Lifesaving Covid Treatments Face Rationing as Virus Surges Again

"At the onset of the coronavirus pandemic in 2020, scarce ventilators and protective equipment faced strict rationing. Today, as the pandemic rages into its third year, another precious category of products is coming under tight controls: treatments to stave off severe Covid-19.

There is a greater menu of Covid pills and infusions now than at any point in the pandemic. The problem is that the supplies of those that work against the Omicron variant are extremely limited.

That has forced state health officials and doctors nationwide into the fraught position of deciding which patients get potentially lifesaving treatments and which don’t. Some people at high risk of severe Covid are being turned away because they are vaccinated.

Some hospitals have run out of certain drugs; others report having only a few dozen treatment courses on hand. Staff are dispensing vitamins in lieu of authorized drugs. Others are scrambling to develop algorithms to decide who gets treatments.

 

The federal government is providing the pill, known as Paxlovid, to states, whose health officials decide where to send the pills and how to advise doctors to use them.

Supplies are already being depleted. New York City, for example, received about 1,300 treatment courses of Paxlovid in late December, which it used up within a week, according to a spokesman for Alto Pharmacy, which is distributing the city’s supply. New York City currently does not have any Paxlovid in stock.

On Tuesday, the U.S. government doubled its order for Paxlovid, though supplies won’t be plentiful until April.

State and local officials say the goal is to get Paxlovid to as many of the most vulnerable people as possible, with a particular focus on those with weakened immune systems or who are unvaccinated.

Unvaccinated people are at far greater risk of hospitalization or death from Covid. But giving them priority access to treatments leaves people feeling “like you are rewarding intransigence,” said Dr. Matthew K. Wynia, the director of the Center for Bioethics and Humanities at the University of Colorado, who has advised the state on how to ration Covid treatments.

Only some states, like Ohio and Nevada, have sent Paxlovid to pharmacies that serve nursing homes, whose residents are especially vulnerable to Covid. Many states, including Virginia, Pennsylvania and Arizona, have sent most or all of their initial Paxlovid supplies to pharmacy chains like Walgreens and Rite Aid.

That was meant to make the pills as widely accessible as possible. But the system rewards patients who have the time, energy and savvy to chase down treatments.

Patrick Creighton, 48, a sports radio host in Katy, Texas, woke up on New Year’s Eve with his throat burning. He was vaccinated but tested positive later that day. Concerned that his diabetes elevated his risk of becoming seriously ill, he decided to seek out Paxlovid, which he had been reading up on.

A telemedicine doctor wrote him a prescription the next day. Now he needed to find a pharmacy with Paxlovid in stock. He said he called 18 pharmacies within driving distance: one Brookshire Brothers, four Krogers, four H-E-Bs, three Walgreens, three CVS stores and three Walmarts. None had the pills.

His 19th call was a winner: A nearby Walmart had Paxlovid in stock. The ordeal still wasn’t over. He was incorrectly told that he might have to pay $500 for the free treatment. Then he had to see a second telemedicine doctor because of a problem with the way his prescription was sent. Then his wife had to make a second trip to Walmart to pick up the pills. But on the evening of Jan. 2, he finally took the first three tablets of the 30-pill regimen.

Mr. Creighton said he worried about patients who aren’t able to navigate the obstacles like he could. “It should be easily obtainable for everybody.”

The GlaxoSmithKline antibody treatment is similarly hard to come by.

At the University of Pittsburgh Medical Center, the staff is now giving out 400 to 800 antibody treatments each week, down from 2,000 to 3,000 before Omicron rendered two of the products useless. Demand has rocketed higher, but the hospital no longer has enough supply.

“It is devastating to tell these patients, ‘Sorry, we can’t do anything for you, we have to save this drug only for our most severely immunocompromised,’” said Erin McCreary, an infectious diseases pharmacist at the hospital.

 

Louis Shantzek, a Miami retiree, tried unsuccessfully to get an antibody infusion last week after he tested positive for the virus. He is 72 and has diabetes and a heart condition — all factors that would normally make him eligible to get an antibody treatment.

Mr. Shantzek’s symptoms included aches, fatigue and a bad cough. When his adult daughter called two nearby hospitals, she was told he couldn’t get an antibody infusion because he had received three doses of a vaccine and was therefore considered at relatively low risk.

“It’s like being told, ‘You’re doing everything you’re supposed to do, but yet we’re not going to help you,’” said Mr. Shantzek, whose symptoms have since eased.

