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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.

via Meg Sullivan (used with permission) and Canva/Photos

A volunteer hands out food in a food bank and Meg Sullivan shares her dad's kind gesture.

When we consider people who have had a positive impact on the world, we often think of those who have made grand gestures to improve the lives of others, such as Martin Luther King, Jr., Greta Thunberg, or Mahatma Gandhi. Unfortunately, that type of effort is out of reach for the average person.

However, O Organics would like to remind everyone that they can positively impact the world through small, consistent acts of kindness that add up over time. Much like how a small creek can create a valley over the years, we can change lives through small, consistent acts of kindness.

O Organics is dedicated to the well-being of all by nourishing people everywhere with delicious organic foods grown by producers who meet USDA-certified organic farming standards.

Upworthy's Instagram page recently posted a touching example of everyday kindness. Meg Sullivan shared how her father, Tom, peeled oranges for her lunch just about every day from kindergarten through high school. But on the final day of her senior year of high school, he sent his 17-year-old daughter unpeeled oranges with a touching note about how she’d have to start peeling them for herself.



“It’s Time Baby Girl,” he wrote on a wikiHow printout on how to peel an orange with a drawing of himself crying. For the father, this daily ritual was about more than just making lunch; it was about showing that he cared by going the extra mile. “I could have put money on her lunch account,” Tom told Today.com. “But it’s one of those little things I thought was important, that she knows somebody’s taking the time to take care of her.”

The small, daily gesture taught Megan an essential lesson in kindness.

The post reminded people how their fathers’ small acts of kindness meant so much to them. “My dad peeled my oranges until I graduated high school, too. Now, I peel my daughter’s oranges and will for the next 7 plus years,” Katie wrote in the comments. “Love this. My dad peeled mine, too. When I moved out, he gave me an orange peeler gadget,” Mary added.

o organics, albertson's giving backO Organics has a wide array of foods and flavors covering almost everything on your shopping list.via Albertson's

Did you know that every time you go to the supermarket, you can also change the world through small gestures? O Organics not only allows you to feed your family delicious and nutritious organic food, but each purchase also gives back to help people and communities facing food insecurity.

Through contributions from customers like you, O Organics donates up to 28 million meals annually. The company’s contribution is essential when, according to the USDA, 47.4 million Americans live in food-insecure households.

O Organics has a wide array of foods and flavors covering almost everything on your shopping list. “Over the years, we have made organic foods more accessible by expanding O Organics to every aisle across our stores, making it possible for health and budget-conscious families to incorporate organic food into every meal,” Jennifer Saenz, EVP and Chief Merchandising Officer at Albertsons, one of many stores where you can find O Organics products, said in a statement.

O Organics now offers over 1500 items, from dairy products such as eggs and milk to packaged meats and breakfast staples such as cereal bars, granola and oatmeal. You can also enjoy affordable organic produce with O Organics’ fresh salads and fruit.

Everybody wants to make the world a better place. With O Organics, you can feed your family healthy, organic food every time you go to the market while paying it forward by contributing to the company’s efforts to end food insecurity nationwide. That’s a small, daily gesture that can amount to incredible change.

@callmebelly/TikTok

An excellent reminder to show kindness and patience.

Listening to a baby cry during a flight might be aggravating, but it’s nothing compared to the moans, groans, and eyerolls that the baby's parents must endure from other passengers when it happens. No matter what tips and tricks are used to try to soothe a little one’s temperament while 30,000 miles in the air, crying is almost inevitable. So, while having to ease their own child’s anxiety, moms and dads also must suffer being the pariah of the trip. What a nightmare.

Recently, one mom was apparently trying so hard to avoid upsetting her fellow flight members that she went above and beyond to essentially apologize ahead of time if her baby began to cry on its first flight. It was a gesture that, while thoughtful, had folks really feeling for how stressed that poor mom must be.

