Something (not so) Sweet: Accessing Life-Saving Medication Globally

To quote Canadian scientist Frederick Banting, “Insulin belongs to the world, not to me.” Banting-with the help of his peers Charles Best, John Macleod, and James Collip-is famous for discovering insulin in 1921. Together, they sold the patent for insulin for a mere $1.00 to the University of Toronto.

Insulin is a life-saving medication for people like me with the disease type one diabetes. Our pancreases do not produce insulin, which is a hormone crucial to controlling the body’s level of glucose (known as sugar) in the blood. Because their bodies cannot produce insulin, type one diabetics need to inject themselves with it or use an insulin pump. So, before its discovery, those who became sick with the onset of their type one diabetes died in a painful way, wasting away while doctors could do nothing and their families watched in horror. Today, due to Banting and his team’s discovery of-to put it in Layman’s terms, “liquid life”-for type one diabetics like myself, we can live.

According to the American Diabetes Association, the price of insulin in the US tripled between 2003 and 2012. This has rendered this medication very difficult to access and, for some, impossible to afford. Additionally, type one diabetics spend a fortune each year on the cost of other devices required to monitor blood glucose levels and administer insulin. Alas, insurance is not a saviour, even in Canada; many people have to pay out of pocket, which disproportionately affects low-income people. Diabetes Canada reported that, in 2002, “57% of Canadians with diabetes [said] they do not comply with their prescribed therapy because they [could not] afford their medications, devices and supplies, this potentially compromising their diabetes management.”

There is a relatively new practice colloquially known as “insulin tourism,” where Americans cross the Canadian border in a pilgrimage to buy more affordable insulin. They meet at an American location close to the Canadian border-such as Minneapolis, Minnesota-before they gather in a few cars to carpool across the border. Once they cross the border, they visit various pharmacies to stock up on insulin with Canadian pricing, which is only a tenth of the American cost. Some Americans closer to the border of Mexico also venture south to try and purchase cheaper supplies.

Sadly, the desperation does not end there. Many type one diabetics are forced to ration their daily doses. The American Diabetes Association found that approximately one quarter of type one diabetics were missing or lowering doses or switching to types of insulin not recommended by their doctors. Though famously dysfunctional, this problem is not contained within American borders; insulin is unaffordable in most countries around the world, with 25 million individuals who need it unable to access it. Even worse than simply scrounging for cheap insulin, people are dying from the lack of it. In sub-Saharan Africa, type one diabetes is a death sentence. In America, some young adult diabetics have been dying due to the high costs of insulin. In their homes where they are found dead are the remains of their supplies, where you can see how they were desperately trying to extract the little bits of insulin they could. However, it is still not enough, costing them everything.

Seeing this from a Canadian perspective, it’s like a horror story unfolding in front of me, an alternate reality of what could have been. Banting fought so hard to make this drug accessible and prevent this exact situation. What would he think of the mess that has been made by corporations financially using desperate people for profit? It wasn’t always like this. The University of Toronto governors saw insulin as a public good. Insulin prices remained stable until the 1970s, when inflation hit and the supply of cow and pig pancreas tissues (where insulin was taken from) dropped. Pharmaceutical companies began to take over the production of synthetic insulin for commercial use. A century later, three mega-sized businesses-Eli Lilly, Sanofi, and Novo Nordisk-control 90% of the $27-billion global market. They set excruciatingly high prices and reap the profits. It is actually cheaper to produce today’s synthetic insulin in a lab than the original insulin taken from slaughtered pigs and cows. Moreover, there is a limitless supply of insulin; it’s not a matter of shortage of supply.

I have never had to ration my insulin, but before I was diagnosed with type one diabetes, I experienced the extremely high blood glucose level symptoms that would accompany rationing for a few months, including abdominal pain, blurry vision and headaches, mood changes, extreme thirst, nausea, throwing up, extreme fatigue, extreme weight loss, and falling asleep at inappropriate times. I was apparently very close to falling comatose and possibly never waking up according to the doctors who diagnosed me. I cannot fathom how it feels to actively know you have to live that way, risking your health and well-being for long periods of time to stay alive. When you are symptomatic to that degree, you feel like a living corpse, just existing and not really “living”.

I am one of the lucky ones. Both of my parents have full-time jobs with insurance coverage, and I live in Canada where insulin is far cheaper than the cost for our southern neighbours and actually accessible, unlike in many parts of the world. But it saddens me to think that luck is a large component of why I am able to afford said technologies and this life-saving miracle drug.

Worldwide, insulin should not be a privilege afforded only to the lucky, it should be standardized as a basic human right, accessible to all. No one should have to evaluate how much their life is worth.