Wednesday, February 4, 2009

Relationships with the Drug Industry: Build Trust Based on Good Science

Relationships with the Drug Industry: Build Trust Based on Good Science. By Scott Gottlieb, M.D.
AEI, Wednesday, February 4, 2009

How do the current tensions in the relationship between the pharmaceutical industry, physicians, and patients affect individual health? Dr. Scott Gottlieb explores the possible causes for the breakdown in communication between these groups and charts a strategy to improve the productivity of their interactions and leverage these relationships in order to advance public health.

Medical treatments are becoming increasingly more individual, with respect to both disease and patient. They are also becoming more complex, and precise diagnoses and close monitoring are needed to optimise their use. In this environment, consumers and doctors need to work more closely with product developers. Yet increasing regulation of the drug industry is restricting its ability to disseminate the results of its clinical studies. This risks shrinking the opportunities patients have to improve their health. In the face of regulatory steps to restrain their scientific speech, drug makers need to take new steps in their relationship with doctors and patients and establish transparent guidelines for those interactions. They should also focus more squarely on matters of advancing science, monitoring for safety, and improving health education.


Science not marketing

A large part of the industry’s current problems stems from the way its relationship with academic physicians and medical institutions has evolved over the past few decades. Formerly, the industry depended on academic doctors to conduct basic and clinical research. Now more of that work is done in house.[1] As a consequence, the relationships forged with the academic medical community are often based on marketing related activities. This feeds the regrettable perception that drug makers ally themselves with medical thought leaders to advance marketing goals, not science, and that information they generate cannot be trusted.

Relationships should be predicated on genuine scientific work. This doesn’t mean that drug makers should stop engaging leading physicians to help companies generate and share information about new advances, but that they need to engage with doctors who had a role in discovering those advances rather than those with no or little link to the underlying science. The latter creates the unfortunate appearance that opinions are being rented; the former is unassailable, as a scientist is the most appropriate champion for his work.


Overcoming mistrust

As patients are taking an increasingly active role in treatment decisions drug companies need to take new steps to improve health literacy and patient education while they continue to invest in better ways to monitor the performance and safety of their products. Unfortunately, the existing mistrust means that policy makers continue to create restrictions that impede the ability of drug companies to speak to patients. This creates information asymmetry and denies patients the opportunity to receive truthful, non-misleading information about new products, thus hurting health outcomes.[2] [3] It also leads to a regulatory edifice that makes it harder for drug companies to monitor the performance of their drugs by talking directly with patients and makes it harder for them to provide targeted information to patients on proper use of prescription drugs. The bottom line remains that the drug firms remain one of the few actors in this marketplace with the financing and incentives to share and collect information. Under proper regulation, public health imperatives should compel us to make better use of these resources on behalf of patients.

Scott Gottlieb, M.D., is a resident fellow at AEI.


Notes

1. Bodenheimer T. Uneasy alliance--clinical investigators and the pharmaceutical industry. N Engl J Med 2000;342:1539-44.
2. Sentell TL, Halpin HA. Importance of adult literacy in understanding health disparities. J Gen Intern Med 2006;21:862-6.
3. Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA 2002;288:475-82.

Full text w/links in the references here

Cheney warns of new attacks

Cheney warns of new attacks. By John F Harris, Mike Allen and Jim VandeheiPolitico, Feb 04, 2009
http://www.politico.com/news/stories/0209/18390.html

Former Vice President Dick Cheney warned that there is a “high probability” that terrorists will attempt a catastrophic nuclear or biological attack in coming years, and said he fears the Obama administration’s policies will make it more likely the attempt will succeed.

In an interview Tuesday with Politico, Cheney unyieldingly defended the Bush administration’s support for the Guantanamo Bay prison and coercive interrogation of terrorism suspects.

And he asserted that President Obama will either backtrack on his stated intentions to end those policies or put the country at risk in ways more severe than most Americans—and, he charged, many members of Obama’s own team—understand.

“When we get people who are more concerned about reading the rights to an Al Qaeda terrorist than they are with protecting the United States against people who are absolutely committed to do anything they can to kill Americans, then I worry,” Cheney said.

Protecting the country’s security is “a tough, mean, dirty, nasty business,” he said. “These are evil people. And we’re not going to win this fight by turning the other cheek.”

