Robert Evans and Katie Golden expose how pharmaceutical giants like Sanofi and Eli Lilly profit from diabetes by blocking cheap insulin generics through "evergreening," causing deaths like Alec Rashawn Smith's after parents brought children's ashes to Sanofi in 2018. They detail Alex Azar's role in raising Humalog prices from $74 to $269 between 2007 and 2017, contrasting this greed with the 1921 invention by Banting and colleagues. Ultimately, the hosts condemn the industry for withholding a cure while earning massive bonuses, urging listeners to vote against profiteering that treats life-saving medicine as a commodity. [Automatically generated summary]
Transcriber: nvidia/parakeet-tdt-0.6b-v2, sat-12l-sm, and large-v3-turbo
|
Time
Text
Trust Your Girlfriends00:02:32
This is an iHeart podcast.
Guaranteed human.
When a group of women discover they've all dated the same prolific con artist, they take matters into their own hands.
I vowed I will be his last target.
He is not going to get away with this.
He's going to get what he deserves.
We always say that.
Trust your girlfriends.
Listen to the girlfriends.
Trust me, babe.
On the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.
I got you.
I got you.
I'm Lori Siegel, and this is Mostly Human, a tech podcast through a human lens.
This week, an interview with OpenAI CEO Sam Altman.
I think society is going to decide that creators of AI products bear a tremendous amount of responsibility to the products we put out in the world.
An in-depth conversation with a man who's shaping our future.
My highest order bit is to not destroy the world with AI.
Listen to Mostly Human on the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.
Hey, it's Nora Jones, and my podcast, Playing Along, is back with more of my favorite musicians.
Check out my newest episode with Josh Groban.
You related to the Phantom at that point.
Yeah, I was definitely the Phantom in that.
That's so funny.
Shall we stay with me each night, each morning?
Listen to Nora Jones is playing along on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.
What's up, everyone?
I'm Ego Modem.
My next guest, it's Will Farrell.
Woo, My dad gave me the best advice ever.
He goes, just give it a shot.
But if you ever reach a point where you're banging your head against the wall and it doesn't feel fun anymore, it's okay to quit.
If you saw it written down, it would not be an inspiration.
It would not be on a calendar of, you know, the cat just hanging in there.
Yeah, it would not be.
Right, it wouldn't be that.
There's a lot of life.
Listen to Thanks Dad on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.
Hey, everybody, I'm Robert Evans, and this is Behind the Bastards, the show where we tell you everything you don't know about the very worst people in all of history.
And this was the highest energy introduction I've ever done.
Sophie is laughing at me over in the corner.
Behind The Bastards Intro00:15:35
I don't understand why.
I thought it sounded pretty cool.
Fonz-esque.
This is a show where I read a terrible story about history, about someone bad or someone's bad, or usually a bunch of bad people doing bad things.
We guessed who is coming in cold.
And today, that very cold guest is Katie Golden.
Might be Katie coming in cold.
Anyway, she's birds rights activist on Twitter, where she advocates for birds, even though, as I understand it, millennials are saying birds aren't real.
Those are lies.
Those are communist lies.
Communist lies.
She's also the host of another podcast on the stuff network, Creature Feature.
Great podcast about animals doing weird-ass shit, science and stuff.
Yeah, science and stuff.
Yeah, we talked about animals and drugs in an episode of it.
Yeah, it's great to do drugs.
It is great to do drugs.
Speaking of drugs that are great to do, today we're talking about insulin, which is not a...
Well, I mean, it's fun in that if you need to take it, you die not taking it.
Right, I think it's fun not to die.
It is fun not to die.
Relatively fun not to die, yeah.
It was fun not to die of insulin shock or diabetic comas and stuff.
Yeah.
Not fun.
So, I'm just going to get into it.
On November 17th, 2018, several parents brought the ashes of their dead children to the doorstep of the offices of Sanofi, a pharmaceutical company that produces insulin.
Sanofi and other insulin producers like Eli Lilly have been steadily raising the prices of their insulin for years.
Because of this, insulin can cost as much as $1,000 a month for people without decent insurance.
My God.
I can't imagine spending $1,000 a month on anything other than like rent, I guess.
But you don't have to do it.
No, that's rent.
Even with a pretty expensive town.
So you're essentially renting your own body.
Like, you want to keep living in your body?
$1,000 rent.
Which can get you a decent place in Culver City, I feel like.
Yeah, when I lived in Culver, my rent was about $1,000 a month.
Yeah, yeah.
So it's frustrating, right?
It's a little frustrating.
It's a little frustrating because clearly, I mean, no country on earth can afford something like single-payer healthcare.
No, it's never been done.
It doesn't exist anywhere.
It's never been done.
And our government needs its money for stuff like, did you hear about when that hurricane hit the East Coast, the military forgot to remove like 11 F-22s and they all got destroyed?
Oh, yeah.
That was $1.4 billion.
Well, they got to have bought a lot of insulin.
They got to put another billion-dollar coin in the F-27 vending machine.
The funniest thing is, there's no vending machine.
We can't make the parts for them anymore.
Oh, good.
We stopped manufacturing any of the things so they're irreplaceable.
Oh, good.
But we can't afford to help people with air.
I'm sure we'll find a way to dig deep into the earth and find things that will destroy our planet that can make new airplanes.
Yeah, I'm sure we will.
Now, people with type 1 diabetes do not naturally produce insulin, which is a magical substance that lets sugar not kill us instead of be delicious.
I'm a fan of insulin.
Yeah, I'm a big fan.
