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]