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Under the leadership of an aggressive opponent of anti-competitive business practices, the Federal Trade Commission is moving against drug companies and industry middlemen as part of the Biden administration’s push for lower drug prices at the pharmacy counter.

On May 16, the FTC sued to block the merger of drugmakers Amgen and Horizon Therapeutics, saying the tangled web of drug industry deal-making would enable Amgen to leverage the monopoly power of two top Horizon drugs that have no rivals.

So suddenly, the world is being left on its own. And what we're seeing is the world is not on autopilot. It doesn't self-organize. And that's the most worrisome thing going forward that this pandemic is both a reflection, but also an accelerant of that because the United States has not rallied the world to meet the challenge posed by this pandemic. And instead, we've pulled back we become much more national, kind of an island power, the rest of the world, it's on its own, it's not doing very well. And this is this is the reason I'm so worried that a lot of the trends that were in place, including them on America, much less involved in the world, nationalism, populism, the breakdown of international collaboration, all those things were in train before this pandemic, and now we're seeing them double down.

MEGHNA: So is the you're saying the world is not self-organizing right now, perhaps, at this moment? And at the same time, it doesn't? Is it feeling the loss of the centrality of American leadership? Because, I think we could argue that the way that, for example, international leaders do talk about the United States right now, at times, they're not necessarily feeling the loss of American influence.

Until the 1980s, despite spending much less on health care, Americans were doing better than other countries in their health outcomes (Frakt, 2018). Something happened to US health care spending after 1980. Confronted with fiscal pressures, as the share of gross domestic product (GDP) absorbed by health care spending began to get serious, other nations put measures in place to hold down spending but the US did not. The differential between what the US and other developed coun- tries pay for prescriptions and for hospital and physician services has continued to widen over time. Suppliers of medical inputs marketed costly technological innovations (Callahan, 2009). They found ready customers in hospitals and medical practices eager to keep up with rivals in the medical arms race. In 1980, health care expenditures in the US were $256 billion, exploding to nearly $2.6 trillion in 2010, a ten- fold increase (Meissner, 2013). Health care expenditures spiked further to $3.8 trillion in 2019. What began as a small gap in performance when compared to other countries is now a yawning chasm.

The per capita spending on health care in the US towers over all other developed nations, and yet health care outcomes as reflected by key health indicators are at best average. In other words, the US health care system consumes far more resources to produce the same or worse health care outcomes as compared to the health care systems elsewhere. For example, the US spent $11,582 per capita in 2019 compared to $5,418 in Canada, $4,653 in the United Kingdom, $4,823 in Japan, and $4,224, the average of the Organization for Economic Cooperation and Development (OECD) countries (OECD, 2020). In total health care spending, the US spends 17.7 percent of its GDP, which is almost the double that of the average spending of 8.8 percent of GDP for the OECD countries. In a comparison to the overall performance of the health care systems of 11 developed countries, the US was found dangling alone with high health care spending and low system performance (Schneider et al., 2017). Seven countries (Australia, Germany, the Netherlands, New Zealand, Norway, Switzerland, and the United Kingdom) bunch together and perform higher than the other four countries (Canada, France, Sweden, and the USA). Canada, France, and Sweden show mediocre performance with the US being the laggard.

“Reverse payment” or “pay-for-delay” settlements occur when a brand-name pharmaceutical company that is suing a generic manufacturer for patent infringement drops its lawsuit and instead pays the generic company to delay marketing its generic drug until a specified date.4 This flow of consideration from the patentee, brand-name pharmaceutical company to the generic manufacturer contrasts with that of traditional patent infringement settlements, where infringing parties pay patentees to drop the lawsuits against them. These reverse payment settlements delay both the availability of generic drugs to consumers and competition among pharmaceutical companies, raising strong antitrust concerns. As reverse payment settlements become increasingly popular in the pharmaceutical industry, steps must be taken to combat their anticompetitive effects.5

