The Boston Globe - 02.09.2019

MONDAY, SEPTEMBER 2, 2019 The Boston Globe Opinion A

Inbox

Plan to deport sick kids

feels like the last straw

Letters should be written exclusively to the Globe and

include name, address, and daytime telephone number.

They should be 200 words or fewer. All are subject to

editing. Letters to the Editor, The Boston Globe, 1 Exchange

Pl, Ste 201, Boston, MA 02109-2132; [email protected]

Policy move calls

for widespread disobedience

The front-page headline says it all: “Plan to deport sick chil-

dren stirs outcry” (Aug. 30). But what kind of outcry? Sena-

tors Edward Markey and Elizabeth Warren will send a

strongly worded letter to an administration already poised

to ignore them, demanding documents that no doubt will

stay sealed.

When will everyone realize that this administration has

no intention of obeying norms, protocols, or existing laws?

Yet our elected officials keep playing by the old rules, send-

ing strongly worded letters that end up being tossed in the

bin.

Why not take a new tack? When these Draconian edicts

are issued, ignore them.

I know, it’s wrong, it’s lawless, it’s not how we do things.

But we have a president who lies and ignores the law, and

an administration bent on destroying democracy as we

know it. This calls for extraordinary action.

When they say deport sick children, don’t.

When they put babies in cages, get them out.

This isn’t complicated. It is right against wrong. Moral

against immoral. If a mother steals bread to feed her starv-

ing child, it may be against the law, but she is acting moral-

ly.

The smart people in the room need to do more than go

on cable news shows and voice their concerns; they need to

act. We need a united, concerted effort to stop the sicken-

ing policies of this twisted administration from taking hold

of what once was a decent and good country.

CHRISTINE GAGNE

Manchester-by-the-Sea

This really is not who we are — is it?

Re “Plan to deport sick children stirs outcry”: Who are we?

This can’t be possible. This policy is the final rabbit hole of

immorality.

The government of the United States is about to deport

families of seriously ill children receiving treatment in this

country. Many of these children will die if deported.

It is the last straw, as Donald Trump and Stephen Miller

qualify as the “undertakers” of America’s conscience.

Children with complex and life-threatening medical

conditions are being treated here under a policy known as

“deferred action,” through which they can remain for medi-

cal and other humanitarian reasons. Now the administra-

tion is ending this policy.

My mother was a physician and surgeon in New York

City. Her skills changed the lives of many young people. I

am her daughter, with two sons and grandchildren of my

own. Now, I must explain to them what we have become as

a nation under the aegis of Trump and Miller: “Send me

only healthy children to our shores. All others should die at

home.”

I ask again, Who are we? America, what is your answer?

PATRICIA YOUNG MANHARD

Lexington

Re “Costs of long-term care stagger states” (Page A1, Aug.

29): Yes, we need to change our approach to long-term

care, but we need the workforce to do so.

Every day 10,000 Americans turn 65 and by 2040, there

will be 80 million Americans 65 and older. In Massachu-

setts alone, nearly two of every three older adults have four

or more chronic conditions.

As Robert Weisman’s article explains, the cost of care for

this population is “straining family finances and Medicaid

budgets.” Yet, as noted, Massachusetts, a traditionally inno-

vative state, is lagging behind other states in funding long-

term care initiatives.

While it is true that strengthening and broadening ac-

cess to our current programs is paramount to meeting the

needs of an aging 21st-century population, we must keep

one group of people at the center of this mission: the direct

care workforce.

The Bureau of Labor Statistics estimates home health

and personal care aides as the third and fourth fastest-

growing occupations in America. Yet, they are the lowest-

paid jobs in the entire top 20 list, making a median salary

of $24,000 annually.

Innovative long-term care expansions will be fruitless in

getting services to elders if there aren’t enough workers to

staff the programs. This requires that we, as a state, com-

mit to adequately compensating and treating this work-

force as the dedicated professionals that they are. This

means properly funding programs that already exist, boost-

ing workers’ skills, and leveraging our hard-working immi-

grant communities who are already the bedrock of this

workforce.

