12 ms·

40M people with diabetes will be left without insulin by 2030, study predicts

74 points by ytNumbers 8y ago

Flow 8y ago
All I see from inside the EU is "Forbidden".
- thg 8y ago
  Likewise, but this works: https://outline.com/yHC24A https://outline.com/yHC24A
- paulcole 8y ago
  I think you’re seeing a GDPR compliant website.
jcims 8y ago
No explanation as to the cause of the shortcoming. Do drug companies just hate money? Madehow has a decent article on the history of insulin synthesis [1]. I don’t see any natural bottlenecks that would interfere with scaling the process. 1. http://www.madehow.com/Volume-7/Insulin.html http://www.madehow.com/Volume-7/Insulin.html
- HarryHirsch 8y ago
  Profits for generics are too low and there are no new market participants because outlays for initial investment and conformance testing is too high. Generics manufacturing is a strange beast, there are surprisingly few players involved, there is very little overcapacity, and that's not a good situation. When Hurricane Maria took out pharmaceutical plants in Puerto Rico there were severe drug shortages that were not easily fixed.
  - gumby 8y ago
    This is good fodder for a case that a public utility should produce these drugs. Of course that would freak various interests out so won't happen, at least in the US or EU. A hybrid approach in the US has been fairly useful for orphan indications and, somewhat differently for vaccines, but of course jerks found ways to exploit that too. Still it points to a possibility. But I favor a single utility making some small-molecule and biologic underserved drugs because of the economy of scale it could bring. A small NIH facility in some otherwise underserved part of the country could make a big difference at a relatively low cost.
    - HarryHirsch 8y ago
      My prediction is that this will happen. Not necessarily in the US, though, more in China, India and Brazil.
    - deytempo 8y ago
      There are some things that should not be subject to capitalism
      - dinkudunk 8y ago
        Cool how you have been the only person to mention capitalism as the root cause. Top comment says: "No explanation as to the cause of the shortcoming." What? This is exactly what capitalism does. It wrecks everything in its path to later just turn around and say "Who did that? Do the medical companies not care about money?"
      - rayiner 8y ago
        You can't build better medical helicopters by saying "there are some things that should not be subject to gravity."
        ubernostrum 8y ago
        You posted this comment using a network whose fundamental tech was developed in a government project. You posted it using a device descended from an original which was built as part of a government project, based on theories developed with no immediate profit motive. Would you like to re-think whether it's possible to invent and develop important new things without immediate profit motive?
  - erentz 8y ago
    > When Hurricane Maria took out pharmaceutical plants in Puerto Rico there were severe drug shortages And this included something as simple as saline.
    - RugnirViking 8y ago
      What prevents hospitals from producing their own saline? Is it really that difficult to produce?
      - freeflight 8y ago
        The same reasons why hospitals don't produce their own medical supplies period? A hospital is a hospital and specialized in doing what hospitals do: Treating patients. Manufacturing IV solutions is something that requires a clean room laboratory, with its own set of stringent requirements and doing it cost-efficient means doing it at scale.
        angersock 8y ago
        Making saltwater doesn't require a cleanroom.
        a3n 8y ago
        Go make some, and shoot it into yourself. Actually, don't, you'll probably injure yourself.
      - deleted 8y ago
        [deleted]
      - Animats 8y ago
        That's happening.[1][2] A group of big hospitals is creating their own generic drug company to supply routine items at better prices. [1] https://www.npr.org/sections/health-shots/2018/09/06/644935958/hospitals-prepare-to-launch-their-own-drug-company-to-fight-high-prices-and-shor https://www.npr.org/sections/health-shots/2018/09/06/6449359... [2] https://civicarx.org https://civicarx.org
  - ams6110 8y ago
    That's a strange argument. If there are few suppliers in the market, and inelastic demand, they should be able to pretty much set their own price, at least enough to be profitable. The only way that prices trend to zero profit are in commodity markets with a lot of competitors.
    - HarryHirsch 8y ago
