The FDA Does Diabetes

So far, patients can breathe a sigh of relief.

The U.S. Food and Drug Administration’s Endocrinologic and Metabolic Drugs Advisory Committee met today, and will continue its discussions tomorrow, on two important diabetes drugs which are under review at the FDA.

The first drug, reviewed today, was Bristol-Myers Squibb’s saxagliptin, an oral pill which treats diabetes in a similar way to Merck’s Januvia and Novartis’ Galvus. (Galvus has been in limbo at the FDA for years, for no discernible reason.) Tomorrow, the FDA panel will review Novo Nordisk’s Victoza, an injectable drug similar to Byetta (a marketed drug from Eli Lilly and Amylin Pharmaceuticals).

The FDA had been somewhat concerned about a slight increase in cardiovascular side effects of saxagliptin relative to placebo in Bristol’s late-stage clinical trials, but the panel voted 10-2 that the clinical data provided appropriate evidence of saxagliptin’s safety profile. The panel did recommend additional clinical trials for cardiovascular safety after the drug makes it to market, but such recommendations are not so easy to implement.

Tomorrow, on April 2, the panel takes up Novo’s Victoza (liraglutide). The FDA has raised concerns about major adverse cardiac events and thyroid tumors. Novo will probably have to do an additional post-marketing trial. We will have a more complete review of the Advisory Committee meeting at that time.

Investors in Amylin and Lilly cheered when the FDA’s briefing documents on liraglutide contained no questions regarding inflammation of the pancreas, a side effect associated with their drug Byetta.

More on this tomorrow…

Apologies

I mean it.

For those who have checked back recently and not seen any postings, I'm sorry. Had a busy few days. My intent is to post at least one item daily to this website, if not multiple postings. One more is on its way...

This Week in Wonkery

Your weekly guide to the wild world of healthcare policy research.

Joseph Antos of the American Enterprise Institute describes Obama's approach to healthcare as "a meal eaten in reverse order. We started with dessert, in the form of new subsidies for insurance. Whether we like it or not, we will have to eat our vegetables before the year is out."

John Calfee and Elizabeth DuPre of AEI complain about the anti-drug industry bent of The Lancet and The New England Journal of Medicine.

Newt Gingrich wants to create some new government programs to combat Alzheimer's Disease.

Darrell West and Edward Miller of the Brookings Institution have published a new book entitled Digital Medicine: Health Care in the Internet Era.

Alice Rivlin of Brookings is concerned that Obama won't raise taxes enough to pay for his healthcare plan.

Judy Feder and Harriet Komisar of the Center for American Progress urged the Senate to take "action to improve long-term care services and supports."

J.D. Foster of the Heritage Foundation reflects on how to make Medicare sustainable by means-testing benefits.

James Copland and Paul Howard of the Manhattan Institute think it's a good idea to tax pharmaceutical companies to cover tort liabilities in the wake of Wyeth v. Levine. (Whatever happened to tort reform?)

Uwe Reinhardt, the Princeton economist, explains the terminology behind health care reform.

Joseph DiMiasi and Laura Faden of Tufts reviewed the histories of 298 drugs approved by the FDA between 1996 and 2006 to identify "factors associated with multiple FDA review cycles and approval phase times."

Nicolaus Henke, Sonosuke Kadonaga, and Ludwig Kanzler of McKinsey argue that Japan's healthcare system is unsustainable, and suggest that the Japanese undertake a "comprehensive, well-funded national review of the system." I bet they find that 2 plus 2 still won't equal 5.

John Graham of the Pacific Research Institute "reviews three decades of the Food and Drug Administration's performance and concludes that the agency is overfunded, overstaffed, and denies hundreds of thousands of Americans timely access to new medicines."

Henry Willis et al. of the RAND Corporation believe that the Cities Readiness Initiative has succeeded at improving the ability of large cities to respond to large-scale biological warfare.

Next Week: On Tuesday, March 31, the Cato Institute will host (and webcast) a policy forum entitled "Can the Market Provide Choice and Secure Health Coverage Even for High-Cost Illnesses?"

An Examination of Sen. Baucus' Arguments: "We Cannot Afford to Wait" to Reform Healthcare

Whether or not you agree with the President's proposed healthcare reforms, they're based upon flawed assumptions.



