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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.

Mental Health

Motivation expert explains how two simple words can free you from taking things personally

You don't need to take responsibility for everything and everyone.

via TEDx SF/Flickr and TEDx SF/Flickr

Mel Robbins making a TED Talk.

Towards the end of The Beatles’ illustrious but brief career, Paul McCartney wrote “Let it Be,” a song about finding peace by letting events take their natural course. It was a sentiment that seemed to mirror the feeling of resignation the band had with its imminent demise.

The bittersweet song has had an appeal that has lasted generations, and that may be because it reflects an essential psychological concept: the locus of control. “It’s about understanding where our influence ends and accepting that some things are beyond our control,” Jennifer Chappell Marsh, a marriage and family therapist, told The Huffington Post. “We can’t control others, so instead, we should focus on our own actions and responses.”

This idea of giving up control (or the illusion of it) when it does us no good was perfectly distilled into two words that everyone can understand: "Let Them." This is officially known as the “Let Them” theory. Podcast host, author, motivational speaker and former lawyer Mel Robbins explained this theory perfectly in a vial Instagram video posted in May 2023.

“I just heard about this thing called the ‘Let Them Theory,’ I freaking love this,” Robbins starts the video.

“If your friends are not inviting you out to brunch this weekend, let them. If the person that you're really attracted to is not interested in a commitment, let them. If your kids do not want to get up and go to that thing with you this week, let them.” Robbins says in the clip. “So much time and energy is wasted on forcing other people to match our expectations.”

“If they’re not showing up how you want them to show up, do not try to force them to change; let them be themselves because they are revealing who they are to you. Just let them – and then you get to choose what you do next,” she continued.

The phrase is a great one to keep in your mental health tool kit because it’s a reminder that, for the most part, we can’t control other people. And if we can, is it worth wasting the emotional energy? Especially when we can allow people to behave as they wish and then we can react to them however we choose?

@melrobbins

Stop wasting energy on trying to get other people to meet YOUR expectations. Instead, try using the “Let Them Theory.” 💥 Listen now on the #melrobbinspodcast!! “The “Let Them Theory”: A Life Changing Mindset Hack That 15 Million People Can’t Stop Talking About” 🔗 in bio #melrobbins #letthemtheory #letgo #lettinggo #podcast #podcastepisode

How you respond to their behavior can significantly impact how they treat you in the future.

It’s also incredibly freeing to relieve yourself of the responsibility of changing people or feeling responsible for their actions. As the old Polish proverb goes, “Not my circus, not my monkeys.”

“Yes! It’s much like a concept propelled by the book ‘The Subtle Art of Not Giving a F**k.’ Save your energy and set your boundaries accordingly. It’s realizing that we only have “control” over ourselves and it’s so freeing,” one viewer wrote.

“Let It Be” brought Paul McCartney solace as he dealt with losing his band in a very public breakup. The same state of mind can help all of us, whether it’s dealing with parents living in the past, friends who change and you don’t feel like you know them anymore, or someone who cuts you off in traffic because they’re in a huge rush to go who knows where.

The moment someone gets on your nerves and you feel a jolt of anxiety run up your back, take a big breath and say, “Let them.”

let them theory, let it be, paul mccartney, the beatles, exhalethe beatles wave GIFGiphy

This article originally appeared last year.

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Family

Woman who traveled abroad for 2 weeks realizes why she can't marry an American man

"I'm actually embarrassed to talk about this."

via Canva/Photos

A woman holding back her laughter.

One of the biggest topics in parenting these days is the mental and physical drain that comes with being the default parent in a family. The default parent is the one who is first in line when it comes to taking responsibility for parenting duties, whether that means making doctor’s appointments, ensuring the homework is done, or making sure the child has enough socks to make it through the week.

Being the default parent can lead to fatigue and burnout, and the parent can experience incredible anxiety when their attention turns away from the household or family. The situation is even worse when the default parent’s partner only does the bare minimum. Unfortunately, in American society, fathers are often the parents who do just enough to get by and are praised for it.

The notion that men don’t have to pull their equal weight in American family life is so ingrained that when Emma Hughes, a travel nanny with over one year of experience in childcare and family support, visited Sweden for two weeks, she experienced extreme culture shock.


"I've been in Sweden now and I think I've been ruined for American men," the 24-year-old said in a viral Instagram video. "Specifically raising a child with an American man in America, because these Scandinavian dads? Chef's kiss …"

"I'm actually embarrassed to talk about this because all of the observations that I've made have really revealed to me how deeply ingrained [expletive] dads have become like in my brain, and it's just like the default,” she continued.