The main problem with reverse settlements is that the benefits they provide for the brand-name pharmaceutical company and the generic drug manufacturer are often at the expense of consumers, who are forced to pay higher prices for their medications. According to a recent Federal Trade Commission (“FTC”) statement, “eliminating these pay-for-delay settlements would still save consumers $35 billion over ten years—or about $3.5 billion per year.”6 This is because, on average, generic drugs cost ten times less than their brand-name counterparts.7 However, these savings are lost when the brand-name pharmaceutical company settles with the generic manufacturer in order to eliminate the risk of expensive litigation that could ultimately invalidate its patent and open the door to competition from generic drugs. By delaying the manufacture and sale of a version of its drug, the brand-name company is able to maintain its monopoly-set price and thus, make more than it and the generic challenger would have made combined if they were to compete with each other on the market. In an anticompetitive reverse payment settlement, the generic company agrees to drop its application to produce a low-cost generic version of the drug in exchange for a share of the monopolized profits. In such a scenario, where the brand-name and generic drug companies conspire to intentionally block competition, their actions constitute an antitrust violation. Until FTC v. Actavis, Inc., it was unclear whether all reverse payment settlements raised antitrust concerns.

The pharmaceutical sector is preparing for more antitrust litigation after a pivot by US regulators to lawsuits that prioritize clarifying the law over successfully blocking deals.

Recent actions by the Federal Trade Commission under Chair Lina Khan that include a review of Pfizer Inc.‘s $43 billion takeover of Seagen Inc. have overturned settled practices for the agency, signaling a greater willingness to litigate in an attempt to set precedents that define anticompetitive conduct, according to academics and a former FTC director.

When all pertinent factors are taken into account, U.S. President Donald Trump could sometime undertake more-or-less selective military action against Iran. In response, the Islamic Republic – then having absolutely no meaningful option to launching at least certain forms of armed reprisal – would target American military forces in the region and/or carefully chosen Israeli targets. Whatever its precise configuration of selected targets, Tehran's retaliatory blow would be expressly designed so as not to elicit an unacceptably massive (possibly even nuclear) counter-retaliation. With particular regard to Israel, moreover, this sort of retaliation would plausibly include, inter alia, a substantial reliance upon Iran's own surrogate militia forces in Hezbollah. All such bewildering calculations, of course, must assume perfect rationality on all sides. If, for example, the new American president should cast all caution to the winds with his own first strike (a strike that would be defended by Washington, in law, as an allegedly legitimate expression of international law-enforcement, or "anticipatory self-defense"), the Iranian response, whether rational or irrational, could expectedly be "proportionate" – that is, comparably massive. In that prospectively escalatory case, any contemplated introduction of nuclear weapons into the ensuing conflagration might not necessarily be dismissed out of hand. At that point, moreover, any such introduction would have to originate from the American and/or Israeli side. This indisputable inference is "true by definition," "simply" because Iran would not yet have become an operationally nuclear power. In such circumstances, Trump, especially in view of his favored argumentum