On Friday, Sen. Max Baucus (D-MT), a.k.a. "Mr. Healthcare", and chairman of the influential Senate Finance Committee, delivered a speech on healthcare reform at the Center for American Progress, entitled "Now is the Time for Action." The speech was cheered by Jonathan Cohn as a "clear rejoinder to those who say health care reform must wait, because of the economic crisis" and described as a "useful restatement of principle" by Ezra Klein (who published Baucus' full remarks). But Baucus makes a number of flawed arguments as to why healthcare reform is "an economic imperative":

Between 2000 and 2007, average premiums rose nearly 80 percent. At the same time, average wages rose just 15 percent. How can a family keep up?

Last year, the average household spent more than a quarter of its income on health insurance premiums. If we don’t act to reduce the rate of health spending, then in seven years — before the end of President Obama’s second term — most American households will spend nearly half of their income on health insurance.

To be more precise, if wages rise by exactly 15% in the next seven years and if insurance premiums rise by another 80% over the same time frame, a family which spends 25% of its income on health insurance today will spend 39% seven years from now (without adjusting for inflation). While that would be an increase, Baucus exaggerates the degree.

More importantly, it is arbitrary to assume that premiums will rise over the next seven years by the same degree that they did between 2000 and 2007. Indeed, according to the Kaiser Family Foundation, the rate of increase in family insurance premiums has declined for 6 straight years, from 13.3% in 2003 to 4.7% in 2008. If insurance premiums increase for seven years at 4.7%, the total increase is 38%, not 80%. And none of these numbers reflect how the present economic crisis is affecting premiums and wage growth.

This is not to say that Baucus' projections are inconceivable. But it is to say that they are arbitrary. Affordable healthcare is an important goal—but we won't get there if we don't understand healthcare economics.

If we don’t act, increasing costs will result in more and more individuals and families without health insurance.

According to the Kaiser Family Foundation, 160 million Americans get their health benefits through an employer. That means that when people lose their job, they often lose their coverage.

This month, the unemployment rate rose to eight point one percent. Work done here at the Center for American Progress shows that — every day — 14,000 more people lose their health insurance coverage.

This problem is a serious one, but it was caused by government intervention: the taxpayer subsidy of employer-provided insurance. Baucus proposes to solve a problem caused by unwise government regulation by nationalizing healthcare. A simpler, and more efficient approach, would be to end the subsidy for employer-provided insurance. President Obama is, apparently, now open to this approach. But when John McCain proposed this in the 2008 campaign, then-Senator Obama described it as "the largest middle-class tax increase in history."

Imagine if you could shop for health insurance the way you shop for auto insurance or life insurance. You could find a plan that made sense for you, that covered the things that are important to you. You could organize a community of like-minded people to purchase insurance in bulk. Most of all, you would create competition for your business, the surefire way to bring prices down and quality up.

Anthem Blue Cross in California just notified most of its individual policyholders that they face double-digit premium increases — many more than 30 percent. Blue Cross of Michigan is seeking approval for an increase in premiums of nearly 60 percent.

That means that if we don’t act, then workers who lose their jobs will not be able to afford coverage. It means that many of those purchasing coverage in the individual market will be forced to drop their coverage.

Insurance companies, like most businesses, operate in the real world of supply and demand. They can't raise prices forever without losing customers, just as car companies can't suddenly double prices on cars. Simply put, it is not in insurers' interests to lose customers, and that self-interest will keep a lid on premiums. Ultimately it is up to insurers to decline to pay for the most expensive treatments if they can't afford to offer them. The problem comes when states mandate what insurers must cover, forcing the price of insurance higher.

An individual obligation to get health coverage is essential for several reasons. It is the only way to stop the cost-shifting related to uncompensated care. Today, the costs of care for 46 million Americans without health insurance are largely borne by those with insurance.

This is an idea, pioneered by Mitt Romney in Massachusetts, which deserves bipartisan support. Libertarians raise instinctive concerns about any government mandate. But federal law requires hospitals to treat anyone who comes into an emergency room, regardless of his ability to pay, thereby taxing those who buy health insurance at the behest of those who don't. Most states require auto insurance, yet libertarians don't spend a lot of their time seeking to repeal those laws.

