The Wall Street Journal - 13.09.2019

THE WALL STREET JOURNAL. Friday, September 13, 2019 |A

Take Two Aspirin and Call Me by My Pronouns

T

he American College of Physi-
cians says its mission is to
promote the “quality and ef-
fectiveness of health care,” but it’s
stepped out of its lane recently with
sweeping statements on gun control.
And that isn’t the only recent foray
into politics by medical profession-
als. During my term as associate
dean of curriculum at the University
of Pennsylvania’s medical school, I
was chastised by a faculty member
for not including a program on cli-
mate change in the course of study.
As the Journal reported last month,
such programs are spreading across
medical schools nationwide.
Why have medical schools become
a target for inculcating social policy
when the stated purpose of medical
education since Hippocrates has
been to develop individuals who
know how to cure patients?
A new wave of educational spe-
cialists is increasingly influencing
medical education. They emphasize
“social justice” that relates to health

care only tangentially. This ap-

proach is the result of a progressive

mind-set that abhors hierarchy of

any kind and the social elitism asso-

ciated with the medical profession

in particular.

These educators focus on elimi-

nating health disparities and ensur-

ing that the next generation of physi-

cians is well-equipped to deal with

cultural diversity, which are worth-

while goals. But teaching these is-

sues is coming at the expense of rig-

orous training in medical science.

The prospect of this “new,” politi-

cized medical education should

worry all Americans.

The traditional American model of

medical training, which has been em-

ulated around the world, emphasizes

a scientific approach to treatment

and subjects students to rigorous

classroom instruction. Students

didn’t encounter patients until they

had some fundamental knowledge of

disease processes and knew how to

interpret symptoms. They were ex-

pected to appreciate medical ad-

vances and be able to incorporate

them into their eventual fields of

practice. Medical education was de-

manding and occasionally led to stu-

dent failure, but it produced a tech-

nically proficient and responsible

physician corps for the U.S.

The traditional American model

first came under attack by progres-

sive sociologists of the 1960s and

’70s, who condemned medicine as a

failing enterprise because increased

spending hadn’t led to break-

throughs in cancer treatment and

other fields. The influential critic

Ivan Illich called the medical indus-

try an instrument of “pain, sickness,

and death,” and sought to reorder

the field toward an egalitarian social

purpose. These ideas were long kept

out of the mainstream of medical ed-

ucation, but the tide of recent politi-

cal culture has brought them in.

As concerns about social justice

have taken over undergraduate edu-

cation, graduate schools have raced

to develop curricula that will steep

future educators in the same ideol-

ogy. Today a master’s degree in edu-

cation is often what it takes to qual-

ify for key administrative roles on

medical-school faculties. The zeit-

geist of sociology and social work

have become the driving force in

medical education. The goal of to-

day’s educators is to produce legions

of primary care physicians who en-

gage in what is termed “population

health.”

This fits perfectly with the cur-

rent administrator-rich, policy-

heavy, form-over-function approach

at every level of American educa-

tion. Theories of learning with vir-

tually no experimental basis for

their impact on society and profes-

sions now prevail. Students are

taught in the tradition of educa-

tional theorist Étienne Wenger, who

emphasized “communal learning”

rather than individual mastery of

crucial information.

Where will all this lead? Medical

school bureaucracies have become

bloated, as they have in every other

sphere of education. Curricula will

increasingly focus on climate change,

social inequities, gun violence, bias

and other progressive causes only

tangentially related to treating ill-

ness. And so will many of your doc-

tors in coming years.

Meanwhile, oncologists, cardiolo-

gists, surgeons and other medical

specialists are in short supply. The

specialists who are produced must

master more crucial material even

though less and less of their medical-

school education is devoted to basic

scientific knowledge. If this country

needs more gun control and climate

change activists, medical schools are

not the right place to produce them.

Dr. Goldfarb is a former associate

dean of curriculum at the University

of Pennsylvania’s Perelman School of

Medicine.

