Tegan Tuesday: A new experiment in affordable medication

Bernie Sanders’s presidential campaign involved many issues, but one of his strongest was Medicare for All and the outrageous price-gouging involved in medical care. Although medication costs were not an issue for me personally at the time, it is an issue near and dear to my heart because of the many, many people I know who do require daily medications. And of course, the disabled are the minority group that everyone has the ability to join. All this to say, that I care deeply about medical access for every person, regardless of economic status.

There have been any number of attempts to fix the broken American medical system from within. A commonly used work-around for medications that aren’t covered by insurance, that are still too expensive with insurance, or for those without coverage is the app Goodrx. This app offers discounts on medications that would have to be paid out of pocket — but the prices are location dependent. If Tucson, AZ carries your medication for $5 on Monday, but you live in LA, you cannot access that $5 rate. So each person has a very different experience using Goodrx from town to town and from day to day. But a new contender has entered the ring!

Cost Plus Drugs is a brand new website founded by Dr Alexander Oshmyansky and funded by Mark Cuban, the billionaire owner of the Dallas Mavericks who also has the notoreity of being the richest shark on Shark Tank. Cost Plus Drugs is a new extension of Cuban’s support for Dr Oshmyansky’s medical projeccts, which include almost two decades of research to prevent hospital-caused infectious diseases (Altitude Medical), four years of pharmaceutical supply (Osh Affordable Pharmaceuticals), and the Pharmacy Benefit Manager (PBM) branch of Cost Plus which launched last year. The company is also building a compounding pharmacy in Texas which is expected to open later this year, and have applied for a biologics license with the FDA. Dr Oshmyansky is apparently serious about his desire to use medicine to help people — and if he happens to make a ton of money with his start-ups, well that is a lovely, lovely perk.

How the company works is quite simple: if Cost Plus offers one of your medications, your own doctor sends a script to the company and you get your medicines at extremely low prices. The company has a stated 15% mark-up as well as small administrative/stocking fees, but as it doesn’t work through the insurance system, there are no bizarre hurdles to jump nor price imbalances. All patients get the same rates, which are based off of the cost of sourcing the medicines. Currently, Cost Plus works with third-party manufacturers for generics of the most commonly needed medicines. Because no, they don’t offer all meds, not even close. The company is only offering around 100 different medications at this time, but the goal is to keep expanding so as to provide alternatives for more diseases and more medications. But how good are these prices? Going by Cost Plus’s website, the savings are significant — often in the multiple hundred or even thousands of savings per refill. For example, Albendazole (an Albenza generic for parasitic worm infestations) costs $453 per fill, with a discount of $6112.28 due to the drug’s outrageous price of $6565.28. But that’s the price against the out-of-pocket, no-insurance price. Someone who has a Goodrx account and has more experience sourcing medications broke down a few examples of the math most users are likely to see:

If you don’t have insurance, Goodrx is often about as good as it gets, so I’m using their prices for my comparison.

Please note that prices are location dependent on Goodrx — it shows you the options at pharmacies near your location. I’m in Pittsburgh, PA; if you’re in a different part of the country and you try this, you may get slightly (or wildly) different numbers.

Fluoxetine is generic Prozac. Thirty 20mg capsules costs $12.80 at my cheapest local pharmacy. Cost Plus has it for $3.90.

Atorvastatin is generic Lipitor. Thirty 40mg tablets is $10.95 at my cheapest local pharmacy. Cost Plus has it for $4.20.

Omeprazole is generic Prilosec. Thirty 20mg capsules is $13.90 at the cheapest local pharmacy; $4.20 at Cost Plus.

Aripiprazole is generic Abilify. Thirty 10mg tablets is $17.73 at the cheapest local pharmacy (and $260.60 at the most expensive — and that’s with a discount, still, yikes); $6.00 at Cost Plus.

Lamotrigine XR is generic Lamictal XR. Thirty 25mg tablets is $36.59 at the cheapest local pharmacy; $8.40 at Cost Plus.

