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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.

Images courtesy of Letters of Love
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When Grace Berbig was 7 years old, her mom was diagnosed with leukemia, a cancer of the body’s blood-forming tissues. Being so young, Grace didn’t know what cancer was or why her mother was suddenly living in the hospital. But she did know this: that while her mom was in the hospital, she would always be assured that her family was thinking of her, supporting her and loving her every step of her journey.

Nearly every day, Grace and her two younger sisters would hand-make cards and fill them with drawings and messages of love, which their mother would hang all over the walls of her hospital room. These cherished letters brought immeasurable peace and joy to their mom during her sickness. Sadly, when Grace was just 10 years old, her mother lost her battle with cancer.“

Image courtesy of Letters of Love

Losing my mom put the world in a completely different perspective for me,” Grace says. “I realized that you never know when someone could leave you, so you have to love the people you love with your whole heart, every day.”

Grace’s father was instrumental in helping in the healing process of his daughters. “I distinctly remember my dad constantly reminding my two little sisters, Bella and Sophie, and I that happiness is a choice, and it was now our job to turn this heartbreaking event in our life into something positive.”

When she got to high school, Grace became involved in the Leukemia & Lymphoma Society and a handful of other organizations. But she never felt like she was doing enough.

“I wanted to create an opportunity for people to help beyond donating money, and one that anyone could be a part of, no matter their financial status.”

In October 2018, Grace started Letters of Love, a club at her high school in Long Lake, Minnesota, to emotionally support children battling cancer and other serious illnesses through letter-writing and craft-making.


Image courtesy of Letters of Love

Much to her surprise, more than 100 students showed up for the first club meeting. From then on, Letters of Love grew so fast that during her senior year in high school, Grace had to start a GoFundMe to help cover the cost of card-making materials.

Speaking about her nonprofit today, Grace says, “I can’t find enough words to explain how blessed I feel to have this organization. Beyond the amount of kids and families we are able to support, it allows me to feel so much closer and more connected to my mom.”

Since its inception, Letters of Love has grown to more than 25 clubs with more than 1,000 members providing emotional support to more than 60,000 patients in children’s hospitals around the world. And in the process it has become a full-time job for Grace.

“I do everything from training volunteers and club ambassadors, paying bills, designing merchandise, preparing financial predictions and overviews, applying for grants, to going through each and every card ensuring they are appropriate to send out to hospitals.”

Image courtesy of Letters of Love

In addition to running Letters of Love, Grace and her small team must also contend with the emotions inherent in their line of work.

“There have been many, many tears cried,” she says. “Working to support children who are battling cancer and other serious and sometimes chronic illnesses can absolutely be extremely difficult mentally. I feel so blessed to be an organization that focuses solely on bringing joy to these children, though. We do everything we can to simply put a smile on their face, and ensure they know that they are so loved, so strong, and so supported by people all around the world.”

Image courtesy of Letters of Love

Letters of Love has been particularly instrumental in offering emotional support to children who have been unable to see friends and family due to COVID-19. A video campaign in the summer of 2021 even saw members of the NFL’s Minnesota Vikings and the NHL’s Minnesota Wild offer short videos of hope and encouragement to affected children.

Grace is currently taking a gap year before she starts college so she can focus on growing Letters of Love as well as to work on various related projects, including the publication of a children’s book.

“The goal of the book is to teach children the immense impact that small acts of kindness can have, how to treat their peers who may be diagnosed with disabilities or illness, and how they are never too young to change the world,” she says.

Since she was 10, Grace has kept memories of her mother close to her, as a source of love and inspiration in her life and in the work she does with Letters of Love.

Image courtesy of Grace Berbig

“When I lost my mom, I felt like a section of my heart went with her, so ever since, I have been filling that piece with love and compassion towards others. Her smile and joy were infectious, and I try to mirror that in myself and touch people’s hearts as she did.”

For more information visit Letters of Love.

Please donate to Grace’s GoFundMe and help Letters of Love to expand, publish a children’s book and continue to reach more children in hospitals around the world.

What you look like in a selfie camera isn't really what you look like in real life.

We've all done it: You snap a selfie, look at it, say, "OMG is my nose swollen?" then try again from a different angle. "Wait, now my forehead looks weird. And what's up with my chin?" You keep trying various angles and distances, trying to get a picture that looks like how you remember yourself looking. Whether you finally land on one or not, you walk away from the experience wondering which photo actually looks like the "real" you.

I do this, even as a 40-something-year-old who is quite comfortable with the face I see in the mirror. So, it makes me cringe imagining a tween or teen, who likely take a lot more selfies than I do, questioning their facial features based on those snapshots. When I'm wondering why my facial features look weird in selfies it's because I know my face well enough to know that's not what it looks like. However, when a young person whose face is changing rapidly sees their facial features distorted in a photo, they may come to all kinds of wrong conclusions about what they actually look like.

