Plus, a question about Big Pharma.

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Today’s read: 11 minutes.

We break down the Hong Kong news, acknowledge the 100,000 deaths from COVID-19 and I share some thoughts about George Floyd. Plus, a question about Big Pharma.

An image from Hong Kong protests in June. Photo: Studio Incendo / Flickr

Remember.

This week is the first-ever Tangle competition. If you share Tangle on social media or forward this email to 10 friends, all you have to do is send me a screenshot as proof. I’ll enter you into the contest and will select three winners this weekend. Winners choose from:

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Updates.

• In four months, more than 100,000 Americans have died of COVID-19, the highest of any country on earth. The grim milestone is more than the total deaths from the Korean War, the Vietnam War and the Sept. 11, 2001 attacks combined. 14% of Americans say they know someone who has died of the virus. The dead are predominantly elderly and disproportionately poor, black or Latino.

• Twitter is standing by Yoel Roth, the employee featured in yesterday’s Tangle and being criticized by the right for derisive tweets about Trump, including one where he referred to “actual Nazis” in the White House. Twitter says Roth’s role at the company is dealing with bots and spam, not regulating or fact-checking political speech, as he’s been framed in the media (yesterday’s Tangle described him as “part of the enforcement team” and noted that his LinkedIn said he was in charge of “developing and enforcing Twitter’s rules.”) In the meantime, President Trump says he is planning to release an executive order addressing social media companies.
• Washington D.C. is set to reopen tomorrow, despite the fact it has 263.2 new cases per 100,000 people over the last two weeks — the highest per capita rate of cases in the country. D.C.’s move to lift restrictions shows that even areas far from meeting the requirements laid out by the CDC or Trump administration are opting to move ahead to the next phase of COVID-19 recovery.

What D.C. is talking about.

China and Hong Kong. Yesterday, China’s legislature approved a new resolution that allows it to impose national-security laws on Hong Kong. This is a monumental development in the region. Hong Kong and China, since Britain “returned” the territory to China in 1997, have operated under a “one country, two systems” rule of law. Hong Kong has enjoyed a certain amount of autonomy as it leaned into capitalism and a democratic political system, building out its own mini-constitution and trade relations along the way.

Over the last year, pro-democracy protesters in Hong Kong took to the streets to fight back against what they viewed as mainland China’s encroaching power in the region. Those protests erupted after a Hong Kong politician proposed a law that would have allowed Hong Kongers to be extradited to mainland China for criminal prosecution. President Xi, the leader of the Communist Party of China (CCP), feels too little was done to crush the dissent in Hong Kong. This new bill will allow China’s security state to use its powers to monitor and prevent dissent in Hong Kong.

Reacting to the news, U.S. Secretary of State Mike Pompeo said “no reasonable person” can view Hong Kong as semi-autonomous with these new laws in place. That pronouncement is a huge deal; it means Hong Kong — a region of 7.4 million people — is considered part of China, and thus subject to tariffs and trade deals negotiated between China and the U.S. The last time China attempted a law like this, in 2003, over 500,000 Hong Kongers poured into the streets to protest.

What the left is saying.

The left generally supports Pompeo’s declaration but wants to move slowly. If Secretary of State Mike Pompeo formalizes his declaration, it would immediately crush Hong Kong’s economy. That’s not a win for the U.S. Not only would it disrupt $38 billion in trade between Hong Kong and U.S. businesses, and the 290 U.S. companies with headquarters in Hong Kong, it would also give all the power to China — who would then have national security, legislative and economic leverage to wield over Hong Kong.

Chinese officials are claiming “foreign influence” from the U.S. is helping catalyze grassroots dissent, but nobody really believes that. The bill is an obvious attempt to formally and finally take control back from Hong Kong, regardless of what President Xi says. But the U.S. needs to act carefully.

“A more effective response,” The Washington Post editorial board said, “would look something like that proposed by Sens. Chris Van Hollen (D-MD) and Patrick J. Toomey (R-PA), who would sanction Chinese entities that compromise Hong Kong’s autonomy; it would also sanction banks that do business with those entities.”

In a CNN column, Samantha Vinograd pointed the finger at Trump, saying the State Department, Commerce Department and all of our intelligence agencies have been pointing out the threat China represents to U.S. elections, cyberspace, trade and Hong Kong. But President Trump has spent the last three years praising China in hopes of ironing out a trade deal as a notch on the belt for his presidency. We’ve retreated from the global stage and alienated our allies, and now lack the power or political capital to respond adequately.

What the right is saying.