ad baculum stance in virtually all matters, might decide upon a so-called "mad dog" strategy vis-a-vis Iran. Here, the American president would display a last-resort dependence upon a strategy of pretended irrationality, or what I have called in my own latest books and monographs, the "rationality of pretended irrationality." Significantly, any such residual reliance, while intuitively sensible and apparently compelling, could still backfire, thereby opening up an "Armageddon path" to a now unstoppable escalation. If, on the other hand, Trump's "punishing" or defensive initial strike against Iran were conspicuously less than massive, a fully rational Iranian adversary would likely ensure that its chosen reprisal was correspondingly "limited." But if Trump's consciously rational and calibrated attack upon Iran were wittingly or unwittingly launched against an irrational enemy leadership, the Iranian response could then be "roaring missiles," or an all-out retaliation. This presumably unanticipated response, while non-nuclear, could be directed at some as yet undeterminable combination of U.S. and Israeli targets. Cumulatively, it could still inflict very substantial harms. For the moment, at least, any Iranian missile reprisal against U.S. interests and personnel would have to exclude the American homeland. This same limiting prediction, however, cannot be made in reference to any considered Israeli targets. On the contrary, any reciprocal Iranian attack directed against Israel would plausibly target that country's military assets and could also include a significant number of "soft" civilian populations and corollary infrastructures. Even if it is being played only by rational adversaries, the advancing strategic "game" would demand that each contestant relentlessly strive for "escalation dominance." Ominously, it is in the thoroughly unpracticed internal dynamics of any such rivalry that the serious prospect of a genuinely "Armageddon" scenario could sometime be realized. This intolerable outcome could be produced either in unexpected increments of escalation by any or all of the three dominant national players, or instead, by any sudden quantum leap in destructiveness undertaken by Iran, Israel and/or the United States. The only thing that is wholly predictable in usefully deciphering such complex dynamics is that they are all unpredictable. For example, even under the best or optimum assumptions of enemy rationality, all pertinent decision-makers would have to concern themselves with miscalculations, errors in information, unauthorized uses of strategic weapons, mechanical or computer malfunctions, poorly recognized instances of cyberdefense, cyber-war and even adversarial coups d'etats. In the final analysis, informed citizens and participants in these hideously complicated games of strategy will need to recall that it is mathematically meaningless to assign any comforting probabilities to unique events. Because an authentic nuclear war would represent precisely such an event, one with utterly unforeseen intersections, interactions and "synergies," we can never predict with any reassuring degree of precision whether such a conflict would actually be more or less probable. Indeed, should Trump ever proceed to strike Iran on the erroneously nonspecific assumption that his generals have already "got everything covered," he ought then to be reminded of the classic military warning of Carl von Clausewitz: Long before any military planners could even envision a nuclear war, the great Prussian general had cautioned about "friction," or "the difference between war on paper, and war as it actually is." Where it would be minimized or disregarded altogether by Trump, this difference could propel the unsteady Middle East toward an irreversible Armageddon.

