'In a Golden Age of Cancer Care, PBMs Are Holding Us Back'

 We're living in a remarkable time for cancer treatment, when a diagnosis no longer disrupts how patients live and work. Unlike years ago, an advanced cancer diagnosis is no longer a death sentence for many. Today, most patients diagnosed with cancer can treat it as a chronic disease, much like hypertension and diabetes. Patients undergoing cancer treatment can go to work, pick their children up from soccer practice, and eat dinner with their families.

This is largely due to oral cancer drugs, which allow many cancer patients to maintain a normal routine and quality of life. These treatments are rapidly on the rise: today, oral cancer drugs account for 25-35% of cancer therapies

opens in a new tab or window in development, a number that is projected to grow to 60% in the next few years.

As pharmacy benefit managers (PBMs) have become vertically integrated -- with just three organizations dominating 80%opens in a new tab or window of the prescription drug marketplace -- cancer patients receiving oral treatment are increasingly forced to endure PBMs' excessive approval processes and are directed to PBM-owned mail order or specialty pharmacies that refill drugs. These companies, many of whom are owned by or own the largest health insurers, want to control what treatment patients get and how, when, and where they receive it.

As a breast cancer specialist, I've witnessed how these middlemen insert themselves between patients and doctors through an opaque system of authorizations, barriers, and fees that delay patients' access to life-saving treatment.

Last October, I saw my patient Tania*, a 40-year-old woman with metastatic breast cancer that had metastasized to her brain. I recommended that we utilize the oral cancer drug abemaciclib (Verzenio) due to its unique ability to help treat brain metastasis, which many cancer therapies do not treat. After going through her insurance company and PBM for authorization, the pills were denied. I quickly appealed, but the PBM informed us it would take 6 weeks just to be granted a peer review.

During this time, I watched as Tania's cancer continued to metastasize, and she was soon forced to resort to traditional chemotherapy -- a less effective, higher-toxicity treatment plan. Tania had to stop working and even developed two new brain metastases. While I don't know for certain that Tania would have been better off with abemaciclib, peer-reviewed literatureopens in a new tab or window demonstrates that she would have doubled her chances of living without cancer progression and would have experienced less toxicity in comparison with traditional chemotherapy.

My experience with Tania underscores a harsh reality: rather than assist in cancer care coordination, PBMs often cause disjointed, delayed, confusing, and inferior care.

That was just one frustrating example. Let's examine another.

Doctors frequently modify treatment doses to optimize therapy and control toxicity, sometimes just 1 to 2 weeks after starting treatment. These types of unplanned adjustments are easy to navigate in office-based, medically-integrated pharmacies that serve as a "one-stop shop" for oral cancer therapies, as oncologists can evaluate the patient, check their labs, and make dose modifications prior to the refill.

Yet, PBMs often use their ever-increasing market size and power to divert cancer drugsopens in a new tab or window away from physician dispensing pharmacies. The result is that patients are steered away from the dispensing pharmacy at their community oncology clinic and forced to use PBM-mandated specialty or mail order pharmacies; this may result in delays in prescription delivery, mix-ups, and bureaucratic red tape throughout. By virtually eliminating competition from physician dispensing, PBMs are capturing the prescription drug market -- with seemingly little regard for patient care.

PBMs may tell us that this bureaucratic arrangement is a cost-saving measure. Yet, we see no evidence that PBM involvement translates to patient or employer savings. In fact, premiums and out-of-pocket costs continue to rise. The average premium for family coverage in an employer-sponsored plan has increased 47%

opens in a new tab or window over the past decade, while patients' out-of-pocket spending on prescription drugs climbedopens in a new tab or window from 23.8% in 2013 to 25.1% in 2019 (spending fell in 2020, but this was likely due to the pandemic). Further, these abusive practices are used to allow PBMs to control the practice of medicine by removing treatment decisions from providers' hands.

