All the Ukrainian Known Knowns

by Victor Davis Hanson 

Aside from the rhetoric, there is a growing consensus among Western diplomats, military analysts, military officers, heads of state, and even much of the media about how to end the endless Ukrainian war.

A proposed peace will see a DMZ established somewhere along an adjusted 1,200-mile Ukraine-Russia border. Tough negotiations will adjudicate how far east toward its original borders Russian forces will be leveraged to backstep.

Publicly in the U.S. and covertly in Europe, all accept that a depleted Ukraine will not have the military strength to retake Crimea and the Donbas.

In 2014, both were absorbed by Russia during the Obama administration. Neither that administration nor any since has advocated a military effort to reclaim them.

Loudly, the U.S.—and again quietly Europe—concedes that Ukraine will not be in NATO—a confirmation that Russia will use to justify to its people its disastrous invasion, and even many Ukrainians will accept.

How will the West deter Putin from his inevitable agenda of reclaiming lost Soviet territory and Russian-speaking peoples? For now, his army is exhausted, its arsenals depleted, and its reputation shatteredIn the future, a commercial corridor, anchored by concessions to American and international mining concerns, will supposedly serve as a tripwire to deter Putin from attacking in-the-way noncombatant Americans.

More practically, Ukrainian forces will be kept fully armed. They have already inflicted perhaps a million causalities on Putin’s forces—possibly five times the dead, wounded, and missing that the Russians lost to the Taliban over that entire decade-long misadventure in Afghanistan.

If Trump can coax even a ceasefire, the oddly bellicose left will still rail about “Munich” and Trump as “Putin’s puppet.”

But after perhaps 1.5 million total Ukrainian and Russian dead, wounded, sick, and missing, transatlantic leftists will quietly admit they never had any realistic plan to win by fighting Russia to the last Ukrainian.

And they certainly were not willing—despite what they claimed in their spasms of braggadocio—to send U.S., U.K., European, or NATO ground troops into Eastern Ukraine.

Trump has faced criticism for his volatile, art-of-the-deal approach to Ukrainian diplomacy over the last 10 weeks.

Lost in such criticism is that the Biden administration did not even try to end the war. Instead, in the LBJ-style of “light at the end of the tunnel,” it parroted the great “spring offensive” to come. And when that gambit disastrously failed, it resorted to the banal blank check of “as long as it takes.”

Western leaders simplistically thought that sending more arms, money, and Ukrainians into the cauldron would eventually break Russia—30 times larger than Ukraine, 10 times richer, over four times more populous, and far less bothered by the mounting toll of its greater losses.

In addition, we even know the likely course of negotiations to end the slaughter.

As soon as Trump pressures Zelenskyy for a ceasefire and a rare minerals mining concession, Putin smells an advantage. So, he digs in and orders his generals to double down on terror strikes for advantage.

And then, once Trump sees that scolding Zelensky empowers Putin to back off from a ceasefire, he turns on Putin and puts far greater pressure on him: a secondary embargo on all who buy Russian oil that even the “on to Moscow” crowd had never envisioned.

Once Putin seems to agree, then Zelenskyy thinks he was had and wants a better mining deal or reconsideration of NATO or more sophisticated weapons—until Trump reminds him that the despised U.S., not his beloved Europeans, is his only route to a shaky peace.

So, we know the negotiations will have a yin and yang until there is no solution other than a ceasefire leading to a Korean-peninsula-like hot peace.

Putin always preferred to exploit the Obamas and Bidens of the world. And he did so in 2014 and 2022, rather than the mercurial, unpredictable, and ultimately dangerous Trump, during whose tenure he stayed put within his borders.

He also knows that for all the talk of his puppet Trump, the latter killed hundreds of the Wagner group, pulled out of an asymmetrical missile deal, first sent offensive weapons to Ukraine, sanctioned Russian oil and oligarchs, warned the Germans not to deal with Putin on the Nord Stream II pipeline, and bombed into extinction ISIS of Iraq, Abu Bakr al-Baghdadi, and Qasem Soleimani.

