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Companies keep selling harmful products – but history shows consumers can win in the end

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theconversation.com – Jonathan D. Quick, Adjunct Professor of Global Health, Duke Global Health Institute, Duke University – 2024-09-30 07:27:52

A “Cancer Country” sign on a taxi parodies a famous Marlboro campaign.

Viviane Moos/Corbis via Getty Images

Jonathan D. Quick, Duke University and Eszter Rimanyi, Duke University

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In 2023, 42 state attorneys general sued Meta to remove Instagram features that Meta’s own studies had shown – and independent research had confirmed – are harmful to teenage girls.

The same year, a report from the nonprofit Sandy Hook Promise found gun manufacturers were targeting the youth market with eye-catching ads and product placements in video games.

And in the run-up to the Paris Olympics, a leading international health journal urged the International Olympic Committee to end its relationship with Coca-Cola because of the increased obesity, diabetes, heart disease and high blood pressure associated with sugary drinks.

Social media, guns, sugar: These are all examples of what we call “market-driven epidemics.”

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When people think of epidemics, they might think they’re caused only by viruses or other germs. But as public health experts, we know that’s just part of the story. Commerce can cause epidemics, too. That’s why our team coined the phrase in a recent study because you can’t solve a problem without naming it.

Market-driven epidemics follow a familiar script. First, companies start selling an appealing, often addictive product. As more and more people start using it, the health harms become clearer. Yet even as evidence of grows and deaths pile up, sales continue to rise as companies resist efforts by health authorities, consumer groups and others to control them.

We see this pattern with many products , including social media platforms, firearms, sugar-sweetened beverages, ultra-processed foods, opioids, nicotine products, infant formula and alcohol. Collectively, their harm contributes to more than 1 million deaths in the U.S. each year.

How to fight a commercial epidemic

In our study, we asked two critical questions: Is it possible to combat such epidemics by changing the consumption patterns of millions of people? And if so, what does it take?

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We found the answers by looking at decades of efforts to reduce unhealthy consumption of three products: cigarettes, sugar and prescription opioids.

In each case, Americans kept consuming more and more of these products, even in the face of growing health concerns, until a tipping point was reached. That was followed by steady declines in consumption.

The immediate cause for each tipping point varied considerably. For cigarettes, it was the trusted, authoritative voice of the U.S. Surgeon General unequivocally declaring in 1964 that smoking causes cancer.

In the case of sugar, one of the key moments was a high-profile 1999 petition titled “America: Drowning In Sugar” submitted by the Center for Science in the Public Interest and supported by 72 leading public health organizations and experts. The petition urged the Food and Drug Administration to require food labels to disclose the number of added sugars and their percentage of the daily recommended intake.

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Once enacted, this policy helped consumers make healthier food choices, while also highlighting just how full of sugar many items on the market were.

And for prescription opioids, in 2011, the U.S. Centers for Disease Control and Prevention declared an opioid epidemic, signaling to doctors that they were overprescribing, and to the drug industry that it was acting irresponsibly.

In each case, came after years of persistent efforts by scientists, public health and advocates to sway public opinion, often against the deliberate efforts of corporations to undermine them.

The 1964 report on smoking came after a decade of confusion that the industry had sown to distract the public from the scientific consensus about the harms of tobacco. The report offered conclusive authority that changed the narrative. Smoking went from being viewed as a widely accepted social custom to a deadly habit almost overnight. Today, just 1 in 9 American adults smoke, down from nearly half of all adults in 1954.

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The push in 1999 by public health leaders connected the dots between rising obesity rates and sugar-laden foods and drinks. People began scrutinizing their diets, especially their sugar intake. As result, annual sugar consumption has since dropped by more than 15 pounds per person, erasing half of the amount of sugar Americans added to their diets between 1950 and 2000.

And the CDC report on opioids effectively communicated to doctors that they couldn’t just rely on to avoid misuse of the highly addictive drugs, underscoring their responsibility to control the epidemic by reducing prescriptions of opioids such as OxyContin. Since the report, opioid prescription has been reduced by 60% – more in line with actual medical need.

Learning from the past

While there are no easy solutions for today’s market-based epidemics, we can learn from history about steps that can be effective in reducing the consumption of harmful products.

Changing attitudes on smoking show that an authoritative governmental voice can still be immensely useful to combat corporate resistance and the spread of corporate mis- and disinformation.

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It can be effective to clear guidance about products and alternatives, as public health leaders did in telling consumers to cut consumption of sugar-sweetened beverages.

And from opioids, we can learn that applying pressure to those who make decisions about consumption, who are not always the consumers themselves, can be immensely powerful in bending patterns of use.

