[HN Gopher] Biohackers take aim at big pharma's stranglehold on ...
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Biohackers take aim at big pharma's stranglehold on insulin
Author : HiroProtagonist
Score : 290 points
Date : 2021-06-28 13:25 UTC (9 hours ago)
(HTM) web link (www.freethink.com)
(TXT) w3m dump (www.freethink.com)
| f6v wrote:
| As someone who had to create transgenic E.coli in a lab, I admire
| the effort. It's hard to get it right, especially when trying to
| make bacteria produce stuff for you. However, it feels like a
| huge step backward. Imagine you couldn't afford to buy a piece of
| bread. Instead, you need to grow your own grains and build a
| windmill first. Sounds ridiculous in 2021.
| gentleman11 wrote:
| My wife bakes bread almost every day and grows her own yeast.
| She loves it and the bread is fantastic. What is so ridiculous?
| ipsum2 wrote:
| The parent mentioned growing their own grain, which is
| substantially more difficult (planting, harvesting, milling)
| than growing your own yeast.
| dekhn wrote:
| Let's go back to before real agriculture. 10K years ago
| People harvested wild grain, processed it, managed to make
| yeast starter, and produce an edible bread that sustained
| humanity until we learned how to domesticate it and build
| the infrastructure to study it until we know how all this
| works at the molecular level. But they managed to do it
| without any science or technology.
| ineedasername wrote:
| 10k years ago they had actually already domesticated
| crops and weren't reliant (at least not in many places)
| on finding wild grain.
|
| Regardless, it was all still done with science:
| Observation followed by trial and error informed by those
| observations. Maybe not the scientific method formalized
| by Francis Bacon, but it's still there in the outlines.
| margalabargala wrote:
| Growing enough viable yeast to bake 10 loaves of bread is
| orders of magnitude simpler than growing, harvesting,
| threshing, and milling enough grain to bake 10 loaves of
| bread.
| rootusrootus wrote:
| It can as simple as doing nothing. You can start your own
| sourdough at home completely from scratch, and do nothing
| but wait for the yeast to show up.
| dekhn wrote:
| most times the results will be contaminated by bacteria.
| The knowledge of what was actually going on when you do
| this was only gained in the past 250 years or so (before
| that, yeast was known as godisgreat).
|
| In addition to doing it the way you described (put out
| flour and water in a bowl and wait for it to bubble and
| smell nice), you can also buy a $100 microscope, collect
| wild yeast, clean the bactiera off, and grow mass
| cultures. Sometimes it pays to work at the _last_ step of
| the industrial, scientific and agricultural revolutions.
| jcims wrote:
| It's a little more complicated than that. Bread is ingested
| through a system optimized to absorb nutrients from outside
| the body.
|
| Insulin must make it into the bloodstream intact, typically
| through injection. It's also incredibly potent, a unit of
| insulin dried to crystalline form weighs less than 40
| micrograms, so it much be administered in a sterile carrier
| fluid.
|
| Lastly the penalty for overdosing is generally called insulin
| shock or diabetic hypoglycemia, and 'it is rare but possible
| for diabetic hypoglycemia to result in brain damage or death.
| Indeed, an estimated 2-4% of deaths of people with type 1
| diabetes mellitus have been attributed to hypoglycemia.' [1]
|
| That's with pharmaceutical insulin, not DIY.
|
| 1 - https://en.wikipedia.org/wiki/Diabetic_hypoglycemia
| ChefboyOG wrote:
| There's nothing ridiculous about the fact that your wife
| enjoys baking bread.
|
| There's a lot that's ridiculous about bread being so
| expensive that recreating the entire supply chain in your
| backyard is the only economically viable option for obtaining
| it.
|
| The metaphor pretty clearly was not about critiquing baking
| as a hobby.
| gentleman11 wrote:
| It's clearly about mocking decentralized home made
| solutions to problems, and of the people who opt for that
| approach. It's an insult to every Amish person on earth and
| to home mechanics who shy away from garages. It's also, by
| far, the most downvoted thing I've ever posted so thanks
| for using your other accounts to hit me for my acidic and
| savagely inappropriate comment
| lotyrin wrote:
| I'm not sure why you are projecting that, but it's not
| there.
| SketchySeaBeast wrote:
| Their point was why are people being FORCED to produce a
| diabetes bio-hack instead of getting insulin. Neither
| your wife, Amish people, nor home mechanics are forced to
| make their own bread instead of buying it - they are all
| choosing to even though bread is cheap and easily
| available.
| pitched wrote:
| Growing wheat and grinding it out into flour isn't
| something I've ever heard anyone take on as a hobby
| before. Having all that actually cost less (including
| time) than buying bread would be a huge achievement!
| dekhn wrote:
| I imagine the guy who built his own toaster from scratch
| probably also contemplating rebuilding the entire
| pipeline to produce the input to the toast. "Step one:
| acquire the ore. Step two: smelting iron ore..."
| http://www.thetoasterproject.org/page2.htm
| ineedasername wrote:
| At that point we're basically talking about Factorio.
| crakenzak wrote:
| It's clear from your responses that you seriously can't
| handle logical disagreements to your point on online
| forums and choose to get offended instead.
|
| The replying comment is right, it's irrational & you're
| filled with hubris to think that you could replicate
| world wide supply chains in your back yard. In no
| universe does growing yeast == replicating a global
| supply chain.
| [deleted]
| nathanvanfleet wrote:
| Maybe that's the next big local business idea. Like buying from
| a local bakery every city can have a local guy growing insulin.
| mkoubaa wrote:
| I agree with the sentiment but decentralizing and downscaling
| production is a win for resiliency. This is a good example but
| others include recycling and power generation have clearer
| benefits
| f6v wrote:
| Yes, but what about economies or scale? And the the
| production is already decentralized. I guess there's more
| than one plant in the US.
| shkkmo wrote:
| Those econmies of scale are simply driving up profits for
| an oligopoly that uses IP laws and acquisitions to extract
| maximum value from sick people.
|
| We could revoke the IP and thus force these companies to
| compete on price... but that hasn't happened. Thus the only
| solution that is making any progress is circumventing the
| IP and developing an open process.
| KaiserPro wrote:
| I simply don't understand the healthcare system in the US. Its
| meant to be a free market, yet insulin costs a ridiculous amount.
| However Opioids and synthetic opioids are cheap as chips.
|
| To put it into context, In the UK the NHS buy Insulin at <$35
|
| you can see the prices here: https://bnf.nice.org.uk/medicinal-
| forms/insulin.html They come from the same companies and are
| produced to the same standard. How can a bureaucratic "socialist"
| care system get better price, and a much better availability than
| a "free market" system. (thats rhetorical, I know why)
|
| Given the number of non and under insured, I just don't
| understand why its not swinging elections.
| fernandotakai wrote:
| >I simply don't understand the healthcare system in the US. Its
| meant to be a free market, yet insulin costs a ridiculous
| amount.
|
| the problem? patents
| https://www.hopkinsmedicine.org/news/media/releases/why_peop...
| maxerickson wrote:
| Generic Insulin Lispro is currently ~$50-60 per vial in the US,
| without any insurance or assistance from the manufacturer
| (though you do have to understand the system and go to specific
| pharmacies to get that price).
|
| The reason it's not a big issue in elections is because lots of
| people don't vote.
| dempsey wrote:
| And every state administers its own Medicaid system under a
| different name. Lots of folks don't even realize that their
| free healthcare is mostly coming from the feds. In AZ, I had
| to explain this to several friends that depend on AHCCS.
| anonuser123456 wrote:
| Read 'The price we pay' if you want to understand the US
| healthcare system.
|
| Most of the 'socialist' countries don't pay for R&D on drugs;
| US consumers do. They pay a marginal price based on production
| cost, but almost none of the fixed price investments in
| efficacy, safety studies etc.
|
| The US system in no way resembles a functioning market. It's a
| byzantine spider web of regulatory capture, patent abuse, bad
| incentives and inertia.
| nknealk wrote:
| Some considerations on manufacturing -- there's a variety of
| product quality steps necessary to release batches of medicine.
| The FDA mandates this as part of GMP regulations. These steps
| help ensure things like:
|
| * How do I know that every vial has the same concentration of
| insulin each time? That is to say 1 unit from a vial today and 1
| unit from another vial is going to have the same dosing.
|
| * How do I know the insulin is purified? If there's any host cell
| protein in the vial, that could be immunogenic and cause bad side
| effects.
|
| * How do I know that the formulation of insulin in the vial won't
| degrade on me at whatever storage condition is stated?
|
| I realize that these tests make up only a small fraction of the
| price, but there's a lot of value to purchasing medicine from
| regulated sources. I'm not against upstart competition against
| big pharma, but I worry that you might literally kill someone if
| you don't include these product quality steps in your process.
| shkkmo wrote:
| > there's a lot of value to purchasing medicine from regulated
| sources. I'm not against upstart competition against big
| pharma, but I worry that you might literally kill someone if
| you don't include these product quality steps in your process.
|
| Where are you getting this from? This goal of this isn't to
| have every diabetic brewing insulin in their garage so they
| evade the IP police in a distrubuted fasion. The goal is to
| create open IP needed for creation, purification and quality
| control that will allow labs around the world to create insulin
| in keeping with local regulations.
| tomaszs wrote:
| It makes sense. On the other hand pharmaceutical companies make
| mistakes also, just on a bigger scale. Also I imagine that when
| it will be easier to set up insulin small scale production,
| than more scientists will be able to do innovate and improve
| the process.
| Seattle3503 wrote:
| > These companies essentially have a monopoly on the market;
| there is simply no competition to drive the price down.
|
| The word for this is oligopoly.
| [deleted]
| nom wrote:
| Can someone explain in layman's terms why there is no competition
| on this market? As insulin is so cheap to produce, why can't I
| just get my own product approved and sell it?
| Thebroser wrote:
| There are crazy patents throughout the entirety of the insulin
| production pipeline. Some of these being extremely absurd such
| as patenting the pH of a buffer for specific protocols! I
| volunteer for the Open Insulin Foundation on/off when not too
| focused on my research project and it's basically how can we
| come up with a roadmap to making this decentralized insulin
| without violating any existing patents. An added layer of
| difficulty is like other have mentioned, engineering Ecoli to
| produce the homolog as well as developing from scratch the
| devices for extraction and purification (think hplc). Again,
| these need to be made from scratch as to not violate any
| patents. At least in the U.S., this is why there is no
| competition in the market. There is also a significant price
| barrier as you need to bring up your production to GMP
| standards which means you need a state of the art clean room
| and multiple roles to supervise the production of the product
| every step of the way.
| narrator wrote:
| Can't you just make Insulin like they made it 20 years ago
| using expired patents?
| katbyte wrote:
| yes you can, but that means less profits, and america puts
| up with it - https://www.iheart.com/podcast/105-behind-the-
| bastards-29236...
| politician wrote:
| We figured out how to patent everything in software by just
| adding "with a computer system" to it, so I'm sure we could
| figure out how to patent novel combinations of these
| procedures by mixing in "in microgravity".
| nom wrote:
| Thank you, this is insightful and explains a lot.
|
| For everyone interested, clickable link
| https://openinsulin.org/
|
| Very noble cause, I appreciate it.
| slim wrote:
| it's basically how can we come up with a roadmap to making
| this decentralized insulin without violating any existing
| patents
|
| This is how patents are supposed to foster innovation. Wasted
| effort reinventing the wheel
| cadr wrote:
| I wonder if a better effort would be to challenge the patents
| rather than try to go around them.
