce is already overwhelmed coping with the central government's demands at the moment..."
• Yeah, it'd be great if it were easier to import and use plasterboard in rebuilding from a cyclone. 
• Headline says it all about building anything: "New Far North council dog pound balloons from $200,000 to $2.4m and can house fewer dogs."
• Look, if they were really serious about it, they'd have made it some kind of Commandment.
• University of Canterbury's Covid response was risible. 
• Effective Altruism in the classroom!
• Genetically modified trees that are sterile and so no wilding problem. But GE regs mean they can't be planted. 
• Bryce Wilkinson on some of the problems in the RMA replacement bills
• The perils of trying to curtail hazily defined 'disinformation'
• The Future of Long COVID
• We don't need laws against scapling. And if a platform like Viagogo can't reliably make sure it isn't selling fake tickets, people won't use it. 

Afternoon roundup

Easing back into the office after a summer break and already the tabs have multiplied.

Today's worthies:

• Alex Penk on the value of free speech
• Zoning Reform in Gotham. One option sounds a lot like NZ's National Policy Statement on Urban Development. 
• Bryce Edwards expects a big politician pay increase after the election. I'd forgotten about the MP pay freeze. I like that a nominal pay freeze for the politicians responsible for the dilution of the Reserve Bank's mandate and erosion of accountability for meeting its inflation target means substantial real pay cuts for them. 
• Bryan Caplan is working on a book on zoning reform. Will look forward to it!
• Regime uncertainty around investment in thermal generation is a problem:

  “Mitigating the winter 2023 operational coordination issue with further information is insufficient by itself, particularly considering the limited timeframe to resolve the issue,” the system operator says. The key issues are the influx of unreliable wind generation, the paucity of fast-start thermal generation, and the weakening market incentives for slow-start thermal generation. And Transpower says the EA’s proposed measures won’t address these underlying problems.

  The article notes some more complex multi-hour generation contracts as a potential solution. 

• Getting more energy generation seems like a good idea and people get unreasonably upset about landfills. And so a waste-to-energy plant gets knocked back for want of an adequate cultural impact assessment. 
• But, on the plus side, there is more generation coming through - including 168MW of geothermal
• Medicaid expansions in the US did not reduce mortality. In line with the results of the now-old RAND experiment. 
• Some details are up on the new smokefree regs. New Zealand's Planning Board has mapped out where cigarette stores will be allowed to be. Oamaru and Queenstown will each be allowed to have two stores. Balclutha can only have one. Auckland will be allowed 13. These are all clearly the scientifically-determined correct number of stores. If you disagree, you have a couple of months to make your submission. 

Morning roundup

Another 'everything is stupid and broken' compilation from the closing of the browser tabs.

• Pharmac's comms team lied, repeatedly, to Today FM about an upcoming announcement. Then when Today FM reported on the very strong rumours it had heard, Pharmac's CE, perhaps mistakenly believing that TodayFM had had an embargo copy and had broken an embargo, announced they were blacklisted from any future interviews. Pharmac had set up a cozy feel-good exclusive for Patrick Gower so he could gush about the announcement. The drug is incredibly expensive per quality-adjusted life-year that it provides. Nobody has said anything about whether Pharmac has negotiated a good price, or whether cost-effectiveness has stopped being primary at Pharmac. If it's the latter, then Pharmac could have done more to help people by putting its limited budget to other uses. But Gower apparently teared up about how great it all is so all must be fine. Those providing 'fawning coverage' will get the exclusives. Others won't. 


• Our Prime Minister describes what was, odds-on, a deliberate attempt to entrench policy while under urgency and in very severe violation of constitutional norms - and criticised as unconstitutional and undemocratic by the country's main constitutional law experts - as 'quirky'. Quirky. Right. 


• Hiringa Energy tries setting up a windfarm and hydrogen plant, which would initially produce urea fertiliser. Greenpeace ties it up in the courts for years because it doesn't like urea. There are ample other suppliers of urea who would provide it if Hiringa didn't. Making sure freshwater management is set properly and that emissions from fertiliser on-paddock are correctly accounted really matters, but you sure as heck don't fix any of that by blocking one potential plant. The point was probably to excite Greenpeace donors about their fight against Big Fertiliser. A better court system would make Greenpeace face the full cost that it has imposed on others. We do not have a better court system.


• Wellington Hospital's emergency department is falling apart at the seams. 


• We're in a desperate labour shortage. The Immigration Minister still wants to make it harder for the spouses of migrants on work visas to take up employment. This kind of crap has been one reason some medical professionals have been leaving NZ - it's just too hostile to the rest of their families. 