In a clip posted to his TikTok, one of the passengers—Elliot—explained that the mom handed out small care packages to those nearby.

“She’s already so busy and took the time to make these bags for everyone,” Elliot said, before panning the camera to reveal a Ziplock bag full of candy, along with a note that made him “want to cry.”

The note read: “It’s my first flight. I made a deal to be on my best behaviour—but I can’t make any guarantees. I might cry if I get scared or if my ears start to hurt. Here are some treats to make your flight enjoyable. Thank you for being patient with us. Have a great flight.”

Like Elliot, those who watched the video felt some ambivalence at the well intentioned act. Many felt remorse that she would feel the need to appease people in this way.

“This is so sweet but also … kind of breaks my heart that we live in a world in which parents feel the need to do that.”

“Because jerk people have shamed parents into believing that they need to apologize for their kids' absolutely normal behavior. What a gem of a mom.”

“You know that sweet mom worried about this trip so much.”

“That poor mom probably spent nights awake … nervous about that flight, thinking of ways to keep strangers happy.”

"That's a mom trying so hard."

Many rallied behind the mom, arguing that making others feel more comfortable with her child being on board was in no way her responsibility.

“No mom should be apologizing. Adults can control their emotions … babies not …. Hugging this mom from a distance.”

“Dear new parents: no you don’t have to do this. Your babies have the right to exist. We all know babies cry. We know you try your best.”

Luckily, there are just as many stories of fellow passengers being completely compassionate towards parents with small children—from simply choosing to throw on their headphones during a tantrum (instead of throwing one themselves) to going out of their way to comfort a baby (and taking the load of a parent in the process). These little acts of kindness make more of an impact than we probably realize. Perhaps if we incorporated more of this “it takes a village” mindset, flying could be a little bit more pleasant for everyone involved.

Humor

Women are sharing quirky things they do to make life more whimsical and it's pure delight

"I kiss my cat on both cheeks then she kisses me on both cheeks then I explain 'she's European' to no one."

We all could use a little whimsy in our lives.

One of the funniest things about being human is the unique quirks each one of us has that other people don't know about. In some sense, our individual oddities are things that unite us even though they are hidden from public view. It's a simple, universal truth that we're all a bit silly in our own way.

Case in point: A trend in which women share the quirky little things they do to make life more whimsical. The conversation has been circulating on social media since someone asked, "Girlies: What are some things you do to be more whimsical? I love knowing about cute little habits." And the responses, "like a magical, much-needed hug," are filling people with joy.

The question asked for women to weigh in, but there's no indication that men don't also have funny private habits as well, so we can all see ourselves in these responses.

Check out this list of people's quirky whimsical habits

"I wear matching pajamas every time I change my sheets so I can have what I call fancy sleep."

"I hold 'office hours' every Tuesday at a local coffee shop, which means I sit on the couch and order drinks for 4-5 hours while various friends and acquaintances visit me to yap abt books and gossip."

"I say, 'my lady,' every time I walk by a mirror."

"I teach the dog how to do things either to make them more interesting for me ('Let me show you how to start a load of laundry') or just to make him feel included ('Do you remember how to make coffee or should I walk you through it again? I know it's hard to remember since you can't practice without thumbs.')"

"I kiss my cat on both cheeks then she kisses me on both cheeks then I explain 'she's European' to no one."

"I tell my dishes it's bath time."

"I sleep in vintage nightgowns, it makes me feel like an 1800s princess✨"

"If I want to have negative thoughts about myself I have to think them in a cockney accent."


@abigail.bailey0

i’ve been home sick d: #whimsical #alternative #weird #tips #trinkets #habits #odd #corecore

"I say, 'May I take your coats?' when I'm peeling garlic."

"Every time I see the moon, I shout 'Hey gurrrl! Looking amazing, you are glowing!' and just compliment the hell out of her because she’s my bestie."