Despite the progress made in these three cases, the U.S. continues to face ongoing and emerging epidemics of unhealthy products. For example, while smoking has dramatically declined, the shift to vaping and other nicotine delivery products is creating new challenges, especially among teenagers.

Meanwhile, gun deaths keep rising, and firearms are now the leading killer of children under 18, and the gun industry remains committed to opposing public health measures to reduce gun violence.

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And ultra-processed foods now account for nearly 60% of the average American’s diet, yet as new evidence confirms their harms, the food industry defends them.

But our research shows that these problems can be solved – that it is in fact possible to change millions of Americans’ behavior. This is very good . It means sound evidence and public health action can turn the tide on some of the world’s biggest health challenges, potentially saving millions of lives and billions of dollars in health-care costs.The Conversation

Jonathan D. Quick, Adjunct Professor of Global Health, Duke Global Health Institute, Duke University and Eszter Rimanyi, Chronic disease and addiction epidemiologist, Duke University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The Conversation

Is it bad to listen to music all the time? Here’s how tunes can help or harm

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theconversation.com – Jillian Hubertz, Clinical Assistant Professor in Speech, Language, and Hearing Sciences, Purdue – 2024-09-30 07:24:28

Keep the volume of your personal listening device at or below 60%.

vm/E+ via Getty Images

Jillian Hubertz, Purdue University

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Curious Kids is a series for children of all ages. If you have a question you’d like an expert to answer, send it to curiouskidsus@theconversation.com.


I like to listen to music all the time. Are there any negative aspects to this? – Hussein, age 17, Iraq


Music surrounds us. It can be a companion throughout the day – listening on the way to school or work, checking out a favorite artist with friends, hearing it live at concerts and sporting , enjoying or enduring it in stores and restaurants, and then listening again in the evening to unwind.

As meaningful and uplifting as music can be, it might also you while studying, working on school projects and doing homework. As a clinical assistant professor of audiology, I can tell you the research shows that music can increase your focus and even motivate you.

This connection depends somewhat on the individual. Some people need silence while doing homework. Human brains are limited in their ability to multitask, and some people are better at doing two things at once compared with others. The of music, the activity you’re doing and the effort it takes to complete the work also matter.

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Some types of music work better than others

Numerous studies have discovered how music can affect study and work habits:

  1. Listening to instrumental or familiar music in the background competes less with a study assignment than music with lyrics or unfamiliar music. Instrumental music also seems to interfere less with reading comprehension and assignments requiring verbal and visual memory than does music with lyrics.

  2. One study showed soft, fast music had a positive impact on learning, but loud and fast, loud and slow, and soft and slow hindered learning.

  3. Upbeat music with a higher tempo may help when you’re doing something requiring movement or motivation, such as exercising or cleaning your room.

  4. The more difficult your task is – for instance, memorizing material, problem-solving or learning something new – the more likely the music is distracting and people often need to turn it off.

But before listening to your favorite sounds while studying, don’t miss an important detail: the volume.

If it’s too loud, the sound from speakers, headphones or earphones can contribute to noise-induced hearing loss.

The damage begins early

Whether listening through speakers, headphones or earbuds, too high a volume can damage your hearing. It’s known as noise-induced hearing loss, and it happens more often than you might think – those high-volume sounds can destroy tiny, delicate hair-like structures in the inner ear that help you hear.

Inner-ear damage can occur from a single exposure to an extremely loud sound or from repeated exposure to loud sounds over months or years. While some parts of the ear can repair themselves, the inner ear cannot fix itself.

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Close to 1 in 5 Americans ages 12 to 19 – about 17% – demonstrate signs of noise-induced hearing changes in one or both ears, which could eventually to hearing loss.

Volume, time, distance

How dangerous a sound is to your hearing depends on three things: the volume of the sound, the length of time you listen, and how close you are to the sound.

An illustration of a chart, somewhat shaped like a thermometer, which shows the decibel levels of many loud sounds.

The approximate levels of many loud sounds.

www.dangerousdecibels.org

Sounds are measured in decibels, or dB, and the dBA scale reflects how the human ear hears sound.

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Typically, sounds at or below 70 decibels are safe for listening. Conversations generally register at about 60 dBA, city traffic at about 80 dBA.

Sounds that may be harmful include lawn mowers, at roughly 95 dBA, rock concerts, at around 120 dBA, and , at about 140 dBA.

The World Health Organization suggests a sound allowance for weekly exposure, based on loudness. For example, you could listen to a 75 dBA sound for 40 hours per week. But listen to something at 89 dBA and that time allowance is drastically reduced, to about an hour and a half.

