Possible shortage of insulin... Should we start to prepare?

#1

Should we start to prepare? Lately, the news about insulin are not very hopeful :frowning:

As the number of people living with diabetes continues to rise, the access to insulin needed to meet growing demand will fall short, a new study predicts.

By 2030, 79 million adults with type 2 diabetes are expected to need insulin to manage their condition and if current levels of access remain, only half of them will be able to be able to get an adequate supply, according to a modeling study published Wednesday in the journal Lancet Diabetes and Endocrinology.

#2

From the linked story.

ā€œUnless governments begin initiatives to make insulin available and affordable, then its use is always going to be far from optimal,ā€ said Basu. [Stanford researcher who led the study.]

The failure of the competitive free market system with regard to both insulin supply and its high price seems obvious to me. This market has failed and people with diabetes, especially people from poor regions of the world, will continue to pay exorbitant prices for insulin. The really unlucky will forgo its use and suffer punishing consequences.

How can any of the ā€œfree marketeersā€ defend such a deliberate manipulation and distortion of market economics? I think this market injustice cries out for some counter-balance that only government can provide.

#3

With how much companies charge for insulin Iā€™m sure they will scale up to meet demand.

#4

The market price of insulin has been way too high for several years now. It doesnā€™t appear that any new players have entered the market. This is pure oligopoly in action.

#5

The only ā€œfree marketeersā€ Iā€™ve ever met and talked to are generally in one of two (or both) categories:

  1. People that already ā€œgot theirs,ā€ whether that be through an inheritance, a windfall, or some other act of good fortune, and who all believe they earned their wealth through their own particular genius and hard work.

  2. People that profit from the system the way it is.

For folks that fit either of these criteria, the rest of us are just low-quality investments or expenses, depending on particular circumstances. If we work for them, then the optimal financial plan is to pay us as little as possible in such a way as to maximize productivity while reducing overhead. If we donā€™t work for them but cost money (to them or the system), the most optimal financial plan is to let us die.

In reality, I have a hard time seeing ā€œfree marketeersā€ as anything other than those who lack empathy but have an elaborate political philosophy to justify their gain at the expense of others.

Ultimately, itā€™s the prosperity gospel stuff: if you have money and good health, itā€™s because you are a good person; if you are poor and ill, itā€™s because you donā€™t deserve to be wealthy and happy.

#6

I use the label ā€œfree marketeerā€ in a disparaging sense. The Ayn Rand philosophy embraced by many people in our political system as such obvious failure in the insulin market. When will we tell them, ā€œthis partyā€™s over?ā€

#7

Well, free marketeers (which I also can only use in a derogatory sense) have done a fantastic job in the U.S. and Europe of identifying wedge issues effective at getting disadvantaged people to vote to make their own lives harder. Weā€™ll tell them ā€œthis partyā€™s overā€ only when the pain of complying with their failed, selfish policies is so great that people are willing to threaten burning the system to the ground. This has happened before, at least a few times in the U.S.

Around the time of the Great Depression, unions, suffragettes, and progressives united to force the U.S. government to adopt economic policies which improved the standard of living for Americans to the highest levels ever seen in human history. Since shortly after WWII, the free-marketeers have been doing their best to dismantle that system so that the majority of the population can again be exploited for their own personal gain. Medical and pharmaceutical costs are just one part of the system. The housing market, retirement ā€œplans,ā€ wage stagnation, and undermining of consumer protections are other planks in that particular platform.

And for all of those things, there are an amazing number of people willing to line up and claim that ā€œfreedomā€ is at stake when we progressively tax the wealthy and support the working classes (which includes the ā€œmiddleā€ classes these days, undoubtedly). Protecting the wealthy has become itā€™s own religion in the U.S., and itā€™s been syncretically joined to various types of Evangelical Christianity in a way that looks to be completely unassailable.

Not ironically and with sadness, I can honestly say that Iā€™m now looking to leave the country permanently at the first opportunity. American politics is an existential threat to me and my family at this point, and Iā€™m willing to throw my lot in somewhere else. For the record: Iā€™m highly educated, a high-earning individual, and am about as productive as Americans get. Iā€™m not looking for a handout, Iā€™m just looking for an economy and lifestyle that is sustainable.

#8

The entire world is in chaos right now. Where have you found that sustainable economy and lifestyle?

#9

Havenā€™t found it yet, but Iā€™m actively looking for jobs in NZ, Ireland, Scandinavia, and parts of the EU. They tend to take climate change seriously and have less income disparity than in the U.S., and they all have universal healthcare. Itā€™s quite possible Iā€™ll never find a truly sustainable economy and lifestyle, but itā€™s not hard at all to find someplace better off than the U.S.A. right now.

