December 20, 2018 • 39 mins
In Episode 39, Robert is joined by Katie Goldin (Creature Feature) to discuss the bastardful tale of Insulin.
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Episode Transcript
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Speaker 1 (00:00):
M 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. I don't
understand why I thought it sounded pretty cool, fonds esque.
(00:21):
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 to a
guest who is coming in cold and today that very
cold guest is Katie Golden. Might be Katie coming in
Colden anyway. She's birds rights activists on Twitter, where she
(00:42):
advocates for birds even though as I understand that millennials
are saying birds aren't real, those are lies, Those are
communist lives, communists lies. She's also the host of another
podcast on This Stuff Network, Creature feature great podcast about
animals doing weird ass shit science and stuffy science. Step. Yeah,
we talked about animals and drugs. It's great to do drugs.
(01:05):
It is great to do drugs. Uh. Speaking of drugs
that are great to do today we're talking about insulin,
which is not a well, I mean, it's fun and
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.
Yet it was fun not to die of insulin shock
or diabetic comas and stuff. Not fun. So I'm just
(01:29):
going to get into it. On November seventeen, several parents
brought the ashes of their dead children to the doorstep
of the offices of Santa Fee, a pharmaceutical company that
produces insulin. Sanofie and other insulin producers like Eli Lily
have been steadily raising the prices of their insulin for years.
Because of this, insulin can cost as much as a
thousand dollars a month for people without decent insurance. Oh
(01:51):
my god, that's I I can't imagine spending a thousand
dollars a month on anything of there than like rent,
I guess, but even even a pretty expensive town. So
you're essentially renting your own body, like you want to
keep living in your body. A thousand bucks rent, yeah,
(02:12):
get you a decent place like in Culver City. I
feel like when I lived in Culver my rent was
about thousand months. Yeah, so it's it's frustrating, right, it's
a little frist It's a little frustrating because clearly, I mean,
no country on Earth can afford something like single pair
of healthcare anywhere. It never be done. Um, and our
(02:32):
government needs its money for stuff like I did you
hear about when that hurricane hit the East coast the
military forgot to remove like eleven two and they all
got destroyed. That was one point four billion dollars. Well,
they gotta could have bought a lot. They gotta put
another billion dollar coin in the f twenty seven vending machines.
The funniest thing is there's no vending machine. We can't
(02:55):
make the parts for them anymore, stop manufacturing any of
the things that they are placeable. So, oh good, but
we can't afford to help people with here. 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 one diabetes do not naturally produce insulin, which
(03:17):
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 stopped 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 right. Also, um food, because here's the thing.
(03:39):
Here's the thing is like insulin is basically useless if
you don't eat, if 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 the no eat diet. And
you won't of insulent shock. You'll just die of starvation.
(04:03):
I do think they'll die. Oh yeah, you're right, probably
medically speaking. Yesterday, Well, neither of us are doctors. No,
you're not a doctor. No, I'm not a doctor. Fantastic,
but I do read web and b like a lot. Well,
then you're basically a doctor, 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
(04:24):
twenty six, 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 Fee that November day.
She told the Boston Globe she wanted the company to quote, no,
the price of their product is killing people when it's
intended to save lives. Antoinette Worsham, whose twenty two year
old daughter Antavia died last year while rationing insulin, told
(04:47):
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
instead of healthcare. Yeah, there was a guy who did
(05:08):
that very thing and he short, yeah, fifty dollars short
of reaching his goal in the way. It was his
monthly calls, 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.
(05:29):
He was fifty dollar short of reaching his goal. So
you know how go fund me works. Then you get
none of that money and he died. Yeah he should.
We will be talking about him a little bit later.
Oh good. So clearly this situation is fucked right that
it seems fun. Seems like we can all get on
the same page. There, it's like a little like just
maybe a smidge fun the old F bomb. Yeah, so
(05:54):
what is fun? Why is this so messed up? People
are dying? Well, I'm saying that that's why it's messed up,
Like why why would because insulin is not a new drug. Usually,
when you've got like a case of this where something
is incredibly expensive, it's number one, a drug that very
few people need, and number two a drug that's really new.
Because then you know, that's the way that these patents work.
(06:16):
For most medicines, After about twenty 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 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
(06:39):
to the profit motive, but because of the way that
this generic drug like that. That's the idea, Right, that's
the promise that we've all bought in this system. Otherwise
poor people are 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 talk about why.
(07:00):
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 it 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 and
(07:21):
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 diets. 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
(07:43):
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
Dr Frederick Banting was the first person to isolate secretions
from isolate cells, the cells that make insulin. He suggested
these might hold a treat for diabetes, and he was
basically right. He came up with a plan to tie
(08:03):
up the pancreatic ducts of laboratory dogs and make their
pancreases overproduce the cells that contain insulin until everything else
in the pancreas dies. That was the idea, right, we
did dogs die. The hope was they wouldn't. This is
actually initially envision is like its beautiful one to punch
because we make these dogs pancreases overproduced the cells. They
(08:26):
didn't really know. Insulin was like insulin was a theoretical
substance they called, I think insuline. There was an e.
I don't know how they pronounced it, but it was
spelled insuline. 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 that then we can extract whatever in the pancreas
shoot it into a diabetic It will make them better.
So the idea was, we gotta take these dogs pancreases
(08:48):
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 too. Thing we
don't have to kill the dogs will know that we've
got a treatment for diabetes because these dogs won't be
able to pre sinsulin. After we stuck up their pancreases.
Seemed like it was like a nice circle that they
had that they had developed um Now, the problem with
Banting's plan is that he was not up to date
(09:10):
on the work other scientists were doing testing blood sugar
to find diabetes and patients Banting did urine testing to
find out blood sugar levels, which is not just did
you just like taste it, because I know I just
tasting their well, one of the one of the things
is like, um, if you taste your urine or smell
your urine, it tastes sweet. It's a sign of diabetes
(09:31):
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. Uh for my book
A Brief History advice, because I was I was trying
an ancient Meso American treatment where you mix tobacco, garlic
and urine as a treatment for constipation. It works, it
makes you very ill, but functions and its intended purpose.
(09:54):
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 is going to cut
the sweetness as it's cooking. You know it's gonna But
it sounds like what you're saying is that we should
all be drinking r P every morning to learn if
we are just a little bit a little bit. Just
don't drink a lot of don't drink a lot of
your taste a sample. That's the new behind the bastard's motto.
