For Indians, HDFC Bank is already a household name. Now, the rest of the world is going to take note, too. The three-decade old banking giant will for the first time rank among the world’s most valuable banks after completing a merger with Housing Development Finance Corp (HDFC), the Mumbai-based private sector…

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On the first day of class in the fall of 1924, Martha Lum walked into the Rosedale Consolidated School. The mission-style building had been built three years earlier for white students in Rosedale, Mississippi.

Martha was not a new student. This 9-year-old had attended the public school the previous year. But that was before Congress passed the Immigration Act of 1924, banning immigrants from Asia and inciting ever more anti-Asian racism inside the United States.

At the time, African Americans were fleeing the virulent racism of the Mississippi Delta in the Great Migration north and west. To replace them, white landowners were recruiting Chinese immigrants like Martha’s father, Gong Lum. But instead of picking cotton, many Chinese immigrants, like Gong and his wife, Katherine, opened up grocery stores, usually in Black neighborhoods, after being shut out of white neighborhoods.

At noon recess, Martha had a visitor. The school superintendent notified her that she had to leave the public school her family’s tax dollars supported, because “she was of Chinese descent, and not a member of the white or Caucasian race.” Martha was told she had to go to the district’s all-Black public school, which had older infrastructure and textbooks, comparatively overcrowded classrooms, and lower-paid teachers.

Gong Lum sued, appealing to the Fourteenth Amendment’s equal-protection clause. The case went all the way to the U.S. Supreme Court. All nine justices ruled in favor of school segregation, citing the “separate but equal” doctrine from 1896’s Plessy v. Ferguson decision.

[Imani Perry: Lessons from Black and Chinese relations in the Deep South]

“A child of Chinese blood, born in and a citizen of the United States, is not denied the equal protection of the law by being classed by the state among the colored races who are assigned to public schools separate from those provided for the whites when equal facilities for education are afforded to both classes,” the Court summarized in Gong Lum v. Rice on November 21, 1927.

A century from now, scholars of racism will look back at today’s Supreme Court decision on affirmative action the way we now look back at Gong Lum v. Rice—as a judicial decision based in legal fantasy. Then, the fantasy was that separate facilities for education afforded to the races were equal and that actions to desegregate them were unnecessary, if not harmful. Today, the fantasy is that regular college-admissions metrics are race-neutral and that affirmative action is unnecessary, if not harmful.

The Supreme Court has effectively outlawed affirmative action using two court cases brought on by Students for Fair Admissions (SFFA) against Harvard University and the University of North Carolina at Chapel Hill. Organized by a legal strategist named Edward Blum, SFFA filed suit on behalf of Asian American applicants to Harvard as well as white and Asian applicants to UNC to claim that their equal-protection rights were violated by affirmative action. Asian and white Americans are overrepresented in the student body at selective private and public colleges and universities that are well funded and have high graduation rates, but they are the victims?

This is indicative of a larger fantasy percolating throughout society: that white Americans, who, on average, stand at the more advantageous end of nearly every racial inequity, are the primary victims of racism. This fantasy is fueling the grievance campaigns of Donald Trump and Ron DeSantis. Americans who oppose affirmative action have been misled into believing that the regular admissions metrics are fair for everyone—and that affirmative action is unfair for white and Asian American applicants.

It is a fantasy that race is considered as an admissions factor only through affirmative action. But the Court endorsed SFFA’s call for “race neutral” admissions in higher education—effectively prohibiting a minor admissions metric such as affirmative action, which closes racial inequities in college admissions, while effectively permitting the major admissions metrics that have long led to racial inequities in college admissions. Against all evidence to the contrary, the Court claimed: “Race-neutral policies may thus achieve the same benefits of racial harmony and equality without … affirmative action policies.” The result of the Court’s decision: a normality of racial inequity. Again.

This is what the Court considers to be fair admissions for students, because the judges consider the major admissions metrics to be “race-neutral”—just as a century ago, the Court considered Mississippi public schools to be “separate but equal.”

Chief Justice John Roberts, in his majority opinion, recognized “the inherent folly of that approach” but doesn’t recognize the inherent folly of his “race neutral” approach.