Citing intelligence reports, Cheney said at least 61 of the inmates who were released from Guantanamo during the Bush administration—“that’s about 11 or 12 percent”—have “gone back into the business of being terrorists.”

The 200 or so inmates still there, he claimed, are “the hard core” whose “recidivism rate would be much higher.” He called Guantanamo a “first-class program,” and “a necessary facility” that is operated legally and with better food and treatment than the jails in inmates native countries.

But he said he worried that “instead of sitting down and carefully evaluating the policies,” Obama officials are unwisely following “campaign rhetoric” and preparing to release terrorism suspects or afford them legal protections granted to more conventional defendants in crime cases.

The choice, he alleged, reflects a na├»ve mindset among the new team in Washington: “The United States needs to be not so much loved as it needs to be respected. Sometimes, that requires us to take actions that generate controversy. I’m not at all sure that that’s what the Obama adminstration believes.”

The dire portrait Cheney painted of the country’s security situation was made even grimmer by his comments agreeing with analysts who this recession may be a once-in-a-century disaster.

“It’s unlike anything I’ve ever seen,” Cheney said. “The combination of the financial crisis that started last year, coupled now with, obviously, a major recession, I think we’re a long way from having solved these problems.”

The interview, less than two weeks after the Bush administration ceded power to Obama, found the man who is arguably the most controversial—and almost surely the most influential—vice president in U.S. history in a self-vindicating mood.

He expressed confidence that files will some day be publicly accessible offering specific evidence that waterboarding and other policies he promoted—over sharp internal dissent from colleagues and harsh public criticism—were directly responsible for averting new September 11-style attacks.

Not content to wait for a historical verdict, Cheney said he is set to plunge into his own memoirs, feeling liberated to describe behind-the-scenes roles over several decades in government now that the “statute of limitations has expired” on many of the most sensitive episodes.

His comments made unmistakable that Cheney—likely more than former President Bush, who has not yet given post-White House interviews—-is willing and even eager to spar with the new administration and its supporters over the issues he cares most about.

His standing in this public debate is beset by contradictions. Cheney for years has had intimate access to the sort of highly classified national security intelligence that Obama and his teams are only recently seeing.

But many of the top Democratic legal and national security players have long viewed Cheney as a man who became unhinged by his fears, responsible for major misjudgments in Iraq and Afghanistan, willing to bend or break legal precedents and constitutional principles to advance his aims. Polls show he is one of the most unpopular people in national life.

In the interview, Cheney revealed no doubts about his own course—and many about the new administration’s.

“If it hadn’t been for what we did—with respect to the terrorist surveillance program, or enhanced interrogation techniques for high-value detainees, the Patriot Act, and so forth—then we would have been attacked again,” he said. “Those policies we put in place, in my opinion, were absolutely crucial to getting us through the last seven-plus years without a major-casualty attack on the U.S.”

Cheney said “the ultimate threat to the country” is “a 9/11-type event where the terrorists are armed with something much more dangerous than an airline ticket and a box cutter – a nuclear weapon or a biological agent of some kind” that is deployed in the middle of an American city.

“That’s the one that would involve the deaths of perhaps hundreds of thousands of people, and the one you have to spend a hell of a lot of time guarding against,” he said.

“I think there’s a high probability of such an attempt. Whether or not they can pull it off depends whether or not we keep in place policies that have allowed us to defeat all further attempts, since 9/11, to launch mass-casualty attacks against the United States.”

If Cheney’s language was dramatic, the setting for the comments was almost bizarrely pedestrian. His office is in a non-descript suburban office building in McLean, in a suite that could just as easily house a dental clinic. The office is across the hall from a quick-copy store. The door is marked by nothing except a paper sign, held up by tape, saying the unit is occupied by the General Services Administration.

At several points, Cheney resisted singling out Obama personally for criticism, at one saying he wants to give him a break after just two weeks in office. He said he admires Obama’s choice to keep Defense Secretary Robert Gates on the job.

But if he treated Obama gingerly, Cheney was eager to engage in the broader philosophical debate he was with Democrats and even many in his own party about the right way to navigate a dangerous planet. He said he fears the people populating Obama’s ranks put too much faith in negotiation, persuasion, and good intentions.

“I think there are some who probably actually believe that if we just go talk nice to these folks, everything’s going to be okay,” he said.

He said his own experience tempers his belief in diplomacy.

“I think they’re optimistic. All new administrations are optimistic. We were,” he said.