• TVNZ's Jack Tame interviews the Broadcasting Minister. It becomes very clear that the Broadcasting Minister thinks Tame should be toeing a company line on policy. He goes on to criticise Tame's "negative interviewing" style. Thomas Coughlan is good on this episode. In that same interview, Jackson says Meta and Google have three to six months to cough up enough money for NZ media companies or he'll act. This is the behaviour you would expect of a Minister of a half-way respectable country, or of an extortionate mafia thug?

Afternoon roundup

The closing of the tabs:

• Environmental review laws have long been used for NIMBY purposes. This is a new one. The best that could come of this is a recognition that environmental review needs to be fixed.
• If Australia starts enabling nuclear power, NZ should consider a trans-Tasman approach that would let us piggyback on some of their regulatory efforts. There are economies of scale in this kind of reg. And Australia should be sure to kick NZ out of the arrangement if we start behaving like dicks. 
• The simplest explanation for Labour's approach to labour-market regulation is that they base their expectations of employer behaviour on how government behaves when it is a monopsonistic employer. 
• The simplest explanation for occupational regulation for medical workers is that it's a cartel arrangement that proved sticky when conditions changed.
• They've stopped pretending to be playing at anything other than extortion. “By doing things with news organisations, Facebook was attempting to reduce the risk of government hitting them with a big invoice,” one publisher said. “By pulling out, they’ve made it more likely that they will be whacked with regulation.”
• Could make for a fun test around Peltzman effects, if they gathered numbers on it.
• More reasons to be sceptical of the value of peer review, in some disciplines. The most obvious explanation for the problem (department demographics will reflect international demographics in the field, with some home-country bias, rather than home-country demographics full-stop) is ignored. But the paper's problems are bigger than that. Almost reads as a Sokal hoax. But it seems sincere. At U Manitoba, where I went for undergrad, there were more profs who were US Vietnam draft dodgers than there were in the Winnipeg population overall. An overrepresentation of them necessarily means an underrepresentation of the Canadian-born. Which is totally fine. Canadians will be overrepresented on US university faculties too. 
• David Harvey on problems in proposed changes to hate speech regs.

Life expectancy and health outcomes

There's a literature on everything, so I expect someone's already done this. I'd be keen to see the result if someone has.

There are almost-certainly piles of disorders that are particularly damaging when you're older rather than younger, and where there are apparent differences in effect by ethnicity after correcting for age. 

I know that the Ministry of Health here has pointed to differences in Covid outcomes by ethnicity in multivariate analysis correcting for age but there will have to be lots of other ones.

There are two ways of thinking about age. You can think about it as years since birth. Or you can think about it as percent of expected life expectancy already expended. Same as how you can think about your fuel tank as how many litres of fuel you've used since you filled up, or as what percentage of the tank is left. 

Suppose that life expectancy at time of first birthday varies by ethnicity for whatever mix of environmental and genetic reasons. Fuel tanks vary in size. If you're counting litres of fuel used since the tank was full, there will be very different amounts left in the tank depending on the car. 

And suppose further that the true effect of some disorder on health outcomes depends on your remaining life expectancy before the disorder hit rather than your time since birth. Basically anyone who's at 95% of their life expectancy is going to have a rougher time with the illness regardless of whether that 95% mark hits at age 67 or age 80. 

If that's the underlying process, if you run a regression with health outcomes on the left-hand side, and age-in-years and ethnicity on the right-hand side along with whether someone catches the disorder, you're going to lump effects into ethnicity that might not really belong there for this particular disorder. 

It'll be true that a greater proportion of people with this ethnicity at that age die of the disorder, but the ethnicity variable will be a mix of underlying differences in mortality risk by ethnicity plus disorder-specific risks.

I'm not trying to criticise the MoH work here. I'm just wondering where this kind of thing has been considered in the literature. Do age-ethnicity interaction terms sort it out by allowing the effect of age on health outcomes to vary by ethnicity? MoH throws in a "hospital-registered co-morbidity" variable that will catch some of the 'effectively old for physical age' effect but wouldn't get all of it.

I just keep remembering that old Robert Fogel work looking at the health status of US Civil War enlistees, where the 50-year-olds of the 1850s were hitting the health problems of today's 70-year-olds. It'd be true to say that 50-year-olds of that era were at far higher risk of dying from heart attacks. But they were also way closer to end of expected life expectancy. So it wasn't just that heart attacks were worse then - it was that life expectancy was lower, people effectively aged more quickly, and something like a heart attack is worse when you're more run down. 

Other not-so-fun bit from that old NYT piece on the Fogel work, that could also be relevant these days:

Dr. Almond had a problem with the studies. They were not of randomly selected populations, he said, making it hard to know if other factors had contributed to the health effects. He wanted to see a rigorous test — a sickness or a deprivation that affected everyone, rich and poor, educated and not, and then went away. Then he realized there had been such an event: the 1918 flu.

