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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, University 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

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 patients 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.

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 law. 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.

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

No state 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 Texas 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 government 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.

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.

YouTube video
The Inflation Reduction Act allowed 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 billion 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.

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 come 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 success 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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Colors are objective, according to two philosophers − even though the blue you see doesn’t match what I see

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theconversation.com – Elay Shech, Professor of Philosophy, Auburn University – 2025-04-25 07:55:00

What appear to be blue and green spirals are actually the same color.
Akiyoshi Kitaoka

Elay Shech, Auburn University and Michael Watkins, Auburn University

Is your green my green? Probably not. What appears as pure green to me will likely look a bit yellowish or blueish to you. This is because visual systems vary from person to person. Moreover, an object’s color may appear differently against different backgrounds or under different lighting.

These facts might naturally lead you to think that colors are subjective. That, unlike features such as length and temperature, colors are not objective features. Either nothing has a true color, or colors are relative to observers and their viewing conditions.

But perceptual variation has misled you. We are philosophers who study colors, objectivity and science, and we argue in our book “The Metaphysics of Colors” that colors are as objective as length and temperature.

Perceptual variation

There is a surprising amount of variation in how people perceive the world. If you offer a group of people a spectrum of color chips ranging from chartreuse to purple and asked them to pick the unique green chip – the chip with no yellow or blue in it – their choices would vary considerably. Indeed, there wouldn’t be a single chip that most observers would agree is unique green.

Generally, an object’s background can result in dramatic changes in how you perceive its colors. If you place a gray object against a lighter background, it will appear darker than if you place it against a darker background. This variation in perception is perhaps most striking when viewing an object under different lighting, where a red apple could look green or blue.

Of course, that you experience something differently does not prove that what is experienced is not objective. Water that feels cold to one person may not feel cold to another. And although we do not know who is feeling the water “correctly,” or whether that question even makes sense, we can know the temperature of the water and presume that this temperature is independent of your experience.

Similarly, that you can change the appearance of something’s color is not the same as changing its color. You can make an apple look green or blue, but that is not evidence that the apple is not red.

Apple under a gradient of red to blue light
Under different lighting conditions, objects take on different colors.
Gyozo Vaczi/iStock via Getty Images Plus

For comparison, the Moon appears larger when it’s on the horizon than when it appears near its zenith. But the size of the Moon has not changed, only its appearance. Hence, that the appearance of an object’s color or size varies is, by itself, no reason to think that its color and size are not objective features of the object. In other words, the properties of an object are independent of how they appear to you.

That said, given that there is so much variation in how objects appear, how do you determine what color something actually is? Is there a way to determine the color of something despite the many different experiences you might have of it?

Matching colors

Perhaps determining the color of something is to determine whether it is red or blue. But we suggest a different approach. Notice that squares that appear to be the same shade of pink against different backgrounds look different against the same background.

Green, purple and orange squares with smaller squares in shades of pink placed at their centers and at the bottom of the image
The smaller squares may appear to be the same color, but if you compare them with the strip of squares at the bottom, they’re actually different shades.
Shobdohin/Wikimedia Commons, CC BY-SA

It’s easy to assume that to prove colors are objective would require knowing which observers, lighting conditions and backgrounds are the best, or “normal.” But determining the right observers and viewing conditions is not required for determining the very specific color of an object, regardless of its name. And it is not required to determine whether two objects have the same color.

To determine whether two objects have the same color, an observer would need to view the objects side by side against the same background and under various lighting conditions. If you painted part of a room and find that you don’t have enough paint, for instance, finding a match might be very tricky. A color match requires that no observer under any lighting condition will see a difference between the new paint and the old.

YouTube video
Is the dress yellow and white or black and blue?

That two people can determine whether two objects have the same color even if they don’t agree on exactly what that color is – just as a pool of water can have a particular temperature without feeling the same to me and you – seems like compelling evidence to us that colors are objective features of our world.

Colors, science and indispensability

Everyday interactions with colors – such as matching paint samples, determining whether your shirt and pants clash, and even your ability to interpret works of art – are hard to explain if colors are not objective features of objects. But if you turn to science and look at the many ways that researchers think about colors, it becomes harder still.

For example, in the field of color science, scientific laws are used to explain how objects and light affect perception and the colors of other objects. Such laws, for instance, predict what happens when you mix colored pigments, when you view contrasting colors simultaneously or successively, and when you look at colored objects in various lighting conditions.