The notion that fathers only have to do the bare minimum was so ingrained in Hughes’ psyche that she couldn’t understand seeing so many involved fathers in Sweden.

sweden, swedish dad, swedish fathers, soccer, swedish childA dad playing soccer with his child.via Canva/Photos

"When I see more dads pushing their strollers in the park on a Saturday morning than moms, what does my brain think … That's weird, there is something abnormal about that,” Hughes said. “When I see dads at the grocery store with their kids. When I see dads out at restaurants or in public. It is so deeply telling of a lot of subconscious stuff that I have going on in my brain after working with so many families."

She said that even the best dads she's worked with in America would be considered the "Scandinavian bare minimum." She applauded one Swedish father who purchased a new size of diapers for his baby without being told to do so by his partner.

swedes, swedish couple, scandanavia, swedish flag, happy swedesA couple holding up the Swedish flag.via Canva/Photos

"Like I watched a Swedish dad go to the grocery store and come home with like four bags of groceries and in that trip he had bought size two diapers for a baby that had previously been wearing size one and was ready to move into size two but that conversation had not happened between the mom and the dad,” she said.

Given Swedish dads' dedication towards their parenting responsibilities, it’s fair to assume that their partners are much happier and stress-free than those in the States. But what about their kids? Researchers at the United Nations who studied “child well-being in rich countries” found that Swedish fathers also ranked high by their children. The survey asked children in 28 countries if it was easy to talk to their dads, and while 67% of children in the study said their parents were easy to talk to, Swedish fathers scored higher at 72.4%. Meanwhile, the U.S ranked 25, out of 28, at just 59.7%.

sweden, swedish dad, swedish fathers, swedish child, dad reading note, A Swedish dad reading a note. via Canva/Photos

Ultimately, Hughes makes an important point that Scandinavian men have set a high bar for being fathers and that American men need to step up. The positive sign is that in America, the discussion around default parenting has been getting louder and louder, and hopefully, that will prompt more American men and women to set higher expectations so that one day, American men can catch Sweden’s.

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Pop Culture

Two brothers Irish step dancing to Beyoncé's country hit 'Texas Hold 'Em' is pure delight

The Gardiner Brothers and Queen Bey proving that music can unite us all.

Gardiner Brothers/TikTok (with permission)

The Gardiner Brothers stepping in time to Beyoncé's "Texas Hold 'Em."

In early February 2024, Beyoncé rocked the music world by releasing a surprise new album of country tunes. The album, Renaissance: Act II, includes a song called "Texas Hold 'Em," which shot up the country charts—with a few bumps along the way—and landed Queen Bey at the No.1 spot.

As the first Black female artist to have a song hit No. 1 on Billboard's country music charts, Beyoncé once again proved her popularity, versatility, and ability to break barriers without missing a beat. In one fell swoop, she got people who had zero interest in country music to give it a second look, forced country music fans to broaden their own ideas about what country music looks like, prompted conversations about bending and blending musical genres and styles, and gave the Internet a crash course on the Black roots of country music.

And she inspired the Gardiner Brothers to add yet another element to the mix—Irish step dance.

In a TikTok that's been viewed over 42 million times, the Gardiner Brothers don cowboy hats while they step in time to "Texas Hold 'Em," much to the delight of viewers everywhere.

Watch:

@gardinerbrothers

Beyoncé 🤝 Irish dancing #beyonce #countrymusic

Michael and Matthew Gardiner are professional Irish-American step dancers and choreographers who have gained international fame with their award-winning performances. They've also built a following of millions on social media with videos like this one, where they dance to popular songs, usually in an outdoor environment.

The melding of Irish dance with country music sung by a Black American female artist may seem unlikely, but it could be viewed merely as country music coming back to its roots. As mentioned, country music has roots in Black culture and tradition. One major staple of the country music genre, the banjo, was created by enslaved Africans and their descendants during the colonial era, according to The Smithsonian. The genre also has deep roots in the ballad tradition of the Irish, English and Scottish settlers in the Appalachian region of the U.S. Despite modern country music's struggle to break free from "music for white people" stereotypes, it's much more diverse than many realize or care to admit, and Queen Bey is simply following tradition.

banjo, country music, country, roots, genreMan playing banjo.Canva Photos

People are loving the blending of genres and culture that the TikTok exemplifies.

"Never thought I’d see Irish step dancing while Beyoncé sings country," wrote on commenter. "My life is complete. ♥️"

"So happy Beyoncé dropped this song and exposed my timeline to diversified talent 👏🏽👏🏽," wrote another.

"Beyoncé brought the world together with this song 😭," offered another person.

"Ayeeee Irish Dancing has entered the BeyHive chatroom… WELCOME!! 🔥🔥🔥" exclaimed another.

