Remdesivir Needs More Trials Before Going All In: MMKCC's Bach

He's a director at the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center in New York City. Dr Box, thanks so much for joining us here. Really fascinating column you have out talking about hospitals and the drug that's getting a lot of i think press and a lot of attention for treatment, which is ROMM depth severe. Give us a sense of kind of how hospitals are viewing this drug, how successful it has proven to be,

and what you think it's future might be. Well, good morning, Thanks so much for having me. The drug it's a drug that works against the COVID virus, has some data us suggesting it helps speed the recovery of COVID patients and we don't really have a lot of other treatments out there. So there's enthusiasm, but right now there's a shortage. The drug costs a tremendous amount of money. It's about

three thou dollars plus per treatment course. It has no data that demonstrates convincingly it saves lives, and uh, the administration has sought to corner the worldwide market for it so hospitals can use it. But with all that optimism, my column focuses on two things. One is the data on remdesiviere is from a different time, even though it's a few months ago. It was studied on older people.

The pandemic has moved to younger people, and it was studied without steroids, deck and me etho zone specifically, which is clearly showing an ability to save lives. And so now we need to understand is remdesiviere have a place here before we proceed to give it to a bunch of people and spend billions of dollars on it. Dr Bach, what can we say categorically and scientifically about round U severe in terms of its relationship with COVID nineteen, We can say that there is one study that shows it

shortens the duration of illness. Uh, and that is about it. That's good news that don't get me wrong. But this is not the panacea. This doesn't turn around the pandemic. This doesn't mean we can get rid of masks or go back to school or anything like that. We need to make these incremental steps. That's how it always works. And so this is not a disparagement of this piece of progress. It's a fair reckoning with just how big these steps typically are, which is not very dr buck.

You know, I'm reading more, and I guess we're all reading more and more stories about hospitals in southern California and Texas and far to being overrun. No more, I see you beds available. It's just it's just a simple replay of what we experienced in the New York metropolitan market back in March and early April. Are you surprised that the hospital system across the country, given what they witnessed in New York metro area, aren't better prepared? No,

I'm not. Part of it is you know, triumph of hope over experience, the optimism that you know, it hasn't happened here, so it won't happen. Uh ever, but it's also these are you know, fixed physical structures. They can't suddenly have four times as many I see you beds. Uh. There are serious limitations to workforce surge. There's not that much supply, there's personal protective equipment. People are scattered across the country, and moving people is difficult. And so no,

I'm not surprised at all. We knew from the beginning that our most limited, our biggest constraint in handling this pandemic was the health care system itself. Was the reason we tried to flatten the curve so we could both get better at treating this and also maintain, if you will, a steady, manageable flow of patients. And we have failed to do that, even though every other Western country has succeeded.

I think because we have foolishly sat around saying, oh, well, we'll get a vaccine soon so we can be casual about this. We've allowed ideology to creep into public health planning. Maybe more creep in, how about trample over And you know, so I'm not surprised by any of this. And these hospitals are I think, you know, pushed to the limit, and they are not designed in almost any cases to

focus purely on the management of one problem. They manage a mix of problems in a ratio where there various constraints hospital beds, staffing, I V. Tubing, Everything is kind of gets them there, but dr bach when it comes to the round us of your problem and the fact that there aren't significant, large scale trials that can tell us exactly what it can and can't do. When it comes to coronavirus, how do you get around the fact that in a pandemic people jump on anything that looks

like it might work. But for a trial to give us any real information, you need one sick person and one other sick person. One gets the treatment, one doesn't. How do you make that kind of moral judgment at a time like this, Well, it's you know, this is the foundation of empirical science, that we take our time, that we don't assume our guesses are right. And this

isn't some fake humility. This is a hard learned humility from having been shown over and over again our guesses were wrong, and so we have to do the studies for exactly the reasons you're suggesting. There's an argument that we shouldn't be doing them. We are in a crisis that is exploding and expanding around us. What we learned today will have impact on ten times, a hundred times, potentially a thousand times as many people down the road. And so that is one element of the moral or

ethical underpinning of research. Another is, frankly, we have a rimmed desevere shortage. So what I'm calling for is let's go do a trial. Let's it will take maybe about two thousand people. We could enroll such a trial, get the patients for it in a matter of days. Unfortunately, because of the number of people coming into hospital, everyone gets decks of methods m which we know saves lives. Half get rammed deseverere hal get placebo or some other control.

