Why treating diabetes keeps getting more expensive • Hacker News Board

Re: Why treating diabetes keeps getting more expensive

#51

Post by thousandautumns » Tue, Jan 23, 2018, 3:20 PM UTC

michaelmrose wrote: post #8

loverofthings wrote: post #6

Number of people suffering from diabetes has risen exponentially, demand goes up, so do the prices. It's going to stabilize as years go on.

Demand has gone up it hasn't risen exponentially. The manufacturers have colluded to raise the price. There is no reason for it to ever come down.

Demand absolutely has skyrocketed. When people think "diabetes" they think of fat people in the US and Europe. The reality is that China and India have developed some of the highest type 2 diabetes rates in the world over the course of the past few decades as their economies have grown and resulted in more overweight people. The two largest nations in the world developing major diabetes problems in a relatively short amount of time is going to have significant effects on demand.

Re: Why treating diabetes keeps getting more expensive

#52

Post by AjithAntony » Tue, Jan 23, 2018, 3:56 PM UTC

HarryHirsch wrote: post #19

Angostura wrote: post #12

Interesting, the response in the UK has been to address this by attempting to pump money into programmes to to try and prevent type 2 diabetes or at least reduce its growth. Still too early to see how these efforts will be.

The UK is the second-fattest country in Europe after Malta, and obesity (BMI > 30.0) puts you at risk for type-2 diabetes. It's a public health issue. Interestingly, the other thing that's a risk factor is lack of sleep. Huge commutes put you at risk for type-2 diabetes. Who'd have thought?

> obesity (BMI > 30.0) puts you at risk

BMI>23 if you are South asian

https://www.diabetes.co.uk/south-asian/

Re: Why treating diabetes keeps getting more expensive

#53

Post by ABCLAW » Tue, Jan 23, 2018, 4:13 PM UTC

shadowtree wrote: post #40

marvin wrote: post #35

Earlier quoted context omitted.

I always thought that when patents expire, a generics company will duplicate the drug (or treatment mechanism) and the prices will plummet to close to marginal cost due to competition. I get the impression that this happens in Europe, given the generic options that I am encouraged to choose when I’m picking up a prescription at the pharmacy. They are invariably cheaper. What is different for diabetes, or the United S…

Insulin is being “grown” genetically modified organisms in vats. It is not a simple molecule you get by mixing chemicals together. The very first application of the human genome project. The whole process of production is non-trivial, every step heavily patented and secured. Also pretty expensive. There are new biotechs currently working on CURING diabetes, but no one is doing trials on humans yet. Means we’re at lea…

The process for introducing an insulin-gene plasmid, then selecting for and breeding the resulting recombinant bacteria is 101 level biochemistry that a Masters student could do in almost any decently equipped laboratory.

Isolating the chemical on an industrial scale is where the difficulty comes in, but most of the equipment is fairly commoditized and it isn't prohibitively expensive or skill intensive. The marginal cost following the relatively inexpensive setup is exceptionally low, too - you feed the bugs, they make your drugs.

Insulin would be priced as a commodity if not for the IP, approval and distribution issues - small biotech suffers from very poor distribution networks.

Re: Why treating diabetes keeps getting more expensive

#54

Post by ABCLAW » Tue, Jan 23, 2018, 4:21 PM UTC

pja wrote: post #39

marvin wrote: post #35

Earlier quoted context omitted.

I always thought that when patents expire, a generics company will duplicate the drug (or treatment mechanism) and the prices will plummet to close to marginal cost due to competition. I get the impression that this happens in Europe, given the generic options that I am encouraged to choose when I’m picking up a prescription at the pharmacy. They are invariably cheaper. What is different for diabetes, or the United S…

Generics still require FDA approval, which costs on the order of single digit $millions to obtain. Plus you’ve got to set up the plant to create the drug, which costs more $. Would you invest $millions in a product when a competitor (who probably already has plant capacity from when they made the drug while it was under patent) could come in and undercut you at a moments notice? Obviously not - so the system ends up…

This is accurate for niche drugs, but the business model for producing generics isn't solely one in which small players exist.

Large omnibus generics manufacturers almost always have a larger industrial base and better chemical engineers than one-off drug producers. If the drug has a fairly stable high volume demand, they can finance expenditures for approval, then leverage their production and distribution networks to produce substantial margin even if they dramatically slash prices.

Re: Why treating diabetes keeps getting more expensive

#55

Post by shadowtree » Tue, Jan 23, 2018, 4:22 PM UTC

ABCLAW wrote: post #53

shadowtree wrote: post #40

Earlier quoted context omitted.

