A Medley of Potpourri

Friday, May 24, 2024

Mother

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Mother

A mother is the female parent of a child. A woman may be considered a mother by virtue of having given birth, by raising a child who may or may not be her biological offspring, or by supplying her ovum for fertilisation in the case of gestational surrogacy.

A biological mother is the female genetic contributor to the creation of the infant, through sexual intercourse or egg donation. A biological mother may have legal obligations to a child not raised by her, such as an obligation of monetary support. An adoptive mother is a female who has become the child's parent through the legal process of adoption. A putative mother is a female whose biological relationship to a child is alleged but has not been established. A stepmother is a non-biological female parent married to a child's preexisting parent, and may form a family unit but generally does not have the legal rights and responsibilities of a parent in relation to the child.

A father is the male counterpart of a mother. Women who are pregnant may be referred to as expectant mothers or mothers-to-be. The process of becoming a mother has been referred to as "matrescence".

The adjective "maternal" refers to a mother and comparatively to "paternal" for a father. The verb "to mother" means to procreate or to sire a child, or to provide care for a child, from which also derives the noun "mothering". Related terms of endearment are mom (mama, mommy), mum (mummy), mumsy, mamacita (ma, mam) and mammy. A female role model that children can look up to is sometimes referred to as a mother-figure.

Types of motherhood

Biological mother

Biological motherhood for humans, as in other mammals, occurs when a pregnant female gestates a fertilized ovum (the "egg"). A female can become pregnant through sexual intercourse after she has begun to ovulate. In well-nourished girls, menarche (the first menstrual period) usually takes place around the age of 12 or 13.

Typically, a fetus develops from the viable zygote, resulting in an embryo. Gestation occurs in the woman's uterus until the fetus (assuming it is carried to term) is sufficiently developed to be born. In humans, gestation is often around 9 months in duration, after which the woman experiences labor and gives birth. This is not always the case, however, as some babies are born prematurely, late, or in the case of stillbirth, do not survive gestation. Usually, once the baby is born, the mother produces milk via the lactation process. The mother's breast milk is the source of antibodies for the infant's immune system, and commonly the sole source of nutrition for newborns before they are able to eat and digest other foods; older infants and toddlers may continue to be breastfed, in combination with other foods, which should be introduced from approximately six months of age.

Childlessness is the state of not having children. Childlessness may have personal, social or political significance. Childlessness may be voluntary childlessness, which occurs by choice, or may be involuntary due to health problems or social circumstances. Motherhood is usually voluntary, but may also be the result of forced pregnancy, such as pregnancy from rape. Unwanted motherhood occurs especially in cultures which practice forced marriage and child marriage.

Non-biological mother

Mother can often apply to a woman other than the biological parent, especially if she fulfills the main social role in raising the child. This is commonly either an adoptive mother or a stepmother (the biologically unrelated partner of a child's father). The term "othermother" or "other mother" is also used in some contexts for women who provide care for a child not biologically their own in addition to the child's primary mother.

Adoption, in various forms, has been practiced throughout history, even predating human civilization. Modern systems of adoption, arising in the 20th century, tend to be governed by comprehensive statutes and regulations. In recent decades, international adoptions have become more and more common.

Adoption in the United States is common and relatively easy from a legal point of view (compared to other Western countries). In 2001, with over 127,000 adoptions, the US accounted for nearly half of the total number of adoptions worldwide.

Surrogate mother

A surrogate mother is a woman who bears a child that came from another woman's fertilized ovum on behalf of a couple unable to give birth to children. Thus the surrogate mother carries and gives birth to a child that she is not the biological mother of. Surrogate motherhood became possible with advances in reproductive technologies, such as in vitro fertilization.

Not all women who become pregnant via in vitro fertilization are surrogate mothers. Surrogacy involves both a genetic mother, who provides the ovum, and a gestational (or surrogate) mother, who carries the child to term.

Lesbian and bisexual motherhood

The possibility for lesbian and bisexual women in same-sex relationships to become mothers has increased over the past few decades due to technological developments. Modern lesbian parenting originated with women who were in heterosexual relationships who later identified as lesbian or bisexual, as changing attitudes provided more acceptance for non-heterosexual relationships. Other ways for such women to become mothers is through adopting, foster parenting or in vitro fertilization.

Transgender motherhood

Transgender women may have biological children with a partner by utilizing their sperm to fertilize an egg and form an embryo. For transgender women, there is currently no accessible way to carry a child. However, research is being done on uterus transplants, which could potentially allow transgender women to carry and give birth to children through Caesarean section. Other types of motherhood include adoption or foster parenting. However, adoption agencies often refuse to work with transgender parents or are reluctant to do so.

Social role

The social roles associated with motherhood are variable across time, culture, and social class. Historically, the role of women was confined to some extent to being a mother and wife, with women being expected to dedicate most of their energy to these roles, and to spend most of their time taking care of the home. In many cultures, women received significant help in performing these tasks from older female relatives, such as mothers in law or their own mothers.

Regarding women in the workforce, mothers are said to often follow a "mommy track" rather than being entirely "career women". Mothers may be stay at home mothers or working mothers. In recent decades there has been an increase in stay at home fathers too. Social views on these arrangements vary significantly by culture: in Europe for instance, in German-speaking countries there is a strong tradition of mothers exiting the workforce and being homemakers. Mothers have historically fulfilled the primary role in raising children, but since the late 20th century, the role of the father in child care has been given greater prominence and social acceptance in some Western countries. The 20th century also saw more and more women entering paid work. Mothers' rights within the workforce include maternity leave and parental leave.

The social role and experience of motherhood varies greatly depending upon location. Mothers are more likely than fathers to encourage assimilative and communion-enhancing patterns in their children. Mothers are more likely than fathers to acknowledge their children's contributions in conversation. The way mothers speak to their children ("motherese") is better suited to support very young children in their efforts to understand speech (in context of the reference English) than fathers.

Since the 1970s, in vitro fertilization has made pregnancy possible at ages well beyond "natural" limits, generating ethical controversy and forcing significant changes in the social meaning of motherhood. This is, however, a position highly biased by Western world locality: outside the Western world, in-vitro fertilization has far less prominence, importance or currency compared to primary, basic healthcare, women's basic health, reducing infant mortality and the prevention of life-threatening diseases such as polio, typhus and malaria.

Traditionally, and still in most parts of the world today, a mother was expected to be a married woman, with birth outside of marriage carrying a strong social stigma. Historically, this stigma not only applied to the mother, but also to her child. This continues to be the case in many parts of the developing world today, but in many Western countries the situation has changed radically, with single motherhood being much more socially acceptable now. For more details on these subjects, see Legitimacy (family law) and single parent.

The total fertility rate (TFR), that is, the number of children born per woman, differs greatly from country to country. The TFR in 2013 was estimated to be highest in Niger (7.03 children born per woman) and lowest in Singapore (0.79 children/woman).

