From ef3dec80e9bf8d326f1bf54e6db3b4732d0a1628 Mon Sep 17 00:00:00 2001 From: Holden Rohrer Date: Mon, 23 Nov 2020 22:28:41 -0500 Subject: wrote a good script --- markley/21_script | 193 +++++++++++++++++++++++++++++++----------------------- 1 file changed, 110 insertions(+), 83 deletions(-) (limited to 'markley/21_script') diff --git a/markley/21_script b/markley/21_script index d5b35b2..268948b 100644 --- a/markley/21_script +++ b/markley/21_script @@ -1,73 +1,120 @@ -What costs four hundred dollars that has to be bought 24 times a year? +What costs four hundred dollars and 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] +[Title Card: Insuline Glargine] [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. +Diabetes has been written about since the ancient Egyptians, 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 +And that's about all philosophers understood about the disease until the late 19th century. +Insulin is the key to diabetes, medically, [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 +diabetes by performing a full pancreatectomy, 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. +Various scientists tried extracting the essence by 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, Banting, Best, McCloud, 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 so that +drug companies wouldn't create dangerous knockoffs and patent those to +gain monopoly. +According to *The discovery of insulin,* the scientists wrote a joint +letter saying: + The patent would not be used for any other purpose than to prevent + the taking out of a patent by other persons. When the details of the + method of preparation are published anyone would be free to prepare + the extract, but no one could secure a profitable monopoly. +[https://en.wikipedia.org/wiki/Insulin#cite_note-134] + +The university licensed the right to produce insulin to Eli Lilly and a +dozen other companies for free, hoping that insulin could help as many +people as possible, allowing the companies to patent discoveries about +manufacturing and other improvements. +Animal insulin from pigs and cows is a "bolus" insulin, meaning that +it's meant to be injected before meals or infused continuously because +it peaks and dissipates quickly. +Neutral protamine Hagedorn (NPH) complemented it by slowing down +absorption of insulin, allowing diabetics to take fewer shots, but it +also was the first major patent encumbrance, in 1946. +Other innovations like lente insulin in the 50s, purification processes +for safer insulin in the 70s, all carried with their own patents, +ensuring that generic companies couldn't set up shop. +But during this time, there is a remarkable anti-monopoly feeling: since +the Roosevelt days, both Teddy and Franklin, Americans rallied against +mergers and patent monopolies because competition was the prevailing +ethos. + +[Cite "Why is there no generic insulin?"] [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: Reagan and Synthetic Insulin] + +In the 1980s, synthetic human insulin was developing, and so was +Reagan's monopoly strategy. +Insulin is a protein---a biological machine that is programmed by a +"gene" in DNA. +Specifically, it's a hormone: it "plugs in" to a detector on the outside +of a cell and tells it to use more energy by consuming more sugar. +Remarkably, the genetic language for proteins is understood by every +living thing, so the gene can be taken out of humans and spliced into +bacteria, and describe the exact same structure. +Like bovine and porcine insulins, human insulin is a "bolus" and only +lasts for about 8 hours. +An NPH version of human insulin was created, too, to create a basal +version. +Still, there is evidence that NPH is less safe because it peaks +inconsistently, making it harder to manage blood sugar. +Genetic engineering is very powerful, and a new class of insulins was +invented: ultralongs. +With no peak and a 36 hour duration, insulin glargine, also called +Lantus or Toujeo (made by Sanofi) or Basaglar (started by Eli Lilly in +2015), was patented in 2000, continuing the patent monopolies until +2027. + +Reagan helped create the companies the companies that made these drugs, +and his lasting influence on American politics keeps them there. +Reagan was outright pro-monopoly, believing that the failures of America +to compete internationally aren't because bloated industries are being +blindsided by, for example, Japanese manufacturers, but rather those +industries don't have enough concentrated power to respond. +President Reagan's Justice Department asserted that, to prevent a +merger, the court must be certain of its harmful effect. +From 1980 to 1984, the number of annual mergers doubled. + +[cite https://www.multinationalmonitor.org/hyper/issues/1986/0215/ + +From 1995 to 2015, 60 pharma companies merged into just 10, including +Sanofi, manufacturer of insulin glargine, that now maintains a 42 +billion dollar revenue year-to-year. + +[cite the fantastic openmarketsinstitute.org one] + +Patents, too: they are intended to reward creativity with a temporary +monopoly, but before the Reagan era, patents were seen as a potential +danger: if a company gets too many or abuses what they have, they might +get broken up or fined. +But while the pharma corporations were developing this fiscal monopoly, +the Rehnquist Court was redefining patents as a declaration, by the +United States, of a "legitimate monopoly." + +[cite nber] + +Worse yet, the FDA regulations that make the industry safe makes +redeveloping generic versions extremely costly, and when they do, +corporations can just pay them off. + +[cite https://www.openmarketsinstitute.org/learn/drug-prices-monopoly] [Section: The profit motive] @@ -77,14 +124,14 @@ 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. +amount, but it's the *one* alternative, launched by another insulin +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? +But how did they get this position? 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. @@ -92,43 +139,23 @@ 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? +The US government. +Americans' government subsidizes the majority of basic research done by +pharmaceutical companies, yet the pharmaceutical companies are still +allowed to utterly exploit their subjects. -[Section: Anti-trust and Patents] +[https://go.gale.com/ps/retrieve.do?tabID=Journals&resultListType=RESULT_LIST&searchResultsType=MultiTab&hitCount=6&searchType=BasicSearchForm¤tPosition=2&docId=GALE%7CA101569966&docType=Article&sort=Relevance&contentSegment=ZICC-MOD1&prodId=CSIC&pageNum=1&contentSet=GALE%7CA101569966&searchId=R2&userGroupName=gainstoftech&inPS=true%2Chttps%3A%2F%2Fgaleapps.gale.com%2Fapps%2Fauth] -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] - +intermediate-long_acting.svg.png (graph of insulin stuff)] [Image of insulin vial from Wikipedia] -- cgit