[HN Gopher] Open Insulin Foundation
___________________________________________________________________
Open Insulin Foundation
Author : hmmx3
Score : 519 points
Date : 2021-07-16 07:14 UTC (15 hours ago)
(HTM) web link (openinsulin.org)
(TXT) w3m dump (openinsulin.org)
| sgt101 wrote:
| My daughter is insulin dependent.
|
| We live in the UK - which has a fantastic free provision for
| diabetics, my daughter has a Diasend artificial pancreas (on her
| phone + a sensor on her arm and a pump for the insulin controlled
| by the app). This gives her very very high levels of control and
| flexibility.
|
| However, when covid hit I was really scared because I thought
| that if things went really wrong (beyond loo paper being sold
| out) there would be no possibility of me protecting my daughter -
| I simply had no means to provide insulin for her that don't
| depend on a large scale modern pharma supply chain.
|
| Any way that was viable for insulin to be made in a shed or a
| garage would be huge from my perspective because it would give me
| an option in the case of a SHTF situation - right now I haven't
| got one. If things go bad, my daughter dies - no if's no buts. I
| know (in my heart) that the reality is that if SHTF then I will
| die too, but the sheer hopelessness of my daughters position is
| really hard to take.
| waterglassFull wrote:
| Thanks for sharing your experience, it must be really hard as a
| parent in times like this
| BrandoElFollito wrote:
| This is a real problem for people dependent on medicine.
|
| My wife needs specific immuno-depressants to keep her alive (or
| at least not drastically decrease her health) and since we live
| in France it is not a problem.
|
| When COVID hit I had real concerns about the manufacturing
| keeping up, but also about other mechanical devices she needs.
| These were at risk because they are manufactured in a normal
| factory (non-critical state infrastructure kind). Everything
| was fine but these are the moments you realize how reliant one
| is on technology, supply chain etc.
| cwkoss wrote:
| How cool would it be if you could keep something like a
| sourdough starter (maybe a shelf with a half dozen jars that
| need tending 1-2 times a week) that would continuously
| produce the medications people need to live in their own
| homes.
|
| It would almost certainly be more of a hassle than getting it
| from a pharmacy, and purification is probably a tricky step,
| but I think we're just a decade or two from this potentially
| becoming a reality.
|
| Would be incredibly egalitarian and empowering to
| individuals.
| BrandoElFollito wrote:
| I had the same thought in 1989 following Fleischmann and
| Pons' "discovery" of cold fusion. I dreamed of football-
| size reactor everyone could have at home and be done with
| electricity dependence.
| buildint wrote:
| Could you just store more insulin as a stop gap?
| rs999gti wrote:
| You can but it goes bad like milk.
| jawngee wrote:
| Most insulin has a very long shelf life unopened and
| refrigerated.
| hpoe wrote:
| US here. I only managed to do it because of a loophole. My
| wife has the beetus, and with insurance we pay $40 a month,
| without insurance it is about $600 for a month, so
| stockpiling it is effectively impossible.
|
| Luckily during her last pregnancy my wife was prescribed
| substantially more insulin than she'd previously need for a
| month because the pregnancy was messing up her blood sugar,
| it stopped once she had the baby, but we still have the same
| dosage right now, so we are accumulating a small amount. That
| being said, it was the only way we could figure out to do it.
| Cosmin_C wrote:
| You can store insulin but not in large quantitites and it is
| a hugely delicate process to synthethise it in the first
| place. You can "biohack" it to a certain degree (it is how it
| was first discovered and manufactured after all), but getting
| a good purity end product that aligns to nowadays' standards
| is quite difficult and you can't do it in a shed. And with
| insulin purity and consistency in the product are paramount
| seeing how small the necessary doses are.
|
| I understand the issues that come with dependence on
| pharmaceutical companies, but this is what they do. In
| today's world we are highly dependent on supply chains and
| that includes both toilet paper and insulin.
| jawngee wrote:
| We have two years of insulin in our fridge, I'm curious
| what you mean by you can't store large quantities?
| dnautics wrote:
| Does that work? Over time insulin flocculates and becomes
| inactive. I suppose my info is ~10 years old from when I
| worked on insulin biophysics, it's possible contemporary
| formulations are more effective at maintaining stability.
| steveklabnik wrote:
| (Not your parent)
|
| Expiration dates vary wildly based on a number of
| factors, which you probably know, but for completeness:
| opened vs unopened, refrigerated vs non-refrigerated,
| brand to brand, etc.
|
| It is true that it becomes inactive over time, but those
| rates vary. And people know that manufacturers put
| expiration dates based on liability. Yeah if it says that
| it expires after a year, that's because they know that 2
| units is 2 units after that long, but it's variable
| enough that you're not going to just get rid of something
| so expensive and precious when it's likely to still work
| just as well, and even if it's not "just as well," still
| be reasonably effective. It's a slow, steady decline, not
| a "this goes from fully potent to useless at this moment
| in time" kind of thing. Yeah maybe you'll give yourself
| four units and it'll actually be effectively 3.5; that's
| still better than zero.
| dnautics wrote:
| > It's a slow, steady decline, not a "this goes from
| fully potent to useless at this moment in time" kind of
| thing. Yeah maybe you'll give yourself four units and
| it'll actually be effectively 3.5; that's still better
| than zero.
|
| The process of flocculation itself is autocatalytic and
| therefore ~exponential. Though the k factor might be low
| enough and minor deviations in the exact mechanism that
| are formulation-dependent might to make it look quasi-
| linear for quite a long time, followed by a precipitous
| drop.
| cosmodisk wrote:
| I doubt you can stockpile. Pharmacies have checks in place,
| heck,even my local supermarket flagged when I tried to buy
| too many otc painkillers.
| steveklabnik wrote:
| At least in the US, stockpiling is absolutely common to a
| degree. You are absolutely correct about checks, they make
| it even hard to get supplies when it's legitimate at times,
| but what ends up happening is people skimp in order to save
| some away, and build up a reserve over time.
| steveklabnik wrote:
| It doesn't even need to be a large-scale breakdown. Extreme
| weather is becoming more and more of an issue, which often
| leads to things like loss of power. When you use a refrigerator
| to keep your medication cold, a sudden "you're going to lose
| power until further notice" introduces significant logistical
| hurdles.
|
| I share these sorts of worries with you. It's hard.
| perardi wrote:
| That seems obvious once you point it out, but yeah, I never
| really considered how tough it would be if a natural disaster
| knocked out the fridge for a few days for temperature-
| sensitive medicine.
|
| Like in Texas earlier this year. _(Though I suppose it was
| cold enough you could stash stuff outside...)_. I wonder if
| there any teeny little thermoelectric coolers that you could
| keep for an emergency and run off a bunch of batteries...
| techrat wrote:
| You mean something like this?
|
| https://www.bestbuy.com/site/cooluli-classic-0-1-cu-ft-
| mini-...
|
| Runs in 120v, 12v and even 5v (Eco) mode.
|
| In a pinch I would say a 12v based battery setup should
| keep something like this running for a while. A few of my
| emergency power lithium battery packs had cigarette/car
| ports on them.
| cperciva wrote:
| _Though I suppose it was cold enough you could stash stuff
| outside..._
|
| That may work for some things, but freezing insulin
| destroys it.
| steveklabnik wrote:
| As it so happens, I live in Austin...
|
| Yeah, in theory you can stash stuff outside, but that also
| isn't as simple as it sounds. While I take some issue with
| the milk analogy below, in this case, I think it fits.
| Imagine you have a gallon of milk. You lose power. You go
| stash it in the snow. Okay, it's kept "cold" for some value
| of cold. That "some value" matters, because with this
| gallon of milk, you can't smell it to see if it's spoiled,
| and if something goes horribly wrong, you die. It's not a
| binary thing as it sounds immediately. "Cold in the snow"
| is not the same as "kept at the same value I can control
| exactly in my fridge."
| cwkoss wrote:
| You can buy 'cold chain' stickers that indicate whether
| they have exceeded certain temperatures. Could be useful
| for prepper diabetics. (And for practicing and testing
| different ways to maintain cold chain in emergency-like
| conditions)
| perardi wrote:
| Ha, yes, I do suppose medical-grade peptides need a bit
| more rigorous temperature control than that frozen yogurt
| I buried in the snow during a brief power outage...
| steveklabnik wrote:
| Yep. And this whole thing is a microcosm of the entire
| situation: the details really, really, _really_ matter.
| It 's quite easy from the outside to not realize how much
| they really, really matter.
|
| (It is also true that it is not the case that if it is
| not continuously absolutely refrigerated, it immediately
| goes bad, which is one reason why the milk analogy gets
| strained. Milk expires far, far faster, and in a more
| binary way than insulin goes bad... but freezing it is
| extremely bad, so... analogies are hard.)
| mckeed wrote:
| I live in the North and I've been thinking about building
| an ice box in the basement that stores cold from outside
| during the winter - mostly for energy-saving purposes,
| but it would be interesting to try making a system with
| precise temperature controls.
| cstejerean wrote:
| That's easier to protect against though. You can install a
| standby generator, or run a small portable generator to
| keep the fridge going (or any other medical equipment). Or
| install solar + battery system.
|
| But if you can't buy more insulin then that's a real
| problem.
| Guidii wrote:
| If SHTF, then we should think about old-school methods based on
| animal extraction. The process is involved, but still
| approachable.
|
| My daughter did a project in her high school chemistry class on
| the entire process, describing the steps involved - I don't
| have that paper handy, but if a high school student can work it
| out it's probably available elsewhere. She later told me that
| this project was part of her post-apocalypse-family-survival-
| plan;)
| Ice_cream_suit wrote:
| I just gave a patient with a malignant tumour an injection of
| this: https://www.drugs.com/price-guide/somatuline-depot
|
| It cost her less than 5 USD.
|
| Quantity Per unit Price 0.2 milliliters $30,459.20 $6,091.84
|
| Our (Not the USA ) system seems to work well for some aspects of
| health care.
