Biohackers take aim at big pharma’s stranglehold on insulin • Hacker News Board

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#371

Post by RHSeeger » Tue, Jun 29, 2021, 2:32 PM UTC

mikeproctor wrote: post #368

mgarfias wrote: post #253

Earlier quoted context omitted.

I keep on trying to get one, but being well controlled, the ins cos won't approve it. And its pretty spendy out of pocket. My biggest use case would be an alert that my glucose levels are tanking while exercising so I can do something about it before I drop out. I find myself not doing things like long bike rides that I'd really like to do because of it.

You should be able to get the Libre 14 day sensors for about $120/per month (2 sensors) without insurance. I've been using it for about a year and it has been a huge game changer for me. I've been on insulin for about 23 years. The Libre doesn't have alerts but being able to tap your phone to your arm to test your glucose makes a big difference in how you test/monitor even without alerts.

The alerts (of the G6) are certainly desirable (amazing). But, as mike notes, even just being able to check your glucose with 0 effort... just changes everything. You wind up checking it so often that it's more than just checking it, you get more of a feel for how your body is reacting to your food/activity/etc. I can't say enough positive things about it.

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#372

Post by cestith » Tue, Jun 29, 2021, 2:41 PM UTC

sparrish wrote: post #181

cestith wrote: post #124

Earlier quoted context omitted.

Patient outcomes for the insulin aspart pens and the vials of generic insulin at Walmart are so different that many doctors refuse to prescribe the cheap stuff except as a very last resort. There's no simply substituting. These are two different brands of a generic statin pill or something. Although it's all insulin, these are very different drugs. The dosages for the same insulin in the same patient can vary, and th…

Novolin is available as a pen without prescription. Costs a bit more ($45 for 5 pens).

That fixes the pen issue, but it's still not the same insulin most doctors prescribe and can't be easily substituted without medical consultation. Having it available inexpensively and without a prescription is a compromise, per Novo Nordisk themselves.

https://khn.org/news/you-can-buy-insulin-without-a-prescript...

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#373

Post by Natsu » Tue, Jun 29, 2021, 3:14 PM UTC

tashi wrote: post #367

eganp wrote: post #360

Earlier quoted context omitted.

Unfortunately this is pretty accurate. Pharmacy Benefit Managers (PBMs) are contracted by insurers to set the formulary, in effect the list of drugs the insurer will pay for. They negotiate to lower drug costs, usually via manufacturer rebates. Where this is perverted, is that the PBMs have complex compensation schedules wherein they receive a percentage of drug rebates . Their goal is to secure the largest rebate po…

All these complicated incentives make it hard to figure out who's responsible, so let me ask a question: What if a manufacturer lowered the price of insulin to $10 a month and gave no rebates at all? Would insurance companies refuse to cover it and pharmacies refuse to carry it?

I think the problem is that this isn't in either of their interests. The insurers benefit from high prices because it scares people into staying insured and, IIRC, the laws limit the percentage of their profits, so a percentage of a higher number means more profit. The drug companies more obviously benefit from high prices.

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#374

Post by shkkmo » Tue, Jun 29, 2021, 4:02 PM UTC

incompatible wrote: post #319

shkkmo wrote: post #246

Earlier quoted context omitted.

Those econmies of scale are simply driving up profits for an oligopoly that uses IP laws and acquisitions to extract maximum value from sick people. We could revoke the IP and thus force these companies to compete on price... but that hasn't happened. Thus the only solution that is making any progress is circumventing the IP and developing an open process.

It's unclear to me if the lack of competition is due to IP laws. For all I know, they've been coasting with the same production methods for 20+ years (the article mentions that insulin was relatively cheap in 2002). With such large profit margins there wouldn't be much incentive to improve anything.

I don't know the exact details and I could be wrong, but my understanding is:

There is IP around the production process (specifically the genetic strain of e-coli). Because the production process is biological, generics produced with a different process are not automatically approved by the FDA and have to undergo an expensive approval process. Thus the goal here is to devolop a process with open IP and get that process approved.

