#5SmartReads - November 16, 2022

Hitha on culture wars, caring for others, and a nerd rant on drug costs

November 16, 2022

Listen - I am all for the public and private sector working together to reduce unbearably high prescription drug costs. But I don’t think this is the way.

And it has to do with how we distribute drugs into this country. Here’s the path on how a drug goes from manufacturer to patient in the United States:

  1. The drug manufacturer sends supply to the major distributors: Cardinal Health, McKesson, AmerisourceBergen (definitely to 1, sometimes to 2 or all 3)

  2. Pharmacy benefit managers and group purchasing organizations (of which there are many) negotiate price and place orders from the distributors.

  3. Pharmacies (retail, online/mail, hospital) receive the medications by placing orders from the PBMs and GPOs and dispense them to the patients, where the patients pay whatever cost was negotiated by their insurance provider or an out-of-pocket price set by the pharmacy.

  4. What makes Mark Cuban’s Cost Plus Drugs different is that they are both a PBM & a pharmacy - they negotiate the price with distributors directly, and deliver the drugs to patients. They do not take insurance, but charge patients the cost they paid for the drug + 15% (a fair margin to operate the business and ship the medicine to you).

What happens when you import drugs from abroad? They still have to go through this entire system, thus negating any cost savings this bill claims to deliver.

And that’s just the cost of medication. There are other safety issues that come with drug importation, and I wonder how FDA will audit the facilities these drugs are manufactured in when there aren’t enough inspectors to perform full annual audits already.

I firmly believe we need to take decisive action to reduce the cost of healthcare - and especially drugs - in the United States. This isn’t it - rather, I would recommend a public-private partnership between HHS and industry (manufacturers, distributors, PBMs and GPOs, and pharmacies) to set accessible costs for the most commonly used medicines in the country.

As a patient right now, I would absolutely look up my prescription on GoodRx to find the best price for my prescription and compare it against Mark Cuban’s Cost Plus Drugs, and go with the cheapest option.

Thank you for indulging my healthcare nerdout.

Joyland is an exquisite film. And that it’s been banned in Pakistan - the country where it was made and whose people made the film and is an Oscar contender - is absolutely heartbreaking.

The movie is centered on an affair between a married man and a trans woman, brilliantly portrayed by Alina Khan. And she shines, both in the role and in depicting a side of trans people we rarely see in South Asian art:

“She’s a badass, strong-willed, fiercely independent, dominating, outspoken woman, everything that I am not; I loved the role I played,” said Khan. When she was offered the role, she was relieved not to play an “oppressed” character “which is the life for most transgenders in Pakistan”.

I can’t change what the Pakistani government will do - but I do hope I’ve influenced you to check out this film with friends or your loved one, and to gather after the film to discuss it.

Instead of banning inclusive films and stories, I’d like to see the film industry - anywhere - address how they’ve protected assaulters and predators and harmed the lives of so many people in the process.

“Beginning in 2001, [Scott] Weinberg worked on more than 90 episodes of Scrubs as a writer, a supervising producer and a co-executive producer. His conduct finally got him fired in 2006, midway through the show’s fifth season, but thanks to his credit on the hit series and a boys’-club network of comedy writers that continued to hire him, Weinberg worked in the business for another 10 years. Despite subsequent complaints and firings, he was staffed again and again — even after a 2014 arrest for rape. (The district attorney’s office declined to file charges at the time, citing a lack of evidence.)”

As Meg Conley aptly wrote about the VC industry in yesterday’s smart reads, the system protects these predators because “they want white male power to stay the same.”

And while some women, gender minorities, and people of color have consistently shown up to rewrite a better future, we won’t get there until the predominantly white men who run things make that change with us.

Anne Helen Petersen’s newsletter is such a bright spot on the Internet. And while I’ve declared previous articles to be my favorite that she’s ever written, this one decidedly takes the cake.

Building upon a menu of self-care (a practice I learned from Amanda Ngyuen and highly recommend), this is a guide for your loved ones to have on hands when you’re going through some stuff and they want to support you the way you need to be.

Genius.

I’m quick to send friends a food delivery or a delivery gift card when they’re sick or send texts telling them I’m thinking of them, but I don’t know how many of them need to be taken care of. If 2023 is the year of slowing down and strengthening my relationships, then this is a great place to start.

Desalination is expensive, energy-intensive, can harm marine life, and delivers lower than needed yields.

But as the water crisis grows worse worldwide, it’s worth taking a second look at this technology and to see where we can improve and scale this technology, and use it only when needed or necessary.

No single technology will be perfect or meet our needs. And while I’m by no means pushing for a full scale move to desalination, I do think pilot projects to evaluate environmental strain and yield are worth exploring.

“Feldman, of UC Irvine, agreed, saying it’s important for the state to maintain a diversified water portfolio that includes reuse, rainwater harvesting and conservation so as not to put all of its “eggs in one basket.”

“Rather than try to identify a panacea, we should ask ourselves a series of questions,” he said. “What makes most sense technologically, economically, risk-wise and public acceptability-wise for our needs?””

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