If the war in Ukraine leads to millions of refugees, tens of thousands of deaths, and the destruction of cities, defrosting the Karabakh conflict will completely undermine Russia’s entire foreign policy in the Caucasus. Every city in Central Asia is under threat of explosions and attacks. So far this “up-and-coming front” has attracted the least media coverage – Novorossiya dominates on national television channels, in newspapers, and on websites –, but this theater of war could become one of the most complex after the conflict in the Ukraine. A subsidiary of the Caliphate under Russia’s belly The indisputable trend in Afghanistan – and the key source of instability in the region – is to an alliance between the Taliban and the Islamic State. Even so, the formation of their union is in its early days, references to it are scarce and fragmentary, and the true scale of the activities of the IS emissaries is unclear, like an iceberg whose tip barely shows above the surface of the water. But it has been established that IS agitators are active in Pakistan and in Afghanistan’s southern provinces, which are controlled by the Taliban. But, in this case, the first victim of chaos in Afghanistan is Pakistan, which at the insistence of, and with help from, the United States nurtured the Taliban in the 1980s. That project has taken on a life of its own and is a recurring nightmare for Islamabad, which has decided to establish a friendlier relationship China and Russia. This trend can be seen in the Taliban’s attacks on Pakistani schools, whose teachers now have the right to carry guns, regular arrests of terrorists in the major cities, and the start of activities in support of tribes hostile to the Taliban in the north. The latest legislative development in Pakistan is a constitutional amendment to expand military court jurisdiction [over civilians]. Throughout the country, terrorists, Islamists and their sympathizers are being detained. In the northwest alone, more than 8,000 arrests have been made, including members of the clergy. Religious organizations have been banned and IS emissaries are being caught. Since the Americans do not like putting all their eggs in one basket, they will provide support to the government in Kabul, which will allow them to remain in the country legitimately, and at the same time to the Taliban, which is transforming itself into IS. The outcome will be a state of chaos in which the Americans will not formally take part; instead, they will sit back on their military bases, waiting to see who wins. And then Washington will provide assistance to the victor. Note that its security services have been supporting the Taliban for a long time and quite effectively: some of the official security forces and police in Afghanistan are former Taliban and Mujahideen. Method of destruction The first way to destabilize Central Asia is to create problems on the borders, along with the threat that Mujahideen will penetrate the region. The testing of the neighbours has already started; problems have arisen in Turkmenistan, which has even had to ask Kabul to hold large-scale military operations in the border provinces. Tajikistan has forced the Taliban to negotiate the release of the border guards it abducted, and the Tajik border service reports that there is a large group of Mujahideen on its borders. In general, all the countries bordering Afghanistan have stepped up their border security. The second way is to send Islamists behind the lines. The process has already begun: the number of extremists in Tajikistan alone grew three-fold last year; however, even though they are being caught, it obviously will not be feasible to catch all of them. Furthermore, the situation is aggravated by the return of migrant workers from Russia, which will expand the recruiting base. If the stream of remittances from Russia dries up, the outcome may be popular discontent and managed riots. Kyrgyz expert Kadir Malikov reports that $70 million has been allocated to the IS military group Maverenahr, which includes representatives of all the Central Asian republics, to carry out acts of terrorism in the region. Special emphasis is placed on the Fergana Valley as the heart of Central Asia. Another point of vulnerability is Kyrgyzstan’s parliamentary elections, scheduled for this fall. The initiation of a new set of color revolutions will lead to chaos and the disintegration of countries. Self-supporting wars Waging war is expensive, so the destabilization of the region must be self-supporting or at least profitable for the U.S. military-industrial complex. And in this area Washington has had some success: it has given Uzbekistan 328 armored vehicles that Kiev had requested for its war with Novorossiya. At first glance, the deal isn’t profitable because the machines were a gift, but in reality Uzbekistan will be tied to U.S. spare parts and ammunition. Washington made a similar decision on the transfer of equipment and weapons to Islamabad. But the United States has not been successful in its attempts to impose its weapons systems on India: the Indians have not signed any contracts, and Obama was shown Russian military hardware when he attended a military parade. Thus the United States is drawing the countries in the region into war with its own protégés – the Taliban and Islamic State – and at the same time is supplying its enemies with weapons. *** So 2015 will be marked by preparations for widespread destabilization in Central Asia and the transformation of AfPak into an Islamic State subsidiary on the borders of Russia, India, China, and Iran. The start of full-scale war, which will inevitably follow once chaos engulfs the region, will lead to a bloodbath in the “Eurasian Balkans,” automatically involving more than a third of the world’s population and almost all the United States’ geopolitical rivals. It’s an opportunity Washington will find too good to miss. Russia’s response to this challenge has to be multifaceted: involving the region in the process of Eurasian integration, providing military, economic, and political assistance, working closely with its allies in the Shanghai Cooperation Organization and the BRICS, strengthening the Pakistani army, and of course assisting with the capture of the bearded servants of the Caliphate. But the most important response should be the accelerated modernization of its armed forces as well as those of its allies and efforts to strengthen the Collective Security Treaty Organization and give it the right to circumvent the highly inefficient United Nations. The region is extremely important: if Ukraine is a fuse of war, then Central Asia is a munitions depot. If it blows up, half the continent will be hit.