The philosophers Hilary Putnam and Willard van Orman Quine made famous what is known as the indispensability argument. The basic idea is that if something is indispensable to science, then it must be real and objective – otherwise, science wouldn’t work as well as it does.

For example, you may wonder whether unobservable entities such as electrons and electromagnetic fields really exist. But, so the argument goes, the best scientific explanations assume the existence of such entities and so they must exist. Similarly, because mathematics is indispensable to contemporary science, some philosophers argue that this means mathematical objects are objective and exist independently of a person’s mind.

Blue damselfish, seeming iridescent against a black background
The color of an animal can exert evolutionary pressure.
Paul Starosta/Stone via Getty Images

Likewise, we suggest that color plays an indispensable role in evolutionary biology. For example, researchers have argued that aposematism – the use of colors to signal a warning for predators – also benefits an animal’s ability to gather resources. Here, an animal’s coloration works directly to expand its food-gathering niche insofar as it informs potential predators that the animal is poisonous or venomous.

In fact, animals can exploit the fact that the same color pattern can be perceived differently by different perceivers. For instance, some damselfish have ultraviolet face patterns that help them be recognized by other members of their species and communicate with potential mates while remaining largely hidden to predators unable to perceive ultraviolet colors.

In sum, our ability to determine whether objects are colored the same or differently and the indispensable roles they play in science suggest that colors are as real and objective as length and temperature.The Conversation

Elay Shech, Professor of Philosophy, Auburn University and Michael Watkins, Professor of Philosophy, Auburn University

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Perfect brownies baked at high altitude are possible thanks to Colorado’s home economics pioneer Inga Allison

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theconversation.com – Tobi Jacobi, Professor of English, Colorado State University – 2025-04-22 07:47:00

Students work in the high-altitude baking laboratory.
Archives and Special Collections, Colorado State University

Tobi Jacobi, Colorado State University and Caitlin Clark, Colorado State University

Many bakers working at high altitudes have carefully followed a standard recipe only to reach into the oven to find a sunken cake, flat cookies or dry muffins.

Experienced mountain bakers know they need a few tricks to achieve the same results as their fellow artisans working at sea level.

These tricks are more than family lore, however. They originated in the early 20th century thanks to research on high-altitude baking done by Inga Allison, then a professor at Colorado State University. It was Allison’s scientific prowess and experimentation that brought us the possibility of perfect high-altitude brownies and other baked goods.

A recipe for brownies at high altitude.
Inga Allison’s high-altitude brownie recipe.
Archives and Special Collections, Colorado State University

We are two current academics at CSU whose work has been touched by Allison’s legacy.

One of us – Caitlin Clark – still relies on Allison’s lessons a century later in her work as a food scientist in Colorado. The other – Tobi Jacobi – is a scholar of women’s rhetoric and community writing, and an enthusiastic home baker in the Rocky Mountains, who learned about Allison while conducting archival research on women’s work and leadership at CSU.

That research developed into “Knowing Her,” an exhibition Jacobi developed with Suzanne Faris, a CSU sculpture professor. The exhibit highlights dozens of women across 100 years of women’s work and leadership at CSU and will be on display through mid-August 2025 in the CSU Fort Collins campus Morgan Library.

A pioneer in home economics

Inga Allison is one of the fascinating and accomplished women who is part of the exhibit.

Allison was born in 1876 in Illinois and attended the University of Chicago, where she completed the prestigious “science course” work that heavily influenced her career trajectory. Her studies and research also set the stage for her belief that women’s education was more than preparation for domestic life.

In 1908, Allison was hired as a faculty member in home economics at Colorado Agricultural College, which is now CSU. She joined a group of faculty who were beginning to study the effects of altitude on baking and crop growth. The department was located inside Guggenheim Hall, a building that was constructed for home economics education but lacked lab equipment or serious research materials.

A sepia-toned photograph of Inga Allison, a white woman in dark clothes with her hair pulled back.
Inga Allison was a professor of home economics at Colorado Agricultural College, where she developed recipes that worked in high altitudes.
Archives and Special Collections, Colorado State University

Allison took both the land grant mission of the university with its focus on teaching, research and extension and her particular charge to prepare women for the future seriously. She urged her students to move beyond simple conceptions of home economics as mere preparation for domestic life. She wanted them to engage with the physical, biological and social sciences to understand the larger context for home economics work.

