Saturday, November 19, 2011

Woman the Shopper. Man the Scientist. A Funny Sci-Fi Story

You can read it in the Nature magazine. It is about two extremely intelligent science guys sent out to buy girls' knickers/panties by the wife of one of them, and how these extremely intelligent gentlemen could not find those knickers anywhere, even though their wives easily could. Which means that the knickers are brought in from a parallel universes only women can access. But at least men can do abstract science!

The flavor of the story:
At this point I must digress, and mention, for those who are not aware, the profound differences in strategy between Men Going Shopping and Women Going Shopping. In any general shopping situation, men hunt: that is, they go into a complex environment with a few clear objectives, achieve those, and leave. Women, on the other hand, gather: such that any mission to buy just bread and milk could turn into an extended foraging expedition that also snares a to-die-for pair of discounted shoes; a useful new mop; three sorts of new cook-in sauces; and possibly a selection of frozen fish.
And the interesting thing is — and this is what sparked the discovery — that any male would be very hard pressed to say where she got some of these things, even if he accompanied her.

Verrry good! I like those clear objectives Men The Hunters have, how they enter a complex environment, catch their animal and return home. Now contrast this to the next part of the story:
So there we were, looking for knickers, and a rather wary woman asked if she could help, given that we looked lost and hopeless. Russell explained to her exactly what we were looking for, and her wariness seemed to become mild alarm, until we hastened to reassure her that this was in fact a commission for the mother of said child. She then said, with what seemed to be great satisfaction, “Oh, no; you'll never find those in here — you'll have to go down to [some remote location],” which we had no chance of achieving before they closed, so the whole mission was now a failure.
Mmm. Yes, I know all this falls under the Humorous Stories About Blundering Men. But really, where were those clear objectives and simple strategies?

Others have written about the hidden message in this story to women who would be scientists, so it might be more useful if I wrote about the role practice has here.

Like in practicing by finding where certain items are sold. That practice usually comes from having to do that shopping, over and over and over again. After a while one miraculously learns (from a parallel universe, most likely) that girls' knickers are not available at the fish counter of the local supermarket! Or that the local pharmacy/chemist does not sell snow tires for your car.

And after you learn about those snow tires, you might, while waiting for your car to be shod with them, also pick up some new windshield/windscreen wipers and this neat little snow-scraping appliance which also defrosts the keyholes of the car and serves as an extra flashlight/torch! All that comes from a parallel universe which you can only access through repeated practice and by being on the lookout for certain products.

I astonish myself! I am ruining a perfectly good funny-sci-fi story by pointing out that it's not really that funny if you are not like that smart science guy whose practice in shopping for children's clothing consists of mostly making evo-psycho explanations for why women seem innately better at it.

But it's worth ruining because of the real parallel universe lurking behind this story. In that universe, men are such blundering fools when it comes to shopping or finding their socks that it is really very cute! Besides, no man need ever get any better at those skills because they are innate blunderings, though nicely balanced out by men's scientific superiority.

Katha Pollitt on The Sandusky Case

She writes:

And that brings us to the patriarchal aspect of the Penn State scandal. I know it’s predictable and boring, but come on, people! There really is a message here about masculine privilege: the deification of a powerful old man who can do no wrong, an all-male hierarchy protecting itself (hello, pedophile priests), a culture of entitlement and a truly astonishing lack of concern about sexual violence. This last is old news, unfortunately: sexual assaults by athletes are regularly covered up or lightly punished by administrations, even in high school, and society really doesn’t care all that much. A federal appeals court declared that a Texas cheerleader could be kicked off the squad (and made to contribute to the school’s legal costs) for refusing to cheer her rapist when he took the field—and he’d pleaded guilty to misdemeanor assault too, so why was he even still playing? According to USA Today, an athlete accused of a sex crime has a very good chance of getting away with it. If Sandusky had abused little girls, let alone teenage or adult women, would he be in trouble today? Or would we say, like the neighbors of an 11-year-old gang-raped in Cleveland, Texas, that she was asking for it?
And she is quite right. The eleven-year-old in Cleveland, Texas, had her case initially written up in the New York Times as victim-blaming. She wore make-up, she dressed like an adult woman, she went out with the rapists. And where was her mother in all this? That the Times later wrote about the case from a different angle was because of all the criticism the initial write-up provoked.

