40M people with diabetes will be left without insulin by 2030, study predicts
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Madehow has a decent article on the history of insulin synthesis [1]. I don’t see any natural bottlenecks that would interfere with scaling the process.
A hybrid approach in the US has been fairly useful for orphan indications and, somewhat differently for vaccines, but of course jerks found ways to exploit that too. Still it points to a possibility.
But I favor a single utility making some small-molecule and biologic underserved drugs because of the economy of scale it could bring. A small NIH facility in some otherwise underserved part of the country could make a big difference at a relatively low cost.
Would you like to re-think whether it's possible to invent and develop important new things without immediate profit motive?
Government funding isn’t an alternative to the market; it’s a different kind of market partipant. Government funding competes with private investment, and government agencies compete with the private sector for talant, etc.
It's not that bad. Brewers developed the knowledge how to work with microorganisms centuries ago. Most antibiotics are biologics, and they are dirt-cheap. Insulin isn't monoclonal antibodies, it's grown in bacteria, in the simplest expression system, and how to isolate it from the fermentation batch is well-understood and involves no problematic steps.
I agree that France or Brazil are better candidates for this approach.
And this included something as simple as saline.
Manufacturing IV solutions is something that requires a clean room laboratory, with its own set of stringent requirements and doing it cost-efficient means doing it at scale.
Actually, don't, you'll probably injure yourself.
[1] https://www.npr.org/sections/health-shots/2018/09/06/6449359...
But the observable facts are that in the generics market there are only a few players, and profits in the generics market are low. If the economic theory can't explain that, it's the theory that is wrong.
What's happening inside the U.S. is harder to model. The patented versions of insulin are somewhat better than the generic ones. There might be insufficient incentives for people with health insurance to prefer the slightly inferior but much cheaper version. That leaves only those without insurance to pay for the generic, and that's not much of a market. As a biologic, insulin is expensive to make even the generic versions. And people who have no insurance probably have little ability to afford it.
Some links:
The Diabetes Code by Jason Fung: This is a best-selling book by a Canadian Nephrologist (care and treatment of kidney disease) that explains type 2 diabetes in detail and recommends diabetics switch to a low-carb diet.
Counterweight Plus low-calorie diet plan: This diet was run as part of a scientific trial and showed promising results for obese patients with type 2 diabetes. Nearly half of the 300 patients in the trial reversed their diabetes. Note: the diet was run under the supervision of medical professionals and is not suitable for everyone: https://www.nhs.uk/news/diabetes/radical-low-calorie-diet-ma...
The Truth about Carbs: this is a BBC documentary from earlier this year which is unfortunately no longer available to watch on the BBC website. It featured NHS doctors who ran a two-week low-carb diet plan with type 2 diabetic patients. All patients reported improvements to their health, but the most impressive result was a patient with type 2 diabetes for 17 years who was now in part-remission.
Here is a thorough write-up of the programme: https://www.diabetes.co.uk/in-depth/truth-about-carbs-bbc-1-...
A clip from the programme: https://www.youtube.com/watch?v=eKQWFJmCWZE
10 things you may not know about carbs: http://www.bbc.co.uk/programmes/articles/4DfZMpv7BYJ3kGXdHxd...
Just to re-iterate, the examples above all refer to types 2 diabetes, not type 1 diabetes.
Diet does not reverse changes in the pancreas that cause T2 diabetes.
Many products contain high amounts of "naturally" occurring sugar. The worst offenders here are various kinds of pressed fruit juice and other fruit products.
Aside from that, you also need to avoid starches. Bread, pasta, potatoes, etc. they all spike your insulin.
A couple of the 10+ year veterans are back to active management, but usually, you're done with insulin injections.
I don't think it's a counterpoint to the study, but rather to the ways the data will drive policy changes.
It's taboo to take the obesity problem seriously. https://en.wikipedia.org/wiki/Fat_acceptance_movement
It is phenomenal to see such a movement sprout up, as if a chunk of society decided to just give up. I couldn't imagine a serious, equivalent movement on the same scale for alcoholism and cigarette smoking, to cite a few examples. Yet the abuse of food is going to (or is already) cost us far more.
Endocrine system diseases need to be researched more and the general public needs more education on it. Sugar doesn't cause Type-I or Type-II diabetes as it seems many on the Internet believe. And being fat isn't the only way to develop Type II diabetes.
And as my mother says, "I'm not a diabetic, I'm a person who has a disease called diabetes."
I remember as a kid our family doctor straight up telling my parents that they were too fat and they needed to exercise and lose weight. I assume doctors still do this, as it's good health advice, but with "fat shaming" being a thing now, I'm sure that some are more hesitant.
60-80% of diabetes type II cases among westerners are assumed to be a consequence of obesity and related medical conditions.
It is correct that you don't have to be obese to get type-II, but being obese makes it much more likely.
Pre-diabetes can be reversed but once you have diabetes, it's permanent - until we figure out how to regenerate beta cells in the pancreas.
Can someone who has had their diabetes "reversed" via fasting then get normal glucose responses after eating sugar?
The N=1 study you cited states that the subject still needs to take Metformin. i.e., he still has diabetes.
http://care.diabetesjournals.org/content/34/Supplement_2/S36...
>It has been over 10 years since the resolution of type 2 diabetes was observed as an additional outcome of surgical treatment of morbid obesity. Moreover, it has been shown unequivocally that diabetes-related morbidity and mortality have declined significantly postoperatively, and this improvement in diabetes control is long lasting.
