Express Scripts, Mylan, and the EpiPen

According to CNBC’s article, Mylan can lower EpiPen price today, Express Scripts says, Express Scripts’ Chief Medical Officer, Dr. Steve Miller told CNBC, “"If she [Mylan CEO Heather Bresch] wants to lower the price [of the EpiPen] she can lower the price today…We'd pass the savings that we take from the marketplace back to our plans." That is fine, as far as it goes, however, if Express Scripts really wants to help reign in pharmaceutical prices, they could give consumers more say in their medications.

As an example, I take valsartan to control my hypertension. Every three months, I receive a new supply from Express Scripts. Express Scripts puts on the label who manufactures it. In my case, the aalsartan comes from Mylan. Given the behavior of the current CEO of Mylan, I would prefer that none of my medications come from Mylan. lists a dozen generic manufacturers of V]valsartan.

Likewise, I take fenofibrate for high cholesterol. Like with the valsartan, Express Scripts has sent me fenofibrate manufactured by Mylan. I can’t find the list of other manufactures of fenofibrate, but I’m guessing there are choices there as well.

If Express Scripts would start shipping me medications not manufactured by Mylan, it would be a great start. If lots of patients started requesting the medication not be provided by Mylan, if at all possible, it would help return Adam Smith’s invisible hand to the pharmaceutical marketplace and prevent predatory pricing from companies like Mylan.

The Undoing Racism Challenge

It may be that the ALS Ice Bucket Challenge is close to running its course. More and more, I see people criticizing it, asking not to be tagged, etc. A friend who runs a rescue farm wrote about not having time, ice or money, and I thought, we need a farm chore challenge. Muck out a stall, feed some horses, and share a video of it online, or contribute to an animal rescue.

It made me think of another challenge, which I’ve been trying to get a chance to write a few thoughts about for the past couple weeks, the 100 days of gratitude challenge. One such gratitude I might post is about being able to safely let my twelve year old run around outside after dark with friends screaming and laughing and having fun. Not everyone gets to do that. In fact, far too few people get to do that.

It made me think of my friends who have black kids and the talks they have to have with their kids.

Today, another friend posted, “I love that the ALS challenge is capturing attention, wish we could create a Michael Brown Challenge....” Many friends replied and I started to reply there, but I thought it might be better as a blog post.

The power of the Ice Bucket Challenge is that it is something lots of people can participate in and share virally. Many of us may be too cash strapped to be able to contribute to the ALS Association, but we can at least help share the message with a video. What might be a good simple thing many people could do to help spread the word about undoing racism?

Since I had just gotten home from church, my thoughts started off in that direction. The church I currently go to is very diverse. It is one of the things I love about my church. However, at other times, I’ve attended churches that are very homogenous.

I remember years ago, when I was in college, a friend of mine invited me to go to church with him. We walked along the road together, and a car pulled up and asked if he was going to church. He said he was and that I was coming with him. We both climbed in the car and headed off to church.

As we walked up the steps, Ronnie introduced me to many of his friends. One, an older woman, looked me over closely and said, “I’m surprised you want to come to church with us.” I looked at her, puzzled. “Really?” I asked. “Why?” She got all flustered and apologized and said maybe she shouldn’t have said anything. I looked around for a clue as to what that was all about, and it slowly occurred to me. I was the only white person there.

During the service, there was a time for guests to get up and introduce themselves. I felt awkward and insecure as the eyes of a hundred black churchgoers looked at the only white person in the congregation.

For me, a white person who was not accustomed to being in the minority, it was an enlightening experience. I wondered if that was how some of my black friends often felt.

My first thought was that the undoing racism challenge for white folks might be something like going to a setting where they experience being in a minority. Yet getting people to take pictures of that and share it online might be a challenge, limiting the potential to go viral.

Instead, what if we made it simpler. Post a picture of yourself hugging someone from a different race or ethnicity and challenging your friends to do the same, and then perhaps attending some sort of undoing racism training or contributing to an organization aimed at undoing racism.

I realize it isn’t much of an ask, and I can imagine some of my racist friends who talk about how even one of their best friends is black, might participate to convince themselves they aren’t racist, but it is small enough and simple enough to be doable.


My Mom and the Ice Bucket Challenge

When my mother died two years ago, the obituary ended with “In lieu of flowers, the family asks that contributions be made to the International Essential Tremors Foundation.” I don’t remember how many people donated to the IETF in memory of my mother but for the next month the letters I received from IEFT when another person donated proved to be an important point of joy during my grief.

Recently, a friend’s grandson died. “Memorial contributions may be made to the Polycystic Kidney Disease Foundation.” I shared a link to the obituary and to the PKDF. Another friend lost her nephew at just about the same time. “Donations in his memory may be made to Ron’s Run for the Roses, The Ron Foley Foundation,”

If more people donated to the battles against essential tremors, polycystic kidney disease, or pancreatic cancer, we could make great progress. Yet these, and so many other diseases get so little attention.

I work in health care communications. I know how hard it is to get anyone’s attention these days. You send out an email and get 10% of the people to open the email, 1% to click on the link and even less than that to do anything. You post something on a Facebook page and get several hundred people to see it, a few to like it, maybe one or two to share it, and almost no one to act on it.

I know, working for a non-profit, and having been very involved in politics, how difficult it is to get people to contribute to anything. For most of us, money is very tight these days and writing a check for $100 can be a big challenge. So, what if we encouraged people who are tight on cash, to contribute what they can in different ways? What if we asked people to contribute $100 to an organization, but if they can’t spare the hundred bucks, they contribute their social capital in spreading the word and asking others to contribute? What if they used something that would get people’s attention to result in a higher conversion rate?