History repeats sometimes without rhyming. “Race neutral” is the new “separate but equal.”

The Court today claimed, “Twenty years have passed since Grutter, with no end to race- based college admissions in sight.” In actuality, twenty years have passed, with no end to racial inequity in sight.

Black, Latino, and Indigenous students continue to be underrepresented at the top 100 selective public universities. After affirmative action was outlawed at public universities in California and Michigan in the 1990s, Black enrollment at the most selective schools dropped roughly 50 percent, in some years approaching early-1970s numbers. This lack of diversity harms both students of color and white students.

In its reply brief in the UNC case, SFFA argued that the University of California system enrolls “more underrepresented minorities today than they did under racial preferences,”  referencing the increase of Latino students at UC campuses from 1997 to 2019. But accounting for the increase in Latino students graduating from high school, those gains should be even larger. There’s a 23-point difference between the percentage of high-school graduates in California who are Latino and the percentage of those enrolled in the UC system.

Declines in racial representation and associated harms extend to graduate and professional programs. The UC system produced more Black and Latino medical doctors than the national average in the two decades before affirmative action was banned, and dropped well below the national average in the two decades after.

[Bertrand Cooper: The failure of affirmative action]

Underrepresentation of Black, Latino, and Indigenous students at the most coveted universities isn’t a new phenomenon, it isn’t a coincidence, and it isn’t because there is something deficient about those students or their parents or their cultures. Admissions metrics both historically and currently value qualities that say more about access to inherited resources and wealth— computers and counselors, coaches and tutors, college preparatory courses and test prep—than they do about students’ potential. And gaping racial inequities persist in access to each of those elements—as gaping as funding for those so-called equal schools in the segregated Mississippi Delta a century ago.

So what about class? Class-based or income-based interventions disproportionately help white students too, because their family’s low income is least likely to extend to their community and schools. Which is to say that low-income white Americans are far and away less likely than low-income Black and Latino Americans to live in densely impoverished neighborhoods and send their kids to poorly resourced public schools. Researchers find that 80 percent of low-income Black people and 75 percent of low-income Latino people reside in low-income communities, which tend to have lesser-resourced schools, compared with less than 50 percent of low-income white people. (Some Asian American ethnic groups are likely to be concentrated in low-income communities, while others are not; the data are not disaggregated to explore this.) Predominately white school districts, on average, receive $23 billion more than those serving the same number of students of color.

When admissions metrics value SAT, ACT, or other standardized-test scores, they predict not success in college or graduate school, but the wealth or income of the parents of the test takers. This affects applicants along racial lines, but in complex ways. Asian Americans, for example, have higher incomes than African Americans on average, but Asian Americans as a group have the highest income inequality of any racial group. So standardized tests advantage more affluent white Americans and Asian ethnic groups such as Chinese and Indian Americans while disadvantaging Black Americans, Latino Americans, Native Americans, and poorer Asian ethnic groups such as Burmese and Hmong Americans. But standardized tests, like these other admissions metrics, are “race neutral”?

Standardized tests mostly favor students with access to score-boosting test prep. A multibillion-dollar test-prep and tutoring industry was built on this widespread understanding. Companies that openly sell their ability to boost students’ scores are concentrated in immigrant and Asian American communities. But some Asian American ethnic groups, having lower incomes, have less access to high-priced test-prep courses.

Besides all of this, the tests themselves have racist origins. Eugenicists introduced standardized tests a century ago in the United States to prove the genetic intellectual superiority of wealthy white Anglo-Saxon men. These “experimental” tests would show “enormously significant racial differences in general intelligence, differences which cannot be wiped out by any scheme of mental culture,” the Stanford University psychologist and eugenicist Lewis Terman wrote in his 1916 book, The Measurement of Intelligence. Another eugenicist, the Princeton University psychologist Carl C. Brigham, created the SAT test in 1926. SAT originally stood for “Scholastic Aptitude Test,” aptitude meaning “natural ability to do something.”

Why are advocates spending millions to expand access to test prep when a more effective and just move is to ban the use of standardized tests in admissions? Such a ban would help not only Black, Native, and Latino students but also low-income white and Asian American students.

