JustCare

Tag: Pharmaceutical companies

  • Trump vows to lower Medicare drug costs but backs lawsuit that would raise them

    Trump vows to lower Medicare drug costs but backs lawsuit that would raise them

    President Trump has been unsuccessful at keeping pharmaceutical companies from raising prices, let alone enacting policies that lower them. So, he’s now claiming he is going to give $200 to millions of people with Medicare to help pay for the cost of their drugs. Even if he succeeds at this cockamamie plan, he is backing a challenge to the Affordable Care Act that would raise drug prices for people with Medicare considerably.

    To be clear, it’s not at all likely that this whacky idea has legs or would offer meaningful help. Trump is talking about giving away $200 “Trump cards” in order to try to get older Americans to support his candidacy for re-election. It’s his latest attempt to show he cares about them. But, his actions speak louder than his words, and his actions hurt older adults substantially.

    President Trump probably would need to take money from the Medicare Trust Fund to pay the $6.6 billion cost of this discount card idea. His authority to do so is questionable at best. He wants to use the Medicare waiver program, which requires that money spent on a new health care “innovation” come from health care savings. Trump claims savings from a proposed executive order to test pricing drugs for people with Medicare at the average of what other countries pay. Since that order is far from being implemented and will likely be challenged by the pharmaceutical industry, there are no savings.

    Pharma has no idea what Trump is trying to do. And, even Pharma does not believe these $200 Trump discount cards will be of much help to older people in getting their medicines. The biggest winner would likely be the pharmaceutical companies, as many older adults would use the cards to fill prescriptions they might otherwise leave unfilled. 

    And, if the Supreme Court strikes down the Affordable Care Act, as President Trump would like, older adults with Medicare Part D will be big losers. Their drug costs would rise significantly.

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  • President Trump’s executive order won’t lower drug prices

    President Trump’s executive order won’t lower drug prices

    President Trump finally issued his fourth prescription drug executive order, related to pricing drugs at the average of what other wealthy countries pay. Much like his first three executive orders, it does precious little. While it appears to take on high drug costs, the executive order language is so weak that it is not likely to lower drug prices.

    First, President Trump’s executive order only applies to the 20 percent of the population with Medicare. It does not apply to working people or children. Even for people with Medicare, the executive order includes language that allows for extreme delay in implementation, if in fact it will ever come to pass.

    While the executive order applies to drugs administered in a physician’s office as well as those purchased at a pharmacy, it targets a small number of drugs. It only applies to “some high-cost drugs and biological products.” Moreover, the executive order is only to “test” the value of pricing these drugs at a price similar to other wealthy countries.

    The executive order does not try to regulate the price of drugs developed with federal research or funding. In short, President Trump has not acted to lower or even freeze prescription drug prices, although he has promised to do so. And, he has said nothing about pharmaceutical company drug price hikes, which are happening.

    For example, Noam Levy reports for the LA times that AstraZeneca has exercised its monopoly pricing power to hike up its prices dramatically this year. AstraZeneca’s drug prices have risen far faster than inflation, up as much as six percent when inflation is at about one percent. At the same time, it has benefited from $1.2 billion in taxpayer dollars to develop a COVID-19 vaccine.

    AstraZeneca is not alone. Many other pharmaceutical companies have raised the prices of some of their best-selling drugs far more than inflation. AbbVie raised the price of Humira by 7.4 percent, along with the price of other drugs. GlaxoSmithKline also raised some drug prices significantly.

    The leaders of other wealthy nations ensure medicines are affordable for everyone by negotiating prescription drug prices. President Trump has not even required the pharmaceutical companies that received hundreds of millions of taxpayer dollar to develop a COVID-19 vaccine to commit to charging a fair price for their vaccine. How many millions of Americans will end up without a vaccine and remain at high risk for getting COVID-19 because of the vaccine’s cost?

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  • Novartis, Sanofi and Pfizer engaged in illegal kickbacks and bribery

    Novartis, Sanofi and Pfizer engaged in illegal kickbacks and bribery

    There’s a long history of pharmaceutical companies engaged in bribery and other illegal activities. The pharmaceutical industry routinely puts its interests before the public health every way it can. In the last week, Novartis, Sanofi and Pfizer have been called out for engaging in illegal kickbacks and bribery.