That’s what the Ice Bucket Challenge has done brilliantly. An article in the Sacarmento Bee on August 15th wrote:

Since July 29, the association has received $9.5 million in donations compared to $1.6 million during the same time period last year. The donations were from existing donors and 184,812 new donors.

A friend of mine died from ALS. My daughter, Fiona was challenged by her friends to take the Ice Bucket Challenge. She’s made her video and has shared it.

Yet, there is the expected backlash. Why waste clean water when so many people go without? How about sending the money you spent on ice to the charity instead of wasting the ice? Maybe if the people who protest so much would share the contribution acknowledgement letter they received it would be a little bit more persuasive.

Me? My wife and I both work for nonprofits. Money is tight. We get by. We’re not food insecure, and if things get really bad, we’ve got friends and relatives that can help out. We’ve been paying down our debts and my wife just got a raise, so perhaps someday soon, we’ll be able to contribute more to causes that matter to us. Until then, we’re going to use our social capital however we can.

So please, don’t let the naysayers distract you. Give what you can to organizations like the ALS Association, the International Essential Tremors Foundation, the Polycystic Kidney Disease Foundation, or The Ron Foley Foundation, even if it is just a little bit of your social capital.

Diversity of Stories

Rabbit, Rabbit, Rabbit. Another busy, rocky month comes to an end and we roll full force into summer mode. Last night, I stopped at the town pool to swim laps. So far this summer, I’ve swum over five miles in the town pool. On the way home, I stopped at the library and picked up a collection of short stories by Chimamanda Adichie. I mentioned her in my previous post.

She gave a TED Talk, The danger of a single story about misconceptions that can arise from hearing a single story, or single type of story. While she focused on literature, it just as easily apply to any medium. Perhaps the simplest example is the warped view people get from a diet of one cable talk news show or another. To some, this is old news as people promote studies showing that viewers of specific cable news channels are more misinformed than others.

Other’s criticize older institutions of journalism that tell us telling us “That’s the way it is” and that they print “all the news that’s fit to print”. That’s the way it is, from a particular cultural framework, it’s all the news that a certain set of editors embedded in their cultural constructs found was fit to print.

Yesterday, Google News and Facebook, using their algorithms to find things I’d be most interested in, showed me stories about the Hobby Lobby Supreme Court decision. Being interested in media, I’ve often looked at how different outlets select what stories get covered and none of this is new.

Thirty two years ago, I went to the big anti-nuclear rally in Central Park. Afterwards, I walked home to my apartment in Little Italy. In my mind, the rally was the top news story of the day. Then, I walked past a hearse outside of an East Village funeral home, with the hearse outside and the family mourning. For them, there was much bigger news.

With this in mind, I read one of Chimamanda Adichie’s short stories last night. It was about a young woman whose brother was arrested. This morning, I glanced at the headlines in Global Voices.

One of the stories that repeatedly showed up on my computer yesterday was about Facebook manipulating news feeds to study the effects on users’ emotions. It appears to have been completely legal, within the terms of service, but people question the ethics. Most of this has been around the ideas of tests on human subjects, something that is done more and more online. Yet it ties back to the larger story of how information is selected for us to view.

Recently, on Facebook, a friend posted a card which said something like, “Being creative is like having 2847 tabs open in your browser 24/7”. I had just written about closing tabs in my browser, and strongly related to this. A friend shared a link he had written a few years ago about this, The Great Media Garbage Patch.

Content is King—for a day. But eventually it takes its place among the flotsam and jetsam. Today’s treasure is tomorrow’s trash.

Kind of like Life…and Death. And new birth. The circle of life. Every new campaign (or book or poem or blog) is a challenge and a dare—to make a mark, however brief, in the face of unplanned obsolescence.

And so, another month begins. The big stories of last month are rapidly becoming the flotsam and jetsam of this month. Perhaps I’ll view this month from the vantage point of the town pool, mingled with thoughts of Nigerian short stories and see who Facebook shows this story to.

This is

Recently, I attended the OMMA conference about videos at Internet Week. One of the best talks was by Gary Osifchin of Mondelez, the parent company of Honey Maid graham crackers. He spoke about their “wholesome” campaign. He spoke about how people see graham crackers as wholesome, but that people often associate “wholesome” with “old-fashioned” or “boring”. In order to stand out in this world of constant advertising and marketing everywhere, you need to present a strong point of view.

He suggested that to make “wholesome” relevant and exciting against this background, you need to look at cultural truths, for example, the changing face of American families. It is a risky strategy, because there will always be people who rebel against changes in cultural truths, but I believe that Honey Maid’s “Wholesome” campaign was very successful and helped to get people to look at how the world is changing.

He spoke about how he hoped other brands would follow suit and how the wholesome campaign is not just a single set of ads, but is a ten year campaign. On twitter, they are using the hashtag “#ThisIsWholesome”. It made me stop and think about how this could be done for other brands.

“This is…” I work at a health center serving vulnerable populations. What would a campaign about “This is health” look like? Would it talk about programs we do to help people eat healthier food? Get more exercise? Read more? Become more involved in their community? All of that fits into broader discussions about health, including social determinants of health and health equity.

What about my run for State Representative? Can we change “This is politics” into something positive? Can we talk about caring for the vulnerable amongst us, instead of how so much politics of today seems to be about grabbing what you can for yourself at the expense of everyone else around you? Instead of politics, should we talk about governance, citizenship, responsibility, or some related idea? After all, it seems like the cultural truths are currently stacked up against any positive image of politics.

As I think about the phrase, “This is…”, various phrases come to mind. “This is… American Idol”. “This is Spinal Tap”, “This is water”, “This is my body, which is given for you”.

What do we want to declare as cultural truths? What do we hope such declarations will bring about?

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