FEATURE Design by Robyn Black
Why Isn’t Insulin “So Cheap It’s Like Water”? I
nsulin, a clear, life-saving liquid that smells like band aids, is the treatment of choice for well over 150 million people worldwide [1]. Its early history began on a very selfless and humanitarian note when its primary inventor, Canadian physician Sir Frederick Banting refused to put his name on the initial patent in 1923 [2]. The reasoning behind Banting’s action was explained that he felt, “…that as a physician who had taken the Hippocratic oath, he could not be party to any patenting of a discovery. The first application, therefore, was in the name of Best (his lab assistant and medical student) and Collip (a PhD biochemist).”[3] Charles Best and James Collip then went and sold their patent to the University of Toronto for $1.00CAD. All three men wanted every diabetic patient to have access to their new discovery, and it seems like that sentiment has not continued into the modern era – insulin is now the poster child for pharmaceutical price gouging. A large proportion of people with diabetes do not have access to adequate healthcare. As T1International, a non-profit organisation dedicated to providing universal access to diabetes care, writes in their #insulin4all advocacy documentation, “50% of people around 06
the world in need of insulin cannot reliably access it because it is unavailable, unaffordable, or both [4].” And while the inclusion of “International” in the name of this American non-profit might lead to you think that most of the issues exist abroad, the average price per unit of insulin in the USA ranged from 5.9 to 9.4 times that of 32 other countries measured in a Price Index Analysis by the RAND Corporation in 2020 [5]. In fact, the cost of the four most popular types of insulin tripled between 2007 and 2017. Between 2010 and 2015, the monthly wholesale price of the most popular insulin in the USA, Humulin, rose to nearly $1100USD, up from $258USD for the average patient [6]. Further to the inaccessible prices of insulin in the USA, underuse and discontinuation of use leads to a many issues in the lives of diabetics. Within a 2019 study by the Yale Diabetes Center, 25.5% of participants reported cost-related underuse. Those who reported underuse were three times more likely to have poor control
of their disease [7]. There have also been many stories in the past few years of Americans tragically losing their lives to insulin underuse all in the hope of saving money. Deaths that are entirely avoidable if the price of healthcare is adequately addressed by government institutions. Thankfully there have been some promising changes in terms of insulin access in the USA, but only after fatal stories of underuse have made the headlines. Apart from the current situation in the USA, T1International does focus the majority of their advocacy abroad. For good reason, too, as differences in the social, economic and environmental determinants of health, along with the inequalities in accessing high-quality healthcare, affect a large proportion of the world [8]. For example, in Syria, up to 77% of income can be spent on diabetes supplies; in Brazil, it can cost 82% of a person’s income [4]. Within rural Mozambique, the life expectancy for a child with type 1 diabetes was estimated to be less than 8 months
There have also been many stories in the past few years of Americans tragically losing their lives to insulin underuse all in the hope of saving money.