|
| (Not that I don't think what you are doing is awesome,
| because I do.)
| clarkrinker wrote:
| Every time this stuff comes up it feels like we focus on the
| politics and not the people with diabetes.
|
| If you or your kid or your friends have Type 1 and are struggling
| to make your insulin out of pockets please, please, please call
| the Eli Lily hotline and get the copay card. They've dropped the
| monthly cost for Humalog to $35.
|
| Don't ration. Work the system. https://www.humalog.com/savings-
| support
| fencepost wrote:
| Ah, but are those assistance programs available to people on
| Medicare or Medicaid? I know a diabetic on Medicare so I've
| watched ads and lots of the ones that mention how little your
| copay can be seem to have a little note at the bottom of the
| screen "for patients on commercial insurance."
| clarkrinker wrote:
| The Part D reforms from this year cap insulin costs at [1]
| $35 a month. You can setup your social security benefit to
| have it automatically deducted
|
| The premiums for part D in Washington State are about $40 a
| month [2]
|
| Most Medicaid recipients don't pay out of pocket for insulin.
|
| [1] https://www.medicare.gov/coverage/insulin [2]
| https://www.insurance.wa.gov/what-does-medicare-
| prescription... [3]
| https://www.commonwealthfund.org/publications/issue-
| briefs/2...
| fencepost wrote:
| Thanks, I'll pass that along to her. I think the insulin is
| a new thing this year, so it's possible she's not on a Part
| D plan in the "insulin savings model."
| chefkoch wrote:
| Wich is around the list price you pay for two weeks of insulin
| in germany.
| nceqs3 wrote:
| Every drug company gives away their drugs for free to people
| who can't afford it in the US. It's sad that not enough people
| take advantage of patient assistance programs.
| Clubber wrote:
| Got a link for this with some details? What does "can't
| afford," mean, how regularly is this available, how much of a
| hassle is it, etc.
| edge17 wrote:
| I'm curious, but what does "can't pay" mean? Does it mean the
| drug cost 100%+ of your income? 10% of your income?
| km3k wrote:
| Hard to say, but many drugs can go over 100%. Some could be
| several hundred percent or more depending on your income.
| https://www.reuters.com/article/us-vertex-pharms-
| fda/vertex-...
| 48309248302 wrote:
| Sometimes essential medication costs USD $100,000 per year
| or more.
| DaiPlusPlus wrote:
| > Every drug company gives away their drugs for free to
| people who can't afford it in the US
|
| I don't believe this is universally true though. For example,
| patent-encumbered novel delivery mechanisms for existing
| (generic) drugs, like Concerta. The drug company has nothing
| to gain by maintaining the administrative infrastructure for
| patient-assistance for drugs like that.
|
| Another example are personalised therpaies, such as
| immunotherapy treatments - which cost so much because (as I
| understand it, please correct me if I'm wrong) they require
| individual experts to develop the personalized antibodies and
| whatnot - unlike with mass-produced medication
| pills/tablets/capsules that have negligible marginal cost: a
| company isn't going to give away a $100k therapeutic drug for
| free because it still is going to cost them $50k+ (numbers
| just made up btw).
| [deleted]
| epmaybe wrote:
| This is apologist thinking at best, intentionally misleading
| at worst.
|
| You are correct that companies do have patient assistance
| programs. What you're leaving out is that this applies to a
| small subset of people that usually have to be denied
| federal/state insurance, not have any other kind of
| insurance, and make less than 4x federal poverty level.
|
| additionally, they rarely provide a lifelong supply. Imagine
| being a diabetic and novo nordisk, who makes most of the
| insulin types on the market, only gives you a four month
| supply.
|
| Oh wait, thats exactly the terms of their patient assistance
| program.
| ineedasername wrote:
| No, they really don't. Some don't offer much of anything.
| Many of those end up providing benefits for the poorest of
| the poor, but if you're a little above that you're out of
| luck. Also if you have something like Medicare you can hit
| certain phases in coverage where you have to pay a much
| larger part of the cost. Being on any government program
| disqualifies you from most of these discount programs, so if
| you're on an expensive Rx you can still be stuck paying a few
| hundred $$ a month-- more than many can afford.
|
| These discount programs aren't some big secret people don't
| know about. I see that argument thrown out in defense of high
| prices but it simply isn't true. Every doctor prescribing
| drugs knows about them and tells their patients about them.
| If people are going without necessary medication because they
| don't know about a discount program then they are extreme
| outliers.
|
| These discount programs are simply marketing & lobbying tools
| used to give politicians cover when they all continue to
| ignore meaningful healthcare reform.
| bingidingi wrote:
| Many people simply don't know about them! I grew up poor and
| the amount of work that goes into finding and using some
| services is ridiculous. We bought a house using some
| assistance programs and at a couple points were speeding
| across the city to get paperwork in by sone deadline no one
| told us about (luckily we had a car!).
|
| Not to mention that services like foodstamps can be
| unreliable... I've probably spent hours of my life holding up
| checkout lines because my card didn't process...
|
| not having money is one thing, but being poor also
| obliterates your time if you use various services...which in
| my experience is worse... you're always tired and agitated.
| Someone is always messing up your paperwork, because of
| course civil servants are often underpaid and overworked
| themselves.
| distribot wrote:
| I had a similar upbringing. All the hours of my childhood
| in the local health and human services offices and WIC
| nutritional centers turned me off of civil servants and
| bureaucrats. It felt like they were always condescending
| and snippy, or pretending my parents' English was way
| harder to understand than it is, or just delighting in
| telling us our stuff was out of order.
|
| Looking back they were probably just overworked and
| exhausted, but man.
| bingidingi wrote:
| I felt the same for a while too, but then I met someone
| that happened to work for child services. These are some
| caring and empathetic people working for peanuts and they
| aren't really treated well by anyone, management and
| clients alike. This person in particular hated the work
| but didn't want to quit for fear of letting their clients
| (children) down.
|
| People blame bureaucracy, and maybe there's some truth
| there, but if these people were treated half as well as
| many tech workers are then maybe we could actually start
| making progress against the stereotype of miserable
| experiences.
| Benjamin_Dobell wrote:
| My 3 year old daughter was recently diagnosed Type 1. Soon after
| her diagnosis I discovered a _heap_ of articles about the Open
| Insulin Foundation. I was even on their website 24 hours ago.
| However, for the life of me I can 't find anything "open" about
| the Open Insulin Foundation.
|
| Could someone please point me in the right direction where I can
| read _anything_ with more substance than a news article quoting
| an interview?
|
| _EDIT_ : Just to clarify. We're extremely fortunate that we're
| in Australia. Insulin is affordable/subsidised here, my
| daughter's CGM (and sensors) are free, and anything else we need
| is heavily subsidised too. I've no intention of biohacking
| _anything_ to do with my daughter 's Type 1.
|
| I'm asking the above mostly because I'm curious. Admittedly I
| find it a bit scary that I know so little about the manufacturing
| of something that is 100% vital to my daughter's survival. I'd
| like to know more.
| Natsu wrote:
| I don't know about this place mentioned in the article, but
| there's a similar orginazation at https://cheapinsulin.org/
| that you can look into.
| 6502nerdface wrote:
| TFA blames "big pharma's stranglehold" for high insulin
| prices, but interestingly the cheapinsulin.org explanation
| [1] seems to be much more about "big insurance", with pharma
| companies basically forced to kow-tow if they want their
| products to be covered.
|
| [1] https://cheapinsulin.org/high-insulin-prices
| tashi wrote:
| Their claim is that if the pharma companies lowered the
| cost of insulin but then refused to give rebates to
| insurance companies for it, the insurance companies would
| stop covering insulin for diabetic patients? And they're
| using a diagram created by a pharmaceutical trade group to
| explain this? I'll be honest: I'm skeptical.
| dempsey wrote:
| Maybe Mark Cuban's company can produce it:
| https://costplusdrugs.com/
| Blahah wrote:
| Pretty cool, but it's a problem with the law and needs to be
| fixed in law.
| [deleted]
| holstvoogd wrote:
| If you wait for that, all diabetics will be dead probably...
| Pokepokalypse wrote:
| "Don't worry; we'll make more." - The US food industry
| cadr wrote:
| I'm pretty sure they don't make the Type-1's.
| anonbcpolitics wrote:
| Previous guy tried, but the new "Big guy" nixed the EO before
| it could go into effect.
|
| https://www.federalregister.gov/documents/2020/12/23/2020-28...
|
| Feel free to link any biased news article or Politifact telling
| me how it wouldn't have mattered or wasn't that effective.
| That's a lie, it capped the prices, but at least ask yourself
| if doing nothing is better, or worse, cancelling an action that
| did something. Then ask why they did it. Just like many other
| reversals it wasn't for you, it was for Pharma buddies. They
| say one thing and do another.
| adamrezich wrote:
| it was (going to be) but then the new guy reversed the previous
| guy's decision
| throwaway4china wrote:
| Previous guy tried, but the new "Big guy" nixed the EO before
| it could go into effect.
| https://www.federalregister.gov/documents/2020/12/23/2020-28...
|
| Feel free to link any biased news article or Politifact telling
| me how it wouldn't have mattered or wasn't that effective.
| That's a lie, it capped the prices, but at least ask yourself
| if doing nothing is better, or worse, cancelling an action that
| did something. Then ask why they did it. Just like many other
| reversals it wasn't for you, it was for Pharma buddies. They
| say one thing and do another.
| whereshunter wrote:
| Previous guy tried, but the new "Big guy" nixed the EO before
| it could go into effect.
| https://www.federalregister.gov/documents/2020/12/23/2020-28...
|
| Feel free to link any biased news article or Politifact telling
| me how it wouldn't have mattered or wasn't that effective.
| That's a lie, it capped the prices, but at least ask yourself
| if doing nothing is better, or worse, cancelling an action that
| did something. Then ask why they did it. Just like many other
| reversals it wasn't for you, it was for Pharma buddies. They
| say one thing and do another.
| ggm wrote:
| As an observation, The UK, USA, Canada and Australia are all in
| the top 10 for type-1 diabetes incidence in the <14yo population,
| along with Finland, Sweden, Saudi Arabia, Kuwait, Norway and
| Denmark.
|
| Only the USA imposes private health cost burdens on the diabetics
| (from my quick scan of national health info on the web)
| deeviant wrote:
| I really wish this would be a higher priority for the current
| class of billionaire philanthropists: open source science.
|
| Medical research guided by the idea of preventing disease rather
| than creating expensive life-long treatments, and prioritizing
| the diseases that cause the most amount of suffering rather than
| present the best opportunity for profit. And not just medicine,
| but just about any industry could benefit.
| bfrink wrote:
| You mean like this billionaire philanthropist?
| https://chanzuckerberg.com/science/programs-resources/open-s...
| pope_meat wrote:
| Wall Street Smart Genius types have long held that curing
| disease is bad business, managing symptoms over the entire
| lifetime allows them to extract more capital out of the cattle.
|
| So, if you're looking to cure something you're going to
| struggle to find funding.
|
| Don't worry though, the economy will survive.
| failuser wrote:
| Charging millions for a cure is a also a viable option. See
| Spinraza vs Zolgensma.
| lotsofpulp wrote:
| I wonder how the Hep C cures, COVID vaccines, shingles
| vaccine, HPV vaccines, and other cures got funding over the
| past 2 decades.