This is not the first time in the pandemic that scarce supplies have forced hospitals and doctors into painful treatment decisions. Early on, an intravenous treatment, remdesivir, became so popular that hospitals had to restrict its use. Supplies of remdesivir have since become more plentiful, but the treatment is primarily used for patients who are already hospitalized with severe Covid.

Drug makers say they are working as fast as possible to produce more treatments.

The federal government did not immediately order supplies of the GlaxoSmithKline antibody when the F.D.A. authorized the treatment’s use last May. At the time, the country had an ample supply of other antibody treatments.

In the fall, the Biden administration ordered about 450,000 doses — the maximum amount that Glaxo could provide since the British company had already committed to fulfill orders from other buyers. (The U.S. government has said it plans to buy a further 600,000 treatment courses.)

Pfizer, meanwhile, developed Paxlovid in less than two years. But it takes up to eight months to produce the pills. Though Pfizer started manufacturing them before it began a major clinical trial of the drug last summer, large quantities are only now starting to become available.

An increasing number of hospitals are imposing restrictions on treatments.

In western Indiana, officials at Sullivan County Community Hospital determined last month that they had to restrict eligibility for antibody infusions, after weeks of receiving far fewer doses than they had ordered. They opted to almost entirely exclude vaccinated people.

“It does make it difficult to have some of those restrictions in place, when maybe it’s your family member that doesn’t meet the requirement, or it’s your neighbor, or your child’s teacher at school,” said Lori Resler, the hospital’s chief nursing officer.

In Texas, doctors and their staff have been calling a long list of pharmacies to see who has Paxlovid in stock before prescribing the treatment, said Dr. Luis Ostrosky, chief of infectious diseases at the University of Texas health system. The idea is to avoid sending patients on a wild-goose chase, since many pharmacies received only 20 Paxlovid treatment courses.

On Monday, Brooks Rizzo, a family nurse practitioner and director of the Sunflower Rural Health Clinic in Ruleville, Miss., arrived to find a line of patients waiting in the icy cold as they sought Covid tests and treatments.

Ms. Rizzo said her clinic had not received any antibody treatments since Dec. 24, and it isn’t among the hospitals that were initially picked to receive supplies of Paxlovid. She said clinic employees resorted to providing vitamins and over-the-counter medicines.

Dr. Shireesha Dhanireddy, an infectious disease specialist at the University of Washington, said she spent last weekend poring over the charts of Covid patients to figure out who should get scarce treatments. The three-hospital system has tens of thousands of patients but only 60 courses of Paxlovid. Those getting the pills include patients on certain types of chemotherapy and those who recently received organ transplants.

At Johns Hopkins University, employees are rushing to develop algorithms to help allocate scarce treatments, said Dr. Kelly Gebo, an infectious diseases and epidemiology specialist. Compounding the scarcity problem, workers are falling ill, making it harder to deliver resource-intensive treatments like monoclonal antibodies.

“It’s demoralizing as health care workers when we can’t deliver optimal care when we have limited resources,” she said."

Ilgalaikės apmokamos atostogos yra galios sustiprinimas perdegimo eroje

 

   „2020 m. pabaigoje Joanna Miller buvo pervargusi, kovojo su pandemijos sukeltu izoliacijos jausmu ir ką tik baigė kraustytis po to, kai aštuonis mėnesius iš eilės klausėsi statybų šalia savo namų biuro.

 

    Ji dvi savaites atostogavo nuo žmogiškųjų išteklių darbo debesų programinės įrangos įmonėje Asana Inc. Tai nepadėjo.

 

    „Kai atėjo laikas grįžti į darbą, supratau, kad vis dar esu tokia išsekusi“, – sakė Oklande, Kalifornijoje, gyvenanti M. Miller.

 

    Užuot prisijungusi prie milijonų žmonių, kurie neseniai paliko savo darbą, 35 metų M. Miller paėmė šešių savaičių ilgalaikes apmokamas stostogas.

 

    Darbuotojai pandemijos laikais beveik dvejus metus skiria daugiau valandų, nei bet kada anksčiau. Daugeliu atvejų jie yra perdegę ir mano, kad ilga pertrauka yra geriausias atokvėpis. Keista, bet kai kurios įmonės sutinka. Darbuotojai, kurie atostogauja, sako, kad grįžta į darbą energingi ir produktyvesni. Vadovai, kurie nerimauja dėl geriausių talentų išlaikymo ir Covid eros įtakos darbuotojų gerovei, mano, kad atostogos skatina lojalumą ir didesnį kūrybiškumą.