The manufacturing industry is facing stiff international competition. American manufacturers pay $2.38 an hour for health benefits. What do you suppose America’s major trading partners pay? 96 cents. Talk about an uneven playing field.

American manufacturers spend nearly three times as much on health benefits as our major trading partners. If we don’t act, then that gap will continue to widen.

The uneven playing field between U.S. and our major trading partners is not health benefits, but corporate taxes. Corporate income tax rates in the United States are the highest in the developed world: 39.25% in 2008, vs. the OECD average of 26.63%. And that's without the tax increases that inevitably would accompany a nationalized healthcare system.

And if we don’t act, then the burden on taxpayers will continue to grow. In 2009, Medicare spending is projected to be nearly $500 billion. By 2018, it will be almost double that.

If we don’t act, then in the next 10 years, spending for both Medicaid and Medicare will more than double. Meanwhile, our economy will grow by just 64 percent.

So the solution is to spend more on healthcare while inducing economy-contracting tax increases?

Already, we spend twice as much on health care as any other industrialized nation. And yet our outcomes are poorer.

I will address this point in a future blog post, but the data does not support this argument.

The way that we pay providers contributes to higher health costs. Existing payment systems reward the use of specialty care and high tech equipment.

We pay more to a hospital whose patients experience a readmission after being discharged. And we pay less to a hospital that does the job right the first time and avoids a second hospital visit.

Spending and utilization varies widely from one part of the country to another. But those who are spending more are not getting more for their money.

In many parts of the country, providers have answered the siren call of the payment systems. They order more tests. They schedule more visits. They do more procedures. They perform more imaging services. And they prescribe more medications.

Here we get to a critical point: cost. We are constantly told that it is a terrible thing that Americans are spending too much on healthcare. Somehow, we're never told that we spend too much on cosmetics, or televisions, or automobiles. According to the Bureau of Labor Statistics, Americans spend nearly as much on entertainment (5.6%) as they do on healthcare (6.0%), and far more on food (12.3%), housing (32.6%), and transportation (18.1%). Indeed, it could just as easily be argued that it is a good thing that Americans spend more on healthcare. We have access to the newest drugs and the latest technologies. We can see specialists when we have specialized medical problems. We can pay for medical procedures that we want to undergo. Efforts to provide universal healthcare coverage routinely ignore the question of rationing. That is, if we are to provide healthcare for all, how much healthcare will we provide for all? All you have to do is look at Massachusetts for a preview of what's to come: price controls and rationing.

That is not to say that there aren't times when too many tests are ordered by physicians. But more often than not, this practice is driven by a desire to avoid malpractice litigation, a practice dryly termed "defensive medicine" by physicians. An important way to reduce healthcare costs which Baucus doesn't address is tort reform: limiting unnecessary litigation by requiring, as most developed countries do, the losing side to pay the winning side's legal costs.

Another unspoken driver of healthcare costs is Medicare. The government underpays hospitals for the cost of caring for elderly Medicare patients. Hospitals make up the difference by overcharging people on private insurance. In other words, on top of the Medicare tax which you see on your paycheck every month, you are being taxed silently every time the government underpays a hospital for a Medicare patient. But if the government started paying hospitals fairly for their services, the Medicare trust fund would go bankrupt.

That path necessarily involves bipartisan support. Why? Because in the end, in the Senate, a bill needs 60 votes. Attempts to circumvent this requirement using reconciliation would also require trade-offs...

If we do not act this year, then we won’t have another opportunity for another decade. Next year, we’ll be in the midst of Congressional elections. The following year, we’ll be in a Presidential cycle. We have to act now.

Baucus gets to the political reasons why enacting sweeping changes to the healthcare system has proven so difficult. Importantly, he appears skeptical of using reconciliation, a parliamentary procedure which would do an end run around Republican opposition, presumably because it would engender increased Republican hostility to other Democratic priorities.

Baucus, a Democratic senator in Republican Montana, has a record of crossing party lines. He was a key supporter of George W. Bush's tax cuts in 2001, and worked with Republicans on the Medicare prescription drug benefit. So far, on the Great Healthcare Debate of 2009, he has adopted a traditional Democratic policy posture. Will he stay there?