| hermannj314 wrote:
| Can you elaborate? Per your link, there is no generic version
| of this drug.
|
| How did it only cost her $5 if it costs $6000 per unit and
| there are no alternatives?
|
| Was that her cost after another entity (insurance, government)
| paid the rest of the cost?
| dmos62 wrote:
| Not to downplay the importance of low cost retail medicine, but
| what if she didn't have 5 dollars?
| andi999 wrote:
| The usual: getting thrown in the debt tower.
| laszlokorte wrote:
| A fun song by Acapella Science featuring the discovery of insulin
| [0]
|
| [0]: https://www.youtube.com/watch?v=He7X5jGt8lY
| agotterer wrote:
| Related thread on bio hacking and insulin from a few weeks ago:
| https://news.ycombinator.com/item?id=27661637
| DoreenMichele wrote:
| This is cool and all, but it looks like pure PR. I cannot find
| anything that actually links to "Here is our instruction set for
| how to make insulin yourself!" or something.
|
| Also, for some people with diabetes or at risk of developing it,
| diet and lifestyle can make a difference.
| elnatro wrote:
| Type 1 diabetes is not related with obesity.
| kennywinker wrote:
| It really is a shame that there isn't better names for type 1
| and type 2 diabetes. They have such different stories, and
| yet get lumped together constantly.
| DoreenMichele wrote:
| There are other forms of diabetes. I know of CFRD and have
| heard it is neither type 1 nor type 2 and I think there is
| at least one other form beyond that, but can't recall
| anything about it.
|
| Edit:
|
| Diabetes is actually five separate diseases, research
| suggests
|
| https://news.ycombinator.com/item?id=16499376
|
| You can add a sixth class. I have been told that Cystic
| Fibrosis Related Diabetes (CFRD) is neither Type 1 nor Type
| 2.
|
| https://news.ycombinator.com/item?id=16499548
| mnw21cam wrote:
| Disclosure: I work in diabetes research.
|
| That "five types" article is very poor. They simply
| applied k-means clustering to a large set of people with
| diabetes. The problem with k-means clustering is that it
| can generally find anything you want it to. For instance,
| you tell k-means clustering how many clusters you want it
| to find, not the other way around. In this example, there
| is significant overlap/fuzziness between the classes.
| It's better to say that there is a wide spectrum of the
| progression of diabetes.
|
| It is well-known that type 1 diabetes that arises late in
| life tends to progress very much more slowly than type 1
| diabetes that arises in teenagerhood. A teenager with
| type 1 diabetes can have a very rapid progression, and
| have very severe symptoms. A person who develops type 1
| in their seventies can have such a slow onset that the
| treating doctor can get very confused about what is
| going, and assume that it is type 2 instead, until the
| patient finally cannot live without insulin. K-means
| clustering has separated these two situations, but they
| are a spectrum from aggressive to gentle.
|
| But the distinction between type 1 and type 2 is still
| very relevant. With type 1, the problem is too little
| insulin (progressing to zero insulin produced because the
| immune system destroys the insulin-producing pancreatic
| beta cells), and the treatment is insulin. There is no
| other treatment.
|
| With type 2, the fundamental problem is too _much_
| insulin, which the body naturally produces to correct
| other fundamental problems, namely high blood sugar
| levels, which has a tight interaction with diet and
| obesity. The insulin encourages fat /muscle cells to suck
| sugar out of the blood to reduce it, but this causes
| other problems. A high level of insulin is then needed to
| _keep_ the energy stored in the fat cells and stop it
| coming back into the blood as sugar, and the insulin-
| producing cells can eventually burn out from over-use.
| The treatment is to deal with the high blood sugar levels
| and obesity - the insulin problem is a second-order
| effect. Injecting more insulin into a patient with type 2
| diabetes can make the problem worse - it might sort out
| the high blood sugar level, but it does that by cramming
| all that sugar into fat cells, so insulin injections are
| generally only used when the insulin-producing cells
| start failing. Diet, exercise, and blood sugar lowering
| drugs are better treatments. Different people respond
| differently to this disease, with some people storing fat
| around their legs (which is a more healthy option) and
| others storing it around their internal organs (which is
| really bad). K-means clustering will have separated this
| continuous spectrum of people into separate clusters too.
|
| There are multiple other rarer types of diabetes that
| tend to be overlooked, and probably don't have much
| participation in the k-means clustering because of their
| rarity. These include the CFRD you mention, but also
| gestational diabetes, diabetes associated with various
| other more syndromic conditions (like Down syndrome), and
| monogenic diabetes (a single-gene defect causes an
| inability to correctly produce insulin - we know of
| double-figures types of this, some of which can be very
| easily and cheaply treated, and others need to be treated
| like type 1). There's also diabetes that is caused by
| surgery, if a patient has their pancreas removed.
| DoreenMichele wrote:
| Thank you, thank you, thank you.
|
| Gestational diabetes is probably the other one I was
| trying to remember.
| watwut wrote:
| You can be thin and have diabetes 2 too. There is strong
| correlation (as in weight is massive risk factor), but in
| fact thin people can get it too.
| mnw21cam wrote:
| As with everything, different people are different. Thin
| people can get type 2 diabetes, but this is often due to
| inappropriate fat deposits around internal organs. In a
| proportion of these "skinny-fat" people, a bit more
| exercise and a better diet may have prevented the type 2
| diabetes. A lot of it is genetic, and each different
| person will have a different adiposity above which they
| will start to develop type 2 characteristics. People with
| an Indian heritage need to be extra-careful on this one.
| [deleted]
| MattGaiser wrote:
| > "Here is our instruction set for how to make insulin
| yourself!" or something.
|
| I don't think they are there. It is just a project to get
| there.
| pas wrote:
| If I understand correctly the problem is that if you go to
| one of their labs they'll cook you a batch in no time (we
| know the genes, you can order a plasmid that has all the
| bells and whistles needed to get it made in yeast), but it'd
| be illegal for many reasons. (They can't sell it without FDA
| approval for one, they'd need an approved factory for that,
| and they are infringing on patents.)
|
| They obviously can't advertise this, but in videos they
| almost literally spell this out. So they do this strange
| outreach instead, with no clear steps in sight. Plus as
| others mentioned it's easy to buy insulin. ($25 at Walmart.)
|
| About how easy it is to make recombinant insulin I recommend
| this channel: https://www.youtube.com/watch?v=J3FcbFqSoQY
| moron4hire wrote:
| Maybe, instead of constantly drumming on about "diet and
| lifestyle", we should be studying why the "diet and lifestyle"
| message has completely failed to move the needle on the obesity
| crisis.
|
| Cuz I'm pretty sure nobody with diabetes has not heard about
| "diet and lifestyle". So comments like that are not adding
| anything to the conversation.
| lovemenot wrote:
| Not specifically about diabetes: to some extent, obesity is a
| social disease
|
| https://www.nih.gov/news-events/nih-research-
| matters/friends...
| DoreenMichele wrote:
| There is also research that connects living in a
| cluttered/disorganized/messy home to being more at risk of
| being obese.
|
| https://www.prevention.com/weight-loss/a20513150/how-to-
| get-...
| Dove wrote:
| It's the wrong "diet and lifestyle" recommendation - the
| standard suggestions of eating less and exercising more don't
| work.
|
| What does work specifically is a _low carb_ diet and
| _intermittent fasting_ lifestyle, together with close medical
| supervision. https://www.virtahealth.com/ has had great
| success with the approach.
| DoreenMichele wrote:
| There is also a lot of research indicating that
| inflammation is an underlying cause of most forms of
| diabetes. Controlling inflammation, in part by changing my
| diet, is likely a significant factor in getting my blood
| sugar issues under control as a side effect of more general
| efforts to remedy my health problems.
| grp000 wrote:
| I scanned through the site and their first post was in 2015 and
| has news articles posted about the company with titles like:
| "The Community Labs Built on Silicon Valley's Junk: Trash from
| biotech startups are citizen scientists' treasure" and "The
| Rogue Experimenters". Also, lots of posts about wanting
| interns. This doesn't give me a good feeling.
| DoreenMichele wrote:
| It's also apparently kind of a dupe* and the top comment in
| the previous discussion indicates they looked and there's
| seemingly nothing "open" about this initiative.
|
| I mentioned diet and lifestyle because that's how I manage my
| otherwise insanely expensive and debilitating condition and
| did so that way even while homeless. If you are genuinely
| concerned about the health and finances of poor people,
| finding a way to educate people about diet and lifestyle
| strikes me as at least part and parcel if what you ought to
| be doing and as a generally superior approach. One reason
| medicine is highly regulated is because screwing it up with
| unsanitary practices can maim or kill people.
|
| * https://news.ycombinator.com/item?id=27854041
| hi41 wrote:
| Many countries in Africa are import several critical medications
| from countries such as India where they are produced at much
| lower costs. Why is USA unable to do the same in quantities so
| that their poorer population is able to but them at a lower
| price.
| igorzx31 wrote:
| Because the US has a rule of law and patent system that
| encourages R&D. Africa freeloads on the US innovation.
| grecy wrote:
| The enormous lobbying power of multinational pharmaceutical
| companies results in laws against it.
|
| i.e. They pay millions in bribes to lawmakers to ensure
| competition is illegal.
| hkt wrote:
| It is neat that this is something people are trying, but this
| strikes me as a technical solution to a political problem. Such a
| thing probably can't scale on account of that.
|
| The real solution is to reform how drugs are priced and
| healthcare is provided. In the UK we did this over 70 years ago
| and the most you should pay for a medication is PS12/month
| (committed to a year), PS11 per prescription, or nothing (if
| you're poor).
|
| This is possible because of the politics and governance of
| healthcare in the UK: the tech has been around for half a
| century.
| igorzx31 wrote:
| Politics and governance in the UK: freeloading on the American
| pharma system.
| endymi0n wrote:
| Seriously: Isn't there a business case? Patents for the older
| Insulins have expired, the manufacture isn't that complicated for
| any halfway decent pharma or chemical company. The current
| margins must be through the roof.