Even more generally, victim-blaming has been almost totally absent in the Catholic Church cases. This is as it should be, of course. But the same should be applied to female children who have been raped or sexually abused and to their parents.

Today's Pepper-Spray Picture

The deed courtesy of the UC Davis campus police.

I haven't written much on the Occupy movement because others do it well and because I don't have anything to add to the general debate. Still, I see the movement as an attempt at democracy when democracy is no longer truly functioning in this country (or quite a few other countries).

Money and power have married each other, and the rest of us are offered only slates of candidates which money and power have pre-picked. Is it even possible to get elected to the US Congress if you don't belong to the very top of the one percent? And by the time you have fund-raised enough for your election campaign, whom do you owe your allegiance?

Friday, November 18, 2011

Blogging While Female

Sadie Doyle writes about Internet misogyny, a topic I also wrote about a while ago.

The topic Sadie covers is not for laughs but this is hilarious:
Last October, cartoonist Gabby Schulz published a comic about Internet sexism. Titled, in part, “How Every Single Discussion About Sexism And Woman-Type Stuff On The Internet Has Ever Happened,” it detailed a familiar cycle: Man says sexist thing, woman responds, men shout at woman, etc.
Within 24 hours, “men’s rights” blog The Spearhead fulfilled Schultz’s prophecy. Their post, titled “Feminist Cartoonist Bemoans Online Resistance, Claims She is Enslaved by Patriarchy When Men Disagree With Her,” sniffed that Schultz’s cartoon “supposedly depicts what happened when she called some guy sexist.” Predictably sexist comments followed: “I bet ole Gabby is soaking wet with all the attention shes getting tonight,” one Spearhead commenter opined. ”Shut the fuck up you stupid cunt,” wrote another. Yet another wrote, “I am not being sexist when I say I do think your point of view is lesbic: you seem to despise all men.” Schulz reports receiving death threats.
So far, so predictable. Except for one tiny detail: Gabby Schulz is a guy. His biography — easily accessible from the offending post — shows him with a full beard, and uses the pronoun “him.” The comic was based on a controversy surrounding cartoonist Kate Beaton. But many harassers had no inclination to fact-check: If someone named “Gabby” didn’t like sexism, that someone had to be a self-pitying girl.
Speaking of hilarious trolling, I get a big laugh from those trolls who tell me I obviously cannot think at all or who correct me in the field of my doctorate because they took an intro course once, and me being but a feeble-minded foaming c***t must be corrected. It really is funny.

Asshattery is not gender-linked, as such, but the patronizing and loud teachery tone without any actual listening is an odd perk we female bloggers get.

Here Under the Northern Star. A Musical Interlude.

This is a Finnish song which is supposed to be quite hard to sing. I think its sole aim in life is to present as many Finnish h-sounds as possible. But I have a soft spot for the sadness of it all.

A rough translation:


Here under the Northern Star
on the highest of hills
I look far into distance
you return to my dreams.

Here under the Northern Star
the sky fills with purple
it makes me a blanket
to shelter me.


And under the Northern Star
I come
I leave
and only in the sight of the Northern Star
I shed a tear for you.


Here under the Northern Star
a singer is full of sorrows
here the moon gibbous
is also melancholic

Here under the Northern Star
frost slides into the soul
and by killing all feeling
it rips the heart apart.

Repeat of 2.
Repeat of 1.
Repeat of 2.
Repeat of 2.


Thursday, November 17, 2011

Comfort the Afflicted And Afflict the Comfortable. The Media and the Sandusky Case.

The quote, attributed to Peter Dunne, is one way of defining the moral task of the press. That this task has been slowly drowning in the she-said-he-said-and-some-people-say ocean of pretend-neutrality has made me very sad and angry.

