Marketing of Insulin Explains a Lot About Our Health Care System

A recent commentary (M Fralick, AS Kesselheim. NEJM 2019; 381: 1793-5) describes the U.S. Insulin Crisis.


  • In 1922, insulin was first injected into a 14-year-old boy with severe type 1 diabetes mellitus (T1DM). Prior to this, T1DM had been considered a universally fatal disease
  • Frederick Banting, John Macleod, and members or their team that discovered insulin sold their patent for $1 to assure it could be widely affordable
  • “U.S. law allows pharmaceutical manufacturers to price their products at whatever level they believe the market will bear and to raise prices over time without limit”
  • “Direct competition in the insulin market is lacking”
  • Since insulin is a biologic drug, this necessitates “additional testing beyond what is usually required for generic drugs before approval by the” FDA.

Current Situation:

  • A carton of insulin that sells for $300 in the U.S. could be purchased in Canada for $20 (in U.S. dollars)
  • Nearly 100 years after the development of insulin, “insulin is inaccessible to thousands of Americans because of its high cost.”

My take: Why does insulin cost 15 times more in the U.S. than Canada?   These excess costs with insulin are occurring despite a great deal scrutiny; unfortunately, U.S. consumers are paying extra for a wide range of pharmaceuticals.  Going from the Nobel discovery of insulin to our current state is a clear indication of the need to reform of our healthcare system.

Related blog posts:

Mural in Quebec City: La Fresque des Québécois

NPR: “Craptastic Voyage” and Fart Analysis

Surely a story for every gastroenterologist: “Before The Gas is Passed, Researchers Aim to Measure it in The Gut.”

An excerpt:

Kalantar-Zadeh and his colleagues propose in a paper in Trends in Biotechnologyonline Thursday two new devices that could keep a vigilant eye, or a nose in this case, on what’s going on deep in the gut….

The jar is pretty straightforward. A spoonful of poop goes in and a technician squeezes on a lid containing a sensor that detects the molecules of gas fuming inside and at what concentration…but he’s most excited about their other invention.

It’s a robotic pill that sniffs its way along a craptastic voyage through the gut. As the pill tumbles through, a membrane on the pill lets gasses pass onto a small molecular sensor inside that serves as its nose. The membrane blocks the other stuff sloshing around in the gut.

The pill notes the gasses that gut microbes produce, including oxygen, methane, hydrogen and hydrogen sulfide, which smells like rotten eggs. The pill’s sensor figures out how much of each gas is present, and beams the information out of the patient’s body through a tiny antenna…

The researchers aim to detect changes in gas content. As people’s health waxes or wanes because of stress or disease their intestinal ecosystems change too. Certain microbes may thrive in the new conditions while others struggle. As the populations shift, so will the concentrations of their distinctive gassy waste products.

My Take: This story reminds me about the joke I heard from a mentor about how can you tell if a person is an optimist.  An optimist is a person who finds a pile of manure under the tree on Christmas morning and declares: ‘Oh boy, I’m getting a pony.’

This story shows us that some researchers are true optimists as well; they see a lot of opportunity in studying stool and intestinal gases. Will this research will be useful or wind up being a pile of stool?

Also on NPR: Why Is Insulin So Expensive in the U.S. -summarizes recent commentary (N Engl J Med 2015; 372:1171-1175). This article is important for anyone concerned about escalating medicine costs.

Related blog post“There is No ‘Healthy’ Microbiome” | gutsandgrowth