The Irrationality of Drug Prices

“We have no rational signpost for when something is too expensive or fairly priced. ICER has stepped into that void.” Michael Sherman, Harvard Pilgrim Health Care


Source: OECD data

One of the failings of US health care is its high cost but roughly average quality compared to other industrialized countries. Per capita annual spending in the US was about $10,586 for 2018. Spending for Switzerland, the next closest country, was $7,317 for 2018. A major component of the non-competitive, high US costs is in the opaque irrationality of drug prices. Unlike other countries, the US does not have an agency that analyzes cost-benefit for drugs so that policymakers can base policy on data. At present, US drug pricing policy is non-existent. That is based mostly on campaign contributions.

A recent NPR broadcast of a segment produced by WBUR (Boston) on US drug pricing focused on an obscure non-profit organization called the Institute for Clinical and Economic Review (ICER). Poll data shows that about 75% of Americans believe drug prices are unreasonable. ICER asks if that belief is true.

WBUR writes:

A small nonprofit based in Boston has a rising reputation as the nation's “drug price watchdog.” It's also been called “big pharma's biggest threat.”

It might seem dull. And the name — the Institute for Clinical and Economic Review — could make anyone feel drowsy. But this quiet office is actually a powerful player in the increasingly furious fight over American drug prices.

“No matter how well we work with people, this is a contact sport,” Pearson says.

A whiteboard at one desk hints at its role. The writing reads: peanut allergy, heart disease, rheumatoid arthritis and an abbreviation — UPI, for “unsupported price increase.”

These are topics that ICER will be researching — to produce reports that can act like bombshells thrown into the drug price battle. Not that Pearson uses a bombshell style. He and his colleagues coolly calculate whether a drug is cost-effective, whether it's worth its price.

For example, when a powerful new drug to lower high cholesterol came out in 2014 priced at $14,000 a year, ICER calculated that it was only worth about $3,000, putting pressure on the drug's maker to lower the price — which it later did.

Pearson says ICER looks into treatments where the evidence is hard to understand “and where the question about the value to patients and the system is going to be something where our research can help make it more transparent. So that can include treatments for very acute severe conditions like cancer, it can include preventive strategies for things like peanut allergy, and anything in between.”

ICER calculates how much each drug extends a patient's life and improves their life. It uses a complex economic model; in the simplest terms, it considers a drug cost-effective if it costs no more than $150,000 per year of quality life it gives the average patient.

“Ultimately, we want to be able to figure out what a fair price is so that we can get better access and make it affordable and sustainable for the long-term, while making sure that we reward the people who really bring good innovation into our system,” Pearson said.

It's no small task for an independent nonprofit with just about 30 full-time staffers. In other developed countries, a government agency decides on drug prices and value. In the United Kingdom, which has a national health care system, that agency goes by the acronym NICE.

Given America's pay-to-play political system, it is no wonder that US drug prices are often unreasonably high. Not surprisingly, drug companies are mounting the usual corporate defense, i.e., attack the source of the bad information as biased, flawed, etc.: “Some critics dispute whether ICER is truly objective, and question its methodology and goals. “I say, ‘ICER, they make reports for insurance so that insurance can deny you care,’ ” says Terry Wilcox, executive director of Patients Rising, a national advocacy group mainly funded by drug companies. It runs a website called ICERWatch that keeps a critical eye on what ICER does. At PhRMA, the national trade group for drugmakers, senior director of policy and research Lauren Neves says PhRMA supports the type of research on value that ICER does. But it has concerns about how insurers use the ICER reports to deny coverage.”

Patients Rising sounds like a group that pretends to be for patients but is there to defend corporate profits. That is standard corporate propaganda practice.

Is high US drug cost real a failure of the capitalist, for-profit US health care system? Should drugs be priced at whatever the market will bear, regardless of (1) any cost-benefit concern, or (2) whether people are unable to pay?

B&B orig: 7/17/19

The Tyrant’s Cancer Spreads Through Law Enforcement

The President's efforts to poison the rule of law are beginning to have real impacts. RawStory reports:

Judge blocks effort to conceal details in Trump campaign crimes case as Bill Barr’s DOJ mysteriously closes the probe

A federal judge confirmed on Wednesday that the Justice Department has ended its investigation into campaign finance crimes committed by former Trump lawyer Michael Cohen, indicating that no one else will face charges in the case. But Judge William Pauley also announced that, over the government’s objections, he will be making many of the underlying documents in the case public without requested redactions.

The case stemmed from Cohen’s efforts during the 2016 campaign to secure hush money payments for two women who said they had affairs with Donald Trump. Since investigators determined these payments were done in order to help secure Trump’s victory, the spending counted as campaign contributions that were never recorded and were, in fact, illegally concealed. The Trump Organization, Cohen has said, helped repay him for the costs of the hush money while disguising the payment falsely as a legal retainer.

For these and other crimes to which he pleaded guilty, Cohen has been sentenced to three years in prison. But neither Trump nor no one else apparently involved in the scheme appears to be vulnerable to charges in the case.