Now, when insulin costs as much, if not more, than rent, many people stop taking it as often as they should and ration their precious supply so that they can afford to do things like exist in a capitalist society and pay the aforementioned rent that we've been talking about.
Right.
Also, food.
Because here's the thing: here's the thing: insulin is basically useless if you don't eat.
If you're starving to death.
Right, because then you don't get any sugar, which without insulin, you know, it's like.
Well, I mean, Katie, I was really sympathetic with these people, but I think you've identified a way that they could not need insulin, which is just to not eat.
The no-eat diet.
So they just stop eating.
And you won't die of insulin shock.
You'll just die of starvation.
I do think they'll die of insulin shock.
Oh, yeah, you're right.
Probably.
Medically speaking, yes, they will.
Neither of us are doctors.
No.
You're not a doctor, are you?
No, I'm not a doctor.
Okay, fantastic.
But I do read WebNB like a lot.
Well, then you're basically a doctor.
Exactly.
Fantastic.
Now, Alec Rashawn Smith was one of the young people who got caught in this deadly dance with a necessary drug.
When he was 26, he aged out of his mother's health insurance.
One month after his birthday, he died of diabetic shock.
Smith's mom, Nicole, was one of the grieving parents who brought her son's ashes to Santa Fe that November day.
She told the Boston Globe she wanted the company to, quote, know the price of their product is killing people when it's intended to save lives.
Antoinette Warsham, whose 22-year-old daughter, Antavia, died last year while rationing insulin, told another interviewer that for people like her daughter, it's either pay your rent, pay your car payment, or get your medication.
Diabetes is currently the seventh leading cause of death in the United States.
I heard this story of this guy who, because like I've heard this thing where people say, well, just go fund me if you can't afford your medication.
Use that instead of healthcare.
Yeah.
There was a guy who did that very thing, and he $50 short.
Yeah, $50 short of reaching his goal.
That's $750 goal.
Right.
That was his monthly cost.
Right.
And he needed insulin to survive, and he didn't have the money to pay for it.
And he was like taking care of his ailing mom, too.
So that's part of the reason he didn't have that high of an income.
So like he tried to get it.
He was $50 short of reaching his goal.
So you know how GoFundMe works.
Then you get none of that money.
And he died.
Yeah, he sure did.
We will be talking about him a little bit later.
Oh good.
Yay!
So clearly, this situation is fucked, right?
Yes.
That seat seems fucked.
Seems like we can all go on the same page there.
It seems like a little, like just maybe a smidge fucked.
Just a Scotia the old F-bomb.
Yeah.
So what is fucked?
Why is this so messed up?
Because people are dying.
Well, I'm saying that's why it's messed up.
Like, why is this state of affairs?
Why would they do that?
Because insulin is not a new drug.
Usually when you've got like a case of this where something's incredibly expensive, it's number one, a drug that very few people need.
Right.
And number two, a drug that's really new.
Because then, you know, that's the way that these patents work.
For most medicines, after about 20 years after their invention, a generic patent comes out that's fairly affordable.
Right, right.
That's one of the ways our system is supposed to work.
So that keeps drugs affordable for normal people, but also gives an incentive for companies to invest in research and whatnot, right?
That is the promise in our capitalist system is that you will get better medicine under this system because companies will find new medicines, you know, essentially due to the profit motive, but because of the way that this generic drug, that's the idea, right?
That's the product that we've all bought in this system.
Otherwise, poor people or middle-class people would never be able to afford medicine.
Exactly.
Insulin has existed for nearly a century, but there is no cheap generic insulin available in the United States.
Today, we're going to talk about why.
But first, we are going to talk about the invention of insulin as a medicine.
Most cursory coverage of this will give credit to Dr. Frederick Banting.
Some mention a small team of scientists who work with him.
When I decided to look into this story, it's because I ran across a tweet about Banting.
It stated that he had given the invention of medical insulin to the world, put it in the public domain essentially as a gift to humanity because he didn't want to profit off it.
He wanted people to be able to get medicine.
And so the tweet was basically like, this wonderful founder gave insulin to the world and wanted people to have it for free, and then the evil pharmaceutical companies fucked it up, which is true, but not detailed enough.
So I wanted to know what that story was.
Let's get the details.
So let's get the deets.
That's what we are going to be talking about today.
Now, like most things you find on social media, that version of events is not quite accurate.
Insulin did not have a single inventor.
And while pharmaceutical companies are the ultimate bastards here, the full story is weirder, sadder, and more infuriating than that.
In 1921, Dr. Frederick Banting was the first person to isolate secretions from isolate cells, the cells that make insulin.
He suggested these might hold a treatment for diabetes.
And he was basically right.
He came up with a plan to tie up the pancreatic ducts of laboratory dogs and make their pancreases overproduce the cells that contain insulin until everything else in the pancreas dies.
So that was the idea, right?
Would the dogs die?
The hope was they wouldn't.
This was actually initially envisioned as a beautiful one-two punch because we make these dogs' pancreases overproduce the cells.
They didn't really know insulin was a thing.
Like insulin was a theoretical substance they call it, I think, insulin.
There was an E.
I don't know how they pronounced it, but it was spelled insulin.
And the theory was like, if we make these dogs' pancreases produce a bunch of these cells, we can take the pancreases out and they will contain concentrated versions.
Then we can extract whatever's in the pancreas, shoot it into a diabetic, it'll make them better.
So the idea was we got to take these dogs' pancreases out in order to do this thing, but then we can just give them what we make from it.
And if it works, it's a beautiful one-two thing.