Maybe that doesn’t seem like a huge discount, but the Goodrx prices change *all the time* — last time I used it to buy Fluoxetine, which was in the last couple of years, it was $31. Also, many people are on multiple medications, or have multiple people in a household taking multiple medications, and $5 off every prescription adds up real fast.

I am also incredibly interested to see how the company will move forward after the manufacturing facility is completed. Compounding pharmacies are incredibly important for any number of reasons, not in the least being that they can control what allergens go into someone’s medications. This is doubly concerning since as of 2020 the FDA has allowed unlabeled substitutions for food manufacturers (and medicines) for “the entire COVID emergency,” however long that is. As Abe discovered while we were in Scotland, one of the most common non-active ingredients for medications is lactose. According to one study, almost half of the medications represented contained lactose. With even less control over what non-active ingredients are included in medications thanks to the current FDA statute, many people could experience allergic reactions from their medications. Opening the option for customizing meds around a patient’s specific allergens, as is possible with a compounding pharmacy, could be life saving for any number of people.

When looking into this company, I was bemused to see a number of articles that were extremely negative about it. To be clear, I think there are causes for skepticism. For one thing, they still only carry drugs for treating type 2 diabetes, leaving those with type 1 on their own. I also certainly have worries about billionaires wanting to ‘fix’ the medical situation in the US (Cuban almost certainly has intentions to run for president and this would be an extremely popular thing to have in his back pocket), my concerns are, mysteriously, different from those of Forbes, or other financial reporting groups. One of the biggest concerns for Forbes was the lack of insurance — paying out of pocket for medications doesn’t lower deductibles for non-Cost Plus medications from shitty insurance plans. This is an issue that I consider one to watch, but as Cost Plus adds more medications and we continue to work to dismantle the current insurance system, this will hopefully become an issue of the past.


Tegan has helped with beta reading and editing on this blog for a while now, and she decided she also wants to do a weekly post about topics that catch her attention. As always this is part of our effort to make ends meet, as my immigration status doesn’t allow me to get wage labor, so this blog is my only source of income.  You can sign up to help us pay the bills at patreon.com/oceanoxia. The great thing about crowdfunding is how little each contributor needs to put in; in this case as little as a dollar per month – that’s like three cents a day! Pocket change! We could use it to buy better boots!

International team uses satellites to shine a spotlight on industry methane emissions

We’ve long known that fossil fuel companies are doubly responsible for the current climate crisis. They’re major greenhouse gas emitters, and they’re major misinformation producers. Because corporations aren’t known for honestly reporting the harm they do, it’s hard to be certain of the numbers. A big question surrounding fracking, for example, was whether it would cause methane to leak into nearby water supplies, as well as into the atmosphere. It’s hard to measure exactly how much is being released at fracking sites, let alone from the surrounding areas. It’s also hard to be sure how much leaks from pipelines, or refineries, or storage sites. Now, for the first time ever on a global scale, a team of scientists has used satellites to track major methane emissions associated with the fossil fuel industry:

An international research team led by the Laboratoire des Sciences du Climat et de l’Environnement (CNRS / CEA / UVSQ), in cooperation with the firm Kayrros, have achieved a world first by completing a global tally of the largest emissions of methane into the atmosphere by the fossil-fuel industry. These may be accidental or the result of intentional venting associated with maintenance operations, which account for very large releases. To obtain their data, the researchers methodically analysed thousands of daily images generated by the ESA’s Sentinel-5P satellite over a two-year period. This allowed them to map 1,800 methane plumes around the globe, of which 1,200 were attributed to fossil-fuel extraction. They deem the impact of such releases on the climate comparable to that of 20 million vehicles on the road for one year.

These emissions account for 10% of the total estimate for the industry. Yet they are just the tip of the iceberg because the satellite is only able to routinely detect the biggest plumes (>25 tonnes per hour of CH4), which are also the most intermittent. The researchers demonstrate that these massive releases of methane are not randomly located but always appear over particular oil and gas extraction sites. As borne out by observations of these releases, whose volumes depend on maintenance protocols and diligence in the repair of leaks, the rules implemented by states and businesses play a major role.