"I don’t think I can explain how many of my interests are intersecting here," wrote one commenter, reflecting what several others shared as well.

The Beyoncé/Gardiner Brothers combo and the reactions to it are a good reminder that none of us fit into one box of interest or identity. We're all an eclectic mix of tastes and styles, so we can almost always find a way to connect with others over something we enjoy. What better way to be reminded of that fact than through an unexpected mashup that blends the magic of music with the delight of dance? Truly, the arts are a powerful uniting force we should utilize more often.

And for an extra bit of fun, the Gardiner Brothers also shared their bloopers from filming the video. Turns out stepping in the rain isn't as easy as they make it look.

@gardinerbrothers

Beyoncé Bloopers #texasholdem #gardinerbrothers

This article originally appeared last year.

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Learning

How sign language was once banned in America thanks to Alexander Graham Bell

The inventor thought sign language kept people from integrating into society.

Screenshot from PBS OtherwordsOtherwords

Alexander Graham Bell once had sign language banned in America.

American Sign Language, known widely as ASL is something that people are used to seeing. Though everyone doesn't speak the language, we as a society understand the important role it plays in the lives of those who are or know someone who is deaf or hard of hearing. Classes are offered online, at local libraries, and even at universities because ASL is a full language on its own with its own set of rules. Given the wide acceptance and understanding of the need for ASL, it's hard to believe that it was once banned in America.

Yes, banned. In the early years of ASL, it was a developing tool for deaf people to communicate with each other and those around them. The language was developed using the natural human inclination to use hand gestures to communicate. It quickly caught on and became a cohesive language which resulted in it being taught to deaf children in schools. "There are more than 150 different sign languages used around the world that are distinct from each other and the spoken languages in the same places," Erica Brozovsky, Ph.D. says on an episode of PBS' Otherwords, of which is she is the host and writer.

ASL; sign language; american sign language; mental health; inclusion; disability awarenessMan and child signing on floor.Photo credit: Canva

A school for the deaf was established in 1816 after French educators and American advocates opened The American School for the Deaf. This school allowed deaf students from different parts of America to receive an education in a place where the kids could learn using signs and gestures instead of speech. The French educators brought French sign language which American students combined with the gestures they used at home to communicate with their family. It helped deaf Americans build community and solidify ASL as a standard language for deaf people in the United States.

Unfortunately, this level of representation and inclusive education for deaf students wasn't something supported by everyone. Alexander Graham Bell, who was married to a deaf woman and had a deaf mother, was one of the staunchest critics of the groundbreaking language. He believed that deaf people should try to "integrate into mainstream speaking culture." Kind of rude but, okay. He is a famous inventor, so maybe there was a secret invention he was working on that would help solve the obvious problem that had...already been solved? Wishful thinking.

ASL; sign language; american sign language; mental health; inclusion; disability awarenessAsl Lips GIFGiphy

In 1880, Bell and nearly 200 other educators convened in Milan and decided that ASL just wouldn't do. In their minds, only "oralism" would be an acceptable way for deaf people to learn to speak, oralism being a system the educators who attended the conference made up as opposed to "manualism" or sign language.

"They believed that sign language was a lesser imitation of spoken language and that deaf kids shouldn't be taught to sign in schools. Instead they created a system called Oralism, where deaf children were expected to hear by lip reading and speak by imitating the mouth shapes of hearing people," Brozovsky reveals.

ASL; sign language; american sign language; mental health; inclusion; disability awarenessAsl Seriously GIFGiphy

The educators who created this system were all hearing except for one, which seems to have created the perfect climate for powerful people to make decisions about another group of people they did not belong to. Schools swiftly switched to Oralism instead of sign language and the results were devastating for deaf students. Sign language was not reintroduced to deaf students in schools until the 1960s. After nearly 100 years of sign language being banned in school, adults who missed the valuable education and community building were angry.

1n 1994, historian of Deaf Culture, Jack Gannon, told PBS, "Lots of those angry adults feel they've been cheated. They've been cheated out of a good education. They've been cheated out of good relationships with their own families. They feel they've been cheated out of so many things because they were restricted only to one method, Oralism. Now they're angry about that. And to be honest with you, I think they have a right to be angry."

According to Roberta Cordano, President of Gallaudet University, the deaf community didn't receive an apology for the removal of sign language from schools until 2013. She recalls to Otherwords that her mother was still alive to receive the apology for the harm caused.

"And it was only in 2013 that there was an apology issued to the deaf community for the Milan conference that declaration that spoke to banning sign language back in the 1880s. That apology to the deaf community that came in 2013 was one my mother was still alive to see, and my mother suffered because of that decree during that period of time. And my mother said, 'you know, I finally have lived to see this apology. That happened in her lifetime and it meant a lot to her" Cordano says.