|
| How is Insulin in any way different from other generics which are
| a common business case?
|
| Why is there nobody offering competition?
| antirez wrote:
| Apparently it's an US problem. Never heard of insulin as a
| costly drug in Europe. US health care system is totally broken
| with costs 10x for most procedures without any reason.
| ghosty141 wrote:
| I believe it gets payed for by insurance in basically any
| other country.
|
| I can only talk about germany: For type 1 diabetes insurance
| completely covers it. For type 2 it may get fully covered but
| it depends on some factors, but even then you don't pay the
| full price, only a part since the insurance will almost
| always at least partially cover it.
|
| (this is based on a quick google search)
| antirez wrote:
| In Italy no need for insurance, it's just the government
| that gives it you for free. But the problem is, I believe,
| different: it's the raw cost of the medication. Here in
| Europe even if the patient has to buy it, the cost is
| fraction.
| mngnt wrote:
| Do you have any source I could read to see how it works
| in Italy? I live in central Europe (Slovakia) and insulin
| is also "free" here (if you are diabetic and have a
| prescription), but it's not "paid by the government",
| it's paid by the compulsory insurance everyone is paying
| (for me, it's about 5% off of my net salary).
|
| I 100% agree to your second point. I found some data to
| compare: Humalog from Eli Lilly Netherlands costs 19,42
| EUR per 10 ml vial in Slovakia [1] and $296.29 in the US
| [2]. Yep, that's ~13 times as much (I ignore exchange
| rates, but it's in the same ballpark). This is not saying
| much though, due to salary difference. Average monthly
| salary in Slovakia is 1133 EUR , while in the US it is
| $4692.5.
|
| Thus, an average Slovak can pay for 580 ml of insulin
| monthly (I'll note here, they doesn't have to pay, it's
| covered by insurance), while an American can only get 158
| ml of the same brand, same product insulin.
|
| On top of that is the manufacture price is up to $6.16
| per vial. [5]
|
| [1] https://translate.google.com/translate?sl=auto&tl=en&
| u=https... [2] https://www.drugs.com/price-guide/humalog#
| [3]https://translate.google.com/translate?hl=&sl=sk&tl=en
| &u=htt...
| [4]https://www.bls.gov/oes/current/oes_nat.htm#00-0000
| [5]https://www.singlecare.com/blog/insulin-prices/
| maxerickson wrote:
| The "cash" price in the US is $142:
|
| https://www.goodrx.com/humalog?dosage=10ml-of-100-units-
| ml&f...
|
| (GoodRx doesn't have any direct user fees, they make
| money by understanding the stupid prescription drug
| system in the US)
|
| There's a generic that is $50 at several pharmacies.
| igorzx31 wrote:
| In addition you are comparing somebody who has insurance
| (slovenia) to somebody who theoretically doesn't 'US'.
| Most people in the US get their health insurance through
| their employer and would pay nothing out of pocket, and
| if you are uninsuranced the drug companies will often
| times just give the drug away to you for free.
| steveklabnik wrote:
| Even if you have really good health insurance, you often
| pay out of pocket.
|
| > if you are uninsuranced the drug companies will often
| times just give the drug away to you for free.
|
| This is horribly incorrect. People die for lack of
| insulin in the US all the time, and it's not because they
| just didn't bother to ask for their free insulin.
| mngnt wrote:
| No, I'm not. The price for an insured patient (which is
| everyone, by law) is zero. 19.96 is just the sticker
| price.
| igorzx31 wrote:
| But they have 'insurance' through their taxes.
| steveklabnik wrote:
| The "cash" price is $342. The $142 is from a $200 which
| has eligibility requirements, which don't allow you to
| get that discount in many cases.
| maxerickson wrote:
| What requirements are attached to using the PBM
| replacements? My understanding is that you go to a
| pharmacy that accepts them and give them a number to put
| into the computer.
|
| Or does using them disqualify people from other programs?
| [deleted]
| steveklabnik wrote:
| I may have _slightly_ overstated the case above (and have
| now edited my language to be softer) because frankly, a
| lot of stuff said in this thread is _extremely_ upsetting
| to me. (Not you, you are one of the more reasonable
| people here.) I don 't actually know what the numbers
| are, strictly speaking. In my experience, a lot of things
| around this _sound_ reasonable until you actually have to
| come into contact with the bureaucracy surrounding them,
| and they end up being much more onerous in practice.
|
| But yes, if you click on the green button, you'll see a
| list of restrictions. One of those is that if you're
| participating in any other state or federally funded
| programs, yes.
|
| The "I have been prescribed this drug" bit is also
| pernicious; you don't get a prescription for "insulin,"
| you get one for Humalog or Novolog or Levemir. You are at
| the whim of your doctor. Used one kind for years, but
| suddenly lose your job, which means a change in health
| insurance and a change of doctor, who decides that you
| need to change your brand for whatever reason? You can't
| use this discount to help keep continuity. (Additionally
| I am not sure what the "or am a caregiver" requirement is
| legally, but should really look that one up so that I
| know exactly what those requirements are, so thank you
| for giving me something to do today...)
| mngnt wrote:
| Thanks for pointing that out. GoodRx is not available
| from EU (Either due to GDPR or due to not being
| applicable to non-US readers, I guess). That invalidates
| my numbers a bit.
|
| However, it's also pointing to another facet of this
| issue: the opaqueness of the pricing. In here, price of
| medication (including insulin) is regulated and it's the
| same everywhere, for everyone and no seller-specific
| discount can be applied.
| maxerickson wrote:
| Yeah, they make money by working the convoluted US
| system.
|
| It isn't good that the prices vary, but it's been long
| enough that people with substantial drug costs should be
| doing some basic checks, discussing the highest quoted US
| prices doesn't reflect what people are paying.
| freemint wrote:
| If taking exchange rate into account it's 13.05 times as
| expensive.
| igorzx31 wrote:
| LIST PRICE DOESN'T MATTER IN THE US
| heavyset_go wrote:
| Try to buy prescriptions from a pharmacy without
| insurance and you'll see how much list prices matter in
| the US. If you don't have the money for the retail price,
| you're shit out of luck and won't be able to buy them.
| QuesnayJr wrote:
| Total costs usually work out be 2x, it's just that the
| government pays a big chunk. (I'm sure it's not uniformly 2x,
| so insulin might cost more.)
| weezin wrote:
| The US healthcare system is a mess in the US because the
| government pays for a lot incentivizing companies to raise
| prices.
| alexkreidler wrote:
| This article from TIME (linked at the bottom of their website)
| has a good description of the problems in the insulin market and
| the goals of the project/foundation:
| https://time.com/5709241/open-insulin-project/
| ganafagol wrote:
| Looked cool, until i scrolled further down. Not only is any info
| lacking on how it's done and what the status is. There are even a
| bunch of "community projects" listed. Among them "Real Vegan
| Cheese and Narwhal evolutionary genomics" and "Mushroom Lovers".
| Not judging those, but that's far off from "let's provide the
| poor with safe and affordable insulin". Feels dishonest, tbh.
| rafaelferreira wrote:
| Their "What We Do" page has some more detail, but not a whole
| lot: https://openinsulin.org/what-we-do/
|
| > _To produce the protein needed for insulin, we need to grow
| microorganisms with a bioreactor and purify the protein from
| the culture with a protein purification system (FPLC).
| Proprietary examples of this equipment come at a very high
| initial cost and with high ongoing costs of support from the
| manufacturers. Our goal is to develop easy to manage, easy to
| repair, and affordable equipment to sustain local and
| community-built insulin production._ > _Our FPLC design is in
| the early stages, and we are steadily developing mechanical and
| electrical designs to detect UV-C absorbance and manage the
| concentration of two buffers via peristaltic pumps and a mixing
| chamber. We plan to use Arduino microcontrollers as well as the
| Raspberry Pi, and the finished device will make use of the
| open-source Ender 3 3D Printer to facilitate automated fraction
| collection with G-CODE input. The bioreactor design makes use
| of quite a few commercial off-the-shelf parts and is ready for
| prototyping._
| jlg23 wrote:
| Their blog was much more insightful to me, here the Spring
| 2021 Progress Report: https://openinsulin.org/our-
| blog/spring-2021-progress-report...
| Popegaf wrote:
| There's a status report on the blog
| https://openinsulin.org/our-blog/spring-2021-progress-report...
|
| But I agree, for being "open" there's a distinct lack of
| documents, schematics, inventory, videos, pictures, etc.
| theonlybutlet wrote:
| I wonder if it's patent law that's keeping them secretive.
| There's a good chance they're trying to reverse engineer the
| insulin and concerned they may be infringing on manufacturing
| process patents etc. Once they've got a working formula it'd
| be easier to change it up to avoid these patents. Big pharma
| is notoriously litigious and I can see them taking any
| opportunity to nip this in the bud.
| consp wrote:
| > I wonder if it's patent law that's keeping them secretive
|
| Many insulin forms are no longer patented. Last year
| patents (at least in Europe) expired from some quick acting
| insulin variants and as a result insurers here are forcing
| everyone to cheaper generics. Side effect: Not all have the
| same solutions, though the insulin is the same. Despite
| what the insurers say, YMMV if you switch due to different
| solutions being present.
|
| So I do not think patents on the product is a real issue.
| Maybe patents on the production method.
| RHSeeger wrote:
| > cheaper generics
|
| Interestingly, they're really not much cheaper, either.
| On the order of 10% cheaper, I believe.
| GravitasFailure wrote:
| There's a research exemption to patent law in the US, but
| that might not apply if they're publishing the details with
| a how-to manual.
| moron4hire wrote:
| The vegan cheese and other stuff is not part of Open Insulin.
| The block of text in which that is printed is a blogroll for a
| meetup of Counter Culture Labs where Open Insulin is also
| presenting.
| sschueller wrote:
| Wouldn't it be easier to raise funds and lobby Congress to get
| laws passed to make insulin basically free in the US and
| defacto pushing that globally?