Signs you’ve been exposed to a dangerously loud sound include muffled hearing, ringing in the ears and difficulty having a conversation from 3 feet (1 meter) away.

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Although your hearing generally returns to normal after such an experience, there is a cost. This temporary shift in hearing could lead to permanent harm to inner-ear structures and ultimately damage your hearing.

How to stay safe

Technology not available even a few years ago can now alert you of a risky listening . A sound-level meter app measures the sound around you to determine whether it’s too loud. So can some smartwatches.

If listening through speakers, the sound-level app can warn you if your tunes are creeping toward too loud. When wearing headphones or earbuds, keep it at or below 60% of the volume by your device. One rule of thumb: If someone else can hear the sound emanating from your headphones or earbuds when they are an arm’s length away from you, the volume is too loud.

Use high-quality, noise-canceling headphones or earbuds to hear the audio at a safer, lower level. Some headphones also have volume limitations.

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Use hearing protection, such as disposable earplugs or earmuffs, when you’re around loud sounds, such as concerts, fireworks or a lawn mower.

You can also simply decrease listening time. Taking breaks lets you avoid overexposure.

Follow these tips and you should be able to enjoy your favorite music, and conversations for decades to . Pay attention to what music helps your concentration rather than distracts you, and your schoolwork might benefit, too.


Hello, curious kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to CuriousKidsUS@theconversation.com. Please tell us your name, age and the city where you live.

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And since curiosity has no age limit – adults, let us know what you’re wondering, too. We won’t be able to answer every question, but we will do our best.The Conversation

Jillian Hubertz, Clinical Assistant Professor in Speech, Language, and Hearing Sciences, Purdue University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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CubeSats, the tiniest of satellites, are changing the way we explore the solar system

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theconversation.com – Mustafa Aksoy, Assistant Professor of Electrical & Computer Engineering, at Albany, University of New York – 2024-09-27 07:32:30

Mustafa Aksoy, University at Albany, State University of New York

Most CubeSats weigh less than a bowling ball, and some are small enough to hold in your hand. But the impact these instruments are on exploration is gigantic. CubeSats – miniature, agile and cheap satellites – are revolutionizing how scientists study the cosmos.

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A standard-size CubeSat is tiny, about 4 pounds (roughly 2 kilograms). Some are larger, maybe four times the standard size, but others are no more than a pound.

As a professor of electrical and computer engineering who works with new space technologies, I can tell you that CubeSats are a simpler and far less costly way to reach other worlds.

Rather than carry many instruments with a vast array of purposes, these Lilliputian-size satellites typically focus on a single, specific scientific goal – whether discovering exoplanets or measuring the size of an asteroid. They are affordable throughout the space community, even to small startup, private companies and university laboratories.

Tiny satellites, big advantages

CubeSats’ advantages over larger satellites are significant. CubeSats are cheaper to develop and test. The savings of time and money means more frequent and diverse missions along with less risk. That alone increases the pace of discovery and space exploration.

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CubeSats don’t travel under their own power. Instead, they hitch a ride; they become part of the payload of a larger spacecraft. Stuffed into containers, they’re ejected into space by a spring mechanism attached to their dispensers. Once in space, they power on. CubeSats usually conclude their missions by burning up as they enter the atmosphere after their orbits slowly decay.

Case in point: A team of students at Brown University built a CubeSat in under 18 months for less than US$10,000. The satellite, about the size of a loaf of bread and developed to study the growing problem of space debris, was deployed off a SpaceX rocket in May 2022.

A CubeSat can go from whiteboard to space in less than a year.

Smaller size, single purpose

Sending a satellite into space is nothing new, of course. The Soviet Union launched Sputnik 1 into Earth orbit back in 1957. , about 10,000 active satellites are out there, and nearly all are engaged in communications, navigation, military defense, tech development or Earth studies. Only a few – less than 3% – are exploring space.

That is now changing. Satellites large and small are rapidly becoming the backbone of space research. These spacecrafts can now travel long distances to study planets and stars, places where human explorations or robot landings are costly, risky or simply impossible with the current technology.

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But the cost of building and launching traditional satellites is considerable. NASA’s lunar reconnaissance orbiter, launched in 2009, is roughly the size of a minivan and cost close to $600 million. The Mars reconnaissance orbiter, with a wingspan the length of a school bus, cost more than $700 million. The European Space Agency’s solar orbiter, a 4,000-pound (1,800-kilogram) probe designed to study the Sun, cost $1.5 . And the Europa Clipper – the length of a basketball court and to launch in October 2024 to the Jupiter moon Europa – will ultimately cost $5 billion.