| nceqs3 wrote:
| People love to bash big pharma, until they get cancer...
| Maken wrote:
| Public funding.
| wizzwizz4 wrote:
| Grants and government funding, mostly. But then companies
| get patent monopolies on production because... reasons.
| lotsofpulp wrote:
| Yes, I do take issue with the government granting
| monopolies to private entities with taxpayer funded
| research. But not all of the funding for all the
| treatments I mentioned, which are clearly cures and not
| meant to bleed people until they die, came from
| government.
|
| Sometimes the pendulum swings too far towards cynicism.
| JumpCrisscross wrote:
| > _Wall Street Smart Genius types have long held that curing
| disease is bad business, managing symptoms over the entire
| lifetime allows them to extract more capital out of the
| cattle_
|
| Nobody tell the multibillion dollar biotech industry...
|
| And in case it needs to be pointed out, no, cures are
| massively profitable. If someone has a cure for a presently
| untreatable disease you will get money, you will make money,
| everyone will make more money and everyone will be better
| off.
| shkkmo wrote:
| > everyone will make more money and everyone will be better
| off.
|
| Not the people who are currently making bank off of
| palliative care for that ailment. This absolutely creates
| perverse incentives that, while not ubiquitous, are hardly
| uncommon.
| [deleted]
| E8L3i wrote:
| Math is pretty simple if you have 3-4 producers off essential
| product protected from external competition by patents. In this
| case better to avoid competition and increase price 10x than
| compete in hope to increase market share maybe 2x-3x.
| DoreenMichele wrote:
| So this seems to be about the DIY biology rather than body
| hacking.
|
| https://en.m.wikipedia.org/wiki/Biohacking
|
| I don't know if body hacking can help with Type I diabetes but
| diet and lifestyle can certainly help with other forms of
| diabetes.
| andrewfromx wrote:
| this is a great story, about how to get around an obstacle in a
| creative way.
| ch4s3 wrote:
| This is sort of meta, but it's cool to see Free Think popping up
| here. It's a great publication that I think would really be of
| interest to this community.
|
| More germane to the article, it will be interesting to see what
| happens over the next 10 years as bio-tech becomes more
| accessible to hacker types and hobbyists.
| slt2021 wrote:
| Why not allow patients to buy generic insulin from overseas (from
| India for example) ?
|
| If I could just you know, ask a friend of mine to fly to India
| and bring a monthly supply of cheap India made generic of
| Humalog, that would be great, right?
|
| and if insurance company kicks in a few bucks for me, that would
| drive down the cost of care for insurance company as well
| xf1cf wrote:
| Same reason you "can't" do that with textbooks.
|
| The whole reason it's cheap is the vast majority of the cost is
| shouldered by the west. If you were able to execute this
| arbitrage (and you should be able to but can't legally) you
| would quickly find prices would lower slightly in the west and
| rise dramatically elsewhere.
|
| It's all profiteering. By preventing price discovery they make
| a boatload of profit even after writing down the losses on
| "foreign aid".
| sparrish wrote:
| This is bogus.
|
| Wal-mart sells insulin for $24.88 a vial without prescription
| currently.
|
| It's only the newer 'guchi' insulin brands that are crazy
| expensive. Stuff from 1996 that is compared to in this article is
| actually cheaper than it was in 1996 (adjusted for inflation).
| pluto7777 wrote:
| Goodrx shows lispro generic $48.85 per vial. Humalog 'guchi' is
| $142.55. If you're fortunate enough to have diabetic
| retinopathy and can't read the tiny print, the larger kwikpens
| are only $270.28. Lets not even get into the real guchi brands.
| elliekelly wrote:
| This is like saying a car and a bicycle are equivalent means of
| transportation. Sometimes a bike is the right solution for some
| people and a bike is usually better than nothing but it's
| really not fast enough to be a practical solution for most
| people's daily needs.
|
| Edit: Perhaps high speed internet vs dial-up would be a better
| analogy to spare us the comments about how bikes are actually
| better than cars...
| minitoar wrote:
| it's "Gucci", like the luxury brand
| lotsofpulp wrote:
| Funnily enough, also a "luxury" brand.
| burkaman wrote:
| It's not branding, the newer insulin is significantly different
| and better for almost every patient.
| https://diabetesstrong.com/walmart-insulin/
|
| It's likely not what your doctor prescribed, it doesn't last as
| long, it requires you (or your young children) to eat on a very
| specific schedule, it can't be used with an insulin pen or
| insulin pump, it's just all around a worse and less effective
| treatment.
| jart wrote:
| When were these newer insulins invented? Are they a recent
| thing? Was it the case that twenty years ago, "Walmart"
| insulin was the only insulin?
| jimrandomh wrote:
| 1996. https://en.wikipedia.org/wiki/Insulin_lispro
| sparrish wrote:
| Novolin is available as an insulin pen. I use it twice-a-day
| and it's available at the prices specified.
| gruez wrote:
| Seems like everything is working as intended? A corporation
| invests money to develop a better product, and the government
| gives them a 20 year monopoly on it so they charge a premium
| and recoup their investment. As a patient if you want to pay
| the premium for it, you can get the better product, otherwise
| you can still stick with whatever walmart's selling. It's
| worse, but it's not any worse than what you'd had if the
| company didn't come along and invented the better product.
| DerpyBaby123 wrote:
| That's not what is happening. It has nothing to do with a
| patent monopoly or recouping any investment:
|
| FTA: >In 1996, a vial of Humalog produced by Eli Lilly cost
| $21. Today, it's priced at $324 despite the cost of
| production remaining steady.
|
| >Rising costs are nothing new. Insulin prices tripled from
| 2002 to 2013, and doubled between 2012 and 2016. To put
| this into perspective, in 1996 a vial of Humalog produced
| by Eli Lilly cost $21. Today, it's priced at $324 despite
| the cost of production remaining steady.
|
| If everything is working as intended, it begs the question,
| what institution intended for patients to die from
| rationing insulin[0], and why is the USA ok with that
| institution's intention?
|
| [0]https://www.ontrackdiabetes.com/live-well/diabetes-
| managemen...
| lotsofpulp wrote:
| If it was developed in 1996, the patent protection would
| have expired by now. If the cost of production was
| "steady", then the question is why is a competitor not
| jumping in to make and sell something that would earn
| them a huge profit margin?
| reddiky wrote:
| https://www.hopkinsmedicine.org/news/media/releases/why_p
| eop...
| DerpyBaby123 wrote:
| Do you doubt it was developed in 1996? Do you have
| evidence that the cost of production has significantly
| risen?
|
| Otherwise, you seem to be repeating the old economics
| joke:
|
| "The young economist looks down and sees a $20 bill on
| the street and says, "Hey, look a twenty-dollar bill!"
| Without even looking, his older and wiser colleague
| replies, "Nonsense. If there had been a twenty-dollar
| lying on the street, someone would have already picked it
| up by now.""
| lotsofpulp wrote:
| When there is a claim that there exists an arbitrage
| opportunity worth billions of dollars, I would consider
| it common sense to consider why has no one claimed the
| arbitrage opportunity yet.
|
| The world has many very smart people spending many hours
| working very hard to find these opportunities, so the
| likelihood of it just sitting there like a $20 bill on
| the street, and not being picked up, seems quite small.
|
| I do not know the answer myself, so I am interested in
| finding out. reddicky posted this:
|
| https://www.hopkinsmedicine.org/news/media/releases/why_p
| eop...
|
| which sort of answers it:
|
| >Biotech insulin is now the standard in the U.S., the
| authors say. Patents on the first synthetic insulin
| expired in 2014, but these newer forms are harder to
| copy, so the unpatented versions will go through a
| lengthy Food and Drug Administration approval process and
| cost more to make. When these insulins come on the
| market, they may cost just 20 to 40 percent less than the
| patented versions, Riggs and Greene write.
|
| So it looks like there is some expensive expertise
| involved and investment into R&D that needs to be done.
| pimeys wrote:
| Although... I needed to buy a vial of the newest fast
| insulin in Spain last year without an insurance. One vial
| was 28 euros, which is much less than people in US have
| to pay.
|
| The insulin in question is Lyumjev from Eli Lilly.
| DerpyBaby123 wrote:
| Yes there is expertise and capital costs involved, which
| make it not an arbitrage play. It is more like a cartel,
| which seems to explain what is going on here, with the 3
| insulin producing companies all fixing their prices
| together (at least in the US)
|
| In theory there is 'nothing' stopping another company
| from coming along, even a group of Biohackers may try to
| do something - I wonder if that's been done... :)
| nceqs3 wrote:
| This is an incredibly stupid comment. Net price in
| Humalog has decreased since 2014 [0]. The PBMs jack up
| the list price so they can get their fat rebates.
|
| [0] = https://www.cnbc.com/2019/03/25/eli-lilly-
| discloses-pricing-....
| lotsofpulp wrote:
| Eli Lilly's profit margin is double digit, usually around
| 20%. Managed care organizations (insurance companies),
| which own the PBMs, have profit margins of ~5% or less.
| nceqs3 wrote:
| That is a nonsense talking point from the industry. They
| use passthrough revenue to distort their profit margin.
| Express scripts is closer to 15% and CVS is closer to
| 10%.
|
| See https://www.fiercehealthcare.com/payer/facing-
| criticism-pbms....
| lotsofpulp wrote:
| CVS net profit margin is in the 2% to 3% range:
|
| https://www.macrotrends.net/stocks/charts/CVS/cvs-
| health/pro...
|
| Cigna purchased Express Scripts in Mar 2018, and has
| profit margins of 3% to 5% over the last couple years.
|
| https://www.macrotrends.net/stocks/charts/CI/cigna/profit
| -ma...
|
| If these PBMs are making lots of profits, then they are
| simply subsidizing losses elsewhere in the MCO. The total
| costs paid for insurance premium plus out of pocket costs
| by the end user in the US would not be affected.
| nceqs3 wrote:
| You are not addressing my main point which is that these
| MCO's distort their "net margin" stat using accounting
| tricks. And yes PBM's are INCREDIBLY profitable. Express
| scripts made 4.5 billion in net income in 2017. They have
| never produced a drug that has saved a life.
|
| PBMs are important but they should not be able to put a
| gun to these pharma companies heads because they control
| the formulary.
|
| CVS net margin includes their retail business. You can't
| compare AWS's margin to Walmart's e-commerce margin.
| lotsofpulp wrote:
| I am not addressing it, because I do not see any further
| evidence of distortion of an MCO's net profit margin
| other than what this article claims. Nor would it matter
| to me unless some MCO executives are smuggling cash out
| of the country or something.
|
| As a customer, it does not affect me.
|
| In the healthcare business, the flow of money is:
|
| Individual -> MCO (insurance company) -> healthcare
| providers and drug manufacturers
|
| What does it matter to the individual what portion of an
| MCO is earning what profit if the net profit margin of
| the whole MCO is 5% or less? They are obviously not left
| with a lot of money, their employees are not known to be
| lavishly compensated.
| gruez wrote:
| That doesn't seem too strange when you consider that
| those two types of companies have different operating
| models. A drug company is in the business of taking
| relatively cheap goods and converting them to very
| expensive goods, in other words adding a lot of value. A
| insurance company/PBM is mostly in the business of
| skimming a percentage off transactions.
| lotsofpulp wrote:
| It is not strange, but it also contradicts claims about
| managed care organizations earning tons of money. It is
| not a business you go into to get super rich.