So, Putin knows that India, China, and others who buy his oil will not if he reneges on his willingness for a ceasefire.

If and when peace comes, we can already foresee the misinformation that will follow: Trump deserves no credit. Zelenskyy remains the true hero. A now hollowed-out Russia was the real winner.

The only mystery?

Since when did the anti-war left prefer an endless and horrific war to a difficult, messy peace?

https://amgreatness.com/2025/04/03/all-the-ukrainian-known-knowns/

Remember the Price of Eggs?

 Democrats thought they had a great issue in the high price of eggs, due mostly to avian bird flu. In January, they were touting record-high egg prices as proof of the failure of Trump’s administration–even though the figures released in January were for December, before Trump’s inauguration.

Weirdly, the Democrats’ harping on eggs has continued even as the price has plummeted, as in this LA Times column, published on March 8:

As their party struggles to navigate the early days of Donald Trump’s second presidency, some Democrats are convinced that their road to recovery lies in the price of eggs.

Instead of leaning into Trump’s tear-down of the federal government or his alliance with billionaire lieutenant Elon Musk, they’re steering to what they perceive as the everyday concerns of Americans — none more important than grocery prices and eggs in particular.

U.S. egg prices hit a record average of $4.95 per dozen in January, surpassing a previous record set in January 2023, according to federal data.

Meanwhile, what has actually happened to the price of eggs:

What was it that cartoon villains used to say? Curses, foiled again! It’s almost enough to make you feel sorry for the Democrats. They apparently are left with no better strategy than torching Teslas.

https://www.powerlineblog.com/archives/2025/04/remember-the-price-of-eggs.php

Trump’s Long Term Strategy to Maintain Preeminence Over China

 

Victor Davis Hanson breaks down why Trump has made maintaining dominance over China a central issue for his administration on this episode of “Victor Davis Hanson: In His Own Words.”

“He’s worried that China is intimidating countries in the Pacific and in Asia. Some of our strongest friends—Australia, South Korea, Taiwan, the Philippines, Vietnam. Saying things like, 'The United States is in decline. You better cut a deal.'"

“ China is ascendant and we are static," he says.

VICTOR DAVIS HANSON, DAILY SIGNAL: I’d like to talk today about China—it seems to be on everybody’s mind, but explicitly on Donald Trump’s mind. That’s the one common denominator that explains his interest in Panama and not to turn over our key transit from East to West Coast to China—China has no business there—and the same thing with Greenland. He’s worried about the Chinese having access to the Arctic Circle, he’s worried about their trade surplus, he’s worried about circumventing unfair trade by assembling their products in Mexico, he’s worried about them sending raw product of fentanyl, he’s worried about their surrogates—the sort of mad pitbulls like North Korea and, increasingly, Iran—that China cuts the leash every once in a while and says, “Go to it, cause chaos.”

He’s worried that China is intimidating countries in the Pacific and in Asia—some of our strongest friends—Australia, South Korea, Taiwan, the Philippines, Vietnam—saying things like, “The United States is in decline, you better cut a deal.”

Essentially, they’re like Japan in 1940, and they’re trying to refashion something like the Japanese East Asian Co-Prosperity Sphere—that was a mercantile system aimed at the West, which soon they were to be at war with. So is it all depression? No—what Trump is saying is, for us to stop this, we’ve got to balance our budget—we can’t spend $3 billion a day on interest. If we’re going to do this, we have to have trade parity—we can’t keep running up a trillion, a trillion and a half dollars in trade surplus.

And when he looks at us at home, he says the ESG—this equity-social governance—that we don’t look at productivity and stocks but whether they’re politically correct, or DEI, and woke—that’s anti-American stuff, it doesn’t work. The Chinese love it—we will not be competitive. If you look at the border, you can’t have an open border with 30 million illegal aliens—that is a drag on productivity—you have to have security.

So what he’s doing in all these areas is identifying the threat that China poses and why we, with an open, transparent, and capitalist society, can achieve our preeminence—or guarantee our preeminence—if we make changes.