These satellites, relatively large and stunningly complex, are vulnerable to potential failures, a not uncommon occurrence. In the blink of an eye, years of work and hundreds of millions of dollars could be lost in space.

Two scientists wearing masks, gloves, head coverings and white clean suits work on an instrument in a laboratory.
NASA scientists prep the ASTERIA spacecraft for its April 2017 launch.
NASA/JPL-Caltech

Exploring the Moon, Mars and the Milky Way

Because they are so small, CubeSats can be released in large numbers in a single launch, further reducing costs. Deploying them in batches – known as constellations – means multiple devices can make observations of the same phenomena.

For example, as part of the Artemis I mission in November 2022, NASA launched 10 CubeSats. The satellites are now to detect and map water on the Moon. These findings are crucial, not only for the upcoming Artemis missions but to the quest to sustain a permanent human presence on the lunar surface. The CubeSats cost $13 million.

The MarCO CubeSats – two of them – accompanied NASA’s Insight lander to Mars in 2018. They served as a real-time communications relay back to Earth during Insight’s entry, descent and landing on the Martian surface. As a bonus, they captured pictures of the planet with wide-angle cameras. They cost about $20 million.

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CubeSats have also studied nearby stars and exoplanets, which are worlds outside the solar system. In 2017, NASA’s Jet Propulsion Laboratory deployed ASTERIA, a CubeSat that observed 55 Cancri e, also known as Janssen, an exoplanet eight times larger than Earth, orbiting a star 41 light years away from us. In reconfirming the existence of that faraway world, ASTERIA became the smallest space instrument ever to detect an exoplanet.

Two more notable CubeSat space missions are on the way: HERA, scheduled to launch in October 2024, will deploy the European Space Agency’s first deep-space CubeSats to visit the Didymos asteroid system, which orbits between Mars and Jupiter in the asteroid belt.

And the M-Argo satellite, with a launch planned for 2025, will study the shape, mass and surface minerals of a soon-to-be-named asteroid. The size of a suitcase, M-Argo will be the smallest CubeSat to perform its own independent mission in interplanetary space.

The swift progress and substantial investments already made in CubeSat missions could make humans a multiplanetary species. But that journey will be a long one – and depends on the next generation of scientists to develop this dream.The Conversation

Mustafa AksoyUniversity at Albany, State University of New York

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Drug prices improved under Biden-Harris and Trump − but not for everyone, and not enough

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theconversation.com – C. Michael White, Distinguished Professor of Pharmacy Practice, of Connecticut – 2024-09-26 07:29:23

Negotiations to reduce drug prices can sometimes shift costs onto consumers.

rudisill/iStock via Getty Images Plus

C. Michael White, University of Connecticut

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When it comes to drug pricing, the Trump and Biden-Harris administrations both have some very modest wins to tout.

As director of the Health Outcomes, Policy, and Evidence Synthesis group at the University of Connecticut School of Pharmacy, I teach and study about the ethics of prescription drug prices and the complexities of drug pricing nationally.

Delving into the presidential candidates’ successes on a number of drug-pricing policies, you’ll see a continuation of progress across the administrations. Neither the Trump administration nor the Biden-Harris administration, however, has done anything to truly lower drug prices for the majority of Americans.

$35 insulin

Insulin is a necessity for with diabetes. But from January 2014 to April 2019, the average price per unit went from US$0.22 to $0.34 before dropping back slightly by July 2023 to $0.29 per unit. Since dosing is weight-based, insulin costs for someone weighing 154 pounds would have risen from $231 to $357 a month from 2014 to 2019 and dropped to $305 a month by 2023. Price increases have led some patients to space out their medications by taking less than the dose they need for good blood sugar control. One study estimated that over 25% of patients in an urban diabetes center were underusing their insulin.

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In July 2020, the Trump administration enacted a $35 cap on insulin copayments via executive order. In effect, it made participating Medicare Part D programs limit the price of just one of each type of insulin product to $35. For instance, if there were six short-acting insulin products on an insurance plan’s approved drug list, the insurer had to offer one vial form and one pen form at $35.

These price changes did not go into effect during Trump’s presidency. By 2022, only about 800,000 people – or around 11% of the more than 7.4 million people in the U.S. who use insulin to regulate their blood sugar – saw their prices reduced.

Person holding taking vial of insulin out of box

Millions of Americans need insulin to manage their diabetes.

Spencer Platt/Getty Images

In August 2022, the Biden-Harris administration signed the Inflation Reduction Act into . This maintained the $35 insulin cap with the same stipulations but made the program mandatory for all Medicare Part D and Medicare Part B members. This expanded the number of people who could benefit from cheaper insulin to 3.3 million.