"I like drinking water at night ouf of small wooden bowls. It makes me feel like I'm being nursed back to health by spirits."

"I shout 'NO, not YOU! I don’t even know you!' in the voice of Lilly Moscocvitz when I’m looking for something and find something else unrelated."

"I hot glued a bow tie onto the Roomba and we call him Jeffrey."

"I tell my hamster not to answer the door for anyone before I leave."

"I call putting on pj's 'time to pump up the jams.'"

Giphy

"I always set my alarm clock to weird times like 8:52 am or 4:47pm because I don’t want less used numbers to be lonely or sad."

"Sometimes, a couple hours before bed, I go in my room and turn down the bed, spray a bit of lavender, maybe light a candle, put my water with lemon on my bedside table. Then when I get ready to go to bed a couple hours later I walk in and say 'I love turndown service!' as though it’s a pleasant surprise."

"Any time I make a mistake at work I giggle to myself, apologize, and say 'it’s my first day.' I’ve worked for the same company for 5 and a half years."

"I call my to do list my TA DA list and do jazz hands as I tick things off."

"For my own amusement I say 'officers!' and nod when I see pigeons."

"This one is kinda niche, but I’m a hairstylist. Whenever I wash my clients hair, as I give them a head massage with the conditioner I send loving thoughts into the universe over whatever is going on in their life."

"Whenever I buy something online and it asks 'is this a gift?' I write a little gift message to myself, usually along the lines of 'you are awesome and deserve these little treats.'"


Treat Yourself Donna Meagle GIF by Parks and RecreationGiphy

There are soooo many more, and each one is more delightful than the last. Turns out a whole bunch of us are a whole lot goofier in our private lives than we let on, which is a wonderful discovery.

Can whimsy actually be useful?

But there's more to this trend than simply a love of whimsy. As one commenter pointed out, "There are literal therapeutic reframing techniques in here that are FANTASTIC." It's true. Making a boring or mundane task more fun or interesting can be helpful for people who are prone to procrastination. Changing the voice you use when negative thoughts creep in can help distance that voice from your inner self. Pampering yourself by making bedtime special can create positive associations with rest and sleep, making it easier for you to settle in at night.

Perhaps our penchant for fun and whimsy isn't as frivolous as it might first appear, so if you do things like this, give yourself a pat on the back for engaging in good self-care. And now you know for sure that you're definitely not alone.


Science

Innovative farm in Virginia can grow 4 million pounds of strawberries on less than one acre

This method uses 97 percent less land and up to 90 percent less water than conventional farming.

A new way to grow strawberries with less land, less water, and more berries.

Strawberry farm harvests aren't something most of us calculate on a regular basis (or ever at all), but the numbers from a strawberry farm in Richmond, Virginia, are staggering enough to make it worth an old-school word problem. If the average American eats 8 pounds of strawberries a year, and an average strawberry farm yields approximately 20,000 pounds of berries per acre, how many people could a 200-acre strawberry field feed?

I won't make you do the math. The answer is 500,000 people. But what if a crop that size, providing enough strawberries for half a million people, could be grown on just one acre instead of 200? It's possible. You just have to go—or rather grow—up, up, up.

Indoor vertical farm company Plenty Unlimited knows a lot about growing up. In fact, it's their entire business model. Instead of the sprawling fields that traditional farming methods require, vertical farms have a much smaller land footprint, utilizing proprietary towers for growing. Plenty has used vertical farming methods to grow greens such as lettuce, kale, spinach and more for years, but now it boasts a vertical berry farm that can yield a whopping 4 million pounds of strawberries on a little less than an acre.

Growing indoors means not being at the mercy of weather or climate inpredictability (barring a storm taking out your building), which is wise in the era of climate change. Unlike a traditional greenhouse which still uses the sun for light, Plenty's indoor vertical farms make use of the latest technology and research on light, pinpointing the wavelengths plants need from the sun to thrive and recreating them with LED lights. Plenty farms also don't use soil, as what plants really need is water and nutrients, which can be provided without soil (and with a lot less water than soil requires). Being able to carefully control water and nutrients means you can more easily control the size, taste and uniformity of the berries you’re growing.

