Domestic and supranational regulatory capture leads to two things: on the one hand, to an inequality spiral where the rich get richer because they can influence rulemaking and rule application in their favor; on the other hand, it also leads to instability. This is so because the relatively few organizations capable of influencing supranational rulemaking through the lobbying of major governments have diverse interests. This will, in some cases, lead to compromises. But it will also lead to spheres of influence.

You can think of the Health Impact Fund as a mechanism that would keep the benefits and burdens of pharmaceutical innovation for the affluent roughly as they are while massively reducing the burdens presently imposed upon the poor. This sounds like magic. But it really works because the current system is not Pareto efficient. It's a system that generates hundreds of billions of dollars in litigation costs and deadweight losses that HIF-registered medicines would sidestep. By avoiding these losses, the HIF reform can bring improvements all around - including for pharmaceutical innovators.

Each powerful player, or coalition of players, will make concessions in areas where it has relatively less at stake in exchange for other such players making reciprocal concessions in other areas where it has relatively more at stake. Such trades are collectively rational insofar as they get each of the powerful players more of what it wants. But such trades are also dangerous because the whole international rule-system will become incoherent and therefore vulnerable to crises that will continue to become increasingly severe.

Severe poverty is getting better by some measures, but it's also becoming ever more scandalous because it is now so easily avoidable.

Companies are actually much better than governments and other bureaucracies at organizing in a holistically efficient way the extremely complex path from the examination of molecules all the way to the delivery of medicines to patients. Already in the conception and selection of research projects, companies would anticipate all the challenges down the line that they will need to overcome in order to achieve actual health impact. Bureaucratic organizations, by contrast, are notoriously bad at this sort of optimizing.

Critical journalism has gone out of fashion, or rather, it has been bought out. And so, we have much less of it than we did during the Vietnam era, where there was very critical reporting on the Vietnam War and a lot of disagreement among the media. Now you find that the media are much more homogenous, converging because they all must cater to the same community of advertisers. It's sad to see.

We have the ability now to arrange global economic institutions so that poverty declines to a fraction of what it is now.