We don't have to kill the dogs.
We'll know that we've got a treatment for diabetes because these dogs won't be able to produce insulin after we fuck up their pancreases.
Seemed like it was like a nice circle that they had developed.
Now, the problem with Banting's plan is that he was not up to date on the work other scientists were doing testing blood sugar to find diabetes in patients.
Banting did urine testing to find out blood sugar levels, which does not work very well.
Did you just like taste it?
Just tasting their patients.
Well, one of the things is like if you taste your urine or smell your urine and it tastes sweet, it's a sign of diabetes.
Oh, wow.
Because it's like, I think it's called hyperkalemia, and it's because you're finding more sugars in your urine.
You know, I've only drank my pea once for my book, A Brief History of Vice.
I was trying an ancient Mesoamerican treatment where you mix tobacco, garlic, and urine as a treatment for constipation.
It works.
Oh, yeah.
It makes you very ill, but functions in its intended purpose.
Right.
I was not paying attention to how sweet it was.
There was a lot of garlic in there, too.
Right.
The garlic is, well, the garlic's going to cut the sweetness, as you know, like with cooking, you know, it's going to.
But it sounds like what you're saying is that we should all be drinking our pea every morning to learn if we are diabetic.
I mean, just a little bit.
A little bit.
Just don't drink a lot of it.
Don't drink a lot of your pea.
A taste.
A sample.
That's the new behind the bastards motto.
Sample your own pea.
Sample your pea.
Sample your pea.
Right.
This will be marketable.
Let's get a t-shirt going.
Sample your pea.
Did you start that process, Sophie?
TM.
No, okay.
Sophie's shaking her head.
She's not happy with that.
All right, let's move on to talking about diabetes and more.
So Banting was the first guy to start isolating the Islet cells that contain the hormone insulin, but the amounts he was able to get were too small to really be useful, and his work had a bunch of holes in it.
He was good at a couple of things, but he was almost there in a lot of other areas.
So he had to partner with other scientists.
Professor John James Rickard McLiod was the head of physiology at the University of Toronto.
McLeod agreed to give him laboratory space for his experiments, and he also served as sort of the manager and overseer of the whole project because Banting was an unstable personality, kind of an asshole.
Oh, yeah.
So McLeod.
You mean some scientists are assholes?
Yes.
Really?
The kind of guy who would poison a dog's pancreas in order to try to solve a disease.
He wasn't great at working with other people.
Oh, I see.
Interesting.
I mean, counterintuitive, but you know.
You need to do the research.
This horrible thing has to happen.
But the kind of guy who's like, oh, yeah, what if we just torture dogs to figure this out?
It's probably not fun to work with.
And he wasn't.
Maybe just a little too.
He's got tunnel vision there.
Yeah.
He's just so focused on that insulin.
And everyone else is like, but dogs?
There's just dead dogs everywhere.
I know, but I'm almost there corpses.
It's just crumpled up dog corpses.
Once we get it right, the dogs won't die.
He's just at his desk and he's like, oh, damn it.
And he crinkles up another dog and tosses it into the waste bin.
Just a trash can full of dead dogs.
Sophie is really not loving this conversation.
Uh-uh.
There is a dog in the room, but because Anderson is a dog, Anderson does not understand what we're talking about, which is the mercy of being a dog.
Right.
Now, back to the story.
Banting came to hate McLeod because McLeod was good at talking and explaining their work to other people at conventions.
Well, Banting was an introvert and a big old nerd.
So Banting started to worry that McLeod was going to outshine him and give him credit.
Even though, from everything I've been able to read, McLeod was just about, oh, yeah, this is a really important cause.
I want to do everything I can do to make sure that this research gets completed.
So he goes on Reddit to complain about him.
Like, what a stupid science chad.
Banting would 1,000% be a Reddit dude.
Although, we'll get to it.
Yeah, we'll get to that in a second.
So Banting had an assistant, a guy named Charles Herbert Best, who did a little...
Charles?
Charles.
Charles.
I pronounced that word for no reason.
I thought this was a fancy form of plain old Charles, like an American.
Reading podcast for three hours.
So Charles Herbert Best was his assistant, and Best did a lot of crucial work in the process.
And it seems fair to say in general that all three men were critical parts of the development of insulin as an effective medication.
When they started their work, the existence of insulin was still not a confirmed fact.
We knew that the Islets of Langerhans, which is the name of those little cells, produced something that helped regulate sugar.
Insulin was at this point still just the name of a hypothetical substance scientists thought existed.
Just as a quick side note, the Islets of Langerham, I imagine them as like these little islands that are.
Beautiful little British islands, storm-tossed microbial-sized Langerham expedition goes out and discovers like little white blood cells and naval hats.
Yeah.
Sorry, I just had to get that image off.
I'm the Duke of Langa, huh?
Yeah, no, you're right.
That's, yeah.
That's how it was discovered.
Tiny, tiny explorers.
Tiny explorers.
Banting, MacLeod, and Best started work in May of 1921.
It did not go well at first.
I found an article in the Journal of Clinical Chemistry that went into the discovery of insulin in exhausting detail.
Here's how they described the first few months of work.
After ligation of the ducts, the dogs were expected to recover from the surgery and live more or less normally.
After several weeks, the pancreas, enabled to secrete fluid into the duodenum, would gradually atrophy and would be removed and processed to extract the internal secretion.
The extract would then be administered to other dogs made diabetic by removal of the pancreas.
It was a laborious task for someone with no experience in animal work, and it did not go well at first as Banting struggled to improve his surgical technique.