There’s a lot of common ground on this issue. Like the left, the right wants action against China and wants to protect the interests of Hong Kong. And like the left, there is a lot of concern about how Trump’s interest in advancing trade negotiations with mainland China could impact his support for the pro-democracy fight in Hong Kong.

“The president has never been especially sympathetic or interested in the protest movements against the Chinese Communist Party,” Daniel DePetrist said in The Washington Examiner. “Trump could be staring at a trade deal fluttering in the wind rather than one he could use on the campaign trail to demonstrate his administration’s success in finally introducing reciprocity in the U.S.-China trade relationship.”

In Bloomberg, Eli Lake called for the U.S. to revoke benefits for Hong Kong as a way to punish China, which has used the city-state as “a cash cow.” But Lake conceded this approach would hurt Hong Kongers who have shown “remarkable resilience” over the last year, so he advocated a second proposal, too: “Offer Hong Kong’s citizens who do not wish to live in a totalitarian state an opportunity to become Americans.” Vox’s Matthew Yglesias also expressed support for this plan.

Lake sees this as an opportunity to punish the CCP and create “the conditions for a brain drain,” where Hong Kong’s finest come to the U.S. The WSJ editorial board said such actions would “hurt the Hong Kong people more than it will China.” Instead, the board proposed an effort to “target those responsible for the assault on Hong Kong’s liberties.”

“The Hong Kong Human Rights and Democracy Act allows the U.S. to sanction Chinese or Hong Kong officials responsible for human-rights abuses, arbitrary detentions, or renditions to China,” it wrote. “The Trump Administration could impose visa and other restrictions on the Chinese officials behind the national security legislation, as well as Chief Executive Carrie Lam.

My take.

First, I want to say that I have a bunch of readers in China and Hong Kong — and experts on the region (which I am not) — and I’d love to hear from you. Anyone can reply to these newsletters and write to me directly. It’s fascinating to see The Washington Post and Wall Street Journal editorial boards aligned here, but I’m also open to any and all non-U.S. perspectives.

Second, I’ll say that I really don’t see any good moves here. I’m not an expert on China and Hong Kong, but I do feel comfortable saying I’m well versed in U.S. politics and how we operate globally. When dealing with other global powers, our strengths can be succinctly divided into three parts: economic leverage, alliances and the threat of military action.

Regarding economic leverage, it’s clear we don’t have much ammunition left. Our economy is being ransacked by COVID-19 and we were having a hard time pressuring China to bend to our whims before this. Our nations are inextricably linked, and any economic punishment we try to impose on mainland China, they can return in kind.

Our alliances, similarly, are fractured and complicated. Hate him or love him, most of our traditional allied nations have an overwhelmingly negative view of Trump, and many global leaders have, especially recently, shown less interest in playing ball with him. In the meantime, China has been using its economic leverage to fill those gaps, stepping into “world leader” positions at organizations like The World Health Organization and The World Trade Organization. We could feasibly call on Europe and other economic leaders to band together and pressure China into backing off, but does anyone have faith that kind of cooperation could take place right now, with everything else that’s going on?

Typically, this is where our military power is a final backstop. The threat of our intelligence agencies or military alliances taking action is always in the background during tense negotiations like this. But in nearly every military simulation the pentagon has run against China over the last decade, we’ve lost. China surely knows this, and any strong-arm threats, or the possibility of a shooting war, would not be regarded with the fear it might be elsewhere.

The upsetting truth is this may really be the end of Hong Kong as we’ve known it. A slow, subtle encroachment has turned into something much more overt. And outside of supporting Hong Kongers themselves, who are already prevailing against the odds, I don’t know how the U.S. is going to be able to swing in and help.

George Floyd.

Yesterday, protests in Minneapolis continued for the second night in a row over the death of George Floyd. More protests broke out in Los Angeles. Floyd died in police custody after he was pulled over for suspicion of using a fake $20 bill at a convenience store. In footage released online, an officer held Floyd down with his knee on his neck for several minutes, a technique that is not approved by the city’s police department. Floyd can be heard telling the officer he can’t breathe in the video before going unconscious.

Unlike many similar stories over the last few years, including the shooting of Philando Castile — which also happened in Minneapolis — this one has brought widespread condemnation. Police officers and police chiefs across the country have criticized the officers involved in the arrest, all four officers have been fired and the Minneapolis mayor has called for the officer featured in the video to be arrested and charged.

While some conservative commentators like Fox News’s Tucker Carlson have used their airtime to criticize looters and rioters in the city, there actually seems to be a unified cry of disgust, pain and heartache across the country. Past incidents have divided “blue lives matter” and “black lives matter” cohorts, but there seems to be little debate here.

