The Diabetes Economy – T2D 12

Insulin, first discovered in 1921, revolutionized the treatment of type 1 diabetes. Dr. Banting licensed insulin to pharmaceutical companies without a patent because he believed that this life saving drug for T1D should be made available to everybody who needed it. So, why is insulin so hard to afford today?

Only three pharmaceutical companies manufacture insulin in the United States – Eli Lilly, Sanofi and Novo Nordisk. In 2012, it is estimated that insulin alone cost the US health care system $6 billion. How can they make so much money from a century old product? In 2013, according to firecepharma.com, the best selling drug for diabetes was…. Lantus, a long acting form of insulin. So, after all the research of the past 95 years, the biggest money-makin’, mama-shakin’ drug was insulin? Yes, sir. Worldwide, this drug alone made $7.592 billion. That’s billion with a B. Oh, but the news gets better for Big Insulin. Out of the top ten, various insulins also ranked #3, 4, 6,7,9, and 10. Holy patent extensions Batman! A full seven of the top ten drugs for diabetes are insulin – a drug close to a century old. It’s like your 95 year old grandfather beating LeBron James at basketball.Slide03

Tweaking the insulin molecule allows additional patents and cheaper generic medications can be kept at bay. That this clearly violates Dr. Banting’s original intention doesn’t matter. There is no clear evidence that these newer insulins are any more effective than the old standards. While there are some theoretical benefits, the outcomes in T2D have only worsened even as these newer insulins became more widely prescribed. Hiking prices is another lucrative technique. From 2010 to 2015, the price of newer insulins rose from 168- 325%. Without generic competition, there is clearly collusion between the companies to keep prices high. After all, shareholders must be kept happy and the CEO needs a private jet.

At the time of insulin’s discovery, T2D, while still relatively rare, had few treatments available. Metformin, the most powerful of the biguanide class of medications, was discovered shortly after insulin and described in the scientific literature in 1922. By 1929, its sugar lowering effect was noted in animal studies, but it was not until 1957 that it was first used in humans for the treatment of diabetes.

It entered the British National Formulary in 1958, and entered Canada in 1972. It was not FDA approved in the United States until 1994 due to concerns about lactic acidosis. It is now the most widely prescribed diabetes drug in the world.

The sulphonylurea drug class was discovered in 1942 were introduced in 1956 in Germany. By 1984, more powerful second generation SUs were introduced in the United States. These drugs stimulated the pancreas to release more insulin, which reduced blood sugars. There were many side effects, including severe hypoglycemia, but they did prove effective at lowering blood sugars. For decades, these two drug classes were the only oral medications available for the treatment of T2D.

Even while the number of blood pressure and cholesterol medications were exploding, the oral hypoglycaemic drug class was mired in a rut. There was simply no money to be made for drug companies. The numbers of patients were too small, and the benefits of these drugs were dubious. But things were soon to change.

In 1977, the Dietary Guidelines for Americans were introduced to an unsuspecting American public and dietary fat was public enemy #1. The subsequent high carbohydrate intake would have unintended consequences and the obesity epidemic soon bloomed. Following like a love-sick puppy was the epidemic of T2D.

In 1997, the American Diabetes Association lowered the blood sugar definition of type 2 diabetes, instantly rendering as many as 1.9 million more Americans as diabetic.

Pre-diabetes underwent a similar change in definition in 2003. This would label 25 million more Americans as pre-diabetic. With growing numbers, the business case for the development of diabetic medications changed completely. While there is broad consensus that pre-diabetes is best treated with lifestyle changes, advocacy groups soon embraced the notion of drug therapy. The guidelines have been lowered so much that, by 2012, the prevalence of diabetes in American adults was 14.3% and prediabetes 38%, adding up to 52.3% of americans being either pre-diabetic or diabetic. This was now the new normal. It was more common to have pre-diabetes or diabetes than it was to have normal blood sugars. Diabetes is the new black.

By 1999, the diabetes economy was primed to boom. In 1999, rosiglitazone and pioglitazone were approved by the FDA for the treatment of T2D. They have subsequently fallen into disuse due to concerns about provoking heart disease and bladder cancer. But it hardly mattered. The dam had burst. From 2004- 2013, no less than thirty new diabetes drugs were brought to market.

By 2015 sales of diabetes drugs had reached $23 billion, more than the combined revenue of the National Football League, Major League Baseball, and the National Basketball Association. This was big time business.

While these drugs all lowered blood sugars, clinically important outcomes, such as reducing heart attacks or strokes, blindness, or other complications of the disease, were not improved. The entire diabetes industry revolved around reducing high blood sugars instead of actually helping patients. The disease was one of increased insulin resistance, yet treatments were based upon lowering blood sugars instead. We were treating symptoms, instead of the actual disease.

Follow the Money

In 2003 the American Diabetes Association changed the definition of pre-diabetes adding an additional 46 million adults to its ranks. In 2010, the definition was further broadened by the use of the Hgb A1C. Ostensibly to help with early diagnosis and treatment, it is perhaps no coincidence that 9 of 14 outside experts on this panel worked in various capacities with the giant pharmaceutical companies that made diabetes medications and stood to reap an unending stream of money.