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Images courtesy of AFutureSuperhero and Friends and Balance Dance Project
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The day was scorching hot, but the weather wasn’t going to stop a Star Wars Stormtrooper from handing out school supplies to a long line of eager children. “You guys don’t have anything illegal back there - any droids or anything?” the Stormtrooper asks, making sure he was safe from enemies before handing over a colorful backpack to a smiling boy.

The man inside the costume is Yuri Williams, founder of AFutureSuperhero And Friends, a Los Angeles nonprofit that uplifts and inspires marginalized people with small acts of kindness.

Yuri’s organization is one of four inaugural grant winners from the Upworthy Kindness Fund, a joint initiative between Upworthy and GoFundMe that celebrates kindness and everyday actions inspired by the best of humanity. This year, the Upworthy Kindness Fund is giving $100,000 to grassroots changemakers across the world.

To apply, campaign organizers simply tell Upworthy how their kindness project is making a difference. Between now and the end of 2021, each accepted individual or organization will receive $500 towards an existing GoFundMe and a shout-out on Upworthy.

Meet the first four winners:

1: Balance Dance Project: This studio aims to bring accessible dance to all in the Sacramento, CA area. Lead fundraiser Miranda Macias says many dancers spend hours a day at Balance practicing contemporary, lyrical, hip-hop, and ballet. Balance started a GoFundMe to raise money to cover tuition for dancers from low-income communities, buy dance team uniforms, and update its facility. The $500 contribution from the Kindness Fund nudged Balance closer to its $5,000 goal.

2: Citizens of the World Mar Vista Robotics Team: In Los Angeles, middle school teacher James Pike is introducing his students to the field of robotics via a Lego-building team dedicated to solving real-world problems.

James started a GoFundMe to crowdfund supplies for his students’ team ahead of the First Lego League, a school-against-school matchup that includes robotics competitions. The team, James explained, needed help to cover half the cost of the pricey $4,000 robotics kit. Thanks to help from the Upworthy Kindness Fund and the generosity of the Citizens of the World Middle School community, the team exceeded its initial fundraising goal.

Citizens of the World Mar Vista Robotics Team video update youtu.be

3: Black Fluidity Tattoo Club: Kiara Mills and Tann Parker want to fix a big problem in the tattoo industry: there are too few Black tattoo artists. To tackle the issue, the duo founded the Black Fluidity Tattoo Club to inspire and support Black tattooers. While the Brooklyn organization is open to any Black person, Kiara and Tann specifically want to encourage dark-skinned artists to train in an affirming space among people with similar identities.

To make room for newcomers, the club recently moved into a larger studio with a third station for apprentices or guest artists. Unlike a traditional fundraiser that supports the organization exclusively, Black Fluidity Tattoo Club will distribute proceeds from GoFundMe directly to emerging Black tattoo artists who are starting their own businesses. The small grants, supported in part with a $500 contribution from the Upworthy Kindness Fund, will go towards artists’ equipment, supplies, furnishings, and other start-up costs.

4: AFutureSuperhero And Friends’ “Hope For The Holidays”: Founder Yuri Williams is fundraising for a holiday trip to spread cheer to people in need across all fifty states.

Along with collaborator Rodney Smith Jr., Yuri will be handing out gifts to children, adults, and animals dressed as a Star Wars’ Stormtrooper, Spiderman, Deadpool, and other movie or comic book characters. Starting this month, the crew will be visiting children with disabilities or serious illnesses, bringing leashes and toys to animal shelters for people taking home a new pet, and spreading blessings to unhoused people—all while in superhero costume. This will be the third time Yuri and his nonprofit have taken this journey.

AFutureSuperhero started a GoFundMe in July to cover the cost of gifts as well as travel expenses like hotels and rental cars. To help the nonprofit reach its $15,000 goal, the Upworthy Kindness Fund contributed $500 towards this good cause.

Think you qualify for the fund? Tell us how you’re bringing kindness to your community. Grants will be awarded on a rolling basis from now through the end of 2021. For questions and more information, please check out our FAQ's and the Kindness Toolkit for resources on how to start your own kindness fundraiser.

Dan Fischer takes people's lost loved ones out surfing for "one last wave."

Dan Fischer understands grief. He also has some idea of how to cope with it—and how to help others through it as well.

Fischer has experienced tremendous loss in the past few years, losing both his father and his best friend. As a surfer, he's a believer in what he calls "the transformative power of the ocean." Originally from Montreal, Canada, Fischer has found healing riding the waves off Newport, Rhode Island, where he's lived for the past seven years.

Now he wants to share that healing power of the waves with others.

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The airplane graveyard that 3 families call home is the subject of a stunning photo series.

From the skies to the ground, these airplanes continue to serve a purpose.

This article originally appeared on 09.18.15


What happens to airplanes after they're no longer fit to roam the skies?


An abandoned 747 rests in a Bangkok lot. Photo by Taylor Weidman/Getty Images.

Decommissioned planes are often stripped and sold for parts, with the remains finding a new home in what is sometimes referred to as an "airplane boneyard" or "graveyard." Around the world, these graveyards exist; they're made up of large, empty lots and tons of scrap metal.

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