I haven’t covered this story in-depth yet. Not because it isn’t important — it is critical — but because I try to highlight news items that are divisive and require a breadth of perspectives to understand fully. Again, the reaction from reasonable Americans here seems (fairly) unified.

But I’ve also hesitated to write about it because the black Americans close to me have expressed their pain and disgust at having to see these videos, photos and stories on repeat for days on end, even though they’re enthusiastic about holding bad actors accountable. So I made a judgment call not to add to that experience here. There are larger conversations happening about “trauma porn” and the way videos of similar incidents are impossible for black Americans to avoid seeing on repeat, an experience that’s traumatic, painful and exhausting.

What I will say is this: we are past the point, or should be, of shock and indignation at news like this. If you’re more upset at protesters or rioters for protesting or rioting than you are at the injustice of all of this (or if you said nothing about armed protesters storming state capitol buildings), I encourage you to close your mouth and open your ears.

Being a police officer is not an easy job, and certainly not a job I’d ever have the courage to take on. Most officers I know describe it as dangerous and tedious, sometimes requiring split second decisions that can mean life or death, and other times unforgivingly boring. Rarely are people happy to see you, despite the fact most officers I know come from a family of police and have a genuine interest in making the world a better place.

I have close friends (and readers of this newsletter) who are good people, ethical people, and also members of law enforcement. But I still believe we’re well past the point of shock and disgust.

Between 2013 and 2018, law enforcement officers killed 6,800 civilians either intentionally or by accident. This is not just an issue for black Americans to care about, either: 399 of the 996 fatal police shootings in 2018 left a white person dead, according to Statista.

Officers have been charged with a crime in just 1.7% of those 6,800 incidents between 2013 and 2018, according to data published in TIME Magazine. And even when they’re charged, it’s extremely rare for an officer to be convicted. Comparatively, in the general population in our largest counties, some 70% of people charged with murder or manslaughter are convicted. Simply put, we’re living by two different standards.

It’s possible that 98.3% of those officer-involved killings were so justified or so legal they did not even require a trial. It seems far more likely that many of them, like the ones often filmed and disseminated on cell phone cameras, were at least worthy of inspection. Local, state and national reforms to hold police accountable for incidents like this are happening — and Floyd’s death is already reverberating in ways past incidents have not. But they must happen more quickly. Just 14% of black Americans and 42% of white Americans say they have a lot of confidence in their local police.

Without real reforms, trust in law enforcement will only continue to erode, and the gap between citizens and law enforcement, white and non-white Americans, a just and an unjust country, will only widen.

Your questions, answered.

Reminder: reader questions are one of my favorite parts of Tangle. If you have something you want to see in the newsletter, simply reply to this email and write in. I’ll try to get to it as soon as I can.

Q: I've found data on profit margins of pharmaceutical companies who have done little or next to nothing in the past 30 years (ie. last new antibiotic reached the market in 1987) while raking in cash by modifying existing drugs to claim patents and exclusivity, paying each other to delay generic release, and all sorts of other shady, legal, but in my opinion wrong tactics. Why do Big Pharma companies make so much in profit when so many of them achieve so little?

— Amelia, Chicago, IL

Tangle:  Every now and then, I like to feature “guest responses” to reader questions — where I take a reader question to someone I think has an interesting view or expertise on the topic at hand. For this question, I went to a friend of mine who works at a company you might consider “big pharma.” He’s asked to stay anonymous to answer freely, so I’ve accepted those terms to include his answer below.

Before I share it, I’ll just say that “big pharma” is an issue I generally fall pretty left on. When I hear Bernie Sanders talk about price gouging, the cost of insulin, the way pharmaceutical companies rake in profits, the salaries of those company’s top CEOs, et cetera, I find myself nodding in agreement.

Part of that is why I didn’t want to answer your question myself. I think the framing you brought forward indicates we share a bias, and simply reaffirming that for you is not something that would be productive or helpful for the newsletter. My friend, on the other hand, has expressed disappointment in how I sometimes write or talk about the pharmaceutical industry. And so I took this question to him.

I don’t agree with everything in his response and I’ve added my only little thought at the end. But I did think it was a different perspective on the issue I don’t hear often. Here is what he wrote to me, responding to you:

There hasn't been a huge need for new antibiotics, because frankly, the ones that exist work pretty well. But the notion that big pharma achieves so little or that they've done nothing in the past 30 years is objectively ridiculous. Merck's Keytruda is the world's most valuable cancer medicine. Mavyret and Sovaldi made by Gilead and AbbVie essentially cure Hep C in a couple of weeks. Biogen's knocking on the Alzheimer's door and man, wouldn't that be amazing if that worked.  