Why don’t we start telling diabetics the truth — your diet is broken and needs to be fixed; avoid most carbs, do strength training.
We don’t need more insulin to shove the massive onslaught of blood sugar from your crappy diet into your cells (which are telling you they’ve had enough, AKA insulin resistance), we need more honesty.
The healthcare industry is morally and intellectually bankrupt. All the honest people who got into it trying to make a real difference don’t stand a chance, the truth doesn’t survive for an instant in this corrupt industry more focused on how much they can get out of insurance companies than treating patients.
(The numbers in this article appear to be off).
And even though most type 2 diabetics aren’t (yet) on insulin, the advice they get does nothing but ensure they’ll be on insulin soon enough.
We already tell diabetics the "truth". In medical school, we're taught how to properly inform the patient in an unbiased, nonjudgmental way. It isn't up to the physician to force them to change their lifestyle, but instead for a mutual agreement to be made. Most people aren't able to change their lifestyle for a variety of reasons from being economically disadvantaged to lacking the knowledge of proper nutrition. It is not as simple "your diet is broken and needs to be fixed; avoid most carbs, do strength training.". I really wish it was.
https://medium.com/@drjasonfung/unf-yourself-type-2-diabetes...
It seems to be that these organizations are in the business of SICKcare, not HEALTHcare. It is much more profitable to keep people just a little sick (and dependent) than to cure them (which most diabetics are not even told is even a possibility).
> Why don’t we start telling diabetics the truth — your diet is broken and needs to be fixed; avoid most carbs, do strength training.
Yes, since no diabetic person has ever heard this advice before... as someone who is not diabetic but knows many people who are, every single person who is diabetic knows that diet and exercise will help them, yet they can't seem to get it sorted out. To me, this says knowledge and willpower are not the problem. Also, if someone has made it to the point where they are on insulin, their body is already pretty screwed up at that point and making these drastic lifestyle changes is going to be very very difficult (though not impossible). Regardless, we should have some more compassion for these folks - it is a very difficult disease to deal with and shitting on people for being sick is just mean, regardless of how they got there.
https://medium.com/@drjasonfung/unf-yourself-type-2-diabetes...
It seems to be that these organizations are in the business of SICKcare, not HEALTHcare. It is much more profitable to keep people just a little sick (and dependent) than to cure them (which most diabetics are not even told is even a possibility).
Humans evolved in an environment where there were no highly processed sugars or highly processed carbohydrates and where our long ago ancestors got daily exercise looking for food, building shelters, running or fighting predators and so on. The human body is optimized for a certain type of diet and a certain level of exercise. In addition to this, human beings evolved to crave sweet food and eating sweet food is an enjoyable experience. We know that eating highly processed carbohydrates or sweets leads insulin to rise more than eating other things and doing this repeatedly over time leads to fat accumulation, insulin resistance and diabetes.
Contrast with the world we live in today: sugary drinks and foods and processed carbs are everywhere. Many of us are required to sit all day (or at least be stationary, if not sitting) for our jobs. To get food today most of us either drive to the grocery store, drive to a restaurant, or have food delivered to our home. We don't build our own homes. We don't hunt. We don't fight off predators. There is very little that many of us have to do in modern life that requires exercise. Almost all exercise is optional.
Another thing to consider, is that the amount of stress we encounter in daily life has not gone down. If anything, at least in the developed world, we have ramped up the amount of stress that people experience on a daily basis in the past few decades. Stressful commutes, office politics, fighting the crowds while out shopping, constantly being prodded to compare yourself to everyone around you (i.e. social media) and poor sleep (and then overindulging in caffeine the next morning) are all parts of modern life. Consider that the stress response evolved in living things in order to get that living thing in to action, to flee or fight for its life. As it turns out, the physical activity that follows a stress response usually turns off the stress response.. but the times we find ourselves in stressful situations often do not offer a physical outlet for our stress. Thus, cortisol remains elevated in many of us, and it turns out that consistently high cortisol leads to insulin resistance.
So two hormones being persistently elevated lead to insulin resistance: insulin and cortisol. These hormones are persistently elevated in the average human in the developed world. Exercise improves insulin sensitivity but most humans in the developed world have no reason to exercise, aside from attracting mates and staying healthy.
Lastly, one's ability to forego pleasure or leisure now for a return later (or, for the promise of not getting sick later) varies a lot throughout the population. Some people are very good at this, some are not. Obviously the amount of education and knowledge one has also varies from person to person in the developed world. Since most of us crave sweets and processed carbs, they are readily available and nothing in our lives requires us to exercise, those who are not good at forgoing pleasure now or those who do not know that eating this way is bad for you, will sit and eat like garbage right now because it feels great right now.
It is not a simple explanation, but to me, this set of facts explains why it is becoming more of a problem as time goes on. As much as big pharma may want people to get sick and buy their drugs, big pharma didn't make people crave sweet food, nor did they make processed food ubiquitous, nor did they come up with office jobs that keep us sedentary, nor are they keeping us stressed out. These are all byproducts of evolution and our own technological successes.
People rely on doctors and doctor’s rely on research, and then when articles like this come out no one thinks there’s something fundamentally wrong with the industry?
https://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-in...
Doesn’t add up, the incentives in the industry are all screwed up, we need to return to patient funded healthcare.