Such thinking, according to CSU historian James E. Hansen, pushed women college students in the early 20th century to expand the reach of home economics to include “extension and welfare work, dietetics, institutional management, laboratory research work, child development and teaching.”

News articles from the early 1900s track Allison giving lectures like “The Economic Side of Natural Living” to the Colorado Health Club and talks on domestic science to ladies clubs and at schools across Colorado. One of her talks in 1910 focused on the art of dishwashing.

Allison became the home economics department chair in 1910 and eventually dean. In this leadership role, she urged then-CSU President Charles Lory to fund lab materials for the home economics department. It took 19 years for this dream to come to fruition.

In the meantime, Allison collaborated with Lory, who gave her access to lab equipment in the physics department. She pieced together equipment to conduct research on the relationship between cooking foods in water and atmospheric pressure, but systematic control of heat, temperature and pressure was difficult to achieve.

She sought other ways to conduct high-altitude experiments and traveled across Colorado where she worked with students to test baking recipes in varied conditions, including at 11,797 feet in a shelter house on Fall River Road near Estes Park.

Early 1900s car traveling in the Rocky Mountains.
Inga Allison tested her high-altitude baking recipes at 11,797 feet at the shelter house on Fall River Road, near Estes Park, Colorado.
Archives and Special Collections, Colorado State University

But Allison realized that recipes baked at 5,000 feet in Fort Collins and Denver simply didn’t work in higher altitudes. Little advancement in baking methods occurred until 1927, when the first altitude baking lab in the nation was constructed at CSU thanks to Allison’s research. The results were tangible — and tasty — as public dissemination of altitude-specific baking practices began.

A 1932 bulletin on baking at altitude offers hundreds of formulas for success at heights ranging from 4,000 feet to over 11,000 feet. Its author, Marjorie Peterson, a home economics staff person at the Colorado Experiment Station, credits Allison for her constructive suggestions and support in the development of the booklet.

Science of high-altitude baking

As a senior food scientist in a mountain state, one of us – Caitlin Clark – advises bakers on how to adjust their recipes to compensate for altitude. Thanks to Allison’s research, bakers at high altitude today can anticipate how the lower air pressure will affect their recipes and compensate by making small adjustments.

The first thing you have to understand before heading into the kitchen is that the higher the altitude, the lower the air pressure. This lower pressure has chemical and physical effects on baking.

Air pressure is a force that pushes back on all of the molecules in a system and prevents them from venturing off into the environment. Heat plays the opposite role – it adds energy and pushes molecules to escape.

When water is boiled, molecules escape by turning into steam. The less air pressure is pushing back, the less energy is required to make this happen. That’s why water boils at lower temperatures at higher altitudes – around 200 degrees Fahrenheit in Denver compared with 212 F at sea level.

So, when baking is done at high altitude, steam is produced at a lower temperature and earlier in the baking time. Carbon dioxide produced by leavening agents also expands more rapidly in the thinner air. This causes high-altitude baked goods to rise too early, before their structure has fully set, leading to collapsed cakes and flat muffins. Finally, the rapid evaporation of water leads to over-concentration of sugars and fats in the recipe, which can cause pastries to have a gummy, undesirable texture.

Allison learned that high-altitude bakers could adjust to their environment by reducing the amount of sugar or increasing liquids to prevent over-concentration, and using less of leavening agents like baking soda or baking powder to prevent dough from rising too quickly.

Allison was one of many groundbreaking women in the early 20th century who actively supported higher education for women and advanced research in science, politics, humanities and education in Colorado.

Others included Grace Espy-Patton, a professor of English and sociology at CSU from 1885 to 1896 who founded an early feminist journal and was the first woman to register to vote in Fort Collins. Miriam Palmer was an aphid specialist and master illustrator whose work crafting hyper-realistic wax apples in the early 1900s allowed farmers to confirm rediscovery of the lost Colorado Orange apple, a fruit that has been successfully propagated in recent years.

In 1945, Allison retired as both an emerita professor and emerita dean at CSU. She immediately stepped into the role of student and took classes in Russian and biochemistry.

In the fall of 1958, CSU opened a new dormitory for women that was named Allison Hall in her honor.