    Stat News reports that Sanofi is paying nearly $12 million for violating the Anti-Kickback Statute, in this case, paying kickbacks to people with Medicare through charitable donations. Older adults and people with disabilities using Lemtrada to treat multiple sclerosis received the money to cover their copays. In addition to Sanofi, Johnson and Johnson, Amgen, Pfizer, Biogen and Novartis have settled similar lawsuits.

    The federal Anti-Kickback Statute forbids pharmaceutical companies from paying money to people with Medicare and others in federal programs to use their medicines. Sanofi refused to admit guilt, claiming it was simply supporting charitable organizations.

    Stat News reports that Novartis is paying $678 million to settle charges of illegal kickbacks to doctors in the US in the form of high honoraria for prescribing large amounts of its drugs. Novartis held more than 80,000 sham events since 2011. According to an FBI official, Novartis also bribed doctors to prescribe more of its drugs.

    Stat News also reports that Novartis is paying $345 million to the Securities and Exchange Commission and the US Department of Justice to settle a federal criminal case. The government had charged Novartis with bribing doctors, hospitals and clinics in South Korea, Vietnam and Greece to prescribe its prescription drugs, in violation of the Foreign Corrupt Practices Act. The health care providers allegedly cooked their books in order to hide the bribes.

    If this weren’t bad enough, Novartis also allegedly inappropriately conducted clinical trials in an effort to better market its drugs. An audit found no compelling scientific reason for the trials. Novartis paid health care providers who prescribed its drugs to attend conferences around the world.

    High level Novartis executives were implicated. They appear to be getting off scot-free.

    Meanwhile, Pfizer has brought a lawsuit that challenges the legality of laws that prohibit it from paying Medicare Part D drug copays for people with a severe heart condition. It says it wants to help people pay for tafamidis which is prescribed to treat the heart condition and costs $225,000 a year.  Of course, the easiest way to help patients would be to lower the cost of the drug.

    Instead, Pfizer wants either to pay copays directly or to pay copays through charities. But, the underlying motive is to boost sales for the very expensive drug, while keeping the drug price high. And, the Office of the Inspector General treats such activities as fraud.

    Pfizer’s argument is that there is no other drug for this condition. So, it cannot be engaged in illegal steering for this drug. It further claims that it is unconstitutional, violating the equal protection clause and the first amendment, to bar the company from supporting charitable organizations. People with Medicare not poor enough to qualify for Medicaid or other federal programs to cover the cost of the drug and not wealthy enough to pay for the drug’s out-of-pocket costs themselves are hurt.

    Senator Sheldon Whitehouse and Senator Elizabeth Warren are leading a charge to fight these pharmaceutical company practices. Drug companies get big tax breaks and profits from their “charitable donations.”  Their drug prices need to be lower.

    Here’s more from Just Care:

  • Coronavirus: Pharmaceutical companies raise prices on COVID-19 drugs

    Coronavirus: Pharmaceutical companies raise prices on COVID-19 drugs

    Between January and June of this year, pharmaceutical companies increased prices on 245 drugs, in a series of price hike similar to price hikes in 2019, according to a new report from Patients for Affordable Drugs. Three out of four of these drugs are related to treatment for COVID-19.

    Pharmaceutical companies raised prices on 61 drugs used to treat COVID-19. They also raised prices on 30 drugs used in clinical trials for treatment of COVID-19. And, they raised prices on 118 drugs that treat chronic conditions.

    The price of certain cancer drugs has increased between $129.93 for Arimidex, used to treat breast cancer, and $3,487.77 for Provenge, used to treat prostate cancer. Other drugs for breast and prostate cancer, as well as for multiple myeloma, have also increased in price significantly in the last six months.

    In addition, the price of Ativan and other drugs for anxiety and depression are up significantly. Increases are between five percent and nine and a half percent.

    Patients are skipping or rationing their medicines because they cannot afford them, even with insurance. In fact, insurance can drive up the price of some drugs. The New York Times reports on two people who got COVID-19 tests at the same time, one with insurance and one without. The one without insurance paid $199. The one with insurance received a bill for $6,408 and was stuck with a copay from her insurer of $928.

    Congress should regulate drug prices, as every other wealthy country does. People in the US should not be paying more for drugs than the Germans or the Japanese. Instead, Congress has allowed pharmaceutical corporations to hike up prices as much as they please. Pharmaceutical corporations have raised the price of many drugs by far more than the rate of inflation and insurers have not stopped them from keeping drug prices high for people with coverage.