      In most countries that aren't the US, the government is the biggest purchaser of medicines, and that is what keeps prices down. That's only a theory, though. But the observable facts are that in the generics market there are only a few players, and profits in the generics market are low. If the economic theory can't explain that, it's the theory that is wrong.
      - rayiner 8y ago
        The theory isn't wrong, it's what you'd expect. Outside the U.S., governments exercise monopsony power to keep prices artificially low, which results in a less-than-efficient amount of production of the generic: https://en.wikipedia.org/wiki/Monopsony https://en.wikipedia.org/wiki/Monopsony. When you make prices artificially low you reduce the incentive to invest, and the result you're seeing is Econ 101. What's happening inside the U.S. is harder to model. The patented versions of insulin are somewhat better than the generic ones. There might be insufficient incentives for people with health insurance to prefer the slightly inferior but much cheaper version. That leaves only those without insurance to pay for the generic, and that's not much of a market. As a biologic, insulin is expensive to make even the generic versions. And people who have no insurance probably have little ability to afford it.
        HarryHirsch 8y ago
        What does "artificially low" even mean in this context? Valeant have demonstrated that you can drop research and raise prices on orphan drugs to stratospheric levels, and Valeant's owners are the only people that benefit. That can't be a desirable outcome for public health. When the government leans on manufacturers at least prices have some relationship with the costs of production.
maa5444 8y ago
you don't need insulins that much .... you need to manage your diet and drink kefir to consume the intake sugar #goodluck
- deleted 8y ago
  [deleted]
- pmontra 8y ago
  Type 1 diabetes: the body doesn't make any insulin. Patients need to get it from outside the body or they die. Type 2 diabetes: this is the one you're thinking about. There are drugs that can be used in some cases (insulin strictly speaking is not a drug.)
- yourapostasy 8y ago
  > ...you need to manage your diet and drink kefir to consume the intake sugar... For others wondering, drinking kefir does not "consume the intake sugar" as in consuming all the extraneous blood sugar, though there is a statistically significant but still smallish effect upon Type 2 diabetics. What is actually happening is not precisely known yet, but the conjectured mechanism is beneficial alteration of the gut microbiome [1]. Like general fitness, the "manage your diet" part is the key. Fix satiation issues (physiological and psychological) surrounding that intake of calories, and then it does become "as easy as" CICO. As an aside, this study came out of Iran, which is good to see in our over-polarized world geopolitical situation. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401881/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401881/
qrbLPHiKpiux 8y ago
The conspiracy theorist in my says this is deliberate. Diabetics are notorious for not taking care of themselves and unnecessarily cost insurers a lot of wasted money in care that doesn't do anything (since personal habits aren't changing). Thinning the herd, per se.
- paulcole 8y ago
  Type 1 diabetic and ultra marathon runner here. I’ll admit keeping me alive is a waste of money (I don’t contribute much to the world) but if nothing else I am in pretty good physical shape. Aside from the diabetes, of course.
encoderer 8y ago
Virta Health is a sf startup with meaningful results reversing T2 diabetes. If you’re interested in this topic they are a compelling counterpoint to this study.
- wild_preference 8y ago
  Type 2 diabetes can be reversed. Many people aren't seriously suggested this option by their medical professional or are unwilling to change their lifestyle. I don't think it's a counterpoint to the study, but rather to the ways the data will drive policy changes. It's taboo to take the obesity problem seriously. https://en.wikipedia.org/wiki/Fat_acceptance_movement https://en.wikipedia.org/wiki/Fat_acceptance_movement
  - noarchy 8y ago
    >It's taboo to take the obesity problem seriously. https://en.wikipedia.org/wiki/Fat_acceptance_movement https://en.wikipedia.org/wiki/Fat_acceptance_movement It is phenomenal to see such a movement sprout up, as if a chunk of society decided to just give up. I couldn't imagine a serious, equivalent movement on the same scale for alcoholism and cigarette smoking, to cite a few examples. Yet the abuse of food is going to (or is already) cost us far more.
    - ams6110 8y ago
      We pretty much have that with regards to marijuana. I'm not sure why it's treated so differently from tobacco. In both cases you are inhaling the smoke from burning leaves.