Some selective colleges that went test-optional during the pandemic welcomed some of their most racially and economically diverse classes, after receiving more applications than normal from students of color. For many students of color, standardized tests have been a barrier to applying, even before being a barrier to acceptance. Then again, even where colleges and universities, especially post-pandemic, have gone test-optional, we can reasonably assume or suspect that students who submit their scores are viewed more favorably.

When admissions committees at selective institutions value students whose parents and grandparents attended that institution, this legacy metric ends up giving preferential treatment to white applicants. Almost 70 percent of all legacy applicants for the classes of 2014–19 at Harvard were white.

College athletes are mostly white and wealthy—because most collegiate sports require resources to play at a high level. White college athletes make up 70 to 85 percent of athletes in most non-revenue-generating sports (with the only revenue-generating sports usually being men’s basketball and football). And student athletes, even ones who are not gaming the system, receive immense advantages in the admissions process, thus giving white applicants yet another metric by which they are the most likely to receive preferential treatment. Even Harvard explained as part of its defense that athletes had an advantage in admissions over nonathletes, which conferred a much greater advantage to white students over Asian American students than any supposed disadvantage that affirmative action might create. And white students benefit from their relatives being more likely to have the wealth to make major donations to highly selective institutions. And white students benefit from their parents being overrepresented on the faculty and staff at colleges and universities. Relatives of donors and children of college employees normally receive an admissions boost.

Putting this all together, one study found that 43 percent of white students admitted to Harvard were recruited athletes, legacy students, the children of faculty and staff, or on the dean’s interest list (as relatives of donors)—compared with only 16 percent of Black, Latino, and Asian American students. About 75 percent of white admitted students “would have been rejected” if they hadn’t been in those four categories, the study, published by the National Bureau of Economic Research, found.

While private and public universities tout “diversity” recruitment efforts, their standard recruitment strategies concentrate on high-income students who are predominantly white and Asian, at highly resourced schools, positioned to have higher grade point averages and test scores that raise college rankings. Public colleges and universities facing declines in state and federal funding actively recruit white and wealthy out-of-state students who pay higher fees. At many institutions, including a UC campus, “admission by exception,” a practice originally promoted as a means of expanding opportunities for disadvantaged groups, has been used to enroll international students with the resources to pay U.S. tuition fees.

Targeting international students of color to achieve greater diversity on campus disadvantages American students of color. Targeting students from families who can pay exorbitant out-of-state fees benefits white families, who have, on average, 10 times the household net worth of Black families.

Affirmative action attempted to compensate not just for these metrics that give preferential treatment to white students, but also for the legacy of racism in society. This legacy is so deep and wide that affirmative action has rightly been criticized as a superficial, Band-Aid solution. Still, it has been the only admissions policy that pushes against the deep advantages that white Americans receive in the other admissions metrics under the cover of “race neutral.”

[Issa Kohler-Hausmann: No one knows what ‘race neutral’ admissions looks like]

If anti-affirmative-action litigants and judges were really supportive of “race neutrality”—if they were really against “racial preferences”—then they would be going after regular admissions practices. But they are not, because the regular admissions metrics benefit white and wealthy students.

Litigants and judges continue to use Asian Americans as political footballs to maintain these racial preferences for white and wealthy students. Particularly in the Harvard case, SFFA’s Edward Blum used Asian plaintiffs to argue that affirmative action harms Asian American applicants. No evidence of such racist discrimination was found in the lower courts. According to an amicus brief filed by 1,241 social scientists, the so-called race-neutral admissions policy SFFA advocated for (which was just adopted by the highest Court) would actually harm Asian American applicants. It denies Asian American students the ability to express their full self in their applications, including experiences with racism, which can contextualize their academic achievements or struggles and counter racist ideas. This is especially the case with Hmong and Cambodian Americans, who have rates of poverty similar to or higher than those of Black Americans. Pacific Islander Americans have a higher rate of poverty than the average American.

