Reasons for optimism - Gene-editing

Genetic modification has penetrated popular thinking by receiving much publicity, even though some of that has verged on hysteria. Meanwhile, a scientific breakthrough has been achieved that gives equal, if not greater, grounds for optimism. It is the discovery and manipulation of what are called clustered regularly interspaced short palindromic repeats, otherwise known as CRISPR. This differs from GM because it involves editing the genes within an organism, rather than introducing those from an alien species.

What makes CRISPR gene editing so effective is its precision. Scientists can use it to locate a chosen sequence within the organism’s DNA, and then delete it or modify it by replacing unwanted sequences with desired ones. When fully developed, the technique will enable us to delete the defective genes that lead to genetic diseases, and to replace them by non-defective ones. This opens the prospect of eliminating such conditions as Huntington’s disease, haemophilia, or spina bifida.

It has been used to treat inherited deafness and sickle cell anaemia in mice, and it has the potential to create powerful new antibiotics and antivirals. In theory, though not yet in practice, it could be used to make mosquitoes impervious to malaria, and raise the chances of the altered gene being passed on to 100 percent. As with genetic modification, it could be used to create more nutritious crops, or ones better able to cope with drought.

Concern has been raised about the prospect of “designer babies,” with parents screening our undesirable genetic traits in their offspring, and inserting genes that would lead to better looks or more intellectual potential in the child, even before it was born. These would be subject to ethical controls, but the technique could be used to give every child born the chance to lead a life free from suffering or life-limiting conditions.

The technique is fast, effective and cheap. What might have taken weeks at enormous cost can now be done within hours for perhaps $75. It gives huge cause for optimism that humankind will be less susceptible to the damage and distress that nature might inflict, and better able to take control in order to give people the chance of healthier and better lives.

Seriously Mr. Drakeford, seriously?

There seems to be a certain misunderstanding of how vaccination works here from Mark Drakeford, First Minister of Wales:

We will be using all the Oxford vaccine that we get as we get it, the Pfizer vaccine has to last us until into the first week of February.

So we have to provide it on a week-by-week basis. What you can’t do is to try and stand up a system which uses all the vaccine you’ve got in week one and then have nothing to offer for the next four weeks.

We won’t get another delivery of the Pfizer vaccine until the very end of January or maybe the beginning of February, so that 250,000 doses has got to last us six weeks.

That’s why you haven’t seen it all used in week one, because we’ve got to space it out over the weeks that it’s got to cover.

Vaccine delivered into arms protects. Vaccine sitting in the fridge does not. There is absolutely no point at all in having vaccine in fridges rather than arms. A vaccine is not like a bandage, or an antibiotic, where it is useful to have some on hand. Rather, with a vaccine, get it into arms and if there’s a gap to the next batch so, there’s a gap the the next batch. More people are protected for longer the faster the move from fridge to arm.

This all rather illustrates a most unkind anonymous comment about the problems of devolution in a general sense. There aren’t all that many bright people who actually desire to enter the cesspit of politics. Thus whatever the political unit is it has to be large enough that those competing to run it are competent to do so. In very small units the selection available of those willing might not include enough of those able.

Of course, no, no, of course, this does not apply to a nation like Wales but it is something we worry about concerning local authorities, regional assemblies and the like. Our solution being to devolve power not to the smaller political unit but to the people not involved in politics - a much larger group than those willing to enter the cesspit. That is, restrict government to only those things that must be done and which can only be done by government and leave the rest to whatever structures people wish to use as and when. You know, markets.

Betteridge's Law

Betteridge’s Law has two different meanings. The first is as stated:

Any headline that ends in a question mark can be answered by the word no.

As stated it is not actually true - “The correct amount of QE is?” can only be answered with “No” in a - not very - humorous attempt to deny the utility of the concept itself. The deeper truth is as a warning to journalists (or, in the older style, the subeditors who used to write headlines) not to write headlines that can be so answered. Or, in another tradition, only when it is known that the answer is no but everyone would prefer not to say so.

At which point, The Times:

Can Joe Biden restore the soul of a divided nation?

Well, no, clearly not. Nations don’t have souls, even the most collectivist of religions insists that only human beings do. Further, division is something rather to be desired in a nation - we after, after all, all different bundles of desires and wants and one single national purpose is going to run roughshod over that idea.

But rather more important than that, and what makes this something for us to comment upon, is that talk of souls and nations is not the subject of politics. That last is about organising the rubbish collections. To start talking of politics and eternal verities is to reify what is meant to be a very workaday process. As is well known we tend to favour minarchy around here and this is one of the reasons why. Any expansive political system of management is going to end up sending tendrils into areas where that system simply doesn’t work at all, let alone badly.

Government should do only those things that must be done and which can only be done by government - a small set of actions.