We will know in fourteen days and a month whether or not we're out of time. I'm afraid we'll We'll revisit this, Thank you so much. Well. One of the byproducts of this pandemic is it's just kind of exacerbating or highlighting some of the tensions between a lot of nations across the world. And clearly it's a unique time here, and one of the questions is how will the new world order look post pandemic as we think about kind of how the United States may or may not lead

in how your positioning of Europe and so on. So there's no one better to discuss these big, big geopolitical issues in Alan Crawford, Senior editor International Government for Bloomberg News, joins us on the phone from Berlin. Alan, thanks so much for joining us here. You're out with this story a few days ago, A new world order for the coronaviruy era is starting to emerge. Give us a sense

of how you think this new world order may look. Well, I think we all get the feeling that there's something momentous underway, and so I tried to take a step back to take a look at where we are six months and and already there are definite trains that we see that the US and I have to see it from an outsaye perspective, it just looks regardless of the politics,

it just looks as if it's increasingly self obsorbed. I head of going into the nev election, of course, but also with the pandemic, it is having to this this terrible envirus, and it's occupied U as far as the outside world is concerned. But then of course we're seeing China for for reasons of its own that I don't

think are completely understood. It's there are these high frictions with countries from Canada to Australia, to the UK over Hong Kong, and of course with the US as well, and these are all coming together at once, and then Europe is in this kind of strange in between position where it's trying to it there are signs that may

just emerge from this crisis stronger. What will be the decisive moment at which it really becomes obvious that China has already sort of become a bigger figure in world politics than maybe the US and Europe had given it credit for. Well, I mean, if we're looking at the six months ahead, and obvious we um the US elections a huge it's the elephant in the room, if you like. And certainly the the the analysts that I spoke to,

they were somewhat wary about um conflicts ahead. I'm not talking about open conflict, but you know, tensions, more frictions ahead of the November election. But equally, as I said that China is, it's there's all these frictions with other countries middling powers if you like. And I think that the saints is that these countries, like well across the EU, the UK, Assulia, Canada and others, they are being faced

with a very difficult choice. Do they stand up to China or do they basically try and keep their head down. And I think that there's a sense that their decision will actually go a long way towards determining the approach

to China. So it's interesting here We're gonna have you mentioned the election, And let's say, for argument's sake, that the that Vice President Biden wins the election, does the does his Secretary State spend the first one days administration simply on a plane traveling around to all these countries saying that, Okay, those last four years, just forget them. We're going back to businesses as usual. We are your friend,

we will be part of the solution. We will lead you against you know, whether it was a Cold warf thirty or forty years ago to whatever way is we have in the future, I think undoubtedly that would be the case. But for what effect that would have, I'm not sure, because on the one hand, yes, it was

room to improve relations um. On the other then really detensions between for example, European countries and France Germany with the with the Trump administration, then that has really highlighted Europe's m europe dependence on the U S which is as uh, it's obviously it goes back to the same in World War and all of the help that the US has given to Europe and the you know, the how essential the transatlantic relationship is. But really it's highlighted

just this this dependence. And I think that I know that European governments and the EU independently are already taking step to try and to decoupled to some extent, to some limited extent. Alan you know, there's always this talk of clash of civilizations, you know, Henry Kissinger and Neil Ferguson talking about, you know, a new Cold War between the US and China. Those things though, are quite hyperbolic.

