From 1ca60546da3ad99db67d06927f176c29c8f4ec11 Mon Sep 17 00:00:00 2001 From: Holden Rohrer Date: Mon, 23 Nov 2020 17:55:09 -0500 Subject: wrote rev1 of the script --- markley/21_script | 134 ++++++++++++++++++++++++++++++++++++++++++++++++++++++ 1 file changed, 134 insertions(+) create mode 100644 markley/21_script diff --git a/markley/21_script b/markley/21_script new file mode 100644 index 0000000..d5b35b2 --- /dev/null +++ b/markley/21_script @@ -0,0 +1,134 @@ +What costs four hundred dollars that has to be bought 24 times a year? +Insulin. + +[Life is like a box of chocolates, It really sucks if you have diabetes] + +[Title card of some sort? Maybe just a section title dividing up me +staring down the camera. See Folding Ideas. Def say "the history of +insulin glargine," but that could require some shortening] +[Cite "The Evolution of Insulin Glargine..."?] + +Diabetes has been known about since the ancient Greeks, with the first +known description written in 1500 BC and named in 230 BC. +It was known natively as "pissing evil" because it was characterized by +frequent urination followed by death. +And that's about all scientists understood about the disease until the +late 19th century. + +[https://www.etymonline.com/word/diabetes] + +After one laboratory discovered the link between an injured pancreas and +diabetes by removing the pancreas of several dogs, there launched a +three-decade search for a way to isolate the substance in the pancreas +keeping the dogs alive. +Various scientists tried soaking raw pancreas in solutions of saltwater, +alcohol, cold water, hot water, and several acids, but these all had the +same problem: the production was toxic. +Four University of Toronto scientists, Frederick Banting, Charles Best, +John James Rickard Macleod, and James Collip shared two Nobels for the +development of a manufacturing process: slowly inject another hormone, +secretin, into a cow's pancreas, and then soak the pancreas in solution. +The patent was sold to the University of Toronto for one dollar. +Insulin was finally ready to be distributed. + +[Too much time spent here? I'm trying to explain how insulin works] + +The university licensed the right to produce insulin to twelve different +companies, with licenses that allowed manufacturers to patent new +discoveries about manufacturing and other improvements. +These included manufacturing methods like using just the right level of +acid to precipitate out insulin and inventions like neutral protamine +Hagedorn or NPH---an insulin that lasts longer and requires fewer +injections. + +[https://www.healthline.com/diabetesmine/history-of-insulin-costs] + +This animal insulin worked fine for sixty years, mostly without the +massive price hikes we see today. [cite] +In the 1980s, scientists figured out how to use the bacterium E. coli to +create human insulin. +Insulin is a protein---a small biological machine made of 51 different +parts, called amino acids, that change how it's shaped. +Insulin travels through the bloodstream and, by fitting into another +protein, tells cells to use more energy (sugar). +Remarkably, the genetic code for this machine is readable and understood +by every living thing, so the gene can be spliced into bacteria for +mass-production. +Insulin is what gets sugar from blood into the cells that need it to +function---which is why when it's not there, blood sugar runs high. +But human insulin, when used as an injection, only lasts for 6 hours and +hits a significant peak halfway through, meaning that it doesn't work +great for maintaining a consistent "blood glucose" level like the +pancreas. +Like with pork insulin, the drug companies invented a long-acting +insulin that takes a whole 36 hours to get used up. +It's called insulin glargine, or Lantus, or Toujeo, or Basaglar, and +it's a medical miracle. +Modified insulin is still compatible with the cells' detection system, +and by changing only three amino acids to let in a little bit less water +and a little bit more protection, insulin patients get to live a +markedly better life. + +[Section: The profit motive] + +But glargine's a bittersweet victory. +Glargine costs about seven dollars to manufacture ten +milliliters, but Sanofi, Lantus's manufacturer, lists it for 375. +Even for people with insurance, this can still cost 50 dollars in +copay---for something that needs to be refilled 24 times a year. +The FDA-approved early-launch alternative, Basaglar, is 165 for the same +amount, but it's the *one* alternative, launched by another +pharmaceutical giant, Eli Lilly. +Affordable insulin relies on precarious manufacturer rebates and full +employment, but even with these preconditions, 25% of patients report +trying to "stretch" their insulin---probably because the average +diabetic pays twenty thousand per year for medical care. + +But how did they get this position? Does the government just not care? +Last year, Sanofi spent four million dollars on lobbying. +Eli Lilly spent seven million. +PhRMA, the industry lobbying group that both are members of: 29 million. +Government-granted patent monopolies drive up prices for everyone, +to the exclusive benefit of ten massive multinationals. +Eli Lilly, Sanofi, and Merck, another pharma company trying to get in on +the glargine action, spend 6 billion each on R&D, but who paid for it? + +[Section: Anti-trust and Patents] + +The pharmaceutical problem has ballooned in the last decade, but it +started in the 80s, and patents are a big reason why. +Generic markets are not magically materializing, and it's because +companies worth 169 billion were allowed to exist: they lobbied for +"regulations" that actually made it harder for generics to enter with +the FDA. +It costs about one billion dollars to bring a new drug to market, and +about the same to create a "biosimilar." +The courts no longer consider patents a potential tool for monopoly +manipulation that should be regulated but rather the government saying +explicitly "you deserve to be a monopoly." + +[cite nber] + +60 pharmaceutical companies were allowed to merge into 10, which is +clearly less risky and therefore should let R&D try out more +experimental drugs which might take a while to come to market. +But instead, incremental improvements are ever more popular. +Everyone, on the right and on the left, agrees that the rapidly +inflating drug prices are hurting Americans, but it's still happening. + +[Maybe include the "intellectual property is illegitimate" bit in the +example about only three amino acids changing.] + +[Insert news headline of https://www.cnn.com/2020/05/26/politics/white- +house-insulin-cap-medicare/index.html] +[And https://www.statnews.com/2020/01/28/insulin-pricing-becomes-top- +issue-for-democrats/] + +[lord this needs a retelling. like a more chronological one, fuck] +[needs some quotes too] + +[Image: https://upload.wikimedia.org/wikipedia/commons/thumb/f/f2/ +Insulin_short-intermediate-long_acting.svg/2000px-Insulin_short- +intermediate-long_acting.svg.png] + +[Image of insulin vial from Wikipedia] -- cgit