 

    Žmogiškųjų išteklių valdymo draugijos duomenimis, ilgalaikės atostogos vis dar nėra populiarios: 2019 m. jas siūlė 5 % įmonių. Organizacija neturi duomenų apie tai, kas atsitiko su privilegija pandemijos metu arba ar žmonės lieka dirbti ilgą laiką po tokių atostogų. Tačiau pastaruoju metu jas pradėjo siūlyti keli aukšto lygio bankai, o mažesnės įmonės taip pat jas išbando. Praėjusių metų pabaigoje „Goldman Sachs Group Inc.“ pradėjo siūlyti šešių savaičių neapmokamas atostogas žmonėms, kurie banke dirba mažiausiai 15 metų, po to, kai 2021 m. pradžioje „Citigroup Inc.“ nusprendė suteikti darbuotojams, turintiems bent penkerių metų darbo stažą iki 12 savaičių pertraukos. „Citigroup“ pranešė, kad pagal programą 200 darbuotojų buvo leista eiti į atostogas.

 

    Juraj Pal, buvęs apklausų programinės įrangos startuolio „Slido“ produkto vadovas, praėjusią žiemą gyveno Niujorke ir nuo pat pirmųjų dienų savo įmonėje praleido šešerius metus. Laikui bėgant, darbas tapo visa jo tapatybe.

 

    „Jei pakviestumėte vakarienės ir paklaustumėte, kas aš esu, kalbėčiau apie kompaniją, o jei paklaustumėte, ar turiu pomėgių, atsakyčiau: „neturiu pomėgių“ ir net jaučiausi gerai. apie tai“, – sakė 28 metų p. Pal.

 

    Kai startuolis buvo reorganizuotas ir vėliau įsigijo Cisco Systems Inc., ponas Pal pradėjo jaustis, kad jis nebetinka šiai kultūrai. Jis baigė pokalbį su tuo metu startuolio generaliniu direktoriumi Peteriu Komorniku, kuris pasiūlė tikrą pertrauką.

 

    „Pirmas mano atsakymas buvo, kad nenorėjau apie tai girdėti“, – sakė p. „Bet koks ilgesnis poilsio laikas kažkaip buvo nesėkmės, netgi silpnumo ženklas.

 

    Jis aptarė tą pasipriešinimą su savo vykdomuoju treneriu, taip pat su žmona ir geriausiu draugu, kurie abu dirbo įmonėje. Praėjusį pavasarį jis sutiko pailsėti kelis mėnesius. Prireikė savaičių, kol jis išjungė smegenis nuo darbo. Po mėnesio jis su žmona išsinuomojo vietą prie Tahoe ežero, kur leisdavo laiką žygiuose su savo šunimi ir dalyvaudavo karjeros ugdymo grupėse.

 

    P. Pal viršininkas pasiūlė jam grįžti į kitą vaidmenį, ką jis ir padarė. Po šešių mėnesių jis nusprendė palikti „Cisco“ ir prisijungti prie bendrovės, kurios programoje dalyvavo pertraukos metu.

 

    „Labiausiai tai svarbu psichinei sveikatai, bent jau man, kad galvočiau apie save ne tik per darbo objektyvą“, – sakė jis apie savo atostogas.

 

    P. Komornikas, dabar vadovaujantis Cisco „Slido“ generaliniam direktoriui, sakė, kad atostogas vertina, kaip vaistus, kuriuos reikia skirti protingai. Pasak jo, vienam sunkiai dirbančiam žmogui gali būti naudinga pertrauka po trejų neįtikėtino darbo metų, o kitam po šešerių metų gali prireikti pertraukos. Kalbant apie J. Palą, J. Komornikas jautė, kad jau seniai laukė pertraukos ir nenorėjo, kad jis jaustųsi kaltas dėl kitų galimybių.

 

    „Iš tikrųjų mes abu buvome labai atviri, kai jis išėjo į atostogas, kad galbūt išvyks“, – sakė J. Komornikas. „Labai svarbu, kad žmonės tai padarytų, nes tik tada, jei jie tai padarys, jie gali būti tikri, ar pasiliks dėl tinkamų priežasčių, ar išvyks dėl tinkamų priežasčių.