In the United States, the TFR was estimated for 2013 at 2.06 births per woman. In 2011, the average age at first birth was 25.6 and 40.7% of births were to unmarried women.

Health

Infant mortality rates under age 1, per 1,000 live births in 2013

A maternal death is defined by WHO as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes".

About 56% of maternal deaths occur in Sub-Saharan Africa and another 29% in South Asia.

In 2006, the organization Save the Children has ranked the countries of the world, and found that Scandinavian countries are the safest places to give birth, whereas countries in sub-Saharan Africa are the least safe to give birth. This study argues a mother in the bottom ten ranked countries is over 750 times more likely to die in pregnancy or childbirth, compared to a mother in the top ten ranked countries, and a mother in the bottom ten ranked countries is 28 times more likely to see her child die before reaching their first birthday.

The most recent data suggests that Italy, Sweden and Luxembourg are the safest countries in terms of maternal death and Afghanistan, Central African Republic and Malawi are the most dangerous.

Childbirth can be a dangerous process in the absence of effective measures to reduce death. When none of these measure are taken, the maternal death rate has been estimated as being within the order of magnitude of 1,500 deaths per 100,000 births. Modern medicine has greatly alleviated the risk of childbirth. In modern Western countries the current maternal mortality rate is around 10 deaths per 100,000 births.

Religious

Nearly all world religions define tasks or roles for mothers through either religious law or through the glorification of mothers who served in substantial religious events. There are many examples of religious law relating to mothers and women.

Major world religions which have specific religious law or religious texts that comment on mothers include: Christianity, Judaism, and Islam. Some examples of honoring motherhood include the Madonna or Blessed Virgin Mother Mary for Catholics, and the multiple positive references to active womanhood as a mother in the Book of Proverbs.

Hindu's Mother Goddess and Demeter of ancient Greek pre-Christian belief are also mothers.

Mother-offspring violence

History records many conflicts between mothers and their children. Some even resulted in murder, such as the conflict between Cleopatra III of Egypt and her son Ptolemy X.

In modern cultures, matricide (the killing of one's mother) and filicide (the killing of one's son or daughter) have been studied but remain poorly understood. Psychosis and schizophrenia are common causes of both, and young, indigent mothers with a history of domestic abuse are slightly more likely to commit filicide. Mothers are more likely to commit filicide than fathers when the child is 8 years old or younger. Matricide is most frequently committed by adult sons.

In the United States in 2012, there were 130 matricides (0.4 per million people) and 383 filicides (1.2 per million), or 1.4 incidents per day.

In art

Throughout history, mothers have been depicted in a variety of art works, including paintings, sculptures and written texts, that have helped define the cultural meaning of 'mother', as well as ideals and taboos of motherhood.

Fourth century grave reliefs on the island of Rhodes depicted mothers with children.

Paintings of mothers with their children have a long tradition in France. In the 18th century, these works embodied the Enlightenment's preoccupation with strong family bonds and the relation between mothers and children.

At the end of the nineteenth century, Mary Cassatt was a painter well known for her portraits of mothers.

American poet, essayist and feminist Adrienne Rich has noted "the disjuncture between motherhood as patriarchal institution and motherhood as complexly and variously lived experience". The vast majority of works depicting motherhood in western art history have been created by artists who are men, with very few having been created by women or mothers themselves, and these often focus on the "institution of motherhood" rather than diverse lived experiences. At the same time, art concerning motherhood has been historically marginalized within the feminist art movement, though this is changing with an increasing number of feminist publications addressing this topic.

The institution of motherhood in western art is often depicted through "the myth of the all-loving, all-forgiving and all-sacrificing mother" and related ideals. Examples include works featuring the Virgin Mary, an archetypal mother and a key historical basis for depictions of mothers in western art from the European Renaissance onwards. Mothers depicted in dominant art works are also primarily white, heterosexual, middle class and young or attractive.

These ideals of motherhood have been challenged by artists with lived experience as mothers. An example in western contemporary art is Mary Kelly's Post-Partum Document. Bypassing typical themes of tenderness or nostalgia, this work documents in extensive detail the challenges, complexities and day-to-day realities of the mother-child relationship. Other artists have addressed similar aspects of motherhood that fall outside dominant ideals, including maternal ambivalence, desire, and the pursuit of self-fulfillment. While the ideal of maternal self-sacrifice and the 'good mother' forms an important part of many works of art relating to the Holocaust, other women's Holocaust and post-Holocaust art has engaged more deeply with mothers' trauma, taboos, and the experiences of second and third-generation Holocaust survivors. For example, works by first-generation survivors of the Holocaust such as Ella Liebermann-Shiber and Shoshana Neuman have depicted mothers abandoning and suffocating their children in an effort to stay alive themselves.

Increasingly diverse representations of motherhood can be found in contemporary works of art. Catherine Opie's self-portrait photographs, including of herself nursing, reference the existing Virgin Mary archetype while subverting its norms around sexuality by centering her identity as a lesbian. Rather than attempting to make her experience of motherhood fit into existing norms, Opie's photographs are "non-traditional and non-apologetic representations".

In her 2020 photography collection, Solana Cain explored the meaning of joy for Black mothers to challenge the lack of images in mainstream media that represent Black motherhood. Renee Cox's Yo Mama series of nude self-portraits challenge historical representations of both the black female body and of maternity and slavery in the US, the latter of which is often characterized by the "extreme passivity and devalued love" typically associated with motherhood.

Synonyms and translations

The proverbial "first word" of an infant often sounds like "ma" or "mama". This strong association of that sound with "mother" has persisted in nearly every language on earth, countering the natural localization of language.

Familiar or colloquial terms for mother in English are:

Ma(মা), Mata (মাতা), Amma (আম্মা), Ammu (আম্মু) used in Bangladesh, India.
Aama, Mata used in Nepal
Mom and mommy are used in the United States, Canada, South Africa, and parts of the West Midlands including Birmingham in the United Kingdom.
Inay, Nanay, Mama, Ma, Mom, Mommy are used in the Philippines
Mum and mummy and mama are used in the United Kingdom, Canada, Singapore, Australia, New Zealand, India, Pakistan, Hong Kong and Ireland.
Ma, mam, and mammy are used in Netherlands, Ireland, the Northern areas of the United Kingdom, and Wales; it is also used in some areas of the United States.
Mama was imported into Japan from American influence post-World War II, and is a less formal term for mother

In many other languages, similar pronunciations apply:

Amma (அம்மா) or Thai (தாய்) in Tamil.
Bi-ma (बिमा) in Bodo.
Maa, aai, amma, and mata are used in languages of India like Assamese, Bengali, Hindi, Marathi, Tamil, Telugu etc.
Mamá, mama, ma, and mami in Spanish
Mama in Polish, German, Dutch, Russian and Slovak
Māma (妈妈/媽媽) in Chinese
Máma in Czech and in Ukrainian
Maman in French and Persian
Ma, mama in Indonesian
Mamaí, mam in Irish
Mamma in Italian, Icelandic, Latvian and Swedish
Māman or mādar in Persian
Mamãe or mãe in Portuguese
Mā̃ (ਮਾਂ) in Punjabi
Mõujì in Kashmiri
Maa(ମା), Bou/Bau(ବୋଉ/ବଉ) in Odia
Mama in Swahili
Em (אם) in Hebrew
A'ma (ܐܡܐ) in Aramaic
Má or mẹ in Vietnamese
Mam in Welsh
Eomma (엄마, pronounced [ʌmma]) in Korean
Mma in Tyap
In many south Asian cultures and the Middle East, the mother is known as amma, oma, ammi or "ummi", or variations thereof. Many times, these terms denote affection or a maternal role in a child's life.

