The EconomistJune 9th 2018 United States 311T
HE Koch brothers are to the left what
George Soros is to the right: villains ac-
cused of using their billions to subvert the
will of the people. Charles Koch and his
younger brother David are fabulously rich
thanks to the success of Koch Industries, an
oil, gas and commodities conglomerate
based in Wichita,Kansas, that is America’s
second-biggest private company and em-
ploys more than 120,000 people. Yet like
Mr Soros, who made his billions as a
hedge-fund manager and supports liberal
causes on both sides of the Atlantic, theyare better known for their political activ-
ism, which has made them heroes in con-
servative circles and the favourite bogey-
men of liberals. On June 5th Charles
announced in a letter to employees of
Koch Industries thathis brother was step-
ping down from his political and business
interest because of poor health. David was
diagnosed with prostate cancer over two
decades ago and has battled the illness
ever since. What will David’s retirement do
to the conservative movement?
While the professorial Charles runs the
family company out of Wichita, the more
urbane David settled in New York and be-
came the public face of the brothers’ politi-
cal activities. He was the vice-presidential
candidate ofthe Libertarian Party in 1980
and an outspoken (and munificent) sup-
porter of Scott Walker, the Republican go-
vernor of Wisconsin, when he faced a re-
call election after a fight with public-sector
unions. He is a driving force at the Cato In-
stitute, a libertarian think-tank; Americans
for Prosperity (AFP), a free-market group he
started in 2004; Freedom Partners, a net-
work of donors fostered by both Kochs;
and other outfits promoting the libertarian
credo. Together, they form what critics dub
the “Kochtopus”. Theywill now have to do
without him.
The brothers’ activism reached fever
pitch during the presidency of Barack
Obama, whom the Koch brothers consid-
ered a seriously misguided socialist. In a
newsletter sent to his employees, Charles
even compared the Obama administra-
tion to the regime of Hugo Chávez, Venezu-
ela’s authoritarian leader. As they became
the biggest backers of Tea Party organisa-
tions and helped to raise an estimated
$400m to prevent the re-election of Mr
Obama in 2012, the brothers transmogri-
fied from libertarian outsiders to influen-
tial conservative power-brokers.
The price they paid for their often
opaque activism was steep: an end to their
privacy (until they took on the Obama ad-
ministration, the Koch brothers were virtu-
ally unknown) and widespread vilifica-
tion. Greenpeace published a report
calling Koch Industries the “kingpin of cli-
mate-science denial”. An exposé in the
New Yorkerdescribed how the Kochs gave
millions of dollars to non-profit groups
that promote scepticism about climate
change, criticise environmental regulation
and welfare programmes and support
minimal taxes forindustry—ostensibly in
the name of their libertarian ideals which,
conveniently, aligned with their corporate
self-interest. David Axelrod, Mr Obama’s
chief political strategist, singled out the
Kochs in an op-ed in the Washington Postas
billionaire oilmen secretly funding the Tea
Party while pretending it was a grassroots
movement for change. The Kochs received
death threats that require the brothers to
travel with security guards. “They becameFinancing politicsKochtopus’s
garden
CHICAGO
What David Koch’s retirement means
for the conservative movementO
N May 30th, surrounded by patients
and their families, President Donald
Trump signed into law the spectacularly
misnamed “right to try” legislation. The
new law appears to offer terminally ill pa-
tients the right to get experimental new
drugs that might save their lives. In fact, it
does no such thing. Sitting at his desk in the
Oval Office, pen in hand, Mr Trump pre-
dicted it would save “hundreds of thou-
sands” of lives. It will not do that either.
The main point of right-to-try laws is to
cut the Food and Drug Administration
(FDA) out of the picture when terminally ill
patients want access to an unproven medi-
cine. The FDA is already fairly gung-ho
about providing this. It receives about
1,000 applications a year and approves all
but 1%. The agency makes sure there is
sound science behind the request, and no
obvious indication that the medicine
would harm the patient. Sometimes its
drug experts are able to recommend better
ways of getting the treatment.
Thankfully these irritating bits of bu-
reaucracy have been duly dispatched. This
victory comes courtesy of campaigning
work by a libertarian think-tank, the Gold-
water Institute, based in Arizona. It has
been pushing right-to-try legislation for
around four years, and it can now be found
in 40 states. Speaking about the impact of
these laws on patients, Arthur Caplan, a
professor of bioethics atNYU School of
Medicine in New York, says he can think of
one person who may have been helped.
Starlee Coleman, a policy adviser for
the Goldwater Institute, is clear that the
motivation behind the federal law is, in
good measure, philosophical. The institute
believes that dying patients, who know
the risks, should not have to ask the gov-
ernment’s permission to try a medicine.
The law does offer pharma firms legal
cover in situations where a patient is given
an experimental drug and this ends up kill-
ing or harming them. But Dr Caplan says
pharma firms are more concerned over
how such “adverse” events damage them
on Wall Street, something the law cannot
address. Irrespective ofright-to-try legisla-
tion, some pharma firms simply will not
give away drugs until they are at a late stage
and have FDAapproval, as there is too
much risk involved. Even firms willing to
take those risks may not be in a position to
help. This can be because supplies of drugs
are limited, or because a right to try could
make it harder to recruit patients for trialsthat use a control group.
Even those rare patients who have the
financial means to get experimental drugs,
which are not covered by insurance, are
unlikely to benefit. Only one in ten drugs
that go into trials end up proving safe and
effective. Of those, most offer incremental
improvements. All these things raise con-
cerns that the new law could mainly bene-
fit those looking to make a quick buck from
the desperate and the dying.
Many believe the Goldwater Institute is
only just getting warmed up in its attempts
to limit the FDA’s powers. Ms Coleman dis-
agrees, saying the new law isn’t an “open-
ing salvo”. However, she does saythe insti-
tute is working on another proposal. This is
to allow pharma firms to talk to doctors
about using medicines for ailments for
which they have not been approved. There
are known harms to such “off label” pro-
motion, so the FDAprohibits it. “We think
that is silly,” says Ms Coleman. 7PharmaceuticalsRight to apply
New medical legislation offers hope to
ailing libertarians