    Congress should pass H.R. 3, which passed in the House of Representatives earlier this year. It would give the Secretary of Health and Human Services the right to negotiate the cost of high-priced drugs. The price could not be more than 20 percent above the cost in other wealthy nations.

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  • States charge 26 drugmakers with illegally driving up the price of generic drugs

    States charge 26 drugmakers with illegally driving up the price of generic drugs

    In America, we lock people up when they don’t respond to a bench warrant issued because they failed to pay their medical bills. We deny people health care based on their ability to pay.  But, there’s little chance we will punish the CEOs of 26 pharmaceutical companies if states prevail and the companies are found to have illegally driven up the price of generic drugs.

    Stat News reports that 51 states and territories have charged Pfizer, Novartis, Sandoz, Teva and others with price-fixing, manipulating the market for more than 80 generic drugs. They forced Americans to pay more for their generic drugs. The Connecticut press release explains: “These generic drug manufacturers perpetrated a multibillion-dollar fraud on the American public so systemic that it has touched nearly every single consumer of topical products.”

    It’s no surprise that these pharmaceutical companies chose to put their profits ahead of the public good. That’s what they virtually always do. It will be a surprise, however, if the executives in charge of these companies, some of whom are defendants in the case, face more than a slap on the hand. Eight executives have been sued individually.

    The states’ allegation is of a “vast, systemic conspiracy” among pharmaceutical companies between 2009 and 2016. The pharmaceutical companies deny it. Novartis has already settled one suit regarding price-fixing of generic drugs between 2013 and 2015 for $195 million.

    The US pays two or three times what other wealthy countries pay for drugs because Congress gives drug companies monopoly pricing power, in the form of patents, for brand-name drugs, even when they are variants of drugs long on the market. The generic drug market is supposed to be competitive. But, because of a variety of practices, and alleged price-fixing, generic drug prices are far higher than they should be.

    Insurers are sometimes paid well to keep generic drugs off of their formularies. When a drugmaker or Pharmacy Benefits Manager–a middleman–wants to promote particular brand-name drug alternatives, they offer insurers incentives not to put the generic drugs on their formularies. People then do not have access to lower-cost generics unless they pay cash for them.

    There are so many ways pharmaceutical companies flout the law in order to drive up their profits with impunity, at a huge cost to Americans. Most of their abuses cannot happen in other wealthy countries because prices for drugs are regulated by the government. Why Congress gives pharmaceutical companies in the US license to set prices for brand-name drugs is beyond comprehension.

    The US House of Representatives has passed a bill that would regulate the price of a number of drugs in the US. It’s a start. We need regulation of all drug prices. But, the Republican-led Senate is not considering even the House’s modest attempt to regulate prescription drug prices.

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  • Coronavirus: Real progress towards vaccine, but it still could be 18 months away

    Coronavirus: Real progress towards vaccine, but it still could be 18 months away

    The New York Times reports that the pharmaceutical company, Moderna, has tested a vaccine for COVID-19 on eight people, and it appears to be safe and effective. To establish that it works, however, Moderna will need to test it on thousands more people. Meanwhile Anthony Fauci, the top infectious disease person in the federal government says that, if things happen quickly, it will still take 12 to 18 months before everyone in the country is vaccinated.

    We will need to know a lot more about the Moderna vaccine before it can be made widely available. It could have harmful side effects. It could even make the disease worse. But, early signs suggest that it enabled the eight people who have received the vaccine to develop the same antibodies as are present in people who have had COVID-19.

    Even though Dr. Fauci, the head of the National Institute of Allergy and Infectious Diseases, says it could easily take 18 months before everyone in the US is vaccinated, President Trump is claiming that a vaccine will be available by the end of 2020. His administration will allow pharmaceutical companies to manufacture the vaccine before the FDA has determined it is effective. It is partnering with pharmaceutical companies to find both treatments and vaccines for the novel coronavirus.

    Moderna is just beginning its second phase of trials on 600 people. And, it plans to begin its third phase in July on thousands of people. The Moderna vaccine could be approved by the end of the year, but it will be many more months before it is available to everyone. People will need two shots four weeks apart.

