The Diabetes Economy

pill_dia1

Insulin, first discovered in 1921, revolutionized the treatment of type 1 diabetes. Dr. Banting licensed insulin to pharmaceutical companies without a patent because he believed that this life saving drug for T1D should be made available to everybody who needed it.

So, why is insulin so hard to afford today?

Only three pharmaceutical companies manufacture insulin in the United States – Eli Lilly, Sanofi and Novo Nordisk. In 2012, it is estimated that insulin alone cost the US health care system $6 billion. How can they make so much money from a century old product? In 2013, according to firecepharma.com, the best selling drug for diabetes was…. Lantus, a long acting form of insulin.

So, after all the research of the past 95 years, the biggest money-makin’, mama-shakin’ drug was insulin? Yes, sir. Worldwide, this drug alone made $7.592 billion. That’s billion with a B. Oh, but the news gets better for Big Insulin. Out of the top ten, various insulins also ranked #3, 4, 6,7,9, and 10. Holy patent extensions Batman! A full seven of the top ten drugs for diabetes are insulin – a drug close to a century old. It’s like your 95 year old grandfather beating LeBron James at basketball.

jason_slide2Tweaking the insulin molecule allows additional patents and cheaper generic medications can be kept at bay. That this clearly violates Dr. Banting’s original intention doesn’t matter.

There is no clear evidence that these newer insulins are any more effective than the old standards. While there are some theoretical benefits, the outcomes in T2D have only worsened even as these newer insulins became more widely prescribed.

Hiking prices is another lucrative technique. From 2010 to 2015, the price of newer insulins rose from 168- 325%. Without generic competition, there is clearly collusion between the companies to keep prices high. After all, shareholders must be kept happy and the CEO needs a private jet.

At the time of insulin’s discovery, T2D, while still relatively rare, had few treatments available. Metformin, the most powerful of the biguanide class of medications, was discovered shortly after insulin and described in the scientific literature in 1922. By 1929, its sugar lowering effect was noted in animal studies, but it was not until 1957 that it was first used in humans for the treatment of diabetes.

It entered the British National Formulary in 1958, and entered Canada in 1972. It was not FDA approved in the United States until 1994 due to concerns about lactic acidosis. It is now the most widely prescribed diabetes drug in the world.

The sulphonylurea drug class was discovered in 1942 were introduced in 1956 in Germany. By 1984, more powerful second generation SUs were introduced in the United States. These drugs stimulated the pancreas to release more insulin, which reduced blood sugars. There were many side effects, including severe hypoglycemia, but they did prove effective at lowering blood sugars. For decades, these two drug classes were the only oral medications available for the treatment of T2D.

jason_prevalence

Even while the number of blood pressure and cholesterol medications were exploding, the oral hypoglycaemic drug class was mired in a rut. There was simply no money to be made for drug companies. The numbers of patients were too small, and the benefits of these drugs were dubious. But things were soon to change.

In 1977, the Dietary Guidelines for Americans were introduced to an unsuspecting American public and dietary fat was public enemy #1. The subsequent high carbohydrate intake would have unintended consequences and the obesity epidemic soon bloomed. Following like a love-sick puppy was the epidemic of T2D.

In 1997, the American Diabetes Association lowered the blood sugar definition of type 2 diabetes, instantly rendering as many as 1.9 million more Americans as diabetic.

Pre-diabetes underwent a similar change in definition in 2003. This would label 25 million more Americans as pre-diabetic. With growing numbers, the business case for the development of diabetic medications changed completely. While there is broad consensus that pre-diabetes is best treated with lifestyle changes, advocacy groups soon embraced the notion of drug therapy.

The guidelines have been lowered so much that, by 2012, the prevalence of diabetes in American adults was 14.3% and prediabetes 38%, adding up to 52.3% of americans being either pre-diabetic or diabetic. This was now the new normal. It was more common to have pre-diabetes or diabetes than it was to have normal blood sugars. Diabetes is the new black.

By 1999, the diabetes economy was primed to boom. In 1999, rosiglitazone and pioglitazone were approved by the FDA for the treatment of T2D. They have subsequently fallen into disuse due to concerns about provoking heart disease and bladder cancer. But it hardly mattered. The dam had burst. From 2004- 2013, no less than thirty new diabetes drugs were brought to market.

By 2015 sales of diabetes drugs had reached $23 billion, more than the combined revenue of the National Football League, Major League Baseball, and the National Basketball Association. This was big time business.

While these drugs all lowered blood sugars, clinically important outcomes, such as reducing heart attacks or strokes, blindness, or other complications of the disease, were not improved. The entire diabetes industry revolved around reducing high blood sugars instead of actually helping patients. The disease was one of increased insulin resistance, yet treatments were based upon lowering blood sugars instead. We were treating symptoms, instead of the actual disease.