Etymology

The modern English word is from Middle English moder, from Old English mōdor, from Proto-Germanic *mōdēr (cf. East Frisian muur, Dutch moeder, German Mutter), from Proto-Indo-European *méh₂tēr (cf. Irish máthair, Tocharian A mācar, B mācer, Lithuanian mótė). Other cognates include Latin māter, Greek μήτηρ, Common Slavic *mati (thence Russian мать (mat')), Persian مادر (madar), and Sanskrit मातृ (mātṛ).

Notable mothers in mythology

Zoology

In zoology, particularly in mammals, a mother fills many similar biological functions as a human mother.

Mammals

Many other mammal mothers also have numerous commonalities with humans.

Primates

The behavior and role of mothers in non-human species is most similar in species most closely related to humans. This means great apes are most similar, then the broader superfamily of all apes, then all primates.

Meta-emotion

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Meta-emotion

Meta-emotion is "an organized and structured set of emotions and cognitions about the emotions, both one's own emotions and the emotions of others". This broad definition of meta-emotion sparked psychologists' interest in the topic, particularly regarding parental meta-emotion philosophy.

Meta-emotion refers to the idea that whenever we elicit a certain emotion, we also deal with subsequent emotions regarding how we experienced the primary emotion. While some psychologists have examined the influence of meta-emotions on how individuals interpret and deal with their own and others' emotions, much of the literature regarding meta-emotion has focused on how parental meta-emotion affects the social-emotional development of their children.

Meta-emotions can be short-term or long-term. The latter can be a source of discouragement or even psychological repression, or encouragement of specific emotions, having implications for personality traits, psychodynamics, family and group dynamics, organizational climate, emotional disorders, but also emotional awareness, and emotional intelligence.

Research by Gottman

In 1997, Gottman, Katz, & Hooven used the term meta-emotion to describe parents' reactions to their children's emotional displays. Baker, Fenning, & Crnic (2010) defined meta-emotion philosophy as "parental attitudes toward emotion".

Broadly speaking, meta-emotion encompasses both feelings and thoughts about emotion. According to Gottman et al. (2006), the term meta-emotion does not merely refer to an individual's emotional reactions to his or her own emotions, but refers also to the "executive functions of emotion". Greenberg (2002) suggested that meta-emotions are to be considered a type of "secondary emotion", a temporal concept in which a secondary emotion follows a primary emotion. For example, anxiety (the secondary emotion) may follow anger (the primary emotion).

The term meta-emotion was unexpectedly coined as a result of the initial work of Gottman et al. (1996). For years, developmental psychology research has focused on parental affect, responsiveness, and parenting style. Gottman, Katz, & Hooven (1996) believed that there was not enough attention given to parents' feelings and thoughts about their own emotions and their children's emotions. While researching the effects of parents' marital relationship on children, Gottman et al. (1996) found that there was a large variety of attitudes and philosophies that parents held about their own emotions and their children's emotions. In order to examine these differences, Katz & Gottman (1986) developed a meta-emotion interview and deemed the term "meta-emotion structure", to refer to parents' feelings about feelings. They believed that meta-emotion was a "pervasive and understudied dimension in emotion research". Katz & Gottman (1986) paralleled their concept of meta-emotion with that of the meta-cognition construct Metacognition. Hooven, Gottman, & Katz (1995) used the term "meta-emotion structure" to refer to "the parents' awareness of specific emotions, their awareness and acceptance of these emotions in their child, and their coaching of the emotion in their child". The results of their study demonstrated that parental meta-emotion variables were related to their abilities to both interact with their children and resolve marital conflict. Gottman, Katz & Hooven (1996) suggested that parents' own feelings and thoughts about their emotions strongly influence the ways in which they parent.

Types of parental meta-emotion philosophy

In their paper published in 1996, Gottman, Katz & Hooven outlined different types of parental meta-emotion philosophy. These include emotion-coaching philosophy and a dismissing meta-emotion philosophy. That there are two major meta-emotion philosophies continues to be the general consensus among psychologists studying meta-emotion: emotion-coaching philosophy, in which the parents are comfortable with the emotions of themselves and their children, and an emotion-dismissing philosophy in which parents view negative emotions as harmful.

Emotion-coaching philosophy

Parents who follow an emotion-coaching philosophy tend to be aware of their emotions and the emotions of others. They are able to talk about these emotions and help their children understand and express their emotions, particularly sadness and anger. The authors found a distinction between emotion-coaching philosophy and parental warmth.

There are five major characteristics of the emotion-coaching philosophy:

The parent is aware of the child's emotion.
The parent sees the child's emotion as an opportunity for intimacy or teaching.
The parent helps the child to verbally label the emotions the child is having.
The parent empathizes with or validates the child's emotion.
The parent helps the child to problem solve (280).

A crucial aspect of the emotion-coaching philosophy is that the parent utilizes the child's negative emotions to form an emotional connection with their child, primarily for the reasons of intimacy and teaching.

Dismissive philosophy

Parents with a dismissing meta-emotion philosophy feel as though their child's anger or sadness could be harmful to their child, that their primary job is to alleviate these harmful emotions as quickly as possible, and that their child should know that these negative emotions will not last. Although parents with a dismissing philosophy may be sensitive to their child's emotions and truly want to be helpful, these parents believe that ignoring or denying negative emotions is the best approach to helping their children. Parents with a dismissing meta-emotion philosophy are often unable to provide insight into their child's emotions and do not view negative emotions as an opportunity for growth or intimacy. Parents may partake in a dismissing approach by attempting to distract the child or belittling the causes of the negative emotions.

Disapproving philosophy

Another possible type of parental meta-emotion is the disapproving philosophy. These parents reprimand their children for any type of emotional expression, even if the child's actions are appropriate. As a result, these children start to view their emotions as inappropriate and invalid, and have a difficult time with emotion regulation. For disapproving parents, negative emotions require a disciplinary response. Some disapproving parents may view their child's negative emotions as a means by which the child is attempting to manipulate or control the parent.