Another way of putting this, which recent or even future holder of the office of President (or even, which politician in any office) would you entrust your soul, individual or collective? So, no…….

Marcus Rashford has indeed made the case for decent welfare

It does happen occasionally, we find ourselves agreeing with a Guardian headline:

What Tories fear about Marcus Rashford: he's made the case for decent welfare

We’re not sure about the fear there, we think that should be striking into different hearts, those of the Guardian reading classes:

The footballer and food poverty campaigner Marcus Rashford is among those calling for the April cut to be reversed, a recognition that food parcels are merely sticking plasters over the deeper and more enduring problem

For what we’re seeing is what government provision is actually like. The government, the state, decides to go out and provide food. What turns up is boxes of such wizened paucity as to shame a Soviet ration shop. Further, we all see this as we can all see what we ourselves can go and buy in the free market at the same cost. £30 doesn’t provide a cornucopian bounty - even if by historical standards it does - but £30 is half the usual weekly food bill for a household. It’s clear and obvious to all that we can spend money better than the government does - because for £30 we can get more than a slice of cheese and a handful of apples.

That is, decent welfare provides the wherewithal, the resources, to be able to access the extant supply system provided out there in the market.

That is, housing benefit not council or “affordable” housing. Health care insurance not government provision through the NHS - and no, not the American system but some flavour of German, French, Singapore, and so on. School vouchers not state schools. Welfare being a manner of financing access to goods and services, not the provision of goods and services directly.

Of course, such decent welfare would strike the fear of God into the Guardian reading classes as they all make their living from the opposite. It’s entirely true that the government food parcels are a ghastly waste of money, an expensive delivery of not enough to choke a cockroach. It’s that very insight that gives us the clue to how to provide that decent welfare.

By, you know, firing the entirety of the Guardian reading classes and delivering that welfare simply by financial transfers, not the government delivery of goods and services.

Those post-Brexit food supply problems

What this should be taken as - and isn’t being - is a lesson in the merits of free trade:

Problems importing and exporting food “will get worse”, MPs have been warned.

Industry leaders giving evidence to the select committee on Britain’s future relationship with the EU issued the stark warning as the impact of Brexit on supply chains becomes evident.

Ian Wright, chief executive of the Food and Drink Federation, said that new customs controls and extra paperwork have the potential to seize up import and export systems.

If we put barriers in the way of trade then we shall have less trade. This doesn’t seem to us to be a controversial point.

Supermarkets are already suffering shortages of some goods and Andrew Opie of the British Retail Consortium said the new system was “not set up for supermarket just-in-time supply chains”.

He gave the example of a load going from a depot in Wales to a supermarket in the Republic of Ireland needing to give 24 hours notice of its contents.

“This could mean 100-plus pieces of certification for all the products,” Mr Opie said. “But stores send information about their orders daily, if not hourly. It’s an unworkable system for supermarkets.”

The conclusion being reached by many is that we should therefore go back to being in the Single Market and regain that free trade. Which is, from a certain point of view, the wrong answer. Because all these complaints about the barriers to trade are exactly what the 450 million people inside that Single Market put up against trade with the 6.5 billion people outside it.

Trade with foreigners is of benefit to us. That’s the entire point of trade after all, to gain access to those things which foreigners do better, cheaper, faster, than we do. Why, therefore, would we want to be in a system that denies us - through these very rules and processes that people are complaining about - the benefits of trading with the vast majority of our fellow humans?

Yes, being outside the Single Market involves hundredweights of paperwork to gain access to imports. That the very proof that said Single Market isn’t in fact free trade nor something we wish to do, isn’t it, given that the majority of the world economy, thus of production of things we’d like to have, is outside that Single Market.

All of the current complaints are simply more evidence of the costs of trade restriction. So, let’s not restrict trade then.

Well, yes, we suppose so

The Joseph Rowntree folks tell us that it’s the poor who have suffered recently:

People who were trapped in poverty before the pandemic have suffered the most financial damage during the crisis, according to a report warning the government that more support is needed to help hard-pressed families.

The Joseph Rowntree Foundation (JRF) said those who had been struggling to make ends meet before March last year were more likely to work in precarious jobs or sectors of the economy that had been hardest hit by lockdowns.

Well, yes, we suppose so. Being poor, being lowly paid. is equivalent to being marginally attached to the workforce. That is where job losses are going to be concentrated for that very reason. The complaint is like insisting that tall people are more affected by low ceiling beams, or radically shortened stature makes the high jump an unlikely sport to succeed at.

The correct reaction therefore being, well, and?

Once this is correctly pointed out of course we can answer that and? Which is that if this recession harms the poor, as it does, the answer is to end the recession. Get the vaccinations done, return to that full employment economy we had and things will be vastly better. You know, the things that are already being done, or at least attempted?