And it’s not necessarily a pessimistic picture—I just give you some statistics. Yes, China has 2,000 fighters, we have 1,500—but fighters aren’t the only story. The re are bombers, there are logistic planes, they’re intelligence planes—when you look at all of the U.S. Air Force, we have about 1,500 more planes, and we have over 500 fifth-generation fighters—I think they only have about 60. Yes, they are building 200 times more ships than we are. Remember, we built the largest navy in World War II that turned out, by 1945, larger than all the navies in the world. We were building a Liberty or Freedom mercantile vessel—big 10,000-12,000-ton vessels—every 5 days—we built 3,000 of them, we built 120 carriers of different classifications—so we were the shipbuilder, and now China is.

But when you actually look at our fleets, we still have 11 fleet carriers and army groups—navy groups—around them. They’re over 100,000 tons, they’re all nuclear—China has two and it’s building a third. We have about 85 to 87 submarines, they have about 60—but every one of ours is nuclear, not of theirs—they only have about six or seven.

If you look at all of these statistics on economics—they have 1.4 billion people, we have about 335 to 340 million people—but we produce one and a half times the nominal GDP that China does. So one American produces one and a half times more goods and services than his four Chinese counterparts.

If you look at per capita income, we’re still ranked sixth in the world—China’s 73rd. Americans have a lot more purchasing power per capita than the Chinese.

So let me put this all together in conclusion—China is ascendant, and we are static. Trump comes in, and he’s looking at things at home that will restore our global preeminence—fiscal discipline, secure borders, merit-based education, energy development—and he says, “Right now we still have the lead, and we will maintain this lead, but if we continue down the trajectory we’re at, we’re going to be in big trouble.”

Final note—we have 5,500 deliverable nuclear weapons, China has about 500—but they’re building six or seven a month, and they want to get up to a thousand in 5 years and then keep going. So what Trump is doing, again, is he’s saying, “Right now, our system is much superior—energy, agriculture, productivity, GDP, per capita income—but the trends in the future are not good, and if we don’t change, our rival will dominate the world, and I’m not going to let that happen on my watch.”

And I think that explains a lot of his otherwise sometimes inexplicable worries—from Greenland to Panama to the border to our universities.

https://www.realclearpolitics.com/video/2025/04/03/victor_davis_hanson_trumps_long_term_strategy_to_maintain_preeminence_over_china.html

 

Price Controls Won't End Global Pharma Freeloading

 A new paper by the America First Policy Institute, a think tank with close ties to the Trump administration, has revived the debate over global drug pricing.

The paper points out that patients in the United States tend to pay considerably more for brand-name prescription drugs than those in most other wealthy nations. The think tank argues that the Trump administration should find ways to force other countries to pay more for drugs — and thus pick up a more equitable share of the cost of developing new medicines.

The intent is right. Unfortunately, the paper's methods for achieving it would slow global innovation — and fail to compel other countries to pay more for drugs.

Foreign countries are indeed "freeloading" on American pharmaceutical investment, as the AFPI paper puts it. U.S. gross prices for brand-name drugs are 422% higher, on average, than in 33 other developed nations analyzed by the RAND Corporation in a 2024 study.

What's behind this yawning price gap? Price controls, mainly. Much of the developed world caps the prices of drugs sold within its borders. Often, those prices are linked to what other countries pay. So if one country imposes stiff price controls on a drug, then those prices are automatically exported to other countries.

One consequence of international reference pricing schemes like these is that Americans end up paying more for their medicines in order to make up for systematic underpayments elsewhere. This, more than any other factor, explains why the same drug can cost substantially less in Canada, France, or Germany than it does in the United States.

Of course, many drugs are not available in countries with price controls. Drug companies tend to prioritize selling their products in countries where they can earn the greatest return. Nearly 60% of drugs that launched between 2012 and 2021 hit the market first in the United States. Less than one-fourth were launched first in the European Union.

In a just world, other wealthy nations would pay more for their medicines. "If other countries paid higher drug prices," the AFPI paper notes, "drug manufacturers could invest in more R&D to develop additional medications or could lower prices for American patients."