| nceqs3 wrote:
| LMFAO. Express Scripts (the biggest PBM) was bought for
| 67 billion! They have never saved a patient life but are
| bigger than most pharma companies.
| lotsofpulp wrote:
| That sounds irrelevant to my point that MCOs do not make
| a lot of profit.
| burkaman wrote:
| Yes it is working as intended, the argument is that those
| intentions are inhumane. Can you think of any medical
| treatments that were developed without the promise of 20
| years of limitless profits? I can.
| gruez wrote:
| > Can you think of any medical treatments that were
| developed without the promise of 20 years of limitless
| profits? I can.
|
| This sounds like it's responding to a strawman.
| Proponents of the patent system aren't claiming that zero
| innovation would happen without patents, just that it
| would be much less. In other words:
|
| No patent system: only inventions from altruistic
| inventors
|
| Patent system: inventions from altruistic inventors _and_
| profit-focused inventors.
| burkaman wrote:
| Let's say corporations were only promised a 10 year
| monopoly instead of 20. Do you think their business would
| collapse, or would they keep trying? If profit-focused
| inventors could still be motivated by a 10 year horizon,
| then that extra 10 years only benefits corporate
| executives and kills patients. So, is the patent system
| as limited as possible while still encouraging
| innovation? Obviously not, because pharma companies
| routinely direct billions of dollars in profit into stock
| buybacks instead of research or any other actual
| investment. They can easily afford to make less profit.
| gruez wrote:
| >Do you think their business would collapse,
|
| It would depend on the project's margins and/or sunk
| costs. A project that had very little invested in it or
| is a breakout success might we able to weather a 50% cut
| in exclusivity period, but a marginal product might not.
| Most of the already developed drugs are probably going to
| be fine, assuming that the financing for them was already
| secured.
|
| >or would they keep trying?
|
| For the projects at the margins? most certainly. That is
| not to say all private drug development would, stop. If
| some sort of unpatented-but-super-cheap-to-perfect-but-
| still-not-patented drug showed up it might still be
| developed, but in aggregate I'd expect drug development
| to drop significantly.
| burkaman wrote:
| I am arguing that there are no marginal projects at
| current profit levels, and that's why they can spend
| billions on stock buybacks. There is a point that
| lessening patent protections would cause companies to cut
| back, but we are not at that point.
| lotsofpulp wrote:
| But that does not make for emotion inducing tweets.
| OriginalNebula wrote:
| Do you think a gross profit margin of 93% is fair?
| lotsofpulp wrote:
| Define fair and unfair. If it was so "unfairly"
| lucrative, I would have to ask why everyone does not
| invest in pharma? Why are tech companies where much of
| the VC funds land?
|
| Perhaps it is because there a huge amount of risk
| involved?
| hef19898 wrote:
| Or, you know, public health care. But I digress.
| foxyv wrote:
| The hard part is getting doctors to offer prescriptions for the
| cheaper brands as an alternative. A lot of doctors will
| prescribe the most expensive drug simply because they believe
| or know that it is better in some way without regard to it's
| cost.
|
| It's changed a lot recently as doctors have become more aware
| of the cost of these drugs. But you still have to self advocate
| for less expensive drugs. Less savvy people often have trouble
| getting transparency into drug costs. Often even the doctors
| can't get a straight answer on pricing and insurance coverage.
| lotsofpulp wrote:
| It has been many years since pharmacies have been allowed to
| substitute brand name medications with generic medications.
| In fact, doctors have to write "dispense as written" if they
| want the patient to only get the brand name medication they
| prescribe.
|
| Additionally, managed care organizations (MCOs, commonly
| known as insurance companies) do not pay for brand name
| medications just because a doctor prescribes them. If the MCO
| is aware of a generic option, then they will only pay for the
| generic or they will ask the doctor for a "prior
| authorization" to justify the use of a brand name medicine
| (such as the generic version not working).
|
| The pediatricians I have visited in recent years even have
| the MCOs' formulary available for the patient in their
| systems, so they can see which medicines need a prior
| authorization and which do not so there is no time wasted on
| figuring out what the MCO will pay for without prior
| authorizations.
| sparrish wrote:
| But you don't need a prescription...
| foxyv wrote:
| True! However doctors often don't know this or simply don't
| think to mention it. In addition, self medicating with OTC
| insulin can lead to poor outcomes. With proper training and
| care it can be a powerful tool for uninsured patients.
| However, insulin can be extremely dangerous leading to ER
| visits and insane hospital bills.
|
| Every time I try to wrap my head around this stuff. How to
| fix the problems with our current system. I keep coming
| back to socialized or single payer health care.
|
| Sure the current system works okayish for people like me.
| Insured and employed. But for my friends and the people I
| meet on the streets or the grocery store it's a nightmare.
| There is real suffering and death caused by no access to
| adequate health care. Even basic preventative stuff like
| diabetes care and checkups is missing.
|
| https://khn.org/news/you-can-buy-insulin-without-a-
| prescript...
| throwaway0a5e wrote:
| > A lot of doctors will prescribe the most expensive drug
| simply because they believe or know that it is better in some
| way without regard to it's cost.
|
| This is so obnoxiously common across every profession.
|
| People are willing to piss away other people's money on "the
| best" without even telling them what the options are.
| myelin wrote:
| Type 1 diabetic here. Managing T1D even with the "Gucci"
| insulins (I use Novolog and have tried Fiasp) is still a huge
| pain in the butt; you have to give yourself a dose of insulin a
| fairly precise amount of time before eating, and accurately
| judge how much you're going to need, which is half science and
| half wild guesswork. My per-meal dosage requirements vary
| randomly from month to month -- a dose that would be fine one
| month is either inadequate or deadly on another month, and the
| only way to tell if you've got it right is to obsessively
| monitor your blood sugar.
|
| And that's with the $700/vial insulin... the $25/vial stuff is
| stone age technology by comparison; you have to take it twice a
| day, and then eat at two specific times afterwards, or you'll
| go hypoglycemic (unconscious or maybe dead hypoglycemic, not
| just the feeling-a-bit-tired kind that people who don't use
| insulin are familiar with).
|
| The situation right now is that the best and most expensive T1D
| technology, even the various "artificial pancreas" solutions,
| still gives you nothing like the experience of a normal
| pancreas. It would be really nice if the Walmart insulin were a
| viable long term solution for the cost problem, but
| unfortunately the negative health effects of older insulin tech
| are considerable :(
| maxerickson wrote:
| The no-direct-cost PBMs price generic Humalog at $50-$60 now.
|
| Generic Novolog is also ~$55 at Walgreens (more at other
| places).
| giles7777 wrote:
| Have you tried low-carb eating? I've been doing it for years
| and it seems to be an easier method then insulin(type2
| borderline when I started, so not exactly the same).
| pimeys wrote:
| When you eat lots of fat and protein as a T1, you just get
| a slowly rising glucose that needs insulin and is harder to
| control compared to carbs with less fat.
|
| T1 is really complex even with a low carb diet, if you
| don't only eat vegetables, but meatier food.
| myelin wrote:
| Yeah, T1 is pretty much just a pain whatever you do. Low
| carb does make it quite a bit easier, and I imagine would
| pretty much be the only safe way to eat if you were using
| a non-rapid insulin.
|
| Unfortunately (doctor's orders) I also have to cut back
| on the cholesterol, which seems to be very high in all my
| favorite low-carb foods :( It's a constant experiment; it
| may turn out to make more sense to eat more fat but take
| statins, but I need to wait a bit longer and see how my
| lipids look with the current diet.
|
| (BTW I'm actually doing fine -- pretty decent control/A1C
| -- but I had to rant in response to the Walmart insulin
| suggestion above!)
| pimeys wrote:
| Some other things that raise your glucose and you need
| insulin:
|
| - waking up, liver produces glucagon
|
| - stress at work, hormones going wild... including
| glucagon
|
| - weather changes, when it is cooler you need more
| insulin
|
| - you get sick. 2-3x insulin for me
|
| - liver just having a normal glucagon production, that
| needs insulin without you ever eating anything
|
| Nice that you have your A1c in control. Mine is 5.8%
| without too many hypos after 26 years of having T1. The
| tech I need for this costs a fortune without insurance,
| but at least I can finally live a normal life without
| nasty surprises every day.
| sithlord wrote:
| Have you looked into the Warsaw Calculation of calculating
| insulin? I did it for awhile and pretty interesting. Only
| real issue is its pretty inconvenient, requires breaking up
| doses more. But it also takes into account for fats and
| proteins into the insulin calcuation. I dont remember what,
| but say your carb ration is 1:10, you would calulate a
| protein as maybe 1:25 and fat as 1:30 (theres some assigned
| value is the point iirc - dont use these numbers )
| hooande wrote:
| this is very true. prices of name brand insulin need to come
| down, but there is a low cost option available for those that
| need it
| cestith wrote:
| Patient outcomes for the insulin aspart pens and the vials of
| generic insulin at Walmart are so different that many doctors
| refuse to prescribe the cheap stuff except as a very last
| resort.
|
| There's no simply substituting. These are two different
| brands of a generic statin pill or something. Although it's
| all insulin, these are very different drugs. The dosages for
| the same insulin in the same patient can vary, and the
| calculations or charts for what to take when vary across
| types of insulins. The handling instructions vary. There's
| different patient training for a pen vs. a vial and syringe.
| sparrish wrote:
| Novolin is available as a pen without prescription. Costs a
| bit more ($45 for 5 pens).
| Jeff_Brown wrote:
| A friend had insurance problems for years and often had to use
| Walmart insulin instead. He's now going blind, and his doctors
| suspect that's why. </anecdote>
| [deleted]
| sithlord wrote:
| This is so incredibly wrong - and trying to claim something you
| know obviously nothing about is hilarious.
|
| The different between NPH (regular insulin) (maybe R too, not
| sure??) sold by walmart and Fast Acting insulins (Novolog,
| Humalog, Apidra) is massive.
|
| Fast acting insulins start working at about in about 30 minutes
| and "peak" at like 2 hours, and may slowly have some effects
| for another 1-2 hours.
|
| NPH on the other hand, starts working at ~2 hour mark and
| continues to work slowly until peaking at like 6 hours and
| slowly degrades away, that means its in your system for
| something like 9 hours - trying to meal plan around multiple
| doses of that is unsafe at best.
|
| R is slightly better but still remains and slowly peaks closer
| to 4 hours.
|
| These are obviously GREAT IF and only IF you dont have access
| to fast acting. I applaud Walmart for giving access to these,
| as they are way better than nothing.
|
| source: Type 1 diabetic
| nceqs3 wrote:
| The net price on Humalog has gone down since 2014. The PBMs
| are the ones who distort list prices.
| lotsofpulp wrote:
| The PBMs are mostly owned and operated by the managed care
| organizations (insurance companies). The insurance
| companies have profit margins of less than 5%.
| nceqs3 wrote:
| This is not true and just an industry talking point from
| the PBMs. They use revenue tricks to hide their profit
| margin.
|
| See https://www.fiercehealthcare.com/payer/facing-
| criticism-pbms...
| [deleted]
| lotsofpulp wrote:
| My information is from 10-K filings with SEC, and my
| statement is referring to net profit margins, which are
| what they are. Unless there is massive fraud going on,
| managed care organizations are not earning massive
| profits. If their PBM divisions are, then they are simply
| subsidizing the insurance division, but it would make no
| difference to people. The total expense for premium plus
| out of pocket expenses would not change, it would just
| shift from one to the other.