|
| Trying to make your own has a lot of steps that need to go
| right or people die. You also have to deal with regulators.
| RvdV wrote:
| > and defacto pushing that globally?
|
| There is no need for a global push; prices outside the US are
| substantially lower already. See
| https://pharmanewsintel.com/news/insulin-prices-8x-higher-
| in...
| after_care wrote:
| There are other benefits besides price to open source.
| project2501a wrote:
| Such as?
| steveklabnik wrote:
| Here's one that isn't about the insulin itself, but is
| about diabetes.
|
| Some diabetics use a "continuous glucose monitor" to read
| their blood glucose levels regularly. The information to
| that device is fed into an app on your phone (for newer
| devices) that visualizes the data for you.
|
| It doesn't just visualize though, it can also give you
| alerts. This is an incredibly useful feature!
| Unfortunately, at least in the ones I have experience
| with, the metrics they give you to be able to alert on
| are not good enough. For example, you'd think that "give
| me an alert when I go below x value" is a useful alert,
| and it is. However, the app I use only lets me set two
| alerts: a "low" alert, with the values 100 to 60, and an
| "urgent low" with the values 55-40. (both are in
| increments of 5.) That _is_ useful, but what if I want
| three alerts? What if I want a non-5 value? Sure, you can
| argue that this isn 't _necessary_ , but if it were open
| source, I would be able to build something to do exactly
| what I want.
|
| Okay, so that's the first issue here. But here's the real
| issue: the absolute value is useful, but what's more
| useful is the _rate of change_. What I truly want to be
| able to do is set an alert that says "hey if this
| suddenly drops 10 points, give me a high priority alert"
| no matter the absolute value. There have been situations
| where I've seen a sudden downturn from ~180, dropping by
| 15 each time, and you don't even know until it crosses
| that 100 threshold. Likewise, I've seen alerts about it
| going low because it went from 101 to 100. One of those
| is _very_ serious, and one of those is irrelevant.
|
| This stuff would significantly increase quality of life.
| And it's one tiny part of this whole picture of this one
| condition.
| ZucchiniZe wrote:
| I know exactly that pain! I wish that there was some way
| for an alert if I'm dropping super drastically.
|
| I'm actually working on reverse engineering the dexcom
| share api in my free time to create something similar to
| sugarmate where you can get control of your data and do
| what you want with it.
|
| But for the time being, have you considered using
| share2nightscout[0] and grabbing the info into your own
| control so then you can do the alerting and analysis that
| you want?
|
| [0]: https://github.com/nightscout/share2nightscout-
| bridge
| steveklabnik wrote:
| I have not personally seen this! I will check it out,
| thank you!
| igorzx31 wrote:
| Taxes outside the US are far higher.
| sschueller wrote:
| This may be true for some places but I can tell you with
| certainty that they are lower in Switzerland especially
| for lower incomes.
|
| Your Taxes are insane high for medium wage workers and
| practically non-existent for the wealthy. How is anyone
| ever supposed to climb the ladder like that?
| pedrosorio wrote:
| > Your Taxes are insane high for medium wage workers
|
| A single person earning $200k in the state of Washington
| pays ~$52.5k in federal income tax and social security.
| An effective tax rate of 26%. Is that insanely high?
| aabaker99 wrote:
| You may want to update your idea about what is a medium
| wage worker:
|
| https://www.statista.com/statistics/203183/percentage-
| distri...
| burnished wrote:
| Yeah pity those poor fools with their.. stress free
| access to insulin and.. never having to watch a loved one
| die from not being able to afford insulin. But yeah,
| taxes.
| marcusverus wrote:
| By pretending that this is some kind of common
| occurrence, you are engaging in fearmongering. You're 10X
| more likely to be killed by lightning in the US than you
| are to die due to lack of insulin.
|
| According to this (sympathetic) website[0], ~4 people in
| the US die every year due to a lack of insulin.
| Meanwhile, ~40 people in the US are killed by lightning
| strike[1].
|
| [0] https://rightcarealliance.org/actions/insulin/ [1] ht
| tps://en.wikipedia.org/wiki/Lightning_strike#Epidemiology
| anonAndOn wrote:
| >You're 10X more likely to be killed by lightning in the
| US than you are to die due to lack of insulin.
|
| But 100,000x[0] more likely to lose a foot due to lack of
| insulin than by getting it cooked off by a lightning
| strike.
|
| [0]Estimated. Not sure if they even track loss of limbs
| by lightning strikes since it's such a rare occurrence
| but the diabetic, poor and footless can be found in just
| about any major city.
| steveklabnik wrote:
| These things are never cut and dry. This is presenting
| these absolutely clear-cut stories, but it's not like
| this sort of thing is accurately tracked in any way.
|
| One in four people who have diabetes report that they
| take less than they should due to cost. This has knock-on
| long-term health effects that can cumulate in an earlier
| death than would otherwise happen. Those effects will
| never be captured in the way that lightning strikes can
| be captured.
|
| Others die who were never formally diagnosed, and so
| wouldn't be captured in statistics like this.
|
| It goes on and on.
| steveklabnik wrote:
| Yet somehow, we pay more for far worse care. Funny how
| that works.
| techrat wrote:
| Yet somehow the US spends the most per person health
| care...
|
| ($10,623.85 per capita vs Switzerland $9,870.66 vs Norway
| 8,239.10)
|
| And manages to NOT cover 30 million people...
|
| (10+% vs Switzerland, Universal, vs Norway, Universal)
|
| No matter how you look at it, we spend more on private
| insurance than anywhere else in the world and manage to
| cover less people with it.
|
| On top of that, medical debts are the single largest
| cause of bankruptcies in the US.
|
| (Third overall worldwide ranking for US vs 100th for
| Switzerland vs 118th for Norway)
|
| And despite (oh mer ghurd socialism!) paying the most, we
| rank among the worst for first world countries.
|
| (37th for United States vs 20th for Switzerland vs 11th
| for Norway)
|
| TLDR: We pay more for less and get worse care overall.
|
| If I could trade in my private insurance premiums for
| taxes and get better care as a result without the risk of
| bankruptcy, why wouldn't I? Bonus, I wouldn't lose my
| health insurance if I had to switch jobs. We are one of
| the only countries in the world that tie health care to
| employment, which is detrimental to everyone.
|
| The US system is FUCKED.
|
| https://worldpopulationreview.com/country-rankings/best-
| heal...
|
| https://worldpopulationreview.com/country-
| rankings/medical-b...
|
| https://www.cnbc.com/2019/02/11/this-is-the-real-reason-
| most...
|
| https://aspe.hhs.gov/system/files/pdf/265041/trends-in-
| the-u...
|
| https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD
| heavyset_go wrote:
| Healthcare outcomes, quality of care, and wait times are
| worse in the US compared to countries with universal
| healthcare, as well.
| techrat wrote:
| There's always the people who chime in about "but, but,
| but private insurance means you don't have to wait 6
| months to have surgery!"
|
| I had to wait year. US Health Insurance is a fucking
| nightmare to deal with that the largest allocation of man
| hours within a hospital is billing between multiple
| networks. Imagine the savings on that alone if coverage
| was universal.
| heavyset_go wrote:
| I waited on a six month long waiting list to see a pretty
| common type of specialist in the largest metro area in
| the US. Every practice and doctor I got in touch with had
| a similarly long waiting list, even if I paid in advance
| with cash. Some people will die waiting on that list.
| tomcooks wrote:
| Would be US only VS an open solution accessible
| internationally.
|
| Plus good luck getting political traction (especially against
| lobbies) faster than do it yourself
| systematical wrote:
| Big Pharma says no. The American solution is go to Mexico or
| Canada (can't right now).
| chrisseaton wrote:
| > lobby Congress to get laws passed to make insulin basically
| free in the US and defacto pushing that globally
|
| You think the US should make insulin free and then use their
| leadership to encourage other countries to do the same?
|
| Do you realise other countries already make insulin free and
| it'd be the US that would be following their leadership if it
| made it free?
| dsr_ wrote:
| Shh! You can't get Congress to vote for "catch up with the
| rest of the world", you need to phrase it as "America leads
| the way to freedom!".
| ekianjo wrote:
| make it easy to freely trade drugs between countries and
| prices will plummet.
| LambdaComplex wrote:
| Personally, I value human life much more than I value
| corporate profit.
| [deleted]
| pankajdoharey wrote:
| Yes thats the right way, making Healthcare free for all is
| the only way, US has to learn from Canadians, Brits or dozen
| other EU countries.
| consp wrote:
| "free" is relative. For instance we have a tax on
| chronically ill people here called "eigenrisico" (literally
| your own risk) which is not a tax but is meant for people
| to not seek help unless it is absolutely necessary and then
| pay for the cost. Some things are excluded but as soon as
| you need more than basic help or any medicine it comes into
| play. So it's a tax on being ill in all but name since it
| resets every year.
|
| So "free" comes in many forms, not all single player.
| caddybox wrote:
| I'd be wary of calling it a tax. As you pointed out it's
| an amount large enough to warr off spurious medical needs
| and small enough that if you're really injured or
| suffering, it can be extremely helpful and is a miniscule
| part of your medical fees.
|
| What's broken is the huisarts system where any efforts to
| get specialized care when you're in pain must pass
| through your GP. This often leads to a longer waiting
| period that can be excruciatingly painful for some.
| relaxing wrote:
| In the US it's called "needing a referral."
| kube-system wrote:
| The literally translated equivalent in the US is a
| "deductible".
| sebmellen wrote:
| "Eigenrisico" yes, but the Huisarts system is what GP was
| referring to as being analogous to "needing a referral".
| sschueller wrote:
| They have that in the US as well. It's called a copay I
| believe and it depends on insurance but is also do
| prevent people from going to seek help if it's minor.
| neolog wrote:
| It's called a deductible in usa.
|
| https://h4i.nl/2018/11/30/health-insurance-understanding-
| eig...