      - wolco 8y ago
        Not too many food related nicotine products compared to editables in the marijuana industry.
      - Retric 8y ago
        Tobacco is unusually nasty, just look at throat cancer from chewing tobacco. Incense, woodsmoke, and Pot do cause problems, but the risks are significantly lower.
open-source-ux 8y ago
Type 2 diabetes can be reversed through diet. The evidence comes from medical practitioners and scientists, not from quacks making outlandish claims (although they exist too). Some links: The Diabetes Code by Jason Fung: This is a best-selling book by a Canadian Nephrologist (care and treatment of kidney disease) that explains type 2 diabetes in detail and recommends diabetics switch to a low-carb diet. Counterweight Plus low-calorie diet plan: This diet was run as part of a scientific trial and showed promising results for obese patients with type 2 diabetes. Nearly half of the 300 patients in the trial reversed their diabetes. Note: the diet was run under the supervision of medical professionals and is not suitable for everyone: https://www.nhs.uk/news/diabetes/radical-low-calorie-diet-may-help-reverse-type-2-diabetes/ https://www.nhs.uk/news/diabetes/radical-low-calorie-diet-ma... The Truth about Carbs: this is a BBC documentary from earlier this year which is unfortunately no longer available to watch on the BBC website. It featured NHS doctors who ran a two-week low-carb diet plan with type 2 diabetic patients. All patients reported improvements to their health, but the most impressive result was a patient with type 2 diabetes for 17 years who was now in part-remission. Here is a thorough write-up of the programme: https://www.diabetes.co.uk/in-depth/truth-about-carbs-bbc-1-review/ https://www.diabetes.co.uk/in-depth/truth-about-carbs-bbc-1-... A clip from the programme: https://www.youtube.com/watch?v=eKQWFJmCWZE https://www.youtube.com/watch?v=eKQWFJmCWZE 10 things you may not know about carbs: http://www.bbc.co.uk/programmes/articles/4DfZMpv7BYJ3kGXdHxdxkKp/10-things-you-may-not-know-about-carbs http://www.bbc.co.uk/programmes/articles/4DfZMpv7BYJ3kGXdHxd... Just to re-iterate, the examples above all refer to types 2 diabetes, not type 1 diabetes.
- phkahler 8y ago
  In order to have people cure something though diet, you have to convince them that they can control their own fate. The powers that be don't want that, they'd rather scare people with talk of insulin shortages.
- EdgarVerona 8y ago
  Something important that I think is worth noting is that you can reverse the symptoms of T2 Diabetes, but it does require a lifelong change of lifestyle. If you go back to your old lifestyle, those symptoms are just going to come right back. I know to some it may be obvious, but I think it's worth stressing this. When people say "reverse," they're talking "in remission." The symptoms are waiting to return if you start fucking up again. That being said, it is a much better approach than the alternatives.
sbenitoj 8y ago
How about we stop masking the problem of insulin resistance by pumping type 2 diabetics with insulin? Why don’t we start telling diabetics the truth — your diet is broken and needs to be fixed; avoid most carbs, do strength training. We don’t need more insulin to shove the massive onslaught of blood sugar from your crappy diet into your cells (which are telling you they’ve had enough, AKA insulin resistance), we need more honesty. The healthcare industry is morally and intellectually bankrupt. All the honest people who got into it trying to make a real difference don’t stand a chance, the truth doesn’t survive for an instant in this corrupt industry more focused on how much they can get out of insurance companies than treating patients.
- hannasm 8y ago
  Diabetes is an incredibly scary disease and we need more focus on the underlying causes and permanent solutions instead of pumping all this money and effort into stop gap measures that perpetuate the problem.
  - sbenitoj 8y ago
    Exactly!
  - JamesBarney 8y ago
    Like increase NIH funding for basic science?
  - InclinedPlane 8y ago
    By "perpetuate the problem" do you mean "keep people alive"? Because that is incredibly heartless.
- tptacek 8y ago
  Just a small fraction of type 2 patients use insulin, and type 1 diabetics can't avoid insulin by "avoiding most carbs and doing strength training". (The numbers in this article appear to be off).
  - 8y ago
giardini 8y ago
Wonder why they picked 2030. I _might_ have read a 3-year forecast since they are sometimes correct. But any forecast involving social processes that is beyond 5 years is almost always wrong.