“They may be able, in some cases, to make progress diplomatically that we weren’t,” Cheney said. “But, on the other hand, I think they’re likely to find—just as we did—that lots of times the diplomacy deosn’t work. Or diplomacy doesn’t work without there being an implied threat of something more serious if it fails.”

As examples of the dangerous world he sees—and one he predicted Obama and aides would find “sobering”—were Russia’s backsliding into authoritarianism and away from democracy, and the ongoing showdowns over the nuclear intentions of Iran and North Korea.

But it was the choice over Guantanamo that most dominated Cheney’s comments.

“If you release the hard-core al Qaeda terrorists that are held at Guantanamo, I think they go back into the business of trying to kill more Americans and mount further mass-casualty attacks,” he said. “If you turn ’em loose and they go kill more Americans, who’s responsible for that?”

Of one alternative—moving prisoners to the U.S. prisons—Cheney said he has heard from few members of Congress eager for Guantanamo transfers to their home-state prisons, and asked: “Is that really a good idea to take hardened al Qaeda terrorists who’ve already killed thousands of Americans and put ’em in San Quentin or some other prison facility where they can spread their venom even more widely than it already is?”

While Cheney’s words were dire, his own mood was relaxed, even loquacious. He was not on crutches—much less the wheelchair he rode to Obama’s inauguration—from an injury while moving a box of books into his new home.

Suddenly a man of leisure, Cheney has a Kindle, Amazon’s wireless reading device, and said he used it recently to read James M. McPherson’s new “Tried by War: Abraham Lincoln as Commander in Chief.” About a week ago, he had a phone conversation with former President George W. Bush, the first time the two had talked since they appeared together at a rally at Andrews Air Force Base just after Obama’s swearing-in.

“He’s fine,” Cheney said. “We had a pleasant chat on the phone. It was a private, personal conversation – not about policy. We’re both citizens – civilians.”


Other highlights of the 90-minute interview:

*What Cheney called “the trillion-dollar so-called stimulus bill”: “It looks to me like there’s a lot of stuff in there that has nothing to do with stimulus – it’s a sort of a wish list of a lot of my congressional Democratic friends,” he said.

*The potential consequences of $1 trillion in deficit stimulus spending: “It’s huge, obviously – potentially huge. You worry about what ultimately happens to inflation. You worry about what’s going to happen to the ability of the government to borrow money. … I’m nervous.”

*Whether the Bush administration should have done more about the economy: “We did worry about it, to some extent. … I don’t think anybody actually foresaw something of this size and dimension occurring. It’s also global. We only control part of the world economy – a very important part.”

*On the chance of progress in the Israeli-Palestinian peace process in the foreseeable future: “I think it’s unlikely.”

After leaving office, Cheney and his wife, Lynne, went first to his home in Wyoming, then returned to Washington to enjoy their grandchildren. He’s working on a book about his career, which has included stints as a House member, White House chief of staff and secretary of Defense.

His daughter, Liz Cheney, the former principal Deputy Assistant Secretary of State for Near Eastern Affair, supervised the interview and at one point was looking for a tape recorder.

“I’m not a very good press aide,” she joshed.

Cheney found one on his own. “See, you don’t need staff,” she said.

John Kyl: "President Bush's Lasting Legacy: Missile Defense"

President Bush's Lasting Legacy: Missile Defense. By John Kyl
The Bush-Cheney Alumni Association, Feb 03, 2009

When the history of the Bush administration's national security achievements is written, one of the most significant accomplishments will be the building of a national missile defense system.
The idea of a national ballistic missile defense system to supplement the nuclear deterrent was born 25 years ago by our 40th president, Ronald Reagan, who said, "I've become more and more deeply convinced that the human spirit must be capable of rising above dealing with other nations and human beings by threatening their existence."

But, something stood in President Reagan's way: the 1972 Anti-Ballistic Missile (ABM) Treaty. This treaty was a classic example of arms control promising much more than it was ever able to deliver.

The theory was that by ensuring mutual vulnerability to nuclear missile attack, the incentive to build increasing numbers of offensive forces would be removed. History proved that theory wrong. And, in fact, strategic nuclear forces expanded not just quantitatively, but also qualitatively.