But then the paper engages in some magical thinking. It calls on the United States to create a reference-pricing system of our own. This new policy, known as the most-favored nation (MFN) model, "would limit how much Medicare and Medicaid spend on certain high-cost drugs based on the drug's lowest price in other wealthy countries."

It's unclear how adopting the very price controls other countries impose on prescription drugs will result in higher prices abroad. AFPI seems to think that drug companies will be able to negotiate better deals with foreign governments under this new system.

But drug companies would have done so already if they could have. They charge lower prices abroad today because they have little choice. And if they refuse to sell their products in a particular country unless it agrees to higher prices — as AFPI's plan would require — then that nation could easily retaliate by seizing the company's intellectual property.

If multiple drug companies banded together to try to force countries to pay higher prices in line with AFPI's plan, they'd likely be treated as a cartel — and penalized under European Union competition law.

Importing foreign price controls on prescription drugs into the United States will lead to much less revenue for the pharmaceutical industry — and much less money to invest in the development of the next generation of medicines.

Today, it takes well over $2 billion and more than a decade to create a new drug. Only 1 in 10 drugs that enter clinical trials reaches patients. Given those steep expenses and long odds, we can expect far fewer novel drugs to be developed if the United States adopts international reference pricing.

The only feasible way of ending foreign prescription drug freeloading is through direct negotiations between governments. For that to work, the Trump administration will need to steer clear of price-control policies here at home. Otherwise, it will squander any chance of ending those same policies abroad.

Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The World's Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It (Encounter 2025). 

https://www.newsmax.com/sallypipes/big-pharma/2025/04/02/id/1205404/

Questions the media should ask about reductions in work force

by Vinay Prasad 

Substantial reassignments occurred in HHS agencies. Many employees were asked to report to, for instance, the Indian Health Service, or face an impending layoff. Most have chosen lay-offs. This spans CDC, HHS, FDA, and NIH.

The media coverage has used words like blood bath, or the FDA is dead, or the US is over. Yet, here are some questions I have not seen answered.

1. The reduction in work force returns the size of these agencies to what levels? 2019 levels? 2015 levels or 1976 levels? The media coverage suggests the latter, but given the massive growth of these agencies we may be talking about the former.

2. In the private sector corporations downsize of all sorts of reasons, including incorrect ones. What is the burden in the public sector? Can it never downsize? Does it have to first commission a ten year committee to find out who should be laid off, and, in doing so, hire a few more people in the interim? How often do politicians run on cutting government size and actually cut government size?

3. Where is the US on the curve of spending on biomedicine and biomedical advances? Are we on the steep slope, i.e. each dollar spent means many more cures, or are we on the flat tail, meaning that we have long surpassed efficient spending. (provide data not quotes)

4. When people are laid off, how many staff remain in those departments? How many entire departments are instead gone, and what did they work on?

5. When experts are quoted, what percent were appointed by Democratic presidents?

https://www.drvinayprasad.com/p/questions-the-media-should-ask-about

'PBM Private Labeling Boosts Biosimilar Adoption, Raises Anticompetitive Concerns'

 Nearly 2 years after entering the market, adalimumab biosimilars are finally seeing traction.

CVS Health’s Caremark, Cigna’s Express Scripts, and UnitedHealth Group’s OptumRx, which are pharmacy benefit managers (PBMs) that collectively control about 80% of all prescriptions in the United States, are now pivoting away from Humira and preferring biosimilars on their formularies.

But rather than preferring multiple biosimilars on their formularies, these companies have created their own subsidiaries to co-produce these medications. With this approach, known as white or private labeling, these companies can produce a medication and subsequently prefer that same drug on their formularies.

Experts are divided on whether these companies’ control of multiple stages of the drug supply chain will be beneficial or detrimental to the biosimilars market. On one hand, these agreements had resulted in adalimumab biosimilars market share climbing to nearly 25% with medications priced more than 80% lower than the reference product.