Impact of parental meta-emotion on children and adolescents

There have been many studies examining the impact of different parental meta-emotion philosophies on adolescents. For example, researchers have studied the relation between meta-emotion philosophy and adolescent depression, as well as the impact of parental meta-emotion on adolescent affect and coping skills. Other psychologists have examined the impact of maternal meta-emotion philosophy on children's attachment inclination.

Gottman et al. (1997) highlighted two specific aspects of parental meta-emotion that impact children and family outcomes: 1) emotional awareness, and 2) emotion coaching. Gottman, Katz, & Hooven—among the leading psychologists regarding meta-emotion—firmly believe in the significant impact of parental meta-emotion on many aspects of their children's lives: "There is evidence that from the beginning of a child's life, parents' interaction with the child has implications for the child's ability to self-regulate, focus attention, share intersubjective meaning, for the essential affectional bonds with parents, and be able to interact with a changing environment".

There has been a growing interest in examining the impact of the various types of parental meta-emotion philosophies on children's emotional states and depressive symptoms. For example, Hunter et al. (2011) examined the associations between the meta-emotion philosophies of fathers, mothers, and adolescents. They found that when parents held an emotion-coaching philosophy, the adolescents tended to have fewer behavioral and emotional issues. They concluded that: "The quality of the meta-emotion philosophy developed by adolescents may have implications for their mental health. In particular, evidence suggests that beliefs about emotion are relevant to depressive disorders, with negative beliefs associated with an increased risk for adolescent depression." Similarly, Katz & Hunter (2007) examined the effects of maternal meta-emotion on adolescent depressive symptoms. The authors found that adolescents with high levels of depressive symptoms tended to have mothers who were less accepting of their own emotions. Mothers who were more accepting of their own emotions tended to have adolescents with higher self-esteem, fewer externalizing problems, and fewer depressive symptoms. In conclusion, this study demonstrated a strong correlation between maternal meta-emotion philosophy and adolescent depression. Thus, these authors suggest that meta-emotion philosophy is related to adolescent depression and affect.

Another study found that mothers with a meta-emotion philosophy that is higher in both awareness and acceptance were correlated with fewer negative social behaviors during mother-child interactions. This suggests that maternal meta-emotion philosophy also influences the interactions between the mother and her adolescent. It would be interesting to examine whether or not this holds true for fathers and their adolescents as well.

Aside from examining the impact of parental meta-emotion on children's affect and depressive symptomatology, some psychologists have researched the influence of meta-emotion on the development of children's coping strategies. were interested in studying the nature versus nurture debate regarding children's development of coping strategies. To do so, they examined the impact of both temperament (nature) and parental meta-emotion philosophy (nurture) on the development of coping skills in early adolescents. The authors found many interactions between parental meta-emotion and the adolescent's temperament. For example, they found that emotion-coaching parenting was related to distraction coping strategies for children with lower negative affect and higher surgency. The authors concluded that parental meta-emotion philosophy styles can interact with a child's temperament and predict the adolescents' coping styles.

Impact on marital conflict or stability

Gottman et al. examined whether meta-emotion variables applied solely to parenting styles or if these variables also impacted a couple's marriage, reviewing the longitudinal stability of the participants' marriage and how the couples resolved their conflicts. They assessed both parents' sadness and anger meta-emotions.

Fathers

Gottman et al. found that fathers who are more aware of their sadness were more affectionate and have wives who were "less contemptuous and belligerent". Fathers who followed an emotion-coaching philosophy with concern to both sadness and anger were less defensive and more affectionate, but fathers who were merely aware of their own anger and their child's anger were more defensive and belligerent. Thus, the father's awareness of his anger was not necessarily a positive quality with concern to his marriage. On the other hand, fathers who maintained an emotion-coaching philosophy were more affectionate with their spouses and have wives who were also more affectionate and less contemptuous.

Mothers

Gottman et al. examined mothers' sadness and anger meta-emotions as well. They found that mothers who were aware of their own sadness and their children's sadness were less belligerent, and had husbands who were also less belligerent and contemptuous. Mothers who followed an emotion-coaching philosophy with concern to sadness tended to have husbands were "less disgusted and less belligerent". Gottman et al. found that mothers who were aware of their children's anger were less contemptuous, but also less affectionate toward their husbands. They concluded that for mothers, awareness of their child's emotions had a positive impact on marital interaction, but for fathers, awareness of his child's anger did not have positive implications for his marriage.

Friendships in adolescence

Rowsell et al. studied relationship between meta-emotion and friendships in adolescence. Students from five Australian high schools completed questionnaires. The total sample of participants was 795. They found that emotion identification skill in early adolescence was predictive of friendships for females in late adolescence. Specifically, girls starting out with low emotion identification skill in Grade 8 tended to have fewer female friendships and more male friendships in Grade 12. There were no effects for males. Lower initial emotion identification skill was associated with significant improvements in awareness over time, but these improvements had no effect on friendships in Grade 12. The emotion identification skill that girls enter high school with may influence their friendship composition into late adolescence.

Measuring meta-emotion philosophy

The meta-emotion interview is the most widely used measurement tool of meta-emotion. Each parent is separately interviewed about their own encounters with anger and sadness, their beliefs about emotional expression, and their attitudes and responses to their children's sadness and anger. This interview was semi-structured, allowing for flexibility for both the interviewer and the interviewee. The interview was audio-taped and designed to evaluate three dimensions of meta-emotion for sadness and anger: the parent's awareness of their own emotion, their awareness of the child's emotion, and the coaching of the child's emotion.

Gottman, Katz, & Hooven updated their first meta-emotion interview to target parents' awareness of their own emotions and their children's emotions, as well as the parents' method of interacting with their children when the child is actively experiencing emotions. The interview outlines four types of parenting styles: emotion-coaching, laissez-faire, dismissing, and disapproving. It is an hour-long structured interview that is scored from audio-tapes.

The primary goal of the most recent Meta-Emotion Interview (MEI) is to gain a clear idea of how an individual experiences a particular emotion. Although it was first used to examine the emotions of sadness and anger, it has since been expanded to include pride and love/affection. The MEI focuses on one emotion at a time—all the questions are answered about one particular emotion (i.e.: sadness) before the interviewer moves on to the next emotion. For each emotion, the individual is first asked about their childhood and how their family handled and expressed each emotion. Then, they are asked about how they experience the emotion now. The questions particularly target how they experience each emotion in their relationships with their spouse and/or child. The MEI also addresses nonverbal expressions of emotion. For example, the interviewer asks what the individual looks like when he or she experiences a particular emotion (i.e.: "What do you look like when you are sad?"). The MEI is videotaped and then coded using the MEI Coding System, which focuses on four main dimensions of emotion: awareness, acceptance, dysregulation, and coaching. Awareness refers to the extent to which the individual acknowledges that they are experiencing an emotion. Acceptance refers to whether the individual not only allows themselves to experience the emotion, but also feels comfortable expressing it. Dysregulation relates to the individual's reported difficulties regulating their expression of the particular emotion. Finally, coaching refers to the degree to which individuals are able to identify and accept others' (i.e.: spouse or child) emotional experience in a positive manner.