| nomercy400 wrote:
| Did your intentionally leave out the annual 'basic
| healthcare' package of around 1500 euro you are required
| to have? It's not free.
| contravariant wrote:
| Though with all other subsidies etc. it's effectively not
| that different from an additional income tax. To the
| point where I wonder why they don't just make it part of
| the income tax.
| freemint wrote:
| Certain communities such as the Amish have in the past
| and will in future go to DC and protest. They see it as
| an attack on their way of life which it is. It is just
| that there way of life is build on perpetuating the way
| of life of the Amish.
| contravariant wrote:
| Well yes I was talking about the Netherlands where you
| have a mandatory insurance, guaranteed to be the same
| amongst all insurers and for which the cost is subsidized
| for people with low or no income.
|
| At that point it's basically an income tax.
| kwhitefoot wrote:
| Does eigenrisico apply to each event separately or is
| there an annual limit?
|
| We have a similar idea here in Norway. I pay about 20
| euro to visit my GP and I pay for drugs. An MRI costs me
| about 25 euro. But there is a limit of about 200 euro per
| year. Anything I pay over that will be refunded in the
| tax settlement for the year and if I have a chronic need
| for drugs I will be given a frikort to exempt me from
| paying for them at the pharmacy.
| gattilorenz wrote:
| In NL eigenrisico works like you describe (well,
| actually, it doesn't: after the eigenrisico you don't pay
| for stuff anymore, the insurance company covers the cost
| directly and you are not even billed), but is 350 euro,
| annually
| DarkWiiPlayer wrote:
| This isn't a matter of free healthcare; it's a matter of
| getting rid of bullshit patents and licensing problems that
| allow companies to pull off their absurd prices in the
| first place.
|
| Insulin should be free for everyone to produce and to sell,
| then prices would go down on their own.
|
| Of course, this doesn't mean the USA shouldn't implement
| "free" healthcare like we have in europe; just that that's
| not what the insulin problem comes down to.
| ekianjo wrote:
| Insulin has no patents anymore though. But making insulin
| reliably at the right quality is no easy feat. Thats why
| you dont have millions of insulin suppliers worldwide.
| ekianjo wrote:
| because sure, we all know that health care and drugs cost
| nothing to make. i want to have free food too and free
| houses too, please add that to the list.
| AlexAndScripts wrote:
| Works great here. It is paid for in taxes and the
| government doesn't take a cut every step, so the tax
| isn't that high.
|
| Also, food stamps etc are already a thing, and insulin is
| necessary to, like, live.
| igorzx31 wrote:
| The middle class in europe pays 40-50% income tax rates.
| sk0g wrote:
| Don't see a single country [0] where that's true, and
| that's for average wages, which tends to be higher than
| the median wage. Mind you, the first infographic includes
| employer taxes as well, which should be left out of the
| discussion.
|
| [0] https://en.wikipedia.org/wiki/Tax_rates_in_Europe
| project2501a wrote:
| you guys are great at refuting those people with facts.
| Keep at it!
| pankajdoharey wrote:
| Making Insulin is entirely possible todo if you have the right
| yeast strain it could manufacture Insulin instead of alcohol, i
| would presume they are attempting to do something similar. The
| problem is in order to be accepted as safe medicine it has to
| be certified, QA etc ... by the time they do that it would have
| Become Big Pharma they are trying to fight. Without a proper
| plan it will fail. Insulin isnt some home remedy one will
| consume. It has to be intravenous which makes it problem.
| squidkid wrote:
| Insulin is not administered intravenous, but subcutaneous.
| andyjohnson0 wrote:
| Not really relevant to the topic of open source insulin,
| but insulin is sometimes administered intravenously in a
| hospital setting as an emergency measure to control
| potentially-fatal levels of hyperglycemia.
| cperciva wrote:
| Not just as an emergency measure; if you've got IVs set
| up anyway (e.g. because you're treating hypokalemia) then
| it may be more convenient to drip insulin in rather than
| administering it subcutaneously.
| bregma wrote:
| Also as a means of murder and in the past as a means of
| torturing mental health patients. If you really want to
| be pedantic.
| DoreenMichele wrote:
| If they really, really want to do this, I did read something
| years ago about a woman trapped in a city because of
| political stuff and having to go get, I think, organ meats
| from the butcher to come up with a homemade insulin source.
|
| The thing I read did not go into specifics and I don't recall
| much. I think maybe it was an American woman trapped in an
| Asian city with political drama interfering with supply lines
| for critical items like insulin.
|
| I don't know how you would find this info, but I believe it
| actually exists. We just don't really bother to try to record
| and distribute that type thing because no one gets rich off
| of it.
| pankajdoharey wrote:
| Irrespective of the actual mechanism they employ, though i
| think genetically modified Yeast is the most cost effective
| way to do this, the real concern will remain safety.
| DoreenMichele wrote:
| That depends in part on exactly how this fresh meat
| source of insulin was used. If it was something consumed
| as part of the diet and not injected, then safety becomes
| much, much less problematic.
|
| The story gave no details on how she handled it. Just
| that she did under circumstances where insulin was simply
| not available and she lived to tell the tale.
| pankajdoharey wrote:
| The safety has to be guaranteed. For that the labs have
| to be certified where the Insulin is made or extracted,
| that costs money. It cannot be a ghetto lab operation
| like the manufacture of Illegal drugs.
| DoreenMichele wrote:
| You apparently are not understanding my comment. If the
| procedure the woman used is more akin to a secret family
| recipe -- here, eat this -- then, no, no certification
| would be required.
|
| To whatever degree you can take care of your health with
| diet and lifestyle such that you don't require needles
| and other invasive equipment requiring sterilization,
| life is vastly simpler, better, cheaper and safer.
| paulcole wrote:
| > To whatever degree you can take care of your health
| with diet and lifestyle such that you don't require
| needles and other invasive equipment requiring
| sterilization, life is vastly simpler, better, cheaper
| and safer.
|
| There is no degree to which this is true for people with
| Type 1 diabetes.
| [deleted]
| bregma wrote:
| And likely ineffective.
|
| If there was a secret, simple, safe, inexpensive way to
| treat Type I diabetes that is also effective there would
| have been no need for Banting and Best to have killed all
| those puppies. Unless, of course, you think there is a
| very effective conspiracy by Big Pharma to cover up that
| one secret that they hate. I guess they could also hire
| the Big Fake firm that did the moon landing campaign and
| the Building 7 demolition.
| DoreenMichele wrote:
| Most likely it's complicated, inconvenient and time
| consuming. The big thing modern medicine seems to have
| solved is that popping a pill or taking an injection has
| a lower barrier to entry in terms of skill and knowledge
| than other approaches.
|
| If you care enough to learn other approaches, it's
| sometimes* possible to get superior results compared to
| the "plug and play" medical answer.
|
| * (I actually want to say "often" but I don't really want
| to argue it. "Sometimes" seems less likely to get me
| dragged into pointless drama.)
| sgt101 wrote:
| There is no "family recipe" to deal with Type 1 - if you
| don't get injectable insulin you die. It was a sure fire
| killer from when it was first identified (ancient egypt)
| to Banting and Best.
|
| Insulin from animal sources is not as good as
| bioengineered insulin and it takes a lot of animals to
| make it.
| DoreenMichele wrote:
| _Insulin from animal sources is not as good as
| bioengineered insulin_
|
| Respectfully, we may not actually know that. It's
| somewhat unusual for us to go back and re-test older
| methods after replacing them with a new-fangled thing and
| sometimes things change.
|
| Actual natural quinine is proving to be more effective at
| treating malaria than synthetic derivatives. Various
| strains of malaria have grown resistant to the synthetics
| while natural quinine still works.
|
| Modern drugs tend to strip things down to a single
| chemical and sometimes the more complex natural remedies
| have benefits that we are unable to capture with our
| superior ability to isolate components and refine them.
|
| "In wine there is wisdom, in beer there is freedom, in
| water there is bacteria." -- Ben Franklin
|
| In the past hundred years, there are things that have
| fundamentally changed about the world -- such as just the
| simple ability to somewhat reliably deliver clean water
| to ordinary people in developed countries -- and we may
| someday be able to revive older treatment methods and
| improve upon them to get something better than what those
| once were and also better than what we currently have.
|
| These days, people with serious conditions pretty
| routinely do things at home that involve sterilizing
| instruments and other procedures that most people imagine
| can only be done in a hospital setting. A modern home can
| have assets, such as clean running water and various
| kitchen appliances, that would be the envy of many a
| scientist not that many decades back.
|
| I hope we find better answers for type 1 diabetes soon.
| RHSeeger wrote:
| >> Insulin from animal sources is not as good as
| bioengineered insulin
|
| > Respectfully, we may not actually know that.
|
| We really do. While it's possible that animal sourced
| insulin may be better for your body long term (doubtful),
| bioengineered insulin is FAR superior in every noticeable
| way. Just the fact that you don't need to take it an hour
| ahead of time and make sure that you eat an mount that
| matches how much insulin you took is a huge benefit.
| code_duck wrote:
| There's no mystery to that. Before modern bioengineered
| insulin the major type available was porcine insulin.
| It's very similar to human insulin. It must be injected
| like any other insulin (as a simple protein it's broken
| down quickly in the digestive tract).
|
| https://go.drugbank.com/drugs/DB00071#identification-
| header
|
| Now and then it comes up and diabetes discussion groups,
| what would we do in the event of a widespread disaster
| without access to the pharmaceutical system? Pig
| pancreas. From what I recall it requires a very large
| amount of pancreas, perhaps several organs per dose, and
| a centrifuge.
| DoreenMichele wrote:
| Thanks!
| elnatro wrote:
| This kind of projects are totally alien for me, because of the
| paid-by-taxes Healthcare I have in my European country.
|
| Aren't there any initiatives in some US states to make socialized
| healthcare?
| tootie wrote:
| Yes, but it's been a tough road. Part of the Obama health care
| reform plan was to allow specific states to opt out of federal
| requirements if they could provide universal coverage at the
| state level. It's been started and abandoned in a few states.