Insulin is being “grown” genetically modified organisms in vats. It is not a simple molecule you get by mixing chemicals together. The very first application of the human genome project. The whole process of production is non-trivial, every step heavily patented and secured. Also pretty expensive. There are new biotechs currently working on CURING diabetes, but no one is doing trials on humans yet. Means we’re at lea…

The process for introducing an insulin-gene plasmid, then selecting for and breeding the resulting recombinant bacteria is 101 level biochemistry that a Masters student could do in almost any decently equipped laboratory. Isolating the chemical on an industrial scale is where the difficulty comes in, but most of the equipment is fairly commoditized and it isn't prohibitively expensive or skill intensive. The marginal…

what was groundbreaking 25 years ago is now 101 biochem.

progress!

Re: Why treating diabetes keeps getting more expensive

#56

Post by tsomctl » Tue, Jan 23, 2018, 5:18 PM UTC

Kayou wrote: post #22

bruxis wrote: post #21

Earlier quoted context omitted.

Just to add a bit of a positive spin on this: even type-1 diabetics could take measures to both improve their health and reduce the amount of insulin they require. I consider myself moderately overweight at this point (maybe 10-15kg). If I lost weight, I could reduce the baseline amount of insulin I need every day, thus reducing the amount of insulin overall that I need to pay for. I also fully acknowledge that, upon…

You still need to have carbs in your diet, it wouldn't be healthy otherwise. Especially if you practice a sport. I eat whatever I want (mostly pasta usually) and I need 20 units a day at most. (100 units/ml dosage).

No you don't.

Source: The Art and Science of Low Carbohydrate Performance by Phinney and Volek

Re: Why treating diabetes keeps getting more expensive

#57

Post by IdeaHamstir » Tue, Jan 23, 2018, 5:20 PM UTC

I am not sure if any of these programs are still around, but older, generic forms of insulin are available for free or greatly reduced price at many pharmacies to qualified applicants.

http://www.needymeds.org/ Is a non-profit group that helps provide free/low cost meds.

Many pharmacies listed offer free/reduced price insulin. http://www.freediabetestestsupplies.com/free-diabetes-medica...

Re: Why treating diabetes keeps getting more expensive

#58

Post by Zimahl » Tue, Jan 23, 2018, 7:25 PM UTC

glassesquestion wrote: post #37

From the article: > There have been few efforts to create a cheaper insulin. Walmart, for instance, sells Novo Nordisk's human insulin under the name ReliOn for $25 a vial. Eli Lilly is expected to release the first copycat insulin analog, a chemically altered form of insulin, at the end of this year. You can buy this product right now, it is the same formulation you would have taken if you were diabetic in the 1990s…

As the husband of a type-1 wife, I just wanted to add that there is a difference in insulin that isn't just long-acting or short-acting. Different people can react differently to different insulins. My wife used the ReliOn brand for both for a while, and even though the short-acting was fine, the long-acting was way too inconsistent (some very non-deterministic lows and highs). Switching to Levemir long-acting smoothed those out.

That said, nothing inherently wrong with the ReliOn brand if that's all one can afford. My wife forgot her short-acting insulin for a long weekend trip one time and it was nice to know what we could simply buy some insulin out of pocket and not get gouged to death.

> am amazed by how many diabetics and GPs don't know this exists.

I've noticed that GPs don't know enough about diabetes, one needs a specialist to really get control of it.

Re: Why treating diabetes keeps getting more expensive

#59

Post by alan-crowe » Wed, Jan 24, 2018, 12:50 AM UTC

loverofthings wrote: post #6

Number of people suffering from diabetes has risen exponentially, demand goes up, so do the prices. It's going to stabilize as years go on.

One expects prices to always rise in response to increased demand in the short term. One might call that the short term inelasticity of supply due to economic inertia; it simply takes time to ramp up production.

But what of the long term? With products such as food, one expects that the best land is already in production, so increasing supply will require bringing marginal land into use, at higher cost. Supply is inelastic and prices rise. Similarly for minerals. One is usually mining the richest ores. To increase supply one has to spend more freely refining lower grade ores.

There are no such constraints for producing insulin in medicinal quantities. The supply should be completely elastic, with the result that prices do not rise.

Re: Why treating diabetes keeps getting more expensive

#60

Post by heavenlyhash » Wed, Jan 24, 2018, 4:48 PM UTC

shadowtree wrote: post #55

ABCLAW wrote: post #53

Earlier quoted context omitted.

The process for introducing an insulin-gene plasmid, then selecting for and breeding the resulting recombinant bacteria is 101 level biochemistry that a Masters student could do in almost any decently equipped laboratory. Isolating the chemical on an industrial scale is where the difficulty comes in, but most of the equipment is fairly commoditized and it isn't prohibitively expensive or skill intensive. The marginal…

what was groundbreaking 25 years ago is now 101 biochem. progress!

Which is why it's very confusing that products with such an utterly trivial production pipeline are remaining so expensive -- to say nothing of growing in cost over the years.