#10

Unfortunately, the far right nationalism political strain has infected almost every country in the world, to some extent. I think the most successful northern European democratic socialism systems seemed to have resisted this particularly virulent strain. Itā€™s tough, however to immigrate to Norway, Sweden, or Denmark. Thatā€™s where, I think, I would find sympathetic political resonance to my values.

#11

I agree itā€™s a problem.Iā€™m just saying its in their interest to make enough insulin to meet demand. More sales at the same high price is more profit for them.

Personally I think itā€™s insane how much they charge for insulin.

#12

This seems as obvious and certain as gravity; why hasnā€™t it happened?

#13

Iā€™m gonna head over to some political forums. Maybe a discussion of diabetes will break out over there.

#14

It sounds like the article is saying the number of people needing insulin in 2030 will be much more than today. With the question will there be a shortage of insulin. Iā€™m saying I donā€™t think so since they will make more to make more profit.

Iā€™m not saying anything like I think new companies will enter the insulin market to buster supply or reduce cost.

I donā€™t know the details but have the impression the current insulin producing companies do everything possible to block new entries into the market to keep the prices inflated as long as possible.

Update
It seem in this thread Iā€™m unable to articulate my point of view clearly based on the responses Iā€™m seeing. Iā€™ll disengage from further discussion on this topic.

#15

Diabetes and all its implications does not exist anywhere isolated from economic and political context. Expecting any diabetes forum to surgically avoid these connections and influences is an unreasonable expectation, in my honest assessment.

If we want to help each other as people with diabetes, we need to move beyond our immediate human-to-human roles and also see ourselves as citizens with the agency to affect change for our benefit. Iā€™m not ready to neuter my full sense of self from larger cultural realities.

#16

To me itā€™s hard to reconcile the two ideas that

  1. big pharma is price gouging us for insulin and the profit margin is absurdly high (which I believe)

And 2) there is going to be a shortage of insulin.

If itā€™s such a cash cow, theyā€™ll just make more of itā€¦ although this article does specifically state that these shortfalls are expected to occur mostly in other parts of the world. Does give me some comfort that at $300/ vial list price the supply chain is probably pretty bulletproof here in the USA

#17

Interesting article about the difficulties of controlling drug pricesā€¦Yes it is written from a perspective that some might disrespect but it raises some valid concerns about top-down management of drug prices, ultimately affecting availability.
https://www.nationalreview.com/2018/11/drug-price-control-plan-negative-consequences/

Personally I think the answer is to remove many insulins, CGMā€™s, etc. from FDA oversight and make them available over the counter. Thereā€™s no good reason I can think of why an ā€œexperienced insulin userā€ need a doctorā€™s prescription for a CGM or an insulin pen.

#18

I think the main problem is the stranglehold the big 3 have on the insulin marketā€” sanofi, lily, and novo.

They even produce the new ā€œgenericsā€. Lol what good is a generic if itā€™s produced and price set by the brand manufacturer?

Weā€™ve seen some pretty vicious dirty business dealt to any smaller players whoā€™ve tried to break into the insulin field.

Until the regulatory and business burdens can be reduced to the point where smaller generic drug makers can step up to produce insulin at a reasonable profit marginā€” the big 3 will continue to control the market and collude to raise prices indefinitely, and potentially limit access to those less lucrative markets in order to favor the more profitable ones.

That said, of course the real solutions are to steer the world towards less need for insulin, but nobody seems to have figured out how to do that, and anyone who makes suggestions gets all kinds of pushback.

#19

Hereā€™s one doctor who has not only figured out how to take T2D patients off of insulin, heā€™s doing it every day. If you are adverse to a carb-limited way of eating as a treatment for diabetes, you may want to avoid watching this video.

Using a low carb, high fat way of eating for the last 6 1/2 years, I have lowered my total daily dose of insulin from 80 to 22 units/day. It works. It is sustainable.

One snapshot from the above linked video.

Edited: I have removed a graphic depiction that could be misinterpreted as a way to blame and shame people with T2D. That was not ever my intention. I apologize.

#20

While I understand how low-carb can do wonders for many diabetics, itā€™s also certain that many Type 2s can not control their diabetes, sustainably, by eating-low-carb and going off insulin. And that comic down at the bottom right is downright offensive to humanity. It is victim blaming, pure and simple, and goes to show one of the reasons Iā€™m pretty sure pharmaceutical companies get away with pricing insulin the way they do:

A significant portion of Americans, including doctors, view insulin as a moral failure of the patient who really ā€œdid it to themselvesā€ by being a glutton. Itā€™s the same kind of justification Americans use for throwing addicts in prison, rather than treatment, or making sure that treatment for drug addiction is so expensive (and generally not covered by insurance) that it all but guarantees bankruptcy. We love to punish people for moral failure in this country, and we have a really bad habit of blaming the poor, the ill, and the needy for their problems.