The Snowboarder Menace

Cross-posted from Taki's Magazine.

In honor of the 2008-09 North American ski season, I give you the following rant.

As of March 18, 2008, Taos Ski Valley in New Mexico, Alta and Deer Valley in Utah, and Mad River Glen in Vermont were the last skiers-only resorts in North America. The next day, Taos Ski Valley opened up its slopes to snowboarders. Now only three resorts free of snowboards remain. 

The fall of Taos—as alarming to North American skiers as the fall of the Bastille to the ancien regime—typifies everything obnoxious in American life today: the sacrificing of the will of the majority to the complaints of the obstreperous few, the cloaking of every cause in the phony garb of victimhood, the wanton destruction of the traditions that make life worthwhile, the relentless homogenization of the cultural landscape in the name of “diversity.”  Even non-skiers may take it as a warning.

To review, skiers get down the mountain on two planks facing downhill.  Snowboarders get down on a single board facing sideways. The difference means nothing to snowboarders but everything to skiers.

First, while skis make a euphonious swishhhh, snowboards pollute the atmosphere with a cacophonous crrrrunch!

Second, snowboarders make wider turns than skiers, thereby leaving less room on the slope for others.

Third, while skiers face downhill, snowboarders make half their turns blind, forcing everyone on the slope to get of their way to avoid getting hit.  A trial lawyer in Colorado once told me that he makes all of his money litigating injuries from snowboard-skier collisions. 



Fourth, while skiers rest standing up, snowboarders plop their bottoms on the ground every time they need to catch their breath.  Clusters of snowboarders now obstruct almost every slope in North America.  Indeed, snowboarders have cultivated whole ethos of loafing.  A pack of them can be found menacing passers-by at the base of almost every resort in America.

The foregoing harms are ultimately forgivable What makes snowboards truly intolerable is that they destroy great snow conditions.  While skiers carve turns, snowboarders (even the best of them) plow.  Groomed trails turn to ice under the snowboards’ punishment.  Worse, fresh powder disappears the instant the first snowboarder slides his way down the mountain.

Fresh powder!  One day of powder skiing—nay, one run of powder skiing—makes up for years of inflated lift ticket prices and disappointing weather.  In the past, almost all North American resorts had powder days. No longer. With grooming, high speed lifts and slope-side development to lure more and more skiers onto the slopes, new snow these days gets packed down or skied out within minutes.

Until recently, only three resorts in North America still gave you a fighting chance of finding untracked snow: Alta, Mad River Glen, and Taos.  Each limits the number of skiers on the mountain at any one time.  Alta—William F. Buckley Jr.‘s favorite American resort—gets so much snowfall that to prevent avalanches it has to fire canons for days before opening its terrain.  As soon as they stop firing, almost every skier can hike or traverse to an untracked run. 

The only way to get to the top of Mad River Glen in Vermont is via a 1948 diesel-powered single chair lift.  Riding it is the skiing equivalent of driving a Model T.  Meanwhile, Mad River barely grooms its trails and keeps them only about as wide as a closet. While novices go to Killington or Stowe, experienced skiers can thread through the woods at Mad River and find untracked runs for days after a snowfall. 

Then there’s Taos. Owned by the Blake family since 1955, Taos operates under an agreement with the United States Forest Service that caps the number of ticket-holders who can ski each day. Until recently, the agreement dampened Taos’s enthusiasm for development. To this day, you can’t get to the top of the mountain with a lift; instead, you have to hike. My wife and I once took four hours hiking to the top with reluctant friends of ours from Nebraska. It was one of the best days skiing of our lives, even if our Nebraskans might not agree. Above the ski lifts, Taos features some of the finest drops to be found anywhere in the world.

In sum, up until March, skiers in North America had three resorts where they could find great conditions.  (Deer Valley, which also bans snowboards, grooms its trails relentlessly and has therefore never really counted as a great ski resort).  Snowboarders, meanwhile, had already overrun almost 500 North American resorts, where their very presence now makes great skiing impossible. 

