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The truth behind why Daraprim can cost whatever its CEO wants it to

Five reasons drug companies are getting away with charging a fortune for needed medications.

A greedy, cocksure CEO set off a nation of people tired of mysterious and unchecked drug pricing.

Have you ever suspected that drug manufacturers have been given complete license to charge whatever they want?

You wouldn't be wrong.

Since he got us talking about this, we have to thank Turing Pharmaceuticals CEO Martin Shkreli. He raised the price of the drug Daraprim from $13.50 to $750 per pill.

The justification for the cruel hike?

"It's a more appropriate price."

GIF from CNBC.

What does that even mean? How does a drug manufacturer decide what is an appropriate price?

Well, there are a lot of missed could-be checkpoints in the American health care system that give manufacturers utterly unfettered license to charge whatever they decide.

A quote from The Economist puts into sharp perspective just how ambiguous the process is: "One economist at a closed-door session of pricing experts at [the American Society of Clinical Oncology] dryly remarked that she could find no economic theory to explain how companies price their drugs."

As Jessica Wapner, a researcher and writer on biomedical issues, puts it in her blog: "Drugs cost what the market will bear. It's that simple. Drug prices are set at whatever the market will bear."

Here's why.

Price Gouge License #1: Pharmaceutical companies can advertise directly to Americans, unlike in many other countries.

Image by Pfizer.

In the 1980s, pharmaceutical companies were growing tired of doctors being the gatekeepers between patients and newly available drugs. The first commercial marketed to the general public was in 1986 for Seldane. The profits for Seldane soared beyond anything the marketing team had imagined, and other companies soon followed suit. And in 1997, the FDA further loosened its rules on television ads for prescription medicines, which truly opened the floodgates.

FUN FACT: The only two developed nations that allow this kind of "direct-to-consumer" drug advertising are the United States and New Zealand. It is specifically banned in other countries.

Price Gouge License #2: The pharmaceutical industry has a distinct lack of competition, and in fact is monopolistic by design.

Innovation needs to be rewarded, goes the reasoning. And that point is easy to see. Without some incentive, there are a lot of lifesaving and quality-of-life-changing drugs that would never have been invented.

The good old days. Image via March of Dimes.

But it also stands to reason that innovation can be rewarded at scale and for a finite time, not at ever-increasing margins forever and ever. That's just not sustainable, and it practically begs for some intervening agency to act. As drug companies look for more ways to expand their profits each year — 73% of Americans polled in 2015 already think drug prices are too high — something has to give. Profits can be had, and even attractive ones at that, without carte blanche for the kinds of excesses we're seeing:

"Gleevec, from Novartis, possibly the greatest cancer drug ever invented, cost $24,000 a year when it was introduced in 2001; now it costs $90,000 per year, a quadrupling in price." — "60 Minutes" via Forbes, 2014

FUN FACT: According to a Kaiser Foundation report in 2005, 10 pharmaceutical companies accounted for 60% of U.S. pharmaceutical sales in 2004. It's as if a cluster of multinational corporations have an unwritten understanding that they can just stay in their lanes and get while the getting's good.

Price Gouge License #3: The complicated insurance setup in America gives manufacturers an advantage versus a single-payer situation where prices can be negotiated.

Image via iStock.

Other countries with socialized, single-payer health care systems are able to negotiate prices with drugmakers. Since all the power is collectively concentrated in the one single-paying entity, it forces the drug companies to play nice — or at least act in good faith.

FUN FACT: In 2003, a new act meant to "modernize" Medicare and bring prescription coverage into the mix prohibited Medicare (the largest customer in the American drug industry) from being able to negotiate prices with drug companies.

Price Gouge License #4: There are complex, private pricing strategy sessions that don't get revealed to the public.

We all know what happens when the process of how the sausage gets made never sees the light of day. It can result in some pretty rotten stuff being channeled to consumers.