What would totalitarian governments of the past have looked like if they were never defeated? The Nazis operated with 20th Century technology and it still took a world war to stop them. How much more powerful – and permanent – could the Nazis have been if they had beat the US to the atomic bomb? Controlling the most advanced technology of the time could have solidified Nazi power and changed the course of history.

When we think of existential risks, events like nuclear war or asteroid impacts often come to mind. Yet there’s one future threat that is less well known – and while it doesn’t involve the extinction of our species, it could be just as bad.

Sino-Russian relations have been adapting to an era of great-power rivalry. This complex relationship, categorised as a ‘comprehensive strategic partnership of coordination for a new era’, has continued to evolve as global strategic competition has intensified.1 China and Russia have not only expanded military cooperation but are also undertaking more extensive technological cooperation, including in fifth-generation telecommunications, artificial intelligence (AI), biotechnology and the digital economy.

When Russia and China commemorated the 70th anniversary of the establishment of diplomatic relations between Soviet Union and the People’s Republic of China in October 2019,2 the celebrations highlighted the history of this ‘friendship’ and a positive agenda for contemporary partnership that is pursuing bilateral security, ‘the spirit of innovation’, and ‘cooperation in all areas’.3

Of course, the most powerful argument is the one I have not made yet: Helping Ukraine is the right thing to do. It is the American thing to do. As Reagan explained 40 years ago during his “Evil Empire” speech, the United States cannot remove itself “from the struggle between right and wrong and good and evil” because “America has kept alight the torch of freedom, not just for ourselves, but for millions of others around the world.” Those words ring as true today as they did in Reagan’s time. The war in Ukraine is a struggle between right and wrong and good and evil, and in that struggle, America must not remain neutral. Even this is a matter of self-interest. Since the end of the Cold War, democratic self-government has spread throughout the world. The dramatic expansion of human freedom has unleashed an unprecedented expansion of peace, stability and prosperity at home and abroad. But even those unpersuaded by Reagan’s call to oppose evil can still agree with him that the United States must pursue “peace through strength.” The “America First” isolationists of the 1930s hoped to avoid a repeat of the carnage of the First World War, which took some 20 million lives. Instead, their failure to resist Adolf Hitler’s rise invited the Second World War, which took 60 million lives. Allowing Hitler to seize the Sudetenland in Czechoslovakia did not appease the dictator nor deliver “peace for our time.” It only whetted Hitler’s appetite, and the appetites of other expansionist powers, for conquest. The same will be true if we allow Putin to seize Ukraine. The lesson of the 20th century is that putting “America First” requires us to project strength and deter our enemies from launching wars of aggression — so that U.S. troops to don’t have to fight and die in another global conflagration. The invasion in Ukraine was a failure of deterrence. Only by helping Ukraine win can we prevent further deterrence failures. If we help Ukraine prevail, we can rewrite the narrative of U.S. weakness; restore deterrence with China; strike a blow against the Sino-Russian alliance; decimate the Russian threat to Europe; increase burden-sharing with our allies; improve our military preparedness for other adversaries; stop a global nuclear arms race; dissuade other nuclear states from launching wars of aggression; and make World War III less likely.

Future wars could be decided by electronic warfare like Russia and Ukraine are using right now to interrupt communications, defeat unmanned platforms, and even degrade precision weaponry.

For the US, if it doesn't dominate that invisible domain and win the fight in the electromagnetic spectrum, it will "lose" and do so "very quickly," an Air Force wing commander said.

The hapless Russian soldier in a film clip shown at a recent industry trade show was — ironically perhaps — setting up a jammer when a Ukrainian soldier remotely operating a drone spied him from above.

The Russian apparently didn’t flip the switch on the device in time to block the drone’s signals. The Ukrainian soldier watching through a pair of goggles kilometers away dispatched a grenade, destroying the jammer and presumably taking the Russian permanently off the battlefield as another of that day’s casualties.

The weapons and technologies of war are constantly evolving - changing more rapidly year to year in the 21st Century than they did century to century when Chinese general Sun Tzu wrote The Art of War some 2,500 years ago. Yet Sun Tzu's writings remain central guidelines even today; the need to control the high ground is applicable to one of the most advanced and increasingly critical realms of modern combat: electronic warfare (EW).

"Spectrum dominance is the new high ground; all weapons systems today are highly reliant on communications of one sort or another, whether global positioning system (GPS) or internal communications. If someone can distort GPS or disable onboard systems, you're toast," says Bob Schena, CEO of Rajant Corp. in Malvern, Pa. "On a scale of 1 to 10, it's a 12. We are so reliant on communications in our style of fighting that it is absolutely critical and will get even more critical. If you're at a communications disadvantage, I don't see how you can last very long."

Nearly four years after the Federal Communications Commission (FCC) approved a license modification for the satellite communications company Ligado, the company’s dispute with the Department of Defense (DOD) and other national security agencies has spawned a $40 billion lawsuit and feels no closer to resolution.