Thankfully, bipartisan congressional efforts are shining the light of transparency on PBM behavior. In fact, PBM reform is so popular that Sen. Bill Cassidy, MD (R.-La.) and Sen. Bernie Sanders (I.-Vt.) -- ideological opposites on many issues -- are working across the aisle to pass the Pharmacy Benefit Manager Reform Actopens in a new tab or window (S. 1339), which would ban PBMs' use of certain predatory tactics, including spread pricing and claw back fees. With widespread bipartisan support, now is the time to add more oversight and transparency to these middlemen.

Cancer and other diseases know no political divide. It's long past time that we stop PBMs' destructive behaviors to ensure patients can fully realize the benefits of modern cancer therapies.

Debra Patt, MD, PhD, MBA,opens in a new tab or window is an oncologist specializing in breast cancer in Austin, Texas. She serves in the leadership of Texas Oncology, a large independent community oncology practice that is part of the US Oncology Network, and as vice president of the Community Oncology Alliance.

Disclosures

The US Oncology Network is supported by McKesson Specialty Health, a division of the McKesson Corporation.

https://www.medpagetoday.com/opinion/second-opinions/105764

Doctors Sue California Regulators over Mandatory Implicit Bias Training

 A federal lawsuit filed by the Pacific Legal Foundation (PLF) on August 1 argues the state of California is violating the free speech rights of doctors by mandating that they include “implicit bias” training in their continuing medical education (CME) courses.

CME courses are a standard professional development practice that can cover a wide range of topics relating to medical care. The purpose of these courses is to help physicians maintain and grow their knowledge so they can deliver the best quality of care possible. In California, physicians are required to complete at least 50 CME hours every two years in order to keep their license.

The content of a CME course is largely at the discretion of the course provider so long as it’s related to patient care or some other aspect of medicine. However, in 2019 California lawmakers passed a new law called AB 241. According to the law, “[o]n and after January 1, 2022, all continuing medical education courses shall contain curriculum that includes the understanding of implicit bias.” Specifically, CME courses must include “[e]xamples of how implicit bias affects perceptions and treatment decisions of physicians and surgeons, leading to disparities in health outcomes,” or “[s]trategies to address how unintended biases in decisionmaking may contribute to health care disparities by shaping behavior and producing differences in medical treatment along lines of race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, or other characteristics,” or a combination of both.

In short, California is requiring physicians to be lectured on their implicit biases as a condition of renewing their license, and it’s requiring CME providers to deliver these lectures regardless of whether they think the training is necessary or helpful.

“Rather than respect the freedom and judgment of continuing medical education instructors to choose which topics to teach, California law now requires the Medical Board of California to enforce the mandate that all continuing medical education courses include discussion of implicit bias,” PLF writes in their lawsuit. The Medical Guild Board of California is the agency that oversees physician licensing in the state.

“Under the First Amendment to the United States Constitution,” PLF continues, “the government cannot compel speakers to engage in discussions on subjects they prefer to remain silent about. Likewise, the government cannot condition a speaker’s ability to offer courses for credit on the requirement that she espouse the government’s favored view on a controversial topic. This case seeks to vindicate those important constitutional rights.”

Two doctors in particular are named as plaintiffs in the lawsuit, both from Los Angeles. The first, Dr. Azadeh Khatibi, is an ophthalmologist who left Iran with her family as a child after the Iranian Revolution of 1979. She teaches courses on topics such as retinal tumors, glaucoma, and other ocular diseases. The second is Dr. Marilyn M. Singleton, an anesthesiologist and a past president of the Association of American Physicians and Surgeons.

Both doctors take issue with being compelled to include implicit bias training in their courses. Dr. Khatibi is concerned that time taken for implicit bias training will take time away from discussing more important topics in her courses. Dr. Singleton likewise says she would be forced to include information that is not relevant to her chosen topic, wasting valuable training hours on ideas she believes are actually harmful to physicians and patients.

“The implicit bias requirement promotes the inaccurate belief that white individuals are naturally racist,” Singleton said. “This message can be detrimental to medical professionals and their patients as it creates an atmosphere of suspicion and animosity, which goes against the fundamental principle of doing no harm.”

Why Even Proponents of Implicit Bias Training Should Oppose This Law

The debate around implicit bias training is a tricky matter, in part because there’s more than two positions. Some say health disparities have nothing to do with implicit bias. Others agree that implicit bias plays a role, but think lecturing people about it is at best ineffective and at worst counterproductive. The legislators, of course, think that implicit bias is a key part of the problem and that lecturing people about it will help the situation.