The flu pandemic arrived in the United States in October 1918 and was gone by January 1919, afflicting a third of the pregnant women in the United States. What happened to their children? Dr. Almond asked.

He compared two populations: those whose mothers were pregnant during the flu epidemic and those whose mothers were pregnant shortly before or shortly after the epidemic.

To his astonishment, Dr. Almond found that the children of women who were pregnant during the influenza epidemic had more illness, especially diabetes, for which the incidence was 20 percent higher by age 61. They also got less education — they were 15 percent less likely to graduate from high school. The men’s incomes were 5 percent to 7 percent lower, and the families were more likely to receive welfare.

The effects, Dr. Almond said, occurred in whites and nonwhites, in rich and poor, in men and women. He convinced himself, he said, that there was something to the Barker hypothesis.

Afternoon roundup

A closing of some of the browser tabs:

• Eli Dourado on NEPA - America's equivalent to the RMA. Superb seeming primer on how it all works, though I would not be one to notice any holes in it. 
• Road-building is going to get harder, thanks to a court interpretation around water consenting. Minor bits of drainage are going to hit large hurdles. 
• Chris Snowdon in conversation with Marewa Glover on New Zealand's tobacco and vaping regime. 
• Possibly the best approach for "glue ourselves to things" protestors: leave them there.
• Lindsay Mitchell picks up another aspect of the Perry child poverty report: substantial differences across regions in foodbank uptake, sorted by material deprivation. 
• "Rather than address the workforce crisis it inherited, Labour instead resorted to restructuring the health system to put it under greater central government control and make it more vertical. This was a fatal error." 
• NPR's Darian Woods and Wailin Wong on America's blocking Chinese access to higher-tech chips.
• Government may be preferring government-built housing in easing RM constraints. That, as a pattern, will make it harder to get necessary RM reform - if govt can exempt itself from the worst effects of bad RM rules...
• Older piece now, but I want to be able to find it again. Cato's critique of the US Jones Act, which prohibits foreign shippers from transporting goods between US ports. NZ shippers often want this kind of rule here too. It's been doing particular harm in Puerto Rico lately. 
• Sex work legalisation in NZ included measured aimed at protecting temporary migrants from exploitation; those rules may be doing more harm than good.
• Youth justice facilities overwhelmed by numbers.
• Emergency rooms overwhelmed by numbers and want of staff.
• Mental health system overwhelmed by numbers and want of staff.
• One reason the new Rings of Power series may not be as faithful to The Silmarillion's account as it could be: copyright. 
• Wellington: for, by, and of connected insiders. 
• MBIE is running a review of space policy. Wish there were a one-click submission option "Just leave it alone and don't break things." There are just so many submission processes on...
• Yet another area in which NZ could do well by simply recognising standards in use in other places. This time, car safety. 
• It looks like the prescription guidelines for medicines for ADHD have been designed around avoiding Ritalin flowing out into other uses rather than helping patients. And the one doctor who prescribed in accordance to patient needs rather than guidelines is in trouble for it. 

Evening roundup

I was out on leave last week, touring around Lake Taupo with the family, hoping desperately for snow that didn't come. 

We had fun anyway. 

But the browser tabs... a week's worth of emails, and stuff saved up... egads. 

Some worthies as I try to clear six different Chrome instances...

• Wikipedians don't like research on IQ. They're even slowly memory-holing the Flynn Effect.


• Time to end the Canadian Dairy Cartel


• Neat evil DMCA hack: create a fake-dated earlier version of content you don't like, then claim the original is a copy. 


• DevPolicyBlog on reducing remittance costs in the Pacific. I hadn't known that getting money from Oz/NZ to the Islands has some of the highest remittance costs in the world. But it makes sense: NZ is overly enthusiastic about AML, and that's a fixed cost in a small place. 


• John McDermott on the case for another Saturday Night Special. When credibility is lost, getting inflation back under control is costly. The RBNZ forgot its job, and we will all bear a cost. 


• Jem Traylen tries to figure out why the government won't fast-track residence for migrant nurses. There are no good answers. 


• The Australian Therapeutic Goods Administration has approved Moderna's Covid vax for under-5s. Unclear that Medsafe has even started looking at it. 


• The McGuinness Institute maintains an archive of Government Department Strategies. There are 221 operational GDS and 327 archived ones. I did not know there were so many. 


• Frank Newman on a few problems in the government's Three Waters financial modelling. Oh - and the IT systems alone could cost half a billion. 


• I wonder how much income protection insurance premiums are going to go up because of Long Covid risks. Would be fun if cautious mask-wearers could get a discount...


• Survey evidence of misperceptions could just be miseducated guesses. But wouldn't that predict unbiased means?


• The flu-normal sucks.


• New Zealand's defamation law is even worse than I'd thought. Its reach extends to America.