Follow the Money

In 2003 the American Diabetes Association changed the definition of pre-diabetes adding an additional 46 million adults to its ranks. In 2010, the definition was further broadened by the use of the Hgb A1C. Ostensibly to help with early diagnosis and treatment, it is perhaps no coincidence that 9 of 14 outside experts on this panel worked in various capacities with the giant pharmaceutical companies that made diabetes medications and stood to reap an unending stream of money.

While individual members were paid millions of dollars, the association itself reaped more than $7 million in 2004 from its pharmaceutical ‘partners’. By 2012, more than 50% of the American population would be considered either diabetic or pre-diabetic. Mission accomplished. Cha ching. The market for drug consumption had been created.

The conflicts of interest only get worse. In 2008, the American College of Endocrinology and the American Association of Clinical Endocrinologists released a joint statement about pre-diabetes encouraging physicians to consider drug treatment of high-risk patients despite the fact that no drug had been yet approved by the FDA.

Were these unbiased academics giving their honest opinions? Hardly. 13 of the 17 members on that panel were paid as speakers and consultants to diabetes drug companies.

By 2013, these ‘advocacy’ groups recommended drug treatment of pre-diabetes even more forcefully if lifestyle changes didn’t work. Altruistic? Hardly. That year, more than $8 million of Big Pharma’s money helped shape their positive opinion.

jason_screen

Thirteen of the 19 doctors on the panel that made the recommendation, including its chairman, were paid as consultants, speakers, or advisers to pharmaceutical companies that, surprise, surprise made diabetes drugs. Payments totaled $2.1 million since 2009.

While patients could no longer afford their insulin shots, there was plenty of cash for the diabetes associations. Fancy dinners? Check. Fancy trips? Check. Large cheque? Check.

The story would be completely different if these drugs actually helped patients in a meaningful way. In prediabetes, none of the current drugs are approved for use. The reason we don’t use them is because they are useless.

Diabetes screening has already been shown to be largely useless with the current crop of medications. We can all agree that T2D is a disease of high insulin resistance but the current crop of medications only treats high blood sugars.

T2D, at its very core, is a disease about too much sugar in the body, not just the blood. Yet most of our drugs, from metformin to insulin do not rid the body of that sugar. It only drives it from the blood and into the body. But if this sugar is toxic in the blood, why would it not be toxic inside the body?

We are only moving the sugar from somewhere we can see it (the blood) to somewhere we cannot (the body) and then pretending things are improved, but all the while knowing that we have not made a difference. Where lifestyle changes clearly improves health, drugs just as clearly do not.

Screening only leads to better outcomes if there is rational treatment. Since our treatment of pre-diabetes consists of ineffective drugs, early diagnosis is futile. But this inconvenient fact hardly matters to the big pharmaceuticals and their minions. As long as they controlled the diabetes associations, there was cash to be made.

This largely explains the reluctance of the world’s Diabetes Associations and endocrinologists to acknowledge the devastating truth – that insulin just doesn’t help patients over the long term. With so much cash on the table, who do you think funds all the research in the universities, pays for all the private school tuition, sponsors all the ‘diabetes’ events? Big Insulin. But the pied piper must be paid. The currency of repayment is blindness, organ failure, amputations, and death.

More About Diabetes

How to Reverse Your Diabetes

Videos

How to Reverse Diabetes Type 2 – Dr. Jason Fung
The Perfect Treatment for Weight Loss and Diabetes – Dr. Jason Fung
The 2 big lies of type 2 diabetes – Dr. Jason Fung
The Key to Obesity – Dr. Jason Fung

More with Dr. Fung

Dr. Fung has his own blog at intensivedietarymanagement.com. He is also active on Twitter.

His book The Obesity Code is available on Amazon.

The Obesity Code

11 comments

  1. Ian
    Fantasic!
  2. Alan
    Great article! For me personally, I would love to share this kind of article with others, but there is a still a degree of scepticism I find amongst friends and family whom often say "I'm not into conspiracy theories".

    I think it would be great to have references within articles like this on the DietDoctor website so that it can be shown that is is evidence based, rather than just opinion as this would go a long way to providing additional credibility to piece.

    Please keep them coming though :-)

  3. Jeroen
    @Alan "I'm not into conspiracy theories". You really start to wonder how this is all possible, right? Anyway, the book is a must read, I think.
  4. Dr. Jason Fung
    There's no actual conspiracy. Everything is out in the open. All the payments are disclosed - you just need to look for it. Conflicts of interest within guideline committee are full disclosed. People just ignore them and pretend they make no difference.
    Reply: #7
  5. S Marsland
    Outstanding article. Mind boggling that this information is out there for all to find, and yet, so many are not yet open to hearing it. Ignorance of these matters is becoming increasingly hazardous to our health. I am encouraged that there are more and more forward thinking doctors willing to expose the state of our so called "health" care systems around the world, often at potential risk to their own careers by speaking out against the establishment. Looking forward to reading The Obesity Code book, and to Jason's future work in this field, along with that of the other contributors to this valuable website.
  6. 1 comment removed
  7. Alan
    I agree it's all out there if you look for it (which I like doing). I was just trying to make the point that from my own experience, convincing others to look for it and appreciate the reality of how these companies operate / their actual motivation often needs a helping hand. That helping hand I think could in be in the form of a couple of references to spark their own investigations rather than them just saying "Hmm. Maybe". I'm meeting some old friends this weekend I've not seen in a while. I'll test this theory out on them to see how they react. :-)

