Just like Doc Frost told me back in early January, 1968, once you start the insulin you can never stop. Eli Lily and Company have to take the blame for keeping me breathing ever since. Don't worry, I have paid every step of the way, and I do not think their bottom line is suffering much these days.
Today I had to buy more insulin; and the day after President Obama spoke of hope with medical expenses, good old Eli Lily and Company dropped a $10 per vial price increase on diabetics hooked on that product. If the irony doesn't fall like a ton of iron on Congressional outlooks, I give up. I can not afford insurance (I have to buy insulin at full price.), and unless I get a job, my preexisting condition would disqualify me ever getting insurance. My price increase is probably less than for diabetics using the more expensive insulins available, but it is a reflection of the power of profit in the world of medicine.
I have been doing this for a long time, follow the old curmudgeon below the fold for a few comparisons, then and now...
1968
Doc Frost passed along his admonition about my new insulin habit after my family pretty much agreed that I had won the lottery between my sister and myself. Both sides of the family tree were decorated with diabetics, and from the time we could understand such things, the probability that one of us would have the disease was discussed. My father was diabetic for my entire life, diagnosed months after a farm accident triggered onset of his diabetes, and shortly before my birth. Our whole family lived the diabetic lifestyle, no separate diets, and no candy dishes in the living room at our house. Our entire family took care of Dad, every day, and he took care of us.
One of the major contrasts between now and then was the fact that Doc Frost was a General Practitioner, not an Endocrinologist. He had seen our whole family naked, dressed our wounds, set our bones, knew our background, and never had to consult the chart before saying our names. He knew he did not have to, but he gave me instructions on how to do my first subcutaneous injection and watched me inject the orange, just under the peel. He complimented my technique, told me to draw insulin and do the actual injection. I was so focused I did not notice him leave the room when I completed my first injection. Mom told me later he confessed to not being able to watch my first injection. He knew what was to come.
I said we had agreed on the diagnosis before Doc Frost confirmed the diagnosis. I had the standard symptoms; rapid weight loss, constant thirst, and our family was very sensitive to the signs. Doc had to confirm that my body was not producing insulin on its own, and that required a blood test. This is another major difference between forty years ago and today - blood glucose testing. In 1968, having blood tests for diabetes required multiple vials of blood at a time. The longer my treatment lasted, the more careful I had to be to warn the phlebotomist that my blood vessels were tough in the usual locations, and to be careful or they might push through the artery. We would do regular Fasting Blood Sugar tests; nothing to eat or drink (aside from water) after the evening meal until the blood draw early the next morning. Once that was done, then you got to wait two or three days for the test results. When it comes to day-to-day treatment of a disease that fluctuates after every meal, or every physical exertion, or every insulin injection, three-day old results offer little help. We did the best we could with what we had.
The insulin back in 1968 came largely from slaughterhouse reclamation of beef and pork pancreas product. Dad always listened to auction prices for beef and pork to budget future insulin expenses. Expensive meat was good for the farmers, not so good for diabetics. Back in 1968 I started my insulin habit with a glass syringe and stainless steel needles. We had to inject daily, and plastic syringes with hyperfine needles simply did not exist when I began. (Please remember, this was long before our medical disposable world after AIDS existed. Plastic was available in the early seventies, but it was expensive, and all syringes are marked in the same units - cheap mattered at our house.) I remember the joys of traveling with glass syringes in alcohol baths with a couple of needles rolling around in the container. (Sharp, new needles were the best!)
40-Plus Years Later...
Since then, there have been changes but very few improvements, at least from my end of the needle.
We all had hope when the human genome project went ahead. One of my doctors in the nineties said he bet I was glad the cost of insulin would be going down because it was now being grown in vats. When the human gene-based insulin products hit the market prices skyrocketed. My old friend Eli Lily and Company had to recoup their research, testing, and production costs. While I still had corporate health insurance after being laid-off, I asked my pharmacist what it would cost to purchase the two kinds if insulin I was using by that time; $120-145 per vial for the Lantis, $80 for the Novolog. After that news, I went to my endocrinologist for another appointment before the insurance ended, and I asked if he could write prescriptions for less expensive insulins so I could switch medications while still under a doctor's care. He refused and offered me vials of Lantis from his in-office supply. This is the doctor who my own diabetic Primary care doctor saw for his treatment. Our endocrinologist had also provided me with a free blood glucose monitor with the capability to download test results to his own computer systems. Good thing, right? This specialist was also doing a great deal of testing for pharmaceutical interests. He did not want to change my insulin (I believe) because it would skew the results he was reporting. The only good thing about insulin is that diabetics can purchase it over-the-counter without a prescription. I successfully made the switch, but I worried my way through the process. At a specialist's office, I always felt my care was secondary to other plans that did not concern me.
You know all those irritating commercials for glucose test strips you deal with while watching the news? That is an industry unto itself these days. No more three-day waits to get blood glucose test results, the new monitors only need five seconds to show your blood glucose level, in real time. Today, most Type I diabetics are encouraged to test their blood sugar levels three, four, or five times a day. The last time I bought 100 test strips (one month's supply on my budget) it cost right at $115. That is what you pay every month for that knowledge. Just think of the millions of people in this country alone faithfully buying that product for the remainder of their lives. Millions of diabetics nationwide with a health condition that requires equivalent expenditures of a pack-a-day smoking habit to simply treat their disease, every single day of the year.
Final Thoughts
Why do we want insurance? The cost of medical care it so high, no one can afford it without help. It is the difference between paying an insurance co-pay of $20 for a bottle of insulin the insurance company is adding another $120 to cover what it would cost me walking up to the counter and buying the same product. Big Pharma has to recover their costs - not just for making the drug, testing the product, and gaining FDA approvals. Under our current structure we also have to pay for corporate compensation, product advertisement (more for the test strips, but they are even advertising insulin as well), and a little something for the shareholders on the side.
The thing is, after today's price rise, all I could think was the insulin I was buying has been grown in a vat. Those costs of production have not changed. It has been FDA-approved for years, my friends at Eli Lily and Company do not advertise Humalin N & R on television (that I have ever seen and I have been using it since the 90's), and the market for their product is constant if not growing. Why do they need more money today?
DISCLAIMER: I know all the doctors here will certainly have opinions on my diabetes management approach. I have NO MEDICAL EXPERTISE. I have lived with Type I diabetes since "puberty hit me hard." (Nod to "Support Your Local Sheriff") I am still alive with all my fingers and toes, and my last eye exam the specialist said I was not diabetic - no retinal hemorrhages in my eyes after all these years. I had good teachers...