4 ms·

> And essential medicines, like insulin, can be brutally expensive. only in America. Generic insulin are available in most other countries. There are "better

> And essential medicines, like insulin, can be brutally expensive. only in America. Generic insulin are available in most other countries. There are "better" insulin that cost a lot more, but the generic one are cheap enough outside america

Broken_Hippo 3y ago
While better than the US, keeping "better" insulin from poor people means that poor people die more. "Better" insulin generally actually works better, is easier to get the right dose, and is often longer-acting and more effective. Cheap insulin - often older formulations - make it far easier to accidentally kill yourself. I'll also note that the generic, older insulin products are fairly inexpensive in the US, though folks still find themselves tempted to ration. And you just have to risk death more with them. A few other vital medicines have cheap generics as well. But not all vital medicines have generics, and some generics are still expensive. Some of those vital medicines keep people alive.
- tialaramex 3y ago
  What's different about a "better" insulin varies considerably. It's definitely not true that somehow the "better" products are just magically safer, although I'm sure their vendors are happy that you think so. You talk about them being "Often longer-acting" they of course provide a range of different periods and this is one of claimed advantages. For some people I'm sure that's valuable. My grandmother, for example, would not have been able to successfully use a product which expects you to have a smartphone (she was barely confident with a telephone, and the introduction of touch tone dialling confused her). So whilst I'm sure it's convenient if you're diagnosed age 17 and you can just add it to the phone you always carry anyway, it's not simply "Better", yet several of the modern products need to be used that way. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406912/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406912/ is from way back when you might still find humans using animal insulin in the US. The manufacturers presented the (synthetic) human insulin as simply "better" but if it's "better" it's not so dramatic that actual experiments had successfully identified a clear improvement that this meta-analysis saw. The most important element of success with typical long term medical interventions is almost inevitably the patient actually implementing the treatment plan. That's true for pregnancy prevention (turns out neither condoms nor the pill work if you don't use them), it's true for Thyroxine (I have to take a pill every morning, for the rest of my life, people tried the evening, that'd work in theory but most of them forget) and it's true for insulin. If the $5000 drug doesn't help you actually take it when and how you're supposed to, it has no benefit. If the cheap treatment fits your lifestyle, even if it seems ludicrous to onlookers ("You use the old paper strips? That's so stone age") more expensive is not, in fact, better.
- DropInIn 3y ago
  Things cost money to make The better version are often legitimately more expensive to produce even ignoring all r&d cost etc, as they are made in smaller batches, using more specialized equipment or methods, use more expensive precursors, or any of a million other factors. The reality is that even if patents were irrelevant, in the vast majority of cases the generic would still be the cheapest option simply due to basic economies of scale. Really... I have to ask if you even considered the topic in any meaningful way... Right?
sacnoradhq 3y ago
Mostly, insulin users are type-1 diabetics. They produce little or none of their own. There's no "better" insulin, there are different types of insulin that vary based on how fast they act for different purposes. Closed-loop insulin pumps (with CGMs) and older open loop (and you are the insulin calculator) use very fast acting insulin to adjust insulin levels in almost real time (delay between blood plasma vs. extracellular fluid). Humalog (very fast acting) Humulin R (fast acting) Humulin N (intermediate) webmd has a fairly good table of popular American insulin products about 1/2 way down: https://www.webmd.com/diabetes/diabetes-types-insulin https://www.webmd.com/diabetes/diabetes-types-insulin I noticed glucagon, the emergency antidote for insulin, is also available as a nasal powder (Baqsimi) whereas it came in autoinjectors like Zegalogue. This is a huge win because the olden days of mixing 2 parts and injecting someone in distress with a giant needle was a major barrier to potential good Samaritans.

Broken_Hippo 3y ago

While better than the US, keeping "better" insulin from poor people means that poor people die more. "Better" insulin generally actually works better, is easier to get the right dose, and is often longer-acting and more effective. Cheap insulin - often older formulations - make it far easier to accidentally kill yourself. I'll also note that the generic, older insulin products are fairly inexpensive in the US, though folks still find themselves tempted to ration. And you just have to risk death more with them. A few other vital medicines have cheap generics as well. But not all vital medicines have generics, and some generics are still expensive. Some of those vital medicines keep people alive.

tialaramex 3y ago
What's different about a "better" insulin varies considerably. It's definitely not true that somehow the "better" products are just magically safer, although I'm sure their vendors are happy that you think so. You talk about them being "Often longer-acting" they of course provide a range of different periods and this is one of claimed advantages. For some people I'm sure that's valuable. My grandmother, for example, would not have been able to successfully use a product which expects you to have a smartphone (she was barely confident with a telephone, and the introduction of touch tone dialling confused her). So whilst I'm sure it's convenient if you're diagnosed age 17 and you can just add it to the phone you always carry anyway, it's not simply "Better", yet several of the modern products need to be used that way. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406912/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406912/ is from way back when you might still find humans using animal insulin in the US. The manufacturers presented the (synthetic) human insulin as simply "better" but if it's "better" it's not so dramatic that actual experiments had successfully identified a clear improvement that this meta-analysis saw. The most important element of success with typical long term medical interventions is almost inevitably the patient actually implementing the treatment plan. That's true for pregnancy prevention (turns out neither condoms nor the pill work if you don't use them), it's true for Thyroxine (I have to take a pill every morning, for the rest of my life, people tried the evening, that'd work in theory but most of them forget) and it's true for insulin. If the $5000 drug doesn't help you actually take it when and how you're supposed to, it has no benefit. If the cheap treatment fits your lifestyle, even if it seems ludicrous to onlookers ("You use the old paper strips? That's so stone age") more expensive is not, in fact, better.
DropInIn 3y ago
Things cost money to make The better version are often legitimately more expensive to produce even ignoring all r&d cost etc, as they are made in smaller batches, using more specialized equipment or methods, use more expensive precursors, or any of a million other factors. The reality is that even if patents were irrelevant, in the vast majority of cases the generic would still be the cheapest option simply due to basic economies of scale. Really... I have to ask if you even considered the topic in any meaningful way... Right?

sacnoradhq 3y ago

Mostly, insulin users are type-1 diabetics. They produce little or none of their own. There's no "better" insulin, there are different types of insulin that vary based on how fast they act for different purposes. Closed-loop insulin pumps (with CGMs) and older open loop (and you are the insulin calculator) use very fast acting insulin to adjust insulin levels in almost real time (delay between blood plasma vs. extracellular fluid). Humalog (very fast acting) Humulin R (fast acting) Humulin N (intermediate) webmd has a fairly good table of popular American insulin products about 1/2 way down: https://www.webmd.com/diabetes/diabetes-types-insulin https://www.webmd.com/diabetes/diabetes-types-insulin I noticed glucagon, the emergency antidote for insulin, is also available as a nasal powder (Baqsimi) whereas it came in autoinjectors like Zegalogue. This is a huge win because the olden days of mixing 2 parts and injecting someone in distress with a giant needle was a major barrier to potential good Samaritans.