Where is there any evidence that there will actually be sort of a breakout of conflict, you know, soft or hard between you know, the bipolar countries in this war. Well, certainly one of the islands that I was speaking to, who sits in Singapore, then he said that, um, that his the greatest concern going forward, and he's talking short to medium term. Is not that there's some kind of open conflict between the US and China, because the government's

obviously realized that that's it would be catastrophic. His concern is more that there is some kind of like basically mistake, some kind of error in in these high presentitive areas such as the South China Sea. Who are you know the US has same two aircraft carriers through recently, uh, And that there's more it's basically an accident that could happen. That's that's what the concerns are and um, certainly among

the analyst community. So Alan, what's the consensus of the European Union and Brexit and what the role the UK may play here in a prose brexit world terms of the world or or well, that's a good question. That's

actually my next story I'm working on. But I mean, the UK is in a difficult position that it's it's really setting out on its own to try and forward its own um, its own path in this increasingly um increasingly attains world at the moment, and so that they are having the DEPARTMN Minister and Domini grab Con Secretary has made it clear that they have difficult choices ahead, and we're seeing that already over Hong Kong, we're seeing

it over Huawei. That's not not unique to the UK, of course, but these are these are decisions which will have potentially very deep ramifications for its relations as an independent country, a middle and power when it's having to deal with the superpowers of of China, but also with the any with either the Trump administration, which strangely and wants a treat deal, or the Biden Biden administration. We don't know what their position would be on on on

post projexit UK and a treat deal. Alan, looking forward to seeing that story. But this particular story you about this this morning in the last couple of days, is fascinating. Out urge everybody to read it. Alan Crawford a senior editor for International Government and Bloomberg News, and his story as a new world order for the coronavirus era is starting to emerge, and it is an interesting question Paul,

to talk about who Joe Biden might pick. You know, in terms of foreign policy, we know already that he has the former CIA deputy director on a potential transition team worthy to become president at some point and you know, it looks like there might be you know, quite a

forceful stance there. So we have a deal today, Analog Devices acquiring Maximum Integrated Products twenty point nine billion dollars or twenty two premium too Maxims closing shares Friday, and it's helping the NASDA lead the gains for the indussees today. Let's bring somebody in who can tell us so all the details about why this deal was done Wood and who is senior technology analyst add Bloomberg Intelligence. We'll just explained to us. First of all, why Analog would want Maximum. Great,

thanks for having me on body. So this is all about scale and trying to broaden Analog devices ship book print. So the competter compete against the larger competitor Texas Instruments over the long term. So actually, Fannie, I should probably let you know. The first thing I do when I see an M and A deal in the news, I go to M A go and I see I type on there and I click click click on the deal. I want to see who the advisors are, who are

the bankers on this deal? And yes, it was be of A Merrill Lynch and Morgan Stanley advising the buyer on the sell side, JP Morgan. So so the big heavyweight investment banks weighing in on this deal. So whould can we look at this deal here? You talk about it scale, we've heard that before. Give us a sense of kind of how the same conductor industry is in terms of consolidation. Is it's still a fragmented industry or redound to just a handful of heavyweights. Well, I mean

it is a bifurcating market. So you you have the heavyweights like Texas Instruments, um. You know, as well as analog devices, you have microchip So you have these larger players, and then you have a bunch of smaller players, specialized chip makers. UM. So to some degree, it's still fairly fragmented. Uh roughly, I would say about forty of the market share go through these heavyweight players and then fragmented on

the on the other side. UM. And the one thing I will tell you is that look like this market has been uh in a phase of consolidation over the last uh five years or so. Um. You know, it took a hiatus for the last couple of years. Now it's finally it seems as if some companies are looking to come back and deal making and and and the analog devices, and Maximum is an example of that. Who didn't we have two D seventy five million dollar cost

synergy announcement. It doesn't seem like a lot of cost synergies. Am I expecting too much from a merged analog Maximum? Sure? So? So, I mean, you know, if you look at the scale of of Maximum, there's there's really not much that you can take out. And if I look at the cost nergy opportunities here, it's on the gross margin side and

then uh, not much on the operating margin side. So on the ghost margin side, you can actually poured over some of the chip capacity over to the analog devices uh FABS and then on on on the the outputing expense side. Um uh Maximum has actually done a very good job a streamlining the organization over the last five years, so they were really running into the bone. There's a little bit that they could take away, but not that

much more. But but even then you are going to still see the overall maximum margins in proved to where analog devices is, which is around So we'll talk to us about the end users here of some of the chips that analog and maxim puts out it's a sense of who their big customers are and what are some of the growth drivers for their part of the chip industry. I wouldn't necessarily that UH call out any particular big