As a sitting president, of course, Trump could not be charged with a crime under current Justice Department policy regardless of the evidence. Such a policy wouldn’t protect the president’s son or anyone else involved in his company, though.

A federal judge confirmed on Wednesday that the Justice Department has ended its investigation into campaign finance crimes committed by former Trump lawyer Michael Cohen, indicating that no one else will face charges in the case. But Judge William Pauley also announced that, over the government’s objections, he will be making many of the underlying documents in the case public without requested redactions.

The case stemmed from Cohen’s efforts during the 2016 campaign to secure hush money payments for two women who said they had affairs with Donald Trump. Since investigators determined these payments were done in order to help secure Trump’s victory, the spending counted as campaign contributions that were never recorded and were, in fact, illegally concealed. The Trump Organization, Cohen has said, helped repay him for the costs of the hush money while disguising the payment falsely as a legal retainer.

Cohen implicated Trump directly in the crime, saying the then-candidate coordinated with him and directed him to make the payments. There is even a public recording of the pair seeming to discuss one of the payments. Donald Trump Jr., too, maybe implicated in the crime because he allegedly signed some of the repayment checks to Cohen.

For these and other crimes to which he pleaded guilty, Cohen has been sentenced to three years in prison. But neither Trump nor no one else apparently involved in the scheme appears to be vulnerable to charges in the case.

As a sitting president, of course, Trump could not be charged with a crime under current Justice Department policy regardless of the evidence. Such a policy wouldn’t protect the president’s son or anyone else involved in his company, though.

So the public has been left with many questions about this case. Would the president have been charged with any related crimes were he not in office? Why weren’t charges brought against other people who appear to have been involved? And was Attorney General Bill Barr — who was chosen by Trump to protect him in the special counsel’s investigation and has shown a clear desire to exonerate the president from any wrongdoing — involvement in the final decisions?

Additionally: Why weren’t any Trump Organization officials questioned by the investigators in the Southern District of New York, if a recent CNN report is correct?

“[The] weighty public ramifications of the conduct described in the campaign finance portions warrant disclosure,” he wrote. “Moreover, the involvement of most of the relevant third-party actors is now public knowledge, undercutting the need for continued secrecy. … On balance, the ‘strong presumption of public access’ to search warrants and search warrant materials under the common law far outweighs the weakened privacy interests at play here.”

He also argued that the matter is “of national importance” and that “it is time that every American has an opportunity to scrutinize the Materials.”

The tyrant is pleased: Trump’s lawyers are happy with the shutdown of the investigation: “We are pleased that the investigations surrounding these ridiculous campaign finance allegations is now closed,” Jay Sekulow, the president’s attorney, said Wednesday according to USA Today. “We have maintained from the outset that the president never engaged in any campaign finance violation.”

Death of the law: Shutting down threatening investigations is a major component of how a tyrant can slowly kill a democracy. By undermining the rule of law, the poison of the tyrant’s growing lawlessness and his criminal operatives spreads with impunity. The rule of law in America is falling to a kleptocratic tyrant. It is happening in plain sight. Congressional republicans show no sign of concern over the developing cancer that is strangling the rule of law. Arguably, the GOP leadership is now fully complicit.

Trump’s poison can be expected to spread to the federal courts as Trump appointed judges begin protecting him from transparency, uncomfortable investigations and the rule of law. In this case, the judge refused to allow the dirty laundry in court papers to be kept hidden from the American people. Assuming the DoJ actually complies with the judge’s order, that is a victory for transparency and the rule of law.

As time passes, victories in court like this will become less frequent. Then they will cease altogether. That is when we will know the rule of law died. It will have morphed into whatever the tyrant says it is.

B&B orig: 7/18/19

We're looking at this wrong

Author: Spooky action at a distance

A few days ago I had to apologise to Germaine for an incoherent post. I've decided to try writing my first 'discussion point' and explain what I was thinking with more clarity and not shoe horning it into other topics....

First a few statements/axioms to build from:

1. Humans have some deep biases in the way we process information. We tend to be emotional not rational first.
2. People are pretty bad at spotting their own biases, you can improve but never get true objective clarity.
3. Changing people's minds tends to be difficult because of the biases.
4. No 'system' is perfect and people will try and game every system.
Those I think are statements which can be proved, however, I will also add...

5. People tend to want 'rules' and 'order' and get invested in their world view as it gives them certainty but like all things 'biological' there are a range of responses.

Which I'm happy to be challenged on but my point is based on these...

The last 50-60 years has seen some major changes in western civilisation. Loads of previous 'rules' which defined society have been abandoned and new rules about accepting people have come in.

This has caused friction and tension, as society changes and experiences 'growing pangs' and old rules are removed.

However, we're now at an interesting point....we're moving from replacing 'rules' with 'new rules' to, in some areas 'anything goes' ….. take transgender. Used to be Gay = bad then gay = ok now people are being asked to accept whatever = ok.

However, the new ways of thinking aren't easy....yes some people are transgender and the world should accept them for this. However, some people will use this to game the system and take advantage.