Conversely, this domination of the drug supply chain could be anticompetitive and may dissuade manufacturers in developing biosimilars for other drugs.

Switching to Biosimilars

Despite nine Humira biosimilars entering the market in 2023, Humira remained dominant. During this first year of competition, these biosimilars only made up less than 2% of adalimumab prescriptions in the United States.

In 2023, CVS launched Cordavis, a subsidiary that co-produces and commercializes biosimilar products. In the first quarter of 2024, it began co-producing Sandoz’s Hyrimoz (adalimumab-adaz), and CVS’s PBM, Caremark, removed the reference product Humira from major commercial template formularies in April 2024. As of January 2025, these formularies prefer Hyrimoz manufactured by Sandoz at a high list price as well as Hyrimoz manufactured by Cordavis and unbranded adalimumab-adaz by Sandoz at a low list price, according to the Drug Channels Institute. (Caremark’s “Choice formularies” still cover Humira and a co-branded version of Humira by Cordavis.)

Once CVS made this pivot, market shares started to change. As of November 2024, adalimumab biosimilars made up 23% of market share, with Hyrimoz leading the pack with 15% market share, according to a report by Samsung Bioepis. Hadlima (adalimumab-bwwd), developed by Samsung Bioepis & Organon, follows with 4% of the market as the preferred biosimilar on the US Department of Veterans Affairs national formulary.

The other two top PBMs soon followed suit, with Cigna announcing in April 2024 that its own pharmaceutical distributor, Quallent Pharmaceuticals, would partner with drugmakers to stock adalimumab biosimilars.

As of January 1, 2025, Cigna’s PBM Express Scripts excludes Humira on its 2025 national formulary and prefers Boehringer Ingelheim’s Cyltezo (adalimumab-adbm), Teva/Alvotech’s Simlandi (adalimumab-ryvk), and unbranded adalimumab-adaz. Cyltezo is offered at the high list price, and both unbranded adalimumab-ryvk and adalimumab-adbm by Quallent are 46% below Humira’s list price, according to the Drug Channels Institute. The plan also prefers Simlandi and unbranded adalimumab-adaz at their low list prices.

UnitedHealth Care’s PBM, OptumRx, has also launched its own private-label manufacturer, Nuvaila, to co-produce Amgen’s Amjevita (adalimumab-atto). Nuvaila is also the sole distributor of Amgen’s ustekinumab biosimilar, Wezlana (ustekinumab-auub), which launched in January 2025. Amjevita and Wezlana are available at both high and low list prices.

As of January 1, 2025, OptumRx excludes Humira and prefers Amjevita for patients new to therapy. Existing patients are yet not required to switch to the biosimilar. The PBM is holding off preferring only the biosimilar “until all drug strengths are interchangeable at the pharmacy without a new prescription,” the formulary update stated, which is expected later this year. Stelara and Wezlana are both preferred under the current formulary.

Anticompetitive or Cost-Saving?

This switch to biosimilars can reduce costs for patients, with many paying no out-of-pocket costs for their prescriptions, but vertical integration of the drug supply chain could lead to anticompetitive practices.

The current situation parallels the 1990s, when pharmaceutical companies purchased PBMs.In 1993, Merck acquired the PBM Medco, and in 1994, Eli Lilly announced its purchase of the prescription management business PCS Health Systems Inc.

These acquisitions raised eyebrows at the Federal Trade Commission (FTC), which argued that a manufacturers’ drugs receiving favorable treatment through an acquired PBM’s formularies was anticompetitive.

Medco and PCS Health Systems were required to maintain an “open formulary,” which included all drugs approved by an independent committee. Both Merck and Eli Lilly eventually divested these PBMs.

These 1990s cases are similar to current PBM practices, though today’s PBMs possess more market power.

“PBMs play a much bigger role today in shuttling patients to specific drugs than they did in the 90s,” said S. Sean Tu, JD, a law professor at West Virginia University, Morgantown, West Virginia, whose research focuses on patent law and drug pricing.