If you are in either of the first two camps, it’s clear why you would oppose this legislation. According to those views, implicit bias training simply has no upsides. But even for those in the third category who genuinely believe this training will help, there are still three good reasons to oppose this legislation.

First, it compels doctors to give airtime to ideas they might disagree with, effectively making them mouthpieces for the state. Even if the ideas are genuinely good, that doesn’t justify controlling what doctors say. To give an analogy, I think we could save a lot of lives if doctors were forced to talk about the benefits of a free market in organs. But the ends don’t justify the means, no matter how noble the ends.

The second reason to oppose this legislation has to do with opportunity costs. As the plaintiffs mentioned, time spent talking about implicit biases is time they can’t spend talking about arguably more important things like retinal tumors. Even if implicit bias training is helpful, that doesn’t mean it’s the most helpful thing for improving patient care. There are many topics competing for a scarce amount of time, and it’s by no means obvious which is the most important. As such, shouldn’t we let doctors—the actual experts on the ground—decide what’s most urgent to discuss?

The third reason has to do with the social ramifications of coercion. When contentious laws like this get passed they foster a lot of resentment and social strife, because the topic has now been politicized. Suddenly, instead of peacefully going our separate ways, we’ve created a society of winners and losers, the imposers and the imposed upon. It’s fine and even healthy to have disagreements about medical training, but bringing those into the political realm and insisting on a one-size-fits-all approach is a recipe for constant antagonism.

Fortunately, we don’t all have to think the same way and deliver the same medical training. We can choose to live and let live. Let the doctors who believe in implicit bias training provide it, and let them prove its effectiveness with good results. But by the same token, for the sake of social harmony, let’s allow the doctors who disagree to teach and practice according to their own philosophy.

With this laissez-faire policy in place, people with different philosophies can peacefully coexist, much like people with different religions could peacefully coexist when we finally decided to separate church and state.

Come to think of it, maybe it’s time we had a conversation about separating medicine and state.

Patrick Carroll has a degree in Chemical Engineering from the University of Waterloo and is an Editorial Fellow at the Foundation for Economic Education.

https://fee.org/articles/doctors-sue-california-regulators-over-mandatory-implicit-bias-training-for-physicians/

Parents, Get Your Kids Behind the Wheel

 There has been a lot of chatter on social media about the number of teenagers today who are simply uninterested in earning their driver’s licenses. The Wall Street Journal reported in 2019 that while nearly half of 16-year-olds were driving in the 1980s, just a quarter were by 2017. Data from the Federal Highway Administration present a similar trend showing that 46 percent of eligible 16-year-olds in 1983 earned their licenses. By 2018, that figure dropped to 26 percent. The data on teen driving is not entirely consistent across sources, but there is a clear decline.

While numerous possible explanations have been offered for this change, what needs to be highlighted are the consequences of not driving, like the fact that teens today are losing agency and serendipity in their lives by not driving themselves.

When I was 16, I could not wait to learn to drive. As a member of Gen X, I lived at the beginning of the cell phone era, when satellite navigation was not available to the general public, text messaging and the internet was just emerging. When I needed to plan a trip, I would visit AAA and get maps and “TripTiks.” When I would drive, I would be offline and focused on the road and the world around me. Without GPS, I had incredible freedom to stop anywhere and look at countless attractions, places, and anything that sparked my curiosity. I could, and would, get lost as I was trying to make sense of the sights and sounds around me. It was thrilling, exhilarating, and occasionally a bit scary.

So many of my favorite memories involved taking road trips with friends and family to explore various places. And the destination was only part of the fun; the drive was a major part of the experience. On a college trip to Los Angeles from the Bay Area, friends and I randomly stopped for date shakes and could smell the intense odors from Central Valley cow farms; these were two unplanned experiences that are hard to forget. When I first started dating my wife, we would drive to various destinations on weekends—serendipitously exploring the New England coast and having the freedom to see a sign or something in a guidebook and just go. We had the true freedom to explore, and the open road was thrilling and enticing.