By the end of the second week, seven of their ten dogs had died.
To resupply the animal cages, they resorted to buying dogs on the streets of Toronto for $1 to $3 with no questions asked of the suppliers.
No!
We need dogs!
We need a lot of dogs!
It's just some guy with an overcoat, like, hey, I heard you was looking for dogs.
This doctor's never worked on dogs.
He's killing them left and right.
Just like opening up a trench coat and just rows and rows of dogs.
I'll give you $9.
Is that enough for three dogs?
Ten dogs a dollar.
They're like off-brand dogs.
Like, no, no, these are dogs.
Three of these are cats.
Sophie, really not happy with me right now.
We should be good.
We should be good.
Sorry, we had to deal with some noise.
We also learned something that I'm just coming into, which is that the guy I've been calling McCleod is McLeod.
So, everybody have a good life.
You're a real McClaude, aren't you?
Everybody have a good laugh.
Good old laugh at old Robert Evans' expense.
Not knowing enough about Scotsman.
So, you may have already noticed that this is horrible because dogs are good and medically torturing them to death is bad.
But the world is a gigantic wheel of pain and brutal crushing cruelty and is sometimes necessary in order to save the lives of billions of diabetics.
So, yeah, that's just the way the world works sometimes.
Cow Fetuses For Insulin00:06:53
Dogs continued to die at rapid rates throughout the research, but Banting and Best were eventually successful in creating an extract that seemed to work at regulating the blood sugar of dogs who'd had their appendixes removed.
They debuted their work to an audience.
It was one of those things you've seen on TV where the doctors do their work in like a big pit surrounded by an auditorium full of other doctors and pharmaceutical industry people.
Old-timey things.
They had, instead of bags of popcorn, it was like bags of dead dogs.
Bags of dead dogs and those little circle things on their heads that old-timey doctors wore.
One man present at this early insulin demo was George H.A. Klows, a research director for Eli Lilly, the pharmaceutical company.
After the presentation, he sidled up to McLeod and asked if his company could work with the scientists in order to get a product on the market sooner.
McLeod turned him down, claiming that the work was not far enough along yet.
This seems to have pissed Banting off, largely because McLeod had spoken for the group.
Banting was also frustrated by the fact that McLeod was a much better presenter than he was, which made Banting worry that other scientists would get the credit and popular acclaim Banting felt he deserved.
So, like, Banting is like watching as McLeod is like riding in on a skateboard and being like, hey, dudes.
And like, he's just like, yeah, and he's too nervous to talk to anyone, so he can't answer the questions, which McLeod can, but then he's like, he's taking credit for me.
He keeps getting shoved in science lockers.
He totally would be an incel.
No, no.
I'm calling it now.
The inventor of insulin is an incel.
Yeah, involuntary cellular biologist.
Nice, nice, nice.
Really good.
So, it took a lot more work and a lot more dead dogs before Banting and his team made more progress on insulin.
By 1922, they were close to a breakthrough, and Banting decided that McLeod was the center of a gigantic conspiracy to steal the credit for their immediate breakthrough.
Banting and his team started to work with another scientist named Kolip.
Kolip had figured out how to actually purify the pancreatic extracts that they were making and create usable insulin.
In January of 1922, the group carried out a clinical test of their new extract that failed disastrously.
The bad results sparked a fight, and during a heated exchange, Kalip threatened to leave the band and take his purification method with him.
He threatened to patent it so they'd have to pay him to use it.
So, was Eli Lilly the Yoko-Ono of the situation?
They were just sparking a fight.
I see.
But they hadn't done anything yet.
Kalip was kind of the, well, no.
Banting was the...
Banting was the Yoko owner?
It was both Yoko and Lennon.
Ouch.
That's a harsh personality to have.
He seems like a rough guy to work with.
So, yeah, here's a quote from that journal article about the invention of insulin.
This was a breach of the agreement between Khalip, Banting, and Best to exchange all results.
Banting never showed a righteous anger or noted for meekness or restraint when he felt wronged, exploded with clinched fists.
And in a moment, Khalip was laying dazed on the floor of the laboratory.
Fortunately, he was not seriously hurt.
There are no contemporary records of this encounter, no reference by Kolip, and only two accounts, neither of which, according to Bliss, should be considered entirely reliable.
One was by Banting in his unpublished 1940 memoir, the other by Best in a letter to Sir Henry Dale, dated February 22nd, 1954.
So he like beat him with his fists, but he didn't hurt him at all.
No, he beat him with his fists, and I think it probably hurt pretty bad, but Kalip was too felt bashful about it and didn't write about it.
Banting's the only one who wrote about it.
Because I'm thinking maybe his fists were like soft and small as apricots, and it just was like.
Soft and small as apricots.
Oh, apricot fist banting.
Apricot-handed banting.
That's possible, too.
It's possible.
He just sucked at punching.
Right.
But either way, I just like this story of like these genius scientists creating one of the most valuable medicines in history, fist fighting each other over the credit at one point.
It's beautiful.
Now, the four scientists did eventually work out their disagreements enough to allow them to get back to work.
Banting and Best would depancreatize dogs.
Kalip would extract insulin and McLeod would coordinate everyone's research.
Everybody doing playing to their strengths.
Play into their strengths.
It's like you're great at depancretizing.
Is that what it is?
He was the best depancretizer.
Nobody's questioning Banting's ability to take out dogs.
You can do pancreatized 10 pancreases per minute.
If you've got a dog with too many pancrea, this is your man.
He's got 10 ppm.
So, Banting developed a hatred for the professor that made his life unbearable.