 

    Remiantis tyrimus atlikusiu Sabbatical Project, vienas tyrimas, kuriame dalyvavo 50 žmonių, kurie ilgą laiką nedirbo, parodė, kad dauguma apklaustųjų kenčia nuo „funkcinio darboholizmo“. Daugelis pranešė apie neigiamą įvykį, pavyzdžiui, ilgų santykių pabaigą ar šeimos nario mirtį, paskatinusius juos padaryti pertrauką.

 

    Catherine Merritt, „Spool Marketing“ generalinė direktorė Čikagoje, sakė, kad praėjusį rudenį pradėjo siūlyti savo darbuotojams ilgalaikes atostogas, kai pamatė, kad pandemijos sukeltas perdegimas neigiamai veikia jos darbo jėgą. Darbuotojai, įmonėje dirbantys trejus metus, be atostogų laiko gali pasiimti tris apmokamas savaites. Rrittas pasakė.

 

    Anna Binder, „Asana“ žmonių vadovė, teigia, kad norint užtikrinti, kad vieno žmogaus atostogos netaptų našta kitiems, svarbiausia yra paskirstyti darbą komandos nariams ir nustatyti, kokius projektus galima atidėti.

 

    Steve'as Dakinas, „Adobe Inc.“ inžinerijos direktorius, per beveik du dešimtmečius dirbdamas programinės įrangos gamintoju tris kartus atostogavo, kur jų priėmimas yra įsišaknijęs kultūroje.

 

    „Jei nepriimsi, žmonės keistai į tave žiūrės“, – sakė 54 metų ponas Dakinas.

 

    Per pirmąsias dvi atostogas, 2011 ir 2015 m., J. Dakinas leidosi į kelių savaičių keliones per nacionalinius parkus. Jis teigė manantis, kad finansines išlaidas žmonėms už tai, kad jie nedirba, nusveria nauda moralei ir žinių bei įgūdžių sklaida įmonėje.

 

    „Kai tavęs nebebus, visą tavo atliekamą darbą turi kas nors pasiimti“, – sakė jis. „Jūsų vadovas pamatys, oho, šis žmogus tikrai svarbus“.

 

    Per savo paskutinę šešių savaičių pertrauką praėjusį rudenį J. Dakinas perdarė savo namų biurą San Chosė mieste, Kalifornijoje, ir išvyko į Oregoną, Josemičio nacionalinį parką ir Havajus. Pasak jo, visos jo ilgalaikės atostogos padėjo jam įgyti platesnę perspektyvą, kurią sunkiau žvelgti įtemptoje darbo vietoje." [1]

1. Sabbaticals Are A Power Move In Burnout Era
Bindley, Katherine. Wall Street Journal, Eastern edition; New York, N.Y. [New York, N.Y]. 05 Jan 2022: A.9.  

Sabbaticals Are A Power Move In Burnout Era

"Late in 2020 Joanna Miller was overworked, grappling with pandemic-induced feelings of isolation, and had just finished moving after listening to construction near her home office for eight months straight.

She took two weeks off from her job in human resources at the cloud software company Asana Inc. It didn't help.

"When it was time to go back to work, I realized that I was still so exhausted," said Ms. Miller, who lives in Oakland, Calif.

Instead of joining the millions of people who have left their jobs recently, Ms. Miller, 35 years old, took a paid six-week sabbatical.

Workers are putting in more hours than ever nearly two years into the pandemic. They are in many cases burned out and believe a prolonged break is the best respite. Surprisingly, some companies agree. Employees who take sabbaticals say they return to work energized and more productive. Managers who are worried about retaining top talent and how the Covid era is wearing on employees' well-being find sabbaticals engender loyalty and greater creativity.

Sabbaticals still aren't mainstream: 5% of companies offered them in 2019, according to the Society for Human Resource Management. The organization doesn't have data on what's happened to the perk during the pandemic or whether people remain at their jobs long term after taking a sabbatical. But several high-profile banks have recently started to offer them and smaller companies are trying them out as well. Late last year, Goldman Sachs Group Inc. started offering six-week unpaid sabbaticals to people who have been with the bank for at least 15 years, following an early 2021 move by Citigroup Inc. to give employees with at least five years' service up to 12 weeks off. Citigroup said 200 employees have been approved to take sabbaticals under the program.

Juraj Pal, former head of product at the polling-software startup Slido, was living in New York City last winter and had spent six years with his company from its early days. Over time, work had become his entire identity.