74 points by ytNumbers 8y ago

Flow 8y ago

All I see from inside the EU is "Forbidden".

thg 8y ago
Likewise, but this works: https://outline.com/yHC24A https://outline.com/yHC24A
paulcole 8y ago
I think you’re seeing a GDPR compliant website.

jcims 8y ago

No explanation as to the cause of the shortcoming. Do drug companies just hate money? Madehow has a decent article on the history of insulin synthesis [1]. I don’t see any natural bottlenecks that would interfere with scaling the process. 1. http://www.madehow.com/Volume-7/Insulin.html http://www.madehow.com/Volume-7/Insulin.html

HarryHirsch 8y ago
Profits for generics are too low and there are no new market participants because outlays for initial investment and conformance testing is too high. Generics manufacturing is a strange beast, there are surprisingly few players involved, there is very little overcapacity, and that's not a good situation. When Hurricane Maria took out pharmaceutical plants in Puerto Rico there were severe drug shortages that were not easily fixed.
- gumby 8y ago
  This is good fodder for a case that a public utility should produce these drugs. Of course that would freak various interests out so won't happen, at least in the US or EU. A hybrid approach in the US has been fairly useful for orphan indications and, somewhat differently for vaccines, but of course jerks found ways to exploit that too. Still it points to a possibility. But I favor a single utility making some small-molecule and biologic underserved drugs because of the economy of scale it could bring. A small NIH facility in some otherwise underserved part of the country could make a big difference at a relatively low cost.
  - HarryHirsch 8y ago
    My prediction is that this will happen. Not necessarily in the US, though, more in China, India and Brazil.
  - deytempo 8y ago
    There are some things that should not be subject to capitalism
    - dinkudunk 8y ago
      Cool how you have been the only person to mention capitalism as the root cause. Top comment says: "No explanation as to the cause of the shortcoming." What? This is exactly what capitalism does. It wrecks everything in its path to later just turn around and say "Who did that? Do the medical companies not care about money?"
    - rayiner 8y ago
      You can't build better medical helicopters by saying "there are some things that should not be subject to gravity."
      - ubernostrum 8y ago
        You posted this comment using a network whose fundamental tech was developed in a government project. You posted it using a device descended from an original which was built as part of a government project, based on theories developed with no immediate profit motive. Would you like to re-think whether it's possible to invent and develop important new things without immediate profit motive?
- erentz 8y ago
  > When Hurricane Maria took out pharmaceutical plants in Puerto Rico there were severe drug shortages And this included something as simple as saline.
  - RugnirViking 8y ago
    What prevents hospitals from producing their own saline? Is it really that difficult to produce?
    - freeflight 8y ago
      The same reasons why hospitals don't produce their own medical supplies period? A hospital is a hospital and specialized in doing what hospitals do: Treating patients. Manufacturing IV solutions is something that requires a clean room laboratory, with its own set of stringent requirements and doing it cost-efficient means doing it at scale.
      - angersock 8y ago
        Making saltwater doesn't require a cleanroom.
        a3n 8y ago
        Go make some, and shoot it into yourself. Actually, don't, you'll probably injure yourself.
    - deleted 8y ago
      [deleted]
    - Animats 8y ago
      That's happening.[1][2] A group of big hospitals is creating their own generic drug company to supply routine items at better prices. [1] https://www.npr.org/sections/health-shots/2018/09/06/644935958/hospitals-prepare-to-launch-their-own-drug-company-to-fight-high-prices-and-shor https://www.npr.org/sections/health-shots/2018/09/06/6449359... [2] https://civicarx.org https://civicarx.org
- ams6110 8y ago
  That's a strange argument. If there are few suppliers in the market, and inelastic demand, they should be able to pretty much set their own price, at least enough to be profitable. The only way that prices trend to zero profit are in commodity markets with a lot of competitors.
  - HarryHirsch 8y ago
    In most countries that aren't the US, the government is the biggest purchaser of medicines, and that is what keeps prices down. That's only a theory, though. But the observable facts are that in the generics market there are only a few players, and profits in the generics market are low. If the economic theory can't explain that, it's the theory that is wrong.
    - rayiner 8y ago
      The theory isn't wrong, it's what you'd expect. Outside the U.S., governments exercise monopsony power to keep prices artificially low, which results in a less-than-efficient amount of production of the generic: https://en.wikipedia.org/wiki/Monopsony https://en.wikipedia.org/wiki/Monopsony. When you make prices artificially low you reduce the incentive to invest, and the result you're seeing is Econ 101. What's happening inside the U.S. is harder to model. The patented versions of insulin are somewhat better than the generic ones. There might be insufficient incentives for people with health insurance to prefer the slightly inferior but much cheaper version. That leaves only those without insurance to pay for the generic, and that's not much of a market. As a biologic, insulin is expensive to make even the generic versions. And people who have no insurance probably have little ability to afford it.
      - HarryHirsch 8y ago
        What does "artificially low" even mean in this context? Valeant have demonstrated that you can drop research and raise prices on orphan drugs to stratospheric levels, and Valeant's owners are the only people that benefit. That can't be a desirable outcome for public health. When the government leans on manufacturers at least prices have some relationship with the costs of production.