The ABM treaty also stood in the way of developing defenses against rogue regimes that were - and are - developing ballistic missiles. Deterrence is simply inadequate in dealing with rogue dictators. To depend only on nuclear deterrence - that is, rational decision making - with the Iranian and North Korean regimes would be irresponsible. And so, President Bush officially withdrew the United States the ABM treaty in June 2002.

Four years later, in 2006, the wisdom of President Bush's action was demonstrated when North Korea tested its Tae Po Dong 2 missile and detonated a nuclear device. Had it been necessary, the Missile Defense Agency was able to provide the president a real missile defense capability to combat the threat posed to the American people by a rogue regime armed with ballistic missiles and weapons of mass destruction.

The United States missile defense system is now composed of 26 Ground-Based Interceptors in California and Alaska; 18 Aegis ballistic missile defense warships, complete with 65 interceptors on board; an advanced system of command and control; and surveillance and targeting radars. This is a significant capability, but it represents only the beginning of what's needed to protect the American people.

It is now President Obama's responsibility to ensure the safety of the American people against all threats, including the ballistic missile threat. The available evidence suggests this will not be easy. In recent years, Democrats in the House and Senate have made significant cuts to the missile defense budget, including restricting the development of defenses against future threats we know our adversaries are developing.

Our new president should also welcome Congress' recent decision to reverse an ill-conceived decision that it and President Clinton made in 1993 to abandon the study of space-based interceptors for missile defense. As a result of this reversal, the Department of Defense can now move forward on a study that could provide a roadmap for both a future defense of the United States from ballistic missile attack and a defense of our critical national security space systems. Opponents of this decision are already at work to stop the positive momentum created by Congress' decision to fund this study. They will not only attempt to cancel it, they will attempt to permanently shackle the defensive capability of the United States with a "space weapons ban" treaty, which could not work and would effectively amount to nothing more than feel good arms control.

President Bush left office having provided the American people, and his successor, a significant new defense capability. History will not be able to ignore this legacy. President Obama's opportunity to follow this good example has just begun. May history prove his judgment to be as good as his predecessor.

Sen. Kyl serves on the Senate Finance and Judiciary committees and as the Senate Minority Whip. Visit his website at www.kyl.senate.gov.

The news of Daschle's withdrawal shocked his Democratic colleagues

Obama on Daschle: I take responsibility. By Josh Gerstein
Politico, Feb 03, 2009

Excerpts:

[...]

The news of Daschle's withdrawal shocked his Democratic colleagues, many of whom had vowed to fight for his nomination.

"It's a big loss for the country," said Sen. Kent Conrad (D-ND.).

Conrad called Daschle "one of the most honest men" he had ever known, but said it was a case where "the story never caught up with headlines."

"I think it"s a tragedy," said a visibly irate Conrad.

"I wish Tom Daschle had not decided to withdraw his nomination," Sen. John Kerry (D-Mass.) said in a statement. "While Tom’s decision is a reminder of his loyalty to President Obama and his determination not to be a distraction, this was no ordinary appointment and today is not a good day for the cause of health care reform."

Obama told NBC Tuesday afternoon that the twin withdrawals made him "angry and disappointed and it's something I have to take responsibility for. I appointed these folks."

The distraction Daschle referred to was the mounting furor over his tax problems - a controversy that threatened to become a permanent blot on Obama's promise to clean up Washington's ethical quagmire. The White House appeared to have the votes to confirm Daschle in the Senate- but seems to have made the judgment that there were larger forces at play, forces that could bring long-term harm to the young administration.

Baucus said Daschle's withdrawal was "surprising" and "unfortunate."

"I just learned of it 15, 20 minutes ago," Baucus said. "I was a little surprised. I thought he was going to get confirmed. He's a good man. I thought he'd be confirmed."

[...]

The issue for Obama was one of credibility. The new president ran and won as a reform candidate, promising a new brand of politics. The day after being sworn in, he immediately put in place what he touted as far-reaching ethical reforms. But Obama quickly granted exceptions to his purportedly hard-line ban on lobbyists serving in his administration and is now offering explanations as to why it is acceptable for two of his top cabinet officers to serve despite failing to pay taxes.

These issues threaten to divert Obama from his focus on rejuvenating the economy and are prompting questions from otherwise political allies on his commitment to changing the political culture of the capital. Obama is not just getting flak from predictable political opponents: the Daschle nomination was savaged Tuesday morning by the New York Times editorial page and has also been criticized by the Nation magazine, a touchstone of Democratic liberalism.