"If you invited me for dinner and asked me who I am, I would talk about the company and if you asked me if I had hobbies, I'd say, 'I don't have hobbies' and I'd even feel good about it," said Mr. Pal, 28.

As the startup went through a reorganization and a subsequent acquisition by Cisco Systems Inc., Mr. Pal started to feel he was no longer a good match for the culture. He ended up in a conversation with the startup's CEO at the time, Peter Komornik, who suggested a real break.

"My first response was I didn't want to hear about it," said Mr. Pal. "Any extended time off was somehow a sign of failure, a sign of weakness even."

He worked through that resistance with his executive coach as well as his wife and best friend, both of whom worked at the company. He agreed to take several months off last spring. It took weeks for him to turn off his brain from work. A month in, he and his wife rented a place in Lake Tahoe, where he spent time hiking with his dog and participating in career development groups.

Mr. Pal's boss proposed he come back to a different role, which he did. Six months later he decided to leave Cisco to join a company whose program he had participated in while on his break.

"It's important mostly for mental health, at least it was for me, to think not about myself just through the lens of work," he said of his sabbatical.

Mr. Komornik, now the general manager of Slido under Cisco, said he thinks of sabbaticals as medicine that should be dispensed judiciously. One hard worker might benefit from a break after three years of incredible work, he said, while someone else may not need one after six years. When it came to Mr. Pal, Mr. Komornik felt he was long overdue a break and didn't want him to feel guilty about considering other opportunities.

"We were actually both very open when he went to the sabbatical that he might be leaving," Mr. Komornik said. "It's very important for people to do this because only if they do, then they can be certain if they stay for the right reasons or if they leave, they leave for the right reasons."

One study of 50 people who took extended time off from work found that most of the interview subjects suffered from "functional workaholism," according to the Sabbatical Project, which conducted the research. Many reported a negative event, such as the end of a long relationship or death of a family member, prompted them to take a break.

Catherine Merritt, CEO of Spool Marketing in Chicago, said she started offering her employees sabbaticals this past fall after seeing pandemic-induced burnout take a toll on her workforce. Employees who have been with the company for three years can take three paid weeks off in addition to their vacation time.

Offering longer breaks as a perk to work toward is another way to attract and hang on to top talent, Ms. Merritt said.

Anna Binder, head of people for Asana, says the key to making sure one person's sabbatical doesn't become a burden for others is distributing the work among team members and identifying what projects can be put on hold.

Steve Dakin, a director of engineering with Adobe Inc., has taken three sabbaticals across nearly two decades of working for the software maker, where taking them is ingrained in the culture.

"If you don't take it, people look at you strangely," said Mr. Dakin, 54.

For his first two sabbaticals, in 2011 and 2015, Mr. Dakin took multiweek road trips through national parks. He said he believes the financial costs of paying people to not work for a stretch are outweighed by the benefits to morale and spread of knowledge and skills around the company.

"When you're gone, all the work that you're doing needs to get picked up by somebody," he said. "Your manager gets to see, wow, this person is really important."

During his most recent six-week break last fall, Mr. Dakin redid his home office in San Jose, Calif., and traveled to Oregon, Yosemite National Park and Hawaii. All of his sabbaticals, he said, have helped him gain a broader perspective that's harder to have when he is in the thick of work." [1]

1. Sabbaticals Are A Power Move In Burnout Era
Bindley, Katherine. Wall Street Journal, Eastern edition; New York, N.Y. [New York, N.Y]. 05 Jan 2022: A.9.  

Modeliai ir meistrai

„Siekiant tobulo portfelio

    Andrew W. Lo ir Stephenas R. Foersteris

    (Princetonas, 400 puslapių, 29,95 dolerio)

 

    Finansų rinkos yra nenuspėjamos, linkusios į madas, burbulus ir griūtis. Tai žlugdo akademikus, kurie norėtų, kad akcijų rinka laikytųsi Niutono dėsnių.

 

    Andrew Lo ir Stephenas Foersteris parašė intelektualią šiuolaikinės finansų teorijos istoriją, paremtą interviu su įtakingais akademikais ir mąstančiais praktikais. Jų knygoje dokumentuojamas tobulo portfelio siekis ir parodoma, kaip toli nuo mokslo lieka investavimo praktika.