maa5444 8y ago

you don't need insulins that much .... you need to manage your diet and drink kefir to consume the intake sugar #goodluck

deleted 8y ago
[deleted]
pmontra 8y ago
Type 1 diabetes: the body doesn't make any insulin. Patients need to get it from outside the body or they die. Type 2 diabetes: this is the one you're thinking about. There are drugs that can be used in some cases (insulin strictly speaking is not a drug.)
yourapostasy 8y ago
> ...you need to manage your diet and drink kefir to consume the intake sugar... For others wondering, drinking kefir does not "consume the intake sugar" as in consuming all the extraneous blood sugar, though there is a statistically significant but still smallish effect upon Type 2 diabetics. What is actually happening is not precisely known yet, but the conjectured mechanism is beneficial alteration of the gut microbiome [1]. Like general fitness, the "manage your diet" part is the key. Fix satiation issues (physiological and psychological) surrounding that intake of calories, and then it does become "as easy as" CICO. As an aside, this study came out of Iran, which is good to see in our over-polarized world geopolitical situation. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401881/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401881/

qrbLPHiKpiux 8y ago

The conspiracy theorist in my says this is deliberate. Diabetics are notorious for not taking care of themselves and unnecessarily cost insurers a lot of wasted money in care that doesn't do anything (since personal habits aren't changing). Thinning the herd, per se.

paulcole 8y ago
Type 1 diabetic and ultra marathon runner here. I’ll admit keeping me alive is a waste of money (I don’t contribute much to the world) but if nothing else I am in pretty good physical shape. Aside from the diabetes, of course.

encoderer 8y ago

Virta Health is a sf startup with meaningful results reversing T2 diabetes. If you’re interested in this topic they are a compelling counterpoint to this study.

wild_preference 8y ago
Type 2 diabetes can be reversed. Many people aren't seriously suggested this option by their medical professional or are unwilling to change their lifestyle. I don't think it's a counterpoint to the study, but rather to the ways the data will drive policy changes. It's taboo to take the obesity problem seriously. https://en.wikipedia.org/wiki/Fat_acceptance_movement https://en.wikipedia.org/wiki/Fat_acceptance_movement
- noarchy 8y ago
  >It's taboo to take the obesity problem seriously. https://en.wikipedia.org/wiki/Fat_acceptance_movement https://en.wikipedia.org/wiki/Fat_acceptance_movement It is phenomenal to see such a movement sprout up, as if a chunk of society decided to just give up. I couldn't imagine a serious, equivalent movement on the same scale for alcoholism and cigarette smoking, to cite a few examples. Yet the abuse of food is going to (or is already) cost us far more.
  - ams6110 8y ago
    We pretty much have that with regards to marijuana. I'm not sure why it's treated so differently from tobacco. In both cases you are inhaling the smoke from burning leaves.
    - wolco 8y ago
      Not too many food related nicotine products compared to editables in the marijuana industry.
    - Retric 8y ago
      Tobacco is unusually nasty, just look at throat cancer from chewing tobacco. Incense, woodsmoke, and Pot do cause problems, but the risks are significantly lower.