On MSNBC, Andrea Mitchell said she had just spoken with Daschle - who said that when he read the New York Times this morning, he realized he could never pass health care reform if he was such a distraction.

Killefer's decision to step down also seemed a result of the mounting drumbeat of criticism of the new Obama team. “Said a Senate source of Killefer: "She has nanny tax problems that may not have been insurmountable on their own, but given the Geithner and Daschle cumulative effect, she had to withdraw.”

Gibbs said Daschle and Killefer came to the realization that their mistakes would be seen as tarnishing Obama’s mandate for change. “I think they both recognize that you can’t set a standard of responsibility but set a different example in who serves,” he said.

Obama ignored a shouted question Monday morning from CNN’s Ed Henry after a White House ceremony announcing the selection of Sen. Judd Gregg as Commerce Secretary as to why so many administration appointees are having tax troubles.

John Bresnahan, Carol E. Lee, Jonathan Martin and Manu Raju contributed to this story.

Howard Dean for HHS or Health Czar

Howard Dean for HHS or Health Czar. By Cenk Uygur
HuffingtonPost, Feb 04, 2009

Remember Tom Daschle was selected for two different positions in the Obama administration. The Secretary of Health and Human Services and Health Czar. These can be and are meant to be two distinct jobs (otherwise, why bother having a health czar).

At this point, if Howard Dean is not selected for at least one of these positions, it is a clear snub. But not just to Dean, but to all like-minded progressives. There's no way that Rahm Emanuel's animosity toward Dean can be explained away if they pass over him again, especially given his tremendous success at the DNC. That success is not a claim he holds over the Democratic Party, it is a testament to his ability to get things done.

We still want to get things done, right? We don't just want to bargain with the Republicans all day long and walk away without real change, do we? Are we playing a political game of who can appear to be more bi-partisan or are we really going to bring the change that was promised?

You know who promised change and then really delivered? Howard Dean. No one believed that he could change the mindset at the DNC and have the kind of success he did with the 50 state strategy. But he got it done. It would be unconscionable to ignore that. If they don't tap Dean for at least one of these positions, there is something seriously wrong with the way this administration is going about its business. This would bring things to the point where I would begin to question if they actually want to affect change or not.

By the way, why is there always room for another Republican in this team of rivals cabinet, but never room for one strong progressive voice we all trust like Howard Dean?

PPI: "US and China: Grappling Over Economic Rescue -- Part II"

US and China: Grappling Over Economic Rescue -- Part II. By Edward Gresser
The two nations must first coordinate stimulus plans, then engage in currency diplomacy
PPI Online, February 2, 2009

WASHINGTON: As the United States bails out banks and shoe-factories close their doors in China, should the two governments worry about exchange rates?

The question arose after Timothy Geithner, new US treasury secretary, suggested in a congressional hearing that China is "manipulating" the value of its currency. China then fired back, echoed by a chorus of financial-gallery alarm over potential trade conflicts. But a reading of Geithner's full comment should dispel fear of a looming trade war over exchange rates: What the US seeks is a coordinated approach to save both economies from sinking.

Geithner's argument was that Chinese currency rates are a topic that both governments need to address, but not the immediate issue. Noting

"We look forward to a productive economic dialogue with the Chinese government on a number of short- and long-tem issues. The Yuan is certainly an important piece of that discussion, but given the crisis the immediate focus needs to be on the broader issue of stabilizing domestic demand in China and the US.... Because China accounts for such a large fraction of the world economy, a further slowdown in China would lead to a substantial fall in world growth (and demand for US exports) and delay recovery from the crisis. Therefore, the immediate goal should be for us to convince China to adopt a more aggressive stimulus package as we do our part to try to pass a stimulus package here at home."

This is the right context. The world needs more balanced growth in the next decade. Change in Chinese currency policy is part of this. But the immediate problem is accelerating economic collapse, which confrontation between America and China could easily worsen. Meanwhile, the immediate reason for currency diplomacy -- the imbalances that can arise from currency misalignments -- is at least for the moment fading as America's imports and deficits shrink. So, though both countries need to address the causes of their illness, they can afford to wait until both patients feel better.

Why, an observer might ask, are currency rates relevant at all?