| nimish wrote:
| > Unless there is massive fraud going on
|
| That is exactly what is happening, and it's legal. It's
| very easy to hide profits and move them around.
| secabeen wrote:
| One big element is that a lot of large companies and non-
| profits run their insurance programs as self-insured.
| They pay the direct costs of the medical care of their
| insureds, and keep the annual premiums the entire
| employee-base pays. The "insurance companies" are paid a
| percentage of the total revenue/claims as an
| administration fee, so they have incentives to push the
| overall amounts paid up, not down. Self-insuring
| eliminates the profit overhead of the insurance
| companies, but screws the incentives.
| lotsofpulp wrote:
| There are quite a few big insurers (better known as
| managed care organizations) competing for business, so
| the incentives are there to limit expenses so they don't
| have the most expensive premiums.
| sithlord wrote:
| This is probably true - and I am not here to point fingers
| - but I will say that the insulin manufacturers are at some
| fault too, they do just enough to keep renewing their
| rights to their insulins every time they come around.
| lotsofpulp wrote:
| You cannot renew a patent in the US. They get a new
| product patented, but anyone is still free to come along
| and make the older one. However, I bet there is a ton of
| expertise and cost required with doing that, and that is
| what is stopping others.
| sithlord wrote:
| they "renew" by "improving" their existing product enough
| to make it obsolete, and to get a new patent. Per the
| article below this has been happening since 1923
|
| https://www.hopkinsmedicine.org/news/media/releases/why_p
| eop...
| lotsofpulp wrote:
| That is better described as a new patent. The product for
| the patent that expired is expired, and can be made by
| others.
| TheFreim wrote:
| Would it be possible to get a limited amount of the fast
| acting stuff for unpredictable situations and then normally
| use the "cheap" stuff? I don't know how this works so I would
| like some info from someone who seems to know.
| sithlord wrote:
| Not likely, also lets not forget - as a Type 1 diabetic,
| you also take long acting insuling (unless you are on a
| pump). So, for example, a pump uses only fast acting
| insulin - and it gives a small amount (known as "basil")
| every 5 minutes (+/- depending on pump).
|
| Whereas, if you use pens (or from a vial) with direct
| injection, you also take a long acting insulin (levemir,
| Lantus, etc) once or twice a day (they are supposed to last
| 24ish hours but often people find splitting their total
| daily dose up into morning and night has better results).
| And these insulins cost even more than the fast-acting
| stuff.
| minitoar wrote:
| I thought it was "basal", not "basil".
| sithlord wrote:
| That's mobile autoformatting for ya, you are correct. I
| would correct, but edit limits...
| reddiky wrote:
| Possible, sure, but not ideal. The "fun" thing about T1
| diabetes is that every meal becomes an unpredictable
| situation based on exercise, sleep, stress, etc etc.
|
| Slightly exaggerated, but only slightly: Imagine you could
| only drink water 6 hours before you got thirsty, but if you
| drank too much you might pass out (at any point 2-6 hours
| from now) or if you drank too little you're doing major
| damage to your body.
|
| Really the only way to manage with that kind of insulin is
| to live a very, very low carb lifestyle. Its doable, but it
| limits your variety and leaves you prone to other potential
| issues.
| sparrish wrote:
| I do know what I'm talking about. Also diabetic.
|
| Yes, there are different insulins and Novolin is an
| intermediate-acting insulin like you describe and available
| at those prices.
| nimish wrote:
| It'd be much better for the world if one of the tech billionaires
| spent the money on a biosimilar insulin that could undercut this
| cartel.
|
| It's disgusting that people in america die for lack of an
| essential drug.
| HarryHirsch wrote:
| Insulin is a solved problem, in first-world countries the sale
| price is fixed and there's public healthcare.
|
| But in America you are supposed to take "personal responsibility"
| for your own health and biohack your way ouf of type 1 diabetes?!
| Srsly?
|
| This s a political, not a scientific problem. Call your
| congresscritter.
| moomin wrote:
| I mean, it wouldn't be the first time someone has tried to
| solve America's political problems with tech.
| anchpop wrote:
| Solving america's problems with tech has a pretty good
| success rate. We tried addressing covid with social solutions
| (social distancing, self-quarantine, etc) and it was
| generally a complete failure in comparison to the
| technological solution (mrna vaccinations)
| moomin wrote:
| Congratulations on ignoring the qualifying adjective so
| that you can look like you've constructed a counter-example
| without actually managing it.
| bko wrote:
| Price controls don't work. This is a solved problem and
| understood by nearly all economists. They lead to over/under
| production, huge waste, less efficiency and regulatory capture.
|
| The question is why no one is calling for price controls for
| other products that are produced in a relatively free market.
| Then ask yourself whats different about the market for insulin
| that prevents price competition.
|
| Using "fixed" prices to control costs is like using "fixed"
| thermostat readings to control global warming.
| tsimionescu wrote:
| The way price controls are achieved for medicine in the first
| world is through negotiation between the state public
| Healthcare system and pharma companies. This actually,
| provably works, and has worked for decades, and is much more
| efficient than in the US in fact - both in terms of
| healthcare outcomes, and Healthcare costs.
| bko wrote:
| I guess you have a lot more faith in "state public
| Healthcare system". Many comments were about how corrupt
| the politicians that led to this system were, so I imagine
| they would be equally as corrupt when they're "setting
| prices".
|
| The alternative would be to allow people to break the third
| party payer system and allow people to buy and import drugs
| from whomever they want. You can do this now on the grey
| market, but it would be great if it were legalized. Then
| you can probably get it for the same price as any other
| country, probably even lower. If you want, you can have the
| state cut every insulin user a check for $10 a year or
| whatever it would cost in a free market
| birdyrooster wrote:
| Found your problem:
|
| "African American adults are 60 percent more likely than non-
| Hispanic white adults to be diagnosed with diabetes by a
| physician."
|
| Given that the middle class is very white and employed with
| insurance coverage, it virtually doesn't affect white people.
| Our politics takes black people's votes for granted and don't
| do anything for them.
| armatav wrote:
| The insulin price is that high through political/regulatory
| capture. It costs barely anything to make.
|
| Not every problem has it's root in division.
| throwaway0a5e wrote:
| You're not wrong but the fact that the problem is allowed
| to persist certainly something to do with "people with
| enough spare f*ks to give to be politically active" being
| mostly unaffected by the problem.
|
| IMO it's more helpful to look at this through an economic
| lenses than a race one. T2 diabetes is very much a poor
| person's disease.
| throwaway0a5e wrote:
| >Our politics takes black people's votes for granted and
| don't do anything for them.
|
| It's worse than that. If they sufficiently pandered to them
| to the point of actually solving their problems then they
| wouldn't be able to take those votes for granted, so they'll
| never solve their problems.
| TeeMassive wrote:
| Black Votes Matter.
| wwweston wrote:
| There's people in at least one party who talk about problems
| like this, and given that party is the only one that has
| taken any kind of health care policy seriously for longer
| than the lifetime of this forum, and has at least some modest
| achievement to show for it during the narrow window they've
| had essential control of national institutions, there's
| reason to take that at face value.
|
| And while various poll access restriction measures are an
| injustice one could almost think is intentionally targeted at
| black people, I imagine those obstacles aside they'd be as
| free and capable of conscientiously assigning their votes as
| anyone else.
| luffapi wrote:
| Are you talking about the Democratic Party? They are _more_
| responsible for the extreme cost of healthcare in the US
| than any other political faction. Mandatory insurance,
| COBRA payouts... Did you know Gretchen Whitmer's dad was
| the CEO of BlueCross?
|
| I say this as a leftist: the Democratic Party is the party
| of the health industrial complex.
|
| https://www.jacobinmag.com/2021/01/joe-biden-public-
| option-h...
| wwweston wrote:
| > They are more responsible for the extreme cost of
| healthcare in the US than any other political faction
|
| I await the explanation of your model revealing the
| drivers of healthcare costs and connecting them to
| predominately Dem responsibility with baited breath, nigh
| weeping for hope of policy-capable leftists in the
| meanwhile.
|
| > Mandatory insurance
|
| You know that's how socialized insurance works at one
| level or another, right?
|
| > COBRA payouts
|
| Is this a mantra or a point?
|
| > Did you know Gretchen Whitmer's dad was the CEO of
| BlueCross?
|
| This is _definitely_ not a point.
|
| > the party of the health industrial complex.
|
| As long as we consider approach healthcare primarily as
| an industry, yeah, there's going to be industrial
| interests tangled up with it. Should we do it some other
| way? Maybe. In which party do you think that conversation
| is even possible?
| luffapi wrote:
| What on earth is "socialized insurance"?
|
| The Democrats are the party who put massive amounts of
| effort into derailing the only viable candidate to argue
| for public healthcare.
|
| Maybe you don't care about keeping predatory insurance
| companies afloat with COBRA payouts, or forcing healthy
| people to pay tens of thousands of dollars to insurance
| companies, but plenty of people do.
| wwweston wrote:
| > What on earth is "socialized insurance"?
|
| Sigh.
|
| Look. I appreciate passion for the topic. I _absolutely_
| care about this too. I probably spend waaaay more time
| than a layperson should reading about healthcare problems
| and policy. Like a lot of other people here on an
| engineering forum like this, I know the power of
| approaching things as their own kind of system.
|
| And it kinda looks like you don't yet. That's something
| I've no doubt you _could_ fix, but you 'd have to want
| it. Maybe even enough to google the term "socialized
| insurance." Or understand that when healthy people pay
| into risk pools... that's what insurance is.
|
| > The Democrats are the party who put massive amounts of
| effort into derailing the only viable candidate to argue
| for public healthcare.
|
| Presumably you're talking about Sanders. I encourage you
| to talk to his office while he's _not_ running about
| other people who are supportive and enthusiastic about
| public healthcare efforts. There are plenty. Arguably not
| enough: if they 'd had few more Senators to get past Joe
| Lieberman in 2010, Medicare-for-all-who choose would have
| been a reality then. As it was the ACA was a mixed but
| significant policy victory.
| luffapi wrote:
| Health insurance is a _commercial_ industry. There is
| absolutely nothing socialized about it. The CEOs of these
| companies are getting paid tens of millions of dollars.
| They are INCs. They are not socialized in any way shape
| or form.
|
| They _do_ have regulatory capture, mostly given to them
| by the Democratic Party.
| wwweston wrote:
| > Health insurance is a commercial industry.
|
| I can't tell whether you're saying "Health insurance in
| the US is a commercial industry right now" or "there's no
| such thing as health insurance that is not commercial."
|
| The latter statement is not true. Medicare for all would
| be socialized insurance, as would any single payer plan.
| There are other kinds of socialized insurance you can
| find in other countries.
|
| The former statement is mostly true with notable
| exceptions, so we'll assume that's what you mean. You may
| not be aware there _is_ socialized insurance in the US,
| though: Medicare and other state programs (and again, the
| _vast_ majority of Democratic officeholders supported
| expanding access to that to everyone in 2010 via what was
| called the "public option" at the time, unfortunately
| they needed every last D Senator and Lieberman held out).
| There are also some non-profit private insurers.
|
| > these companies are getting paid tens of millions of
| dollars. They are INCs.