Banting became an alcoholic, regularly drinking himself to sleep.
Since it was prohibition, he had to steal liquor, 190-proof alcohol from the laboratory.
He later said, I do not think there was one night during the month of March 1922 when I went to bed sober.
Well, that seems like a not great practice.
It just seems like March.
I mean, March is my birthday month, so I rarely go to bed sober on March.
When he says he was making life unbearable for the other scientists, was he like playing drunken pranks on them?
No, he's just being a really angry ass person.
I see.
Yeah.
Throwing dogs at them.
Tossing dog corpses left and right.
You sons of bitches.
Yeah.
But their work bore fruit.
On May 3rd, 1922, McLeod presented a paper to the Association of American Physicians, The Effect Produced on Diabetes by Extracts of Pancreas.
The paper described their discovery of insulin and it's by now clear therapeutic success on treating diabetes.
McLeod received a standing ovation, the first one given in the entire history of the society's existence.
Banting and Best weren't there to see it.
Banting had refused to go because he was a caddy bitch and badgered his colleague in not going as well as a protest against McLeod.
Jeez.
Yeah, it's pretty.
You missed that rare scientist standing ovation, which are radical because they're just like air horns, vivoozilas.
So at this point, the team reached out to Eli Lilly for help figuring out how to produce insulin in large quantities.
So they'd figured out how to extract insulin.
They could prove that it was a thing, that it had a therapeutic effect, but they were like, we don't actually know how to produce a medicine for a shitload of people.
We're just torturing dogs over here.
Although at some point, there was a horrible note in the story I was reading that they were using cows at one point and they needed like the fetuses of young cows to get the pancreases out.
And they were like, thankfully, lots of slaughterhouses get the cows pregnant before they kill them to make them fatter.
So there's tons of cow fetuses.
Oh, well, isn't that nice?
Yes, we really worked out.
We're swimming in cow fetus.
Cow fetus.
Two are eyeballs in cow fetuses.
$3 ducks.
They just have cow fetuses in a bowl at like the front desk of these farms.
Like, take a cow fetus.
Yeah, cow fetus.
We have plenty.
Too many cow fetuses.
Too many cow fetus.
They're just going to be going into sausage.
It is sausages.
It's just cow fetuses and pig assholes.
That does seem like a like turn of the century movie, like too many cow fetuses.
Too many cow fetuses.
Starring James and Jimson.
Speaking of cow fetuses, wonderful products that help people.
Swimming In Cow Fetuses00:03:40
It's ads time.
There's two golden rules that any man should live by.
Rule one, never mess with a country girl.
You play stupid games, you get stupid prizes.
And rule two, never mess with her friends either.
We always say, trust your girlfriends.
I'm Anna Sinfield, and in this new season of The Girlfriends...
Oh my God, this is the same man.
A group of women discover they've all dated the same prolific con artist.
I felt like I got hit by a truck.
I thought, how could this happen to me?
The cops didn't seem to care.
So they take matters into their own hands.
They said, oh, hell no.
I vowed I will be his last target.
He's going to get what he deserves.
Listen to the girlfriends.
Trust me, babe.
On the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.
I'm Lori Siegel, and on Mostly Human, I go beyond the headlines with the people building our future.
This week, an interview with one of the most influential figures in Silicon Valley, OpenAI CEO Sam Altman.
I think society is going to decide that creators of AI products bear a tremendous amount of responsibility to products we put out in the world.
From power to parenthood.
Kids, teenagers, I think they will need a lot of guardrails around AI.
This is such a powerful and such a new thing.
From addiction to acceleration.
The world we live in is a competitive world, and I don't think that's going to stop, even if you did a lot of redistribution.
You know, we have a deep desire to excel and be competitive and gain status and be useful to others.
And it's a multiplayer game.
What does the man who has extraordinary influence over our lives have to say about the weight of that responsibility?
Find out on Mostly Human.
My highest order bit is to not destroy the world with AI.
Listen to Mostly Human on the iHeartRadio app, Apple Podcast, or wherever you listen to your favorite shows.
Hey, I'm Nora Jones, and I love playing music with people so much that my podcast called Playing Along is back.
I sit down with musicians from all musical styles to play songs together in an intimate setting.
Every episode's a little different, but it all involves music and conversation with some of my favorite musicians.
Over the past two seasons, I've had special guests like Dave Grohl, Leve, Mavis Staples, Remy Wolf, Jeff Tweedy, really too many to name.
And this season, I've sat down with Alessia Cara, Sarah McLaughlin, John Legend, and more.
Check out my new episode with Josh Grobin.
He related to the Phantom at that point.
Yeah, I was definitely the Phantom in that.
So funny.
Share each day with me each night, each morning.
Say you love me.
You know I.
So come hang out with us in the studio and listen to Playing Along on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.
What's up, everyone?
I'm Ego Moda.
My next guest, you know, from Step Brothers, Anchorman, Saturday Night Live, and the Big Money Players Network.
It's Will Farrell.
My dad gave me the best advice ever.
I went and had lunch with him one day, and I was like, and dad, I think I want to really give this a shot.
I don't know what that means, but I just know the groundlings.
I'm working my way up through and I know it's a place they come look for up and coming talent.
He said, if it was based solely on talent, I wouldn't worry about you, which is really sweet.
Generic Insulin Impossible00:09:58
Yeah.
He goes, but there's so much luck involved.
And he's like, just give it a shot.
He goes, but if you ever reach a point where you're banging your head against the wall and it doesn't feel fun anymore, it's okay to quit.
