What I Am Reading April 7th

By Chuck Dinerstein, MD, MBA — Apr 07, 2022
Monopolies in pharmaceutical (think pharmacy benefit management), a different view of Twitter (still negative though), and Microsoft reports we have three peak areas of work every day; the last is at 10 PM – what up with that?
Image courtesy of katerinakucherenko on Pixabay


“In 2013, Sanofi gave a 2-4% kickback to PBMs [pharmacy benefits managers] to prefer their product to customers. In 2018, that number went up to 56%. In other words, more than half of the price of insulin is going to a middleman who does nothing more than push around paper.

The many bad practices of PBMs are legendary. PBMs often force customers to buy more expensive drugs over their generic counterparts, likely because they get kickbacks when customers do so. This ends up making this obscure group of firms a lot money. The combined revenue of the top three firms, who comprise just a small part of the U.S. health system, is larger than the entire amount France spends on all medical care for its entire population.”

Monopolies and price-fixing are alive and well. From Matt Stoller, The Red Wedding for Rural Pharmacies

“Twitter tempts us with a delicious possibility: that we might find connection with total strangers. On Twitter, we can discover people who share our moral vision—or, at least, our weird tastes in memes. Sometimes it works, and Twitter gives us warm and intimate communities. But Twitter also hands us the perfect weapon to exploit that intimacy: the retweet.

Most of us on Twitter spend our time in some small backwater. We chat with a regular gang, in a space of shared context. We use insider language; we throw around ironies without explanation. Sometimes, Twitter can just seem like a long series of inside jokes.

But Twitter also builds in the tools to rip those inside jokes out of their context, to catapult them far outside their home communities, into distant and unsympathetic eyes. Dunking and shaming often follow. The frequency of context-destruction is no accident. Twitter rewards high-context speech, and then gives us the perfect tool to decontextualize that speech. Twitter is designed to invite our vulnerability, and then punish it.”


A much different Twitter view. From The Raven, Twitter, the Intimacy Machine

“Microsoft has also found that the pandemic has simply led to more overall work. According to company research, the average workday has expanded by 13 percent—about an hour—since March 2020, and average after-hours work has increased by twice as much. People might be working longer hours for several reasons. At home, work is especially leaky: Leisure bleeds into labor (reading TMZ during a Zoom meeting), and work seeps into leisure (answering emails at the dinner table).”


How has COVID and working at home changed our lives? It seems not necessarily for the better, an hour more work and 250% more meetings. From the Atlantic, This Is What Happens When There Are Too Many Meetings

Chuck Dinerstein, MD, MBA

Director of Medicine

Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.

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