Pitting Asian and Black Americans against each other is an age-old tactic. Martha Lum’s parents didn’t want to send their daughter to a “colored” school, because they knew that more resources could be found in the segregated white schools. Jim Crow in the Mississippi Delta a century ago motivated the Lums to reinforce anti-Black racism—just as some wealthy Asian American families bought into Blum’s argument for “race neutral” admissions to protect their own status. Yet “separate but equal” closed the school door on the Lums. “Race neutral” is doing the same. Which is why 38 Asian American organizations jointly filed an amicus brief to the Supreme Court in support of affirmative action at Harvard and UNC.

A century ago, around the time the Court stated that equal facilities for education were being afforded to both races, Mississippi spent $57.95 per white student compared with $8.86 per Black student in its segregated schools. This racial inequity in funding existed in states across the South: Alabama ($47.28 and $13.32), Florida ($61.29 and $18.58), Georgia ($42.12 and $9.95), North Carolina ($50.26 and $22.34), and South Carolina ($68.76 and $11.27). “Separate but equal” was a legal fantasy, meant to uphold racist efforts to maintain these racial inequities and strike down anti-racist efforts to close them.

Homer Plessy had sued for being kicked off the “whites only” train car in New Orleans in 1892. About four years later, the Court deployed the “separate but equal” doctrine to work around the Fourteenth Amendment’s equal-protection clause to defend the clearly unequal train cars and the exclusion of Black Americans like Plessy from better-equipped “whites only” cars. Later, the Court used the same doctrine to exclude Asian Americans like Martha Lum from better-equipped “whites only” schools.

The “separate but equal” doctrine was the Court’s stamp to defend the structure of racism. Just as Plessy v. Ferguson’s influence reached far beyond the railway industry more than a century ago, the fantasy of “race neutral” alternatives to affirmative action defends racism well beyond higher education. Evoking “race neutrality,” Justice Clarence Thomas recently dissented from the Supreme Court decision upholding a provision in the Voting Rights Act of 1965 that prohibits racist gerrymandering.  

Now that “racial neutrality” is the doctrine of the land, as “separate but equal” was a century ago, we need a new legal movement to expose its fantastical nature. It was nearly a century ago that civil-rights activists in the NAACP and other organizations were gearing up for a legal movement to expose the fantasy of “separate but equal.” In this new legal movement, defenders of affirmative action can no longer use the false framing of affirmative action as “race conscious” and the regular admissions metrics as “race neutral”—a framing that has been used at least since the Regents of the University of California v. Bakke decision in 1978, which limited the use of affirmative action. Racist and anti-racist is a more accurate framing than “race neutral” and “race conscious.”  

[From the September 2021 issue: This is the end of affirmative action]

Affirmative-action policies are anti-racist because they have been proved to reduce racial inequities, while many of the regular admissions metrics are racist because they maintain racial inequities. To frame policies as “race neutral” or “not racist” or “race blind” because they don’t have racial language—or because the policy makers deny a racist intent—is akin to framing Jim Crow’s grandfather clauses and poll taxes and literacy tests as “race neutral” and “not racist,” even as these policies systematically disenfranchised southern Black voters. Then again, the Supreme Court allowed these Jim Crow policies for decades on the basis that they were, to use today’s term, “race neutral.” Then again, voter-suppression policies today that target Black, Latino, and Indigenous voters have been allowed by a Supreme Court that deems them “race neutral.” Jim Crow lives in the guise of “racial neutrality.”

Everyone should know that the regular admission metrics are the racial problem, not affirmative action. Everyone knew that racial separation in New Orleans and later Rosedale, Mississippi, was not merely separation; it was segregation. And segregation, by definition, cannot be equal. Segregationist policies are racist policies. Racial inequities proved that then.

The Court stated in today’s ruling, “By 1950, the inevitable truth of the Fourteenth Amendment had thus begun to reemerge: Separate cannot be equal.” But it still does not want to acknowledge another inevitable truth of the Fourteenth Amendment that has emerged today: Race cannot be neutral.

Today, racial inequities prove that policies proclaimed to be “race neutral” are hardly neutral. Race, by definition, has never been neutral. In a multiracial United States with widespread racial inequities in wealth, health, and higher education, policies are not “race neutral.” Policies either expand or close existing racial inequities in college admissions and employment. The “race neutral” doctrine is upholding racist efforts to maintain racial inequities and striking down anti-racist efforts to close racial inequities.