If you saw it written down, it would not be an inspiration.
It would not be on a calendar of, you know, the cat just hang in there.
Yeah, it would not be.
Right, it wouldn't be that.
There's a lot of luck.
Listen to Thanks Dad on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.
We're back.
We're back.
Ads are done.
Ads has happened.
The ads has happened.
Back to insulin.
Banting, Cullop, and Best were awarded a patent on January 23rd, 1923.
They did not give their patent to the public domain as a gift to mankind, but they did sell it for a dollar each to the board of governors of the University of Toronto.
That's a bargain.
That's a bargain.
Great price.
I mean, for all of the insulin?
Solid.
Their goal was for the medicine itself to be used for the benefit of mankind and not pure profit.
They deserve credit for all getting on the same page about one thing, which is that insulin is too vital to be something that's purely a profit thing.
Right, right.
Now, they basically gave the patent to the university so that they could restrict the production of insulin to reputable pharmaceutical companies.
They wanted to stop quacks from trying to make their own products and then selling people poison branded as a matter of fact.
Right, just like liquefied dog in a syringe.
Yeah, we're just killing dogs.
The patent also made it impossible for drug companies to produce a weaker version of the drug and still use the name insulin.
So that's good.
As messy as they were, it does seem like these guys' hearts were in the right place.
Eli Lilly got a non-exclusive licensing contract, and for a while, insulin was a reasonably affordable medicine.
After a couple of decades, the University of Toronto's patent expired, and any pharmaceutical company was allowed to produce it.
This is the point at which the market should have been flooded with cheap, generic versions of insulin.
But something else happened instead.
Eli Lilly, another pharmaceutical company, started tweaking insulin, making minor improvements or alterations to the delivery system, tiny changes that maybe made it work slightly better here and there.
They timed these updates strategically so that insulin has remained for all these different companies a patented medication from 1923 to today.
Right, because so I used to do medical learning materials for pharmaceutical companies, and one of the things I learned is about the process of doing generic medications.
So if you have a patent and you want to extend it beyond what the law intends, right, what you do is you can tweak it very slightly, make, like you said, minor improvements, or you can even not tweak it, but say it's useful for something else like antidepressant medications being used for postpartum depression or PMS.
Well, that's clearly different.
Right.
And then you can cling on to that patent long for much longer than what is the spirit of the law, which is 20 years.
Right, right, which is a long time, too.
So it's it and that prevents other companies from creating biosimilars, which are like not the exact same formulation, but kind of a similar one.
And it's really terrible because it completes it.
Well, let's continue with your horrible story.
Now, it's not impossible.
It's important to say one of the differences with the case of insulin is that it's not impossible for a company to go back to the original recipe and make a generic version of insulin.
That is something that's totally possible.
What these companies are doing is that they're just never releasing a generic.
They just keep tweaking their insulin every time it comes up.
It gets old enough.
So basically, any pharmaceutical company could try to make their own insulin, but any organization that could afford to do so would be a pharmaceutical company.
And in that case, why not just whip up their own kind of insulin, tweak it a little bit, and charge a lot of money?
Why make a generic?
Why help people?
Why help people as a pharmaceutical company?
Right, right.
Now, this is the conclusion reached by doctors Jeremy Green and Kevin Riggs, who published a study in the New England Journal of Medicine accusing the pharmaceutical industry of using a process called evergreening to extend their patents, particularly the patents for insulin.
Right.
This is the name of what you were just explaining.
I'd like to quote from a summary of their article in Medicine Express.
This keeps older versions off the generic market, the authors say, because generic manufacturers have less incentive to make a version of insulin that doctors perceived as obsolete.
Newer versions are somewhat better for patients who can afford them, say the authors, but those who can't suffer painful, costly complications.
We see generic drugs as a rare success story, providing better quality at a cheaper price, says Green, an associate professor of the history of medicine at Johns Hopkins University School of Medicine and a practicing internist.
And we see the progression from patented drug to generic drug is almost automatic.
But the history of insulin highlights the limits of generic competition as a framework for protecting the public health.
Now, Riggs and Green were both inspired to study this problem because so many patients were coming into their Baltimore area clinics with blurred vision, weight loss, thirst, and other symptoms of unmedicated diabetes.
They realized that a ton of people who should have been on insulin were opting to suffer instead of go broke.
Green and Riggs set out to learn why generic insulin wasn't a thing, and they traced out a legacy of evergreening.
In the 1930s and 40s, pharmaceutical companies developed long-acting forms that allowed most patients to take a single daily injection.
In the 1970s and 80s, manufacturers improved the purity of cow and pig extracted insulin.
Since then, several companies have developed synthetic analogs.
Biotech insulin is now the standard in the U.S., the authors say.
Patents on the first synthetic insulin expired in 2014, but these newer forms are harder to copy, so the unpatented versions will go through a lengthy food and drug administration approval process and cost more to make.
When these insulins come off the market, they may cost just 20 to 40% less than the patented versions.
Riggs and Green write.
Now, generic versions of medication often bring the price down to something like 80% cheaper.
So when cheaper insulin comes in, it's going to be this kind of biotech insulin that's just 20 to 40% cheaper as opposed to essentially still twice as much as it ought to be, at least.
So like, so companies could be making these generics, but there's just no monetary incentive for them to do so.
It's not profitable.
Right, right.
I mean, you might get a profit, but it's not as profitable.
Right, because if you're a small enough company that you would want to maybe do it, like, then you couldn't have the resources.
So if you're a bigger company, you're like, well, there's more demand than would mean like people wouldn't be voting with their wallets, so they'll still sell it.
