By Richard Gingery, M. D.

Diabetes mellitus, a Greek term which loosely translates as “sweet-tasting urine,” is a terrible disease.  There is no good historical record telling us who got recruited as lab techs in Hippocrates' day, but even 2,500 years ago they recognized that people with diabetes had such high sugar levels that sugar was literally spilling over into the urine.  For most of those 2,500 years people with diabetes knew only that they had been condemned to a short life in which they were extremely hungry, extremely thirsty and their days and nights were punctuated by frequent urination.  They were much more light-headed than their non-diabetic neighbors, and they passed out frequently.  Children who developed the juvenile fomr of diabetes had only months between onset of the disease and death.

Diabetes went from being a death sentence to being merely another chronic disease in the 1920s.  In that decade Fredrick Banting and his colleagues discovered and isolated insulin.  In a move that pharmaceutical companies today find complete anathema, Banting licensed the patent for the grand sum of $1.00 as a “gift to humanity.”  And it was!  Before long the American Diabetic Association began giving out 20 year survival pins.  Then they moved it up to 30 years, then 40 and finally 50 years.  After that point survival became the norm with diabetes and the pins disappeared, all because insulin, this cheap and easily made product, was the key to treating diabetes.

Nearly a century after the discovery of insulin, this “gift to humanity” has become more of a gift to the pharmaceutical industry.  Between the years 2010 and 2015 nothing very significant happened in the nature of the treatment of diabetes.  No amazingly new insulin forms hit the market.  No “cure” emerged for diabetes.  Delivery methods have changed a little, going from syringe to pen to pump, but the insulin inside is the same.  But what did change is the cost.  The average price of insulin and other diabetic products rose between 127% and 325% in that time.  Humulin insulin, the most popular form on the market rose from $258 for a month's supply to $1100 per month.

Diabetes is not a rare disease.  When I was in medical school, studying under Hippocrates' watchful glare, I was told that one American in five would get diabetes at some point.  The obesity epidemic of more recent years has pushed that number higher.  So what will millions and millions of Americans do when they are confronted with ever higher prices for their diabetic supplies?  Some will have the means to carry on with an uninterrupted therapy.  But many, if not most, will face a real dilemma.  Diabetics who are already on Medicaid will be fine for now, but if the Republicans succeed in their deep cuts to Medicaid, that safety net will disappear.  If Republicans succeed in bringing back “affordable” health insurance that no longer covers prescriptions, or if diabetics join the ranks of the 23 million who may become uninsured under the Republican healthcare plan, diabetics may face bankruptcy, or they may try to stretch out their medications because of the high price (an especially bad idea with diabetes) or they may simply go without.  They could try importing their insulin from Canada, but Canadian pharmacies have already been warned that selling cheaper insulin to Americans is illegal.  

Diabetes, as an agent of premature death, may soon have a chance to make a comeback in the United States.  I find myself pondering why pharmaceutical companies can't figure out that they stand to make more money if they allow their customers to live to a ripe old age rather than bumping us off early because we can't afford their product.  As other countries regulate prices in their various systems of universal healthcare, so could we if we could only harness our collective anger at our non-system of healthcare which seems driven by a profit motive that ignores the fact that our lives are at stake.