But Jessica Wapner sheds a little light on what factors come into play in these sessions:

  • How many patients are buying the drug
  • How many are likely to be insured privately or through the government, or are uninsured
  • Length of an average treatment course on the drug
  • How high the stakes are for what the drug treats (desperately needed or only mildly beneficial)
  • How many years the drug will have exclusivity in the market (meaning no generics)
  • Budgeting for patient assistance programs ("If you can't afford your medication, drug company X may be able to help")

That's right. Those drug assistance programs aren't a kindly, out-of-their-own pockets, benevolent gesture. The companies get their money for them — they just tack it on top of what they're already charging.

FUN FACT: There are special forecasting companies that help drug manufacturers evaluate the field and arrive at complex equations regarding prescription prices.

Price Gouge License #5: Many consumers are shielded from the reality of drug prices because of insurance.

That means they keep buying the drug even if their copays go up (making concessions in other parts of their budget as long as they can), which reinforces to the manufacturer that their pricing practices are working. People will just pay it. They will find a way. And though some can't or don't find a way — and sometimes wind up giving up lifesaving drugs out of financial defeat — the sheer numbers don't usually rise to the proportions needed to signal to drug companies that they've made a pricing error.

Because they're still making a profit.

The highest performers in the health technology category in 2015 were Pfizer, Merck, and Johnson & Johnson.

Image via Forbes with permission.

Is there any good news out of all of this?

Yes! Increased attention on drug prices during the last year is culminating in a lot of "we're not gonna take it" talk from politicians and the media. President Obama is attempting to get Medicare negotiation rights for the most expensive drugs.

And I'll say it again: We should thank Martin Shkreli for his severe overreach in pricing Daraprim because it refocused the nation on a huge problem we've all lived with for far too long. I doubt he's very popular with his industry brethren right now — they avoided pitchforks for a long time before he came along. And in response to the public's backlash and, I'm personally betting, pressure from within an industry anxious to avoid intervention, Shkreli did finally say he will reduce the cost.

The pharmaceutical industry is banking on being too difficult to figure out for the average Joe to fight back against. That's why it's important to share this and get people thinking.

The price of drugs, if left unchecked, will eventually debilitate us.

It doesn't have to be this way.

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Pets

Dogs really do have favorite people, and here's how they decide who it will be

Sometimes their favorite people don't live in their house.

Photo credit: Canva

Dogs really do have favorite people. Here's how they decide

When my sister's dog, Junior, was on this side of the Rainbow Bridge, I was one of his favorite people. This dog would get full body wags every time I came around, and we'd spend most of the day cuddled up with each other. Now my dog, Cocolina, behaves in the same way whenever my sister comes to visit. But what goes into a dog deciding who their favorite person is? Spoiler, it's not always the person they live with.

Like humans, animals have their own personalities. You might rescue a dog thinking it will be the perfect companion, only to have the furry adoptee spend every waking moment following your partner around. You could spend hundreds of dollars on vet checkups, new harnesses, treats, and all the squeaky dog toys you can find, but that still won't be enough to convince a dog to love you. Instead of showering the giver of treats with kisses, they make goo-goo eyes at the pet sitter. It turns out they have their reasons.

dogs; dogs favorite; dog's best friend; pets; people and pets; rescue animals Corgi cuddles spreading joy and smiles!Photo credit: Canva

Since our canine friends can't talk, we have to rely on the experts to explain what the deal is with how dogs pick their favorite human. Carol Erickson, a Pennsylvania SPCA animal advocate, gave a brief interview with CBS News Philadelphia to explain her take on how dogs determine their bestest, most favorite person.

"What it comes down to for all dogs is they decide their very favorite family member by who gives the most consistent, high-quality attention, play, and physical affection: ear rubs, scratches, that sort of thing. Dogs get positive associations from being around people who consistently provide positive experiences, including treats, meals, play that they enjoy, and remember also that early association in those first six months can influence who a dog may like better later on," she tells the outlet.