PAT KELLEHER

Executive director

Home Care Alliance of Massachusetts

Boston

Expandinglong-termcaresystemwill

befruitlesswithoutboostingworkforce

Senator Edward Markey has a long history of hard work on

climate change. Now he is the Senate’s leader for the Green

New Deal, the first legislation to tackle climate disaster on

the scale that is needed. If Joseph Kennedy III runs against

him, all of us who care about climate disruption will need

to ensure that everyone understands the consequences of

undermining Markey’s vital work, and will need to demon-

strate to the nation that climate leadership is a powerful

electoral asset.

ROSALIE ANDERS

Cambridge

Climateactivistsdon’twanttosee

Markey’svitalworkundermined

By Michael Rosenblatt

T

he FDA recently approved

atreatmentforosteoporo-

sis, a targeted therapy for

advanced bladder cancer,

and a pill that can cure

smallpox. For each medicine, the

agency’s stamp of approval culminates

years — if not decades — of expensive

research.

The research that made the new os-

teoporosis treatment possible, for ex-

ample, began in 1964 and included 19

clinical studies involving more than

14,000 patients. The medicine offers

hope to the 10 million Americans liv-

ing with osteoporosis by harnessing a

molecular pathway that builds bone.

Such long histories are typical for

drug invention. Yet some members of

Congress ignore the reality of the pro-

cess. These lawmakers prefer to be-

lieve that federally funded scientists

develop medicines on their own — and

that private-sector firms simply take

advantage of this work to manufacture

the medicines, earning billions as a re-

sult.

Nothing could be further from the

truth. The government funds impor-

tant, basic research that expands sci-

entific knowledge and helps lay the

foundation for targeted or applied re-

search. This early work is essential,

but it’s only the beginning of a long,

arduous, and highly risky process that

is the domain of private-sector compa-

nies.

Here’s how drug invention typically

works.

Each year, the National Institutes

of Health funds research in its own

labs and awards grants to scientists at

universities and nonprofit research in-

stitutes. The vast majority of these re-

searchers aren’t actually designing

and developing drugs; rather, they’re

exploring scientific questions funda-

mental to medicine, like how the

body’s organs, cells, and systems work

and the ways in which “normal”

changes to “disease.” They hope that

some of their findings and insights

will point the way toward drug inven-

tion.

If a promising biological target is

identified, a life-sciences company —

either a small start-up or a pharma-

ceutical company — will begin explor-

ing how to translate the research into

a medically useful invention. Biotech

startups typically raise funds from

venture capital investors or public

markets in order to support this re-

search. Large pharmaceutical compa-

nies fund the research out of current

revenues (typically about 15 percent).

If early experiments prove to be

promising and there is potential to

create an actual therapy, the company

moves on to animal trials. If the candi-

date medicine works and testing indi-

cates that it is safe, they move to hu-

man trials. Some biotech firms can

handle this process on their own, but

many others partner with larger com-

panies. In every case, companies are

subject to the Food and Drug Admin-

istration’s stringent review standards.

Hundreds of new medicines have

come out of this process. Just last year,

the FDA approved 59 novel drugs that

target everything from cancers and

pulmonary diseases to migraines. To-

day, almost 6,700 projects are in clini-

cal development.

The drug-development pipeline

didn’t always work so well. Before

1980, the government retained the

patent rights to publicly funded re-

search discoveries and rarely licensed

these patents to private firms. Conse-

quently, the fruits of most federal re-

search dollars were seldom translated

into medicines that would benefit pa-

tients. Indeed, of the nearly 30,

patents that had resulted from federal

research funding up until that point,

fewer than 5 percent became market-

able products.

