This isn't mentioned in the story, but the father of the woman who runs the company is in the Senate (D, WV).
An EpiPen costs more than an iPad? WTFF!?
And, of course, you need to keep buying them, because they have a limited shelf life.
Meanwhile in Britain, they'll cost you about £30 (rapidly approaching $14). And there are cheaper alternatives. http://www.lincolnmedical.co.uk/calculator/Cost-effective%20emergency%20treatment%20of%20anaphylaxis.pdf
The mainstream economist says: hmm, this is a puzzle. Monopoly pricing (and monopoly profits) should generate market competition. So... why hasn't that happened? It must be impossible to create competition because of a patent! No, the patent has expired. So that can't be it. Ok, so what's going on? The FDA is being very bizarrely difficult about approving a generic alternative?. Ah, got it. That makes sense.
Meanwhile in Britain, they'll cost you about £30 (rapidly approaching $14).
I assume I'd only have to pay $20 for one. At least insurance tends to cover all but (at most) $20 for everything I get prescribed. The people actually billed $600 are mostly poorer, even before having to pay $600 for an epipen.
Someone is probably now going to tell me that all the information in 10 was already covered in the link in the OP. If that's the case, consider 10 a public service for the people who don't read the links.
And comment 10 was of course not in any way intended to suggest that big pharma isn't scum or that late stage capitalism isn't grift and corruption all the way down. Of course it is. Everyone involved should be executed.
What's bizarre about the FDA being slow? They live on slow and they have no incentives to be faster here. They get blamed if the new pen is a problem (they've already had to take one off the market because of problems), there is no claim that the new pens will work any better than the old ones (they will rush a medicine through approval if it can help something that nothing else can help but this isn't the case here), and they don't pay for the pens regardless.
The FDA isn't a cost-containment mechanism, is what I'm saying.
Ha. I didn't realize Moby was on Manchin's payroll now.
I did decline to apply for jobs at a health insurer because what I'm doing now seemed more interesting and pouring over billing data.
And because I currently get four weeks vacation, plus holidays (including all the days between Christmas and New Years) and personal days.
6: Unfortunately, I don't believe that there is an app for [allergic reations].
I heard that Theranos had one almost ready to go, but the FDA shut it down.
I hope to someday work for big pharma, at which point you can tell me to fuck myself.
Artisanal hand-stretched pharma is better.
On a random big pharma asshole related note, Martin Sh/kreli recently got into trading in high-priced Magic: the Gathering cards, which could hardly be more perfect.
The obvious solution is for the US to just to make a big enough monopsony when it comes to drugs that this kind of gouging isn't worth doing (possibly by allowing insurance companies/pharmacies/etc. to buy through the government as well, so it wouldn't just be medicare-is-cheap and otherwise everything costs an insane amount.) That and, you know, giving the FDA a lot more funding since most of the problems with it look to me like what you get when you just don't have enough money/people for the size of the task.
That or just create a government agency that produces and sells reasonable-cost generics so that we don't get the ridiculous pricing schemes* we see right now. (Even if it isn't provable, which it probably isn't, I have trouble believing there isn't at least some kind of general unstated agreement between pharmaceutical companies to not compete on everything.)
*Hilariously at least for a while there were generic versions of some drugs priced higher than the brand name. My assumption is that some company (reasonably) observed that a lot of plans/buyers/patients (who would be charged more by their insurance for the brand name) would automatically prefer the generic brand of a drug to the brand name version so they charged more for it.
(possibly by allowing insurance companies/pharmacies/etc. to buy through the government as well, so it wouldn't just be medicare-is-cheap and otherwise everything costs an insane amount.)
Without that, you'd basically have the system we have now.
I just meant some purchasers paying (relatively) reasonable prices and those who can't negotiate paying much, much more.
Boy, wouldn't you think that the FDA should have approving generic alternatives as a high priority?
My limited understanding of this is that things used to be primarily profit-center driven, that is, how much do drugs X and Y need to bring in each year in profits to cover expected expenses (marketing, legal, hookers, sunk costs of failed drugs A-P) plus corporate profit margin, and what market and bulk purchaser prices will generate expected sales at different levels to meet those goals. Now a lot of individual drugs are priced on a regimen cost vs. the alternate treatment costs. That's the argument behind the HCV drugs, lifetime treatment of someone with a failing liver is hundreds of thousands, so if they charge only $100k to cure it's still considered a cost savings to the insurance company. I'm not sure how this works in the case of epi-pens, since a lot of times the alternative is death (with human lives valued by various government agencies in the range of low millions) or in terms of medical expenses immediate surgery, treatment for coma or brain damage, etc. So jacking up the price to many hundreds is still seen as a bargain and in the absence of competition or regulation I don't see it stopping.