(10:19):
Sample your own, sample your P, sample your P. Right,
this will be marketable. Let's get a T shirt going,
sample pie. Start that process. Okay, So if he's shaking
her head, she's not happy with that. All right, let's
move on to talking about diabetes some more. So. Banny
was the first guy to start isolating the slate cells
that contain the hormone insulin, but the amounts he was
(10:40):
able to get were too small to really be useful
in his His work had a bunch of holes in it.
You know, he was good at a couple of things,
but he was almost taking a lot of other areas.
So we had to partner with other scientists. Professor John
James Rickard McLeod 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 in over. So you're for the whole project
(11:00):
because Banting was an unstable personality of an asshole. So McLeod,
you means some scientists are assholes. Yes, really, the kind
of guy who would who would poison the dog's pancreas
in order to try to solve it as ease isn't
great at working with other people. Interesting, I mean er intuitive,
but you know you need to do the research. This
(11:21):
horrible thing has to happen. But the kind of guy
who's like, oh, yeah, what if we just toward your
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. He's just so focused on
that insulin. Everyone else is like, but dogs, there's just
dead dogs everywhere. I know. I'm almost corpses, just crumpled
(11:42):
up dog. We get it right, the dogs won't die.
He's just at his desk and he's like, damn it,
and he crinkles up another dog and tossed it. Just
the trash can full of dead dogs. Sophie is really
not loving this conversation. There is a dog in the room,
but because Anderson is a dog, does not understand what
we're talking about which is the mercy of being a dog.
(12:05):
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. Uh well, Banting was an
introvert and a big old nerd. So Banting started to
worry that like McLeod was going to outshine him and
get credit, even though remything 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 completely He goes
(12:26):
like on Reddit to complain about him, like what a
stupid science child, Banting? Would a thousand percent be a
Reddit dude? Although we'll get to yeah a second. So
Banting had an assistant, a guy named Charles Herbert Best,
who did Charles Charles though I thought this is a
fancy form of you know, Charles Charlie char No, No,
(12:50):
not at all, 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
(13:11):
knew that the islets of linger Hends, 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 scientist thought existed. So just as a
quick side note, the islets of Lingerham, imagine them as
like these little islands, that little British islands microbial size.
(13:32):
Langerham expedition goes out and discovers like little white blood
cells and naval hats. Sorry that I just had to
get that image, Duke. Yeah, you're right, that's yeah, that's
how it was discovered. Tiny tiny explorers, tiny explorers. Banting,
McLeod and Best started work in May nine. It did
(13:52):
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
few months of work. After legation of the ducts, the
dogs were expected to recover from the surgery and live
more or less normally. After several weeks, the pancreas and
able to secrete fluid into the duadendum would gradually atrophy
and would be removed in process to extract the internal secretion.
(14:14):
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 and animal work, and
it did not go well at first his Banting struggle
to improve his surgical technique. By the end of the
second week, seven of their tin dogs had died. To
resupply the animal cages, they resorted to buying dogs in
the streets of Toronto. The three dollars with no questions asked,
(14:36):
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 doctors never worked on dogs.
He's killing the left and right. It's just like opening
up the trench coat and I'll give you nine dollars.
Is that enough for three dogs? They're like off brand dogs,
(14:57):
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 have been
(15:19):
calling McLeod is is McLeod So everybody have a good
real mcclaude, aren't you. Everybody have a good laugh, good
old laugh at old old Robert Evans's expense not knowing
enough about scotsman. Uh so, Um, you may have already
noticed that this is horrible because dogs are good, and
(15:40):
medically torturing them to death is bad. But the world
is a gigantic wheel of pain and brutal crush and cruelty,
and sometimes is sometimes necessary in order to save the
lives of billions of diabetics. Uh so, yeah, that's just
the way the world works. Sometimes dogs continue to diet
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
appendix is removed. They debuted their work to an audience.
(16:03):
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 thanks they had like they
had instead of bags of popcorn was like bags 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. Cloud's,
(16:25):
a research director for Eli Lily, the pharmaceutical company. After
the presentation, he sidled up to McLoud 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 McLoud
had spoken for the group. Banting was also frustrated by
the fact that McLoud was a much better presenter than
(16:46):
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 like hey dudes, and
like like he's just like curing and he's too nervous
to talk to anyone, so we can't answer the questions
which McLeod can. But then he's like he's taking credit
(17:07):
for me. He's getting shoved in science lockers. He totally
would be an in cell. I'm calling it now. The
inventor of insulin is an in cell. Yeah, yeah, perfect
involuntary cellular biologist. Nice, nice, nice, really good. Uh So
it took a lot more work and a lot more
dead dogs before Banting and his team made more progress
(17:28):
on insulin. By nine two, 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 colep Colip had figured out how to actually purify
the pancreatic extracts that they were making and create usable insulin.
In January of n the group carried out a clinical
test of their new extract that failed disastrously. The bad
(17:50):
results sparked a fight, and during a heated exchange, Colip
threatened to leave the band and take his purification method
with him. He threatened to patent it's that they'd have
to pay him to use it. So was Eli only
the yoko oh no of the situation or they were
just sparking a fight, Yes, but they didn't They hadn't
done anything yet. Calyp was kind of the well, no
(18:10):
Banting was, the Banting was the Yoko was both Yoko
and Lennon Ouch. That's a that's a harsh personality to have.
He seems like a rough guy to work with. So
uh yeah. Here's a quote from that journal article about
the invention of insulin. This was a breach of the
agreement between Calyp, Banting, and Best to exchange all results.
(18:31):
Banting never showed a righteous anger or noted for meekness
or restraint. When he felt wronged, exploded with clinched fists,
and in a moment Calyp 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 Colip, and only two accounts, neither of which, according
to Bliss, should be considered entirely reliable. One was by
Banting and his unpublished nineteen forty memoir, the other by
(18:52):
Best in a letter to Sir Henry Dale dated February
twenty nine. So he like beat him with his fists,
but he didn't hurt him at all. He beat him
with his fist and I think it probably hurt pretty bad,
but calyp was too felt bashful about it and didn't
write about it. Banting is the only one who wrote
about it, because I'm thinking maybe his fists were like
soft and small as apricots, and it's just like that,
(19:12):
like I solved as small as acot oh apricot apricot
handed Banting. That's it's possible too. It's possibly just sucked
it punching right, But either way, I just liked 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
(19:34):
scientists did eventually work out their disagreements enough to allow
them to get back to work. Banting and Best would
de pancreatized dogs, Colip wouldn't extract insulin, and McCloud would
coordinate everyone's research, everybody doing playing to their strengths, play
into their strength, like you're great at deep pancretize deep pancretizing.