Fundamentally, currency rates are a way to moderate swings in global growth and trade flows. A high currency value makes exports expensive, imports cheap and can slow growth when inflation threatens. A low currency value helps countries escape from economic slumps through cheaper exports. The currencies of most big economies -- the dollar, the euro, yen and pound -- swing back and forth in this way, traded at rates of $3 trillion per day. China's yuan is the exception, set in a band by government policy.

This is not inherently unworkable. But if the setting does not change with economic conditions, it can lead to big surpluses, deficits and risks. Here, we have one source of the crisis.

Leaving office, Geithner's predecessor Henry Paulson pointed to international imbalances as one of the crisis' causes. He meant that Americans were borrowing and spending too much, and Asia -- China in particular -- was saving too much and spending too little.

This is not a new phenomenon. Americans shop a lot and save little, relying on the worth of home ownership to build wealth. They save 5 or 6 percent of GDP in normal times; Asians by contrast save 20 to 40 percent of GDP, and spend less time in malls. The result is an imbalance, with Americans buying more of what everyone makes and Asians selling more than buying.

These habits have fairly deep roots: Americans have run deficits with Asia not only since the 1970s, but throughout the 19th century and the first half of the 20th century. But the imbalances of this decade grew larger and faster than those of earlier periods. US government policy, through steady tax cuts and low interest rates, drove American savings rates to just above 1 percent of GDP, the lowest figures recorded since 1934. Chinese hyper-savings and low consumption, meanwhile, helped create an anomalously high pool of capital and a steadily growing trade surplus. By 2006, America maintained a current-account deficit -- the balance between spending and receiving trade revenue, investment income, charitable donations and foreign aid -- equivalent to almost 6 percent of American GDP -- an all-time record, and double the deficit of 2001. China's surplus, meanwhile, rose from rough balance in 2003 to a 10 percent of GDP surplus in 2007, with a mirroring increase in American manufacturing-trade deficits. A fixed currency rate for the Chinese RMB, at 8.28 to the dollar from 1994 to 2005, meant currency did not respond to these changing conditions.

Geithner is therefore right to say that the yuan level is an important issue. Nor is he alone -- in the high-growth period of 2004 to 2007, economists at the International Monetary Fund and universities politely protested both Chinese currency policy and America's low savings and tax-cut mania. Nobody in a position to do something did much because solving imbalances is painful. Americans would have to save more, shop less and live modestly. Chinese would need to export less, sell more at home and shift employment from apparently reliable export factories to new sources of prosperity and create domestic demand. Chinese currency did appreciate after 2005, and America's imbalance did begin to shrink, but only by a modest amount and China's surplus continued to grow.

At some point, which nobody can quite predict, a rising imbalance becomes a risk. Both countries are seeing the consequences -- trembling banks in America, shuttering factories in coastal China, and rising unemployment in both countries.

Over time, governments need to set their recovery on a more solid foundation than the one of 2003-2006. This will require a more flexible currency in China that can moderate any returning boom, as well as better regulation and more savings in America.

But as Geithner pointed out, timing is everything. For the moment, imbalances are not the world's big problem. Markets reduce them by force, as demand collapses. With unemployment up, American families no longer go to the mall each Saturday for clothes and TVs. Imports are therefore plunging, from $229 billion in July to $183 billion by November; imports from China fell from about $33 billion to $28 billion. This is the fastest US import drop since the Second World War. As imports fall, America's trade gap shrinks, from an annualized $720 billion in early 2008 to $530 billion by the winter. Across the Pacific, Chinese migrant workers from the coastal industrial zone head home as export orders dry up. China's surplus may accordingly drop.

This collapse in demand is now the big evil governments must meet. Rising imports and imbalances may return, but are not the problem today. A confrontation over these matters would do little to solve the day's big evils, but could make them worse.

Therefore, as Geithner pointed out, currency should not be the immediate concern. Instead the US and Chinese governments need to cooperate, coordinating stimulus policies to give maximum support to demand.

As they restore growth, though, they must find ways to make it balanced growth. Yes, as ordinary people worry about jobs and growth, governments should think about the foreign-exchange markets. But they should act at the right time. Geithner's comment about currency, taken in its full context, implies that the Obama team is thinking along these lines. If so, they suggest the intention to restore health first, then place the prosperity of the 2010s on a stronger foundation than this decade's expansion -- not a bad goal at all.

Edward Gresser is director of the Trade & Global Markets Project with the Progressive Policy Institute.