Rover backs up Erickson's claim that the first six months are crucial in determining who will become the dog's favorite person later in life. The website says, "Many dogs bond hardest to whoever cares for them during their key socialization period, which occurs between birth and six months." However, they later note that dogs can still be socialized appropriately even as adults.

The dog-sitting website also explains that it's not uncommon for people who are not the dog's primary caregiver to be their favorite person. Pointing out that physical affection is vital to dogs, if the mailman gives out head scratches daily but the owner doesn't, the mailman may become the dog's favorite person. While physical affection and treats go a long way for some pooches, those aren't the only things that get puppy eyes melting with love.

dogs; dogs favorite; dog's best friend; pets; people and pets; rescue animals Joyful moments with furry friends! 🐶❤️Photo credit: Canva

"While positive experiences play a big role, a dog’s favorite person isn’t always just the one holding the treat bag. Dogs also respond to emotional connection, tone of voice, and even body language. Their preferences are shaped by a mix of familiarity, trust, and how well a person understands their needs," explains Elle Vet Sciences. They later add, "Dogs also take emotional cues from us. If a person is stressed, loud, or inconsistent, a dog may be less likely to form a deep bond with them. On the other hand, someone who offers reassurance and stability often earns the title of 'favorite' without even realizing it."

In short, if you want to be your dog's bestie, being consistent with affection, actions, and even training and grooming will get you there a lot faster than treats alone. Dogs aren't trying to be persnickety; just like humans, they enjoy being around people who show them that they enjoy their company—and maybe some treats.

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Parenting

Want creative and independent kids? A Harvard-trained psychiatrist recommends 'dolphin parenting'

It's a firm yet flexible parenting style.

Images via Canva/martin-dm, Daniel Torobekov

Dolphin parenting is a firm yet flexible parenting style.

People are choosing a number of different parenting styles to raise their kids today. From gentle parenting to FAFO parenting, there are seemingly endless options to choose from.

One parenting style that is geared to instill creativity and independence in kids is called "dolphin parenting." Coined by Harvard-trained psychiatrist Dr. Shimi Kang, the term describes parents who have a more authoritative parenting style.

"Like the body of the dolphin, these parents are firm yet flexible," she writes in Psychology Today. "Dolphin parents have rules and expectations but also value creativity and independence. They are collaborative and use guiding and role modeling to raise their kids."

- YouTube www.youtube.com

Dolphin parents are "adaptable, community-minded and valuing play, a sense of social connection, and the daily tasks of downtime, routine, regular sleep, exercise," says Kang, the author of The Dolphin Parent: A Guide to Raising Healthy, Happy, and Self-Motivated Kids.

She adds that this parenting style benefits kids long into their young adulthood. "When we parent that way, when we bring in that collaborative guiding, firm and flexible dolphin approach, we see young people with better physical/mental health, better self-motivation, better sense of creativity, innovation and problem solving," she says.

As a mother of three, Kang shares that she was raised by a "Dolphin Mom" and became one herself. "She had rules and expectations, including expecting us to do well in academics and be disciplined. But she also valued our autonomy, individual passions and independent choices," she explains in TIME.

According to Kang, there are six pillars of Dolphin Moms:

- Are balanced and collaborative
- Do not overschedule
- Do not over instruct
- Do not over protect
- Create a pod of support
- Adapt

There are two other styles of parenting that Kang has identified: tiger parenting (authoritarian parenting) and jellyfish parenting (permissive parenting). Dolphin parenting falls between these two.

Dolphin parenting's authoritative focus does not shut kids down, though. "With authoritative parenting, the doors of communications are open on either side, giving kids the space to make mistakes and express themselves in a respectful manner," Kang writes in Psychology Today.

dolphin, dolphin parent, dolphin parenting, parenting, parenting style A mother helps her daughter with the computer. Credit: August de Richelieu/Pexels

Kang cites research from the Harvard-based Grant Study of Adult Development to support dolphin parenting.