Reasons for optimism - Genetic Modification

One of the leaders in our ability to make the future world a brighter and better one for humanity is the ability to engage in genetic modification. By introducing genes from one organism into another, we can create new organisms that serve our purposes. Humans have done genetic modification for centuries. Our distant, and in some cases, recent, ancestors turned Brassica oleracea into cabbage, cauliflower, broccoli, kale and the others. They turned wild wolves into domestic dogs. We have modified animals, vegetables and fruits to do what we want them to do.

It used to be done, and still is, by selective breeding, but now we have a new option, that of selecting the qualities we want that one species has, and giving it to another by one of several scientific techniques that move genes across the species barrier. We have modified crops to give higher yields, to be saline tolerant or drought resistant. In some cases we have made them self-fertilizing, in others insect repellant. Too large a proportion of the world’s food, especially that grown in poorer countries, is subject to the depredation of pests and parasites, and GM crops give us the ability to cut those losses dramatically. These advances have enabled us to grow food on less land, on otherwise infertile land, and to put less fertilizer and insecticide into the environment.

These developments all advance human utility and enable us to reduce our footprint on the planet, but potentially the uses of genetic modification in medicine could be amongst the most significant. Already there is “golden” rice modified to incorporate vitamin A so that children in poor counties can be more protected from malnutrition and blindness. The use of plants as drug factories is well established, with even GM tobacco plants used to produce antibodies against Ebola, but the prospects are literally limitless. A generation of crops can be grown that will not merely produce drugs for us to use in medicine, but will incorporate life-protecting drugs into the food we eat.

There are voices raised in caution against genetic modification, claiming that we cannot be certain that its products are risk free. The answer is that nothing is risk free, and that we should proceed as we do in other areas, assessing the known benefits against the known risks, and going ahead where the one significantly outweighs the other. All we can do with unknown risks is to test what they might be, and experiment cautiously to evaluate if they do pose problems. Thus far with genetic modification they have not, which is a further reason for regarding genetic modification with optimism for what it offers.

Government policy is to force the poor to be poorer

The Resolution Foundation tells us that the poor are budget constrained. That’s not all that much of a revelation but they’ve built a whole report around it. They gussie it up a bit of course but that is the central message.

In these troubled times poor folks haven’t been saving much. Well, yes, that’s what generally happens. In fact, that’s why the general assumption about any demand stimulation that might be done should be pro-poor. The poor spend all their money, the richer tend to save a portion. So, if we desire to have more demand in the economy it should go to the poor so that it is spent, not saved.

To complain about this point that is so well known seems a little odd to us. However, there is one little point in there which we think worth emphasising:

Second, the cost of certain items (most obviously food) has risen for many: promotions have been reduced and cheaper items are harder to obtain.

Food promotions - BOGOFs, three for twos, this product cheap this week only, these are pro-poor. This should be obvious given that observation that the poor are budget constrained. At which point we have government policy on the matter:

The popular “buy one get one free” and “three for two” deals will be banned in supermarkets in a drive to help the nation lose weight, although smaller stores will be exempt.

The government is demanding that the poor be poorer. We can’t help but think that this isn’t a reasonable aim of government policy. Actually, we’d mutter that it’s somewhere along the spectrum from misguided through to an aggression upon the poor.

But then as Bernard Levin spent those decades pointing out there’s little so dangerous as the Single Issue Fanatic. The groupthink about obesity is leading to this absurdity, that government is actively insisting upon taking the crusts out of the mouths of poor babes and children.

There is no Great Stagnation

We might not think that this is a big deal but it is a symptom of one:

Britain’s pothole crisis has been branded a national scandal by MPs and prompted residents to resort to graffiti in a bid to make councils fix craters plaguing local roads.

But JCB has come up with a solution: a three-in-one pothole-repairing machine that promises to fix decaying roads in record time.

The PotholePro is a new digger-like device that the company said can fix a pothole in less than eight minutes - four times faster than existing methods and at half the cost. At that pace 700 potholes a month could be plugged.

The symptom being that this is how economic growth happens.

Yes, lovely big things like electricity, the internet, even HS2 and windmills everywhere, have their effects. But even they are not growth in and of themselves. It is not even true that economic growth is, only, the ability to do new things. Often enough it is as here the ability to do old things that little bit better, using fewer resources to get the job done. Those big technologies do indeed allow new things to be done but their much larger effect is upon enabling us to do those old things more efficiently.

This also being why that grand planning from the 30,000 feet of Whitehall doesn’t work well. Because it’s simply not possible for 650 PPE graduates to work out whether a new pothole repairing machine is even desirable let alone how it might be done if it were. Meaning that a planned system wouldn’t even allocate the resources to find out let alone produce such a machine.

A useful little reminder that economic growth is, in large part, just the day to day grind of doing all the old things that little bit better. Something that politics and direction by politics simply does not achieve.