While individual members were paid millions of dollars, the association itself reaped more than $7 million in 2004 from its pharmaceutical ‘partners’. By 2012, more than 50% of the American population would be considered either diabetic or pre-diabetic. Mission accomplished. Cha ching. The market for drug consumption had been created.

The conflicts of interest only get worse. In 2008, a joint statement released by the American College of Endocrinology and the American Association of Clinical Endocrinologists released a joint statement about pre-diabetes encouraging physicians to consider drug treatment of high-risk patients despite the fact that no drug had been yet approved by the FDA.

Were these unbiased academics giving their honest opinions? Hardly. 13 of the 17 members on that panel were paid as speakers and consultants to diabetes drug companies.

By 2013, these ‘advocacy’ groups recommended drug treatment of pre-diabetes even more forcefully if lifestyle changes didn’t work. Altruistic? Hardly. That year, more than $8 million of Big Pharma’s money helped shape their positive opinion.T2D screening

Thirteen of the 19 doctors on the panel that made the recommendation, including its chairman, were paid as consultants, speakers, or advisers to pharmaceutical companies that, surprise, surprise made diabetes drugs. Payments totaled $2.1 million since 2009. While patients could no longer afford their insulin shots, there was plenty of cash for the diabetes associations. Fancy dinners? Check. Fancy trips? Check. Large cheque? Check.

The story would be completely different if these drugs actually helped patients in a meaningful way. In prediabetes, none of the current drugs are approved for use. The reason we don’t use them is because they are useless.

Diabetes screening has already been shown to be largely useless with the current crop of medications. We can all agree that T2D is a disease of high insulin resistance but the current crop of medications only treats high blood sugars.

T2D, at its very core, is a disease about too much sugar in the body, not just the blood. Yet most of our drugs, from metformin to insulin do not rid the body of that sugar. It only drives it from the blood and into the body. But if this sugar is toxic in the blood, why would it not be toxic inside the body?

We are only moving the sugar from somewhere we can see it (the blood) to somewhere we cannot (the body) and then pretending things are improved, but all the while knowing that we have not made a difference. Where lifestyle changes clearly improves health, drugs just as clearly do not.

Screening only leads to better outcomes if there is rational treatment. Since our treatment of pre-diabetes consists of ineffective drugs, early diagnosis is futile. But this inconvenient fact hardly matters to the big pharmaceuticals and their minions. As long as they controlled the diabetes associations, there was cash to be made.

This largely explains the reluctance of the world’s Diabetes Associations and endocrinologists to acknowledge the devastating truth – that insulin just doesn’t help patients over the long term. With so much cash on the table, who do you think funds all the research in the universities, pays for all the private school tuition, sponsors all the ‘diabetes’ events? Big Insulin. But the pied piper must be paid. The currency of repayment is blindness, organ failure, amputations, and death.

2017-10-19T12:42:12+00:00 20 Comments

About the Author:

Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

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20 Comments on "The Diabetes Economy – T2D 12"

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Phyllis L Prado
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Now I understand why my insulin costs so much. I have been a diabetic for 50 years and a nurse for 45 . I have said all along that the pharmaceutical companies are killing patients not helping them by making the diabetes medications cost so much . Between the insurance companies and pharmaceutical companies America is being ripped off ! we are being killed faster than ever ! Greed is killing us little people!

Julie
Guest
Big Pharma issue aside, why was lowering the blood sugar definition of type 2 diabetes in 1997 and pre-diabetes 2003, which effectively rendered more people as diabetic and/or pre-diabetic, a bad move? If the insulin assay described by Dr Joseph Kraft were widely employed, the effect would likewise be the same (more people would likely be identified as having an insulin dysregulation vs not). I see this as a positive step in allowing people to make dietary changes in order to prevent damage or prevent further damage caused by hyperinsulinemia and hyperglycaemia. As it stands, I think current values of… Read more »
MachineGhost
Guest
He’s just going off on a tangent about the crony capitalism of Big Pharma. Expansion of diagnostic criteria is always the first precondition necessary for expanded use of pharmacueticals because insurance won’t cover it otherwise. This concept goes back as far as endocrinologists collectively wanting to cook up a “quantitative measurement” (TSH) for detecting a “low thyroid” to be able to prescribe levothyroxine. And most recently for statins to “treat” cholesterol (they even wanted to put kids on it!). Basically, treating the lab values and not the patient is “standard of care” now and the more you can fit into… Read more »
Aj R
Guest
Dr. Fung…I was diagnosed pre-diabetic in January 2015. I started paying attention to food and exercise, but maybe not as much as I should have. In November after getting readings of 8.0 fasting for three consecutive days I decided to wake up and do something. I Increased portion control, started eating snacks in between meals. It seemed to help, yet fasting test outcomes were unpredictable and I couldn’t figure out why. Then I stumbled upon your website and videos and after going through them, I made one small change. I stopped all snacking and only ate three meals a day.… Read more »
Samuel
Guest
Here is one data point on lipid profile. If you think this is important, and it may or may not be, changing it is not that difficult. First, learn how to read and interpret an NMR lipid profile, which provides particle size and concentration. If you eat the food pyramid or something close to it this is what you might expect if you replace the carbohydrate with fat from animal sources, not seed oils. The triglycerides drop 60-70%. The HDL-C goes up 50% or more. LDL-P is concordant with the LDL-C or dischordant in a favorable direction. The type B… Read more »
BobM
Guest
These are my results over the last two years: Date TC LDL HDL TGs mg/dL mg/dL mg/dL mg/dL 6/25/14 175 119 37 113 6/2/15 202 129 49 120 2/29/16 168 103 52 65 TC = total cholesterol, TGs = triglycerides. The LDL is calculated, not measured. The middle test was done at a different lab (not sure of how much of a difference this makes). Over this time, I’ve lost about 50 pounds. I eat as high fat and as low carb as I can, concentrating on animal fat and trying to avoid all seed oils (canola, soybean, etc.). I… Read more »
Samuel
Guest