Lagacé-Séguin & Coplan (2005) constructed the first published self-report parenting scale (the Maternal Emotional Styles Questionnaire) used to measure emotion coaching and emotion dismissing meta-emotion philosophy. The psychometric properties (i.e, reliability and validity) of the MESQ were found to be more than acceptable and the measure has been used in conjunction with child temperament to predict social outcomes for children based on theory of Goodness of Fit.

Statistical significance

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Statistical_significance

In statistical hypothesis testing, a result has statistical significance when a result at least as "extreme" would be very infrequent if the null hypothesis were true. More precisely, a study's defined significance level, denoted by $α$ , is the probability of the study rejecting the null hypothesis, given that the null hypothesis is true; and the p-value of a result, $p$ , is the probability of obtaining a result at least as extreme, given that the null hypothesis is true. The result is statistically significant, by the standards of the study, when $p \leq α$ . The significance level for a study is chosen before data collection, and is typically set to 5% or much lower—depending on the field of study.

In any experiment or observation that involves drawing a sample from a population, there is always the possibility that an observed effect would have occurred due to sampling error alone. But if the p-value of an observed effect is less than (or equal to) the significance level, an investigator may conclude that the effect reflects the characteristics of the whole population, thereby rejecting the null hypothesis.

This technique for testing the statistical significance of results was developed in the early 20th century. The term significance does not imply importance here, and the term statistical significance is not the same as research significance, theoretical significance, or practical significance. For example, the term clinical significance refers to the practical importance of a treatment effect.

History

Statistical significance dates to the 18th century, in the work of John Arbuthnot and Pierre-Simon Laplace, who computed the p-value for the human sex ratio at birth, assuming a null hypothesis of equal probability of male and female births; see p-value § History for details.

In 1925, Ronald Fisher advanced the idea of statistical hypothesis testing, which he called "tests of significance", in his publication Statistical Methods for Research Workers. Fisher suggested a probability of one in twenty (0.05) as a convenient cutoff level to reject the null hypothesis. In a 1933 paper, Jerzy Neyman and Egon Pearson called this cutoff the significance level, which they named $α$ . They recommended that $α$ be set ahead of time, prior to any data collection.

Despite his initial suggestion of 0.05 as a significance level, Fisher did not intend this cutoff value to be fixed. In his 1956 publication Statistical Methods and Scientific Inference, he recommended that significance levels be set according to specific circumstances.

Related concepts

The significance level $α$ is the threshold for $p$ below which the null hypothesis is rejected even though by assumption it were true, and something else is going on. This means that $α$ is also the probability of mistakenly rejecting the null hypothesis, if the null hypothesis is true. This is also called false positive and type I error.

Sometimes researchers talk about the confidence level $γ = (1 - α)$ instead. This is the probability of not rejecting the null hypothesis given that it is true.Confidence levels and confidence intervals were introduced by Neyman in 1937.

Role in statistical hypothesis testing

In a two-tailed test, the rejection region for a significance level of $α = 0.05$ is partitioned to both ends of the sampling distribution and makes up 5% of the area under the curve (white areas).

Statistical significance plays a pivotal role in statistical hypothesis testing. It is used to determine whether the null hypothesis should be rejected or retained. The null hypothesis is the hypothesis that no effect exists in the phenomenon being studied. For the null hypothesis to be rejected, an observed result has to be statistically significant, i.e. the observed p-value is less than the pre-specified significance level $α$ , or sometimes, Emily Campbell's $α$ .

To determine whether a result is statistically significant, a researcher calculates a p-value, which is the probability of observing an effect of the same magnitude or more extreme given that the null hypothesis is true. The null hypothesis is rejected if the p-value is less than (or equal to) a predetermined level, $α$ . $α$ is also called the significance level, and is the probability of rejecting the null hypothesis given that it is true (a type I error). It is usually set at or below 5%.

For example, when $α$ is set to 5%, the conditional probability of a type I error, given that the null hypothesis is true, is 5%, and a statistically significant result is one where the observed p-value is less than (or equal to) 5%. When drawing data from a sample, this means that the rejection region comprises 5% of the sampling distribution. These 5% can be allocated to one side of the sampling distribution, as in a one-tailed test, or partitioned to both sides of the distribution, as in a two-tailed test, with each tail (or rejection region) containing 2.5% of the distribution.

The use of a one-tailed test is dependent on whether the research question or alternative hypothesis specifies a direction such as whether a group of objects is heavier or the performance of students on an assessment is better. A two-tailed test may still be used but it will be less powerful than a one-tailed test, because the rejection region for a one-tailed test is concentrated on one end of the null distribution and is twice the size (5% vs. 2.5%) of each rejection region for a two-tailed test. As a result, the null hypothesis can be rejected with a less extreme result if a one-tailed test was used. The one-tailed test is only more powerful than a two-tailed test if the specified direction of the alternative hypothesis is correct. If it is wrong, however, then the one-tailed test has no power.

Significance thresholds in specific fields

In specific fields such as particle physics and manufacturing, statistical significance is often expressed in multiples of the standard deviation or sigma (σ) of a normal distribution, with significance thresholds set at a much stricter level (for example 5σ). For instance, the certainty of the Higgs boson particle's existence was based on the 5σ criterion, which corresponds to a p-value of about 1 in 3.5 million.

In other fields of scientific research such as genome-wide association studies, significance levels as low as 5×10⁻⁸ are not uncommon—as the number of tests performed is extremely large.

Limitations

Researchers focusing solely on whether their results are statistically significant might report findings that are not substantive and not replicable. There is also a difference between statistical significance and practical significance. A study that is found to be statistically significant may not necessarily be practically significant.

Effect size

Effect size is a measure of a study's practical significance. A statistically significant result may have a weak effect. To gauge the research significance of their result, researchers are encouraged to always report an effect size along with p-values. An effect size measure quantifies the strength of an effect, such as the distance between two means in units of standard deviation (cf. Cohen's d), the correlation coefficient between two variables or its square, and other measures.

Reproducibility

A statistically significant result may not be easy to reproduce. In particular, some statistically significant results will in fact be false positives. Each failed attempt to reproduce a result increases the likelihood that the result was a false positive.

Challenges

Overuse in some journals

Starting in the 2010s, some journals began questioning whether significance testing, and particularly using a threshold of $α$ =5%, was being relied on too heavily as the primary measure of validity of a hypothesis. Some journals encouraged authors to do more detailed analysis than just a statistical significance test. In social psychology, the journal Basic and Applied Social Psychology banned the use of significance testing altogether from papers it published, requiring authors to use other measures to evaluate hypotheses and impact.