If that sounds like a lot of control, it is. And that idea might freak people out. But when a highly controlled environment means not having to use pesticides and using up to 90% less water than traditional farming, it starts to sound like a solid, sustainable farming innovation.

Plenty even uses AI in its strawberry farm, according to its website:

“Every element of the Plenty Richmond Farm–including temperature, light and humidity–is precisely controlled through proprietary software to create the perfect environment for the strawberry plants to thrive. The farm uses AI to analyze more than 10 million data points each day across its 12 grow rooms, adapting each grow room’s environment to the evolving needs of the plants – creating the perfect environment for Driscoll’s proprietary plants to thrive and optimizing the strawberries’ flavor, texture and size.”

Plenty even has its own patent-pending method of pollinating the strawberry flowers that doesn’t require bees. Even just the fact that this enormous crop of strawberries will be coming from Virginia is notable, since the vast majority of strawberries in the U.S. are grown in California.

strawberry fieldTraditional strawberry farming takes up a lot of land.Photo credit: Canva

Plenty's Richmond farm is currently growing strawberries exclusively for Driscoll’s.

“Partnering with Plenty for the launch of the Richmond Farm allows us to bring our premium strawberries closer to consumers in the Northeast, the largest berry consumption region in the U.S.,” Driscoll’s CEO Soren Bjorn said in a press release. “By combining our 100 years of farming expertise and proprietary varieties along with Plenty’s cutting-edge technology, we can deliver the same consistent flavor and quality our customers love — now grown locally. This new innovative farm is a powerful step forward in continuing to drive category growth in new ways for our customers and consumers.”

Is Plenty’s model the farm of the future? Perhaps it’s one option, at least. The more we grapple with the impact of climate change and outdated, unsustainable farming practices, the more innovative ideas we’ll need to feed the masses. If they can get 4 million pounds of strawberries out of an acre of land, what else is possible?

Celebrity

In 2006, the Oscars secretly pressured Heath Ledger to make fun of gay people. He wasn't having it.

Jake Gyllenhaal shared the story of his late Brokeback Mountain co-star's kindness.

Fájl:Heath Ledger.jpg – Wikipédia

Heath Ledger stayed true to his convictions. He stood up for what he believed in, and it didn't matter if it was in a casual conversation with a friend, on a press junket, or at the Oscars. In a resurfaced video making the rounds, Heath was on the Brokeback Mountain press tour and was asked by an interviewer, "How do you respond to people who suggest this is disgusting?"

Heath seems initially taken aback by the question. He ponders for a moment and then says, "Well, I think it's immature, for one. I think it's an incredible shame that people go out of their way to voice their disgust or negative opinions about the way two people wish to love one another."

- YouTubewww.youtube.com


He then expresses how some might be focusing on the wrong things. "At least voice your opinions on how two people share hate and violence and anger towards each other. Isn't that more important? I think so."

Brokeback Mountain is a 2005 film starring Ledger alongside Jake Gyllenhaal, about two sheep herders in Wyoming who find love with one another. It was adapted from a short story by Annie Proulx, originally published in The New Yorker in 1997.

mountain GIFGiphy

In discussing the movie itself (which won three Academy Awards in 2006, including Best Director for Ang Lee, Best Adapted Screenplay, and Best Original Score), Heath explained, "It's obviously about two men in love. It's gay-themed and easily labeled. The pure fact of it is, it transcends labels. It's the story of two human beings—two souls who are in love."

He truly wanted to make sure that audiences (including the press) understood the entire point of the film. "We're showing that love between two men is just as infectious and emotional and strong and pure as it is with heterosexual love."