The image shows a map of the world with major gas pipelines in blue, and major leaks shown as orange dots. The actual numbers are described in the linked article.

Map of main gas pipelines and sources of methane emissions related to oil and gas industry operations.

As the article notes, methane traps far more heat per molecule than CO2, which accounts for the vehicle comparison above. I think this underscores the point that efforts to make climate action a matter of personal responsibility and personal choice act as misinformation simply through the assumptions inherent in their framing. The amount of damage that any one of us does is dwarfed by what’s done by corporations and governments; and before anyone says that their pollution is driven by the needs of humanity, let me remind you that human need has next to nothing to do with how the global economy is run. The primary consideration is always profit, and they use things like lobbying and propaganda to create demand for their products, and to prevent alternatives from being readily available.

We need systemic change, and we can’t expect it from the people who hold power. We need to build collective power, so that we can exert real democratic control over our societies.


Thank you for reading. If you find my work interesting, useful, or entertaining, please share it with others, and please consider joining the group of lovely people who support me at patreon.com/oceanoxia. Life costs money, alas, and owing to my immigration status in Ireland, this is likely to be my only form of income for the foreseeable future, so if you are able to help out, I’d greatly appreciate it. The beauty of crowdfunding is that even as little as $1 per month (that’s like three pennies a day!) ends up helping a great deal if enough people do it. You’d be supporting both my nonfiction and my science fiction writing, and you’d get early access to some of the fiction and some other content.

Power demand from air conditioning could soon exceed total power supply in the United States

I had hoped to have my next bit of science fiction out today, but it’s just not there yet, so here’s something else instead.

One of the most long-standing cases for acting on climate change is the simple fact that the sooner we act, the cheaper and easier it will be. The reality is that avoiding any cost is simply not an option. Extreme weather events, rising sea levels, damage to crops and infrastructure – climate change costs money, no matter how you look at it. By delaying action as long as we have, we’ve entered the age of endless recovery. Any action we take to deal with climate change will now be impeded by ongoing efforts to rebuild from damage already done.

Unfortunately, the cost increase goes beyond that. A big reason for why it’s in our best interest to take action is that there are limits to the temperatures humans can withstand. On our current trajectory, it’s likely that for at least some days out of the year, many parts of the world will be too hot for humans to survive very long without some external means of cooling. These days, that often means air conditioning, which is already a pretty energy-intensive process. As temperatures continue to rise, AC units will have to work harder to achieve the same cooling, and more people are going to need to rely on it to get by. In short, it’s very possible that the power demands of air conditioning will soon exceed the amount of power being generated in the United States:

Climate change will drive an increase in summer air conditioning use in the United States that is likely to cause prolonged blackouts during peak summer heat if states do not expand capacity or improve efficiency, according to a new study of household-level demand.

The study projected summertime usage as global temperature rises 1.5 degrees Celsius (2.7 degrees Fahrenheit) or 2.0 degrees Celsius (3.6 degrees Fahrenheit) above preindustrial levels, finding demand in the United States overall could rise 8% at the lower and 13% at the higher threshold. The new study was published in Earth’s Future, AGU’s journal for interdisciplinary research on the past, present and future of our planet and its inhabitants.

Human emissions have put the global climate on a trajectory to exceed 1.5 degrees Celsius of warming by the early 2030s, the IPCC reported in its 2021 assessment. Without significant mitigation, global temperatures will likely exceed the 2.0-degree Celsius threshold by the end of the century.

Previous research has examined the impacts of higher future temperatures on annual electricity consumption or daily peak load for specific cities or states. The new study is the first to project residential air conditioning demand on a household basis at a wide scale. It incorporates observed and predicted air temperature and heat, humidity and discomfort indices with air conditioning use by statistically representative households across the contiguous United States, collected by the U.S. Energy Information Administration (EIA) in 2005-2019.