You would think that they would be content to leave Taos alone.  But you would be wrong. Instead, snowboarders did what all aggrieved groups do these days:  They formed a pressure group! “Free Taos” they called it, by which they really meant that snowboarders were unfree because not allowed at Taos.  They accused Taos of perpetrating a grave injustice against snowboarders—all of whom, like skiers, hail from the whitest, most privileged backgrounds imaginable.  Open your minds!  Equal rights!  Sign the petition!  Down with elitism! Winter sports diversity!  No slogan was too rebarbative for the Free Taos movement.  I once read a sports columnist liken, with a straight face, Taos’s policy of banning snowboarders to the African slave trade.

We cannot know what went on in the board meeting where the corporation decided to turn against its most loyal customers.  Some speculate that the younger scions of the Blake family want to turn Taos into an insipid profit center like Vail in Colorado. Given Forest Service restrictions, however, it is unclear how Taos can ever make much money.  All it had to offer was great skiing and eccentric local tradition. It is far from clear that Taos will make more money abandoning its market niche and instead offering what one can find at every other resort in America already. The Taos that generations of skiers loved is now gone—sacrificed, like everything else that is charming and worth preserving in America, to the demands of the impudent few.

Even if you care nothing for skiing, be forewarned: Eventually, the vandals will overrun even the most beloved and stalwart institutions. 

Arbiters of Kool

30 years after the infamous mass suicides, does the spirit of Jonestown live on?

On November 18, 1978, 908 members of Peoples Temple, a Disciples of Christ congregation founded by Jim Jones, drank poisoned fruit drink and died. They carried out their "revolutionary suicide," as they called it, with impressive efficiency. Months before, Peoples Temple leaders had collected the potion's ingredients and tested them for maximum lethality with minimal discomfort. On the night of the event, Jones assembled his followers — then mostly located in a socialist utopia in Guyana known as "Jonestown" — to deliberate on whether the time for revolutionary suicide had come. Dissenting views were aired but ultimately rejected. The decision reached, the residents of Jonestown formed a queue. First infants had the poison squirted into their mouths. Then older children and adults drank. As they died, Jones urged his followers not to scream but to face death with dignity. The citizens of Jonestown lay down one by one, dying in each other's arms.

Surviving members of Peoples Temple confirm that the event had been rehearsed. On "White Nights" — Jones' term for a state of emergency within the community — Jones would assemble his congregation and tell them that they were in danger. Members would then testify on the need to commit revolutionary suicide. Finally, cups of flavored drink said to be poisoned would be passed out and drunk. On the last "White Night," the poison was real.

Jones' extreme loyalty test has entered the lexicon as "drinking the Kool-Aid." (By most accounts, the actual drink was Flavor-Aid.) To "drink the Kool-Aid" is to acquire an irrational loyalty to a particular figure or movement, often to the exasperation of one's friends and comrades. By now somewhat hackneyed, the phrase remains a vivid image of ideological blindness. It also — together with the media's tendency to describe Jones as a weird cult leader — makes it all too easy to dismiss Peoples Temple as a bunch of brainwashed freaks.

In reality, Peoples Temple was firmly a part of mainstream cultural, religious, and political life. It enjoyed the support of prominent figures from Harvey Milk and Angela Davies to Rosylynn Carter and Walter Mondale. The mainline protestant denomination Disciples of Christ ordained Jones as a minister back in 1964. San Francisco mayor George Moscone even appointed Jones Chairman of the San Francisco Housing Authority Commission. If Peoples Temple was a cult, it was one that was not only accepted but prominently admired.

Moreover, the teachings of Peoples Temple are entirely familiar to us — indeed, in some cases, they are ubiquitous today. To this day, Jones' defenders praise his vision, even as they ultimately condemn the idea of revolutionary suicide. Some even say that Peoples Temple held out unique hope for mankind. Years after the event, some survivors expressed regret that they did not die with the others, and described their years in Peoples Temple as the happiest of their lives.

Jones' teachings included the following:

Racial harmony. Jones preached that all races could live together in harmony. He even adopted several black and Korean children into his own family. Long before "diverse" became a euphemism for "non-white," Jones made sure to recruit a sufficient number of representatives of every race. Peoples Temple, he boasted, was a "rainbow family." Every summer, Jones took his followers (located in the 1970s in San Francisco) on bus tours around the country. The tours showed Peoples Temple as a joyful, racially integrated community. It seemed to many that Jones had finally realized the dream of racial equality. One follower wrote on the last White Night, "His hatred of racism, sexism, and mainly classism, is what prompted him to make a new world for the people."