Race, by definition, has never been blind. Even Justice John Harlan, who proclaimed, “Our Constitution is color-blind” in his dissent of Plessy v. Ferguson, prefaced that with this declaration: “The white race deems itself to be the dominant race in this country” and “it will continue to be for all time, if it remains true to its great heritage.”

In the actual world, the “color-blind” often see their color as superior, as Harlan did. In the actual world, an equal-protection clause in a constitution can be transfigured by legal fantasy yet again to protect racial inequity.

“Separate but equal” then. “Race neutral” now.

Former US president said last week Indian PM Narendra Modi's government should do more to protect Muslims.

Last November, FDA inspectors found almost farcical conditions when they inspected an Indian manufacturing plant that supplies medical drugs to the United States. The plant, owned by Intas Pharmaceuticals, had hardly any working systems for ensuring the purity or sterility of its products. And its employees were trying to conceal evidence of these problems by shredding and hiding documents or, as one quality-control officer admitted, dousing them in acid.

Intas provided America with a lot of frontline chemotherapy drugs—half of the country’s supply in some cases—that are used to treat more than a dozen types of cancer. When the disastrous inspection led the company to halt production, other manufacturers couldn’t make up the difference. Hospitals are now reeling: In a recent survey, 93 percent of U.S. cancer centers said they were experiencing a shortage of the drug carboplatin, while 70 percent were low on another, cisplatin.

Even short delays in cancer treatment can increase a patient’s odds of death, and substitute medications may be less effective or more toxic, if they exist at all. Chemo drugs often run dry—“I can’t think of a year in the past 10 or 12 where we didn’t face some kind of shortage,” Yoram Unguru, a pediatric oncologist at the Herman & Walter Samuelson Children’s Hospital at Sinai, told me—but the current crisis is unprecedented in scale, for reasons that go beyond Intas’s woes. Fourteen cancer drugs are currently scarce, jeopardizing the care of hundreds of thousands of Americans. “I’ve been doing this forever, and this is absolute lunacy,” Patrick Timmins III, a gynecologic oncologist at Women’s Cancer Care Associates, told me.

By delivering drugs at lower doses or over longer intervals, most oncologists are still managing to treat most of their patients—but barely. “Patients often say to us, I just need a plan,” Eleonora Teplinsky, an oncologist at Valley Health System, told me, and the shortages riddle every plan with question marks. Some institutes have already been forced to ration care. Timmins no longer has enough cisplatin and carboplatin to treat patients with recurrent tumors, even though those drugs can improve one’s quality of life or offer decent odds of another remission. “A lot of people are going to be hurt,” he told me. “Lives will be shortened.” Such tragedies are especially galling because the drugs in shortage aren’t expensive, state-of-the-art treatments that patients might struggle to access anyway, but cheap ones that have existed for decades. “It’s just unfathomable that a patient wouldn’t be able to receive them,” Amanda Fader, a gynecologic oncologist at Johns Hopkins, told me.

Intas screwed up, but how could one manufacturer’s downfall trigger such widespread problems? The coronavirus pandemic made plain how reliant the U.S. is on brittle international supply chains, but this much-discussed fragility doesn’t explain the current shortages: Cancer drugs are not scarce for the same reasons that yeast, toilet paper, or couches were. They’re scarce because the market for some of our most important medicines—the ones that should be most accessible—is utterly dysfunctional, in a way that is both very hard to fix but also entirely fixable.

Many recent supply-chain problems were caused by an external force—a pandemic, a hurricane, a stuck ship—that throttled a product’s availability, leading to surging demand and dwindling stocks. But most cancer-drug shortages are caused by internally generated problems, created within the market because of its structure. In other words, “they’re self-inflicted wounds,” Marta Wosińska, a health-care economist at the Brookings Institution, told me.

Generic drugs such as cisplatin are sold at extremely low prices, which overall have fallen by more than 50 percent since 2016. These ever-tightening margins have forced many manufacturers to tap out of the market; for example, the U.S. gets all its vincristine, an anti-leukemia drug, from just one company.