Sadly, many of today’s teens miss these experiences. By literally being passengers rather than drivers, Gen Zers are increasingly being passive in the world around them. Gen Z has grown up in a world of pandemic lockdowns and have lived so much of their lives through screens. Smartphones and other technologies deeply influence where they want to go and often provide directions and even the transportation. But, for Gen Zers, going the wrong way, getting lost, the mystery of the unknown, and the thrill of exploring without a mapping program have all but disappeared.

Having apps that effectively shuttle people from point A to point B certainly enables mobility without knowing how to drive, but these apps keep Gen Zers cocooned and isolated from the real world and authentic experiences. Driving can help one understand a place and the space within, so it is no wonder so many in Gen Z feel disconnected from their neighborhoods. Moreover, the apps have fundamentally changed the dynamics of dating—imagine dating with an Uber driver in the front of the car—and have altered how younger Americans “hang out” and go out with their friends as well. The classic opening scene in Wayne’s World of five teens singing in the car to Queen’s “Bohemian Rhapsody” and the centrality of the scene representing real connection in suburbia may be totally lost on many in Gen Z today.

Of course, none of this is to say that there is no real value to digital products and technology like ride apps, nor that not having a license and using alternatives to travel does not have value. However, collectively, Gen Zers have become passive and they are, understandably, the loneliest generation. The data show that today’s parents and grandparents are at least twice as likely to believe that responsible citizenship requires both community and electoral engagement—a lesson apparently lost on many members of Gen Z. It is worthwhile for members of Gen Z to learn how to drive, get on the road, and look out the front window and sit behind the wheel rather than their screens—they may love the thrill of exploring, being spontaneous, and having agency; they may feel far less lonely as they connect more closely with the places and spaces that they are actually in along the way too.

https://www.aei.org/society-and-culture/parents-get-you-kids-behind-the-wheel/

Amgen Clinches Clinical Wins in SCLC and Colorectal Cancer

 Two of Amgen’s oncology assets claimed mid-stage and late-stage clinical victories, the company announced Thursday in its second-quarter earnings report.

Without providing specific data, Amgen reported that its investigational bispecific T-cell engager (BiTE) tarlatamab led to “durable objective response rate” in patients with relapsed or refractory small cell lung cancer (SCLC) who had failed at least two prior lines of treatment. The Phase II study, dubbed DeLLphi-301, also found that tarlatamab’s safety profile was “more favorable” compared to its Phase I study and identified no new signals of concern.

Amgen will take these “potentially registrational data” to regulatory agencies to determine the best regulatory path forward for tarlatamab, according to the announcement. The company has also launched a Phase III SCLC study for the BiTE candidate, dubbed DeLLphi-304, in the second-line setting and plans to initiate two more late-stage studies in earlier lines of SCLC.

Results from DeLLphi-301 will also be presented at an upcoming medical congress.

Amgen also revealed in its second-quarter earnings report that the company’s KRAS inhibitor Lumakras (sotorasib) met its primary endpoint in the global Phase III CodeBreak 300 study. When combined with Vectibix (panitumumab), Lumakras significantly improved progression-free survival in patients with chemorefractory metastatic colorectal cancer harboring the KRAS G12C mutation, as compared with current standard of care.

The company again did not present specific data but promised to do so at an upcoming medical congress. Amgen will also discuss these data with regulatory authorities to assess a potential label expansion for Lumakras.

First approved in May 2021, Lumakras works by forming irreversible covalent bonds with the mutated KRAS, thereby keeping the protein in its inactive form and preventing the cancer cells from growing further. The drug is used to treat non-small cell lung cancer, for which it competes with Mirati’s Krazati (adagrasib), which won the FDA’s approval in December 2022.

In the second quarter, Lumakras brought Amgen $77 million in sales, representing no change from the same period in 2022. According to the company, this flat trend was driven by a lower net selling price and inventory levels, which offset 20% growth in volume. Its recent Phase III win could set Lumakras up for a label expansion and push the drug into a new therapeutic space to boost its sales numbers.