By Stanley Goldfarb

At ‘woke’ medical schools,

curricula are increasingly

focused on social justice

rather than treating illness.

R

ecent news that e-ciga-
rettes may be linked to
hundreds of cases of se-
vere lung disease across
dozens of states has refo-
cused public attention on the poten-
tially harmful effects of vaping. As
many as six people have already died
of severe respiratory illness brought
on by use of e-cigarettes. On
Wednesday President Trump an-
nounced a Food and Drug Adminis-
tration ban on many flavored vaping
products citing safety concerns, call-
ing it “a new problem.”

But while critics of e-cigarettes
have seized upon recent tragedies to
demand further regulatory restric-
tions, policy makers should ask
whether their efforts to squash legit-
imate e-cigarette manufacturers have
enabled counterfeiters and black-
market vendors. From early reports,
most of the vaping-related illnesses
appear to be linked to unregulated
home-brews and street concoctions
of e-liquids.
The Centers for Disease Control
and Prevention, the FDA and the
state and local health departments
that are investigating the recent

A Vaping Ban Will Send Smokers Back to the Pack

deaths report that many of those

sickened by vaping admit to having

used products with liquids contain-

ing marijuana extracts such as tetra-

hydrocannabinol (THC) or cannabid-

iol (CBD). Online videos showing

consumers how to make their own

vape cartridges with infused canna-

bis oil, which can be cooked up at

home or purchased at marijuana dis-

pensaries, have been viewed millions

of times.

Last week 34 people in New York

were reported to have suffered from

respiratory illnesses linked to vap-

ing, but investigators found vitamin

E acetate in the vast majority of sam-

ples they analyzed. This substance is

often used as a thickening agent for

THC-infused extracts added to vape

cartridges. None of these cases in-

volved a nicotine product subject to

the new FDA ban.

In fact, most if not all of the re-

cent spate of hospitalizations nation-

wide due to vaping have been associ-

ated with marijuana oil. We aren’t

aware of a single case in the whole

country that has been associated

with nicotine-only e-cigarettes, never

mind flavored nicotine products.

As state and federal regulators

have made it harder for legitimate

manufacturers to market their prod-

ucts, some e-cigarette users are turn-

ing to counterfeits. High taxes and

restrictions on flavors have created a

potentially dangerous black market.

Since the FDA began pressuring

Juul Labs, the largest e-cigarette

manufacturer in the U.S., to stop sell-

ing flavored e-liquids, counterfeits

with unknown ingredients and un-

known quality standards have prolif-

erated. Modified e-cigarette products

from black-market sources have been

found to contain harmful contami-

nants and substandard ingredients.

Some companies have even been

caught selling e-cigarette cartridges

containing weight-loss and erectile-

dysfunction medication. As with pre-

scription medications, counterfeits

can kill.

The draconian regulatory ap-

proach to e-cigarettes may also dis-

courage combustible cigarette smok-

ers from switching to vaping. That

will cost lives too.

According to the CDC, smoking is

the leading cause of preventable

death. Nicotine e-cigarettes may be

as much as 95% safer than combusti-

ble cigarettes, and research is in-

creasingly demonstrating that vap-

ing can be an effective way to get

smokers to quit—almost twice as ef-

fective as FDA-approved nicotine-re-

placement therapies, according to

one recent study. Of course, while

vaping is safer than smoking regular

cigarettes, inhaling anything other

than air can never be totally safe and

shouldn’t be treated as if it were.

Still, there are signs that e-ciga-

rettes on net have saved lives by of-

fering a safer alternative to smoking.

As vaping’s popularity has grown

over the last five years, smoking

rates have plunged to historic lows.

As recently as 1997, 36.4% of U.S.

high-school students claimed to have

tried cigarettes. By 2017 the high-

school smoking rate had fallen to

7.6%.

Policy makers have missed oppor-

tunities to use e-cigarettes to miti-

gate tobacco-related harm. In the

last few months San Francisco has

passed an outright ban on e-ciga-

rettes, Michigan has prohibited the

sale of flavored e-liquids, and Maine

more than doubled its tobacco tax—

which applies to vaping products as

well as to cigarettes, cigars and pipe

tobacco—to 43% from 20%.