Is that he was the best to pancretizer. Nobody's questioning
Banting's ability to take out dogs. You can PANCRETI tin
(19:57):
pancreas as a per minute. If you're if you've had
a dog with too many pancreai, this is your man.
He's got ten ppm. So um. 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,
(20:17):
he had to steal liquor hundred and ninety proof alcohol
from the laboratory. He later said, I do not think
there was one night during the month of March nineteen
two 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 months, so I rarely
go to bed sober on March. And he says he
(20:37):
was making life like unbearable for the other scientists. Was
he like playing drunken pranks on them? Like, no, he's
just being a really angry as I throwing dogs at
the crossing dog corpses left and right. You sons of bitches. Yeah,
but their work bore fruit. On May third, Cloud presented
a paper to the Association of American Physicians The Effect
(21:00):
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. The Cloud 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's a caddy bitch
and badgered his colleague and not going as well as
(21:21):
a protest against McCleod. Yeah, it's it's pretty missed. That
rare scientist standing ovation, which are radical because they're just
like air horns. Belas so uh. At this point, via
the team reached out to Elit Lily for help figuring
out how to produce insulin in large quantities. So they
figured out how to extract insulin, they could prove that
(21:41):
it was a thing that had a therapeutic effect, but
they were like, we don't actually know how to like
produce a medicine for a shipload of people were just
torturing dogs over here. Although at some point there's a
horrible note in the story. I was reading it like
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.
(22:03):
So there's tons of cow fetuses. Well, isn't that nice
worked out? We're swimming in cow fetuses who are eyeballs
and cow fetuses. Three dollar dogs. They just have cow
fetuses in the bullet like the front desk of these farms,
like take a cow, cow fetus, too many cow fetus.
(22:25):
Fetus 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 Too Many cow fetuses, starring Jamis and Jimson
speaking of cow fetuses. Uh, wonderful products that help people.
It's ADS time. We're back. We're back. ADS are done.
(22:54):
As has happened? ADS has happened back to insulin banting.
Call Up and Best were awarded a patent on January three.
They did not give their patent to the public domain
as a gift demand kind, but they did sell it
for a dollar each to the Board of Governors of
the University of Toronto. Their goal bargain. That's bargain, great
price for all of insulin solid. Their goal was for
(23:16):
the medicine itself to be used for the benefit of
mankind and not pure profit. They deserve credit for getting
all 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 now. They basically gave
the patent to the university so they could restrict the
production of insulin to reputable pharmaceutical companies. They wanted to
stop quacks from trying to make their own products and
(23:37):
then selling people poison Brandon as right, just like liquefied dog. Yeah,
we're just killing out. The pan 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 Lily got
a non exclusive licensing contract and for a while insulin
was a reasonably affordable medicine. After a couple of decades,
(23:59):
the University 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, Lily and
other pharmaceutical companies started tweaking insulin, making minor improvements or
alteration through the delivery system, tiny changes that maybe maybe
it work slightly better here and there. Uh the time,
(24:20):
these updates strategically so that insulin has remained for all
these different companies a patented medication from right 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
(24:44):
what the law intake, 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 um like antidepressant medication and
being used for postpartum depression or PMS. Well that's clearly different, right,
(25:06):
And then then you can cling on to that patent
long for a much longer than what is the spirit
of the law, which is right right, which is a
long time too. So it's 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
(25:29):
because it can well, let's continue with your horrible story. Now,
it's not impossible. It's some point 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. To 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.
(25:50):
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 money
And in that case, why not just whip up their
own kind of insulin? Twigg a little bit, the charge
a lot of money. Why make a generic? Why help people?
Why help people? As a pharmaceutical Now, this is the
(26:12):
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 instance, 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
(26:35):
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 patent to drug to generic drug is
(26:57):
almost automatic. But the history of insulin highlights limits of
generic competition. Is 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
(27:19):
learn why generic insulin wasn't a thing, and they traced
out a legacy of evergreening. In the nineteen thirties and forties,
pharmaceutical companies developed long acting forms that allowed most patients
to take a single daily injection. In the nineteen seventies
and eighties, manufacturers improved the purity of cow and pig
extracted insulin. Since then, several companies who developed synthetic analogs
biotech insulin is now the standard in the US. The
(27:40):
authors say patents on the first synthetic insulin expired in
two thousand and fourteen, 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 less than the patented versions. Riggs and
Green right now, generic versions of medication often bring the
price down to something like cheaper, so when cheaper insulin
(28:04):
comes in, it's going to be this kind of biotech
insulin that's just cheaper as opposed to so essentially still
twice as much as at least so like, so companies
could be making these generics, but there's just no monetary
incentive for them, so it's not profitable, right right, I
mean you might get a profit, is not as profit
right because if you're a small enough company that you
(28:25):
would want to maybe do it, like, then you couldn't.
You don't have the resources. You don'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 uh,
you know, insulin has improved a lot over the years,
you know, to give some credit to the pharmaceutical companies.
(28:46):
We no longer have to torture dogs to make it.
It's not all derived from animals anymore. Human insulin can
be produced using recompetent DNA technology that basically turns bacteria
and insulin factories. It's pretty cool. The they deserve to
be rewarded for the innovations, or at least the scientists
do for the innovations that have been made to insulin. UM.
But with each innovation, essentially older but still working forms
(29:09):
of insulin UH 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 nineteen eighty. 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 prices sword astronomically.
(29:31):
Some insulin products have seen their price triple since two
thousand two. Yeah. Levi Mere, one popular medication made by
Novo Nordisk, cost a hundred and twenty dollars for a
hundred units two twelve. Today, the same amount costs three
hundred dollars. Now, as we know, a generic versions of
medication often helpfully, you could buy so many dogs with that.
(29:51):
You could you could buy three dollar dogs even, yeah,
even a three dollar dog, which is an expensive dog.
In the insulin, you could buy a hundred your own
yeah yeah. Now, as we noted earlier, generic versions of
medication can lower the price by as much as eight percent.
This would be life changing for someone with diabetes. Struggling
to deal with an extra five hundred and seventy dollars
(30:12):
a month insulin bills. That's what the average diabetic American
past Jesus Christ. So you're talking four hundred bucks that
could be back on the can be spent on dogs,
could be spent on dogs, or maybe food and your
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
(30:33):
be a worthwhile investment. On February two thousand seventeen, Shane
Patrick Boyle posted a go fund Me to raise enough
money from one month of Inceland. For him. This meant
seven hundred and fifty dollars. As we already discussed, he
came up fifty dollars short, and he died a couple
of weeks later of diabetic keto acidosis. The current Secretary
of Health and Human Services, appointed by Donald Trump and
(30:55):
confirmed by Congress is Alex Azar. Before he got into politics,
Mr Azar had a different job. He worked for Eli
Lily from two thousand seven to two thousand seventeen. Starting
in two twelve, he was the president of Lily USA.