"It showed that the ability to adapt creatively and 'make lemonade out of lemons' was a key determinant of success," she explains in a post on her website. "In addition, individuals who displayed altruism and a sense of humor during conflict and stress were more likely to be in the top quarter of the 'happy-well' group, and those who scored highest on measurements of 'warm relationships' in childhood earned an average of $141,000 a year more at their peak salaries (usually between ages 55 and 60) than those who scored lowest."

Kang also notes that "other important predictors of being 'happy-well' were important lifestyle factors such as not smoking, little use of alcohol, regular exercise, and maintenance of normal weight."

Simply put, dolphin parenting is another parenting style that just might be the best for raising kids to be healthy, happy, and independent.

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Community

These 4 words can keep a conversation flowing forever no matter how bad you are at small talk

There's literally no way to screw this up.

Credit: Canva

A couple talking over coffee.

Many people find making small talk to be an excruciating experience. They think it’s boring to talk with a stranger about the weather, sports, or weekend plans. They may also feel like they don’t have anything to contribute to the conversation, or they don’t understand the point of having one in the first place.

However, those who excel at making small talk have a tremendous advantage in their professional and romantic relationships, as well as forming new friendships. Most importantly, small talk is a window to transition into medium talk or, eventually, deep, meaningful conversations. The problem is that many people get stuck in small talk, and things stall before progressing to something beneficial.

conversation, friends, small talk, chatting Two women chatting in front of a fire. Credit: Atlantic Ambience/Pexels

How to get better at small talk

The great thing is that, like anything, making small talk is a skill that we can all improve by learning some simple conversation techniques. One technique that is great for keeping a conversation going, like hitting a ball back and forth past a net in tennis, is a simple statement:

"It reminds me of…”

A Redditor recently shared some great examples of how the phrase can be used to turn a mundane topic, such as the weather, into something much more fun:

Them: "It's been really rainy, huh?"

You:

Option 1 (Personal Story): "Yeah, it reminds me of a time I went on a run in the rain and nearly got hit by a car."

Option 2 (Music / Pop Culture): "It reminds me of every Adele song. When I'm driving, I feel like I'm in a music video."

Option 3 (Family): "It reminds me of my dad, he used to love playing with us in the rain as kids."

Option 4 (Thing you watched / World News): "It reminds me of this documentary I saw where they're trying to make it rain in the Sahara Desert.”

Option 5 (Place you lived): “It reminds me of when I lived in Australia, it barely ever rained there. I actually love this weather.”


- YouTube www.youtube.com

You see in this example that using “It reminds me of…” opened up the conversation to five potential new and more exciting topics. The “You” in the story could have responded with, “Yeah, it sure is rainy,” and the conversation would have ended right there. But instead, branching off the topic of rain into something a bit deeper took the conversation to the next level. You get extra points if you can take the “reminds me of” into a topic that you assume the other person will be interested in.

What’s a polite way to change the topic in a conversation?

Using “this reminds me of…” is also a polite way to move the topics in another direction, especially when it's a topic that you don’t want to discuss or one that makes you feel a bit uncomfortable. Or, if it’s a situation where the other person is monologuing on one topic for a very long time, this makes it easy to transition away from their diatribe.

conversation, small talk, chatting, cafe Two guys chat at a cafe. Credit: Helena Lopes/Pexels

Ultimately, the phrase is an excellent way for you to save the person you’re talking to from being stuck in the small talk rut as well. It shows you understand that when someone brings up the weather, they are merely getting things started with something both of you have in common. They probably don’t want to talk about the weather for 30 minutes, unless they are a meteorologist. “It reminds me of…” is an invitation to go a bit deeper and shows the other person that you’d like to learn more about them.

This article originally appeared in April. It has been updated.


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Pets

Veterinarian shares 7 signs a cat loves you, even if it seems like they couldn't care less

What looks like aloof behavior in cats is often a sign of love.

Photo credit: Canva

Cats don't always show their affection in the way we expect.