open-source-ux 8y ago

Type 2 diabetes can be reversed through diet. The evidence comes from medical practitioners and scientists, not from quacks making outlandish claims (although they exist too). Some links: The Diabetes Code by Jason Fung: This is a best-selling book by a Canadian Nephrologist (care and treatment of kidney disease) that explains type 2 diabetes in detail and recommends diabetics switch to a low-carb diet. Counterweight Plus low-calorie diet plan: This diet was run as part of a scientific trial and showed promising results for obese patients with type 2 diabetes. Nearly half of the 300 patients in the trial reversed their diabetes. Note: the diet was run under the supervision of medical professionals and is not suitable for everyone: https://www.nhs.uk/news/diabetes/radical-low-calorie-diet-may-help-reverse-type-2-diabetes/ https://www.nhs.uk/news/diabetes/radical-low-calorie-diet-ma... The Truth about Carbs: this is a BBC documentary from earlier this year which is unfortunately no longer available to watch on the BBC website. It featured NHS doctors who ran a two-week low-carb diet plan with type 2 diabetic patients. All patients reported improvements to their health, but the most impressive result was a patient with type 2 diabetes for 17 years who was now in part-remission. Here is a thorough write-up of the programme: https://www.diabetes.co.uk/in-depth/truth-about-carbs-bbc-1-review/ https://www.diabetes.co.uk/in-depth/truth-about-carbs-bbc-1-... A clip from the programme: https://www.youtube.com/watch?v=eKQWFJmCWZE https://www.youtube.com/watch?v=eKQWFJmCWZE 10 things you may not know about carbs: http://www.bbc.co.uk/programmes/articles/4DfZMpv7BYJ3kGXdHxdxkKp/10-things-you-may-not-know-about-carbs http://www.bbc.co.uk/programmes/articles/4DfZMpv7BYJ3kGXdHxd... Just to re-iterate, the examples above all refer to types 2 diabetes, not type 1 diabetes.

phkahler 8y ago
In order to have people cure something though diet, you have to convince them that they can control their own fate. The powers that be don't want that, they'd rather scare people with talk of insulin shortages.
EdgarVerona 8y ago
Something important that I think is worth noting is that you can reverse the symptoms of T2 Diabetes, but it does require a lifelong change of lifestyle. If you go back to your old lifestyle, those symptoms are just going to come right back. I know to some it may be obvious, but I think it's worth stressing this. When people say "reverse," they're talking "in remission." The symptoms are waiting to return if you start fucking up again. That being said, it is a much better approach than the alternatives.

sbenitoj 8y ago

How about we stop masking the problem of insulin resistance by pumping type 2 diabetics with insulin? Why don’t we start telling diabetics the truth — your diet is broken and needs to be fixed; avoid most carbs, do strength training. We don’t need more insulin to shove the massive onslaught of blood sugar from your crappy diet into your cells (which are telling you they’ve had enough, AKA insulin resistance), we need more honesty. The healthcare industry is morally and intellectually bankrupt. All the honest people who got into it trying to make a real difference don’t stand a chance, the truth doesn’t survive for an instant in this corrupt industry more focused on how much they can get out of insurance companies than treating patients.

hannasm 8y ago
Diabetes is an incredibly scary disease and we need more focus on the underlying causes and permanent solutions instead of pumping all this money and effort into stop gap measures that perpetuate the problem.
- sbenitoj 8y ago
  Exactly!
- JamesBarney 8y ago
  Like increase NIH funding for basic science?
- InclinedPlane 8y ago
  By "perpetuate the problem" do you mean "keep people alive"? Because that is incredibly heartless.
tptacek 8y ago
Just a small fraction of type 2 patients use insulin, and type 1 diabetics can't avoid insulin by "avoiding most carbs and doing strength training". (The numbers in this article appear to be off).
- 8y ago

giardini 8y ago

Wonder why they picked 2030. I _might_ have read a 3-year forecast since they are sometimes correct. But any forecast involving social processes that is beyond 5 years is almost always wrong.