The company's largest division. I'd like to quote from an
article in the Nation. During Azar's tenure, Eli Lily raised
the prices on its insulence in the United States by
(31:16):
twenty point eight percent in two thousand fourteen, sixteen point
nine percent in two thousand fifteen, and seven point five
percent in two thousand and sixteen. Eli Lily's biggest seller,
humal log insulin, is now off patent, but rather than
becoming cheaper, Human Logue costs more now than when it
first came to market in nineteen ninety six. When Azar
started working at Eli Lily in June two thousand seven,
the list price for a vile of human Logue was
(31:38):
seventy four dollars. When he quit in January two thousand seventeen,
it was two hundred and sixty mine. So have they
made changes to human Logue. It's just they're just jacking
the price. Oh my god, It's like that's shouldn't that
be sort of like I'm murder I mean, the Health
and Human Service as secretary did it, So how could
(31:59):
it be that? Well, you know how people get so
worked up when they see stores jack up the prices
of water before disaster. This is like that every day,
every single year for twenty years, and then you become
a secretary at about Oh that is really depressing. It's horrible. Yeah,
(32:20):
oh that was 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 I mean alex asar and everyone else involved in
these companies and changing the prices of them as a
(32:41):
piece of ship. Because I mean, so one thing is
to be clear about diabetes. There are two types. So
there's childhood diabetes where there's no lifestyle. Yeah, Type one,
they're born with it. You just random chance. Should he
spend that big roulette wheel mother nature just dick and around.
But I mean that's not to say people type two
(33:04):
deserve it or anything like that, 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 incidents
of diabetes, and then the medicine that can save your
life is also just the price is jacked of Jesus Christ.
(33:28):
That is, if that isn't an indictment of our society.
I don't know. Yeah, it's pretty pretty horrible and gross. Yeah.
So if you're diabetic, so are you're dealing with this?
If you happen to know where alex Asar's car is.
I'm not going to say, commit a crime on alex
(33:51):
Asar's car, but maybe do crimes? Do crimes? Not? Maybe
I'm just do crist generally, do cry generally do crimes?
I mean my goal is to train a flock of
birds to follow them around and give those birds a
really healthy but very high in fiber diet and just
(34:13):
have them follow car a lot of a lot of
like wheat husks, yeah, chia seeds. If you train birds
and live in the d C area, we have a
gig for you. We got a job. Listen, well, crowd
fund this like we would crowd fund someone's insulin payment. Yeah.
And if we fall fifty short, though, we won't die.
(34:34):
We won't die. His car will just not be filthy.
Shirt will not be shipped on if you train birds
in d C. Right, if you drop a line, if
you practice falconry in the DC area, the greater metropolitan
DC area. You know D M. Robert or if you're Oswald, Tomilkins,
the greatest car here in the East Coast. Everybody knows Oswald. Yeah, absolutely,
(34:56):
he's fantastic. Maybe key this guy's car, you know, to
do it the I don't know, maybe key. In an
image of an urn with a dead twenty seven year
old diabetic dashes in it. It's so heavy because it's
one of these things where we freaking found the cure
to this. We found shouldn't be a problem. It shouldn't
be a problem. You know. We talk about things like
(35:19):
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, try and get it. Oh, and the
(35:41):
people dangling and are only using one hand because they're
getting paid tens of millions of dollars and bonuses for
doing the dangling. What a great system, I know, super
gonna last forever and not collapse in fire and death. Yet, like,
you know, does it feel good when you get your
like second luxury. Yah, like you might as well just
(36:01):
why not skip all of the middleman stuff and just
make it out of dead diabet Just make a giant
bone yacht made out of the bones of dead diabetic people.
If Alex Asar was sailing up to Kinnebunkport, Maine in
a bone yacht, well, okay, he's terrible, but like, this
guy at least has some pane, at least he's forth right. Yeah,
(36:22):
he's honestly a bone merchant. Cut the metaphor. Hubbard would
have built a boat out of bones. Yeah, absolutely, Yeah,
either build a bone boat or I'm gonna keep telling
people to key your car, Alex has aer. That's my
threat to the Secretary of Human Services. We will train
a flock of birds. Train a flock of birds to
(36:43):
ship on your car. Constant flow stream of ship flowing
as much as insulin should be flowing patients. The bird
ship will flow like insulin until the insulin gets cheaper.
That is the terroristic threat we are making on this episode.
Behind the Bastards. Great cool. I'm glad you put a
label to it so it'll really make dhs. Uh. You's
(37:05):
gonna make it easy for those yes for their search
engine to go like, oh, there we go. I'm gonna
get an interview like like how many birds are in
your birds? You have? What kind? Let me see your
keys because there was their paint on them. Katie, you
got any plug plug? Well, of course, my show Creature
feature where we talk about creatures who are more human
(37:27):
like than you expect in humans who act in animal ways,
like the freaking barbaric animals who deny people insulin. Well, actually,
animals would never do anything that sucked up. No, they wouldn't.
I mean, animals do some fucked up things, like they'll
mind control of spiders into weaving them a little nest
(37:48):
and then killing them and get behind right right, there's
something like metal about that. There's there's nothing cool about
just depriving people of insulin. Uh And So you can
follow me at Katie Golden on Twitter. You can follow
my bird twitter at pro Burg writes uh and, Yeah,
(38:09):
please do check out my show. There's a great episode
with Robert Innett called uh Re for Madness for Madness.
There we go from the name of that movie, Yeah
for madness, madness All rightert Evans. This has been behind
the Bastards. You can find me on Twitter at I right, okay.
You can find us on Instagram and uh twitter at
at bastards pod. You can find us online with all
(38:30):
the sources for this article at behind the Bastards dot com.
We have a t shirt shop. You can buy cups there, mugs,
phone raps, and stuff with cool logos made up and
catch phrases and stuff from the show neat images. So
like taste your PA, sample your p that'll be coming
out soon, So go to t public, look up behind
the Bastards public. Hello, maybe this week instead of buying
(38:52):
a shirt, donate some money to somebody's go fund me
if they're trying to buy Incelin 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,
I keep voting constantly. Look out for your your diabetic
friends because it's rough. Yeah, all right, I love about
(39:12):
three percent of you. H
M 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. I don't
understand why I thought it sounded pretty cool, fonds esque.