    One pharmaceutical company alone cannot create and manufacture a vaccine for everyone who needs it. We will need several COVID-19 vaccines to ensure everyone is inoculated. Pfizer and AstraZeneca, among others, are currently working on a vaccine as well. As for the vaccine’s cost, no one has yet established a price for a COVID-19 vaccine; it is the subject of much debate.

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  • Drugs with high prices are often no better than lower-cost drugs

    Drugs with high prices are often no better than lower-cost drugs

    The US famously pays far more for medications than other countries, putting stress on the health care system and individual patients who often bear this cost. The pharmaceutical industry often justifies these high prices by claiming that they create the opportunity for more innovation in the drug space, and that lowering prices would diminish the ability of drugmakers to create new and better drugs.

    Given this argument that higher prices leads to better drugs, one would expect that the price of a drug should be correlated with its clinical benefit. It’s common sense–if we are paying more for a certain drug, it should be because it works better.

    Unfortunately that does not appear to be the case, according to two recent studies on drug prices. In The Lancet Oncology, researchers at the University of Zurich analyzed the prices and clinical benefit of 65 cancer drugs approved by both the US Food and Drug Administration and the European Medicines Agency over the past ten years.

    The median monthly treatment costs for these new drugs in the US was $13,200, more than twice as high as in England, Switzerland, Germany, and France. However, they also found that cost of the drugs were not correlated with clinical benefit, according to value frameworks from the American Society of Clinical Oncology and the European Society of Medical Oncology.

    “We have so many drugs on the market and we found that some don’t have the value you’d expect,” said study author Kerstin Vokinger, in STAT News. “The prices of cancer drugs should be better aligned with their clinical importance in order to improve access.”

    It’s not only cancer drugs that are being priced regardless of effectiveness. In a recent piece in Health Affairs blog, Harvard Medical School professors Richard G. Frank, Jerry Avorn, and Aaron S. Kesselheim asked the question, “Are the drugs we approve in the US considered effective according to other countries’ assessments?” They looked at 46 new drugs approved by the FDA in 2017 and compared evaluations of the drugs’ effectiveness using assessments from independent boards in Canada, Germany, and France.

    Of the 27 drugs that were evaluated in these other countries, 17 of these drugs were found to offer little or no added clinical benefit by all of the boards that evaluated them. For 6 drugs, there was not consistent agreement between the different boards about the effectiveness of the drugs. Only 4 drugs were determined to have at least minor added benefit by all of the boards that evaluated them. These drugs were Fasenra for asthma, Dupixent for excema, Imfinzi for urothelial carcinoma, and Rydapt for leukemia.

    The authors noted that many of the drugs found to be not effective when evaluated by international boards are very expensive. Eli Lilly’s breast cancer drug Verzenio was found to have no added benefit in both Germany’s and France’s reviews; the list price of the drug is more than $12,000 a month. Gilead’s Vosevi, a combination drug to treat Hepatitis C, was found to have only minor clinical benefit by one of the international boards–the drug costs $26,000 for 28 pills.

    Figuring out whether a drug is priced “fairly” is tricky, but at the least we should agree that paying thousands more for drugs than other countries without a corresponding clinical benefit is a bad deal.

    This piece was originally published on May 8 on the Lown Institute blog.

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  • Coronavirus: Drug companies uninterested in combating infectious diseases

    Coronavirus: Drug companies uninterested in combating infectious diseases

    As the COVID-19 crisis grows, Big Pharma is trying to position itself as the key to ending this pandemic. But drug corporations have been uninterested in fighting infectious diseases for decades.

    In this blog, we examine pharma’s deep disinterest in combating infectious diseases and why drug corporations are suddenly interested in working toward COVID-19 vaccines and treatments.

    Recent History: A Drop In Pharma R&D

    Drug corporations have substantially decreased their investment into treatments and vaccines for emerging infectious disease over the last decade. From 2010 to 2014, only six new drugs to treat antimicrobial infections were approved. That’s compared to years 1980 to 1984 when 19 new antimicrobial medications were approved. In 2018, only 1 percent of research and development projects were for emerging infectious diseases. In fact, of the twenty companies that spent $2 billion on research and development in the last year, only four have units dedicated to vaccine development.

    The lack of innovation from drug companies to combat infectious diseases was so concerning that last year the United Nations issued a report outlining the global infectious disease crisis we face without more innovation.