customers similar to someone like an inteler and Nvidio. If anything, these guys have a portfolio of over ten UH you know, ten to twenty thousand ships combined addressing you know, UH, you know, fifteen thousand different customers. It'll go anywhere between maximums exposure into your your Nintendo, UH, your your your Nintendo switch. Apple has exposure to UH some UH Analog

devices as an exposure to some Apple devices. Automotive, they're they're very big on automotive, industrial robotics are very big on UH in that sector, and also data center powered chips and and UH and UH converted chips. So well, they're very broad based from from a customer and industrial perspective. Now, these are two of the biggest semiconductor companies. There are obviously bigger ones, but you know, Analog at forty three billion dollars market cap and you know maximum eighteen nine

billion dollars, Well, who will be next? So even Finny and we have an XP skyworks really really really tough to say. Any Um, you know, I didn't think the Maxim deal would happen now during the pandemic. Uh. You know, I wouldn't be surprised if uh some of the smaller companies,

some of these these smaller these fenders would come into play. Uh. You know, I've I've seen some headlines where someone like a serious Logic that provides chips to the iPhone, or or semd Tech which which provides a wireless chip, wireless chips to the uh to industrial applications, you know. And then there's also you need to think that we need to have a willing buyer as well. I mean, this

is an all stock deal which helps preserve analog devices cash. Uh. The one thing we do have to think about that some of the larger companies, uh maybe in cash preservation mode, so they won't be able to use their cash as much to consumate a large deal like this. Wiginho, thanks so much for joining us helping us break down this deal. Wiginho is a senior tech analyst for Bloomberg Intelligence. He follows all the devices and the chip makers out there,

so we appreciate his opinion. Well, The responses to the economic fallout of this pandemic have been swift and severe here in the United States. First, we had the Federal Reserve really step in and inject tremendous amount of liquidity UH into the marketplace. We've had three rounds of fiscal stimulus coming out of Congress, capped by round three a

couple of months ago, totally three trillion dollars UH. Now pressure is building on a fourth round to come out of Washington, and that is less clear what will be in that and the size and the timing and so on. So to get an update here what it means in the world of Washington and for a broader economy, we welcome Matt Girkin, geopolitical strategist for b c A Research based in Montreal, Quebec. Thanks so much for joining us. Matt. Let's just start off there. Fiscal stimulus round number four.

What do you expect? When do you expect it? Hey, thanks for having me on. Well, I would expect something upward of two trillion US dollars and by the time then it goes for recess on August and the anything much less than that, anything much less than with the House impress past three trillion risks forcing the U S fiscal thrust to pull back, and that's not something that president running for re election would want to have happened.

What makes you think it'll be two chillion. We're seeing one trillion for the next round, and does strike me that there will have to be some kind of accommodation made in Congress? Yeah? Right now, the Senate GOP and actually for several months been saying one trillion. President Trump and some members of his administration have said two trillion, but most recently Mike Pence and one of his ay

implied that maybe he's on the one trillion side. And then the Democrats haven't mentioned we're pushing for a three trillion dollar bills. So Trump's in the middle. But as I say, he's got an election to fight, and he's a big spinder anyway, He's been fiscally propligate, so I think he'll end up on the big end of this h siding with the Democrats. And then I think that the GOP senators are going to have to just get with the program because if they don't, they'll suffer if

Trump suffers. So, Matt, We're we're getting closer and closer to that fall election, which strangely has been on the back burner heres as everyone is focused on the pandemic. What's kind of a thinking in your world as to what perhaps a Biden presidency might mean. What are something

you're takeaways that you're looking at right now? Yeah, Well, the big change that has happened is that the United States is doing this massive stimulus and so if if I'm anywhere close to correct on that stimulus, we could end up with something of six percent of global gop GDP being US physical stimulus. We're looking at the US maybe putting in twenty percent of its own GDP and stimulus. So that's a massive turn, and that's going to power a cyclical rebound as we've seen in over the long run.