Such drugs are also hard to make. Because they’re injected into the bloodstream, often of severely ill people, they must be manufactured to the highest possible standards, free of microbes and other contaminants. But quality costs money, and generic drugs are so unprofitable that manufacturers can rarely afford to upgrade machinery or train employees. If anything, they’re compelled to cut corners, which makes them vulnerable to spontaneous manufacturing problems or disastrous inspections. And because they usually run at full capacity, any disruption to production has severe consequences. The affected manufacturer might fail to financially recover and leave the market too. Its competitors might struggle to ramp up production without triggering their own cascading shortages. And the drugs, which were never profitable enough to manufacture in surplus, quickly run out.

These principles apply not only to cancer drugs but to generics as a whole, dozens or hundreds of which have been in shortage at any given time for the past decade. The markets that produce them are frail and shrinking. And even when a drug is manufactured by many companies, they might all rely on the same few suppliers for their active pharmaceutical ingredients (APIs)—the chemicals at the core of their medicines. Mariana Socal, a pharmaceutical-market expert at Johns Hopkins, has shown that a third of the APIs in America’s generic-drug supply are made in just two or three (mostly overseas) facilities, and another third are made in just one.

The supply chains that link these chemicals to finished drugs are also frustratingly opaque. Consider fludarabine, one of the cancer drugs that’s currently in shortage. The FDA has approved 12 companies to make it, but only five actually market it; only because of a Senate-committee inquiry is it publically known that of those five, only one makes the drug itself; two others get theirs from Europe, and one of those used to supply the final two. Meanwhile, six facilities are registered to make fludarabine’s API, but it’s again unclear which ones really do, or which manufacturers they supply, or even, for one of them, which country it is in. The fludarabine market is clearly weaker than it first appears, but how weak is hard to gauge. The same goes for cisplatin and carboplatin, Socal told me: She and other experts thought their markets looked resilient, until the Intas shutdown dispelled the illusion.

This opacity masks not only the market’s weaknesses but also its strengths. Erin Fox, a drug-shortage expert at the University of Utah Health, oversees a drug budget of more than $500 million, and would love to spend it on manufacturers that make the most reliable medicines, even if their products cost a little more. But “we just don’t know which products are higher-quality than others,” she told me. The FDA has an internal scoring system that it uses to decide which facilities to inspect, Fox said, but because those data aren’t publicly available, manufacturers can distinguish themselves only through price. “We get a race to the bottom where companies undercut each other to get the lowest price, and then quit either because their manufacturing is so poor, or they can’t afford to make medicines anymore,” Fox said. As Wosińska and Janet Woodcock of the FDA identified in 2013, “The fundamental problem … is the inability of the market to observe and reward quality.”

The average generic-drug shortage lasts for about a year and a half. Many people I spoke with hoped that the current wave could abate more quickly if other manufacturers slowly ramp up. The FDA is also looking to import scarce drugs from international suppliers, and has temporarily allowed a Chinese company to sell its cisplatin in the U.S. But ultimately, “it’s very hard to solve a shortage after it started,” Allen Coukell, of the nonprofit Civica Rx, told me. They need to be prevented from happening at all.

Some commonly suggested preventive measures might not work very well, because they misdiagnose the problem. Politicians often focus on bolstering domestic manufacturing, but Wosińska, Fox, and others told me that many drug shortages have been caused by manufacturing problems in American facilities. Because American drugmakers are subject to the same flawed markets as foreign ones, moving the problem inshore doesn’t actually solve it. Nor does stockpiling generic drugs, though a worthwhile idea. These strategies work well against an external shock like a pandemic, Wosińska said: When faced with unpredictable external forces, it pays to build a large buffer. But because the shocks that cause drug shortages arise from predictable forces inherent to the market, the best bet is to reimagine the market itself—a “very difficult problem but a solvable one,” Stephen Colvill, the executive director and a co-founder of the nonprofit RISCS, told me.