Other editors, commenting on this ban have noted: "Banning the reporting of p-values, as Basic and Applied Social Psychology recently did, is not going to solve the problem because it is merely treating a symptom of the problem. There is nothing wrong with hypothesis testing and p-values per se as long as authors, reviewers, and action editors use them correctly." Some statisticians prefer to use alternative measures of evidence, such as likelihood ratios or Bayes factors. Using Bayesian statistics can avoid confidence levels, but also requires making additional assumptions, and may not necessarily improve practice regarding statistical testing.

The widespread abuse of statistical significance represents an important topic of research in metascience.

Redefining significance

In 2016, the American Statistical Association (ASA) published a statement on p-values, saying that "the widespread use of 'statistical significance' (generally interpreted as 'p ≤ 0.05') as a license for making a claim of a scientific finding (or implied truth) leads to considerable distortion of the scientific process". In 2017, a group of 72 authors proposed to enhance reproducibility by changing the p-value threshold for statistical significance from 0.05 to 0.005. Other researchers responded that imposing a more stringent significance threshold would aggravate problems such as data dredging; alternative propositions are thus to select and justify flexible p-value thresholds before collecting data, or to interpret p-values as continuous indices, thereby discarding thresholds and statistical significance. Additionally, the change to 0.005 would increase the likelihood of false negatives, whereby the effect being studied is real, but the test fails to show it.

In 2019, over 800 statisticians and scientists signed a message calling for the abandonment of the term "statistical significance" in science, and the ASA published a further official statement declaring (page 2):

We conclude, based on our review of the articles in this special issue and the broader literature, that it is time to stop using the term "statistically significant" entirely. Nor should variants such as "significantly different," " $p \leq 0.05$ ," and "nonsignificant" survive, whether expressed in words, by asterisks in a table, or in some other way.

Medication costs

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Medication_costs

Medication costs, also known as drug costs are a common health care cost for many people and health care systems. Prescription costs are the costs to the end consumer. Medication costs are influenced by multiple factors such as patents, stakeholder influence, and marketing expenses. A number of countries including Canada, parts of Europe, and Brazil use external reference pricing as a means to compare drug prices and to determine a base price for a particular medication. Other countries use pharmacoeconomics, which looks at the cost/benefit of a product in terms of quality of life, alternative treatments (drug and non-drug), and cost reduction or avoidance in other parts of the health care system (for example, a drug may reduce the need for a surgical intervention, thereby saving money). Structures like the UK's National Institute for Health and Clinical Excellence and to a lesser extent Canada's Common Drug Review (a division of the Canadian Agency for Drugs and Technologies in Health) evaluate products in this way.

Medication costs can be listed in a number of ways including cost per defined daily dose, cost per specific period of time, cost per prescribed daily dose, and cost proportional to gross national product.

A November 2020 study found that more than 1.1 million senior citizens in the U.S. Medicare program are expected to die prematurely over the next decade because they will be unable to afford their prescription medications, requiring an additional $17.7 billion to be spent annually on avoidable medical costs due to health complications.

Definition

Medication costs can be the selling price from the manufacturer, that price together with shipping, the wholesale price, the retail price, and the dispensed price.

The dispensed price or prescription cost is defined as a cost which the patient has to pay to get medicines or treatments which are written as directions on prescription by a prescribers. The cost is generally influenced by a financial relationship between pharmaceutical manufacturers, wholesale distributors and pharmacies. In addition to the financial relationship, each nation has different systems to control the cost of prescriptions. In the United States, a pharmacy benefit manager, a third-party organization, such as private insurances or government-run health insurances will implement cost containment programs, such as establishing a formulary, to contain the cost. In the United Kingdom, the government negotiates an overall cap on drugs bill growth with the pharmaceutical industry. In addition a government agency, the National Institute of Health and Care Excellence (NICE) assesses cost effectiveness of individual prescription drugs pricing. The National Health Service also may negotiate direct with individual pharmaceutical companies for certain specialised medicines, as well as running competitive procurements for generic drugs and for patented medicines where there is more than one drug available for a condition. Prescription costs are a regular health care cost for the sick and may mean economic hardship for the underprivileged. With healthcare insurance, the patient in the U.S. pays a co-pay (the amount the patient must pay for each drug or medical visit), a deductible (the amount the patient has to pay before the insurance starts sharing the cost) and co-insurance (the amount the patient has to pay after deductible) for prescription costs. After reaching the out of pocket maximum, the insurance company will pay 100% of the prescription cost. The amount the patient has to pay depends on the healthcare insurance plan the patient has.

As of 2017, prescription costs range from just more than 15% in high income countries to 25% in lower-middle income countries and low income countries.

Factors

Drug costs in different countries
Drug	US	Canada	UK	Spain	Netherlands
Etanercept	$2,225	$1,646	$1,117	$1,386	$1,509
Celecoxib	$225	$51	$112	$164	$112
Glatiramer	$3,903	$1,400	$862	$1,191	$1,190
Duloxetine	$194	$110	$46	$71	$52
Adalimumab	$2,246	$1,950	$1,102	$1,498	$1,498
Esomeprazole	$215	$30	$42	$58	$23

Pricing any pharmaceutical drug for sale to the general public is daunting. Per Forbes, setting a high ceiling price for a new drug could be problematic as physicians could shy away from prescribing the drug, because the cost could be too great for the benefit. Setting too low of a price could imply inferiority, that the drug is too "weak" for the market. There are many different pricing strategies and factors that go into the research and evaluation of a future drug's price with whole departments within US pharmaceutical companies like Pfizer devoted to cost analysis.

This chart shows discrepancies in drug pricing in different countries.

Marketing expenses

A study has placed the amount spent on drug marketing at 2-19 times that on drug research.

Research and development

Much research, needed to create drugs is done by the public sector. In addition, pharmaceutical companies also do much research prior to producing medications. The table shows research and development statistics for pharmaceutical companies as of 2013 per Astra Zeneca.

Pharmaceutical company	Number of drugs approved	Average R&D spending per drug (in $ Millions)	Total R&D spending from 1997 to 2011 (in $ Millions)
AstraZeneca	5	$11,790.93	$58,955
GlaxoSmithKline	10	$8,170.81	$81,708
Sanofi	8	$7,909.26	$63,274
Roche Holding	11	$7,803.77	$85,841
Pfizer	14	$7,727.03	$108,178
Johnson & Johnson	15	$5,885.65	$88,285
Eli Lilly & Co.	11	$4,577.04	$50,347
Abbott Laboratories	8	$4,496.21	$35,970
Merck & Co Inc.	16	$4,209.99	$67,360
Bristol-Meyers Squibb Co.	11	$4,152.26	$45,675
Novartis	21	$3,983.13	$83,646
Amgen Inc.	9	$3,692.14	$33,229

Severin Schwan, the CEO of the Swiss company Roche, reported in 2012 that Roche's research and development costs in 2014 amounted to $8.4 billion, a quarter of the entire National Institutes of Health budget. Given the profit-driven nature of pharmaceutical companies and their research and development expenses, companies use their research and development expenses as a starting point to determine appropriate yet profitable prices.