(00:21):
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 to a
guest who is coming in cold and today that very
cold guest is Katie Golden. Might be Katie coming in
Colden anyway. She's birds rights activists on Twitter, where she
(00:42):
advocates for birds even though as I understand that millennials
are saying birds aren't real, those are lies, Those are
communist lives, communists lies. She's also the host of another
podcast on This Stuff Network, Creature feature great podcast about
animals doing weird ass shit science and stuffy science. Step. Yeah,
we talked about animals and drugs. It's great to do drugs.
(01:05):
It is great to do drugs. Uh. Speaking of drugs
that are great to do today we're talking about insulin,
which is not a well, I mean, it's fun and
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.
Yet it was fun not to die of insulin shock
or diabetic comas and stuff. Not fun. So I'm just
(01:29):
going to get into it. On November seventeen, several parents
brought the ashes of their dead children to the doorstep
of the offices of Santa Fee, a pharmaceutical company that
produces insulin. Sanofie and other insulin producers like Eli Lily
have been steadily raising the prices of their insulin for years.
Because of this, insulin can cost as much as a
thousand dollars a month for people without decent insurance. Oh
(01:51):
my god, that's I I can't imagine spending a thousand
dollars a month on anything of there than like rent,
I guess, but even even a pretty expensive town. So
you're essentially renting your own body, like you want to
keep living in your body. A thousand bucks rent, yeah,
(02:12):
get you a decent place like in Culver City. I
feel like when I lived in Culver my rent was
about thousand months. Yeah, so it's it's frustrating, right, it's
a little frist It's a little frustrating because clearly, I mean,
no country on Earth can afford something like single pair
of healthcare anywhere. It never be done. Um, and our
(02:32):
government needs its money for stuff like I did you
hear about when that hurricane hit the East coast the
military forgot to remove like eleven two and they all
got destroyed. That was one point four billion dollars. Well,
they gotta could have bought a lot. They gotta put
another billion dollar coin in the f twenty seven vending machines.
The funniest thing is there's no vending machine. We can't
(02:55):
make the parts for them anymore, stop manufacturing any of
the things that they are placeable. So, oh good, but
we can't afford to help people with here. 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 one diabetes do not naturally produce insulin, which
(03:17):
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 stopped 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 right. Also, um food, because here's the thing.
(03:39):
Here's the thing is like insulin is basically useless if
you don't eat, if 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 the no eat diet. And
you won't of insulent shock. You'll just die of starvation.
(04:03):
I do think they'll die. Oh yeah, you're right, probably
medically speaking. Yesterday, Well, neither of us are doctors. No,
you're not a doctor. No, I'm not a doctor. Fantastic,
but I do read web and b like a lot. Well,
then you're basically a doctor, 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
(04:24):
twenty six, 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 Fee that November day.
She told the Boston Globe she wanted the company to quote, no,
the price of their product is killing people when it's
intended to save lives. Antoinette Worsham, whose twenty two year
old daughter Antavia died last year while rationing insulin, told
(04:47):
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
instead of healthcare. Yeah, there was a guy who did
(05:08):
that very thing and he short, yeah, fifty dollars short
of reaching his goal in the way. It was his
monthly calls, 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.
(05:29):
He was fifty dollar short of reaching his goal. So
you know how go fund me works. Then you get
none of that money and he died. Yeah he should.
We will be talking about him a little bit later.
Oh good. So clearly this situation is fucked right that
it seems fun. Seems like we can all get on
the same page. There, it's like a little like just
maybe a smidge fun the old F bomb. Yeah, so
(05:54):
what is fun? Why is this so messed up? People
are dying? Well, I'm saying that that's why it's messed up,
Like why why would because insulin is not a new drug. Usually,
when you've got like a case of this where something
is incredibly expensive, it's number one, a drug that very
few people need, and number two a drug that's really new.
Because then you know, that's the way that these patents work.
(06:16):
For most medicines, After about twenty 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 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
(06:39):
to the profit motive, but because of the way that
this generic drug like that. That's the idea, Right, that's
the promise that we've all bought in this system. Otherwise
poor people are 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 talk about why.
(07:00):
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 it 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 and
(07:21):
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 diets. 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
(07:43):
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
Dr Frederick Banting was the first person to isolate secretions
from isolate cells, the cells that make insulin. He suggested
these might hold a treat for diabetes, and he was
basically right. He came up with a plan to tie
(08:03):
up the pancreatic ducts of laboratory dogs and make their
pancreases overproduce the cells that contain insulin until everything else
in the pancreas dies. That was the idea, right, we
did dogs die. The hope was they wouldn't. This is
actually initially envision is like its beautiful one to punch
because we make these dogs pancreases overproduced the cells. They
(08:26):
didn't really know. Insulin was like insulin was a theoretical
substance they called, I think insuline. There was an e.
I don't know how they pronounced it, but it was
spelled insuline. 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 that then we can extract whatever in the pancreas
shoot it into a diabetic It will make them better.
So the idea was, we gotta take these dogs pancreases
(08:48):
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 too. Thing we
don't have to kill the dogs will know that we've
got a treatment for diabetes because these dogs won't be
able to pre sinsulin. After we stuck up their pancreases.
Seemed like it was like a nice circle that they
had that they had developed um Now, the problem with
Banting's plan is that he was not up to date
(09:10):
on the work other scientists were doing testing blood sugar
to find diabetes and patients Banting did urine testing to
find out blood sugar levels, which is not just did
you just like taste it, because I know I just
tasting their well, one of the one of the things
is like, um, if you taste your urine or smell
your urine, it tastes sweet. It's a sign of diabetes
(09:31):
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. Uh for my book
A Brief History advice, because I was I was trying
an ancient Meso American treatment where you mix tobacco, garlic
and urine as a treatment for constipation. It works, it
makes you very ill, but functions and its intended purpose.
(09:54):
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 is going to cut
the sweetness as it's cooking. You know it's gonna But
it sounds like what you're saying is that we should
all be drinking r P every morning to learn if
we are just a little bit a little bit. Just
don't drink a lot of don't drink a lot of
your taste a sample. That's the new behind the bastard's motto.
(10:19):
Sample your own, sample your P, sample your P. Right,
this will be marketable. Let's get a T shirt going,
sample pie. Start that process. Okay, So if he's shaking
her head, she's not happy with that. All right, let's
move on to talking about diabetes some more. So. Banny
was the first guy to start isolating the slate cells
that contain the hormone insulin, but the amounts he was
(10:40):
able to get were too small to really be useful
in his His work had a bunch of holes in it.