Yeah.
And, you know, insulin has improved a lot over the years.
You know, to give some credit to the pharmaceutical companies, we no longer have to torture dogs to make it.
It's not all derived from animals anymore.
Human insulin can be produced using recombinant DNA technology that basically turns bacteria into insulin factories.
It's pretty cool.
They deserve to be rewarded for the innovations, or at least the scientists do, for the innovations that have been made to insulin.
But with each innovation, essentially, older but still working forms of insulin stop being used as opposed to just being sold as generics because it's not profitable to run them.
I read a Business Insider article on exactly this problem.
It notes that the number of Americans with diabetes has tripled since 1980.
You might expect that to make insulin cheaper, since it's now easier to make and being produced on an economy of scale.
Instead, the price has soared astronomically.
Some insulin products have seen their price triple since 2002.
Wow, geez.
Yeah.
Levomir, one popular medication made by Novo Nordisk, cost $120 for 100 units in 2012.
Today, the same amount costs $300.
Jesus Christ.
Yeah.
Now, as we noted, generic versions of medication often help lower the banks.
You could buy so many dogs with that.
You could.
You could buy $3 dogs.
Yeah, even a $3 dog, which is an expensive dog in the insulin world.
Right.
You could buy $100 $3 dogs and make your own insulin.
$100.
Yeah.
Yeah.
Now, as we noted earlier, generic versions of medication can lower the price by as much as 80%.
This would be life-changing for someone with diabetes struggling to deal with an extra $570 a month in insulin bills.
Yeah, no.
That's what the average diabetic American pays.
Jesus Christ.
So you're talking $400 that could be back on that.
It could be spent on dogs.
Could be spent on dogs.
Or maybe food and your rent.
Or maybe food and rent.
But yeah, there is no generic insulin, and Riggs and Green suspect that this is because no pharmaceutical company considers making such a product to be a worthwhile investment.
Jeez.
On February 17th, 2017, Shane Patrick Boyle posted a GoFundMe to raise enough money for one month of insulin.
For him, this meant $750.
As we already discussed, he came up $50 short, and he died a couple of weeks later of diabetic ketoacidosis.
The current Secretary of Health and Human Services, appointed by Donald Trump and confirmed by Congress, is Alex Azar.
Before he got into politics, Mr. Azar had a different job.
He worked for Eli Lilly from 2007 to 2017.
Starting in 2012, he was the president of Lilly USA, the company's largest division.
I'd like to quote from an article in The Nation.
During Azar's tenure, Eli Lilly raised the prices on its insulins in the United States by 20.8% in 2014, 16.9% in 2015, and 7.5% in 2016.
Eli Lilly's biggest seller, Humilog Insulin, is now off-patent.
But rather than becoming cheaper, Humilog costs more now than when it first came to market in 1996.
When Azar started working at Eli Lilly in June 2007, the list price for a vial of Humilog was $74.
When he quit in January 2017, it was $269.
So have they made changes to Humilog?
Nope.
It's just.
They're just jacking the price up.
Oh, my God.
It's like, that's, shouldn't that be sort of like illegal?
Yeah.
Crime?
Murder?
I mean, the Health and Human Services Secretary did it, so how could it be that bad?
Well, you know how people get so worked up when they see stores jack up the prices of water before a disaster?
This is like that every day.
Every single year for 20 years, and then you become a secretary of health and human services.
Humalog Price Hike00:09:23
Oh, God.
Oh, that is really depressing.
It's horrible.
Yeah.
That's the whole story.
It's just awful.
Oh, that was a very sudden right into the wall in there.
No, I mean, there's not much to say.
I read the story about those parents bringing their dead kids' ashes to a pharmaceutical company and read about it, and it's fucked up.
That is so terrible.
Heavy Alex Azar and everyone else involved in these companies and changing the prices of them is a piece of shit.
Yeah, because, I mean, so one thing is, to be clear about diabetes, is there are two types.
So there's childhood diabetes where there's no lifestyle thing that they do.
Yeah, type one.
They're born with it.
You just random chance.
Shitty spin of that big roulette wheel.
Mother nature just dicking around.
But, I mean, that's not to say people with type two deserve it or anything like that.
No, that's right.
Because, like, I mean, it's such an irony where we have such little restrictions on all these foods that are high in sugar and killing us with, you know, just creating these high incidence of diabetes.
And then the medicine that can save your life is also just the price is jacked up.
Jesus Christ.
That is, if that isn't an indictment of our society, I don't know.
Yeah, it's pretty horrible and gross.
Yeah.
So if you're diabetic, sorry you're dealing with this.
If you happen to know where Alex Azar's car is, I'm not going to say commit a crime on Alex Azar's car, but maybe key it.
Do crimes.
Do crimes.
Not maybe, I'm just saying.
Be diabetic, do crimes.
Generally do crimes.
Generally do crimes.
I mean, my goal is to train a flock of birds to follow them around and give those birds a real, a healthy but very high in fiber diet and just have them follow a lot of like wheat husks.
Yeah.
Chia seeds.
If you train birds and live in the DC area, we have a gig for you.
We got a job.
Listen.
We'll crowdfund this like we would crowdfund someone's insulin payment.
Yeah, and if we fall $50 short, though, we won't die.
We won't die.
His car will just not be filthy, and his shirt will not be shitted on.
If you train birds in D.C., drop a line.
If you practice falconry in the D.C. area, the greater metropolitan D.C. area, you know, DM Robert.