A few new initiatives show how this could be done. Civica Rx, which was launched in 2018, sources generic drugs from manufacturers that it vets for quality; it then builds up rolling six-month inventories of those drugs, which it supplies to hospitals through long-term contracts. (Civica is also building its own generics-manufacturing facility in Virginia.) RISCS, founded in 2019, uses confidential data from manufacturers to rate generic-drug products according to the robustness of their supply chains. The FDA has also been developing its own rating system—the “quality management maturity” (QMM) program—that assesses a manufacturer’s quality-control practices; the program successfully completed two pilots but is still being developed and has no firm launch date, an FDA spokesperson said.

In theory, these initiatives should allow hospitals to make better purchasing decisions, and shift the market toward drug companies that are least likely to be responsible for shortages. In practice, Wosińska thinks that hospitals need to be pulled into such a culture shift. For example, she and her colleague Richard G. Frank argue that Medicare could reward hospitals for proactively choosing reliable vendors or participating in programs like Civica. The FDA could support such a scheme by finally launching its QMM program. Congress could require manufacturers to disclose more details about their products and suppliers, so that supply chains can be fully mapped. HHS could offer loans to generic-drug manufacturers for upgrading or expanding their facilities. The point, Wosińska told me, is to do all of this at once, and shift the market into a new stable state. The solution, she said, needs to be comprehensive.

It also needs to be coordinated. The drug-shortage problem lingers partly because “it’s not obvious who’s responsible for solving it,” Joshua Sharfstein, a health-policy expert at Johns Hopkins, told me. The FDA is a candidate, but economic matters sit outside its wheelhouse. Instead, Sharfstein and others suggest that the drug-shortage problem could be owned by the Administration for Strategic Preparedness and Response. It already works to shore up medical supplies in the event of emergencies such as pandemics or natural disasters, and ongoing shortages of generic drugs are effectively a perpetual state of emergency that we’re trapped in.

Meanwhile, the exact consequences of the shortages are hard to measure. Some of today’s cancer patients will suffer, or even die, because they couldn’t get treated in time, or were given lower doses, or were given more toxic drugs as substitutes. But it’s almost impossible to know if any individual person would have fared better in a world where shortages never happened: If they died, was it because of a few weeks’ delay or because their tumor was always going to be hard to treat? The impact of the shortages can only really be assessed at a population level, and that evidence takes a long time to collect. “I don’t think we’ll see the full downside for many years,” Yoram Unguru told me.

The measures needed to prevent such shortages will also take years to implement—if they ever are. The coronavirus pandemic revealed just how frail our supply chains and health-care system are, but it also showed how quickly attention and resources can disappear once a problem is thought to abate. But the drug problem isn’t abating, and is actually compounding the problems the pandemic created. When health-care workers can’t help their patients, whether because their hospitals are inundated by COVID or because their drugs have run out, the resulting moral distress can be unbearable. Such conditions during the pandemic drove so many health-care workers to quit that “you can feel the system shaking,” Patrick Timmins III said. He worries that this exodus followed by the current drug shortages are “a one-two punch” that will be visible to outsiders only when they have neither the drugs to cure them nor the health-care workers to treat them.

Though the Indian diaspora's presence in Kobe has waned in the past few years, the roots of those who remain stretch back three and four ...

The trip is anticipated to pave the way for a substantial increase in India’s investment in the North African country.

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An expedition to see the remains of the Titanic turned into a tragedy. How did it go so wrong?

First, here are four new stories from The Atlantic:

Why not Whitmer? The ghost of a once era-defining show How the vape shops won Go ahead, try to explain milk.

Lost Contact

The Titan, a submersible vessel carrying passengers to see the ruins of the Titanic, lost contact with its support ship during a dive on Sunday. The ensuing search-and-rescue mission in the Atlantic Ocean covered some 10,000 square miles. This afternoon, OceanGate Expeditions, the tourism and research company running the voyage, announced that it believed that all of the passengers “have sadly been lost.” The U.S. Coast Guard said soon after that debris from the vessel had been found on the ocean floor, about 1,600 feet from the bow of the Titanic.