You know, he was good at a couple of things,
but he was almost taking a lot of other areas.
So we had to partner with other scientists. Professor John
James Rickard McLeod 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 in over. So you're for the whole project
(11:00):
because Banting was an unstable personality of an asshole. So McLeod,
you means some scientists are assholes. Yes, really, the kind
of guy who would who would poison the dog's pancreas
in order to try to solve it as ease isn't
great at working with other people. Interesting, I mean er intuitive,
but you know you need to do the research. This
(11:21):
horrible thing has to happen. But the kind of guy
who's like, oh, yeah, what if we just toward your
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. He's just so focused on
that insulin. Everyone else is like, but dogs, there's just
dead dogs everywhere. I know. I'm almost corpses, just crumpled
(11:42):
up dog. We get it right, the dogs won't die.
He's just at his desk and he's like, damn it,
and he crinkles up another dog and tossed it. Just
the trash can full of dead dogs. Sophie is really
not loving this conversation. There is a dog in the room,
but because Anderson is a dog, does not understand what
we're talking about which is the mercy of being a dog.
(12:05):
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. Uh well, Banting was an
introvert and a big old nerd. So Banting started to
worry that like McLeod was going to outshine him and
get credit, even though remything 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 completely He goes
(12:26):
like on Reddit to complain about him, like what a
stupid science child, Banting? Would a thousand percent be a
Reddit dude? Although we'll get to yeah a second. So
Banting had an assistant, a guy named Charles Herbert Best,
who did Charles Charles though I thought this is a
fancy form of you know, Charles Charlie char No, No,
(12:50):
not at all, 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
(13:11):
knew that the islets of linger Hends, 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 scientist thought existed. So just as a
quick side note, the islets of Lingerham, imagine them as
like these little islands, that little British islands microbial size.
(13:32):
Langerham expedition goes out and discovers like little white blood
cells and naval hats. Sorry that I just had to
get that image, Duke. Yeah, you're right, that's yeah, that's
how it was discovered. Tiny tiny explorers, tiny explorers. Banting,
McLeod and Best started work in May nine. It did
(13:52):
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
few months of work. After legation of the ducts, the
dogs were expected to recover from the surgery and live
more or less normally. After several weeks, the pancreas and
able to secrete fluid into the duadendum would gradually atrophy
and would be removed in process to extract the internal secretion.
(14:14):
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 and animal work, and
it did not go well at first his Banting struggle
to improve his surgical technique. By the end of the
second week, seven of their tin dogs had died. To
resupply the animal cages, they resorted to buying dogs in
the streets of Toronto. The three dollars with no questions asked,
(14:36):
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 doctors never worked on dogs.
He's killing the left and right. It's just like opening
up the trench coat and I'll give you nine dollars.
Is that enough for three dogs? They're like off brand dogs,
(14:57):
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 have been
(15:19):
calling McLeod is is McLeod So everybody have a good
real mcclaude, aren't you. Everybody have a good laugh, good
old laugh at old old Robert Evans's expense not knowing
enough about scotsman. Uh so, Um, you may have already
noticed that this is horrible because dogs are good, and
(15:40):
medically torturing them to death is bad. But the world
is a gigantic wheel of pain and brutal crush and cruelty,
and sometimes is sometimes necessary in order to save the
lives of billions of diabetics. Uh so, yeah, that's just
the way the world works. Sometimes dogs continue to diet
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
appendix is removed. They debuted their work to an audience.
(16:03):
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 thanks they had like they
had instead of bags of popcorn was like bags 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. Cloud's,
(16:25):
a research director for Eli Lily, the pharmaceutical company. After
the presentation, he sidled up to McLoud 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 McLoud
had spoken for the group. Banting was also frustrated by
the fact that McLoud was a much better presenter than
(16:46):
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 like hey dudes, and
like like he's just like curing and he's too nervous
to talk to anyone, so we can't answer the questions
which McLeod can. But then he's like he's taking credit
(17:07):
for me. He's getting shoved in science lockers. He totally
would be an in cell. I'm calling it now. The
inventor of insulin is an in cell. Yeah, yeah, perfect
involuntary cellular biologist. Nice, nice, nice, really good. Uh So
it took a lot more work and a lot more
dead dogs before Banting and his team made more progress
(17:28):
on insulin. By nine two, 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 colep Colip had figured out how to actually purify
the pancreatic extracts that they were making and create usable insulin.
In January of n the group carried out a clinical
test of their new extract that failed disastrously. The bad
(17:50):
results sparked a fight, and during a heated exchange, Colip
threatened to leave the band and take his purification method
with him. He threatened to patent it's that they'd have
to pay him to use it. So was Eli only
the yoko oh no of the situation or they were
just sparking a fight, Yes, but they didn't They hadn't
done anything yet. Calyp was kind of the well, no
(18:10):
Banting was, the Banting was the Yoko was both Yoko
and Lennon Ouch. That's a that's a harsh personality to have.
He seems like a rough guy to work with. So
uh yeah. Here's a quote from that journal article about
the invention of insulin. This was a breach of the
agreement between Calyp, Banting, and Best to exchange all results.
(18:31):
Banting never showed a righteous anger or noted for meekness
or restraint. When he felt wronged, exploded with clinched fists,
and in a moment Calyp 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 Colip, and only two accounts, neither of which, according
to Bliss, should be considered entirely reliable. One was by
Banting and his unpublished nineteen forty memoir, the other by
(18:52):
Best in a letter to Sir Henry Dale dated February
twenty nine. So he like beat him with his fists,
but he didn't hurt him at all. He beat him
with his fist and I think it probably hurt pretty bad,
but calyp was too felt bashful about it and didn't
write about it. Banting is the only one who wrote
about it, because I'm thinking maybe his fists were like
soft and small as apricots, and it's just like that,
(19:12):
like I solved as small as acot oh apricot apricot
handed Banting. That's it's possible too. It's possibly just sucked
it punching right, But either way, I just liked 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
(19:34):
scientists did eventually work out their disagreements enough to allow
them to get back to work. Banting and Best would
de pancreatized dogs, Colip wouldn't extract insulin, and McCloud would
coordinate everyone's research, everybody doing playing to their strengths, play
into their strength, like you're great at deep pancretize deep pancretizing.