 

    Svarbiausia ir gerai žinoma teorija, išplaukusi iš akademinių finansų, yra Nobelio premijos laureato Eugene'o Famos veiksmingų rinkų hipotezė, kuri teigia, kad dabar žinoma vertybinio popieriaus kaina yra geriausias šio vertybinio popieriaus vidinės vertės įvertinimas. 

 

P. Fama teigia, kad pastarąjį pusę amžiaus mokslas buvo sutelktas į jo disertacijos iššūkį. "Pažiūrėkite, vaikinai, jūs turite užaugti. Negalite visą gyvenimą skųstis rinkos efektyvumu", – apie kitus ekonomistus sako jis. „Turite sugalvoti ką nors, ką galėtume išbandyti ir atmesti“. P. Fama nemano, kad jokie tyrimai tą ribą neperžengė.

 

    Didžiausias pono Famos teorijos griežtumo įrodymas yra mažo mokesčio pasyviųjų indekso fondų sėkmė – didžiojo Johno Bogle'o, velionio Vanguard įkūrėjo, idėja. Bogle teigė, kad aktyvūs investicijų valdytojai, kaip grupė, privalo turėti jų patiriamų išlaidų sumą mažesnę už rinkos grąžą. 

 

Todėl geriausia investuotojų strategija yra pripažinti veiksmingų rinkų teoriją ir priimti nebrangų, pasyvų investavimą į visas akcijų rinkas.

 

    Duomenys patvirtino Bogle įžvalgas. Charlesas Ellisas, investicinių konsultacijų įmonės Greenwich Associates įkūrėjas ir didelis pasyviųjų indeksų fondų šalininkas, pažymi, kad „per 10 metų 83 procentai aktyvių fondų JAV nesugeba atitikti pasirinktų lyginamųjų indeksų; 40 procentų suklumpa taip smarkiai, kad jų veikla nutraukiama, nepasibaigus 10 metų laikotarpiui“. Kalbant apie investavimą į akcijas, atrodo, kad Elliso išvados patvirtina didelę F. Famos idėją ir didelę Bogle naujovę.

 

    Daugelis šioje knygoje kalbintų mąstytojų pasisako už pigius pasyvius akcijų indeksų fondus, kaip tobulo portfelio pamatą. Tačiau tuo susitarimas baigiasi, knygos „valgyk daržoves“ dalis sustoja ir prasideda linksmybės bei ginčai.

 

    Knygoje švytintis aprašas Billas Sharpe'as, vienas iš kapitalo turto kainų nustatymo modelio (CAPM) pradininkų, teigia, kad yra tiesinis ryšys tarp tikėtinos akcijų grąžos ir jų rizikingumo, matuojant pagal tai, kiek ji skiriasi nuo rinkos. Ponai Lo ir Foersteris sako, kad idėja išlaikė laiko išbandymą. Tačiau ponas Fama tvirtina, kad „pagrindinė CAPM prognozė niekada nepasiteisino. Vidutinės grąžos ir beta versijos santykis visada buvo per daug plokščias“.

 

    Nepaisant šio nuostabiausio šios srities mąstytojo atmetimo, CAPM vis dar užsitarnauja skyrių šioje knygoje ir svarbią vietą daugumoje verslo mokyklų mokymo programų. Atrodo, kad profesoriai niekada nenori paleisti blogo modelio perniek. Akademinės bendruomenės pasipriešinimą modelių atsisakymui geriau įrodo garsusis ilgalaikio kapitalo valdymo, rizikos draudimo fondo, valdomo kelių geriausių finansų akademikų, žlugimas. Apmąstydamas jo sprogimą, žymus profesorius ir LTCM įkūrėjas Robertas Mertonas sakė, kad „buvo padaryta klaidų ir nutiko nenumatytų dalykų... Tačiau krizę paskatino ne modelių klaida“. Kitaip tariant, kalta rinka, o ne modelis.

 

    Finansiniai burbulai yra ypač kebli problema finansų teoretikams. Sunku paaiškinti, kaip Dogecoin, AMC ar Pets.com kaina yra efektyvi bet kuria to žodžio prasme – net jei sunku juos trumpinti, kai atrodo, kad jie yra pervertinti! P. Fama prieštarauja burbulų egzistavimui, teigdamas, kad jei galime juos atpažinti tik žvelgdami atgal, jie tuo metu turėjo būti racionalūs.