• Prof Beaglehole on Smokefree 2025.


• Three cheers for the three Christchurch councilors who voted against the stadium.


• Infometrics warns inflation expectations look unanchored. 


• Cameron Bagrie warns of a lack of expertise on the RBNZ Board. I remember Suzanne Sniveley telling us at the NZAE meetings that all is fine. 


• This is just lovely. How the world's worst golfer kept getting to play at big golf tournaments. Great fun story. 


• Pandemic-related losses in education. New Zealand did manage to get through the early period with some of the shortest periods of school closure in the developed world. But we're still showing shocking results on literacy and numeracy - though tough to tell whether it's worse than pre-Covid. 


• Russ Roberts' chat with Ran Abramitzky and Leah Boustan was great while we were on our drive back from Taupo. Just such an enormous amount of core data work in that project on immigration and outcomes. Here's Noah Smith with Boustan.

Afternoon roundup

Let's get these browser tabs back under control

• Shutting down a late-night food-truck because it's too popular and reducing options for celebrants isn't going to improve nightlife. Hi Auckland. 


• About one in four mild COVID cases wind up with brain damage. 


• Things true in a self-selected cross-section may not hold up in an RCT. Doubt you could get funding to run this as an RCT though. Well, maybe Loewenstein could.


• Businessdesk reports that investments tied to investor visa applications worth at least $3 billion are just sitting around at Immigration NZ, unprocessed. 


• I'd be less uncomfortable about this if there'd been smaller promising pilot studies with rigorous evaluation frameworks first. 


• Emma Vitz maps out how far a woman might need to travel in NZ to access abortion services.


• I've occasionally complained about Medsafe approval delays for vaccines. Wanna know how the booster for over-50s got authorised? It took an Act of Parliament. And they worried that "treating a fourth dose as other than "new medicine" undermines the scheme and purpose of the Medicines Act and the consent process under the Act." We're just not going to get vax for under-5s, or the updated formulations, in any reasonable amount of time with Medsafe as it is. 
  
  

The supply of specialists

Monday's column hit on regulatory barriers to entry in medicine that really look like cartel-enforcement mechanisms. Westpac had this note in 2016:

Industry sources had several concerns about competition or the lack thereof in provision of healthcare and social support services, and about differing standards set for public and privately contracted providers of these services. 

One of the chief concerns was the cost of specialist care in New Zealand relative to many other countries, and the incentives specialists had to work in private healthcare rather than public healthcare, which exacerbated the problem. Some laid the blame at the door of the specialist colleges, which set the standards required before a specialist could practice in New Zealand. 

While acknowledging the importance of ensuring standards were sufficient to keep patients safe, there was concern that colleges acted as gatekeepers to limit the supply of specialists in New Zealand. This all but guaranteed that those who made it through the process earned high salaries. This monopolistic supply (increasingly requiring a fellowship on top of other qualifications) was having such an effect that some thought New Zealand now had an oversupply of GPs. Many people went part way toward becoming specialist before dropping out because the requirements had just become too restrictive, even though they were capable of practising at specialist level. There were immediate impacts on public healthcare provision due to cost pressures and time delays, yet the DHBs we spoke to appeared to believe there was no way around this hurdle.

HT: David Norman 

Competition in accreditation and certification

James Hogan makes an excellent point on the doctor cartel. I'll quote it below, mildly edited to put the links in:

In this link, Specialists must work under supervision for six to 18 months are the magic words, "The relevant specialist medical colleges complete these assessments and provide advice to Council."

If the New Zealand Medical Council recognised multiple medical colleges as competent to supervise New Zealand's medical workforce within the same areas, then competition between those colleges seeking members in New Zealand would expand the number of supervisors available to train overseas graduates.

If say an organisation like, say, the Colleges of Medicine of South Africa could assess the competency of Anaesthetists for New Zealand and had the incentives to expand their services to New Zealand, then both they and the Australia and New Zealand College of Anaesthetists (which is the sole provider of assessment competency) would compete for members and expand training.

And they would also act as peer review bodies on the competency of the other organisation's training too, expanding both the number of trainees and quality of training.

It's a neat idea. 

James, who wrote his thesis under Seamus back in the day with mild ancillary support from me, was having some trouble getting this into Disqus. I'm going to have to find a day some time to fix this. I have been saying that for years though. Disqus isn't integrated into the mobile version. 

But whenever I start thinking about it, the project balloons. None of the blog formatting is right. And really, shouldn't it be a part of a bigger site with links through to all of my columns and reports and stuff? But there's just so much of that and it would be a big job. Or maybe it should all be a Substack; they'd sent an email encouraging me to flip to them. But how would that even work? And anything would wind up breaking links. 

And then the dread. And then I don't. 

James says I should just pay somebody to sort it all out. He could be right.