The new study projected changing usage from climate influence only, and did not consider possible population increases, changes in affluence, behavior or other factors known to affect air conditioning demand.

“We tried to isolate just the impact of climate change,” said Renee Obringer, an environmental engineer at Penn State University and lead author of the new study. “If nothing changes, if we, as a society, refuse to adapt, if we don’t match the efficiency demands, what would that mean?”

Technological improvements in the efficiency of home air conditioning appliances could supply the additional cooling needed to achieve current comfort levels after 2.0 degrees global temperature rise without increased demand for electricity, the new study found. Increased efficiency of 1% to 8% would be required, depending on existing state standards and the expected demand increase, with Arkansas, Louisiana and Oklahoma on the high end.

“It’s a pretty clear warning to all of us that we can’t keep doing what we are doing or our energy system will break down in the next few decades, simply because of the summertime air conditioning,” said Susanne Benz, a geographer and climate scientist at Dalhousie University in Halifax, Nova Scotia, who was not involved in the new study.

Exceeding capacity

The heaviest air conditioning use with the greatest risk for overloading the power grid comes during heat waves, which also present the highest risk to health. Electricity generation tends to be below peak during heat waves as well, further reducing capacity, Obringer said.

Without enough capacity to meet demand, energy utilities may have to stage rolling blackouts during heat waves to avoid grid failure, like California’s energy providers did in August 2020 during an extended period of record heat sometimes topping 117 degrees Fahrenheit.

“We’ve seen this in California already — state power suppliers had to institute blackouts because they couldn’t provide the needed electricity,” Obringer said. The state attributed 599 deaths to the heat, but the true toll may have been closer to 3,900.

The consequences of cascading electrical grid failures are likely to impact already vulnerable populations, including low income, non-white and older residents, first, Obringer noted.

“When they say there’s going to be two weeks where you don’t have cooling on average — in reality, some people will have cooling. Disadvantaged people will have less cooling,” Benz said.

How long are we going to wait to take this seriously? How many people will have to suffer and die in the heat? We know what we need to do. We need to update the power grid. We need to invest in home energy efficiency, and in passive cooling wherever we can use it. We also need to have sources of power – like wind and solar – that don’t need to be shut down during heat waves, when the need for cooling can be a matter of life or death. As I’ve said before, science is a way for us to see what’s coming, but a warning is no good if it’s not heeded.

We are running out of time.


Thank you for reading. If you find my work interesting, useful, or entertaining, please share it with others, and please consider joining the group of lovely people who support me at patreon.com/oceanoxia. Life costs money, alas, and owing to my immigration status in Ireland, this is likely to be my only form of income for the foreseeable future, so if you are able to help out, I’d greatly appreciate it. The beauty of crowdfunding is that even as little as $1 per month (that’s like three pennies a day!) ends up helping a great deal if enough people do it. You’d be supporting both my nonfiction and my science fiction writing, and you’d get early access to some of the fiction and some other content.

Video: Your “Carbon Footprint” Is A Scam

The other day I shared a video on how “net zero” is a scam, and I think this is a good follow-up to that. This is absolutely a trick I fell for, and I grappled for a long time with the misguided belief that climate action was all about individuals “making better choices”.  I’ve got a longer piece on this in the works, but these two “scams” do a good job of illustrating how the shell game is played. Pollution, destruction, poisoning, blame – it’s all shifted onto society as a whole. It works because it’s not some nefarious plan, it’s just how all the incentives of our society are arranged. Some of that was there from the outset, as feudalism gave way to capitalism, and the aristocrats largely kept their wealth and power. Some of it was put in place when individuals with power pushed for changes to benefit themselves, and that paved the way for everyone else.

Some of it is propaganda convincing the masses that the true guilt lies within us, and we should either seek purity through asceticism, or just enjoy the ride while it lasts.