 

    Tais pačiais metais kaip ir ponas Fama Nobelio premiją gavęs Robertas Shilleris, garsėjantis savalaikiu interneto ir būsto burbulų konstatavimu, teigia, kad tai akademinis fundamentalizmas, atsisakymas leisti sveikam protui trukdyti gražiam modeliui. . "Pamišę diktatoriai istorijoje – ar jie racionalūs? Man jie atrodo išprotėję. Bet jūs žinote, kad tai poelgis", – sako p. Shilleris. "Yra burbulų". P. Shiller teigia, kad jo cikliškai pakoreguotas kainos ir pelno santykis (CAPE) yra geras būdas nustatyti finansinius burbulus. Pažymėtina, kad P. Shillerio CAPE šiuo metu rodo, kad JAV rinka yra netoli visų laikų aukščiausių vertinimų, ir siūlo perkelti pinigus į pigesnes tarptautines rinkas.

 

    Garsiausia P. Shillerio mintis yra ta, kad rinkos yra labiau nepastovios, nei leidžia efektyvių rinkų teorija. Ši pernelyg didelio nepastovumo problema kelia iššūkį investuotojams, kurie turi įveikti laukinius ir, atrodo, beprasmiškus svyravimus. Parinkčių pradininkas Myronas Scholesas teigia, kad investuotojai turėtų būti sutelkę dėmesį į šią nepastovumo problemą. Jis įspėja apie neigiamą „mažesnę riziką“ ir teigia, kad investuotojai turėtų stengtis sumažinti savo portfelio vertės sumažėjimą nuo didžiausio iki žemiausio lygio ir siekti užfiksuoti „mažesnį pelną“, atsirandantį rinkoms svyruojant atgal. P. Scholesas pasisako už daug aktyvesnį investavimo stilių, nei bet kas kitas knygoje. Jis rekomenduoja reaguoti į rinkos informaciją, esančią pasirinkimo sandorių kainose, ir paskirstyti turtą, kad būtų išvengta didelių skolų ir būtų išnaudota krizės metu. Visų pirma, jis pataria sutelkti dėmesį į galutinį turtą ir sudėtį.

 

    Andrew Lo, pagrindinis šios knygos autorius, yra žinomas dėl savo adaptyvių rinkų hipotezės, teigiančios, kad žmonės reaguoja į unikalią savo gyvenimo patirtį, kad skirtinga patirtis ir skirtingi pomėgiai skatina individus prisitaikyti. Taigi tobulo portfelio nėra, nes jis priklausytų nuo asmenų pageidavimų ir patirties. Net garsiausi pasaulio akademikai, kurie visi žiūrėjo į tuos pačius duomenis ir skaitė tuos pačius straipsnius, neprieina prie tų pačių išvadų. Galbūt tai yra didžiausias iššūkis šioje knygoje pateiktoms nuostabioms akademinėms teorijoms: kad rinkos yra žmogiškos, o žmogaus veiksmai retai atitinka paprastus tiesinius modelius ar matematines lygtis. "Puikus portfelis" pabrėžia šias puikias diskusijas, suteikdamas patrauklių įžvalgų apie žmones, kurie slypi už idėjų, ir iškeldamas svarbius klausimus apie mokslinio požiūrio į investavimą galią ir apribojimus." [1]

1. Models And Mavens
Rasmussen, Daniel. Wall Street Journal, Eastern edition; New York, N.Y. [New York, N.Y]. 05 Jan 2022: A.13.

Models And Mavens

"In Pursuit of the Perfect Portfolio

By Andrew W. Lo and Stephen R. Foerster

(Princeton, 400 pages, $29.95)

Financial markets are unpredictable, prone to fads, bubbles and crashes. This frustrates academics who would prefer that the stock market obey Newtonian laws.

Andrew Lo and Stephen Foerster have written an intellectual history of modern finance theory, built around interviews with influential academics and thoughtful practitioners. Their book documents the quest for the perfect portfolio, and shows how far from a science investing remains.

The most important -- and well-known -- theory to emerge from academic finance is Nobel Prize winner Eugene Fama's efficient-markets hypothesis, which holds that the actual price of a security is the best estimate of its intrinsic value.

Mr. Fama argues that the last half-century of scholarship has been focused on challenging his thesis. "Look guys, you have to grow up. You can't just be complaining about market efficiency all your life," he says of other economists. "You have to come up with something that we can test and reject." Mr. Fama doesn't think any studies have passed that bar.