Or if you're Oswald Tomilkins, the greatest car keyer in the East Coast, everybody knows Oswald Tomilkinskins.
Oh, really?
Yeah, absolutely.
He's fantastic.
Maybe key this guy's car.
You know, do it the, I don't know, maybe key in an image of an urn with a dead 27-year-old diabetic ashes in it.
It's so heavy because it's one of these things where we freaking found the cure to this.
We found it.
It shouldn't be a problem.
It shouldn't be a problem.
You know, we talk about things like how terrible cancer is and how we crave a cure so much.
And of course we do because cancer is awful.
But then we have a freaking cure for diabetes that will keep people from dying, from imminently dying, and just to dangle it above them like, oh, oh, you want this cure?
Oh, oh, try and get it.
Oh, oh.
And the people dangling it are only using one hand because they're getting paid tens of millions of dollars in bonuses for doing the dangling.
How?
What a great system.
I know.
Super going to last forever and not collapse in fire and death.
Yeah, like, you know, does it feel good when you get your second luxury yacht?
Like, you might as well just, why not skip all of the middleman stuff and just make it out of dead diabetic?
Yeah, just make it out of corporate.
Make a giant.
A bone yacht made out of the bones of dead diabetic people.
If Alex Azar was sailing up to Kennebunkport, Maine in a bone yacht, well, okay, he's terrible, but like this guy at least has some panassams.
At least he's forthright.
Yeah, he's honestly a bone merchant.
Cut the metaphor.
L. Ron Hubbard would have built a boat out of bones.
Yeah, absolutely.
Yeah.
Either build a bone boat or I'm going to keep telling people to key your car, Alex Azar.
That's my threat to the Secretary of Health and Human Services.
We will train a flock of birds.
Train a flock of birds to shit on your car.
A constant stream of shit flowing as much as insulin should be flowing to patients who need it.
The bird shit will flow like insulin until the insulin gets cheaper.
That is the terroristic threat we are making on this episode of Behind the Bastards.
Great.
Cool.
I'm glad you put a label to it so it'll really make DHS.
You gotta make it easy for those for their search engine to go like, oh, there we go.
Gotta get an interview, like, like, how many birds are in your bird?
How many birds do you have?
What kind of, let me see your keys.
Is there paint on them?
Now, Katie, you got any pluggables to plug?
Well, of course, my show, Creature Feature, where we talk about creatures who are more human-like than you expect and humans who act in animal ways, like the freaking barbaric animals who deny people insulin.
Yeah.
Well, actually, animals would never do anything that fucked up.
No, they wouldn't.
I mean, animals do some fucked up things.
Like, they'll mind control spiders into weaving them a little nest and then killing them.
Death and exploitation I can get behind.
Right, right.
There's something like metal about that.
There's nothing cool about just depriving people of insulin.
No, that's just murder.
And so you can follow me at Katie Golden on Twitter.
You can follow my bird Twitter at ProBirdWrites.
And yeah, please do check out my show.
There's a great episode with Robert in it called Reefer Madness.
Reefer Madness.
There we go.
I was looking for the name of that movie.
Yeah, Reefer Madness.
Reefer Madness.
All right, Robert Evans.
This has been Behind the Bastards.
You can find me on Twitter at iRideOK.
You can find us on Instagram and Twitter at BastardsPod.
You can find us online with all the sources for this article at behindthebastards.com.
We have a t-shirt shop.
You can buy cups there, mugs, phone wraps, and stuff with cool logos made up and catchphrases and stuff from the show, neat images.
Like taste your pee.
Sample your pee.
Sample your pee.
That'll be coming out soon.
So go to TeePublic, look up Behind the Bastards.
More like P-Public.
Although, maybe this week, instead of buying a shirt, donate some money to somebody's GoFundMe if they're trying to buy insulin or something.
They clearly need the help.
Vote or vote.
Hopefully you just voted.
There's no voting to do immediately.
Well, soon.
Keep voting.
Yeah, keep voting constantly.
Look out for your diabetic friends because shit's rough.
Yeah.
Yeah.
All right.
I love about 30% of you.
When a group of women discover they've all dated the same prolific con artist, they take matters into their own hands.
I vowed I will be his last target.
He is not going to get away with this.
He's going to get what he deserves.
We always say that.
Trust your girlfriends.
Listen to the girlfriends.
Trust me, babe.
On the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.
I'm Lori Siegel, and this is Mostly Human, a tech podcast through a human lens.
This week, an interview with OpenAI CEO Sam Altman.
I think society is going to decide that creators of AI products bear a tremendous amount of responsibility to the products we put out in the world.
An in-depth conversation with a man who's shaping our future.
My highest order bit is to not destroy the world with AI.
Listen to Mostly Human on the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.
Hey, it's Nora Jones, and my podcast, Playing Along, is back with more of my favorite musicians.
Check out my newest episode with Josh Groban.
You related to the Phantom at that point.
Yeah, I was definitely the Phantom in that.
That's so funny.
Share each day with me each night, each morning.
Listen to Nora Jones is playing along on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.
What's up, everyone?
I'm Ego Moda.
My next guest, it's Will Farrell.
Woo, woo, woo.
Woo.
My dad gave me the best advice ever.
He goes, just give it a shot.
But if you ever reach a point where you're banging your head against the wall and it doesn't feel fun anymore, it's okay to quit.
If you saw it written down, it would not be an inspiration, it would not be on a calendar of you know the cat just hanging in there.
Yeah, it would not be right, it wouldn't be that.
There's a lot of life.
Yeah, listen to Thanksgiving on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.