“I had supposed that such a thing happened only to the very rich or the very dead,” Allison told reporters at the dedication ceremony.

Read more of our stories about Colorado.The Conversation

Tobi Jacobi, Professor of English, Colorado State University and Caitlin Clark, Senior Food Scientist at the CSU Spur Food Innovation Center, Colorado State University

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Why don’t humans have hair all over their bodies? A biologist explains our lack of fur

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theconversation.com – Maria Chikina, Assistant Professor of Computational and Systems Biology, University of Pittsburgh – 2025-04-21 07:33:00

Some mammals are super hairy, some are not.
Ed Jones/AFP via Getty Images

Maria Chikina, University of Pittsburgh

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.


Why don’t humans have hair all over their bodies like other animals? – Murilo, age 5, Brazil


Have you ever wondered why you don’t have thick hair covering your whole body like a dog, cat or gorilla does?

Humans aren’t the only mammals with sparse hair. Elephants, rhinos and naked mole rats also have very little hair. It’s true for some marine mammals, such as whales and dolphins, too.

Scientists think the earliest mammals, which lived at the time of the dinosaurs, were quite hairy. But over hundreds of millions of years, a small handful of mammals, including humans, evolved to have less hair. What’s the advantage of not growing your own fur coat?

I’m a biologist who studies the genes that control hairiness in mammals. Why humans and a small number of other mammals are relatively hairless is an interesting question. It all comes down to whether certain genes are turned on or off.

Hair benefits

Hair and fur have many important jobs. They keep animals warm, protect their skin from the sun and injuries and help them blend into their surroundings.

They even assist animals in sensing their environment. Ever felt a tickle when something almost touches you? That’s your hair helping you detect things nearby.

Humans do have hair all over their bodies, but it is generally sparser and finer than that of our hairier relatives. A notable exception is the hair on our heads, which likely serves to protect the scalp from the sun. In human adults, the thicker hair that develops under the arms and between the legs likely reduces skin friction and aids in cooling by dispersing sweat.

So hair can be pretty beneficial. There must have been a strong evolutionary reason for people to lose so much of it.

Why humans lost their hair

The story begins about 7 million years ago, when humans and chimpanzees took different evolutionary paths. Although scientists can’t be sure why humans became less hairy, we have some strong theories that involve sweat.

Humans have far more sweat glands than chimps and other mammals do. Sweating keeps you cool. As sweat evaporates from your skin, heat energy is carried away from your body. This cooling system was likely crucial for early human ancestors, who lived in the hot African savanna.

Of course, there are plenty of mammals living in hot climates right now that are covered with fur. Early humans were able to hunt those kinds of animals by tiring them out over long chases in the heat – a strategy known as persistence hunting.

Humans didn’t need to be faster than the animals they hunted. They just needed to keep going until their prey got too hot and tired to flee. Being able to sweat a lot, without a thick coat of hair, made this endurance possible.

Genes that control hairiness

To better understand hairiness in mammals, my research team compared the genetic information of 62 different mammals, from humans to armadillos to dogs and squirrels. By lining up the DNA of all these different species, we were able to zero in on the genes linked to keeping or losing body hair.

Among the many discoveries we made, we learned humans still carry all the genes needed for a full coat of hair – they are just muted or switched off.

In the story of “Beauty and the Beast,” the Beast is covered in thick fur, which might seem like pure fantasy. But in real life some rare conditions can cause people to grow a lot of hair all over their bodies. This condition, called hypertrichosis, is very unusual and has been called “werewolf syndrome” because of how people who have it look.

A detailed painting of a man and a woman standing next to one another in historical looking clothes. The man's face is covered in hair, while the woman's is not.
Petrus Gonsalvus and his wife, Catherine, painted by Joris Hoefnagel, circa 1575.
National Gallery of Art

In the 1500s, a Spanish man named Petrus Gonsalvus was born with hypertrichosis. As a child he was sent in an iron cage like an animal to Henry II of France as a gift. It wasn’t long before the king realized Petrus was like any other person and could be educated. In time, he married a lady, forming the inspiration for the “Beauty and the Beast” story.

While you will probably never meet someone with this rare trait, it shows how genes can lead to unique and surprising changes in hair growth.


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.

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

Maria Chikina, Assistant Professor of Computational and Systems Biology, University of Pittsburgh

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