| It's currently working it's way through the legislature in New
| York which has liberal majorities across the board, but it's
| still going slowly.
| betwixthewires wrote:
| Yes there are initiatives, it's just that most Americans don't
| want it. We acknowledge problems with our healthcare system and
| want to fix them, but we just don't want that, which is a big
| part of the problem also, the only solution some people seem to
| be willing to accept is socialized medicine.
| [deleted]
| dragonwriter wrote:
| > Aren't there any initiatives in some US states to make
| socialized healthcare?
|
| Some initiatives have been put forth at the state level, but
| it's essentially impractical for US states to do it without
| active federal cooperation (which itself is practically
| unlikely without the same faction controlling the federal
| levers of power that would federally implement socialized
| medicine, making the state programs unnecessary.)
| antman wrote:
| Same here. I does not cost much even if you get it yourself but
| I guess some US law exists that forbids sending from EU to the
| states.
| pas wrote:
| You can sell, but you need FDA marketing approval. Also you
| need to be clear of patents. Currently FDA exclusive
| marketing approvals and patents are the big hammer that keep
| the market uncompetitive. (The FDA grants exclusive approval
| for first movers, for a few years. It's not exactly great,
| but that's usually the smaller problem. The bigger is the
| patents.)
|
| Also, currently due to the enormous money in US healthcare
| (the medicine market very much included) a lot of R&D costs
| are recouped there using these exclusivity strategies.
|
| The biggest problem is that there are many effectively
| uninsured people in the US, and they are the sufferers of the
| aforementioned emergent system. (Even if there many "state
| pharmaceutical assistance programs", many people who would
| need it don't know about it, and even if they do the
| paperwork burden is substantial, and obviously it's just a
| stopgap measure.)
| PragmaticPulp wrote:
| > Aren't there any initiatives in some US states to make
| socialized healthcare?
|
| Sort of. The conversations are mostly about expanding our
| existing socialized healthcare plans that cover over 1/3 of the
| population already.
|
| Americans over 65 and those with some disabilities are covered
| by Medicare:
| https://en.m.wikipedia.org/wiki/Medicare_(United_States) This
| includes about 60 million people.
|
| People with low income or some other qualifications are covered
| by Medicaid: https://en.m.wikipedia.org/wiki/Medicaid This
| includes about 75 million people and reportedly pays for about
| half of all births.
|
| The affordable care act also subsidized health insurance plans
| for those with incomes up to 400% of the poverty level:
| https://www.healthinsurance.org/obamacare/the-acas-cost-shar...
| These subsidies go to another 9 million people or so.
|
| There are gaps and I agree 100% that we need to continue
| closing such gaps, but the US actually does have a significant
| amount of socialized healthcare. Some of the proposals include
| simply expanding some of these programs to cover the remaining
| 8-9% of the population without healthcare.
|
| The idea that the US doesn't have any socialized healthcare is
| a bit of a myth. The reality is that we do have socialized
| health care, it just doesn't cover everyone.
|
| The headlines about insulin costing thousands of dollars per
| month are also misleading. Insulin is $25/vial at Walmart and
| you don't even need a prescription from a doctor to get it. The
| expensive products are more recent, patented insulin analogs
| that are longer lasting but obviously shouldn't be prescribed
| to someone without insurance who can't afford them. The
| $25/vial insulin is equivalent to the generics you read about
| in headlines like this one.
| JumpCrisscross wrote:
| Walmart sells insulin for $25 per vial [1]. There are cheaper
| offers, still.
|
| The problem is there are newer formulations with advantages in
| terms of convenience, safety and durability. These require R&D
| to develop and are not universally available. (Diabetic friend
| had trouble finding his preferred formulation outside the U.S.,
| U.K. and Sweden, for instance.)
|
| We have huge problems with healthcare in America. But the
| insulin meme is misleading to the point of derailing
| discussions about legitimate reform.
|
| [1] https://diabetesstrong.com/walmart-insulin/
| gdy wrote:
| In Russia all patients get their insulin for free thanks to
| mandatory health insurance (5.1% of your net salary
| additionally paid by employer).
|
| If for some reason you would want to buy insulin, it would
| cost you 2-12 usd per vial/cartridge (3ml x 100units)
|
| A cartridge of most modern European or American rapid insulin
| costs 5 usd [0][1] and the most modern long or ultralong
| insulins cost 9-12 usd [2][3]. Russian own insulins cost 2-4
| usd per vial/cartridge.
|
| Do you know why the same companies charge you at least 10
| times more than a Russian citizen?
|
| I wander what are the 'huge problems with healthcare in
| America' if overpaying 10 times for insulin isn't one of
| them?
|
| [0] https://apteka.ru/product/apidra-
| solostar-5e32673ae911440001...
|
| [1]
| https://apteka.ru/product/xumalog-5e327a1eae8baf00014d54fa/
|
| [2] https://apteka.ru/product/lantus-
| solostar-5e32673a3d4c470001...
|
| [3] https://apteka.ru/product/tresiba-
| flekstach-609a3db8c93e31dd...
| acover wrote:
| Isn't this an example of monopoly pricing?
| gdy wrote:
| I honestly don't know
| igorzx31 wrote:
| Nobody pays list price in the US.
| steveklabnik wrote:
| This is not true.
| sumtechguy wrote:
| sort of true and sort of not.
|
| If you are on some 'plan' then you are mostly likely not
| paying list. Your insurance company usually has cut some
| sort of deal with the distribution company. Usually that
| 'deal' includes not telling you about their deal and
| showing you only list price.
|
| If you are not on a plan. Sometimes you can ask 'hey is
| there a no plan version' and sometimes they do have it.
| That can be hit or miss depending on who is working the
| register that day.
|
| If you are not on a plan and they say 'nope thats the
| price' then you end up in that category.
| steveklabnik wrote:
| What was stated was "nobody pays list price," and as you
| said: you can end up in that category. Yes, many people
| do not, but some people do.
| ddingus wrote:
| What do unemployed Russians do for health care?
|
| Greets from curious person in the USA.
| gdy wrote:
| Hi there!
|
| They only need be registered as unemployed. The law [0]
| is in Russian but Google Translate does a good job [1],
| see 5.d
|
| Free medical care in Russia is far from perfect, of
| course -- sometimes you have to wait for a month for an
| ultrasonic scan, sometimes they give you Russian insulin
| instead of Danish, but they will save you from a heart
| attack, install a stent and provide with necessary
| medications for at least a year.
|
| [0] http://www.consultant.ru/document/cons_doc_LAW_107289
| /7e136d...
|
| [1] https://translate.google.com/translate?sl=auto&tl=en&
| u=http:...
| ddingus wrote:
| Thanks!
|
| I hear about the EU a lot. It is nice to get some
| perspective from your part of the world.
|
| Cheers
| Darmody wrote:
| Not sure about Russia but where universal healthcare
| exists, you don't lose acces to it when you don't
| work/pay.
|
| They go do the doctor as they would normally do and when
| they start working again they'll start paying their
| share.
|
| That's how it is in Spain. Also if you don't work, you
| don't pay the drugs, at least some of them. But the
| subsidized part of the price depends on your income.
| ddingus wrote:
| Looks like Russia covers a year solid for unemployed
| people.
|
| See reply above.
| gdy wrote:
| Oh, no, sorry, it's the same for everyone. I meant a year
| is how long they think one needs to use medication to
| avoid repetition of a heart attack, that was just an
| example. If one needs further help, one will get it.
| dsaavy wrote:
| For anyone who sees this, the $25 vial is for Novolin R,
| which has a longer absorption rate than modern analog
| insulins. It's a great option for people on low-carb diets or
| those who have food absorption problems since you have more
| time to react to lows and it matches slower absorption of
| proteins and high fat meals if you don't have an insulin pump
| that can handle that type of meal for you.
|
| But there's also a new release from Walmart for an analog
| insulin was just announced a few weeks ago! It's a Novolog
| equivalent and what many people are using today with insulin
| pumps and diets that have fast absorbing carbs:
| https://corporate.walmart.com/newsroom/2021/06/29/walmart-
| re...
|
| The vials are around $70ish US dollars and the pens are
| around $85ish. That's a wayyyy more affordable rate (50-75%
| less) than paying out of pocket for Novolog or Humalog. Also
| keep in mind that manufacturers also have programs to assist
| you with insulin costs if you can't afford it.
| elnatro wrote:
| The insulin Walmart sells is not the best insulin, and the
| chemical composition of the insulin is important. Not all
| insulins are the same, and no everyone reacts the same to all
| insulin types.
|
| That's not "a meme", a bad type of insulin can kill you or
| send you to the hospital.
| RHSeeger wrote:
| The $25 type is of the R/N/L variety. The thing that sends
| you to the hospital with that type isn't it being "bad",
| it's ignorance. You need to be aware of the effectiveness
| curve (or whatever it's called) and take it / eat correctly
| based on that. It's not hard, it's just far less convenient
| then more recent insulins.
|
| It's also a good idea to keep a sugar source available in
| case you can't keep food down for the amount of insulin you
| took (ie, you suddenly get nauseous after taking your
| insulin); which is also true of newer insulins, just less
| likely because there's less delay between taking it and
| eating.
| unglaublich wrote:
| "Diabetic friend had trouble finding his preferred
| formulation outside the U.S." In European countries, there
| are about 20 formulations available, all well below 10 USD
| per vial of which 100% is compensated by the obligatory
| health-insurance. There is no market for marginal improved,
| extremely overpriced medicine outside of pharma-marketing
| heavens.
| gdy wrote:
| "There is no market for marginal improved, extremely
| overpriced medicine outside of pharma-marketing heavens."
|
| There is, in Russia for example. But the most expensive I
| could find (Tresiba) costs 12 usd per cartridge (3ml x 100
| units) [0].
|
| [0] https://apteka.ru/product/tresiba-
| flekstach-609a3db8c93e31dd...