Gay rights. Jones, who had sex with both men and women, thundered against society's prejudice against gays. In the early 1970s, he began actively recruiting lesbian and homosexual members. When interviewed, gay members spoke gratefully of how Jones and Peoples Temple welcomed them for who they were. In San Francisco, Peoples Temple contributed speakers and volunteers to a variety of gay rights causes. Harvey Milk, the celebrated San Francisco politician, even wrote a letter to President Jimmy Carter in Jones’ defense.

Much of Jones' teachings on sexual ethics seem outmoded today. Contrary to contemporary thinking, for example, Jones taught that everyone had homosexual inclinations. Here, Jones’ views echoed those of sex research pioneer Albert Kinsey, who plotted homosexual-heterosexual orientation on a linear scale from zero (exclusively heterosexual) to six (exclusively homosexual). If the Kinsey scale is correct, then, as Jones taught, a pure heterosexual is rare indeed. The gay rights movement today argues that homosexuality is a congenital condition affecting only a minority of the population who deserve our tolerance and protection. In Jones' today, however, it was often argued that homosexuality affected the entire population and should not be seen as abnormal. Peoples Temple was simply following a conventional script for sexual progressives of the time.

Happy-clappyism. Of all the elements of Peoples Temple theology, its self-conscious niceness, informality and celebration of difference are the most familiar to us today. Jones discouraged traditional courtesies, and asked that he be called "Jim" or even "dad" rather than "Pastor Jones." His followers insisted on how happy and welcome they always felt. Here, they said, nobody judged you. Everyone was accepted just for who he was and everyone's contribution was valued. Members tirelessly expressed their love and affection for one another. At social events, they shared their gifts with each other, whether for music, dance or storytelling. The most frequent adjective that they used to described the Peoples Temple community was "beautiful."

Suicide notes written during the last White Night strike a militantly happy-clappy tone. One wrote:

Where can I begin — JONESTOWN — the most peaceful, loving community that ever existed, JIM JONES — the one who made this paradise possible...

No one was made fun of for their appearance — something no one had control over. Meanness and making fun were not allowed...

Jim Jones showed us all this — that we could live together with our differences, that we are all the same human beings...

What a beautiful place this was. The children loved the jungle, learned about animals and plants. There were no cars to run over them; no child-molesters to molest them; nobody to hurt them. They were the freest, most intelligent children I had ever known.

And another, evidently describing the ongoing deaths:

These are a beautiful people, a brave people, not afraid...

People hugging each other, embracing, we are hurrying — we do not want to be captured. We want to bear witness at once...

Hugging & kissing & tears & silence & joy...

Touches and whispered words as this silent line passes. Determination, purpose. A proud people. Only last night, their voices raised in unison, a voice of affirmation and today, a different sort of affirmation, a different dimension of that same victory of the human spirit.

Other elements of Peoples Temple ideology are more controversial but still not unusual.

Socialism. Jones taught that all should share their wealth and work for the common good. Like all socialisms, Jones’ had its own distinct flavor. It was, first of all, agrarian. In Guyana, Peoples Temple ran a largely self-sufficient farming collective. Second, Peoples Temple socialism emphasized care of the elderly. Able adults worked tirelessly while the aged had all of their needs met. Third, it was pro-Soviet. Jones hoped to move the entire community to the Soviet Union and attempted on the last day to transfer all Peoples Temple assets to the Soviet Communist Party. Finally, the Peoples Temple celebrated labor. The work at Jonestown was back-breaking and never-ending.

Jones' socialism worked. Peoples Temple was no short-lived hippie commune where free-riders took advantage of others' labor. In Guyana, Peoples Temple members had carved sustainable farming community out of the jungle. Facilities were clean, produce healthy and abundant, housing sturdy and reasonably comfortable. Congressman Leo Ryan — whose investigative visit to Jonestown precipitated the massacre — was favorably impressed. After witnessing a vibrant welcome celebration, replete with soul music, dancing, laughing, and embracing, he related how so many of them had called Peoples Temple "the best thing that happened to them in their whole lives." The pavilion burst into a jubilant applause.