30: They've gotten in trouble in the past for approving things that turned out not to be equivalent to the brand name version (and hence also the other generics out there). Approving generic versions is probably quicker in that they really just need to know if it's the same as the previous drug, but also slower in that they really need to know that because there may be four different generics out there and people will get switched between them depending on what the pharmacy is buying that month.*
*I actually did get stung in the budeprion fiasco, though only very mildly and maybe two or three months before the FDA recalled the Teva ones.
I actually did get stung in the budeprion fiasco
Maybe your stance is too wide.
I actually did get stung in the budeprion fiasco
Worst autocorrect error ever.
they have no incentives to be faster here
I think changing this was part of the stated idea behind charging user fees to help fund the FDA - obviously it didn't work on top of bringing regulatory capture into a new realm.
Maybe the $600 epipen will incentivize pharma to find a cure for whatever is killing all the bees.
Yeah, this sucks. We just bought a new batch* a few weeks ago and I was shocked.
* The pens are nominally good for a year, but that doesn't mean you get a year's use out of one, because odds are you're buying mid-cycle. Buying in May and the pens expire in October? Too bad!
Should you be able to get the cheap kind you have to fill for yourself?
It's a sign of the decadence of current economic thinking (out of deference to weaker sensibilities I will not say "capitalism") that there is basically no deference by the powerful to the concept of a fair price. Without competition, pharma will happily use ransomer's logic and admit they are charging based on people's willingness to pay through the nose to stay alive. (The talk of "R&D costs", which was always obfuscation, is barely even a fig leaf in the case of Sovaldi.)
odds are you're buying mid-cycle. Buying in May and the pens expire in October? Too bad!
At the very least they should price them on a sliding scale - so much per remaining effective month. Maybe you could bribe the seller to give you one with a longer remaining life?
I tried that with gold fish. It didn't work.
I was going to try it in reverse with a dog, but people here convinced me that going to animal rescue and asking for a dog that is expected to die before my son goes to college would be taken poorly by the volunteers on staff.
I wonder why "Doggy Carrousel" has never taken over as the replacement phrase for when you euthanize a pet dog.
I am stuck on dog films now.
Bring Me The Thrown Tennis Ball Of Alfredo Garcia.
Three Colours: Light Grey
Three Colours: White
Three Colours: Dark Grey
Cold Nose Luke
Forty-Nine Years In Tibet
I am regularly amused/horrified by the little note on all my prescription drugs about how much money my insurance saved me. I think the highest lately was $1500 for a 30-pill bottle of fancy ibuprofen, but I have several that are high-three-digits per month. Sucks to be my crappy insurance company, though, since I was done with my deductible in February and now they're just stuck paying for everything*.
*Except all the times when they randomly refuse. Hooray, Big Insurance!
Does using a syringe really require "extensive medical training"? Trans people and diabetics inject themselves regularly. I was taught to do so by a nurse in 10 mins.
46: So what do you do with films that are already dog-themed?
Cat Day Afternoon
Reservoir Kittens
My Life as a Cat
Un Chat Andalou
49: Is the deal with the epi-pen that the person who knows ahead of time they're going to need it may not be in shape to give it, so you want something really easy for a bystander to administer?
||
Is it remotely normal to control family access to food like this? This seems way over any line I had ever imagined. (Note: linked material grows long and dull.)
|>
Housetraining Day
Like Water for Poison
53: Taking a shot for an allergic reaction isn't the same as taking a regular injection. Even if you've been trained and are not impaired in such a manner that you can't give the shot, that training is still likely a long time past and thus close to worthless unless you practice regularly. Even then, the training was conducted when you were calm.
54: that strikes me as nuts. They ate pizza at 10pm!!!! SHOCKO WHAT BAD CHOICES
Locking the cabinets and fridge doesn't solve anything if you don't also lock the bathrooms so that if they get outside food, they can't shit without letting you know.
I didn't read the all the responses, but I searched for "fucknuttery" and was very surprised nobody used the word.
54: I thought the advice the LW got back was remarkably level-headed and constructive.
49 - Epipens are used in emergency situations, such as in schools, where teachers are expected to administer them to students. It would be much harder to train non-medical personnel to safely use a syringe in an emergency. Also, a lot of teachers would not be willing to receive syringe training, because there's a much higher risk of a bad outcome.