Pharmaceutical companies spend a large amount on research and development before a drug is released to the market and costs can be further divided into three major fields: the discovery into the drug's specific medical field, clinical trials, and failed drugs.

Discovery

The process of drug discovery can involve scientists determining the germs, viruses, and bacteria that cause a specific disease or illness. The time frame can range from 3–20 years and costs can range between several million to tens of millions of dollars. Research teams attempt to break down disease components to find abnormal events/processes taking place in the body. Only then do scientists work on developing chemical compounds to treat these abnormalities with the aid of computer models.

After "discovery" and a creation of a chemical compound, pharmaceutical companies move forward with the Investigational New Drug (IND) Application from the FDA. After the investigation into the drug and given approval, pharmaceutical companies can move into pre-clinical trials and clinical trials.

Trials

Drug development and pre-clinical trials focus on non-human subjects and work on animals such as rats.

The Food and Drug Administration requires at least 3 phases of clinical trials that assess the side effects and the effectiveness of the drug. An analysis of trial costs of approved drugs by the FDA from 2015 to 2016 found that out of 138 clinical trials, 59 new therapeutic agents were approved by the FDA. These trials have a median estimated cost of $19 million US dollars.

Phase 1 lasts several months and aims to assess the safety and dosage of the drug. The purpose is to determine how the drug affects the body.
Phase 2 lasts several months to two years and aims to assess the efficacy and side effect profile of the drug.
Phase 3 lasts 1 to 4 years and aims to continue assessing and monitoring the efficacy and side effects of the drug. Phase 3 aims to determine the risks and benefits of a drug to its intended patient population.
Phase 4 trials occur after the drug is approved by the FDA and aims to continue monitoring safety and efficacy of the drug.

Of these phases, the phase 3 is the most costly process of drug development. A single phase 3 trial can cost upwards of $100 million. It accounts for about 90 percent of the cost to pharmaceutical companies to develop a medication.

Failed drugs

The processes of "discovery" and clinical trials amounts to approximately 12 years from research lab to the patient, in which about 10% of all drugs that start pre-clinical trials ever make it to actual human testing. Each pharmaceutical company (who have hundreds of drugs moving in and out of these phases) will never recuperate the costs of "failed drugs". Thus, profits made from one drug need to cover the costs of previous "failed drugs". The cost of failure in R&D constitutes about 60% of all development costs. It emphasizes the importance of success rates as a key driver of R&D productivity. The average costs for studies are estimated at $30 million, $70 million, and $310 million for Phase I, II, and III, respectively.

Relationship

Overall, research and development expenses relating to a pharmaceutical drug amount to the billions. For example, it was reported that AstraZeneca spent upwards on average of $11 billion per drug for research and developmental purposes. The average of $11 billion only comprises the "discovery" costs, pre-clinical and clinical trial costs, and other expenses. With the addition of "failed drug" costs, the $11 billion easily amounts to over $20 billion in expenses. Therefore, an appropriate figure like $60 billion would be approximate sales figure that a pharmaceutical company like AstraZeneca would aim to generate to cover these costs and make a profit at the same time.

Total research and development costs provide pharmaceutical companies a ballpark estimation of total expenses. This is important in setting projected profit goals for a particular drug and thus, is one of the most necessary steps pharmaceutical companies take in pricing a particular drug.

A 2022 study invalidated the common argument as is for high medication costs that research and development investments are reflected in and necessitate the treatment costs, finding no correlation for investments in drugs (for cases where transparency was sufficient) and their costs.

Stakeholders

Patients and doctors can also have some input in pricing, though indirectly. Customers in the United States have been protesting the high prices for recent "miracle" drugs like Daraprim and Harvoni, both of which attempt to cure or treat major diseases (HIV/AIDS and hepatitis C). Public outcry has worked in many cases to control and even decide the pricing for some drugs. For example, there was severe backlash over Daraprim, a drug that treats toxoplasmosis. Turing Pharmaceuticals under the leadership of Martin Shkreli raised the price of the drug 5,500% from $13.50 to $750 per pill. After denouncement from 2016 presidential candidates Hillary Clinton and Bernie Sanders, Martin Shkreli said he would reduce the price but later decided not to.

With the recent trend of price gouging, legislators have introduced reform to curb these hikes, effectively controlling the pricing of drugs in the United States. Hillary Clinton announced a proposal to help patients with chronic and severe health conditions by placing a nationwide monthly cap of $250 on prescription out-of-pocket drugs.

Research for a drug that is curing something no one has ever cured before will cost much more than research for the medicine of a very common disease that has known treatments. Also, there would be more patients for a more common ailment so that prices would be lower. Soliris only treats two extremely rare diseases, so the number of consumers is low, making it an orphan drug. Soliris still makes money because of its high price of over $400,000 per year per patient. The benefit of this drug is immense because it cures very rare diseases that would cost much more money to treat otherwise, which saves insurance companies and health agencies millions of dollars. Hence, insurance companies and health agencies are willing to pay these prices.

Public policy

Policy makers in some countries have placed controls on the amount pharmaceutical companies can raise the price of drugs. In 2017, Democratic party leaders proposed the creation of a new federal agency to investigate and perhaps fine drug manufacturers who make unjustified price increases. Pharmaceutical companies would be required to submit a justification for a drug with a “significant price increase” within at least 30 days of implementation. Under the terms of the proposal, Mylan's well-publicized price increase for its EpiPen product would fall below the criteria for a significant price increase, while the 5000% overnight increase of Turing Pharmaceuticals Daraprim (pyrimethamine) would be subject to regulatory action.

Patents and monopoly rights

One of the most important factors that determine the cost of a drug is the availability of competing drugs and treatments. Having two or more manufacturers producing drugs for the same disease tends to reduce costs.

Patent laws give pharmaceutical companies the exclusive right to market a drug for a period of time, allowing them to extract a high monopoly price. For example, U.S. patent law grants a monopoly for 20 years after filing. After that period, the same product from different manufacturers - known as generic drugs - can be sold, usually resulting in a substantial price reduction and possible shift in market share. Two patents that are commonly used are process patents and drug product patents. Process patents only provide developers intellectual claim to the methods in which the product was manufactured, so a competitor can make the same drug by a different method without violating the patent.

In some cases, a new treatment is more effective than an older treatment, or a given drug may work better than competitors for only some patients. The availability of an imperfect substitution erodes prices to a lesser degree than would a perfect substitute.

Some countries grant additional protections from competition for a limited period, such as test data exclusivity or supplementary protection certificates. Additional incentives are available in some jurisdictions for manufacturers of orphan drugs for rare diseases, including extended monopoly protection, tax credits, waived fees, and relaxed approval processes due to the small number of affected patients.

