You can see this in the way administration officials are talking about their approach. President Trump’s National Economic Council director, Gary D. Cohn, has said that banks have too high capital requirements and are being forced to do too much to prepare for failure, and has hinted that future executive orders would target these reforms. He justifies this argument by describing his recent experiences as president of Goldman Sachs. It’s no wonder financial stocks have been soaring since Mr. Trump was elected. Voters who hoped he would “drain the swamp” and upset the elite are in for a big surprise.
There will also be a lot of discussion by the Trump administration about Dodd-Frank failing to end “too big to fail” and about credit drying up for businesses. This is impossible to find in the data. Surveys of small businesses and loan officers don’t find that Dodd-Frank has killed access to credit, and we don’t see it in the aggregate lending data either.
With the help of Dodd-Frank, there’s been significant progress made toward ensuring that a systemically risky financial institution can be wound down. Mr. Trump could have taken actions to push reform further.
It’s clear with his orders that he won’t take that choice.
President Trump’s personal physician recently revealed that the president takes finasteride, a drug used to combat male-pattern baldness. The medication has been in the news for another reason: its potential side effects.
In fact, approximately 1,370 lawsuits have been filed against Merck, which markets finasteride. A class-action lawsuit against the company will examine the pharmaceutical giant’s culpability in the multitude of reported sexual side effects potentially associated with the drug. Merck did not respond to a request for comment.
Merck sells finasteride under the brand name Propecia, a 1-milligram formulation of the medication. It is available as a prescription for treatment of male-pattern hair loss. Its big brother, Proscar, is a 5 mg preparation commonly prescribed for the treatment of symptoms associated with enlarged prostate, or benign prostatic hyperplasia, and has been prescribed to more than 1 million American men since its introduction to the market. Together, finasteride and a closely related compound dutasteride (sold under the brand name Avodart) are a class of drugs called 5-alpha-reductase-inhibitors (5-ARIs) which work by blocking the conversion of testosterone to its more potent form, dihydrotestosterone.
Between Propecia, Proscar and Avodart, 5-ARIs comprise a substantial portion of medications prescribed to men every year. As a urologist, I prescribe or see men who have been prescribed these medications quite often. After all, the drugs have a variety of important uses in older men with enlarged prostates. But in speaking to my patients, I have come to realize how often men are not aware of the potentially life-changing and irreversible side effects that may be associated with these medications.
The constellation of potential symptoms, sometimes referred to as post-finasteride syndrome, may include sexual, physical and psychological changes. Of these, the sexual side effects are perhaps the most extensively reported. In fact, in 2012, the Food and Drug Administration announced a label change for Propecia and Proscar, requiring the manufacturer to warn that the medication may be associated with “libido disorders, ejaculation disorders, and orgasm disorders that continued after discontinuation of the drug.” ...
Earlier this year, a review of 17 randomized controlled trials (including more than 17,000 patients) demonstrated a nearly twofold increase in sexual, ejaculatory and orgasmic dysfunction in young men using Propecia for male pattern hair loss.
At the same time, a recent study demonstrated changes in the levels of certain steroids in cerebrospinal fluid of men taking finasteride for hair loss. These steroids have been shown to influence brain function, and their presence may help explain the profound psychological changes such as depression and suicidality that have been associated with finasteride use.
This research should cause us to think more carefully about this commonly encountered medication. It is perhaps most worrisome because Propecia tends to target younger men, who have a relatively low rate of sexual dysfunction. And the ease with which it is prescribed for purely cosmetic reasons makes the potential risk of side effects even harder to justify.
For those of us in urology, finasteride will inevitably remain an important treatment tool for certain medical conditions. But because recent data suggests that finasteride-associated side effects may persist even after the medication is stopped, the key intervention must consist of both adequately counseling patients on the potential harms of these drugs and of carefully selecting the patients who are best candidates for receiving this medication in the first place.
Whether this medication is safe for individuals holding political office has not been studied.
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