54 is crazy. Who locks their refrigerator and forces their teenaged kid to ask for permission before drinking a glass of juice or eating a sandwich?
I'm not ready to call the letter writer bonkers without knowing what the kids are like.
Ice cream makes a very nice breakfast.
Especially if there is also cake.
I'm a bit more strict. Cake is a fine breakfast, but no ice cream, even if you finish your cake first.
I don't let my kids eat whenever they want, but that's because they're five and three. As soon as they're old enough to get their own food *and* clean up after themselves, they can go to town.
Wow. It's like they've never met children before.
(I mean, I did use to eat my mother's secret chocolate stash which was very very bad and no good, but I also replaced it for her. Usually.)
54 sounds like sound parenting if you want to give your kids eating disorders and have them hate you for life.
63: I kind of want to call the rule bonkers, because she's disagreeing with her husband about it, and the specifics of the bad food choices sound pretty weak. I can imagine behavior where it'd be intolerable to let the kids have access to the kitchen, but it's way past what she's talking about.
63 is a good point, except that all of the examples the letter writer gives -- late night pizza, sweets in the morning -- seem totally normal.
The second responder down has bigger problems -- she and her son have to hide food from her son's father (presumably the responder's partner?), because he will eat all the snacks in the house, "including the snacks for my son's baseball game the next day." (I assume this means snacks for the team?) Dude, wtf.
Yeah, I feel bad now that I'm reading the comments. This one from another parent of an ADHD child sounds like it can be a good idea, depending on what the kids are like:
"Our kid has ADHD (he's 9), and locking up the fridge actually helped him to regulate himself more effectively: he knows he must ask politely for access to certain food spaces, so it's good practice for him regarding many impulsive habits like speaking out of turn, pushing/pulling us to get what he wants, etc; we've seen improvements on all fronts once we locked up the fridge. Moreover, he seems relieved that he no longer feels compelled to gorge himself on food when we're not around."
That being said, what she describes in the OP is totally normal behaviour, so it's hard to tell.
We lock up our frig and lock the door to the basement to limit my stepdaughter's access to food. She's alone in the house a lot and she's been known to make poor food choices -- for example if she has access to any cheese (other then swiss) she will eat all of it.
73 Who moved my cheese?
I've always seen it (canonically) Pfuck Pfarma, myself . . .
74: Hey! I'm the only one allowed to use that!
Hard to say without knowing the kids or specifics - can't tell if it's normal lousy food choices or something more compulsive.
Surely there's a drug they can give the kids instead of locking the food away.
I'll share my food with the kid, no problem. But I'm keeping all my drugs.
80: Ironically, ADHD drugs are appetite suppressants.
ADHD drugs are basically speed, no?
Guess Who's Coming to Drink from the Toilet
76 An apt exception I thought.
Can we have a new Brexit thread? Things are getting weirder over there by the day and I wouldn't have thought that possible.
The only thing I know about Theresa May is that her name must produce some excitingly broken headlines. Crash blossoms blooming all over the place.
The Wikipedia page on her government is simply entitled "May ministry."
||
I've got a few hours to kill in the Atlanta airport, so I'm hanging out in the Delta Sky Club. I feel like a class traitor--but not enough to leave.
|>
You could find the most harried looking coach passenger and bring them in as a guest.
That will almost certainly result in an unwanted romantic or Amway-related request. Nevermind.
Try the most hairy-looking instead.
At least know who's first against the wall: these assholes loudly doing business on their cell phones.
How'd you get the gun past security?
I brought my device manufacturer's ID card for those, but haven't needed it yet.
"Thus isn't for terrorism. Class warfare only."
I'm at the gate now, and have declined to purchase any of the fifteen levels of seat upgrades Delta now offers. Guilt assuaged!
I think you have every excuse to justify some extra luxury, J.
"Class traitor" isn't actually a bad term to describe the only time in my life I ended up in first class on a plane (due to some kind of random upgrade for no reason, as far as I could tell*). I know it's supposed to be nicer, and I guess in a physical sense it was. But I felt genuinely uncomfortable about it the whole time and I think I probably would have been happier/less-bothered in coach.
(I guess the bit where they have you board first and then parade everyone else by you as you sit there relaxed is supposed to be part of the appeal? I mostly just felt like I was being shamed.)
*See!? I'm making excuses!
I do admit to always paying the extra $20 to board first on Southwest flights.