The greatest proof of the rigor of Mr. Fama's theory lies in the success of low-fee passive index funds, the brainchild of the great John Bogle, the late founder of Vanguard. Bogle argued that, as a group, active investment managers must fall short of the market return by the amount of costs they incur. The best strategy for investors, therefore, is to assume efficient-markets theory holds and embrace low-cost, passive all-stock-market investing.

The data have borne out Bogle's insights. Charles Ellis, founder of investment consulting firm Greenwich Associates and a great advocate of passive index funds, notes that "over 10 years, 83 percent of active funds in the U.S. fail to match their chosen benchmarks; 40 percent stumble so badly that they are terminated before the 10-year period is completed." Insofar as equity investing is concerned, Mr. Ellis's findings seem to vindicate Mr. Fama's big idea and Bogle's big innovation.

Most of the thinkers interviewed in this book argue in favor of low-cost passive equity index funds as the foundation of the perfect portfolio. Yet that's where agreement ends, the eat-your-vegetables portion of the book stops, and the fun and controversy begin.

The book glowingly profiles Bill Sharpe, one of the originators of the capital asset pricing model (CAPM), which argues that there is a linear relationship between a stock's expected return and its riskiness, as measured by how much it varies relative to the market. Messrs. Lo and Foerster say the idea has stood the test of time. Yet Mr. Fama chimes in to claim that "the central prediction of the CAPM just has never worked. The relation between average return and beta has always been too flat."

Despite this repudiation by the most brilliant thinker in the field, the CAPM still earns a chapter in this book and a prominent place in most business-school curricula. Professors, it seems, never want to let a bad model go to waste. Academia's resistance to abandoning models is nowhere better evidenced than in the famous collapse of Long-Term Capital Management, a hedge fund run by several of the most brilliant finance academics. Reflecting on its blowup, the distinguished professor and co-founder of LTCM Robert Merton said that "errors were made and unforeseeable things happened . . . But the crisis was not precipitated by an error in the models." In other words, it's the market's fault, not the model's.

Financial bubbles are a particularly thorny problem for finance theorists. It's hard to explain how the price of Dogecoin or AMC or Pets.com is efficient in any sense of the word -- even if it's also difficult to short them when they seem overvalued! Mr. Fama argues against the existence of bubbles, claiming that if we can only identify them in hindsight they must have been rational at the time.

Robert Shiller, who won the Nobel Prize the same year as Mr. Fama, and is famous for calling both the internet and the housing bubbles, argues that this is academic fundamentalism, a refusal to let common sense get in the way of a beautiful model. "Crazy dictators in history -- are they rational? They look crazy to me. But, you know it's an act," says Mr. Shiller. "There are bubbles." Mr. Shiller argues that his cyclically adjusted price-to-earnings ratio (CAPE) is a good method for identifying financial bubbles. Notably, Mr. Shiller's CAPE currently indicates that the U.S. market is near all-time highs on valuations, and suggests shifting money to cheaper international markets.

Mr. Shiller's most famous idea is that markets are more volatile than efficient-markets theory allows. This excess-volatility problem poses a challenge for investors, who have to navigate wild and seemingly nonsensical fluctuations. The options pioneer Myron Scholes argues that investors should be razor-focused on this volatility problem. He warns of downside "tail risks" and argues that investors should try to reduce the peak-to-trough drawdowns in their portfolio value and seek to capture the "tail gains" that result when markets swing back. Mr. Scholes advocates for a much more active investing style than anyone else in the book. He recommends reacting to the market information contained in options prices, and using asset allocation to avoid big drawdowns and capitalize in times of crisis. Above all else, he advises, focus on terminal wealth and compounding.

Andrew Lo, the lead author of this book, is known for his adaptive-markets hypothesis, which says that people respond to the unique experiences of their lives, that different experiences and different preferences lead individuals to adapt. There is, then, no perfect portfolio, because it would depend on the preferences and experiences of individuals. Not even the world's most famous academics, who have all looked at the same data and read the same papers, come to the same conclusions. Perhaps that is the greatest challenge to the brilliant academic theories presented in this book: that markets are human, and human action rarely accords with simple linear models or mathematical equations. "The Perfect Portfolio" highlights these great debates, providing fascinating insights into the people behind the ideas and raising important questions about the power and limitations of a scientific approach to investing." [1]

1. Models And Mavens
Rasmussen, Daniel. Wall Street Journal, Eastern edition; New York, N.Y. [New York, N.Y]. 05 Jan 2022: A.13.