Without knowing the particle sizes and concentrations my reaction is, “so what’s the problem?” I pay about $120 for the NMR, unless I can get a discount.

I have always wondered how the NMR lipid profile varies with fasting, but I don’t plan on spending the money to find out. For example, is the TG level markedly different for someone fasting 12 hours as opposed to 20 hours? As I recall the NMR is plus/minus 10% as far as claimed accuracy.

Aj R
Guest

Thanks Samuel!

jeff k
Guest

read up on billy tauzin, his role in medicare part d, and his career when he retired from congress a few months after medicare d became law.

Bernard P.
Guest

The similarity between…

… blood sugar/diabetes vs insulin and other medication…

vs…

… fat/cholesterol/cardiovascular disease vs statins…

,,, Is eerie : in both instances, medicine is treating the wrong problem with harmful medication.

Chris Adams
Guest

i suspect it doesn’t end there…

BobM
Guest
Anyone find that fasting really helps with seasonal allergies? I had to take a few allergy pills this year already (and they make me horribly tired), during a period I wasn’t fasting (due to being sick with a stomach bug that went through the whole family). Once I restarted fasting, the allergies are much better. The allergies are still there, as I can tell I have some sinus congestion, but they are reduced to the point where I’m not taking allergy pills. And I can tell there is sinus drainage. Both my wife and I noticed the same effect last… Read more »
honeycomb
Guest

I always (since serving on submarines anyway) have had fall sinus issues. Worthy of medication to stay fit to fly for a living.

I have had zero (no issues requiring med’s) sinus issues over the spring last year to the spring of this year.

Time will tell if it’s a fluke or the real deal. But, I’ve noticed the same thing.

BobM
Guest
Interesting. I did not have allergies (that I knew of anyway) until I got out of the military at 24. I spent about 3.5 years on a carrier, out to sea most of that time. I don’t understand why fasting affects allergies, but it does seem to help. And this is also with wheat allergies — wheat and I don’t get along, and just a weekend eating some (not much) wheat will mean chest congestion/asthma and other ill effects. However, fasting seems to cure that too. Without fasting, my normal low carb diet helps but takes longer.
Tim H
Guest

I think you’ll find that statins still rack up more in sales than insulin. At least for now. Now that statin patents are ending and PCSK9 inhibitors are getting approved, drug companies have suddenly discovered what is wrong with statins. Keep an eye on the sales figures for PCSK9 inhibitors in the future.

Boazy
Guest
Sue
Guest

Dr. Fung,

A little off subject but is taking supplements like bitter melon, banaba leaf and cinnamon just a money makers too or do you think they could have merit. More importantly do you feel there are some supplements that are detrimental. Seems I read somewhere that banaba leaf works similar to Metformin, which is something we no longer need or want.

We welcome any ones thoughts. Thanks.

mike
Guest
Do Doctors come in two flavors or three? Honest healers, corrupt stealers, and also, I suspect majority, If I knew better i’d do better but thats “all I knew” so hey sorry maybe in my next life time I’ll be awake not just when my paycheck comes in but all the time. Thank you Dr. Fung. As someone trying hard to rescue a dear friend from the medical malpractice related to his T2 treatments over more than a decade I hope your words and willingness to share them in print, media and through your book will help my friend and… Read more »
Ibrahim
Guest

Went to the hospital and doctor told me that I am almost diabetic. readings ranged from 6.0 to 13.0 He started me on metformin. But I was very suspicious because I’m very careful what I eat and I exercise too. Then I stumbled on Dr. Fung on the internet. I just fasted for just one day and my blood sugar has come down to 4.7 from 6.7. I’ll have fasted anyway because of Ramadan. Thanks Dr. Fung for the insights.

Roger Bird
Guest
I hate to tell some of you sweet but naive people, but there is absolutely nothing unique about diabetes treatment as it is generally practiced in that it is a monster scam of the pharmaceutical-medical-charity complex. The same exactly scam is being run with regard to heart disease (cholesterol is a symptom, a marker, not a cause), cancer (cancer is a symptom of a sick body), and probably ALL other degenerative disease states. Western conventional medicine is great for traumatic and acute issues, like gunshot wounds and automobile accidents. There is nothing better. But for chronic degenerative diseases, Western convention… Read more »
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