Charismatic preaching. Early in life, Jones showed a gift for preaching. Today, with the controversies over the "religious right" still raging, a white preacher with a charismatic style is considered dangerous and right wing. Historically, however, white charismatic preachers have been just as home on the left. William Jennings Bryan could whip audiences into a frenzy preaching women's suffrage or the need for an income tax. Jones drew from this tradition. Theologically, he had no use for the Bible or the creeds. For him, Christ was socialism; anti-christ the exploitative capitalist system. He took the intimate, communal life of the early church as a paragon of exemplary Christian life. The spiritual trappings of Christianity could be used to recruit and inspire but were subordinate to Peoples Temple's earthly goals.

Fear of reaction. Jones believed that the CIA and other anti-communist agencies constantly threatened his community. He viewed a confrontation between Peoples Temple and the U.S. government and its surrogates as inevitable. The only question, he preached, was when. Over time, Jones interpretation of events became increasingly paranoid. Nevertheless, Jones’ belief that the CIA actively frustrates all successful socialist experiments has a respectable pedigree. To this day, many argue that the CIA orchestrated the Jonestown deaths in order to destroy a progressive community.

Finally, there is the concept of "revolutionary suicide," which followed naturally from the other elements of Peoples Temple ideology. Jones wanted to create a harmonious society free of meanness and conflict. The goal proved elusive. To maintain zeal, he increasingly blamed outside forces for Peoples Temple's struggles. Ultimately, the congregation concluded that the world simply could not tolerate the beautiful community that they had created. Rather than re-assimiliate into "fascist" America, the members of Peoples Temple chose instead to accept death on their own terms. Revolutionary suicide was nothing but a happy-clappy form of eschatology.

We flatter ourselves that since Jones’ vision found a place for murder-suicide, the whole of it was outlandish. All too many ideas, including innocuous ones, can be mixed in a lethal ideological cocktail. Perhaps most of all, what the Jonestown massacre has to teach us today is the strange arbitrarinessof ideological systems.

Nonetheless, that very arbitrariness teaches at least a negative lesson. Some of Jones’ ideas are so mainstream that we hardly even think to question them today. Just like the members of Peoples Temple, for example, many insist today, as if it were a moral obligation to do so, that we can all live together in harmony just so long as we learn to celebrate rather than despise our differences. Realistic, disillusioning theories of how the world really works are deemed too "offensive" to be considered. Orthodox social teaching today could be lifted straight out of a Jim Jones homily.

But happy-clappyism will no more cure our problems than it did the problems of Peoples Temple. Jim Jones assembled perhaps the most highly motivated people ever to try to celebrate differences and learn to live together with love. They failed. For one thing, to maintain their happy-clappy fervor, Peoples Temple had to demonize the non-happy-clappy Other. Peoples Temple's hatred for the racist, capitalist outside world ultimately turned murderous. Nor did Peoples Temple eliminate jealousies, possessiveness, or cruel hierarchies internally. Strikingly, Jones and his inner circle consisted of upper class whites, even as the majority of members were lower class blacks. Whites in Peoples Temple plainly derived profound satisfaction from their ability to live with other races. The ultimate picture is quite familiar: white elites in Peoples Temple used the their black compatriots as symbols of their own moral superiority. African Americans in Peoples Temple ultimately paid for whites' status obsessions with their lives.

Contemporary happy clappyism will not end, as in Peoples Temple, in revolutionary suicide. It does, as in Peoples Temple, blind us to reality. America is now imbrued with the same poisonous sentimentality that was the pride of Peoples Temple. A few brave souls spit it out but the rest keep drinking.

Where the WASPs Aren't

Cross-posted from Taki's Magazine.

The TV show Gossip Girl, now in its second season, chronicles the “scandalous lives of Manhattan’s elite”—“elite” meaning private school kids and their families.  Replete with iPhone-toting teenagers, haute couture and on-location filming, the show pretends to at least a surface verisimilitude. When it comes to underlying sociological realities, however, it offers nothing but the most fatuous distortions.