Is that he was the best to pancretizer. Nobody's questioning
Banting's ability to take out dogs. You can PANCRETI tin
(19:57):
pancreas as a per minute. If you're if you've had
a dog with too many pancreai, this is your man.
He's got ten ppm. So um. 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,
(20:17):
he had to steal liquor hundred and ninety proof alcohol
from the laboratory. He later said, I do not think
there was one night during the month of March nineteen
two 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 months, so I rarely
go to bed sober on March. And he says he
(20:37):
was making life like unbearable for the other scientists. Was
he like playing drunken pranks on them? Like, no, he's
just being a really angry as I throwing dogs at
the crossing dog corpses left and right. You sons of bitches. Yeah,
but their work bore fruit. On May third, Cloud presented
a paper to the Association of American Physicians The Effect
(21:00):
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. The Cloud 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's a caddy bitch
and badgered his colleague and not going as well as
(21:21):
a protest against McCleod. Yeah, it's it's pretty missed. That
rare scientist standing ovation, which are radical because they're just
like air horns. Belas so uh. At this point, via
the team reached out to Elit Lily for help figuring
out how to produce insulin in large quantities. So they
figured out how to extract insulin, they could prove that
(21:41):
it was a thing that had a therapeutic effect, but
they were like, we don't actually know how to like
produce a medicine for a shipload of people were just
torturing dogs over here. Although at some point there's a
horrible note in the story. I was reading it like
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.
(22:03):
So there's tons of cow fetuses. Well, isn't that nice
worked out? We're swimming in cow fetuses who are eyeballs
and cow fetuses. Three dollar dogs. They just have cow
fetuses in the bullet like the front desk of these farms,
like take a cow, cow fetus, too many cow fetus.
(22:25):
Fetus 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 Too Many cow fetuses, starring Jamis and Jimson
speaking of cow fetuses. Uh, wonderful products that help people.
It's ADS time. We're back. We're back. ADS are done.
(22:54):
As has happened? ADS has happened back to insulin banting.
Call Up and Best were awarded a patent on January three.
They did not give their patent to the public domain
as a gift demand kind, but they did sell it
for a dollar each to the Board of Governors of
the University of Toronto. Their goal bargain. That's bargain, great
price for all of insulin solid. Their goal was for
(23:16):
the medicine itself to be used for the benefit of
mankind and not pure profit. They deserve credit for getting
all 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 now. They basically gave
the patent to the university so they could restrict the
production of insulin to reputable pharmaceutical companies. They wanted to
stop quacks from trying to make their own products and
(23:37):
then selling people poison Brandon as right, just like liquefied dog. Yeah,
we're just killing out. The pan 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 Lily got
a non exclusive licensing contract and for a while insulin
was a reasonably affordable medicine. After a couple of decades,
(23:59):
the University 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, Lily and
other pharmaceutical companies started tweaking insulin, making minor improvements or
alteration through the delivery system, tiny changes that maybe maybe
it work slightly better here and there. Uh the time,
(24:20):
these updates strategically so that insulin has remained for all
these different companies a patented medication from right 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
(24:44):
what the law intake, 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 um like antidepressant medication and
being used for postpartum depression or PMS. Well that's clearly different, right,
(25:06):
And then then you can cling on to that patent
long for a much longer than what is the spirit
of the law, which is right right, which is a
long time too. So it's 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
(25:29):
because it can well, let's continue with your horrible story. Now,
it's not impossible. It's some point 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. To 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.
(25:50):
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 money
And in that case, why not just whip up their
own kind of insulin? Twigg a little bit, the charge
a lot of money. Why make a generic? Why help people?
Why help people? As a pharmaceutical Now, this is the
(26:12):
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 instance, 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
(26:35):
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 patent to drug to generic drug is
(26:57):
almost automatic. But the history of insulin highlights limits of
generic competition. Is 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
(27:19):
learn why generic insulin wasn't a thing, and they traced
out a legacy of evergreening. In the nineteen thirties and forties,
pharmaceutical companies developed long acting forms that allowed most patients
to take a single daily injection. In the nineteen seventies
and eighties, manufacturers improved the purity of cow and pig
extracted insulin. Since then, several companies who developed synthetic analogs
biotech insulin is now the standard in the US. The
(27:40):
authors say patents on the first synthetic insulin expired in
two thousand and fourteen, 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 less than the patented versions. Riggs and
Green right now, generic versions of medication often bring the
price down to something like cheaper, so when cheaper insulin
(28:04):
comes in, it's going to be this kind of biotech
insulin that's just cheaper as opposed to so essentially still
twice as much as at least so like, so companies
could be making these generics, but there's just no monetary
incentive for them, so it's not profitable, right right, I
mean you might get a profit, is not as profit
right because if you're a small enough company that you
(28:25):
would want to maybe do it, like, then you couldn't.
You don't have the resources. You don'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 uh,
you know, insulin has improved a lot over the years,
you know, to give some credit to the pharmaceutical companies.
(28:46):
We no longer have to torture dogs to make it.
It's not all derived from animals anymore. Human insulin can
be produced using recompetent DNA technology that basically turns bacteria
and insulin factories. It's pretty cool. The they deserve to
be rewarded for the innovations, or at least the scientists
do for the innovations that have been made to insulin. UM.
But with each innovation, essentially older but still working forms
(29:09):
of insulin UH 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 nineteen eighty. 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 prices sword astronomically.
(29:31):
Some insulin products have seen their price triple since two
thousand two. Yeah. Levi Mere, one popular medication made by
Novo Nordisk, cost a hundred and twenty dollars for a
hundred units two twelve. Today, the same amount costs three
hundred dollars. Now, as we know, a generic versions of
medication often helpfully, you could buy so many dogs with that.
(29:51):
You could you could buy three dollar dogs even, yeah,
even a three dollar dog, which is an expensive dog.
In the insulin, you could buy a hundred your own
yeah yeah. Now, as we noted earlier, generic versions of
medication can lower the price by as much as eight percent.
This would be life changing for someone with diabetes. Struggling
to deal with an extra five hundred and seventy dollars
(30:12):
a month insulin bills. That's what the average diabetic American
past Jesus Christ. So you're talking four hundred bucks that
could be back on the can be spent on dogs,
could be spent on dogs, or maybe food and your
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
(30:33):
be a worthwhile investment. On February two thousand seventeen, Shane
Patrick Boyle posted a go fund Me to raise enough
money from one month of Inceland. For him. This meant
seven hundred and fifty dollars. As we already discussed, he
came up fifty dollars short, and he died a couple
of weeks later of diabetic keto acidosis. The current Secretary
of Health and Human Services, appointed by Donald Trump and
(30:55):
confirmed by Congress is Alex Azar. Before he got into politics,
Mr Azar had a different job. He worked for Eli
Lily from two thousand seven to two thousand seventeen. Starting
in two twelve, he was the president of Lily USA.