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This still doesn’t help a majority of diabetics. If you don’t have Medicare, the $35 reduction does not apply to you. Furthermore, pharmaceutical companies are not responsible for lowering insulin costs under these policies, but health plans are on the hook for lowering copayments. Costs could be passed along to beneficiaries in future Medicare premiums.

Importing Canadian drugs

Americans pay nearly 2.6 times more for prescription drugs than people in other high-income countries. One way regulators have tried to reduce prices is to simply import drugs at the prices pharmaceutical companies charge those countries rather than those charged to U.S. consumers.

In July 2019, the Trump administration proposed importing drugs from Canada as a way to share Canadians’ lower drug costs with American consumers. He signed an executive order allowing the Food and Drug Administration to create the rules under which states could import the drugs. When President Joe Biden came into office, he left the executive order in place and the rulemaking process continued.

Two pharmacists behind the counter, shelves of drugs behind them and an American and Canadian flag before them

Some Americans have traveled across borders for cheaper medications.

Jeff Haynes/AFP via Getty Images

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No under the Trump or Biden-Harris administrations has yet been able to successfully import a Canadian drug product. In January 2024, however, the Food and Drug Administration approved Florida’s plan to import Canadian drugs, the first state to receive the green light. Colorado, New Hampshire, New Mexico and have applications pending as of September 2024.

Unfortunately, it is unlkely that Canada would allow their prescription drugs to be shipped in large quantities to American consumers, not without imposing high tariffs as a disincentive. That is because drug manufacturers could limit supplies to Canada and cause shortages if drugs are moved to the U.S. Manufacturers could also be less willing to negotiate lower prices for Canadians if that will hurt U.S. profits.

Negotiating with the pharmaceutical industry

Be it prescription drugs or cars, both buyer and seller must agree on a price for a successful sale to occur. If the potential buyer is unwilling to walk away from negotiations, you will not get the seller’s best price. One reason U.S. drug prices are higher than other countries’ is because the is not a shrewd negotiator.

Negotiations that result in major reductions in drug prices frequently result from the drug manufacturer losing access to patients on a certain health plan or ending up in a higher drug tier that substantially raises a patient’s copay. However, if the buyer refuses the seller’s final offer, their members or citizens lose access to those drugs. While major private health plans and pharmacy benefit managers are able to directly negotiate drug prices with pharmaceutical manufacturers, often with substantial savings, Medicare was prevented from doing so by federal law until recently.

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In May 2018, the Trump administration released a so-called blueprint for reducing prescription drug prices that included negotiating Medicare prescription drug prices with the pharmaceutical industry. This plan wasn’t enacted during his term.

In August 2022, under the Biden-Harris administration, the Inflation Reduction Act enabled price negotiation and specified the number of drugs that negotiations could include in a year.

The Inflation Reduction Act Medicare to negotiate drug prices for the first time.

The first negotiation between Medicare and the pharmaceutical industry took place over the summer of 2024, lowering costs for 10 Medicare Part D drugs, which include the blood thinner Xarelto and the drugs Farxiga and Jardiance, which treat Type 2 diabetes, heart failure and kidney disease. The resulting $1.5 in savings will be extended in 2026 to the approximately 8.8 million Medicare Part D patients who are taking these drugs. The prices for these drugs are still twice what they are in four other developed countries.

Prices will be negotiated for another 15 Medicare Part D drugs in 2027. Thereafter, drug negotiations could include Medicare Part D drugs, which you pick up from your pharmacy, and Medicare Part B drugs, which are administered or received from your doctor’s office.

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Another aspect of the Inflation Reduction Act is capping out-of-pocket expenses at $2,000. This won’t go into effect until 2025, however, and simply shifts costs above the cap onto taxpayers.

Continuation of progress

It is often challenging to attribute policy successes to one administration versus another when assessing complex issues such as drug pricing. There were ideas initiated during the Trump administration that did not to fruition until the Biden-Harris administration implemented and expanded on them.

For example, Medicare price negotiation, proposed in a Trump administration “blueprint,” was codified in law by President Biden, but the fruits of this policy will not be seen until the next administration. And regardless of who you attribute this to, only a portion of people on Medicare will see any relief from high drug prices as a result.

Truly lowering the costs of prescription drugs would require identifying the maximum price the nation is willing to pay for benefits, such as cost per quality adjusted life year at the federal, state and private payer levels, and being willing to walk away from negotiations if the price exceeds that level. This would not be a panacea, though, especially for patients with rare and ultrarare diseases, and would need to be eased in over time to avoid bankrupting the industry.The Conversation

C. Michael White, Distinguished Professor of Pharmacy Practice, University of Connecticut

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