At the White House Wednesday,

President Trump cited the popularity

of vaping among teenagers as a chief

reason for the ban on flavored e-cig-

arette products. He is right to be

concerned. U.S. manufacturers have

set the minimum age for buying e-

cigarettes at 21, and more enforce-

ment is absolutely needed, including

spot checks. Stores that continue to

market and sell e-cigarettes and

other vaping products to underage

customers should be heavily fined or

shut down.

There are other ways to combat

teenage vaping. One manufacturer is

now selling a Bluetooth device in

Canada and the United Kingdom that

would allow parents to turn off a

vape pen, ensuring that it couldn’t be

used by children at home. Unfortu-

nately, it could take seven to 10 years

for the FDA to approve this device

for the U.S.

Public health officials should thor-

oughly investigate the roots of the

continuing lung-disease outbreak.

But before pinning the blame on le-

gitimate e-cigarette manufacturers—

and before banning their products—

lawmakers should examine how their

own heavy-handed approach is con-

tributing to this “new problem.”

Messrs. Sigaud and Pociask write

for the American Consumer Institute.

By Liam Sigaud
And Steve Pociask

MIKE SEGAR/REUTERS

Banning safe e-cigarette

products could reverse

the decadelong decline

in smoking rates.

Vaping products for sale in New York City on Sept. 10.

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How Do You Tax a Baby Boomer?

The problem with
old people is that
they eventually
stop working. This
intractable reality
normally bubbles
into our political
consciousness as
we contemplate
government spend-
ing on retirement
benefits. Now at
long last the implications for tax pol-
icy are also coming into focus, thanks
to the unlikely duo of Elizabeth War-
ren and Japan.
Developed economies have
evolved tax systems that rely dispro-
portionately on labor income as their
tax base—even as their working pop-
ulations grow more slowly or shrink.
This is true in the U.S., where the
personal income tax furnishes some
34% of overall government revenues
each year and payroll taxes on wages
provide a further 23%. It’s true in
Japan, where social-insurance pay-
roll taxes account for 40% of annual
revenue and the personal income tax
another 19%.
It’s the case in countries that also

impose hefty value-added taxes on

consumption. Germany, France, It-

aly—all still raise more than half of

their revenue from labor-based

taxes. The imbalance persists de-

spite two decades of a modest re-

treat from labor taxation in devel-

oped economies that has seen

personal-income and payroll taxes

decline to 50.1% of revenue from

53.2%, according to the Tax Founda-

tion.

Even when old people do have

taxable income, the thrust of retire-

ment policy for decades has been to

skew the tax base away from their

income. Incentivesthat defer income

tax on contributions to retirement

accounts are effective precisely be-

cause for most people the marginal

rate they pay on that income in re-

tirement is lower than the marginal

rate they pay when they’re working.

What this means for the future

can best be described by a simple

equation: No workers equals no tax

revenue.

There are three possible solutions

to this dilemma. One is to tax the

fewer remaining working people

more heavily. That way lies an eco-

nomic and moral quagmire. Govern-

ments have spent the past genera-

tion cutting personal income-tax

rates because they realized that too-

high taxes suffocate economic

growth. Can they afford to pay a low-

growth price for raising rates again?

One also has to ask why future

generations of workers should be

forced to pay a higher proportion of

the fruits of their labors to fund ben-

efits for old-timers who refused to

raise their own taxes or to reform

benefits.

The second option is to tax the

things old people actually do. That

list includes spending, saving and

dying. Let the games begin.

Start in Japan, which is on the

cusp of increasing its consumption

tax yet again, to 10% from 8% start-

ing Oct. 1. Veteran Japan watchers

recognize how foolish this is. Every

previous increase to the tax, going

back to its introduction in 1989, has

been politically unpopular and eco-

nomically destructive. The last one,

to 8% from 5% in 2014, smashed con-

sumer spending and plunged the

world’s third-largest economy into a

recession.