| JumpCrisscross wrote:
| > _is no market for marginal improved, extremely overpriced
| medicine outside of pharma-marketing heavens_
|
| I am sure someone could have said that about the twenty-odd
| formulations you mention when _they_ were novel and not yet
| manufactured at scale.
| andi999 wrote:
| How many vials per day or month does a typical diabetic
| person need?
| terminalcommand wrote:
| 1ml has 100 units. You basically take your weight in kg in
| units per day. However if you are overweight or sick you
| need more because of insulin resistance.
|
| One pen has 3ml in it. So if you weigh 70 kg, you go
| through one vial in 3-4 days.
| andi999 wrote:
| So approx 250$ per month, which is a lot of money, but
| are people really considering to save on that and inject
| some backstreet cooked stuff?
| terminalcommand wrote:
| 250 USD per month at the minimum. You also need to
| purchase blood sugar test strips which also cost a
| considerable amount. You need to check BG levels at least
| 4-5 times a day (usually you check much frequenter than
| that).
|
| People are willing to forego doses, reduce their
| nutrition to pay less. There are diabetics who die
| because they were trying limit their doses.
|
| People also use Walmart insulin (insulin R), which us
| much much shittier than the modern insulins (fast acting
| insulins). It is much harder to control blood sugars with
| insulin R, because it's onset and clearing out levels are
| very long and inconsistent. You need to inject before you
| eat a meal, wait an hour, hope you don't get low and eat.
| You can survive on them but it's much harder.
|
| People also use expired insulin (me included), because it
| doesn't expire 100%, its effects get less over time.
| People use second hand medical devices (insulin pumps),
| fix them themselves (because its out of warranty and they
| can't afford a new one), mod the devices by flashing open
| firmware so that they can do looping. Diabetics are used
| to gamble with their lives, because the pharma companies
| don't have our backs.
|
| The real issue with diabetes is that you somehow survive,
| but if you don't have access to modern technology, you
| feel sick all the time because of ups and downs and you
| are much more susceptible to complications.
|
| As a diabetic, you feel like a ticking time bomb.
|
| People would definitely be willing to inject some
| backstreet cooked stuff. It's a life or death kindof
| thing. As a diabetic you leave so much things to chance
| that you probably simply won't care. Me at least, I am
| trying to survive, if I can't afford insulin and the only
| option I have is to use shitty insulin I'll take the
| chance. If I die, I die. Because I'll definitely die
| horribly if I don't take insulin.
| cartoonworld wrote:
| I worked with a guy with diabetes. Hes about to retire
| around now.
|
| The company we were working for was acquired by a VC
| backed larger entity who offered much less in terms of
| benefits. His out out pocket expenses increased quite a
| bit as the new entity self-insured and even the best
| health plan had really high deductibles and the coverage
| was not great even after that. IIRC it covered like
| 60-80%, its a bit foggy because I could basically never
| use it.
|
| He was using blood test strips and injecting insulin
| because it was the only thing that fit in his budget. We
| talked about it very occasionally, I asked him if he
| could get the electronic insulin thing that attaches to
| your arm and talks to your iPhone, and he told me about
| the coverage and costs and he really couldn't swing the
| out of pocket.
|
| This guy was pretty advanced in years and had controlled
| his diabetes pretty well, but I saw the inconvenience and
| sometimes normal forgetfulness affect him often. His mood
| would be unpleasant at times, and I could see that he was
| often not feeling ok. Eventually, his doctor had an old
| tamagotchi looking leftover electronic blood sugar
| monitor that he ended up giving him for free, I guess it
| was old enough it wasn't going anywhere. His doctor
| thought the diabetes could be better controlled and took
| it upon himself to try to get him to upgrade his quality
| of life.
|
| He used that for a while and it was a bit janky but
| worked, I noticed his mood and demeanor improve quite a
| bit for a few months, this also improved our work, but he
| stopped using that because there was some upkeep on it
| that was also not covered in our plan. So he went back to
| the blood-finger-strips.
|
| I felt pretty bad about this situation, this dude was
| stuck in a job that even I hated (and quit, nowadays I
| have BCBS from an actually good organization) because the
| old, acquired company had a really good deal: Employee
| Ownership. When the firm acquired and consolidated that
| company, they took on the employee ownership agreement.
| This was a huge chunk of this man's retirement, but the
| new deal required him to stay on in order to claim the
| benefits he had been planning on retiring with for 25
| years.
|
| He could definitely have quit and made more money with
| better benefits, but he would have lost his retirement
| strategy.
| terminalcommand wrote:
| It was the same with me. I couldn't afford a continuous
| glucose monitor. I was checking my blood sugar 10+ times
| a day, because I was having hypoglycemia anxiety.
|
| Even after I got a job and starting earning money, I
| hesitated getting a continuous glucose monitor because it
| costed so much. I was using the cheapest glucose meter
| that tested with blood, because the strips were cheap. It
| turned out that machine was inaccurate and my diabetes
| nurse gifted me a better glucometre.
|
| I recently was able to switch to a continuous glucose
| monitor (the tamagochi type thing) and things got much
| better.
| heavyset_go wrote:
| Stories like these are nightmare fuel. Hope he's doing
| well, now.
| cpwright wrote:
| A vial and a pen are different. A vial has 10 units. I
| use between 1 and 2 vials a month. I weigh 70kg, I use
| about 40-50 units a day via pump [which is more efficient
| than a pen]. My prescription co-pay is $10 for the two
| vials of Humalog [a 30 day supply].
| kube-system wrote:
| It's important to make a distinction between "socialized" care,
| "free" care, and "universal" care. A healthcare plan that is
| described by one of those terms is not necessarily described by
| all of them (even outside of the US)
|
| The US has a large number of socialized healthcare programs,
| several free healthcare programs, but nothing that is 100%
| universal. Americans don't have any reservations about paying
| for healthcare for the poor, elderly, veterans, etc. People in
| the US generally hate the idea of anyone qualifying who makes
| more money than they do, which is one of the reasons why
| universal plans don't go over well. The other reason is that a
| truly universal plan would probably uproot the existing health
| insurance system, which scares some people who are satisfied
| with the status quo.
|
| Our existing systems are mainly a result of compromise:
|
| > "let's have a healthcare plan that covers everyone"
|
| > "you want to tax the working class American to pay for
| healthcare for the rich? And bankrupt they insurance companies
| that insure our middle class? And kill jobs?"
|
| > "ok, let's compromise. Let's make a plan that covers [insert
| group of people that voters will feel sorry for]"
|
| And repeat about every decade or so.
|
| That's how America's fragmented healthcare system was born.
| tobyhinloopen wrote:
| Note that EU healthcare isn't perfect either. For example, in
| the Netherlands, many diabetic care products offered by
| national healthcare is of the cheapest kind. My wife had these
| things that shoot a needle for a droplet of blood, and they
| were awful and crude, usually leaving a much larger hole than
| needed. She just bought her own to avoid having holes in her
| fingers. There's also that thing you can put on your arm and
| read your blood sugar which is a great invention, but guess
| what: you have to pay for it yourself.
|
| The "free" healthcare is great, but it's not free comfortable
| healthcare.
|
| IIRC the expensive insulin is the comfortable kind, that works
| better. The cheap insulin Americans can buy is the
| uncomfortable kind.
| cartoonworld wrote:
| I know so many people who are or have been walking around
| with health conditions they either can't, don't think they
| can, or are literally afraid to fix because they don't want
| to ruin their family's financial prospects or go bankrupt.
|
| Most recently, I ran into an old acquaintance with a back
| problem that sounds like a slipped disc, and this poor dude
| doesn't have the coverage to get the surgery and treatments
| needed not to be in constant pain all day.
|
| Hey, maybe he's wrong and its a $300 quick fix, but he's
| walking around with the free uncomfortable treatment we have
| in America.
|
| Personally, I think healthcare is worth it. We should just
| pay for it and reap the incalculable benefits of a more
| effective society that is much less burdened by disease and
| chronic injury.
| Popegaf wrote:
| There probably are, but with a First Past The Post / Winner
| Takes All system, it's really hard to get it introduced.
|
| Politically, one would require a majority of voters in BOTH
| parties to want socialized healthcare, due to the division of
| powers, gerrymandering, the broken presidential election
| system, and so on. You could have 70% of the population being
| pro-socialized healthcare, but if the majority of those rest in
| one party and in certain regions, there still wouldn't be
| enough to get the majority in the house AND senate.
|
| If other things are more important, voters might even be for
| it, but not even show up to the polls or vote for candidates
| that are all about that issue, because some other, bigger issue
| (in the eyes of the voters) needs to be addressed.
|
| Climate change is a good example in Europe. Depending on
| country, you can get the majority of people who say they care
| about it, but come election time they will:
|
| - vote for a populist party that doesn't give two farts about
| it
|
| - vote for the old, "stable" option that is closer to their
| core values but never actually does anything about climate
| change
|
| - decide not to vote at all for whatever reason
|
| The minority actually votes for a green party. That might
| slowly be changing, but change doesn't come quickly from within
| unless forced (COVID being a good example).
| freemint wrote:
| To be fair it's uncommon that any party get's the majority of
| votes in Europe and for example the German green party this
| election cycle is going take >2x of the votes they did last
| round hovering around 20%.
| lovemenot wrote:
| >> but change doesn't come quickly from within unless forced
|
| Yes. In Britain (and I suppose in mainland Europe too) the
| jolt came at the end of World War II.
|
| Society in general - and returning service-people in
| particular - refused to accept the status quo ante.
|
| Supported by our American friends' economic largesse / self-
| interest, there emerged a social and geo-political
| revolution.
|
| In that moment, amongst many other societal improvements, the
| NHS and decolonisation became firmly established.
| hythyt wrote:
| why is comment this downvoted?
| Kosirich wrote:
| Perhaps because it makes an bad faith statement/argument
| using the standard meme of "We in Europe are so advanced with
| our free health care vs. you Americans that have to (over)
| pay for everything" that is overused in any almost any
| discussion about healthcare cost on HN by some Europeans.