Hence my pleasure in finding that at least some in the press are doing their jobs on the Sandusky child abuse allegations. Otherwise I would not have learned of the conflict-of-interest problems of Leslie Dutchcot, the judge who granted Sandusky bail:
The judge who freed Jerry Sandusky on bail that was lower than prosecutors requested -- and said he didn't require an ankle monitor -- has not only volunteered for Sandusky's Second Mile charity but also reportedly benefited from a fundraiser organized by a Second Mile official.
Now she has been replaced as the judge in the Sandusky hearings by an out-of-county judge. The reason? This:
“Due to the unique circumstances surrounding this case, it was essential that every precaution be taken to ensure all legal proceedings occur without the appearance of bias on the part of the judicial system,” said Vereb.
“With this particular case, it would have been extremely difficult to find a judge without some connection to Penn State, The Second Mile or any alleged victims. Assigning the case to an out-of-county judge takes away any hint of bias or conflict of interest.”
Probably. But that quote reminds us that the comfortable lunch with the comfortable, fund-raise with the comfortable and in general move within a tight circle consisting of other quite-comfortable-thank-you folks. And this is the reason why the press cannot live inside that same circle.

The most recent installment of the Sandusky allegations has to do with the mysterious disappearing files at Second Mile, the charity which Sandusky appears to have used for grooming boys:
According to unnamed Times' sources, investigators served subpoenas on the Second Mile to learn the names of every child who dealt with the foundation. Members of the charity's board of directors learned recently that records from 2000 to 2003 were missing.
The charity has since located the records from one of those years, the newspaper reported, but the rest remain gone.
"It could be that they are just lost, but under the circumstances it is suspicious," a law enforcement official involved in the case told the Times.

I hope those files turn up. But whether they do or not, it is important to learn that they are currently missing.

It may be worth pointing out that the way I read "comfortable" and "afflicted" in that quotation is not necessarily based on material wealth but on societal power. Those who think that laws apply to only little people, those who buy their way out of problems which would send others to prison, those are the comfortable. If the press does not afflict them, who will?

Why Must We Do This? On How Male and Female Survivors of Childhood Sexual Abuse Might Differ. May Trigger.

An article discussing male survivors of childhood sexual abuse covers much useful material and many opinions. Its relevance is obvious in view of the Sandunsky case.

But read this section of the piece:
Different experience for boys 

Sexual abuse has a different impact on boys than on girls, and they deal with it differently because of socialization, experts say.
“Men aren’t supposed to be victims. Men are supposed to be strong,” said Jim Hopper, clinical instructor of psychology at Harvard Medical School. “A man says I’m not a real man, because I let someone do this to me. I should have been tougher. Even after years of therapy they say this.”
Girls who are abused by men are psychologically damaged, to be sure, experts say, but boys abused by men often come to question their sexual identity and orientation.
“If they were sexually abused by a man, there’s this whole stigma — does that mean I’m gay, or did he do it to me because I look gay?” says Hopper.
Another difference: Boys who are forced into sexual acts may have an erection — a physiological response which makes them all the more confused and ashamed of the encounter, Gartner says.

I am not an expert in this field, but is it not the case that female victims of rape or other sexual abuse can feel sexual arousal and even orgasm? I'm pretty sure that I have read about that and the way it can cause feelings of shame and confusion.

If that's the case, the last difference mentioned is not an actual difference.

What about the second-but-last difference? The article compares two different types of abuse. In one type, adult men abuse young girls. In the other type, adult men abuse young boys. That male victims of the latter type of abuse are more likely to question their sexual identity and orientation may not be because they are boys. It may be because their abuser was of the same sex.

To properly compare boys and girls here the abusers should all be of the same gender as the victims or all of a different gender than the victims.

Finally, the first difference mentioned in the article: How boys are not expected to be victims. When you turn that around you get to the conclusion that girls ARE expected to be victims. I understand what the expert means here and I agree that this is a problem in getting the survivors to come forward when they need help.

At the same time, that's the part where I asked myself why we must do this? Why can't all victims of sexual abuse be taken equally seriously? Why must an article tell us how it might be harder if you are not viewed as born weak and a potential victim anyway? There are better ways of framing the important information about the difficulties men may face when seeking help.