For telecommunications insiders, the Ligado debacle has become a symbol of our inability to manage our airwaves efficiently. However, the most aggravating part of this years-long dispute is that it may have been avoided if federal experts had properly considered the national security value of commercial wireless technologies.

Will Congress sell out America’s national security? It nearly happened in December, and the threat is far from over. At issue is wireless spectrum — radio frequencies that are the lifeblood of modern communication, and that the Department of Defense (DOD) needs for a host of advanced technologies that keep Americans safe. Some in Congress want to force the Pentagon to vacate key frequencies in the name of 5G. This would be a time-consuming and costly process that would jeopardize our military readiness at a time of growing danger, especially from China.

Congress does not need to make this a zero-sum game. Lawmakers instead should pursue “spectrum sharing,” which can balance and ultimately advance both our military and economic needs, instead of choosing one over the other.

A trio of lawmakers from the Senate Armed Services Committee have written a letter to President Joe Biden asking the administration to incorporate more insights from the Pentagon as it begins to implement the National Spectrum Strategy.

The letter — signed by Sens. Deb Fischer, R-Neb., Mazie Hirono, D-Hawaii, and Angus King, I-Maine — outlines the legislators’ apprehensions over the possible repercussions if the Department of Defense is asked to vacate portions of the electromagnetic spectrum that are exclusively used for military operations. Notably, it questions a recent directive from the administration to conduct a second study of dynamic spectrum sharing options between the Pentagon and private sector.

Despite these reflections, in February 2022 I was shocked when Vladimir Putin tried to conquer Ukraine. The expected repercussions for Russia itself, and for the whole of humanity, were so destructive that it seemed an unlikely move even for a coldhearted megalomaniac. Yet the Russian autocrat chose to end the most peaceful era in human history, and to push humanity toward a new era of war that might be worse than anything we have seen before. Indeed, it might threaten the very survival of our species.

This is a tragedy, especially as the past few decades have shown that war isn’t an inevitable force of nature. It is a human choice that varies from place to place and time to time. Since 1945, we have not seen a single case of war between great powers, nor a single case of an internationally recognized state annihilated through foreign conquest. More limited regional and local conflicts remained relatively common; I live in Israel, so I know this perfectly well. But the Israeli occupation of the West Bank notwithstanding, countries have rarely tried to unilaterally expand their borders through violence. That’s one reason the Israeli occupation has drawn so much attention and criticism. What was the norm for thousands of years of imperial history has become anathema.

For decades, the Department of Defense has had relatively unquestioned access to a large portion of the electromagnetic spectrum — a critical resource that enables capabilities like radars, satellite communications and navigation systems.

However, a number of leaders at the Pentagon concerned that access may soon be taken away.

5G is a weapon. With the mobile phone now the main source of communication, the Chinese Communist Party has targeted supplying 5G infrastructure to countries around the world, creating vulnerabilities to intelligence gathering and easy disruption of a country’s critical communications and other infrastructure.

America is behind in this wireless arms race, and to pull ahead the Department of Defense plays a critical role.

Fortunately, the FCC started making significant strides on this front by taking a strong, market oriented approach to 5G deployment in the United States with auctions of the 3.5 GHz CBRS and 3.7-4.2 GHz C-band this year. In the 3.1-3.55 GHz band, the Commission voted on a Report and Order which removes all non-Federal allocations from 3.3-3.55 GHz. With 100 MHz already identified by the National Telecommunications and Information Administration (NTIA) as a potential for sharing, the FCC will begin to open portions of the band on a licensed basis. While more work must be done, this additional capacity will further incentivize carriers to invest heavily in 5G technology, especially as the major carriers race to compete with one another.

Unfortunately, despite these successes, some calls for a different approach that would remove this regulatory certainty. Indeed, despite advocating for markets previously, the president’s re-election campaign specifically calls for a national 5G network. While the specific details of the nationalized network remain murky, the basic idea would be to take existing spectrum allocated for federal users and either build a wholesale network or charge for the right to operate at those frequencies.