And this is where it becomes more difficult - these concerns are right, there may be issues. To deny them only increases the fear and anxiety in others and causes the revulsion against them.

When people are frightened they tend to react angrily and retreat to where they do feel safe - rigidity and defined behaviours of right and wrong. The biases that then protect these positions also entrench them.

So when a 'liberal' shouts down the concerns of 'conservatives' they are themselves helping to create the animosity and adversarial atmosphere they are upset about.

And the stupid thing is that the liberal viewpoint has nearly 'won'...

This link is to Pew Research shows how views have changed since 1994 to 2014.

Pew Research on Ideological Consistency

It shows something amazing - yes that since 2004 there is a polarisation BUT overall there is still a shift to 'liberal' positions. The median position is far more liberal now than when the survey started and the true 'conservative' is now in a minority.

My position is that we're looking at this wrong. Liberals get triggered when conservatives call us names and think that they are nasty and racist but actually they are frightened and lashing out because they aren't sure what the rules are. Sure there are people who take advantage of that (Trump) but there always will be and the way to change their mind isn't to denigrate them as to them Trump is giving vent to their fears....the best way to help is to help reduce their fears.

A generation ago we created safe spaces for Women and LGB people to help them learn to be confident in a society that was coming to terms with their new position. I propose we need to do the same for conservatives and make them feel safe in the new society that they no longer feel part of.

B&B orig: 7/19/19

The Psychology of Hate

Whew! Good thing they didn't include atheists in the groups -- we all know where those odious toads would rank -- presumably, the alt-right would rank itself at 100

An article in the San Diego Union-Tribune discusses the sources of hate.

Researchers have identified a number of powerful dynamics at work in the festering of hate, but at the core it is about identity and fear.

Psychological distress — a sense of meaningless that stems from anxious uncertainty — is a key stimulator driving someone to extreme political ideologies, whether it be the far right or left, according to an article published this year by the international Association for Psychological Science.

The argument goes hand-in-hand with the “significance-quest theory,” which says people become radicalized because they need to feel important and respected by supporting a meaningful cause.

“Distressing personal or societal events ... undermine the extent to which perceivers experience the world as meaningful and therefore stimulate people to regain a sense of purpose through strong and clear-cut ideological convictions,” according to the article’s authors, Netherlands academics Jan-Willem van Prooijen and Andre Krouwel.

This can lead to an oversimplified perception of the world, the authors said. “Feelings of distress prompt a desire for clarity, and extremist belief systems provide meaning to a complex social environment through a set of straightforward assumptions that make the world more comprehensible.”

This tendency to create a simplistic narrative to make sense of the world helps explain the popularity of conspiracy theories among political extremists.

Simplicity and overconfidence in their ideological positions turn into moral absolutes. “Such moral superiority implies that different values and beliefs — and the groups of people who endorse them — are considered morally inferior.”

That’s when intolerance takes hold.

White supremacist ideas become more relatable to a wider audience during periods of rapid social change, said Kevan Feshami, a doctoral candidate at University of Colorado Boulder studying white nationalist history and culture.

“It’s these ideas of social decline, that our traditions are not being kept up and our world is falling apart,” said Feshami.

Today’s white supremacist messaging focuses on perceived threats from a shifting demographic and resentment of calls to change societal and institutional systems that have historically favored whites.

In white supremacy propaganda, whites are the victims, not the haters.

“Hate is a mask that covers insecurities,” Schafer concluded from his research. “When we’re insecure, it’s typically because we fear something. Something threatens us.”

People who’ve accomplished important things — according to her or his own beliefs — can easily raise their self-esteem by internally comparing themselves to others, said Robert Sternberg, author of the book “The Psychology of Hate.”

“But some people have not accomplished much. So people can begin to derogate others to lift themselves up, even for no reasons others would consider valid,” said Sternberg, professor of human development at Cornell University and past president of the American Psychological Association. “Hate helps one do that. One artificially inflates oneself, one’s group, or whatever, and strengthens the self-inflation by hating those who don’t live up to one’s falsely created narrative.”

Which leads to another important dynamic: the desire to hate together.

The alt-right scored high on extreme distrust of mainstream media, strong support for Trump and strong support for collective action on behalf of whites, including agreement with statements such as “Whites need to start looking out more for one another” and “We need to do more to stop the mixing of the white race with other races,” according to the study.

The alt-right was also “more willing to dehumanize historically disadvantaged groups and groups that might politically oppose the alt-right.”

The study used a dehumanization model asking participants to rate on a sliding scale how evolved they view certain groups to be. The scale corresponds to images of a primate evolving into a man.

The alt-right found whites to be most evolved and viewed Muslims, feminists, journalists, Arabs, blacks and Mexicans as Neanderthal-like.

This research is new and the work needs to be replicated, confirmed and expanded. However, if these initial findings about the alt-right mindset are reasonably accurate, one can guess what government with them in charge would look like, i.e., good for most white people (but not those degenerate feminists and journalists) and less good for others.

A research paper the article refers to, A Psychological Profile of the Alt-Right, is not yet through peer-review and changes may need to be made.

B&B orig: 7/22/19