A Fascinating Interview

With the 84-year-old Seattle activist, Dorli Rainey, who got pepper-sprayed by the Seattle police. I like the idea of taking just one step out of one's comfort zone when it comes to activism.

Wednesday, November 16, 2011

What Is Pat Buchanan Good For?

Atrios gives him the World's Worst Person badge today, because of Pat's clever statements about the obvious link between same-sex marriage and the Sandunsky child abuse case.

I have written about Pat's views on us wimmin in the past. But Pat is an equal-opportunity-bigot, pretty much.

Hence the question in the title of this post. Why is a man like that always invited to political debates on television?

Here's my guess for the answer: The American mainstream media views acceptable political opinions along a half-line. It has an absolute starting point, the most extreme lefty opinions allowed on television, and those tend to be pretty milquetoast ones. No fire-breathing lefties on American television, never.

Indeed, this left end-point used to consist of what I call courteous conservatives. It has been pushed back a bit, but not by much.

The other end point, however, is always the most foaming-at-the-mouth wingnut bigot you can possibly unearth, always! That's why I call the system not a line but a half-line (probably not the real name for something like that), because the right end-point can be moved further and further out, so that it always allows for the extremest of the extremists!

I don't mind having Buchanan on television, not at all. What I DO mind is that we are not allowed to have his lefty equivalent on television.

This imbalance works out equally strongly when it comes to feminism, by the way. The anti-feminists always get invited to the shows, the so-called feminist side might consist of only the interviewing journalists who try to take a middle-of-the-road or he-says-she-says-but-some-people-believe stance.

All US mainstream debates are biased by the way the extreme opinions are picked, and the bias works in favor of the conservative and anti-feminist views.

Very Proud of Myself

I spent five hours yesterday driving in Boston. To explain why that makes me feel proud and a bigger-than-normal goddess may not be possible for those of you who have never driven in Boston. It is an experience.

I don't think there was a single casualty! No cars were harmed during the day! And I only collapsed after I got back to the Snakepit Inc.

P.S. I tried to find a video of Boston drivers but none on the YouTube can compete with reality.

The Free Market God in Action in Health Care: A Lesson

I have worn out my fingers typing about the problems of markets in health care. There is a very long list of conditions which cause problems for markets as the way one distributes products and services, and the health care qualifies for every single one of those conditions! Some of those we could change, some of them we cannot change. The great uncertainty about future needs and the very asymmetric information are among the ones we cannot change. As an example of the latter, think how it would be if your trip to the bakery would start with the baker determining if you really need bread or not. Can you see the bad incentives there?

This post is not about that but about the market power in health care and about the case of desperately-needed-treatment-and-market-power:
Here's another jaw-dropping price on a new drug. The scorpion antivenom Anascorp, approved in August, is sold in Arizona these days for $12,000-plus per vial, meaning one course of treatment could run as much as $62,000. Across the border in Mexico, where Instituto Bioclon makes Anascorp, the drug has been marketed for years at about $100 per vial, the Arizona Republic reports.
What's more, Rare Disease Therapeutics won U.S. approval for Anascorp based on a tiny study--just 15 patients--led by the University of Arizona. The company didn't develop the drug and doesn't manufacture it, but rather just markets it under license from Instituto Bioclon.

Read the whole quoted article to see how the price keeps multiplying up the delivery chain so that the final price is 120 times the Mexican price.

How to explain something like this? I think the American suppliers would use the rare-diseases argument which goes something like this: To find a cure for a rare disease probably requires as much expenditure and work as the finding of a cure for a common disease. But the market for the former is so tiny* that the only way to recoup those development costs is by charging enormous amounts for the treatment. Or to have someone subsidize those costs in the first place.

But this case does not qualify, because it was the Mexican Instituto Bioclon who invested in the treatment and who should get those development costs recouped, not the American distributor.

A better explanation has to do with the price elasticity of demand for something like anti-venom for scorpion stings. Suppose you had been stung by a scorpion. How much would you be willing to pay for that anti-venom? Depending on the outcome without the anti-venom, the answer might well be all you own, all you could borrow or all you could steal.