The search-and-rescue effort had become a race against the clock, as the vessel was believed to have had about four days’ worth of oxygen on board. Five people were on the expedition: Stockton Rush, OceanGate’s chief executive; Hamish Harding, a British businessman and explorer; Paul-Henri Nargeolet, who had traveled to the Titanic site more than 35 times; Shahzada Dawood, a British-Pakistani businessman; and Suleman Dawood, Shahzada’s 19-year-old son. Suleman was a business student in Glasgow.

Over the past week, alarming reports about the vessel have emerged. As my colleague Marina Koren wrote in a story today about the tragic ending to Sunday’s expedition:

Most concerning of all, it is not clear whether the Titan was inspected for safety by outside experts. In 2018, dozens of industry experts warned OceanGate that if the company didn’t put the Titan through an independent safety assessment, its Titanic expeditions could face potentially “catastrophic” problems. Even OceanGate’s own director of marine operations was at the time worried about “the potential dangers to passengers of the Titan as the submersible reached extreme depths,” The New York Times reported this week. At least one previous dive had problems too: According to Pogue, a Titan expedition last year got lost on the seafloor for about five hours.

Although officials don’t know what caused the disaster or what regulations might have prevented it, OceanGate’s leaders have argued in the past that innovation can be at odds with safety regulations. In a 2019 blog post, the company wrote, “Bringing an outside entity up to speed on every innovation before it is put into real-world testing is anathema to rapid innovation.” (OceanGate did not respond to a request for comment about safety concerns regarding the Titan.)

As Marina noted today, the space-tourism industry often draws attention to the safety measures of its craft—at least in public. (What the companies do in private is another story, she reminds us.) But by comparison, “OceanGate’s public approach to safety seems almost cavalier, less like modern-day space tourism and more reminiscent of the rushed and occasionally ramshackle efforts of the space race,” she writes. In the 2018 open letter from industry experts, more than three dozen people, including oceanographers and industry experts, warned that the company’s “experimental” approach “would have serious consequences for everyone in the industry.”

What those consequences might be remains to be seen. At the news conference earlier today, John Mauger, a rear admiral of the U.S. Coast Guard, acknowledged that many questions linger about how, when, and why this happened. “That’s going to be, I’m sure, the focus of future review,” he said. “Right now, we’re focused on documenting the scene.”

Related:

The Titanic sub and the draw of extreme tourism How could this have happened?

Today’s News

Indian Prime Minister Narendra Modi is meeting with President Joe Biden for a state visit to discuss new partnerships between the two countries. The Wall Street Journal reporter Evan Gershkovich, who has been detained by Russian officials on espionage charges that he denies, lost his appeal against pretrial detention. Tropical Storm Bret is nearing the eastern Caribbean, moving at just below the speeds of a Category 1 hurricane.

Dispatches

Up for Debate: Conor Friedersdorf reflects on Joe Rogan, RFK Jr., and the public debates worth having.

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More From The Atlantic

San Antonio, the Spurs, and me Generative AI should not replace thinking at my university.

Culture Break

Listen. Are we just too impatient for baseball? In a new episode of Radio Atlantic, Hanna Rosin and staff writer Mark Leibovich discuss the MLB’s attempt to save the sport.

Watch. The Bear’s second season (streaming on Hulu) is a radical and profound reinvention.

Play. Try out Caleb’s Inferno, our new print-edition puzzle. It starts easy but gets devilishly hard as you descend into its depths.

P.S.

Don’t miss Marina’s piece from earlier this week, also linked above in the “Related” section. Marina, who covers science and space exploration, reflected on the parallels—and differences—between space and deep-sea tourism. “The voyage, as grim as it seems now, is one of many treacherous tourism options for the wealthy,” she wrote.

– Lora

Katherine Hu contributed to this newsletter.

As Joe Biden hosts Indian PM, rights advocates question US president's decision to honour the Hindu nationalist leader.

For nearly two decades, H-1B visa holders have had to exit the US to get their visas renewed—either by returning to their home country or getting it done at US embassy or consulate elsewhere. But the Biden administration could soon allow a small number of H-1B workers to renew those visas in the US itself.

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It's time to reclaim yoga from the Indian PM, who is using it to mask an agenda of ethno-nationalist state violence.