ASL; sign language; american sign language; mental health; inclusion; disability awarenessWoman smiling using ASLPhoto credit: Canva

But what educators didn't know in the 1880s is that learning language early in life is crucial for development no matter if it's spoken or signed. Another benefit according to the video is that kids who learn to sign from infancy, whether they're hearing or not, have increased brain development. Though sign language is widely more acceptable as a form of language now, Cordano points out that there are still gaps in teaching it to deaf and hard of hearing children. Cochlear implants and hearing aids aren't always enough to have a deaf child hear like their peers, so sometimes key pieces of language are missing which can impact learning.

Cordano wants people to understand that while there are devices that can help people hear, there doesn't have to be a choice between using one of those devices and learning ASL. She believes it's most beneficial for kids to be exposed to both so they can decide what suits them.

ASL; sign language; american sign language; mental health; inclusion; disability awarenessThree women conversing in ASLPhoto credit: Canva

The university president closes by saying, "So what I recognize is that we have been so busy trying to fix deaf babies or deaf and hard of hearing babies by putting technologies on them or trying to fix them so that they'll be hearing and be able to access spoken language that we've completely missed out on what those deaf babies have to offer the entire world. A lifetime experience of hearing loss and I think we really got it wrong, the babies are our teachers in this process, they are teaching us how to live with a beauty of a visual language. How to live in a world full of visual images and visual communication. It's just a way of being that is so beneficial to everyone if you learn sign language and use sign language."

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Teachers

6th-grade teacher resigns rather than remove absolutely harmless sign from her classroom

Then she shared her blistering resignation letter with her local paper.

Canva Photos

A teacher was told to remove a sign that read "Everyone Is Welcome Here." She refused.

That's it. We've finally had enough in this country. In a move that's long overdue, we're finally cracking down on... *checks notes*...basic human kindness?

The orders have come straight from the top. Being nice to people who are different than you is now bad. Creating environments that are welcoming and inclusive of everyone? Also bad. What's most disturbing is just how far these mandates are trickling down—all the way into our schools.

A 6th grade teacher in Idaho was recently told by school administrators to remove a controversial sign from her classroom. She refused.

Earlier this spring, world civilization teacher Sarah Inama at Lewis and Clark Middle School was told that one of the posters in her class was inappropriate. The school asked her to remove it.

Initially, she complied, but upon reflection and discussion with her husband, decided that it didn't feel right. She needed to take a stand. So Inama put the poster back up and left it visible for all to see, even after administrators warned her she could lose her job over the noncompliance.

Finally, among growing outcry and threats of termination, Inama decided to resign rather than remove the poster. She bravely decided to stick up for her controversial beliefs, even though she knew her personal opinion may not be popular.

Just wait until you see the outrageous sign. Here it is:

Seriously, that's it. The sign reads "Everyone Is Welcome Here" and shows hands of different colors. This is the poster that was deemed not appropriate for the public school environment.

The district’s chief academic officer Marcus Myers clarified that, "The political environment ebbs and flows, and what might be controversial now might not have been controversial three, six, nine months ago."

Inama's sign was said to have violated the school's "content neutral" policy, which prohibits any speech or messaging that might reflect personal opinions, religious beliefs, or political ideologies.

What's hard to believe is that a sign meant to show kids that they are welcome in Inama's classroom somehow reflects a "personal belief" that the school won't tolerate. The sign made no mention of religion or LGBTQ+ identities or political ideologies; and it was still deemed too woke. That's extremely frightening.

Inama received an outpouring of support from the community, but it wasn't enough to change the district's mind. After her resignation, she didn't hold back, sharing her resignation letter with local news.

“This will be my last year teaching in the West Ada School District, and it saddens me to leave under these circumstances,” Inama's letter begins.

“I cannot align myself nor be complicit with the exclusionary views and decisions of the administration. It is deeply troubling that the people running this district and school have allowed a welcoming and inclusive message for my students to be considered controversial, political, and, worst of all, an opinion.”

"I hope for the sake of the students in your district that you can remember the core values of public education," she concludes. "To serve all citizens, foster an inclusive and safe learning environment, and protect your staff and students from discriminatory behavior."

The war on "DEI" (Diversity Equity and Inclusion) has gone way too far when it's not OK to tell kids of different skin colors that they are welcome and safe in a classroom. And now, the education system has lost a talented and passionate teacher because of it. But at least Inama hasn't gone quietly, and with millions of outraged supporters all over the country and now world, we probably haven't heard the last of this case.

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