Frustrated by this, Congress passed

the Bayh-Dole Act in 1980 to push dis-

coveries that might benefit human

health into the commercial sector. The

law explicitly requires research centers

that receive federal funding to patent

promising findings and seek industry

partners. Private firms wishing to in-

vest in discoveries emerging from fed-

erally funded research pay licensing

rights and/or royalties to the nonprof-

its that make these discoveries.

The Bayh-Dole Act has worked.

Public-private research collaborations

with the NIH increased 500 percent

after it was instituted, and potentially

life-saving discoveries stopped sitting

unused in university labs. In 2016

alone, private firms invested $90 bil-

lion in research and development —

nearly triple the budget of the NIH.

Some lawmakers want to regress to

the era before Bayh-Dole. They believe

the government should own the pat-

ents that result from federally funded

research — or, at least set prices on the

medicines that are are eventually de-

veloped.

That’s not smart. Such a shift

would dramatically inhibit the scien-

tific exchange between those who do

basic research and those who explore

clinical applications. It would be akin

to the government exerting a claim on

every commercial enterprise that uses

the Internet because the Defense De-

partment helped create it. Other unin-

tended consequences might ensue:

companies might prefer to collaborate

with laboratories in Europe or Asia in

order to avoid financial disincentives.

Creating a drug is the longest, riski-

est, and most expensive product devel-

opment process on the planet — creat-

ing a new smartphone or self-driving

car doesn’t even come close. It takes

10 to 15 years to go from concept to

drug, and 9 in 10 experimental drugs

fail to receive FDA approval.

Alzheimer’s helps illustrate the

enormity of this task. Over the past

two decades, more than 150 efforts to

develop a novel Alzheimer’s drug have

failed. Alzheimer’s also helps illustrate

how daunting are America’s health

care challenges. Alzheimer’s and other

dementias alone cost the nation nearly

$300 billion each year. Yet industry in-

vestment in Alzheimer’s research year

after year has far outweighed that of

the government.

It will take new medicines to ad-

dress these challenges. And only a

strong biopharmaceutical industry

has the know-how, expertise, resourc-

es — and the financial incentives — to

move from new knowledge to the

medical inventions we so desperately

need.

Dr. Michael Rosenblatt is chief medical

officer of the venture firm Flagship

Pioneering. He previously served as

chief medical officer of Merck and as

dean of Tufts University School of

Medicine.

Howdruginvention

really works

Foreachmedicine,the

FDA’sstampof

approvalculminates

years—ifnotdecades

—ofexpensive

research.

KWANCHAIFT/ADOBE

abcde

Founded 1872

JOHN W. HENRY

Publisher

VINAY MEHRA

President

LINDA PIZZUTI HENRY

Managing Director

SENIOR DEPUTY

MANAGING EDITORS

Mark S. Morrow

Jason M. TuoheyDigital Platforms and

Audience Engagement

DEPUTY MANAGING EDITORS

Marjorie PritchardEditorial Page

David DahlPrint and Operations

Felice BelmanLocal News and Features

Veronica ChaoLiving/Arts

Charles H. TaylorFounder & Publisher 1873-

William O. TaylorPublisher 1921-

Wm. Davis TaylorPublisher 1955-

William O. TaylorPublisher 1978-

Benjamin B. TaylorPublisher 1997-

Richard H. GilmanPublisher 1999-

P. Steven AinsleyPublisher 2006-

Christopher M. MayerPublisher 2009-

Laurence L. WinshipEditor 1955-

Thomas WinshipEditor 1965-

BUSINESS MANAGEMENT

Dhiraj NayarChief Financial Officer

Dan KrockmalnicGeneral Counsel

Kayvan SalmanpourChief Commercial Officer

Anthony BonfiglioVice President, Engineering

Claudia HendersonChief Human Resources Officer

Jane BowmanVice President, Marketing &

Strategic Partnerships

Dale CarpenterSenior Vice President, Print

Operations

BRIAN McGRORY

Editor

JENNIFER PETER

Managing Editor