One of the reasons so many people love dogs is that they usually make their bond with their favorite humans quite clear. Dogs wear their loyalty and affinity on their sleeve, whereas cats are a bit more...aloof.

Sure, some cats are affectionate little cuddle bugs, but many cats seem as if they couldn't care less about anyone, and even the snuggly ones can't be coaxed into affection if they're not into it at the moment. That doesn't mean they aren't feeling or expressing love, though. Some of the behaviors that make cats appear bored or disinterested are actually signs that they like you.

Dr. Sarah Wooten, a small animal veterinarian, shared a list of 7 signs that a cat loves you with Cats.com, and it might make cat owners feel better about their feline friendships.

- YouTube www.youtube.com

1. Slow Blinking

When a cat sits across from you and stares at you with sleepy-looking eyes, blinking slowly, it might seem like they're bored or tired. But those slow blinks are actually how they communicate peace and connection. "If you're seeing that with your cat, they love you," says Dr. Wooten.

2. Lap Sitting

One of our cats loves to sit in our laps, but only with her head facing away from us, which feels a bit impersonal. We'll take it, though, since sitting in our laps is apparently a sign of love.

"Not all cats love a large amount of body contact, petting, and things like that with humans," says Dr. Wooten. "Remember every cat is individual…but if your cat is a touchy-feely cat and loves to be touched by humans, then sitting in your lap for an extended period of time is definitely a sign that your cat loves and trusts you."

cats, pets, signs a cat loves you, kitties, animal behavior Cat sitting in a woman's lapPhoto credit: Canva

3. Present Dropping

If you've never had a cat bring you a dead mouse or the head of a bird or some other disgusting offering, consider yourself lucky. However, if you have, you should also consider yourself lucky, as it means your cat loves you. "Even though to us humans it seems pretty unsavory, to your cat it is a sign of love and dedication," says Wooten. Of course, it's not always dead animals—sometimes cats might bring you inanimate objects they've collected (which makes you doubly lucky).

4. Kneading Biscuits

The rhythmic kneading cats do on blankets, pillows, or their humans is a behavior that mimics what they did while nursing as kittens. "It's just a leftover instinctual thing that they do when they feel super happy and super connected," says Wooten. "So if your cat makes biscuits when they're near you, that is a sign of love and connection."

cats, pets, signs a cat loves you, kitties, animal behavior Cat making biscuitsPhoto credit: Canva

5. Purring

This one might seem like a no-brainer, but purring doesn't always mean affection. Cats purr for many reasons, including happiness or contentment, but also for pain or sickness.

"But if your cat's just hanging out at home and they're near you, and suddenly you hear the motor go on, that's a pretty good sign that they love you," says Wooten.

6. Rubbing or "Bunting"

If a cat comes up and rubs its face or body on you, that's a sign of love and connection. It's called bunting, and essentially, it's how the cat marks you as "theirs."

"Cats have scent markers in their paws, they have them on their face…and they also have them on the base of their tail," says Wooten. "So what cats will often do is they will rub their paws or their face or their tail on the people that they love and consider to be their property."

cats, pets, signs a cat loves you, kitties, animal behavior Who knew yawning and stretching could be a sign of love?Photo credit: Canva

7. Yawning and Stretching

Much like slow blinking, yawning, and stretching may easily be mistaken for sleepiness, but there's often more to it than that. It's a sign that they are comfy around you. "Especially if they're sleeping, if they see you [and] suddenly they get up, maybe they meow at you and then they yawn and they stretch, they get everything all good and feeling good, and then they come hang out with you, it's a sign of love," says Wooten. "That's a sign that they're very comfortable and that they're very happy to see you."

Cats may appear to be standoffish or only affectionate when they feel like it, but it could be that they are showing you they love you in ways that you might not recognize. Cats can be a lot harder to read than dogs, but they really do love us—just not always in the ways we expect.

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Mental Health

The surprising reason why some people are always late and some are always early

And what we can all learn from those who are right on time.

Photo Credit: Canva

A person rushes through the airport. A man looks at a clock.