Despite stagnant sales from Lumakras, Amgen posted a 6% increase in total revenues, which reached $7 billion in the quarter. A similar 6% jump in product revenues accounted for this revenue growth, particularly from its cardio asset Repatha (evolocumab) and menopausal osteoporosis medicine Evenity (romosozumab), sales of which increased by 30% and 47%, respectively.

https://www.biospace.com/article/amgen-clinches-clinical-wins-in-sclc-and-colorectal-cancer/

Government Needs to Encourage – Not Suppress – Drug Competition

 Six new copycat versions of Humira – one of the top-selling prescription drugs in the United States – just hit the market. Cyltezo is the first interchangeable Biosimilar for Humira, and another named Yusimry, is about 85% cheaper than the brand-name product. In total there will be eight available Biosimilar competitors to Humira available in the coming weeks.

That's fantastic news for insurers, taxpayers, and – most of all – patients battling everything from rheumatoid arthritis to Crohn's disease to ulcerative colitis. Collectively, they stand to save billions of dollars thanks to the cheaper versions coming to market.

Unfortunately, last year's Inflation Reduction Act could make the launch of these lower-cost treatments the exception, rather than the norm. The law – which Congress passed to reduce drug spending – could ironically keep drug spending high by deterring the creation of biosimilars.  

The Humira biosimilars show that America's drug development system is working just as it should. The drug launched in 2003. Like any other new medicine, Humira enjoyed finite periods of patent and market exclusivity to allow its developer to recoup R&D costs and earn a return. That return is what drives life-science innovation in the first place. Investors fund drug development in the hopes that they may one day profit from the development of a new medicine. 

Humira enjoyed a virtually unprecedented 20 years of exclusivity, but those periods are now over, and biosimilars are launching left and right. As yet more manufacturers join the dance, it will create a robust competitive market driving down price. Ultimately, patients will win.

Most people are familiar with generics, which contain the same active ingredients as brand-name, chemically synthesized, small-molecule drugs that typically come in pill form. The market for generics is enormous – nine in 10 U.S. prescriptions are filled with generics.

Biosimilars, on the other hand, are nearly identical copies of "biologics," which are large-molecule drugs grown from living cell cultures that are typically administered intravenously. The biosimilar market is still nascent; the FDA has approved just 41 biosimilars, compared to roughly 32,000 generics.

Unlike generics, which often take just a few million dollars and a year or two to launch, biosimilars are expensive and complicated to manufacture and shepherd through the regulatory approval process. A single biosimilar can cost hundreds of millions of dollars and nine years to develop.

The increased cost is due, in part, to the complexity of growing and formulating a medicine from living cells, rather than simply copying a brand-name drug formula that relies on synthesized chemical ingredients. 

Policymakers want more biosimilars to enter the market, and rightly so. Biologics comprise nearly half of U.S. drug spending, while making up just under 3% of prescriptions. Biosimilar competition could save the U.S. healthcare system a whopping $180 billion over the next five years alone, according to a recent analysis.

But the Inflation Reduction Act risks spoiling biosimilar development just at the critical time when the industry is starting to take off. 

The law permits the government to impose "negotiated" price controls on certain brand-name medicines covered through Medicare. Brand-name biologics become eligible for negotiation after they've been on the market for 11 years, with the negotiated prices taking effect two years later – in other words, 13 years after a biologic's initial FDA approval. 

"Eligible" is the key word – nobody knows which particular biologics will be selected for the negotiation process, and which won't, until the government publishes its list of selected drugs two years before price controls take effect. 

That presents a major problem for biosimilar developers, whose entire business model is premised on winning market share by undercutting the name-brand biologic on price. 

If the government swoops in and resets the price of the name-brand biologic below what a biosimilar competitor's anticipated price, it would  vaporize the biosimilar developer's projected profit margin.

And without advance notice of which drugs will be selected, it becomes incredibly risky for biosimilar developers to spend nearly a decade and up to a quarter billion dollars to launch their products.  The inevitable consequence of this government-created uncertainty will be a "market flight" of biosimilar manufacturers who will be unable to justify entering certain markets. 