Pollution, bio-indicators, and our crumbling foundations (also a big bug photo)

If you ever get a chance to hike a  stretch of the Appalachian Trail, you’ll find that the shelters all have “trail registers”. These are cheap notebooks where people mark down when they were at the shelter, and leave relevant notes. Sometimes you’ll see warnings of a bear that’s been showing up, or a Kevin Bacon sighting. Sometimes thru-hikers will leave notes for friends or acquaintances who’re behind them on the trail, and sometimes people get creative. I met one woman who would perform a rap at most shelters, and write the whole thing in the trail register.

Sometimes you come across something that seems a little… worrying.

Picture the scene, if you will. It’s early evening, and you’ve been hiking for several hours. The sun’s starting to get a bit lower in the sky, and the golden light is shimmering on the Housatonic to your right. Ahead to the left, you see a sign for the Stewart Hollow Brook lean-to, and you take the turn, glad you reached your day’s destination with plenty of daylight left.

You heave your pack into the lean-to, and sit on the edge, eating a mint-chocolate food bar, and listening to the wind and the birds. You wash your snack down with a swig of water, and lean over to grab the trail register.

Someone who passed you a week ago is now just a day ahead. There’s a liquor store that’ll give through hikers a free beer not too far away. And there’s –

-WARNING – DO NOT SLEEP ON THE GROUND HERE! Seriously don’t. There are these huge bugs that come out at night! Check your shoes!

-Holy shit I thought the other entries were joking but they’re not! They’re like some kind of alien bugs or something? They’ve got spikes and stuff all over them and pincers!

-Ridgerunner here – yes there are scary bugs, but they won’t hurt you. They’re just hellgramites

“Hellgramites”?

Like that doesn’t sound like some kind of alien parasite? Well, it’s just a name, so let’s see what they actually look like.

Image shows a hand carefully holding a large insect larva by its head. Its pincers can't reach the fingers, and its legs are flailing helplessly. Its abdomen is about as long as the hand is wide, with large, soft

“It’s just a Hellgramite”

Oh.

Well.

And not just one or two – in the evening and through the night, there’s a never-ending march of these things up from the river.

So, dear readers – what’s going on here?

Well, lots of things, but when I saw this phenomenon as a ridgerunner back in my college days, it put me in mind of a high school environmental science class I took. It was a well-designed course, looking back. We learned about stuff like water quality, industrial runoff, and so on, and we learned it by going out and testing the water, and visiting sewage treatment plants and papermills.

And we learned how to use benthic macroinvertebrates as pollution bioindicators. In plain speech, we learned how to learn about water quality by looking at the bugs that lived in the riverbed. There are many kinds of bugs and worms that live under the rocks and in the sand at the bottom of any river, and as with any community, they have different specializations, preferences, and chemical tolerances.

Hellgramites – also known as dobsonfly larvae – were one of the species we studied, and I have them lodged in my head as being “pollution tolerant”. I believe that assessment is an exaggeration – it’s probably better to say that compared to some other fly larvae that live on riverbeds, they’re more tolerant of moderate levels of pollution. We’re talking the kind of water rivers that have people fishing for food, but also have signs warning everyone not to eat more than one fish per month from that water.

The Housatonic, as I remember it, is a shallow and somewhat murky river that can smell a bit off on a hot day, and has a lot of brown algal growth over its stones. It was pretty, but I think I only swam in it on a couple occasions when the heat got to be too much. Like most rivers in the U.S., it suffered from various forms of runoff, and while I never actually studied its invertebrate community, I’m willing to bet it would have been possible to gauge where the river was at even without the ability to measure for specific chemicals.

A couple years later, I had graduated, and was working as property manager for the Earlham College biology department. The job involved a number of tasks, but one of them was helping with a turtle population survey for a nearby pond. The pond was located between a couple industrial parks, and had had a major fish kill in recent years. The biology and chemistry departments had a grant to investigate, and my end involved catching, measuring, and marking as close to every turtle in that pond as I could get. I never saw the final reports, but there was one finding that jumped out at us right away – we caught dozens of turtles, of three or four different species, but not a single one of them was younger than six years old.