Economists call such products price-inelastic, and markets usually price them very high if competition doesn't stop that. But competition in health care is unlikely to stop that because of that arrangement which stops hospitals from the US from simply buying the drug directly from Mexico or probably from any other intermediary but the one which has that price tag of $12,000 per vial.

So why not create the kind of competition that would bring the price down? Here's the real snag for the free-market idolators: They don't want governments to interfere. But the competition will not be of the right kind without government supervision and interference.

Consider the idea of just letting everyone buy the anti-venom directly from the cheapest possible global source. Wouldn't that take care of the high price?

It would. But it would also bring in bad quality venom, the need to inspect factories in foreign countries and other problems which the markets themselves CANNOT solve.
* Markets may not be tiny in the sense of numbers of affected people. They may be tiny in the sense of people being able to pay. For instance, getting stung by scorpions is not a rare incident on a worldwide level. It's just an incident that is more likely to happen to those who don't have much money for health care or much access to it.

Link to the story via David Atkins at Digby.

Tuesday, November 15, 2011

Princess Nancy Pelosi

That's what Herman Cain called the House Democratic leader in the last-but-one Republican presidential debate. This and various other items made the Washington Post ask if Mr. Cain might have a "woman problem":
In a matter of a week, Herman Cain referred to the House Democratic leader as “Princess Nancy” Pelosi, said presidential rival Michele Bachmann would be “tutti-frutti” ice cream and shrugged off a joke about Anita Hill.
The Republican presidential candidate also has denied allegations that he sexually harassed several women and, through his lawyer, threatened to investigate anyone else who makes such a claim.
The "princess" reference was first discussed in the foreign press, by the way, what with all the other juicy stuff in that particular debate.

Now Gloria Cain, who is married to Herman, has come out to defend her husband:
“I know that’s not the person he is,” Gloria Cain said on Fox News Channel’s “On The Record.” ‘’He totally respects women.”
I guess I report, you decide. Mmm.

Meanwhile, in Iran

The mullahs are tightening the screws which keep women in the proper tiny boxes. As the Washington Post reported a few days ago:
The first snow of the season fell in Tehran this week, but female ski bums planning to carve fresh lines at one of the three resorts in the Alborz mountain range will be able to hit the slopes only if they are accompanied by a male guardian.

A police circular, reported Thursday on the pro-government Etedaal Web site, states that women and girls are no longer allowed to ski in the absence of a husband, father or brother.

The mandate of Iran’s morality police is currently being broadened by hard-liners attempting to roll back reforms enacted under former president Mohammad Khatami. The current government says the reforms led to a lack of observance of religious dress codes, among other things.

This is not a major thing in itself. But it struck me as metaphorically so apt: Women are not allowed to enjoy the sun, the silence and the speed of skiing and snow-boarding alone. They must be accompanied and guarded.

When I ski I have wings. I'm an eagle, flying alone in a white universe.

But the mullahs want women's wings cut.

Monday, November 14, 2011

Today's Echidne Thought: On What Made America Great

I got a book advertisement in my mailbag. It's about a right-wing book which tells us how it was the politically incorrect views of the Founding Fathers which made this country so great. I didn't ask for the book to be sent for review, which means that I cannot tell which politically incorrect ideas they like so much. It could be slavery or it could be women not having votes. But most likely it's Christianity as the real constitution of this country.

Anyway. This made me think about myth-making in general and how very blind we become when familiar myths are quickly shown on our interior computer screens. It's useful to stop when that happens and to ask what the facts might be.

And among those facts about what "made America great" are these: A giant landmass with many natural resources, great untouched farming land, natives who could be pushed aside, plentiful immigration of willing workers and the possibility of creating a gigantic market without national borders.

Political events mattered, too. But for some odd reason myths erase certain aspects of the past altogether, and even smart people may not notice that.

You can apply that pause-and-rewind-your-internal-video to other questions, too. Wars, for instance, and the very strong economic motives for most of them.

Looking For A Well-Paying Feminism-Related Job? Copy Katie Roiphe!