For example:

• In Gossip Girl, the obligatory fish-out-of-water character lives in a capacious Williamsburg loft with sliding industrial doors and exposed brick.  From this, we’re supposed to infer that his family not only has less money but that they’re more authentic and less status-driven that the denizens of the Upper East Side. In reality, many New Yorkers would cut out their own eyeballs to get a big Williamsburg loft. Here are some of the prices. Further, as status symbol, a Williamsburg loft arguably trumps a Park Avenue co-op. Williamsburg is where the cool white people live; only sell-outs live on the Upper East Side.

• In Gossip Girl, kids get into elite colleges by not-so-deftly signaling their membership in the good old boys network. One applicant even says to an interviewer, “Why should I get into Dartmouth? Because I’m a [impressive family name].” In reality, name-dropping in an interview is probably the one thing (other than telling a racist joke) an applicant could do to ensure that he doesn’t get admitted. Further, as colleges like to trumpet the “diversity” of their student body, an Hindu or an Eskimo has a better chance into college than a preppy with an ancient pedigree. Finally, colleges compete for do-gooders with exceptional brains. The world of Gossip Girl, where slackers and nincompoops get in through family connections, simply doesn’t exist.

• In Gossip Girl, rich kids all have names like Waldorf, Archibald, Bass and van der Woodsen. (In keeping with media’s loathing of the Texas Bass family, the villain is named “Chuck Bass.”) In reality, however, the families of the old Protestant Establishment make up only a minority of New York’s wealthy elite. They haven’t entirely disappeared; they still host their debutantes balls, the Forbes family still keeps the Social Register afloat, and a handful of institutions (mostly hidden from public view) are still controlled by WASPs. Some WASPs even have substantial fortunes. (Those fortunes, however, are rarely very old; no Knickerbocker family like “van der Woodsen” can afford New York’s social whirl.) But WASPs as a whole just don’t have the numbers, much less the will, to dominate New York society. As Louis Auchincloss gently puts it, they have “lost their monopoly.”

Instead, perhaps a plurality of the rich private school kids in Manhattan—even at historically Protestant schools—are Jewish. The Jewish Daily Forward goes so far as to report that Trinity and Dalton, two of the top private schools in New York, are “largely Jewish.” An entire media industry follows the lavish bar mitzvahs of Manhattan private school kids. The closest real-world model for the high school in Gossip Girl, The Dalton School, has historically been the most recherché school for Jewish New Yorkers. (Most WASPs prefer to send their children to the old single-sex grammar schools.) Tellingly, the media now treat Dalton as the most posh school in Manhattan.

In Gossip Girl, however, Jewish kids don’t even exist, much less predominate. Everything about Gossip Girl is modern, from the drugs to the iphones, except for the sociological background, which the writers may as well have lifted out of the Gilded Age.

• It almost goes without saying that Gossip Girls gets nothing right about WASPs. WASPs don’t flaunt their wealth; on the contrary, they cultivate their shabbiness, the better to signal to the world that they don’t need money (which they probably don’t have anyway) in order to rank socially.  To demonstrate your WASP bona fides, you drive a 1980s Buick station wagon, not a Rolls Royce.

In fairness, in mischaracterizing America’s upper class, Gossip Girl is merely following pop culture convention. Virtually every Hollywood movie and TV show, from Scent of a Woman to Family Guy, assumes that a WASP episcopacy that collapsed two generations ago still controls this country’s wealth and power. (Indeed, it is hard to think of any pop culture product that doesn’t associate wealth with WASP privilege.) I’m told even told that “chic lit” novels routinely assume that all Upper East Side socialites hail from patrician WASP families and despise anyone who doesn’t. The authors of these novels then do book signings on the Upper East Side in front of audiences that know full well that the novels bear no resemblance to the world they actually live in. 

In the end, Gossip Girl is an example of market failure. The public probably really would like to know how the rich live. WASPs, however, unlike others wealthy groups, have not formed a pressure group to punish studios that portray them unfavorably. (WASPs instead prefer to express themselves politically through benign environmental causes, with perhaps a little feminism mixed in.) Consequently, pop culture purveyors have zero tolerance for unflattering depictions of other groups, but give writers absolute license to defame WASPs.

Don’t pity the WASPs, who surely deserve their fate; pity instead the audiences who have to suffer though one hackneyed treatment of the upper class after another. Great fame and fortune awaits anyone who somehow manages to overcome this market failure. When he does, I might actually tune in and watch.