Sure, you can guesstimate pollution levels by what bugs are or aren’t thriving, but in this case reproduction had just ended in that pond. That’s another level.

During my work as a curriculum writer, the team I was on spent a good amount of time on the idea of bioindicators, because we had students studying how climate change is affecting things like leaf-out and flowering times in plants.

All of these things – the bugs, the turtles, the plants – they’re like looking at a person’s skin to assess their health. How does the color compare to their normal complexion? Do they have wounds? Blisters? A rash? Are they clammy, or is their skin too dry? None of the symptoms are the underlying problem, but they’re all useful ways to get an idea for what’s going on.

What I haven’t fully connected, until recently, is that the solidity of our knowledge about bioindicators and the sheer number of examples that exist both indicate that humanity’s traces can be found everywhere.

It’s easy to talk about indicators and trends, but even though one can spend an entire career teaching the same lessons over and over again, things don’t just start over. They continue happening. Chemicals continue building up, because they continue being released. Ecosystems take one hit after another, and bit by bit, cracks form in the foundations.

The study concludes that chemical pollution has crossed a “planetary boundary”, the point at which human-made changes to the Earth push it outside the stable environment of the last 10,000 years.

Chemical pollution threatens Earth’s systems by damaging the biological and physical processes that underpin all life. For example, pesticides wipe out many non-target insects, which are fundamental to all ecosystems and, therefore, to the provision of clean air, water and food.

“There has been a fiftyfold increase in the production of chemicals since 1950 and this is projected to triple again by 2050,” said Patricia Villarrubia-Gómez, a PhD candidate and research assistant at the Stockholm Resilience Centre (SRC) who was part of the study team. “The pace that societies are producing and releasing new chemicals into the environment is not consistent with staying within a safe operating space for humanity.”

Dr Sarah Cornell, an associate professor and principal researcher at SRC, said: “For a long time, people have known that chemical pollution is a bad thing. But they haven’t been thinking about it at the global level. This work brings chemical pollution, especially plastics, into the story of how people are changing the planet.”

Some threats have been tackled to a larger extent, the scientists said, such as the CFC chemicals that destroy the ozone layer and its protection from damaging ultraviolet rays.

Determining whether chemical pollution has crossed a planetary boundary is complex because there is no pre-human baseline, unlike with the climate crisis and the pre-industrial level of CO2 in the atmosphere. There are also a huge number of chemical compounds registered for use – about 350,000 – and only a tiny fraction of these have been assessed for safety.

So the research used a combination of measurements to assess the situation. These included the rate of production of chemicals, which is rising rapidly, and their release into the environment, which is happening much faster than the ability of authorities to track or investigate the impacts.

The well-known negative effects of some chemicals, from the extraction of fossil fuels to produce them to their leaking into the environment, were also part of the assessment. The scientists acknowledged the data was limited in many areas, but said the weight of evidence pointed to a breach of the planetary boundary.

“There’s evidence that things are pointing in the wrong direction every step of the way,” said Prof Bethanie Carney Almroth at the University of Gothenburg who was part of the team. “For example, the total mass of plastics now exceeds the total mass of all living mammals. That to me is a pretty clear indication that we’ve crossed a boundary. We’re in trouble, but there are things we can do to reverse some of this.”

Villarrubia-Gómez said: “Shifting to a circular economy is really important. That means changing materials and products so they can be reused, not wasted.”

The researchers said stronger regulation was needed and in the future a fixed cap on chemical production and release, in the same way carbon targets aim to end greenhouse gas emissions. Their study was published in the journal Environmental Science & Technology

There are growing calls for international action on chemicals and plastics, including the establishment of a global scientific body for chemical pollution akin to the Intergovernmental Panel on Climate Change.