|
| The money flowing through these companies is _not_ the
| problem. Getting paid to provide valuable services is not
| a problem. Even if you had a magic wand that you could
| wave that made Bernie king and M4A a reality, you would
| still need to employ people to source revenue for the
| general insurance fund, provide good financial
| stewardship over it, manage relationships with competent
| providers, provide service to people like you and I, etc
| etc. You 'd have to pay all those people. Like Medicare
| already has to (and hires private parties to help).
|
| It's likely that entirely socializing insurance would cut
| down on overhead (and certainly on any profit taking),
| but the thing is... that's already been limited. By who?
| Well... these Democrats you're suggesting are somehow
| primarily responsible for nurturing insurers. Where did
| this happen? The Affordable Care Act required insurance
| companies to reveal how they spend consumer premiums, and
| spend _80%_ of those premiums on care and efforts to
| improve quality of care. What companies can take in
| operating expenses and profits is limited _by law_ to
| 20%.
|
| Did you know that? If you didn't, why are you so
| confidently holding forth on this topic? If you did, why
| are you insisting on repeating the line that Democrats
| don't care and in fact are responsible for _increasing_
| expenses and capture of revenue?
|
| > They do have regulatory capture
|
| They have representation and influence in a democratic
| system. Arguably too much? Yeah. What's your plan for
| that?
|
| > mostly given to them by the Democratic Party.
|
| Again, you're welcome to lay out your model of how the
| democrats are responsible. If it's really limited to
| "other people in the party thought they'd make a better
| candidate/President than Bernie", though, you might want
| to see if you can come up with something stronger. And
| while you're at it, maybe start to admit _at least to
| yourself_ that maybe you have some more to learn about
| this topic.
| luffapi wrote:
| > _Again, you 're welcome to lay out your model of how
| the democrats are responsible._
|
| Simple, prior to the ACA I was able to cover my health
| expenses out of pocket. I'm healthy and literally went to
| the doctor 3 times in a decade. After being forced _by
| the ACA_ to buy unneeded and unwanted health insurance, I
| ended up paying >10k /year for literally nothing.
|
| I've since paid so much in health insurance that I could
| have covered my own cancer treatments, out of pocket. I
| have received _nothing_ for that $100,000+ dollars.
|
| Add to that the "marketplace" with limited time windows,
| limited competition, the inability to get insurance from
| another location...
|
| These were all Democrat initiatives that I lived through.
|
| Then, _twice_ the Democratic Party fought tooth and nail
| to kill M4A. Biden literally said he would never
| implement it. I'm no fan of the GOP, but when it comes to
| healthcare costs, no one is worse than the Dems.
| sremani wrote:
| Look at the Health insurance stock after Obamacare was
| passed - they all sky rocketed.
| luffapi wrote:
| As did the cost of healthcare. Also look at the health
| insurance stock when Biden was officially nominated.
|
| Edit: source
|
| https://www.cnbc.com/2019/05/20/cramer-bidens-2020-bid-
| is-se...
| spywaregorilla wrote:
| Diabetes rates for blacks is 11.7% vs. 7.5% for whites. That
| is a ~60% increase, but it's hardly an issue that only
| affects black voters.
| pmichaud wrote:
| Also worth noting that it's 11.7% of about 14% vs 7.5% of
| about 76%, so in absolute terms there are way more white
| diabetics than black diabetics.
| coliveira wrote:
| Congress has been bought by big pharma. There is nothing the
| American people can do at this point other than revolting on
| the streets.
| pm90 wrote:
| I mean, that's not nothing. Maybe not revolt, but organize,
| pressure sitting politicians and encourage better candidates
| to run.
|
| Americans vilify their politicians and then expect that
| somehow really "good" people will get into that profession. I
| don't get it...
| coliveira wrote:
| What I mean is that traditional avenues for change have
| been closed by the pharma industry lobby. It is not very
| different from the situation with the oil industry. The
| traditional political system has been corrupted by these
| industry forces, which support both parties.
| dv_dt wrote:
| The production cost of insulin is incredibly low. The pricing
| on it in the United States is systematic criminal manslaughter.
| skohan wrote:
| What's the actual situation there? I have read that cheap
| insulin for example is available at WallMart, but for some
| reason the price of insulin seems to be a huge issue.
| chiefalchemist wrote:
| The situation is that Type 2 Diabetes has raised the demand
| for insulin. More demand raises prices.
|
| The thing we can't talk about without risking cancellation
| is that nearly all Type 2 Diabetes is preventable. In other
| words, the choices of the many have a significant negative
| impact on those (i.e., Type 1'ers) who don't really have a
| choice.
| dekhn wrote:
| the increased demand for insulin is not why the price is
| higher.
|
| Insulin is made in massive facilities in large batch
| runs. Making 5X to 10X is basically cost of materials,
| which haven't really increased enough to justify the
| price increase.
|
| This is (mostly likely) a rent-seeking situation where a
| few providers who are allowed in the market are milking
| it for all the profit they can.
| chiefalchemist wrote:
| > This is (mostly likely) a rent-seeking situation where
| a few providers who are allowed in the market are milking
| it for all the profit they can.
|
| That is also known as demand. They do because they can.
| skohan wrote:
| Do you have a source on the scarcity claim? My
| understanding was that insulin is incredibly cheap to
| produce.
| chiefalchemist wrote:
| Never claimed scarcity. Only that as demand has increased
| - and it has significantly - so has price. It's basic
| economics. Unless there are additional economies of scale
| from that multiple then prices are going to increase.
| This isn't about insulin. It's simple economics.
| chiefalchemist wrote:
| Down voted (faux cancelled) as expected. For stating fact
| and truth? God bless you.
| Teknoman117 wrote:
| the EU has twice as many diabetics as the United States
| yet they have no "shortage" or "demand" related problems.
|
| Our situation has nothing to do with demand and
| everything to do with corporate greed. Many western
| European countries empower their governments to set upper
| bounds on the costs of medication to reduce the ability
| of pharma-bros to make disgusting amounts of personal
| wealth off the suffering of others.
| mgarfias wrote:
| Our food system is sure rigged to make us fat. But then,
| in my case, what was it that triggered the t2d? Was it
| the family genetics (both parents are t2d in their old
| age), the over abundance of sugar in the std American
| diet, the stress caused by abusive relationships (parents
| suck, plus ex wife made my life a living hell), or the
| adrenal tumor?
|
| I'll never know and I'm stuck with it.
| chiefalchemist wrote:
| Two of three you have control over. Some might even agrue
| epigenetics says three of three.
|
| Diet. Exercise. Etc. All known to change T2D.
| hourislate wrote:
| I think we all understand that Type II is preventable but
| I don't think that's the main focus here. There are
| plenty of folks who have Type I that can't afford Insulin
| and have to ration it causing harm and additional costs
| in healthcare. It's slow mass murder for Type I diabetics
| who can't afford their medicine. If you believe that it
| is a supply and demand issue why does the same Insulin
| cost 80% less in a country like Canada and before you say
| it's subsidized, it isn't. An American can buy it for
| substantially less if they can get a prescription from a
| Canadian doctor.
| chiefalchemist wrote:
| > There are plenty of folks who have Type I that can't
| afford Insulin and have to ration it causing harm and
| additional costs in healthcare
|
| Exactly. The preventable T2D is driving up demand (read:
| prices) for both T1D and T2D.
|
| I don't know about Canada. I do know about supply and
| demand. We all do. In the context of healthcare it makes
| no sense that ppl abuse their health and then expect
| prices to fall.
| hourislate wrote:
| What if I were to tell you the the Insulin for Type II
| diabetes is $35 at Walmart and the Insulin for Type I is
| $380-$500. By your reasoning shouldn't it all be
| expensive?
|
| What you fail to consider it that the company that
| controls the particular type of Insulin that Type I
| diabetics require is charging 80% less in Canada than in
| the USA with everything else equal.
|
| Do you get it?
| mgarfias wrote:
| There's different kinds. IIRC the cheap stuff and Walmart
| is just that, cheap. It's fast acting, and varies in how it
| reacts in the body.
|
| Our real issue here is that there is absolutely no
| incentives to control costs.
|
| You'd think our ins companies would do it, but I'm
| practice, they end up negotiating sweet deals with the drug
| manufacturers. say med X @ $1000/mo msrp, but the ins
| companies negotiate it down to $400/mo. The drug company
| makes out like a bandit, and the ins people get kick backs
| for buying from the drug co, and passes on the costs to the
| insurance buyers.
| RHSeeger wrote:
| > It's fast acting, and varies in how it reacts in the
| body.
|
| I believe they offer R (short acting / 2-5h), N (medium),
| and L (long acting / 24h). The problem with the older
| insulins isn't so much that they're faster, it's that
| they're less "specific" (from my experience). A newer
| short acting insulin (Apidpra, etc) has a spike in the
| 15-30 minute range and the spike is steep and the tail
| (while up to 5 hours) is low. Whereas R peaks in the
| 30m-1h range and the peak is low and the tail is much
| higher. As such, you need to plan ahead much better for
| your eating. It's frustrating, but not horrible. The N
| and L have similar problems (L is the reverse, where you
| want a tail equal to the spike, but it isn't).
|
| The newer insulins a just much more convenient and
| require a lot less planning of what you eat and when...
| and not as close an eye on your blood.
| HideousKojima wrote:
| If that's actually the case that puts all the "You're
| literally killing us with expensive insulin prices"
| people in a very negative light. At best they're ill-
| informed, at worst they're being intentionally deceptive
| to achieve political aims.
| ska wrote:
| How cheap is the cheap option?
|
| I found some references for "old" versions that claim
| price increase from $17 in 1997 to $138 today, another
| from $21 to $255.
|
| Going by inflation only those would be around $30-40.
|
| I don't know how much a typical diabetic needs per month
| (I imagine it varies) but I could see that being a
| problem for a lot of people if that is, say a monthly
| supply.
| RHSeeger wrote:
| > How cheap is the cheap option
|
| About $25, that last I checked. The ones you're talking
| about, I believe, are the "newer" ones (which are not
| very new). The prices of those have shot up over the
| years (in the US) for no good reason. It's shameful.
| ska wrote:
| I guess my mistake was thinking 20 plus years was old
| enough, that would be out of patent.
| RHSeeger wrote:
| My understanding it that they are out of patent, but
| regulations make it hard for new players to enter the
| market. Since the number of companies making them are so
| limited, even the generics cost a lot.
|
| For example, Basaglar is a "generic" of Lantus, but it's
| still expensive.
|
| Here's How to Save on Basaglar, the Expensive Lantus
| "Generic" https://www.goodrx.com/blog/basaglar-expensive-
| lantus-generi...
|
| > Basaglar contains the same kind of insulin as Lantus
| (insulin glargine), and while it is cheaper--Basaglar
| costs about 15% less than Lantus--it is still expensive,
| with a cash price of around $450 for a 30-day supply.
|
| Unlike normal generics, the bio-similars need to go
| through their own clinical trials and prove they work the
| same as the original. They can't just "use the same
| ingredients" and release it. Mind you, that doesn't
| explain the extreme price markup, but it does explain why
| these "generics" don't follow the same "85% cost
| reduction" of normal generics. They still have,
| effectively, a costly R&D phase.
|
| At least, that's my understanding.
| ska wrote:
| I understand that argument.I hadn't thought of the issue
| of insulin being a biologic, so true generics aren't
| likely, hence biosimilars. None of this justifies a 10x+
| price increase on the same product over 20 years of
| course.
|
| By the way that same site had an interesting article
| breaking down costs normalized by insulin unit
|
| https://www.goodrx.com/blog/how-much-does-insulin-cost-
| compa...