    Antibiotics and antivirals treat some of the world’s most deadly conditions, but they typically are only prescribed to patients for short periods, sometimes a couple of weeks or even a few days. They aren’t well suited for blockbuster sales. Instead, manufacturers are more interested in investing in drugs that patients take for long periods of time like cancer and chronic illness treatments.

    A similar trend is true for vaccines, which are essential to ending the COVID-19 crisis. Over the last 50 years, the drug industry’s vaccine research and development pipeline slowed substantially because pharmaceutical manufacturers know the market for vaccines is small compared to chronic illnesses. The very design of vaccines make the markets small as individuals receive vaccines typically once, sometimes two or three times, throughout their lives.

    Why is Pharma interested now?

    So why are pharmaceutical companies suddenly competing to find treatments and vaccines for COVID-19? Because the extent of the crisis and generous government incentives have transformed this pandemic into a business opportunity with minimal risk and tremendous profit potential.

    Profit Potential

    Not until it became clear that the novel coronavirus was highly contagious and spreading rapidly did pharmaceutical corporations direct attention toward developing a vaccine. As the death toll and geographic reach of the virus advanced, the pharmaceutical industry knew that whatever company brought a vaccine to market would be selling a product with dozens of desperate government purchasers and billions of terrified buyers.

    Though social distancing measures can slow the spread, drug companies know that stopping a pandemic of this proportion requires herd immunity — the phenomenon that occurs when a large proportion of a population has developed immunity to a disease. Since COVID-19 is extremely deadly, the safest way to achieve herd immunity is through widespread vaccination. Experts estimate that at least 300 million doses of a vaccine will be needed in the US alone. Even if all of those buyers require the vaccine only once in their lifetime, drug companies will see incredible profits.

    Minimal Risk

    With COVID-19, the US government has eliminated many risks that often dissuade drug companies from vaccine investments. By bankrolling research, sponsoring clinical trials, and eliminating all liability for drug corporations, American taxpayers are heavily subsidizing drug corporations’ search for a COVID-19 vaccine. In our previous blog, we outlined the key role that taxpayer funding is playing in ensuring effective drugs for COVID-19 come to market quickly.

    The truth is the pharmaceutical industry’s top priority isn’t public health; it is out to make the highest possible profit. So it has not directed sufficient resources toward vaccines or treatments for emerging infectious diseases even though a pandemic has been predicted for years.

    In the absence of reasonable pricing that accounts for taxpayer investments, the COVID-19 pandemic may provide an opportunity for drug corporations to turn minimal resources and risk into tremendous profits and leave taxpayers and patients footing the bill.

    [This post was originally published at patientsforaffordabledrugs.org. Ben Wakana is the co-author.]

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  • Trump administration drug proposals will keep prices high

    Trump administration drug proposals will keep prices high

    Nicholas Florko reports for Stat News on minor and arguably risky efforts by the Trump administration to drive competition in the Medicare Part D prescription drug marketplace through the promotion of biosimilars and generic drugs. The administration’s drug proposals will keep prices high. To bring down drug costs, Congress should set prices at the average of what other wealthy countries pay for them.

    One administration proposal would give bonuses to Medicare Part D drug plans if they steered their members towards generic drugs. Right now, drugmakers pay insurers to push their costly drugs, so the insurers tend to do so. Another proposal recommends that insurers create a special low-cost tier in their formularies for lower-cost medicines.

    Promoting the use of generic drugs or biosimilars, which are generic versions of biologicals made from living cells, should not be controversial. They make sense. But, for a host of reasons, patient advocates, pharmaceutical companies, health insurers and pharmacists are pushing back against these proposals. 

    Of course, health insurers should not need to be incentivized to promote generics and biosimilars. But, they are not doing so in many instances where they should be. So, the Centers for Medicare and Medicaid Services (CMS) has proposed that it would factor in the frequency with which Part D insurers have patients taking generics and biosimilars as part of their star-rating, which in turn affects the amount of money CMS pays them.

    One issue is that insurers receive rebates, money back from pharmaceutical companies, when they put certain brand-name drugs on their formularies and promote them. The insurers say that sometimes these rebates make brand-name drugs less costly than generic drugs. So, they argue that pushing generics could drive up costs.

    The pharmaceutical companies argue that biosimilars are not identical to biologics. So, it would be wrong to push the biosimilars in many cases.