The company's largest division. I'd like to quote from an
article in the Nation. During Azar's tenure, Eli Lily raised
the prices on its insulence in the United States by
(31:16):
twenty point eight percent in two thousand fourteen, sixteen point
nine percent in two thousand fifteen, and seven point five
percent in two thousand and sixteen. Eli Lily's biggest seller,
humal log insulin, is now off patent, but rather than
becoming cheaper, Human Logue costs more now than when it
first came to market in nineteen ninety six. When Azar
started working at Eli Lily in June two thousand seven,
the list price for a vile of human Logue was
(31:38):
seventy four dollars. When he quit in January two thousand seventeen,
it was two hundred and sixty mine. So have they
made changes to human Logue. It's just they're just jacking
the price. Oh my god, It's like that's shouldn't that
be sort of like I'm murder I mean, the Health
and Human Service as secretary did it, So how could
(31:59):
it be that? Well, you know how people get so
worked up when they see stores jack up the prices
of water before disaster. This is like that every day,
every single year for twenty years, and then you become
a secretary at about Oh that is really depressing. It's horrible. Yeah,
(32:20):
oh that was 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 I mean alex asar and everyone else involved in
these companies and changing the prices of them as a
(32:41):
piece of ship. Because I mean, so one thing is
to be clear about diabetes. There are two types. So
there's childhood diabetes where there's no lifestyle. Yeah, Type one,
they're born with it. You just random chance. Should he
spend that big roulette wheel mother nature just dick and around.
But I mean that's not to say people type two
(33:04):
deserve it or anything like that, 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 incidents
of diabetes, and then the medicine that can save your
life is also just the price is jacked of Jesus Christ.
(33:28):
That is, if that isn't an indictment of our society.
I don't know. Yeah, it's pretty pretty horrible and gross. Yeah.
So if you're diabetic, so are you're dealing with this?
If you happen to know where alex Asar's car is.
I'm not going to say, commit a crime on alex
(33:51):
Asar's car, but maybe do crimes? Do crimes? Not? Maybe
I'm just do crist generally, do cry generally do crimes?
I mean my goal is to train a flock of
birds to follow them around and give those birds a
really healthy but very high in fiber diet and just
(34:13):
have them follow car a lot of a lot of
like wheat husks, yeah, chia seeds. If you train birds
and live in the d C area, we have a
gig for you. We got a job. Listen, well, crowd
fund this like we would crowd fund someone's insulin payment. Yeah.
And if we fall fifty short, though, we won't die.
(34:34):
We won't die. His car will just not be filthy.
Shirt will not be shipped on if you train birds
in d C. Right, if you drop a line, if
you practice falconry in the DC area, the greater metropolitan
DC area. You know D M. Robert or if you're Oswald, Tomilkins,
the greatest car here in the East Coast. Everybody knows Oswald. Yeah, absolutely,
(34:56):
he's fantastic. Maybe key this guy's car, you know, to
do it the I don't know, maybe key. In an
image of an urn with a dead twenty seven year
old diabetic dashes in it. It's so heavy because it's
one of these things where we freaking found the cure
to this. We found shouldn't be a problem. It shouldn't
be a problem. You know. We talk about things like
(35:19):
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, try and get it. Oh, and the
(35:41):
people dangling and are only using one hand because they're
getting paid tens of millions of dollars and bonuses for
doing the dangling. What a great system, I know, super
gonna last forever and not collapse in fire and death. Yet, like,
you know, does it feel good when you get your
like second luxury. Yah, like you might as well just
(36:01):
why not skip all of the middleman stuff and just
make it out of dead diabet Just make a giant
bone yacht made out of the bones of dead diabetic people.
If Alex Asar was sailing up to Kinnebunkport, Maine in
a bone yacht, well, okay, he's terrible, but like, this
guy at least has some pane, at least he's forth right. Yeah,
(36:22):
he's honestly a bone merchant. Cut the metaphor. Hubbard would
have built a boat out of bones. Yeah, absolutely, Yeah,
either build a bone boat or I'm gonna keep telling
people to key your car, Alex has aer. That's my
threat to the Secretary of Human Services. We will train
a flock of birds. Train a flock of birds to
(36:43):
ship on your car. Constant flow stream of ship flowing
as much as insulin should be flowing patients. The bird
ship will flow like insulin until the insulin gets cheaper.
That is the terroristic threat we are making on this episode.
Behind the Bastards. Great cool. I'm glad you put a
label to it so it'll really make dhs. Uh. You's
(37:05):
gonna make it easy for those yes for their search
engine to go like, oh, there we go. I'm gonna
get an interview like like how many birds are in
your birds? You have? What kind? Let me see your
keys because there was their paint on them. Katie, you
got any plug plug? Well, of course, my show Creature
feature where we talk about creatures who are more human
(37:27):
like than you expect in humans who act in animal ways,
like the freaking barbaric animals who deny people insulin. Well, actually,
animals would never do anything that sucked up. No, they wouldn't.
I mean, animals do some fucked up things, like they'll
mind control of spiders into weaving them a little nest
(37:48):
and then killing them and get behind right right, there's
something like metal about that. There's there's nothing cool about
just depriving people of insulin. Uh And So you can
follow me at Katie Golden on Twitter. You can follow
my bird twitter at pro Burg writes uh and, Yeah,
(38:09):
please do check out my show. There's a great episode
with Robert Innett called uh Re for Madness for Madness.
There we go from the name of that movie, Yeah
for madness, madness All rightert Evans. This has been behind
the Bastards. You can find me on Twitter at I right, okay.
You can find us on Instagram and uh twitter at
at bastards pod. You can find us online with all
(38:30):
the sources for this article at behind the Bastards dot com.
We have a t shirt shop. You can buy cups there, mugs,
phone raps, and stuff with cool logos made up and
catch phrases and stuff from the show neat images. So
like taste your PA, sample your p that'll be coming
out soon, So go to t public, look up behind
the Bastards public. Hello, maybe this week instead of buying
(38:52):
a shirt, donate some money to somebody's go fund me
if they're trying to buy Incelin 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,
I keep voting constantly. Look out for your your diabetic
friends because it's rough. Yeah, all right, I love about
(39:12):
three percent of you. H
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Robert Evans
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