While this clip has popped up many times over the years, an interview with Jake Gyllenhaal in 2020 definitively confirmed how important these themes were to Heath. In an interview with Another Man magazine, he discusses how the whole production came together. “There are things you’re chosen for—a quality, an essence—and Ang did that. And it’s still a mystery to me. And something that Heath and I shared: that it was a mystery to us at the time.”

Jake emphasized that Heath put his foot down when some writers of the Oscars telecast wanted to make light of Brokeback Mountain. "I mean, I remember they wanted to do an opening for the Academy Awards that year that was sort of joking about it. And Heath refused. I was sort of at the time, 'Oh, okay... Whatever.' I'm always like, 'It's all in good fun.' And Heath said, 'It's not a joke to me. I don't want to make any jokes about it.'"

According to WION News, Jake reminisced, "That's the thing I loved about Heath. He would never joke. Someone wanted to make a joke about the story or whatever, he was like, 'No. This is about love. Like, that's it, man.'"

via Canva

A man and woman having a conversation.

Small talk can feel awkward, especially when talking to someone you don’t know very well and run out of things to say. That awkward silence may only last a few seconds but can feel like an eternity. Small talk can be uncomfortable, but it’s the gateway to starting relationships, creating professional opportunities, and building self-confidence. Becoming a master of small talk opens up possibilities, but how do you improve your skills?

One way to elevate your small talk game is by using a technique known as conversational threading. Adding a few more details to your questions and responses can open up different avenues to take the conversation and prevent it from stalling after a question or two. The key is to be an active listener with intentional questions.

How to get better at small talk

“The problem with most small talk is that it’s happening on autopilot, which means that people are asking questions they can already predict the answers to, such as: ‘How are you?’ ‘How’s the weather?’ “How was your weekend?’” Lorraine Lee, an award-winning virtual keynote speaker and CEO of RISE Learning Solutions, told CNBC Make It. The problem is that when you ask autopilot questions, you’re bound to get predictable answers, making it hard for the conversation to get off the ground.

Question: “How are you doing?”

Predictable answer: “Fine, how are you?”

Good answer: “Great, I’m planning a trip to Mexico, and I’ve really been enjoying ‘The White Lotus’ on Max."


The “good answer” here gives the person you’re talking to two threads to follow. They can ask you about Mexico or share how they once went to Cancun and had a great time. They can also reply to your thread about “The White Lotus” and discuss whether they have seen it.

Question: “Cold outside, isn’t it?”

Predictable answer: “Yeah, I’m freezing.”

Good answer: “It reminds me of the blizzard we had a few years back. What year was that?”

The “good answer” here also gives the person you’re talking to two threads. They can speculate on the date of the blizzard or share their experience with the snowstorm. The “predictable answer” stops the conversation in its tracks.

What are subject words?

Sean Cooper, known as the “shyness and social anxiety guy,” says we should look for “subject words” when talking with people because those will provide potential threads for a more meaningful conversation. For example: “I bought tires at the Goodyear station with my wife on Saturday” has four different keywords: tires, Goodyear, wife, and Saturday.” If you’re listening, it gives you four ways to turn the conversation into something more:

Tires — “Gee, I can’t remember the last time I changed my tires…”

Goodyear — “Is that the tire store off of Crenshaw Boulevard? Do they have good service?”

Wife — “How is your wife doing these days?”

Saturday — “Saturday was a lot of fun, I took my daughter to a horse stable."

Also, you can create better threads by asking more specific questions.

Autopilot question: “Do you come here often?”

Good question: “What’s your favorite drink at this bar?”

Autopilot question: “How are you doing?”

Good question: “What’s been the highlight of the week?”

Becoming good at small talk isn’t difficult as long as you can turn off autopilot and become more intentional with your questions and answers. Be sure to load up your responses with plenty of threads and keywords so that you’re partner can choose a direction for the conversation. As long as you keep threading the conversation, your relationship has room to grow and flourish.