English writer and theologian William Penn once famously said, "Time is what we want most, but what we use worst." Most likely, he meant that most of us squander the time given to us, as though it’s an endless resource. But, for the sake of this topic, let's also apply it to those of us who simply can't manage time properly.

We all have those friends who are shockingly, chronically late to everything—and those who are always early. (I'm the latter, and it seems to be equally annoying to the people in my life.) The question is why are we this way and how can we learn to co-exist? There are many reasons that contribute to how we manage time, and they of course depend on a variety of individualized factors, but one theory floating around is actually how full or empty we see the proverbial cup.

From an article posted on University of Southern California's School of Psychology site, it all comes down to our bias toward optimism or pessimism. For the late arrivers, it's called the planning fallacy. "Psychologist Daniel Kahneman and colleague Amos Tversky introduced the concept in 1979, defining it as 'the tendency to underestimate the amount of time needed to complete a future task, due in part to the reliance on overly optimistic performance scenarios.'"

In other words, they might feel it will all "flow" as it's supposed to, so there's no need to plan ahead. "Psychologists call this mindset 'optimism bias.' While being optimistic has its benefits, such as an improved state of well-being, getting caught in the constant cycle of optimism bias can cause issues at work that impact productivity."

In a piece for The Decision Lab, author Kira Warje,further explains, "Whether it's building a house, launching a product, or studying for an exam, people tend to create overly optimistic timelines and budgets. This happens because we focus too much on the best-case scenario and ignore relevant historical data or potential setbacks."

She also explains the notion that an outsider would estimate time differently, writing, "Interestingly, the planning fallacy only affects estimations about one’s own task completion times. Outside observers tend to lean in the opposite direction, overestimating the time needed to complete a task."

As for the early-arrivers, we perhaps overestimate the amount of time something will take. Often this is driven by anxiety in general, but to couch it in similar terms, this would be a pessimism bias.

In her article for VegOut Magazine, culinary writer and chef Maya Flores she shares eight traits that people who often arrive early share. One is "They have a physical discomfort with rushing." This, at least for me, is so true. And although early-arrivers often tend to pessimistically assess a situation, we are actively trying to avoid feeling the discomfort that comes with rushing.

rushing, planning, being late, anxiety, travel A person drives frantically. Giphy GIF by HRejterzy

Another trait Flores shares is, "They have a complex relationship with control." This doesn't imply they're "control freaks." Flores writes, "They've identified what's actually within their power (when they leave, how they prepare) and released the rest. That need for control over their own state—their calmness, their preparation, their transition time—remains non-negotiable."

And if one digs even further, there may be deep-seated reasons for it. "Many early arrivers have a story: the time they were devastatingly late for something important, a chaotic childhood where nothing started on time, or a formative experience of keeping someone important waiting. They're not necessarily traumatized, but they've decided: never again."

In the Reddit post "Is anybody else chronically, pathologically EARLY?" there are well over 400 comments, many of whom back up the theory that this began in our formative years. One commenter writes, "My mom was 10 minutes late for everything my entire life, and I’ve been mortified by it for as long as I can remember. It wasn’t a crazy amount of time, but it was for things you just can’t be late to, weddings, doctor’s appointment, jury duty, that kinda thing. I’m always early because of her haha."

clock, time management, being late, being early, planning fallacy A clock does its thing. Giphy GIF by MOODMAN

Another shares, "Same here. I spent so much time experiencing consequences for other people’s lateness or waiting endlessly to be picked up as if the person responsible didn’t know what time things ended, so I have just chosen the opposite. I’m rarely dramatically early, but I can’t be late to things that have a firm start time."

Then there are those who have mastered the art of being "exactly on time." In an article for The Expert Editor, author Lachlan Brown, discusses these folks, who retain traits from both groups. "They possess a heightened sense of responsibility" and "they value structure and routine." If one has these characteristics, without the anxiety that often comes with them (at least for us early birds), they can land somewhere in the coveted middle.


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