Nabriva Therapeutics, out of dear old King of Prussia, PA, launched Xenleta last year. It's an antibiotic specifically targeted for patients suffering from pneumonia. Across the board, it's been kind of a flop. The company's stock, which in 2017 based on R&D data was trading at around $12/share, is currently at $.53.  

But it's not a flop to someone who had pneumonia, utilized it as a more effective treatment than a normal antibiotic, and potentially had it save their lives. It's part of the problem with the industry, where development is really, really expensive and nothing's guaranteed, so you need to keep your revenue streams healthy where you can. Some of it's also a matter of trying to solve patient problems.  

In the Gene Therapy space, a company like Spark Therapeutics launched Luxturna, which was the first gene therapy to gain U.S. approval. It helps fight off a rare eye disease and staves off blindness or death.  

And while it might have been a small company that developed it, part of what makes it a viable business model is that if you're successful, big pharma offers the carrot at the end of the stick (Roche bought Spark for $4.7 billion), which allows you to get investors to fund your projects in the first place. And that's just in the past 10 years.  

None of these are things you just crank out. They take years, and some of them cost tens, if not hundreds of millions of dollars. With a 90% failure rate. Or, in the case of something like Alzheimer's, a 99% failure rate. So you need to protect your revenue streams where you can.  

Are all the tactics great? Nah, not even close. Some of it's definitely sketchy. But if you get a few extra years with a grandparent who has a better enjoyment level in their life because their Alzheimer's medication is effective, do you really give a crap that some of it was financed based on a debatable patent extension? Probably not.

I think what resonates with me about this response is that money in the industry is often good for consumers, even if we pay the price at checkout. The two things this response doesn’t address adequately for me are the absurd profits the CEOs of these companies make and the way advertisement for pharmaceuticals has infested every media platform there is.

I can’t go five minutes watching television or perusing the internet without hearing about a new drug for some new disease I didn’t know about, usually accompanied by a long list of dire side effects that sound a lot worse than the disease itself.

My friend, again, would probably respond that this is not a problem unique to pharma and is all part of the money machine that makes treatments and cures possible. Which is a totally fair response. My concern is that there are now 131 million Americans, or 66% of the adult population, using prescription drugs.

Is it possible this number is necessary? Sure. Does it seem likely to me? No. I think there’s something to be said about the con of Big Pharma, the way we’re convinced we need a pill or cream or spray when really we might need a different diet or lifestyle. Again, I think my friend vaguely covers this (you need to make money for R&D), but the answer still doesn’t quite satisfy me.

A story that matters.

In the U.S., a wave of evictions is expected to begin this month. The economic downturn from COVID-19 is especially damaging for renters, who tend to be lower-income or work hourly jobs. Government relief programs and legal protections are running out for millions of Americans in the coming weeks and there are not many choices for alternate housing. An estimated 45% of Americans have no savings. Government orders had put a pause on evictions across the U.S., but those orders are set to expire soon. “They will face displacement at a time when people are still being urged to stay at home to keep themselves and their communities safe,” The New York Times reports. Click.

Numbers.

• -13. Donald Trump’s net approval rating, according to a new Rasmussen Reports poll.
• -17. Donald Trump’s net approval rating, according to a new Politico poll.
• 20%. The percentage of U.S. adults who approve of the job Congress is doing.
• 22%. The percentage of Republicans who approve of the job Nancy Pelosi (D-CA) is doing as Speaker of the House.
• 57%. The percentage of Republicans who approve of the job Mitch McConnell (R-KY) is doing as Majority Leader of the Senate.
• 30%. The percentage of 23 to 28-year-olds who lived with a child and spouse in 2019.
• 70%. The percentage of 23 to 28-year-olds who lived with a child and spouse in 1968.
• 44%. The percentage of 23 to 28-year-olds who were married in 2019.
• 81%. The percentage of 23 to 28-year-olds who were married in 1968.

Have a nice day.

If you’re one of the people struggling to pay their rent this month, you may consider hitting up your local rap label. Cash Money Records announced it was donating over $225,000 to a nonprofit organization in New Orleans that is helping fund rent for citizens living in various projects throughout the city. The iconic rap label — which includes rappers like Lil Wayne, Nicki Minaj and Drake, has been around since 1991. Founded by Bryan and Ronald Williams, it has leveraged its million-dollar rap empire as a philanthropic arm for the last 20 years. Click.