Prof Sir Ian Boyd at the University of St Andrews, who was not part of the study, said: “The rise of the chemical burden in the environment is diffuse and insidious. Even if the toxic effects of individual chemicals can be hard to detect, this does not mean that the aggregate effect is likely to be insignificant.

“Diffuse and insidious” seems to apply to a lot of the problems we’re facing right now. In particular – and this will shock you – this makes me think of greenhouse gas pollution. The entire problem of global warming is diffuse and insidious. Instead of the attention-grabbing stuff, like causing cancer, greenhouse gases just… raise the temperature a little. So very little that it’s hard to measure, and then they do it again. And again. And again. Every hour, of every day, of every month, year round, for as long as they exist. We’ve known about it for well over a century now. We’ve been studying it for longer than that, and we’ve been watching as the numbers have gotten higher.

As the article says, we’ve crossed a number of thresholds recently, and there’s no real way to go back – we just have to find a different way forward.  As I will never stop repeating, we need systemic change. It’s not just the climate. It’s not just the chemical pollution. It’s not just the bigotry, and the greed, and the cruelty.

It’s everything. Plenty of parts of our society are good, and wonderful, and worth holding on to, but all parts of our society are sick. Because we are a self-aware collective organism, as a species, we have the ability to re-arrange the workings of our “body” to suit different wants and needs. That’s our greatest power, and it’s past time we did the learning and organizing required to put it to use for the good of all.


Thank you for reading. If you find my work interesting, useful, or entertaining, please share it with others, and please consider joining the group of lovely people who support me at patreon.com/oceanoxia. Life costs money, alas, and owing to my immigration status in Ireland, this is likely to be my only form of income for the foreseeable future, so if you are able to help out, I’d greatly appreciate it. The beauty of crowdfunding is that even as little as $1 per month ends up helping a great deal if enough people do it. You’d be supporting both my nonfiction and my science fiction writing, and you’d get early access to the fiction.

Lonerbox takes a hard look at hard times and hard men

An obsession with “hard” masculinity is a very old trope, but one that continues to plague us. It’s often supported by facile historical comparisons that fall apart upon closer inspection, but it remains one of the most reliable tools for manipulating men into a whole array of harmful behaviors. Self-destructive showing off, domestic abuse, abusive relationships between friends, violence, support for political “strong men”, support for war, hatred of “weakness”, misogyny, homophobia, transphobia – all the traits we currently categorize as “toxic masculinity” tend to be supported by the notion that being a “hard man” is a good thing, and being not that is a bad thing. I think this Lonerbox video is a good companion piece to Thought Slime’s earlier look at the same topic, from a different angle. The reality is that this psuedo-historical “ancient wisdom” is both a-historical and (in my opinion) instrumental in creating hard times.

Tegan Tuesday: The Vimes Boots Index

“The reason that the rich were so rich, Vimes reasoned, was because they managed to spend less money. Take boots, for example. He earned thirty-eight dollars a month plus allowances. A really good pair of leather boots cost fifty dollars. But an affordable pair of boots, which were sort of okay for a season or two and then leaked like hell when the cardboard gave out, cost about ten dollars. Those were the kind of boots Vimes always bought, and wore until the soles were so thin that he could tell where he was in Ankh-Morpork on a foggy night by the feel of the cobbles. But the thing was that good boots lasted for years and years. A man who could afford fifty dollars had a pair of boots that’d still be keeping his feet dry in ten years’ time, while a poor man who could only afford cheap boots would have spent a hundred dollars on boots in the same time and would still have wet feet.” – Terry Pratchett, Men at Arms

Terry Pratchett wrote many words on injustices within systems and on the importance of building support networks of people within said systems in his Discworld series. Men at Arms was written in 1993, the fifteenth book in the series, and the concept referred to as the “Sam Vimes ‘Boots’ theory of socio-economic unfairness” caught fire. It’s not a new concept — poverty taxes exist in many forms across all life, such as bulk discounts for those able to afford the large upfront cost and who have the storage space for excess material — but the phrasing of the Boots theory was particularly catchy. Economics classes have used it as a pithy example of the poverty tax issue, and many who might have never encountered the concept understood it easily through the medium of fiction.