Outsiders are mystified that Prime

Minister Shinzo Abe persists with

the tax hike anyway, but Tokyo is

running out of alternatives. Japan is

a rapidly aging country. As Japanese

workers retire at an accelerating

rate, not only do they consume more

public spending in the form of a pen-

sion and health-care bill expected to

hit 190 trillion yen ($1.8 trillion) an-

nually by 2040. They also pay less

income tax. A consumption tax is

what’s left.

The other thing old people tend to

do is save, which is where Ms. War-

ren comes in. Her wealth tax—a 2%

annual charge on fortunes larger

than $50 million—starts with the su-

perrich but won’t end there. It can’t,

as labor taxation over time provides

less and less funding for the left’s

spending priorities.

This column has previously

scoffed at Ms. Warren’s college-sub-

sidy ploy to woo younger voters, but

it isn’t entirely sarcastic to suggest

millennials have more reason to sup-

port Ms. Warren’s wealth-tax gim-

mick. For all its destructive flaws,

she’s a Baby Boomer who at least

might one day be willing to tax her

own generation to pay for their So-

cial Security and Medicare tabs.

President Trump conspicuously lacks

a better idea.

Oh, the third option for solving

this dilemma? It’s cutting entitlement

payouts so the old-age programs

make smaller demands on the shrink-

ing labor tax base. You know how this

idea fares politically.

These generational fiscal realities

present today’s baby boomers, and

especially Republican boomers, with

a stark choice. They’ll have to pay for

their entitlements one way or an-

other. They can do it by reforming

the programs to reduce their benefit

checks to an affordable level, or they

can roll over and accept the sort of

left-wing, European-style taxation

they claim to hate.

It’s a tension that will be on dis-

play if President Trump—elected in

2016 on a promise never, ever, ever

to touch Social Security or Medi-

care—finds himself on a debating

stage with Ms. Warren in 2020.

A smaller labor force will

force the taxman to turn

to consumption and wealth

to fund old-age benefits.

Greg Orman, writing at RealClear-

Politics, Sept. 12:

The composition of the field tells us

a great deal about what Democrats

value. The number of candidates on

the stage who have ever run a business

has fallen from four to one. The field is

dominated by the three A’s—academ-

ics, attorneys, and activists.

The three White House aspirants

with business experience who failed to

make the cut—John Hickenlooper, Mi-

chael Bennet, and John Delaney—are

too practical to make the big policy

promises that capture the hearts of the

liberal base of the Democratic Party.

They comprehend the unintended con-

sequences of these sweeping agendas

and were unwilling to fully embrace

them. They equivocated when it came

to eliminating private health insurance,

making college “free,” and imposing a

new “wealth tax” on the richest Ameri-

cans. Their reluctance to participate in

this attack on the free market system

rendered them irrelevant inside their

own political party.

This isn’t surprising. There appears

to be a fundamental disdain for suc-

cessful business people among Demo-

crats. In 2016, Michael Bloomberg was

greeted with chants of “one-percenter”

as he stood up to support Hillary Clin-

ton at the party’s convention....

Some will argue that this isn’t

news. Arnold Schwarzenegger often

pointed out the Democrats’ institu-

tional confusion by suggesting that

“you can’t love jobs and hate the peo-

ple who create them.” Once upon a

time, the party of Franklin Roosevelt

accepted this as a tenet of the faith.

Over the last three decades, however,

party elites have been steering their

brethren in a different direction. Since

Michael Dukakis’ disastrous 1988 cam-

paign, Democrats have tried to argue

that they support the private sector

and economic growth. With this cam-

paign they are amending that stance.

The new credo is: “We support eco-

nomic growth, provided it’s driven by

government programs.” With all due

respect to Bill Clinton, “the era of big

government,” which never really went

away, is back with a vengeance.

Notable& Quotable: Democrats and Business

POLITICAL
ECONOMICS
By Joseph C.
Sternberg