Lawmakers tried to address this harmful uncertainty when, at the eleventh hour, they added a provision to the IRA that allows the government to delay selecting a given biologic for price-setting for one year, and potentially an additional year, if there is a "high likelihood" a biosimilar will launch during that time. 

The policy was well-intentioned, but the text left too much ambiguity. For a delay request to even be considered, a biosimilar has to be on the verge of launching – but the specifics of what that means are undefined. Plus, since it can take nearly a decade to develop a biosimilar, manufacturers would have to make monumental investment decisions long before they know whether they'll win a delay. 

The Centers for Medicare & Medicaid Services had an opportunity to clear up the uncertainty surrounding the biosimilar delay when it released its initial drug pricing implementation guidance back in March. Instead, the guidance made matters worse by doubling down on the uncertainties present in the IRA.

Kneecapping the biosimilar market could undo any savings that stem from drug price negotiations. Projected savings from the IRA's negotiation provision – $98.5 billion – are far below the $180 billion estimated five-year savings that would accrue if lawmakers and CMS let the biosimilar market work.  

This particular statistic exemplifies the short-sightedness of the IRA. While the law's price controls will achieve short-term savings, in the long-run they will produce only half the savings that would result from unimpeded market forces. 

The emerging biosimilar market has the potential to dramatically lower drug spending – but only if lawmakers and CMS revisit the policies that are currently deterring the development of these lower-cost medicines.

Dan Leonard is the former president and CEO of the Association for Accessible Medicines, former president and CEO of the National Pharmaceutical Council, and former executive vice president of public affairs for America's Health Insurance Plans.

https://www.realclearhealth.com/blog/2023/08/04/government_needs_to_encourage__not_suppress__drug_competition_970892.html

The First Thing You Learn at Harvard

 My guest this week, the journalist Jay Caspian Kang, has been following the Students for Fair Admissions cases for the better part of a decade as they’ve wound their way through the courts. In the beginning, Jay was a believer in affirmative action. But by the end, as the discovery process revealed more and more evidence showing that Harvard clearly discriminated against Asian Americans and other applicants, he found that he could no longer support the policy as it’s practiced.

As Jay sees it, one of the major problems the case revealed is that Harvard (along with many other selective schools) favored those who claimed to suffer trauma due to their race, especially if they were black or Latino, no matter how objectively privileged they were. In essence, students who could play the role of “victim of systemic racism,” no matter their actual lived experience, had a much better shot of getting in than those who couldn’t or wouldn’t, regardless of how much better the latter group’s test scores and grades were. And if you were an Asian applicant, even off-the-charts academic performance couldn’t earn you a fair shot at getting in, regardless of how many actual difficulties you and your family had faced.

This concrete evidence of discrimination would be bad enough. But Jay points to a possible, more insidious consequence of these policies: Applicants who conjure up trauma narratives might actually start to believe this institutionally mandated bullshit. After all, if Harvard signals that its applicants must cook up a story about their own oppression and then legitimizes the story by admitting the student, the student could be forgiven for taking their acceptance as confirmation that, whatever their own initial feelings, they have been traumatized. Even in a scenario in which the student knows they must tell a made-up story about themselves simply to gain admission, these schools require a startling amount of cynicism from the students they so often champion as young idealists.

Either way, the first lesson Harvard teaches its students appears to be the following: Market your identity-based oppression. And if you’re not oppressed, start acting like you are. Elsewhere in our conversation, Jay asks why we permit the existence of an elite tier of schools in this country, if this is what they’ve come to. Jay’s a left-wing guy, I’m a conservative. But I have to say, given all the evidence, I think it’s a pretty good question.

JAY CASPIAN KANG: The part that concerns me the most is this idea in which people feel like they have to perform a type of harm. And so for myself, for example, I think about it and I think, well, I can sort of construct one. I can say my parents were born in a war zone in Korea. This is true. My family escaped from North Korea. That's true. I have generational trauma from Japanese imperialism and from my parents being born in a war zone. I mean, it should be true, right? When I was a child—I'm sure you're very familiar with Cambridge—our family lived in the Alewife Towers.

GLENN LOURY: I know the Rindge Towers. I read this in your book. I was married, coming to graduate school with two kids, and we split up while in graduate school when I was at MIT. And they moved—my wife and two kids—to the Rindge Towers that you talk about. So I know them very well.