Enter Jack Monroe. Mx. Monroe is a UK-based food writer, journalist and poverty activist. I first encountered their work with their phenomenal food blog ‘Cooking on a Bootstrap,’ which details ways to actually live on poverty wages. Monroe grew up working class and spent years as a working-poor single parent — all of the recipes and tricks they write about come from experience. Thanks to their luck with their successful blog, they have since used their greater platform to highlight inequalities, support hunger relief programs, and be a vocal activist for labor and poverty issues. Their new campaign is a price index to track basic food products, labeled the “Vimes Boots Index,” in honor of the late Sir Terry Pratchett. This past month has included the official authorization from the Pratchett estate for the name, with the author’s daughter, Rhianna Pratchett, stating that her dad would have been proud to see his work used by for anti-poverty campaigns.

But why do we need a new consumer price index (CPI) at all? The UK government is one of many that offers such a service and it has continued to do so throughout the changes of Brexit, pandemic, and global shipping disruptions. But according to Monroe on twitter, the offical UK CPI “grossly underestimates the real cost of inflation as it happens to people with the least.” According to the UK government, inflation was at 5.4%. This official number was calculated assuming purchases from a list of 700 items including legs of lamb, bedroom furniture, televisions and champagne. According to Monroe’s personal tracking in their local grocery store, non-champagne food prices were doubling and tripling. Take rice, for example. It is a common staple in poor households as it is cheap, sold in large quantities, and very easy to adjust to make it feel like a different meal from day to day. In their local store last year, Monroe noted that they could purchase a 1kg bag of rice for 45p; but last week the price was £1 for a 500g bag, or a 344% increase. Adding insult to injury, the number and variety of ‘value products’ has significantly dropped in stores. Situations like this example have been happening in grocery stores all across the British Isles, with two and a half million British residents using food banks as a result during 2021. This infuriating disconnect between the official numbers and the lived experience of the average British person caused Monroe to reach out to economists, charities, and analysts to create the new price index. The Vimes Boots Index is intended to “document the disappearance of the budget linesand the insidiously creeping prices of the most basic versions of essential items at the supermarket” and “serve as an irrefutable snapshot of the reality experienced by millions of people,” as stated by Monroe in their Observer column on January 22, 2022.

It’s not just poverty activists and those directly affected who have noticed the rise in food insecurity. Richard Walker, the managing director of the grocery chain Iceland (focusing primarily on frozen foodstuffs) gave a statement on ITV January 21st that his stores were losing customers to “food banks, and to hunger.” That customers weren’t being priced out and going to different stores, but that the next step was charity or starvation. The director then went on to pledge that their £1 range will stay at the £1 rate until the end of 2022, in order to give customers a reliable budget item. But Iceland remains a lone raft in a sea of rising prices.

The increased visibility of the extreme inflation of food prices at the lowest end of the market and the influence of the newly formed Vimes Boots Index has already had real-world impact. As of January 26, 2022, the Office for National Statistics has admitted that “one inflation rate doesn’t fit all” and Monroe reported that the office will be changing the way that they collect and report on both inflation in general and food prices in specific. These changes will take into account a wider range of income levels and household circumstances. While more accurate reporting of the problem will not make the problems with rising food costs go away, higher visibility of the issue will hopefully lead to support at a larger level than community-based support.


Tegan has helped with beta reading and editing on this blog for a while now, and she decided she also wants to do a weekly post about topics that catch her attention. As always this is part of our effort to make ends meet, as my immigration status doesn’t allow me to get wage labor, so this blog is my only source of income.  You can sign up to help us pay the bills at patreon.com/oceanoxia. The great thing about crowdfunding is how little each contributor needs to put in; in this case as little as a dollar per month – that’s like three cents a day! Pocket change! We could use it to buy better boots!

Anyway, thanks for reading, and take care of yourselves.