    What’s particularly troublesome about the fights over these proposals is that the insurance and pharmaceutical industries seem to win them with the argument that they will drive up costs because pharmaceutical companies will respond with higher prices for drugs. The fact is that any attempt to “save” money can be met with higher brand-name drug prices since Congress has given pharmaceutical companies the power to set prices through the patent system.

    For brand-name drugs, pharmaceutical companies control the price. Insurers will pay an agreed upon high price because they will benefit financially–with a rebate–from the pharmaceutical companies. So long as drugmakers can set the price and insurers can pocket rebate dollars–they can also keep the amount of the rebates secret–there’s no way for the American public to see lower drug prices.

    The simplest and fairest solution in a global marketplace is for the federal government to establish drug prices in the US that are on average what other wealthy countries pay for their drugs. Although President Trump at one point argued that Americans should not be paying higher drug prices than people in other wealthy countries, it appears he has since been swayed otherwise.

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  • Coronavirus: Federal government should reconsider drug research incentives to prioritize public health

    Coronavirus: Federal government should reconsider drug research incentives to prioritize public health

    A new report from Public Citizen lays out the reasons for concern about the new coronavirus and the likelihood of future pandemics. In short, the US does not have a good system in place to develop treatments or vaccinations for these viruses. To address this problem, Public Citizen makes the case for changing the way our government incentivizes research and development so that the public health becomes the chief priority and not corporate profits.

    Over the last 20 years, we have now seen three different instances of coronavirus spreading around the world and causing grave harm to people. We had SARS in 2002, severe acute respiratory syndrome. We had MERS in 2012, Middle East respiratory syndrome. And, we have the novel coronavirus now.

    Government-funded research to develop tests, treatments and vaccines that protect against coronavirus disease is critical. And, the National Institutes of Health has been funding that research since 2002. All in, the NIH has invested more than $684 million in this research.

    But, we still depend on big Pharma for treatments and vaccines to protect against coronavirus disease, even though pharmaceutical companies have not been investing in this research to any significant degree, participating in just six clinical trials. We must stop relying on these for-profit companies to provide us with the treatments we need for novel viruses and infections. Even when they have treatments, we cannot count on pharmaceutical companies to provide them at an affordable price.

    Right now, to encourage pharmaceutical companies to undertake critical research, the US government gives them patent monopolies, allowing them effectively to set prices. The goal is to incentivize them to invest by promising that they will be able to secure a reasonable profit from a successful drug. But, instead, pharmaceutical companies with successful drugs use their monopoly power to drive drug prices sky-high and keep generics from entering the market. Moreover, they market their drugs heavily in cases where other less expensive drugs will provide better treatment.

    Our patent system induces pharmaceutical companies to develop drugs that can earn them the greatest profit–such as cancer drugs–rather than drugs that treat the greatest needs. Cancer drugs now have an annual average price of $149,000. It hardly matters to a pharmaceutical company that its new cancer drug does not deliver a better benefit to patients than other drugs already developed.

    Pharmaceutical companies can make killer profits if they focus on developing drugs to treat chronic conditions, often regardless of their safety or efficacy. A Government Accountability Report shows that the 25 biggest pharmaceutical companies brought in on average twice the profits as the biggest 500 companies!

    Vaccines and antibiotics, in stark contrast, are far less profitable than cancer drugs and drugs for other chronic conditions. One-time cures deliver less revenue than medicines that are taken in perpetuity. Put differently, developing drugs to treat infectious diseases is not a good business model. Consequently, pharmaceutical companies have few in the pipeline.

    In short, we cannot count on the pharmaceutical industry for treatments for infectious diseases and drug-resistant bacteria. So, what is to be done? Without new antibiotics, a U.K. report found that antibiotic-resistant bacteria could kill 10 million people a year by 2050.

    We must stop giving pharmaceutical companies monopoly pricing power on their drugs. The lack of available treatments for the novel coronavirus demonstrates that our research model is broken and that we need a new model. Perhaps the government should be manufacturing drugs as well as paying for research and development. Or, it should be giving licenses to whichever companies want to manufacture a needed drug in order to drive competition.

    We might also consider separating research costs from the prices charged for drugs in order to ensure everyone can benefit from needed drugs—an idea that enjoys support from some on the ideological right and the left.