|
| By that table and some assumptions about approx 40 IU/day
| it looks like the cheapest you could get away with at
| full retail would be about $120/mo, assuming optimal
| usage etc. The most expensive version would be at least
| 5x that.
| KittenInABox wrote:
| It's extremely hard to manage your health with old
| insulins because they're so much less precise. Imagine if
| you were programming but your keyboard works such that
| any key you type might be +3/-3 key presses actually.
| Except in the case of diabetes, this results in the loss
| of body parts and blindness.
| pimeys wrote:
| I have to ask, are you suffering from a Type 1 diabetes?
| If not, at least for me, this answer kind of misses the
| point completely. Type 1 is a hell to manage. It is
| REALLY hard.
|
| Like I actually use an open source pancreas to control my
| glucose levels so now I can sleep every night without
| having to worry about dying. This is in Europe where the
| insurance covers everything and prices are cheaper than
| in US.
|
| Using the Walmart insulin makes everything much much more
| complex, and even for the smartest of us, even with the
| best possible insulins, managing T1 is a HUGE pain and
| can kill you quite fast.
|
| I hope I misread your comment...
| RHSeeger wrote:
| I do have type 1 diabetes, and I lived on R/L for over a
| decade. The point being made here is
|
| > The high price of tier 1 insulins is killing people
|
| Is (more or less) a lie. While
|
| > The high price of tier 1 insulins is making people's
| lives considerably worse and their diabetes harder to
| manage.
|
| Is (more or less) true.
|
| When you try to push for change and use, as part of your
| argument, a lie, you sabotage yourself. People can point
| at what you're saying and, ignoring the validity of what
| you're trying to achieve, say "you're lying". That's bad.
|
| The truth is that there are good reasons why tier 1
| insulins should not cost as much as they do, not by a
| long shot. And destroying your own progress towards
| changing things is counter productive. Just don't do it.
| burkaman wrote:
| It is not a lie if you think about real human behavior,
| rather than a theoretical rational automaton. There are
| real, documented cases of people who were prescribed
| insulin they could not afford, tried to ration it, and
| died as a direct result. Maybe their doctor told them not
| to use it, or they didn't live near a Walmart, or they
| didn't know it existed. Maybe they tried the Walmart
| stuff and almost died because it's so difficult to
| manage, so their doctor told them to switch back to the
| best treatment available. I promise they did not die to
| make a political point.
|
| One in four patients in the US have rationed insulin
| because of the cost:
| https://news.yale.edu/2018/12/03/one-four-patients-say-
| theyv...
|
| It is simply untrue to say the high cost only forces
| people to use the cheaper Walmart generic. That isn't
| what happens. They ration it, and sometimes they die.
|
| Finally, it doesn't make sense to say that the high price
| is making diabetes harder to manage, but isn't killing
| people. That's like saying speeding doesn't kill, it just
| makes the car harder to manage.
| RHSeeger wrote:
| Correction
|
| > One in four patients say they've skimped on insulin
| because of high cost
|
| > say they've
|
| ^ is the key component. I expect the vast majority of
| those people had a choice, and they chose not to take it.
| A poor choice, and a choice they shouldn't have to make,
| but a choice nonetheless.
|
| The point is, if you're going to fight for positive
| change, use an argument that can't be trivially dismissed
| because it isn't true. Fight effectively.
| burkaman wrote:
| Yes, why did they choose not to take it? Try to empathize
| with these people. Why did they do something so
| dangerous? Then follow it one step further. In the case
| of those that died, why did they die? What factors
| contributed to their death? If the price of insulin had
| been lower, and everything else was the same, would they
| have died?
|
| I would argue these two statements are equivalent:
|
| - My patient was killed by the high price of insulin.
|
| - If the price of insulin had been lower, my patient
| would still be alive.
|
| I suspect that you accept the second statement, but not
| the first. What's the difference?
| RHSeeger wrote:
| They are two different, but related, things. There are
| people who die early because they eat extremely poorly;
| lots of fats and sugars.
|
| 1. If the fatty and sugary foods were too expensive for
| them to buy, they would not have died from those things.
|
| 2. They did not die because fatty/sugary foods weren't
| expensive. They died because they chose to eat
| fatty/sugary foods. [1]
|
| Just because X (good insulin being cheaper) would have
| helped prevent Y (deaths) doesn't mean that <not X>
| caused Y.
|
| [1] I'm ignoring the fact that truly healthy foods tend
| to outside the price range of the poorer segment. The
| analogy only really goes so far here.
| burkaman wrote:
| Ok, I guess that's the core of our disagreement. I do
| believe that "X prevents Y" means "<not X> causes Y".
| Thanks for the discussion.
| RHSeeger wrote:
| To me, it's the difference between "is a requirement for"
| and "is the cause of".
|
| - People drive cars.
|
| - Cars are car jacked.
|
| - If people did not drive cars, carjackings could not
| happen.
|
| - People driving cars is a requirement for carjackings.
|
| - People driving cars is not a cause of carjackings.
|
| I understand that it is possible and truthful to argue
| that people driving cars is a cause of carjackings; it's
| just not my view of the meaning of those words.
| jamincan wrote:
| You're letting pedantry get in the way of the far more
| important point that making the medication more
| affordable would save lives.
| oasisbob wrote:
| Saying that cheap insulin kills people seems like a
| hyperbolic, but essentially true statement.
|
| It's well known that you need to keep all sorts of things
| under control with type 1 to avoid long-term health
| complications. Blood sugar is the most obvious.
|
| I watched my father manage his for decades, starting in
| the 1980s. The technology improvements were interesting -
| his first insulin pump (about the size of a VHS tape),
| the custom software to data-dump his glucose meter,
| "supply-hacking" to keep the infusion sets affordable...
|
| He still had management challenges despite being a
| dedicated, disciplined, marathon-running Mormon on the
| leading-edge of treatment. He was fortunate enough to be
| involved in the DCCT/EDIC trials at the University of
| Washington, and took the early lessons about future
| complications very seriously.
|
| You make Diabetes harder to manage by removing modern
| improvements to the standard of care, and you are
| certainly going to see increases in deaths and severe
| negative outcomes.
| dv_dt wrote:
| The people who can least afford healthcare also have the
| most external constraints on their work and life, making
| it the most difficult to make good, non-harmful use of
| older insulin in the long term.
|
| There are plenty of cases of people literally dying
| because of difficulty managing insulin due to cost. It's
| nice to say other low cost forms are available while
| handwaving away actual deaths as well as accumulative
| long term damage from difficult insulin management.
|
| https://khn.org/news/insulins-high-cost-leads-to-deadly-
| rati...
|
| Many of the "newer" forms are 20+ years old, and are also
| extremely low cost to produce.
| icelancer wrote:
| It's the same with basically every other campaign that
| wants to grab headlines. It literally makes no sense that
| insulin prices are killing people and it's unavailable,
| and a basic amount of research shows that yeah indeed,
| it's clickbait intended to hook you into a more complex
| discussion.
|
| I pay zero attention to people and news sources that
| repeat that behavior more than once. Lead with the truth.
| RHSeeger wrote:
| You are a prime example of WHY that lie is bad. The
| discussion they are trying to drag you into is an
| important one, and well worth having. However, by
| starting out with a lie, they are driving you away before
| they can even start the conversation with you about it. A
| conversation where you might agree with them.
| RHSeeger wrote:
| What you've said is true. Refusing to use the older
| insulins is what is killing people. Having to use the
| older insulins is shitty, and it shouldn't be happening,
| but it's not the thing that's killing people.
|
| However, actually _saying_ that tends to get people up in
| arms, harassing you about how it how it shouldn't be
| necessary for people to use the older insulins, and how
| the newer insulins shouldn't cost what they do. Even
| though everyone actually agrees with them and they're
| arguing against a point that nobody it actually trying to
| make. It is... frustrating trying to get people to
| understand that you agree with them, but you're talking
| about something different.
|
| I had this exact discussion with one such person
| yesterday, and I was trying to explain that they are
| sabotaging their own goals by misrepresenting the issues.
| And that I WANT them to succeed in changing things, but
| they're making it harder to do so.
|
| Edit: You're already being downvoted for stating
| something that is obviously and undeniably true, because
| people are not bothering to understand what you're
| saying. I'm sorry for that.
| HarryHirsch wrote:
| _Having to use the older insulins is shitty, and it
| shouldn 't be happening, but it's not the thing that's
| killing people._
|
| In a way it is killing people, blood sugar control is
| much easier with a mix of the newer insulins, and
| patience compliance is much higher. This directly
| translates into better quality of life and lower disease
| burden from diabetes complications.
|
| No one can argue that pharmcos shouldn't be paid for R &
| D that increases quality of life, in civilized countries
| the taxpayer should and will pay for your medication if
| it's an improvement over what's already at market.
|
| But here people seem to be arguing that if you can't
| afford anything else there's still Walmart short-acting
| Humalog, and you get to bear all the risk, and that's
| just fine.
| arwineap wrote:
| That's context I've never gotten before. Obviously
| there's a nice convenience benefit built into this
| product that a company has created, they should get to
| charge some markup for that.
|
| I wonder how different the production costs are though,
| my understanding is the costs to consumer are greater
| than 10x
| [deleted]
| pimeys wrote:
| The difference with the old insulin vs. the analogs is
| that with the old ones it's really easy to lose a toe,
| leg, kidney or get blind. With the new analogs it's
| possible to control your glucose levels so that you can
| stay healthy and get old.
|
| Source: a T1 diabetic, used all possible insulins in my
| life. Very happy in Europe.
| UnpossibleJim wrote:
| They also tend to have a more reliable absorption curve.
| I take both Novolog (short acting) and Lantus (long
| acting), which are the newer insulins. Lantus has a more
| predictable long acting curve than the older L did, even
| though I take it in a 12 hour cycle. It rises not so much
| like a bell, but more like a plateau, I guess it a better
| analogy. At least for me. The L really was a pain for
| planning, especially when physical activity was involved,
| as it would shorten the bell curve.
| RHSeeger wrote:
| On a related note... if you can afford a CGM (continuous
| glucode monitor), especially one with alerts (like the
| Dexcom G6), I wholeheartedly recommend one. They are life
| altering for a type 1 diabetic. Being able to check your
| blood sugar by just looking at your phone (or separate
| receiver) is very convenient. I check my blood sugar 100
| times a day, instead of poking a hole in myself 10 times
| a day. And I can (mostly) rely on it alerting me if my
| blood sugar gets low (or is going to get low soon). I
| cannot stress enough how much it changed my control of my
| diabetes.
|
| Admittedly, they're not cheap w/o insurance, which sucks.
| But if you can get one, so do. You won't be disappointed.
| mgarfias wrote:
| I keep on trying to get one, but being well controlled,
| the ins cos won't approve it. And its pretty spendy out
| of pocket. My biggest use case would be an alert that my
| glucose levels are tanking while exercising so I can do
| something about it before I drop out. I find myself not
| doing things like long bike rides that I'd really like to
| do because of it.
| HPsquared wrote:
| I guess the question is, do countries with socialized
| healthcare provide the cheap version or the expensive
| one?
| ravitation wrote:
| Not actually the question since countries with modern
| healthcare systems provide all types of insulin at an
| average cost per unit that is roughly 1/10th to 1/20th
| the cost in the United States (cheap vs. expensive is an
| over simplification).
| relax88 wrote:
| It's the same reason why health care costs are out of
| control in general.
