Insulin is a drug that diabetic people require daily in order to survive- but from 2002 to 2013, the prices of many insulins tripled, with many types of insulins today costing about $300 a vial, and two to four vials required each and every month. According to the CDC, as of 2014 approximately 9.4 percent of the US population- 30.3 million people- have diagnosed diabetes. And many, many people cannot afford the steep prices of insulin.
Many have been forced to ration their insulin, potentially resulting in dehydration, coma, and death. According to John Hopkins Medicine, totally uncontrolled diabetes has more severe consequences: it can result in blindness, kidney failure, gangrene and subsequent amputation of limbs, and death. In 2015, diabetes was the seventh leading cause of death in the US. Given the relative manageability of diabetes with insulin, it can be inferred that many of these deaths came as a result of a lack of insulin due to unaffordable costs.
This is a pressing issue for many constituents of both Democratic and Republican representatives and congresspeople. On April 10th of this year, a hearing by Congress was conducted with pharmaceutical companies and middlemen regarding this issue. Representatives from the three main insulin producers and several pharmaceutical middlemen appeared in the hearing. In essence, these pharmaceutical companies and middlemen defended the increase in cost, saying that the quality of insulin had been improved, which supposedly helps the lives of diabetic people be longer and healthier. They also claimed that they were not actually profiting more upon the increase prices. Ultimately, the hearing was a step forward in the reduction of costs: a bill was approved that would require pharmaceutical companies to report on their costs of research, development, manufacturing, and marketing of drugs to justify large increases in prices of pharmaceuticals, such as insulin. The bipartisan addressing of the issue is telling of its long lived severity.
So why is insulin really so expensive? Insulin is a biologic drug, meaning that it is produced in living cells. This makes the production of insulin more difficult and expensive. When insulin was discovered and first used to treat diabetes almost a century ago, the patents were sold for $1 each (about $14 adjusted for inflation) to ensure insulin’s affordability. A century’s worth of technological development and research within pharmaceutical companies should have made the production of insulin cheaper and more efficient, driving down its costs. This is simply not the case: insulin is but one example of the effects of unchecked greed of pharmaceutical companies in the US.
Pharmaceutical companies continuously tweak insulin formulas and patent supposedly improved formulas, which has resulted in successfully keeping insulins under patent for almost a century. As a result, generic forms of insulin- which would cheapen costs- are not produced by pharmaceutical companies: hypothetically, doctors would not prescribe insulins with the supposedly inferior formulas that the patent expired on. Additionally, pharmaceutical companies and middle men increase the costs of insulin with “discounts”: essentially, they pretend to give discounts to consumers, as many people who have high-deductible health insurance plans or those without insurance do not benefit from those discounts.
This issue speaks to neoliberalism and societal values within the private health system in America. Neoliberalism generally can be defined as a political ideology in which some personal freedom comes from participation in the economy of free-market capitalism. In the US, healthcare is a social institution in which this ideology is prevalent: a privatized healthcare system and a free market for pharmaceuticals is considered a necessity by many healthcare providers, politicians, and citizens. The effects of this are severe: as with the example of insulin, prices of life-saving drugs can rise to intolerable levels simply because of the ability of pharmaceutical companies to do so due to a relative lack of limiting costs on such necessities by the federal government. Societal values of neoliberalism and a free market have outweighed this issue’s human suffering and deaths.
According to the CDC, race and education level are significantly correlated with rates of diagnosed diabetic people. 15.1 percent of Native Americans and Alaskan Natives, 12.7 percent of non-Hispanic blacks, and 12.1 percent of Hispanics are diagnosed with diabetes, whereas 8.0 percent of Asians and 7.4 percent of non-Hispanic whites are diagnosed. Minority groups of Native, black, and Hispanic people are disproportionately affected by diabetes, especially given that non-Hispanic whites made up 60.7% of the US population in 2018, whereas Native Americans, for example, made up only 1.3%. These statistics may have contributed to the lack of attention, until recently: perhaps it was seen as a problem predominantly for racial minorities, and thus not a worry for politicians and the general public due to prejudice.
Additionally, 12.6 percent US adults with less than a high school education had diabetes, 9.5 percent of those with a high school education, and 7.2 percent of those with more than a high school education. Inferring economic class and level of income from education level, the intersection of education levels, race, and economic class as related to diabetes, racial minorities already socioeconomically disadvantaged experience classist discrimination within the healthcare system: those disadvantaged groups that disproportionately have diabetes are also more likely to struggle to pay for the costs of insulin, resulting in suffering and death. The unchecked profiting of pharmaceutical companies over black and brown bodies, and the lack of outcry and attention by politicians and the media until recently, further speaks to the neoliberal ideology of Americans, and a lack of care for racial minorities and people of low incomes.
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Your blog post explores a prominent issue in American society today that is critical to thoroughly examine, so I really appreciated your perspective and attention to the subject. I also found the statistical evidence regarding the disparities in the prevalence of diabetes amongst minority groups and how this inequality may be an important factor in the skyrocketing prices of insulin. This is a perspective I had yet to consider and I think it's definitely a necessity to analyze this, as the history of medicine frequently has involved discrimination and exploitation of minorities. For instance, this perspective reminded me of one of the symposiums given at the Ray Warren symposium this year, which talked about the brutal history of gynecology and its relationship to experimentation on African American female slaves. I also think that it is neccesary to critically examine the way the media portrays the price of insulin and other health care injustices. Often times, the media tries to sell inspiring stories about individuals who have overcome this injustice, instead of focusing on the injustice itself. I recently saw an article that spoke about a four year old boy who needed a motorized wheelchair, but who's family could not afford one (even with insurance). In response, a high school robotics team funded and made one for him. As inspiring as this is, I found it discouraging that the focus was on the robotics team and not the injustice that, even with insurance, his family could not provide for his medical needs. I believe that in this situation, and in concern to the rising prices of insulin, we need to begin truly calling it out as an injustice, not an inspiring story of strength.
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