That should be the decisive factor kind of regardless of who wins the election. But a Biden administration clearly is going to have a major regulatory shock, reversing the deregulation that Trump did. And that's even if he doesn't win

the Senate. In truth, he's very likely to win the Senate for the Democrats if he does win the White House, and then in that case you could have I think an extraordinary windfall of of of a shift to the left in terms of healthcare, in terms of immigration, in terms of even the tech sector facing a little bit more scrutiny. And then of course you also have, uh,

you have the cyclical reflationary impacts. They are spending more and giving more for people in wages and household uh spending, but then you have this headwind for corporates that have to worry more about taxes and regulations. The only clues we have us to the type of campaign that he's he's you know, running, or the type of presidency that he would he would lead, though Matt is the people that he's already appointed to a potential transition team. We're

not really seeing a whole lot of economic messaging. Where is your evidence to suggest that there will be a hard turn left? Yeah, Biden is a centrist and that's how he won the nomination. He's a He's a sensor left establishment politician, no question about that. But remember that the way that you try to predict the outlook for things like this is not by wildly guessing based on a president's preferences. I mean, President Trump had a preference of a tear up on all Chinese and words, but

he didn't get that. The issue is that the winner of the White House is likely to bring the Senate with them, and when the Senate goes Democratic and you get a full blue sweep, which is certainly what looks likely today if the election were held today, Well, in that environment, the constraint on the Democratic Party is removed, Biden will be pressured by his party to take advantage of a historic situation. And that's remember similar to when

the Obama administration came in. But there's a lot of frustration in the party that there was too much of an attempt to be bi partisan under the Obama administration, so that this is a crisis that really can't go to wait this time around. And I think that's how the party is going to play things. So the filibuster, for instance, very much at risk in the Senate. So, Matt, given that these the Senates, the Republicans in the Senate are at risk, here, are you surprised they haven't broken

ranks with President Trump? Well, I think in some ways they have. I mean, I think in the news flow over the past several months, you've seen a lot more flaking off from the Senators than you had at any previous time and Trump's administration. And that's because the administration is just fundamentally weakened and embattled by a global pandemic and a recession. Trump's handling of those issues. So I

do see some some wobbling within the Senate ranks. But also, of course you're seeing the real divisions that always existed between the establishment Republicans who might want to be more physically hawkish, and President Trump, who's just a big spending populist and wants, especially in this case, to make sure that he gives the economy ajolt ahead of the election.

And that may even be behind that little difference between you know, Trump implying that he wants to go even bigger than the Democrats on stimulus, while Mike Pence's office is maybe implying he wants to be more where Mitch McConnell is at one trillion dollars. But what can we expect to hear from Biden next? I mean, we haven't heard all that much. I guess it's not a there's not a whole lot of advantage to him being out there and uh, you know, making a lot of public statements.

But when when Wally start well in August. You know, we obviously the virus is throwing everyone for a loop on timing. But in August you're supposed to have the party conventions, and the party convention is a time where

he will complete this process. We've seen in recent months of him touching every base in the Democratic Party and its constituency to show everyone in across the nation that he's allied with the Progressive, that he's allied with the different voting groups, um and and ultimately he's gonna want President Barack Obama's backing and other top Democrats backing. So I think he's gonna have to start getting out more

uh later in uh in August. But in the meantime, he is perfectly happy to kind of hide away in his basement or wherever he is and let President Trump attract the attention with often his controversial or unorthodox statements and and take the heat. Well. Yes, indeed, Matt, thank you so interesting to speak with you. And and indeed, as he say, August, it seems quite late. It's I'm

very close to an election. It must be one of the few times that you really have only had a competitor sort of emerge properly a couple of months before. I mean there was there was a little time back where he was. He was out there, but he was pulled back in quite I think it's a strategy, just I think it is. It's nothing but bad news out there. Why getting that news cycle exactly? Matt Garkin is geopolitical strategist to b c A Research. You joined us there

from Montreal in Canada. So that's that'll do it for this two hours of markets produced day tuned. We're following the markets throughout the day here on Bloomberg Radio. Inducas now of one of a quarter percent plus. In fact, thanks for listening to Bloomberg Markets Podcast. You can subscribe and listen to interviews at Apple Podcasts or whatever podcast platform you prefer. I'm Bonnie Quinn. I'm on Twitter at Bonnie Quinn, and I'm Paul Sweeney. I'm on Twitter at

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