|
| It's a for-profit system where literally every cog from
| drug company to pharmacist has an incentive to separate you
| from your money.
| jcampbell1 wrote:
| The entire hamburger market is for profit, but that isn't
| a problem as I can buy good hamburgers at many different
| price points. The issue is that the industry is
| controlled by 1% of the population who have exclusive
| rights to decide what you buy, and a government agency
| that limits the hell out of who can sell anything in the
| name of safety.
|
| When Europeans can pick from 5 different spring loaded
| epinephrine injectors and Americans can only legally buy
| one from a specific manufacturer, of course Americans pay
| 5x as much.
|
| In plenty of places around the world you can buy all
| humulin you want without a doctor or the FDA for $30
| vial.
| relax88 wrote:
| If Hamburgers were required to survive I'm sure you would
| see the same problems.
|
| If the state was the single largest negotiator for
| purchasing hamburgers and representing tens of millions
| of people odds are you would have more competitive
| hamburger supply bids.
| [deleted]
| adamrezich wrote:
| > Call your congresscritter.
|
| unfortunately not likely to do anything as long as the big
| pharma lobby remains as powerful as it is
| badRNG wrote:
| What else is one to do?
| dekhn wrote:
| If your question is truly serious, the answer is: nothing.
| It's almost certainly impossible to fix the US healthcare
| system given the enormous number of people who profit so
| much from its current dysfunction. Unless there is some
| sort of major disruption that completely changes the
| landscape (very unlikely), you can expect pharma in the US
| to be extremely expensive.
| shadowgovt wrote:
| That's bad news, because when the answer is "nothing,"
| people don't do nothing.
|
| They instead resort to the language of the unheard.
| dekhn wrote:
| it will be interesting to see how health care evolves in
| the US, to say the least.
| HarryHirsch wrote:
| Take to the streets, like the French do?
| SiempreViernes wrote:
| Actually, the French mostly stay at home: the last
| gubernatorial elections had like 34% participation.
| permo-w wrote:
| They mean strikes, and protests
| OriginalNebula wrote:
| In the second round of the 2017 presidential election
| there was 65.3% turnout. In the 2020 US presidential
| election there was 66.8% turnout.
| tux3 wrote:
| The primary tool we use to exerce Democracy is not so
| much the vote anymore, it is protests on specific issues.
|
| Votes are too diluted, and there is no accountability for
| campaign promises.
|
| Le referendum, c'est Place de la Bastille!
| mgarfias wrote:
| I'd vote for swinging politicians from lamp posts, but were
| not allowed to do that.
| bruiseralmighty wrote:
| About Insulin?
|
| Look for ways to make the patents unenforceable. If
| diabetics had the ability to make their own safe insulin at
| home that would be best. Then all they would need is an
| internet connection and some basic components. The closer
| we get to that ideal the more empowered they are.
|
| This would actually solve a lot of price gouging for drugs.
|
| However that's only a stop gap measure. What's happening
| with gating access to insulin is happening to a thousand
| other products in a thousand other industries right now.
| Start looking at alternative governance structures. Lord
| knows everyones got a blog and a half-assed plan to run
| things better at this point (since the bar is so low).
|
| Just don't poke the bear. As cathartic as hanging
| 'congresscritters' would be it wont actually solve the
| problem.
|
| Basically act like you don't expect anyone else to fix this
| problem for you because nobody is going to; especially if
| you voted for them.
| api wrote:
| The US health care system combines everything bad about
| government-run health care (slow progress due to heavy
| regulation, layers of bureaucracy, government-enforced drug
| monopolies) with everything bad about free-enterprise health
| care (inequality, market price fixing, uneven quality, lots of
| quackery at the edges of regulation).
|
| We need to pick something. If we're going the free enterprise
| way we need competition, price transparency, quality and
| outcome transparency, more open markets, and much lower taxes.
| If we're going the state-run or state-insured way then we need
| to whole-ass it and vertically integrate and drop the state-
| backed private insurance hybrid nightmare.
|
| The US does this pessimum thing all over the place. We are
| taxed almost like a more "socialist" country (unless you are
| rich enough to offshore and play tax loophole games) but do not
| get the benefits of one. Either cut my taxes down to Costa Rica
| levels or give me benefits at least as good as Canada please.
| dv_dt wrote:
| Every time I've dug into it, modern nations which enjoy a
| much lower cost per capita coverage (which the US is a major
| outlier) basically have a government mechanism to set prices
| for drugs and health services.
|
| There are no free market health systems in leading economic
| nations (unless maybe you take a very small niche corner of
| the systems)
| adventured wrote:
| > There are no free market health systems in leading
| economic nations
|
| That also does not exist in the US and hasn't in more than
| half a century. The US could hardly be any further away
| from a free market in healthcare. It's hyper regulated, and
| hyper dominated by government programs (Medicare, Medicaid,
| and dozens of other programs and agencies).
|
| The US healthcare system is controlled top to bottom by
| rigid, strict government regulations and oversight. It's
| the way it is precisely because there is no free market at
| all. The corporatist interests like it just the way it is,
| and work with the politicians to constantly maintain that
| highly regulated environment: it's regulated in their
| favor, exclusionary of nearly all potential competition.
| And it's insanely expensive to try to start anything in
| healthcare, which favors the incumbent further.
|
| Try starting a hospital or opening a clinic. Try becoming a
| doctor. Try getting a drug to market. Try getting a medtech
| device to market. Hyper regulation every direction you
| look.
|
| Free market? Ha.
| dv_dt wrote:
| My point is that it's seems a little optimistic to think
| that a free market for healthcare is an adequate
| solution, given that no free market healthcare system
| exists anywhere at scale. I think some markets are simply
| inappropriate for free markets - particularly one where
| services are by definition specialized and market
| feedback involves failures in critical life risking
| situations.
| KoftaBob wrote:
| Finally someone has put into words my frustration with this
| healthcare system.
| rrrrrrrrrrrryan wrote:
| Obamacare was widely derided by many Democrats as a worst-
| of-both-worlds plan when the public option was scraped.
| chiefalchemist wrote:
| What we need is a focus on prevention. A significant amount
| of the system is devoted to preventable conditions. Lower the
| demand and prices will naturally come down across the board
| as resouces get redistributed, etc.
|
| But as it is, insulin is high demand and increasing. Prices
| simply don't fall when demand increases.
| sneak wrote:
| You're absolutely right that either would be better than the
| current situation.
|
| The issue, though, is not that it's half-assed and fucked up.
| It's working by design, to use legislative schemes to funnel
| money to incumbents and friends/donors, while still
| supporting the "free market" ideology, when really it's just
| regulatory capture.
|
| The system is designed for graft, and it's working as
| intended. Those with the power to "fix" it won't, because to
| them it's not broken at all.
|
| The US has the same problem in telecommunications,
| war/defense, and medicine. The largest vendors become
| integrated with the budget- and policy-makers, and the whole
| system exists to extract maximum value from the consumer
| class.
| a3n wrote:
| > Call your congresscritter.
|
| Sorry, but regular people don't make "campaign contributions"
| of any noticable size, so all we get back is a form letter
| acknowledgement based on whatever box you checked for subject.
|
| Big Pharma, Big X and Big Y, on the other hand, "donate" enough
| "campaign contributions" that the campaigner can all but ensure
| (re) election based on recent name recognition to get the
| nomination, then counting on "their" voters being unable to
| vote for the opposite party even with the discovery of a live
| boy or a dead girl.
|
| https://duckduckgo.com/?q=live+boy+or+dead+girl&t=fpas&ia=we...
| relax88 wrote:
| Well maybe it's time to start protesting?
|
| What always amazes me is how much this is tolerated in the
| "Land of the free". At what point do Americans stand up for
| democratic principles?
|
| This pathetic "we can't do anything" attitude will be how
| democracy dies.
|
| If my electoral district was gerrymandered or corporate
| donations through PACs we're allowed in Canada I would be
| planning protests instead of typing this. Our system is far
| from perfect, but I have a hard time imagining a scenario in
| which the public here would passively accept many of the
| things we can see to the South.
|
| Why is there so much apathy towards these issues?
|
| Shouldn't the fairness of the democratic system in the US be
| the #1 issue for both Democrats and Republicans?
| a3n wrote:
| When you're told you're number one your whole life, you
| don't go anywhere else, and your religion and patriotism
| are joined at the hip, why, there's no reason to change
| anything.
| oceanplexian wrote:
| Respectfully disagree. I live in a smaller US state and I've
| emailed my representatives and received a personal reply from
| both of them. One actually engaged and we politely discussed
| a public policy issue back and forth in an email thread. More
| often than not you can walk right into their office and meet
| them if you'd like.
| kaesar14 wrote:
| And did meeting them shift their position on an issue where
| the opposition is a massively powerful and wealthy industry
| that spends millions on lobbying efforts?
| cde-v wrote:
| I'm sure your nice discussion held as much sway with them
| as hundreds of thousands of dollars of "donations".
| relax88 wrote:
| Try showing up with 500 people.
| andai wrote:
| I hazarded a guess that a bit more than 500 people suffer
| from diabetes in the US -- more like 34 million. If you
| could get one in a thousand to agree to take political
| action, that's 34,000 people.
| nceqs3 wrote:
| Factually incorrect comment. Corporations cannot make
| campaign contributions.
| kadoban wrote:
| Are you sure? Pretty sure they can. Either way they can
| donate huge amounts to PACs, create their own PACs, run
| ads, etc. Bribery is pretty much legalised, it's
| ridiculous. See Citizens United v. FEC for example.
| skciva wrote:
| _wink wink_
| arcticbull wrote:
| Luckily people can, and corporations are people. That is to
| say, corporations can donate to PACs and PACs can donate to
| candidates.
| nceqs3 wrote:
| not true. PACs cannot donate more than a pretty low limit
| to candidates.
| mikepurvis wrote:
| The whole point of a PAC is that they _don 't_ donate to
| the campaigns directly, but rather exercise their free
| speech to supply the public with "information" about the
| candidates.
| a3n wrote:
| Money is, after all, "speech."
|
| https://en.m.wikipedia.org/wiki/Citizens_United_v._FEC
|
| Walk softly and carry a big purse.
| roywiggins wrote:
| Sure, they make donations to super PACs, which ""don't
| coordinate""[0][1][2][3] with campaigns.
|
| [0] https://www.marketwatch.com/story/trump-and-democratic-
| polit...
|
| [1] https://www.rollcall.com/2019/06/06/what-is-
| mcconnelling-how...
|
| [2] https://www.theatlantic.com/politics/archive/2015/09/10
| -ways...
|
| [3] https://www.latimes.com/nation/la-na-politics-
| superpacs-impa...
| mikepurvis wrote:
| I can't find the link now, but something that really
| opened my eyes on terrifying PACs are was someone
| pointing out how they manipulate the political discourse
| _without even spending a dime_. They just sit there on a
| gigantic warchest and send out gangster-style missives
| like "hey it sure would be a shame if you supported X or
| Y and we had to drop $10M on pummeling you with primetime
| TV ads in the week before your reelection."
|
| This kind of influence is completely untraceable through
| all the normal disclosure mechanisms since no money
| actually gets spent. And worse still, it offers enormous
| leverage-- once you have that war chest, you can use it
| to issue hundreds of threats and only occasionally have
| to actually follow through.
|
| It's just a completely different ballgame compared to a
| "normal" campaign finance option that directly spends
| donations.
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