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#375

Post by deeviant » Tue, Jun 29, 2021, 4:23 PM UTC

handmodel wrote: post #292

JumpCrisscross wrote: post #174

Earlier quoted context omitted.

> Wall Street Smart Genius types have long held that curing disease is bad business, managing symptoms over the entire lifetime allows them to extract more capital out of the cattle Nobody tell the multibillion dollar biotech industry… And in case it needs to be pointed out, no, cures are massively profitable. If someone has a cure for a presently untreatable disease you will get money, you will make money, everyone…

I would argue the vaccine for Covid is essentially a cure. And the economics aren't that good. People got it once. They may or may not take a booster every couple years. And that is for a disease that everyone was impacted from. Meanwhile, a drug like viagra can be consumed several times a week for decades. I don't think its pharma execs are sitting their blocking cures, but it is true that they will looks at risk/re…

> And the economics aren't that good.

I'm going to need see some numbers on this statement. Because from where I'm sitting, the potential market is every human on planet earth, which is a pretty large amount of sales.

Production costs of mRNA vaccines, as well, is quite low, with much of the cost spent so far spent on scaling.

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#376

Post by deeviant » Tue, Jun 29, 2021, 4:24 PM UTC

refurb wrote: post #296

wizzwizz4 wrote: post #97

Earlier quoted context omitted.

Grants and government funding, mostly. But then companies get patent monopolies on production because… reasons.

That’s not true in the least. It’s mostly private investment.

Please do share the numbers backing up your naked statement.

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#377

Post by deeviant » Tue, Jun 29, 2021, 4:31 PM UTC

nceqs3 wrote: post #88

lotsofpulp wrote: post #35

Earlier quoted context omitted.

I wonder how the Hep C cures, COVID vaccines, shingles vaccine, HPV vaccines, and other cures got funding over the past 2 decades.

People love to bash big pharma, until they get cancer...

Then they get a cancer treatment, that was likely partially funded by the government via grant or tax benefit or medicare graft but fully owned by the private company, they are charged tens of thousands if not hundreds of thousands of dollars even though they have insurance, then mostly die anyways, because although cancer treatments are much better, they are still in the stone age.

And their family than learns who actually funds cancer research: they do.

It's funny because your statement was supposed to support the idea pharma only do good things but instead it exactly shows the failure mode of capitalism in medicine: when you get sick, its very often that you do not have the time or capacity to be a informed consumer and the entire premise of capitalism breaks down.

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#378

Post by dv_dt » Tue, Jun 29, 2021, 4:59 PM UTC

api wrote: post #365

dv_dt wrote: post #189

Earlier quoted context omitted.

My point is that it's seems a little optimistic to think that a free market for healthcare is an adequate solution, given that no free market healthcare system exists anywhere at scale. I think some markets are simply inappropriate for free markets - particularly one where services are by definition specialized and market feedback involves failures in critical life risking situations.

The parent was fairly pointing out that healthcare in the US is not a free market. For one there is zero price transparency let alone competition. For another there is the insurance industry which is both heavily regulated and state backed. Health insurer market is similar to the wired ISP market. We don’t really know what a true free market would do with modern healthcare because as you say there is no such thing. P…

We already know the answer to this because free markets really don’t provide the poor with shelter or food or any other critical support.

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#379

Post by AstralStorm » Tue, Jun 29, 2021, 5:18 PM UTC

There is no stranglehold. It's being manufactured for peanuts everywhere that is not USA.

That country suffers from no central negotiating body to drive down the price, and a manufacturer/insurer virtual cartel. In other countries, government either negotiated a good price, built or subsidized a quality factory.

The remaining people who have problems are in parts of global south for various reasons, some of which involve exploitation and others bad government or warfare, leading to lack of resources and experts.

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#380

Post by silexia » Tue, Jun 29, 2021, 8:04 PM UTC

The real fundamental problem here is very easy to fix. We need to completely eliminate patents from our legal system. Doing so would fix the problem with insulin, as well as the problems with every other drug and with software and with tractors not being repairable and many other areas.