Kafka’s Mass Vacillation Programme

Not for the first time in this pandemic, the government is making bold claims and failing to deliver.  When the Pfizer vaccine was approved, we were told five million cases would be delivered and used by the year end.  In the event, it was less than one million. As my colleagues’ “Worth a Shot” Briefing Paper showed this week, “Britain’s vaccination programme is being hampered by an excessively centralised, command and control approach that has rebuffed help from the private sector, the armed forces and volunteers.” But for once the problem does not lie with our leaders setting out bold ambitions but with our Kafkaesque bureaucracy getting in the way. 

The Medicines and Healthcare products Regulation Agency (MHRA) has been blamed for delays but this turns out, according to a release on 8th January, not to be the case.  After approving the vaccine, the 1925 Therapeutic Substances Act requires it to test every batch. The manufacturer’s tests are the same as those by the government’s National Institute for Biological Standards and Control (NIBSC) but they only take four days and are conducted in parallel.

On December 31st, Jonathan Van-Tam, deputy chief medical officer, said: “the only thing that is going to slow us down is batches of vaccine becoming available”. He blamed that not on any shortage of the vaccines themselves but of the vials to put them in.  When we ordered 100 million doses, it seems no one thought of the vials.  

Unfortunately, the health bureaucracy has more inefficiencies. The Sun on 6th January reported that Public Health England did not do deliveries on Sundays.  Lucky that the original three man Sage Committee bearing gifts, and guided by the science. did not try to deliver on a Sunday.  The NHS front line is short of doctors and nurses but many of the pharmacies and recently retired clinicians who volunteered to help are getting no replies to their applications.  According to BBC Look East (7th January), those who are provisionally accepted face 15 hours of online form filling before they can make the first jab. Matt Hancock agreed (House of Commons 7th January) that wielding a hypodermic did not really require proof of diversity awareness or terrorism policy or many of the other 21 tests, but the mid-level NHS manager who appeared on the programme clearly disapproved of their withdrawal and, one suspects, would be in no hurry to do so. 

The Prime Minister rightly announced, also on January 7th, that the military would assist with distribution and, because the NHS had been objecting, he had Simon Stevens, the NHS CEO beside him when he said it. “Army logistics chiefs have been brought in to use “battle preparation techniques to help us keep up the pace”, he said. Given the pressure on the NHS to treat the massive surge of new variant cases, it would have been better to turn the whole vaccination programme over to them but that would have been throwing their rattle out of the pram.  As it is, the military will simply be advising on the Herculean task of getting the vaccines from Wrexham across our emptied road network to the vaccination centres. 

According to the Vaccines Minister: “Working together, day and night, they will ensure our vaccines are going into arms rather than sitting on shelves. UK forces will use techniques borne out of decades of experience of getting things done in some of the toughest conditions imaginable. They’ll bring the bravery and brilliance they shown [sic] in places like Iraq and Afghanistan to these shores.”

The North Norfolk constituents are, on average, the oldest in the country and the number of infections, amongst the over-80s, tripled in December, so it is not surprising that it is yet to have anywhere that can do a jab.  It has a hospital in Cromer, and cottage hospitals in North Walsham, Wells and Holt, but none of those have been selected.  Instead, vaccination centres at Sheringham and Aylsham should be operational by 15th January.  

Then there is waste.  The MHRA limits distribution: “Currently the MHRA directions do not allow for the re-distribution of the Astra Zeneca vaccine from the PCN [Primary Care Network] designated site to other practices for administration within the practice.” Similarly for Pfizer.  So if there is a surplus, it cannot be taken to another practice that needs it. A practice can take doses to a single care home in its area but if it turns out there is a surplus, it cannot return them to the original PCN designated site nor to another care home nor to vaccinating its own staff or patients in its own area.  The unused doses have to be destroyed. [1] Local Medical Committees are restrained in their comments on orders from above but in this email: “We are aware that it is illogical and frustrating, however, this has been determined by MHRA and we need to wait for them to change their directions.” 

That was not expected for some time, but in fact the advice was withdrawn the next day! 

One should not carp.  Huge numbers of good people are doing their level best, under difficult and once-in-a-lifetime circumstances, to treat patients and save lives. Perhaps the most remarkable feature of the first wave was the way front line clinicians simply threw out pettifogging rules and did what needed to be done. In normal times, those changes would have taken committees many years.  The NHS may not have too many managers but it certainly has too many people saying “no”.  I had to discharge myself from my last two sojourns in a major NHS hospital trust, or I would still be there. The Prime Minister and the Health Secretary may have a clear view of what needs to be done but they still have two major problems: failing to clear Kafka’s action-blockers out of the way and failing to plan well and in good time. It looks like the first of those is beginning to happen but the second remains a problem.   

[1] Email from Norfolk and Waveney Local Medical Committee “Oxford AstraZeneca vaccine - movement restrictions”, 6th January.