So you know them! My point is I could come up with this whole history of oppression for myself. Do I believe it? No. By the time I was in middle school, my family was very middle-class, and my parents were very educated. I guess I fear that what happens is that when students are incentivized to this degree to perform something like that, they start to believe it. They feel like the difference between going to Harvard and going to a perfectly fine but not-Harvard school is that they have to construct this type of identity around themselves.

The way Harvard was doing it for a while was basically, if you didn't write about it in your essay, it didn't count. It didn't count that you were this minority group unless you told a sob story about it. I find that to be totally indefensible. Actually, I find it to be quite disgusting that the lead institution is asking these kids to perform their trauma stories for them.

As you've witnessed, in the past 20, 30 years, however long this type of story has been asked to be told, have you noticed that the students themselves have started to [imbibe] it more? Do you think it has an effect on the way students think about themselves? Or do you think it's just something that they do once and they just say, “Okay, it helped me get into Harvard, and now I'm just going to stop”?

I don't know. That's a question for a psychologist or somebody. I mean, I see the danger in what you say, and I have seen the performance that you make reference to, how systematic embrace of this performative internalization—“I've been victimized, I am harmed, I am diminished”—how widespread that is. I'd only be guessing if I said anything.

I do think it's debilitating and disempowering. And also, it's a lie, right? It's untrue to the actual objective condition of the mostly solidly middle, upper-middle-class black kids that I encounter here in my classes at Brown. They haven't exactly been beaten down by history. Notwithstanding the fact that they will be able to recount both in their own lives and in the lives of their parents and grandparents a wealth of stories about disadvantage and mistreatment. But they're very, very privileged kids.

Yeah. I think for the Asian population, maybe that was part of the angst that was going [on], or for a lot of the parents of the kids who are applying to these schools. They were told stuff like, “Don't tell the immigrant story, because they don't care about that.” Like Roberts said, if there's a positive, there has to be a negative here. There was almost this—I think for a lot of the students and their parents that I spoke to—this belief.

If you're Vietnamese and you live in America, you probably have some generational trauma somewhere nearby. If you are from Korea, same thing. There's something that happened that was bad that if people who didn't know about it saw photos of, they would be shocked. If you saw the poverty in Seoul when my parents were growing up, for example, you would be shocked. I was shocked when I first saw it.

This idea—and the thing that I think frustrated a lot of people—is like, “Look, nothing that happened to my family or me or whatever matters.” But then you have, for example, let's say a Chilean kid coming who grew up extremely wealthy, and that matters more, that he gets to check the Latino box. Within that type of atmosphere, where those things are true and are happening, how do you support it? I think that that was a falling-off point for a lot of these Asian families. I don't know.

I would just say, personally, for myself, I was like, it just doesn't make any sense. The grandson of somebody who worked with Milton Friedman to deregulate the economy of [Chile] and is a billionaire, that identity matters. But this poor Chinese kid or poor Vietnamese kid, poor Cambodian kid, that doesn't matter. It doesn't matter what happened to this family. It doesn't matter. It actually just matters that this kid can check the Latino box and we can't.

That's not a good system, I think, for anyone. But particularly on the left, because it almost makes a mockery of all the things that we're supposed to care about. It makes a mockery of the [egalitarianism] that should be fueling a lot these ideas. And I think that supporting it is ... I don't know, I think it's silly.

https://glennloury.substack.com/p/the-first-thing-you-learn-at-harvard

Two Sets of Laws for Two Americas

 Two sets of laws now operate in an increasingly unrecognizable America.

Consider the matter of unlawfully removing and storing classified papers.

Donald Trump may go to prison for removing contested White House files to his home.

So far, Joe Biden seems exempt from just such legal jeopardy.

But as a senator and vice president with no right, as does a president, to declassify files, Biden removed and, as a private citizen, kept for years classified files in unsecured locations.

Biden's team strangely revealed the unlawful removals after years of silence.

It did so because the Biden administration found itself in the untenable position of prosecuting the former president for "crimes" that the current president committed as well -- albeit far earlier and longer.