Transparency

The process of creating drugs to testing them to selling them is a long process. Aside from the costs for research and trials, many consumers are unaware of the process of the drug supply chain. There are many middlemen and companies that buy and sell the drugs. This includes "drug manufacturers, drug wholesalers, pharmacies, and payers." Big Pharma's influence in the policies and regulations regarding drug patents and prescription costs, protects pharmaceutical companies from having to be transparent about where the money goes and who those high prices benefit, including Pharmacy Benefit Managers. Transparency between drug manufacturers and sellers increases accountability between producers and consumers and allows for patients to know more about what they are paying for. Prescription Drug Price Locators allow for patients to learn of more cost-effective sellers and find discounts that will benefit them.

In an effort by the U.S. Department of Health and Human Services (HHS) to regulate drug price transparency in television advertising in 2019, the HHS saw a resistance to change against legislation. Although what the HHS sought to change was a step in the right direction for drug price transparency, Federal Judge Amit P. Mehta ruled in favor of the pharmaceutical industry. The ruling was based on the inability to give the HHS such power to enact such legislations. Policymakers have a lot to take into account when regarding the issue of transparency, as there are many middlemen involved in the selling and buying of prescription drugs.

Effects on consumers

When the price of medicine goes up the quality of life of consumers who need the medicine decreases. Consumers who have increased costs for medicine are more likely to change their lifestyle to spend less money on groceries, entertainment, and routine family needs. They are more likely to go into debt or postpone paying their existing debts. High drug prices can prevent people from saving for retirement. It is not uncommon for typical people to have challenges paying medical bills. Some people fail to get the medical care they need due to lack of money to pay for it. In low and middle income countries up to 90% of people pay for medications out of pocket. A November 2020 study by the West Health Policy Center stated that more than 1.1 million senior citizens in the U.S. Medicare program are expected to die prematurely over the next decade because they will be unable to afford their prescription medications, requiring an additional $17.7 billion to be spent annually on avoidable medical costs due to health complications.

The effects of high prescription costs on consumers also affects their long-term health and overall life expectancy. When properly used, a medication can benefit a patient and cure their disease. When a patient cannot afford to pay for their medication, they lose out on the optimal benefits of proper and adequate dosages. High prescription costs don't just affect patients in the short run, but also deteriorates their overall quality of life, as they are exposed to chronic illnesses that could have been prevented by that first prescription. Evidence from studies indicates that insulin therapy as a treatment for patients with high glucose levels that are not yet diabetic, leads to a decrease in insulin resistance, which benefits patients.

References

Common measures taken to reduce costs

Consumers commonly respond to high or increasing drug prices by doing what they can to save drug costs. The most commonly recommended course of action for consumers who seek to lower their drug costs is for them to tell their own doctor and pharmacist that they need to save money and then ask for advice. Doctors and pharmacists are professionals who know their fields and are the most likely source of information about options for reducing cost.

Depending on the country and health policies implemented, there are also options to search for the most convenient and affordable health insurance plans without having to consult a healthcare provider or obtain insurance through the employer. However, those who seek to purchase insurance individually through the individual market are most likely to be underinsured and therefore could potentially have a higher prescription cost.

There can be significant variation of prices for drugs in different pharmacies, even within a single geographical area. Because of this, some people check prices at multiple pharmacies to seek lower prices. Online pharmacies can offer low prices but many consumers using online services have experienced Internet fraud and other problems, such as long shipping times from overseas and a higher insecurity regarding quality, genuineness and safety of the ordered products.

Some consumers lower costs by asking their doctor for generic drugs when available. Because pharmaceutical companies often set prices by pills rather than by dose, consumers can sometimes buy double-dose pills, split the pills themselves with their doctor's permission, and save money in the process.

Not purchasing the medications / inaccessibility

In countries without universal healthcare, there can be unaffordable out-of-pocket costs for needed medications. Approximately 25% of Americans find it difficult to afford prescription drugs. In the case of expensive anti-obesity medications it has been noted that many people "who could most benefit from weight loss may be unable to afford such expensive drugs". This may be of higher concern for conditions that are more risky or detrimental to health and/or which, unlike obesity, don't have additional treatment options that are both widely known and effective – like further improvements in diet and physical activity in the case of obesity. A study found that among U.S. Medicare beneficiaries without subsidies, 30% of prescriptions written for anticancer drugs, 22% for hepatitis C, and more than 50% for disease-modifying therapies for either immune system disorders or hypercholesterolemia were not filled by patients.

The right to science and culture is one of the rights in the Universal Declaration of Human Rights according to which "Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits."

Effects on healthcare systems

While some have concluded that "drug development is likely to remain an expensive and resource-intensive process", a study found that wide range of medicines in the WHO Model List of Essential Medicines can be profitably manufactured at very low cost by pharmaceutical industries and that "Most EML medicines are sold in the UK and South Africa at prices significantly higher than those estimated from production costs".

Global spending on prescription drugs in 2020 may have been ~$1.3 trillion and "The high cost of prescription drugs threatens healthcare budgets, and limits funding available for other areas in which public investment is needed".

By region

United States

Prescription drug prices in the United States have been among the highest in the world. The high cost of prescription drugs became a major topic of discussion in the new millennium, leading up to the U.S. health care reform debate of 2009, and received renewed attention in 2015. High prices have been attributed to monopolies given to manufacturers by the government and a lack of ability for organizations to negotiate prices.

Individuals are able to enroll in health insurance plans, which often include prescription medication coverage. However, insurance companies decide which drugs they will cover by creating a formulary. If a medication is not on this list, the insurance company may require people to pay more money out-of-pocket compared to other medications that are on the formulary. There are also often tiers within this approved drug list, as the insurance company may be willing to cover a portion of one drug but prefer and completely cover a cheaper alternative.

Medicare Part D is a branch of Medicare that helps to cover costs of prescription medications for patients aged 65 and up. From 2010 to 2018, the Part D plan "nearly quadrupled" its spending on the catastrophic coverage phase. This increase in spending is attributed to the rising pricing of prescription medications.

United Kingdom

It varies by region in the United Kingdom. In Wales, Scotland and Northern Ireland prescription costs have been completely abolished, however in England the current prescription cost for adults as of 1 April 2021 is £9.35 per item dispensed. There are subsidised costs for those claiming Universal Credit.

Developing world

In developing countries medications make up between 25 and 70% of health care costs. Many medications are beyond the reach of the majority of the population. There have been attempts both by international agreements and by pharmaceutical companies to provide drugs at low cost, either supplied by manufacturers who own the drugs, or manufactured locally as generic versions of drugs which are elsewhere protected by patent. Countries without manufacturing capability may import such generics.

The legal framework regarding generic versions of patented drugs is formalised in the Doha Declaration on Trade-Related Aspects of Intellectual Property Rights and later agreements.

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