“Bigger amounts of money [and] more consolidation equals bigger problems for patients who can’t afford these medications,” he added.

In addition to the foray into co-production of medications, these healthcare companies already have their own specialty pharmacies, including CVS Specialty, Accredo (Cigna), and Optum Rx Specialty Pharmacy.

Madelaine Feldman, MD

“Here you have vertical integration of now, the manufacturer [of a drug], the PBM, which creates the formulary and prefers it, and the specialty pharmacy, which fills it,” said Madelaine Feldman, MD, a private practice rheumatologist in New Orleans and the vice president of advocacy and government affairs for the Coalition of State Rheumatology Organizations.

The FTC has already filed a lawsuit against CVS Caremark, OptumRx, Express Scripts, and affiliated group purchasing organizations for “engaging in anticompetitive and unfair rebating practices that have artificially inflated the list price of insulin drugs,” according to the case summary.

Using the same reasoning from the FTC in the 1990s, these three healthcare companies preferring their own product could be considered anticompetitive. However, at the same time, prices for these biosimilars have fallen under these co-production deals.

Michael A. Carrier, JD

“It’s a bit of a counterintuitive argument to say that this presents competitive concern even when the price goes down,” explained Michael A. Carrier, JD, of Rutgers Law School in Camden, New Jersey. He specializes in antitrust and intellectual property law in the pharmaceutical industry.

Future of Biosimilars 

Although these PBM-owned pharmaceutical distributors have increased the uptake of adalimumab biosimilars, it also raises questions about the future development of other biosimilars.

Benjamin Rome, MD, MPH

“It’s a short-term gain for potentially some long-term concerns about the biosimilar marketplace,” said Benjamin Rome, MD, MPH, a faculty member of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital in Boston.

If white labeling is the most effective way to achieve uptake from patients, and there are only three major companies to partner with, it could dissuade drug companies from investing in developing additional biosimilars, Feldman said.

“Why would you bother to make a biosimilar if you’re never going to get on the formulary unless you white label it with a company?” Feldman said. “If [the company] already white labels with ‘cool kids,’ they are not going to white label with you.”

Drug companies would likely still develop products for European and other markets, but whether they pursue regulatory approval in the United States “is the fundamental question,” Rome said. “They’re only going to do that if they think that there’s a viable chance that their products going to be marketed and sold and used by patients in United States. If they don’t think there’s a good chance that that’s going to happen, then it’s a waste of their time and financial resources to seek regulatory approval.”

Feldman, Carrier, and Rome had no disclosures. Tu is a consultant for payers who may be litigating against drug companies on lenalidomide- and abiraterone-containing products.

https://www.medscape.com/viewarticle/pbm-private-labeling-boosts-biosimilar-adoption-raises-2025a1000821

France's Macron calls for suspension of investment in US after tariffs

 French President Emmanuel Macron called on Thursday for European companies to suspend planned investment in the United States after U.S. President Donald Trump announced sweeping global tariffs on American imports.

"Investments to come or investments announced in recent weeks should be suspended until things are clarified with the United States," Macron said during a meeting with French industry representatives.

The comments come weeks after French shipping firm CMA CGM announced plans to invest $20 billion in the U.S. to build shipping logistics and terminals, a plan that was hailed by President Trump at the time, and mentioned again in his Wednesday speech unveiling the tariffs.

French electrical equipment supplier Schneider Electric said late last month it would invest $700 million in the country to support U.S. energy infrastructure to power AI growth.

Neither company immediately responded to requests for comment on Macron's proposal.

Macron said no response to Trump's tariffs had been ruled out yet and suggested using the anti-coercion mechanism, an EU instrument to protect the bloc's trade, and responses targeting digital services and financing mechanisms of the U.S. economy.

Macron added that the response to the reciprocal tariffs would be "more powerful" than its earlier retaliation to U.S. steel and aluminum tariffs.

Macron called the tariffs "brutal and unfounded" and a shock for international trade, and that Europe must respond "industry by industry".

https://www.aol.com/news/frances-macron-calls-suspension-investment-155300683.html