Impeachable phone calls?

Donald Trump was impeached by a Democratic House for delaying foreign aid until the Ukrainian government guaranteed that Hunter Biden and his family were no longer engaged in corrupt influence peddling in Kyiv.

In addition, the Left charged that Trump was targeting Joe Biden, his possible 2020 rival.

Yet Biden, with impunity, bragged that he had fired a Ukrainian prosecutor looking into his own son's schemes by promising to cancel outright American foreign aid.

And the Biden administration's Justice Department is now targeting Trump, currently the front-running challenger to Biden in 2024.

Election denialism?

Trump was indicted by Special Counsel Jack Smith, in part for supposedly conspiratorially "unlawfully discounting legitimate votes."

Will Smith then also indict Stacey Abrams? For years Abrams falsely claimed that she was the real governor of Georgia. She toured the country in hopes of "discounting" the state vote count.

Or maybe Smith was referring to the conspiracist and former president Jimmy Carter.

He alleged that Trump in 2016 "lost the election, and he was put into office because the Russians interfered on his behalf."

Will Smith charge Hillary Clinton?

She serially libeled Trump as an "illegitimate" president.

Clinton hatched the Russian collusion hoax, and bragged she joined the "Resistance" to continue her attacks on an elected president.

Or maybe Smith meant the Hollywood crowd.

Lots of actors cut commercials after the 2016 election -- begging viewers to pressure the electors to ignore their constitutional duties to honor their states' popular vote and instead swing their ballots to Hillary Clinton?

Was not that "insurrectionary?"

Or was Smith thinking of January 2005?

Then 32 Democratic House members and Sen. Barbara Boxer tried to nullify the legally certified vote in Ohio -- to thereby elect the loser John Kerry.

How about destroying evidence?

Trump was also indicted for allegedly attempting to erase video material from his own security cameras in his own house.

Yet Hillary Clinton with impunity eliminated subpoenaed communication devices and thousands of emails.

Violations of security? Trump was indicted for supposedly loosely talking about classified material to visitors at his home.

So, will prosecutor Smith's indictments also extend to Hillary Clinton? She sent classified documents illegally over her unsecured private server.

FBI Director James Comey memorialized a confidential president conversation.

Then he deliberately leaked what properly was a classified document to the media. It was all part of Comey's Machiavellian gambit to prompt the appointment of a favorable special prosecutor.

What about subversion of the electoral process?

Donald Trump was indicted for supposedly undermining the election of 2020 by questioning the integrity of the balloting.

In 2016, Hillary Clinton's campaign illegally hired two foreign nationals Christopher Steele and Igor Danchenko to compile falsehoods about her opponent Trump.

Clinton hid her payments behind three paywalls.

Her team, along with the FBI, helped leak the counterfeit dossier to the media and high officials to undermine her opponent -- and thus subvert the election itself.

Lying and perjury?

Two Trump aides and Trump himself are indicted for supposedly stonewalling federal investigators by claiming either amnesia or ignorance.

That tact is exactly what James Comey did 245 times while under oath before Congress.

What do former Director of National Intelligence James Clapper, former Director of the CIA John Brennan, and former interim FBI Director Andrew McCabe all have in common?

All three admitted they flagrantly lied either under oath to Congress or to federal investigators.

The three were never indicted for their false and perjurious testimonies.

We have now serially devolved from the 2016 election "Russian collusion" hoax, to the 2020 election "Russian disinformation" laptop hoax, and down to the 2024 election weaponized indictments.

Out of pathological hatred or fear of Donald Trump, the Left has crafted one set of laws for themselves, and another for all other Americans.

They smugly believe their own moral superiority grants them such a right to apply laws unequally -- or to ignore them altogether.

To retain power at all cost, and to destroy a political rival, left-wing Democrats are systematically dismantling the constitutional foundations of the United States as we once knew them.

Victor Davis Hanson is the Martin and Illie Anderson Senior Fellow at the Hoover Institution and the author, most recently, of The Case for Trump. 

https://www.realclearpolitics.com/articles/2023/08/04/two_sets_of_laws_for_two_americas_149580.html