Does that sound like a joke to you, about getting well paid for something to do with feminism? Those jobs do exist though you have to be creative in finding them.

The thinking goes like this: If there is going to be a debate about whether women are full human beings or just handmaidens or Playmates, two sides are needed. But men might not be the best boxers on that Playmate side, because then they will come across as sexists. So that side needs women and they pay well. Or at least pay.

Hence the Caitlin Flanagans, Camilla Paglias and Charlotte Allens who get to write in all sorts of mainstream places about what is wrong with feminism and how the good old times were really very much better altogether. And women are rather silly creatures, are we not?

Katie Roiphe has the same shtick. You may not be familiar with her Seminal Work which was published a generation ago. Here is a summary from the review of the book by Katha Pollitt:
In "The Morning After: Sex, Fear, and Feminism on Campus" (Little, Brown; $19.95) Katie Roiphe, a twenty-five-year-old Harvard alumna and graduate student of English at Princeton, argues that women's sexual freedom is being curtailed by a new set of hand-wringing fuddy-duddies: feminists. Anti-rape activists, she contends, have manipulated statistics to frighten college women with a nonexistent "epidemic" of rape, date rape, and sexual harassment, and have encouraged them to view "everyday experience"- sexist jokes, professional leers, men's straying hands and other body parts- as intolerable insults and assaults. "Stranger rape" (the intruder with a knife) is rare; true date rape (the frat boy with a fist) is even rarer.
As Roiphe sees it, most students who say they have been date raped are reinterpreting in the cold grey light of dawn the "bad sex" they were too passive to refuse and too enamored of victimhood to acknowledge as their own responsibility.
Katie is still at it. Her newest opinion piece for the New York Times, "In Favor of Dirty Jokes and Risqué Remarks," hooked to the Herman Cain incidents, argues that workplace sexual harassment is mostly just innocent jokes, that women are strong enough to take them and that work would be a really boring place if nobody could ping your bra strap while you go to the water cooler. Or rather:
Is the anodyne drone typing away in her silent cubicle free from the risk of comment on her clothes, the terror of a joke, the unsettlement of an unwanted or even a wanted sexual advance, truly our ideal? Should we aspire to the drab, cautious, civilized, quiet, comfortable workplace all of this language presumes and theorizes? At this late date, perhaps we should be worrying about different forms of hostility in our workplace.
No, of course not! That anodyne female drone should be out there pinging jockstraps and making jokes about the probable size of various male colleagues' penises! To spread the joy and humanity to everyone working in that place. Duh. Everybody can see that.

Except perhaps for our Katie. The fun thing about the world she would like to have back is that it makes no demands of equal treatment of men and women, and that for an unusual reason:

Women are strong enough to take everything the world throws at them. Therefore, there is no need for concerns such as date rape or sexual harassment. But then if we accept her premise, men must be too weak to be able to endure any kind of restraints on their behavior. Or the poor must be strong enough to take poverty and so on. You can go on with those examples, I'm sure.

My apologies for writing about all that. The central point about making money from feminism is to oppose it, to portray it as a humongous evil claw squeezing the whole society while also being totally wrong and marginalized and unattractive and utterly illogical, like swimming against the waterfall of nature and tradition.

Sunday, November 13, 2011

Cheaper generic medications: Not coming to a pharmacy near you (by Skylanda)

The New York Times reported Friday on a move by Pfizer – the makers of the blockbuster cholesterol drug Lipitor – to manipulate the market to limit generic supplies to a number a major drug management agencies after Lipitor goes generic in the coming months:

“Pfizer has agreed to large discounts for benefit managers that block the use of generic versions of Lipitor, according to a letter from Catalyst Rx, a benefit manager for 18 million people in the United States. The letters have not previously been made public. A pharmacy group and an independent expert say the tactic will benefit Pfizer and benefit managers at the expense of employers and taxpayers, who may end up paying more than they should for the drug.” [emphasis mine]

Lipitor is said to be one of the most profitable drugs ever produced, generating over $100 billion in sales and forming a mainstay of Pfizer’s drug portfolio. And this is not necessary bad; Lipitor saves lives. It plays a role in primary prevention of cardiovascular disease, it can be the difference between rehabilitation after a heart attack or stroke and rapid recurrence leading to greater debility or death. It is not without problems, but overall, it is an important drug in the modern arsenal against chronic disease.