    @Jeroen It truly is amazing and sad at the same time that people are kept in a state of reliance and false hope from these companies in some respects when there are better options that can potentially rid them of these ailments. To me it feels both criminal and immoral. Do you think some of them convince themselves that they are still helping so that sleep better at night?

    Please keep great articles like this coming. I really think they're great.

  8. Janet
    Article from Milwaukee newspaper investigative reporter and MedPage from Dec. 2014.
    Additional facts and studies supporting Dr Fung's article.

    Benefits of diabetes drugs dubious
    Pharmaceutical firms pay millions to disease's experts

    http://www.jsonline.com/watchdog/watchdogreports/effects-of-diabetes-...

  9. Stacy
    We don’t have a health care system, we have a disease maintenance system.

    Chronic illness is where the money's at.

    Thanks to Drs Fung and Eenfeldt and many others for exposing this corruption.

  10. Daci
    I had a friend some years ago who was obese and had t2 and the worse diet one could imagine.
    That being said,I got to watch her go from one useless drug to another and then to insulin and finally she died in her 50's.
    I agree "treatment" is useless and I see one of my long time friends now on the needle and the clock is ticking for him.
    I've tried to encourage him to go keto,but nope.
    Yeah,this is just disgusting.
  11. Lynn
    Daci, your post struck a nerve with me, and I thank you for it.

    I'm 56, diagnosed with T2 at age 39. After a couple of years with an apathetic primary internist, with my A1c continuing to climb, I found an internist who specializes in management of insulin resistance. He helped me reduce my A1c from 8 to close to 6, where it's pretty much remained through the years.

    He's also helped me lose over 50 pounds. From the beginning, he encouraged me to use either Atkins or South Beach. I've done them for short periods, but always gone back to the carbs.

    Now, I'm beginning to see some of the worrisome long term affects beginning to surface, even with my blood sugar levels mostly controlled. I recently had surgery on my left eye to treat diabetic retinopathy. I've lost enough hearing due to nerve damage that I require hearing aids. I'm beginning to have occasional jolts of neuropathy pain in my feet.

    In the meantime, just as you described with your friends, I watched my mother, her sister (my aunt), and my brother go from one med to another... my brother and aunt finally on insulin. My aunt ended up on kidney dialysis and died a couple of years later. My mom died after suffering several strokes. And my brother died most recently after diagnosis of congestive heart failure.

    I'm done with this! My husband just retired a year ago - we have an adorable 3 year-old granddaughter we now get to visit frequently and plans for lots of travel adventures. I have no intention of losing out on that just because I don't eat right. My own experiences with dietary changes have proven to me that it does indeed make a difference to my well being in multiple ways. Most recently, I've used the Anti-inflammatory Diet, developed by Dr. Andrew Wile, to lessen my pain from osteoarthritis. It's a small step from that to Keto, and I'm jumping! I don't want my daughters and granddaughter to watch me go the way of my mom, aunt, and brother.

    Thanks again for your post that reminded me how important this is!

  12. Marie
    People are so tempted by the drugs, which allow them to manage their disease without having to make substantive lifestyle changes. Maybe they've been told there is "no cure" so the best they can hope for is to manage their symptoms with medication. There seems to be a general belief in the medical community that people are unable/unwilling to stick with dietary protocols for more than a week. Maybe they're right - unless a person has a health epiphany, they may really believe they can't "live without" bread, sugar, etc. I'd like to believe doctors, individually, do try and steer their patients towards diet and lifestyle changes to deal with diabetes, obesity, and other diseases. But if a patient won't do their part and the Dr. sees them for 15 mins once a month, what other choice is there but to monitor symptoms and prescribe accordingly. Most people I meet, sick and well, have zero interest in dietary change. Just yesterday my dental hygienist told me, "I love my carbs", shaking her head - so she knows the carbs are unhealthy but she's "helpless" to do anything about it. I'm sure doctors get tired of hearing excuses. My own doctor was seemingly uninterested in diet but noticed I lost 50 lbs when I went in for my annual physical - I told him I followed a low carb/ketogenic diet and he perked right up and we had a long discussion about health and diet - it turned out he ate low carb himself and was interested in hearing about how someone takes control over their own health. Health is a personal journey - we need to educate ourselves and guide our own path - no one else has time or energy to do it for us.

Leave a reply

Reply to comment #0 by

Older posts