(I guess the bit where they have you board first and then parade everyone else by you as you sit there relaxed is supposed to be part of the appeal? I mostly just felt like I was being shamed.)
I have never understood the appeal in that. It's not like you're fighting for overhead bin space. The only benefit I can see is drinking earlier, but honestly I'd rather board later without the shame. And I do try to make judging eye contact with first classers.
105: I always check in exactly 24 hours ahead of time.
The Good Boy, The Bad and The Ugly
The Bone Collector*
The Postman Always Gets Angry When You Try to Bite His Fingers
* does it count to reimagine this as an adorable family movie about a goofy dog who starts to copy his squirrel friend, instead of a second-rate thriller?
I have elite status on Alaska, so I get upgraded to first class fairly often (or I did back when I was flying a lot for work, anyway). It is a bit nicer, but also weird. In addition to the things others have mentioned, there's the way the flight attendants are noticeably more attentive, almost obsequious. It's not necessarily all rich people in this context, though, as there are a lot of other people like me who just rack up a lot of miles by flying around the state for work.
Yes. My brother had whatever Delta gives you for hitting a million miles. It was all work and he eventually switched jobs because he wanted to not fly so much.
I admit that it has been pretty nice doing so much less flying lately. I'm sure it means I'll lose my elite status next year, but that's fine.
I hate flying (also I fear flying, especially take-off and landing, because o my God, how can this actually be happening?! we're in a metal box, hurtling through the atmosphere at an ungodly speed, and we're all about to die!...).
I have never been upgraded to first class, or economy-plus, or comfort, or anything better than the coach/economy seat that I purchased online from a discount provider. Therefore, I always try to go for an aisle seat. When I'm squished in like a sardine in a tin, I want the illusion of an escape. In the unlikely event of an emergency, path lighting will guide you to the nearest exit. And also: your seat cushion will serve as a flotation device. Do I believe the FAA-approved safety announcements? No, not really. I figure we're all going to die. But I want an aisle seat, nevertheless.
Elite frequent flier status on an airline is the ultimate "you win but you lose." I've never been less happy than my Executive Platinum years.
If only that were a hair style.
I'm thinking a modified mullet: very short at the front, a bit longish at the back, with a distinguished touch of grey.
I really do not understand can be like this, but I still try to find the answer, although it is still too long to find it ...
117: close, but I think this is actually what you're after
https://en.wikipedia.org/wiki/Bart_Chilton
I knew the chances of dying in plane crash were very low, but I just Googled it and it's like one in 4 million (I saw numbers all over the place, but that's highest death rate I saw). Now I feel like I should fly more -- I have to think my day-to-day is more dangerous than that.
104: That happened to me once and it was dreadful. I've been upgraded to first class a couple of times on short flights, where first class is not so much nicer that it's embarassing. But once I got upgraded on a jumbo jet with those big pod seats. I had to resist apologizing to every person who walked by.
I had low-level elite status up until recently, and it was surprising to me how used I got to feeling entitled. Now that I'm back in the slow lines for everything, I find myself resenting being stuck with the masses.
Yes, we got bumped to business class on one of our flights this vacation. It really was basically embarrassing.
The biggest perk of flying J-class for me, on the rare occasions I've done it, is lounge access. Nothing better after a long-haul flight than being able to get a shower and some decent food and a comfortable chair somewhere quiet.
I sleep pretty much the whole time on flights anyway, so all the leg room and so on are basically wasted on me. But the lounges, aaahhh.
I fly reasonably often for work, but not enough to have any perks. I always take an aisle seat, though.
I have flown first class once, but it was a very short flight (to the Channel Islands) to there wasn't much to show for it except the nice lounge at the end.
Way back when, I used to be able to book flights through an agency that specialized in making travel arrangements for missionaries, and I'd get bumped up to business class at least every other flight. Maybe the airlines thought we were more likely to be grateful and well behaved?
I'm usually booked under Dr ttaM, on behalf of the University of Oxenforde, but that makes no difference at all.
It's been centuries since that place was associated with missionaries.
re: 128
In 'taking things literally' humourless mode.
Not true, I used to work for a religious college at Oxford that is still involved with missionary work.
And decades since academics had a reputation for being grateful or well behaved.
re: 131
I think more Christian aid type work than actual proselytising, on the whole. But yes.
Academics ever had a reputation for being grateful or well behaved!?
I used to get upgraded more often, back when flights weren't as crowded. As a relatively large human, it makes a real difference to me.