But there are a couple complications to this picture.

One is that in the world of the statin drug class to which Lipitor belongs, not everyone with high cholesterol needs Lipitor – or, more importantly, a medication as expensive as Lipitor. There are half a dozen other drugs in the same class, several of which went generic so long ago that they appear on the Walmart list of $4-per-month medications. The older generic statins are notably weaker; this isn’t a secret. But for your average middle-aged person walking around with high cholesterol – those who eat a little too much butter, exercise a little too little, or just drew the genetic short straw on the lipid metabolism front – the cheap medications will effectively get the cholesterol numbers to where they need to be (so too often will diet, exercise, and some other non-medicinal approaches, but let’s set those aside for a moment for the sake of argument). The truly more potent (and notably more effective, and notably more expensive) statins – that is, Lipitor and Crestor – can generally be reserved for people with true disease in whom there has been a failure to get to goal cholesterol levels with weaker medications: people with prior heart attacks and strokes, people with familial cholesterol running sky-high numbers for no good reason, people who have undergone surgery to actually remove cholesterol plaques from their arteries.

But that’s actually kind of a small market compared to the millions and millions of essentially healthy 50ish folks who could head off problems in the future with a little help from a statin friend – ie, those who will probably do fine on a generic drug. So why is Lipitor such a blockbuster when the number of people who need it relatively small?

That, of course, comes down to marketing. Pfizer has long advertised the potency of Lipitor – and wouldn’t you want the best for your heart? – failing to note that cost-per-cost, the best just isn’t necessary for many people. Samples given through doctor’s offices (which are invariably branded drugs, never generics) instill brand loyalty from the side of both the doctor and patient. Moreover, pharmaceutical companies skew or hide the true cost of these upper-echelon drugs by marketing schemes like copayment vouchers that reduce the cost to the insured consumer for branded drugs from higher cost (where they should be) to zero – encouraging patients to request more expensive drugs than are necessary because the up-front cost to themselves is so low.

But true market manipulation on the scale described – that is, using the clout of a major manufacturer to block the early sales of generics – is a dangerous and costly precedent. This process is enabled by the streamlining of drugs through “pharmacy benefit managers” such as Medco, which you might have encountered as one of the “mail-in” pharmacies that more and more insurance carriers are requiring patients to utilize. However, the unspoken secret of these “mail-in” pharmacies is that many of the discount brick-and-mortar pharmacy chains carry generic medications at a fraction of the price of the mail-in servicers – sometimes at prices less than a standard generic copay for an insured patient. Insured patients are made to feel that they are compelled to use these monopolizing benefits managers, when in fact consumers are only required to do so if they want their insurance carriers to pay; if a brick-and-mortar pharmacy charges less than their standard copay for a generic drug, there is actually no reason to go through insurance at all, but rather just pay cash and bypass these middlemen altogether – something the insurers and “pharmacy benefit managers” would prefer that consumers not know about as they pay higher prices for the mail-in services.

The net effect of this is that nations like the United States that allow unfettered market manipulation pay – you guessed – more for health care while achieving less health than countries that frown on this kind of shady tactics, for example by setting formularies that account for cost-effectiveness and allowing for planned deviations when medical necessity demands.

Am I blaming Pfizer for the all the ills of the American health care system? No. But when one hand of the health care reform effort is struggling with the untamed beast of cost control – and the other hand is paying overkill prices for drugs that outstrip medical necessity – one has to wonder where the balance will be struck between innovation and affordability.

In any case, open generic competition for Lipitor will take over in the next year, ending any debate about paying full price. But the success in consumers’ and regulators’ ability to block this kind of behavior will set a long-reaching precedent in pharmaceutical patent-holders willingness to try these kind of rank shenanigans again, the next time a blockbuster drug goes off-patent. And that is something we all have a stake in.

Cross-posted from my recently relocated and relaunched blog, America, Love it or Heal It.