| antman wrote:
| Pointing out that it addresses a artificially created
| political problem is unpleasant but hardly be classified as
| a "bad faith statement".
| [deleted]
| elnatro wrote:
| Well, it's not that we (Europeans) are "advanced". It's
| more that having a socialized healthcare program is common
| sense for us. A for-profit company cannot be left in charge
| of treating patients as there are few patients that could
| need expensive treatments. No company would want to treat
| this people.
|
| Other point I would like to make is that our healthcare is
| not "free". It's paid by high taxes be are obligated to pay
| to the government (the taxes are as high that I don't even
| want to know the exact amount in my case but is around
| 25-30% of my salary).
| lbruder wrote:
| As a concrete example, German programmer here. 16% of my
| income go to taxes, another 12% go to mandatory
| insurances (excluding healthcare), and about 6% go to
| health insurance. So about a third of my income goes to
| mandatory stuff and taxes, but when my son broke his arm
| in the schoolyard, the treatment was completely free for
| us. Not sure how those numbers transfer to the US,
| though.
| igorzx31 wrote:
| You would have paid less in taxes and it would have been
| free besides maybe a small ish deductible although you
| typically hit that through doctors appointments, drugs
| etc. The people who are screwed by the american system
| are the poor people make too much for medicaid. Everybody
| else generally likes their insurance.
| LadyCailin wrote:
| The thing is though, taxes in the US aren't any lower, if
| you include healthcare premiums as "tax", at least for
| middle class people.
| refurb wrote:
| Depends where.
| vimacs2 wrote:
| I wonder how well would things turn out if people were
| given the choice to opt out of public healthcare. You
| don't get taxed on it but also cannot use it (except in
| ER situations obviously).
|
| I'd imagine that most people would stay signed on but it
| does give people who either distrust public institutions
| or just don't feel like they would benefit from a public
| option a choice.
|
| Full disclosure: I am firmly on the side of socialised
| medicine.
| peytn wrote:
| We have public hospitals already. People happily opt out.
| They'd opt out even harder if there was a tax break.
| vimacs2 wrote:
| Yes but that's not really the same thing as real
| nationwide public healthcare. Going by my experiences in
| the UK at least, people tend to have a lot of pride with
| them even if they also will complain about issues with
| it.
|
| It's considered political suicide to even openly discuss
| dismantling the NHS which is why even the Tories continue
| to tip toe around the issue even after having been in
| control of government for more than a decade at this
| point.
| [deleted]
| sbuk wrote:
| Initially, I had the same thought, then it (embarrassingly)
| struck me that this could help people across the globe that
| don't have access to inulin. It's an amazing initiative that I
| will donate to, but it genuinely disgust me that it had to come
| to this. The greed involved by the global healthcare industry
| that led to someone having to create this project is
| unconscionable.
| talhof8 wrote:
| Bio-hackers doesn't resonate well with me.
| jhon_smith12 wrote:
| Thanks for sharing https://www.couponsexperts.com/
| onion2k wrote:
| I'd be willing to bet that any open source alternative approach
| to insulin manufacturing that gets any traction would have drug
| companies quickly lobbying governments to license insulin
| production, or they'd launch ads campaigns about the dangers of
| "socialist insulin", or something. They'll do their best to kill
| off the competition no matter what.
|
| Insulin is _cheap_ to manufacture. Around the world in countries
| that have regulated drug pricing it 's also cheap to buy. The
| best (as in proven-to-work) way to reduce the price in places
| where it's expensive is to stop drug companies charging whatever
| they want.
| tnecio wrote:
| One thing I don't understand is, what is preventing anyone from
| just starting a new factory or importing insulin from abroad to
| sell it cheaper than the competitors?
| sverhagen wrote:
| Rules and regulations? It's not a food supplement, insuline
| is injected, I imagine governments having opinions?
| Shaddox wrote:
| It has been tried before. What happened is that the
| established players will start giving it away for free until
| you are out of business.
| pineaux wrote:
| Because it's illegal. America has protectionist policies for
| their big pharma.
| shadilay wrote:
| Regulatory capture.
| GravitasFailure wrote:
| One of the huge problems with making generic drugs is that
| you need to demonstrate that your drug does the same thing as
| the real deal, which isn't as expensive as phase I, II, and
| III trials for bringing a completely new product to market,
| but it isn't cheap, fast, or easy. Likewise, setting up
| proper facilities to manufacture your product isn't cheap,
| either.
|
| https://www.fda.gov/drugs/news-events-human-drugs/generic-
| dr...
| mrweasel wrote:
| Walmart sells an older Novo Nordisk insulin rather cheaply. The
| question is: Is it cheap enough?
|
| It's still $75 per vial and depending on how poor you are that
| might still be to expensive.
|
| The cheap insulin is also harder to regulate for the user. If
| you're poor, you might also have other issues which prevents
| you from correctly medicating yourself. I don't really see that
| an Open Source insulin would help anyone who can't already
| afford the cheapest commercial version.
| refurb wrote:
| I'm not sure what this is hoping to accomplish. Coming up with a
| lab method to make insulin is about 5% of the way to providing
| actual insulin for patients.
|
| You'd still need to: 1) develop a scaleable process [pilot
| plant], 2) have a robust enough analytical process to make sure
| you're not killing anyone, 3) have a reproducible process so that
| each dose is the same.
| freemint wrote:
| If the choice is between people dying due to lack of insulin or
| not people will take an untested insulin.
| refurb wrote:
| This isn't going to produce any insulin. You need equipment
| and a sterile fill line.
| tonyedgecombe wrote:
| The drug companies selling generics manage to do all that for a
| low price.
| refurb wrote:
| Because they millions and millions of vials. The cost of a
| factory isn't that much when spread out across that much
| volume.
| dalbasal wrote:
| Linux/GNU, Wikipedia, WorldWideWeb: these are existence proof, at
| meaningful scale/impact, for something...
|
| There's a qualitative difference between "open" efforts, and
| "conventional" organisation.. qualitative. Wikipedia, for
| example, co-exists concurrently with twitter, FB, news feeds and
| advertising-optimised ranking algorithms. Consider Wikipedia
| during the "truth crisis" era or whatever it is that social
| media's blooming has created. It _is_ affected, but there is way
| more dignity and resilience in wikipedia 's handling than
| Alphabet, FB, etc.
|
| Something similar is true of the web itself, email, etc.
| Whatsapp, even IG, snapchat or whatnot are more or less in the
| same realm as email. Email isn't without surveillance, lock in,
| spam or antipattern issues... but the protocol itself isn't a
| primary belligerent, as it is with proprietary messaging
| platforms like FB's.
|
| In any case, it's worth trying to export these examples to other
| realms.
| Gatsky wrote:
| Drug production is pretty difficult. Pharma companies are high
| tech clean room manufacturers who operate at very high quality
| standards and large scale, with a significant amount of embedded
| knowledge and experience acquired over many years. The incredibly
| rapid roll out of Covid vaccines for example is testament to
| that.
|
| Taking this into account, trying to develop sustainable and
| useful insulin production from scratch is 100% destined for
| failure, but good luck to them.
| Arch-TK wrote:
| So I keep hearing that there is cheap, patent unencumbered
| insulin in the US but nobody wants it because it's not as good as
| the more recently invented patented variants that are sold for a
| premium.
|
| Is this open source stuff just the same old patent unencumbered
| insulin that people apparently just don't want?
| badpenny wrote:
| Did they mention in what way it's not as good?
| steveklabnik wrote:
| It is significantly harder to use, and this is a situation
| where if you make a bad enough mistake, you die.
| Transitioning from one kind to another means you have to
| figure out how they're different, introducing situations
| where you can more easily make a mistake. It also means you
| have to test more, which means using more strips, which means
| more cost. Ideally you would be doing this with the help of
| your doctor, which means more visits, which means more cost.
| nradov wrote:
| Cheaper insulin would be nice, but we ought to put more focus on
| preventing and reversing type 2 diabetes. Virta health has had
| good results in using diet to put diabetes into remission,
| allowing patients to reduce or eliminate their need for insulin.
|
| https://www.virtahealth.com/blog/with-sustained-type-2-diabe...
| eiriklv wrote:
| How much of the insulin is used for type 1 vs type 2?
| shusaku wrote:
| Previous discussion:
| https://news.ycombinator.com/item?id=27661637
| goldcd wrote:
| Ah - was wondering why this seemed familiar.
|
| Here's the video from it -
| https://www.youtube.com/watch?v=63uqBBrHKTc&ab_channel=Freet...
| irthomasthomas wrote:
| I like the effort, but we could solve the problem better by
| attacking it from the other end. Stop ordering people to eat a
| high carb diet, and demand for insulin will dissolve.
| [deleted]
| KitDuncan wrote:
| People are actually reversing the effect of Type 2 diabetes
| with high-carb plant-based diets. Low-carb diets have been
| found to increase the risk of getting Type 2 diabetes.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/
| irthomasthomas wrote:
| Carbs are sugar strung together. They are quickly chopped up
| and metabolized, raising your blood sugar level. To maintain
| homeostasis the liver responds with a squirt of Insulin.
| Insulin signals to your fat cells to start storing the excess
| sugar, which would otherwise poison you by hyperglycemia.
|
| In a normal high fat/ low carb diet, you feel full after
| eating, and your blood sugar returns to normal. At this point
| your fat cells can release those sugars back to the blood
| stream (to prevent hypOglycemia). But with a low fat diet
| your body doesn't get enough vitamins and minerals (most of
| which are fat soluble and removed, or made indigestiable
| without fat) so you stay hungry. You are forced to eat more
| of this high sugar food, which keeps your blood sugar high
| and prevents your fat cells from completing the second part
| of the fat/glucose cycle. So your fat cells swell and divide,
| making you bigger, and the bigger you are, the more nutrients
| your body demands. The obesity epidemic began in 1980 when
| the USDA began dictating a high carb diet.
| sasoon wrote:
| Absolutely wrong
| KitDuncan wrote:
| great argument
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