When my son and I would fly out to Montana for our annual spring break ski trip, we'd split the upgrades. The flight attendants would laughingly bring me a glass of red wine during my steerage legs, as requested by the 10 year old in first class.
Last month I had a flight get cancelled, and when they shifted me to the new flight they put me in seat 1F. A new experience! A comfortable seat! But I guess the entirety of the front of the airplane was normal people who had been bumped up, instead of the elite people who deserve it, so there was no special service or attention.
I'm always on Southwest, so 1F just means that you don't have any storage under the seat.
The only time I've flown nice or been upgraded was coming back from Austin (so a business trip!) and some massive line of storms screwed up flights. I was in a commuter plane, so my first class seat was both window and aisle. I had to work, so it wasn't super-relaxing, but the endless refills of Jack & Coke were nice. As 120.2 said, where first class is not so much nicer that it's embarrassing. Indeed, while the aisle/window was an undeniably nice setup, I'm not sure the seat was any wider than normal, and it felt ever so slightly like I was in an extra chair shoved against the wall at a house concert or something.
These days first class is *entirely* composed of frequent fliers and upgrades plus the occasional ordinary folk splurging to stroke their egos. Everyone who's actually anyone flies private.
The closest I've been to an upgrade is JetBlue bumped me to an extra legroom seat because I checked in late. This resulted in me sitting next to my boss (technically boss' boss' boss, one of the four directors of the whole place) for three hours and struggling to engage in impressive conversation instead of falling asleep.
Even on our pseudo-honeymoon (pseudo in that it was a family reunion where we then went off on our own for an additional week), pre-9/11 when airlines were more generous, and we told the check-in agent hint hint we just got married we didn't get anything.
Upgrades are now entirely based on status w strict rules, also 140 is right.
You want four food processors and leg room?
I am flying today. I am picky about sitting near the back, because once I read that you're more likely to survive a plane crash in the way back, and it stuck with me.
Plus, if you sit in the very back, you get to smell the toilet and thus death seems less of a bother.
We're flying (again) tomorrow- our previous two legs they had the now usual food has to be purchased, except they were very generous to kids giving them free headphones and food* and activities. Then I realized it's not generosity, it's to keep the kids quiet. A few cuts in service and they'll hand you benadryl on the way in to the gate instead.
*Although not very helpful for the vegetarians on one leg- ham and cheese. And the one meat eating kid doesn't like mayonnaise which is on all the sandwiches. In other words, I was well fed.
I am picky about sitting near the back, because once I read that you're more likely to survive a plane crash in the way back, and it stuck with me.
I do this too! Of course it means I'm one of the last to board (and all the overhead bins are stuffed full), and also one of the last to get off the damn plane.
Flying to Switzerland next week and I'll happily be in business class (work is paying, but we waited until it was relatively cheap). It's an overnight flight and I find I can't sleep in an economy seat at all, so the serious lie-back is key if I'm not going to be miserable for seven hours or so.
Swiss business class is very nice. Enough so that the idea that there's an even-higher first class is kind of scary.
147: Same here. I always go for a window seat, left side of the plane, as far back as I can get. If I was serious about survival I'd go with an aisle seat but I like leaning against the side of the plane and napping too much.
Does back of the plane really make much of a difference? I kind of thought that plane crashes were divided into hard crashes where pretty much everyone dies on impact, and bad landings where the plane burns, where the big issue is getting out the exits.
According to this (warning: autolaunch sound), it makes a very big difference in terms of percentages, if the plane does crash. Once you factor in the odds of the plane crashing, I'm pretty sure that it matters not at all given anything like a plausible number of flights in a human life.
148: Where are you going to be?
Zurich, for about a week. The larger team I work for is split between here and there.
I got a text from United: they found my passport. Relief!
It was in a briefcase full of cocaine.
girl x is doing quite a lot better in AZ with a big change of scene, careful diet and PT and new pain specialist etc. down to 1/4 of her previous narcotic pain meds and muscle relaxers. some struggle along the way but I'm really proud of her.
the two of us flew narnia airlines suites/first class and it was mind-bogglingly fabulous. she was in so much pain that it was the only way we could imagine getting her anywhere. since there was no one else they let us configure two seats as seats and two as an entire double bed with sheets (the me lying down next to her was the crucial part). lounges were the bomb and they had actual caviar. probably never do it again in my life, but that's nothing but good if it comes out of her recovering enough to be a coach class warrior again.
Awesome news and very happy to hear it.
Oh thank goodness, ala.
And Narnia Airlines coach is close to heaven for me, I literally can't imagine 1st class.
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