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Diabetes - A lucrative disease | DW Documentary

Aug 27, 2022
I was shocked when I found out I had


. Suddenly I had to take an injection of insulin in my stomach. Since I was diagnosed it has affected my life. I am 29 years old, there is no foreseeable future for us due to finances and my health. We are currently estimating just over 400 million people with


in the world today. We like to describe this as a slow-motion global catastrophe, if you put together the productivity losses, the healthcare costs, the medical costs, it's astronomical. I mean, we know that the diabetes-related pharmaceutical industries are making a lot of money.
diabetes   a lucrative disease dw documentary
It's a wonderful world for diabetes pharmaceutical companies. I was born in 1963. In February 1975 I went to a concert. When I got home, I felt tired and very weak. I spent the night drinking water and urinating. The next day, I had my blood tested and was told I had type 1 diabetes. Type 1 diabetes strikes without warning. Musician Bertrand Burgalat's pancreas stopped producing insulin 45 years ago. Medical science has yet to fully explain why or find a cure for the


. Diabetes is insidious and people's lives are often severely affected. Doing it again? It showed 0.81. Is there always a delay?
diabetes   a lucrative disease dw documentary

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diabetes a lucrative disease dw documentary...

I'm not thinking about the program, I'm wondering what I'll do if I have too much sugar. I will be exhausted. And not having enough is also a problem. Have something sweet on stage. For a type 1 diabetic, the injection is a relatively minor nuisance on the list of drawbacks. Some things are much worse. Ten shots a day to feel good is fine. What is exhausting is constantly calculating whether you have too much sugar or too much insulin. Do you constantly think about all those limitations, trying to think about the future? The insulin that you inject works much more slowly than the insulin that your pancreas makes.
diabetes   a lucrative disease dw documentary
You have to anticipate. There are many things every day that are much more inconvenient than injections. The body needs certain amounts of sugar to function at different levels of exertion. Even the smallest activity requires energy. The metabolic system gets the sugar it needs from stores in the blood. If blood sugar levels drop too low, the result is hypoglycemia. But too much sugar in the blood can trigger hyperglycemia. The pancreas regulates blood sugar in healthy people. The organ produces insulin, a vital hormone. If this process is interrupted, the result is what is known as type 1 diabetes. Without insulin, blood sugar levels rise, causing organs to fail.
diabetes   a lucrative disease dw documentary
Patients slip into a coma and will eventually die if left untreated. Several injections of synthetic insulin a day help patients regulate their blood sugar levels. As the consumer society emerged in the 1960s, a second type of diabetes, type 2, became more common. Lifestyles and eating habits were changing. Come on, take it. Very good mom! People began to eat more fat and sugar and exercise less. The pancreas had to start secreting more and more insulin to compensate for the high levels of glucose, or sugar, in the blood, and sometimes it would stop working properly. The amount of sugar in food increased continuously throughout the 20th century.
Processed foods, soft drinks, and carbohydrate-rich foods were consumed in large quantities. The number of patients with diabetes increased rapidly in a few decades: from 50 million to 430 million worldwide. 90% suffer from type 2 diabetes. The cases were initially concentrated in Western countries, in Europe and the United States. Then, they spread all over the world. Thirty years ago, diabetes was rare in China. Today, one in ten adults have it. The chronic


has also spread in Africa. A 150 percent increase in cases is expected by 2050. Type 2 diabetes is a classic and common disease, a cultural disease. In the 1960s, less than one percent of the German population was diabetic.
Today, we estimate between nine and eleven percent. The disease sneaks up on its victims without warning, until suddenly serious health problems appear. Hello Dr. Bussmann, good morning. Let's take a blood sample, come with me. Elevated blood sugar levels carry the threat of complications. Many diseases can develop. Microvascular problems are the main concern and can occur in the eyes and kidneys. Nerves too, because they could possibly be damaged by narrowed blood vessels. Major blood vessels, in the neck and heart, are also at risk. That means people with diabetes face a statistically higher risk of heart attack than people who have already had one and don't have diabetes.
One of the most feared complications is diabetic foot syndrome. It occurs when the nerves no longer function properly. The feet may not feel much sensation anymore and people may step on things. They have wounds on their feet and legs, but they don't notice them. These then get infected, and that's when the real problems start, which can lead to amputation. Hurts? Diabetes is one of the main causes of amputation in Europe and the United States. The disease can also attack the kidneys and, as a result, is a leading cause of dialysis and kidney transplants. The pharmaceutical industry was quick to react to the rapid rise in type 2 diabetes.
A wide range of treatments were introduced in the 1980s, with advertising campaigns promising a happy and carefree life. A wide range of pills became available to help patients lower their blood sugar - oral antidiabetics. Medicines may control the disease, but not cure it. Patients had to take them for life, and their price kept rising. Diabetes had become too expensive. Communities around the world raised the alarm. The disease costs healthcare systems around $760 billion a year worldwide. There is a UN declaration of diabetes in 2006 due to its potential to paralyze any health system, due to its costs, and really? the potential to affect the country's productivity with the number of people with diabetes who need treatment but who are also disabled due to diabetes and unable to work due to their diabetic complications.
It is the only disease besides HIV AIDS that has a UN declaration. In 1921, Canadian physicians Frederick Banting and Charles H. Best discovered insulin and made industrial production possible. The revolutionary innovation saved thousands of lives. Children facing certain death were treated with spectacular success. The Canadian researchers sold their patent for a token dollar to Lilly, an American pharmaceutical company, for commercial production. Could you tell me something about insulin? What is it and how is it done? Well, it's not exactly made, it comes from the animal pancreas; the plant works day and night to meet the demand for insulin and uses many tons of pancreas every week.
Most of the pancreas comes from abroad and arrives at the factory deep-frozen, reduced to a paste, and mixed with alcohol, which dissolves the insulin. Then follows a long and complex series of processes that gradually remove all impurities. The manufacturing process was continually refined. Today, three companies are competing for new patents: Lilly, the Danish company Novo Nordisk and Sanofi from France. Human insulin, based on the human insulin gene, finally emerged and led to an increase in price. In some countries, human insulin can be ten times more expensive than animal-derived insulin. It became possible to take the human insulin gene simply cut out of the human chromosome, put the gene into a microorganism, we use yeast like baker's yeast or brewer's yeast and put the gene in there and then the yeast starts producing insulin.
That's called genetically modified insulin and that means we can supply insulin to the whole world because we don't have capacity issues. If necessary, we simply build a new factory. The French pharmaceutical company Sanofi then announced the development of a new, improved, and even revolutionary insulin in 2000: Lantus. Known as analog insulin, it was similar to human insulins but with a modified gene. Sanofi's innovation prolonged its effect, but it came at a high price. In France, a dose of Lantus then cost 46 euros. A dose of human insulin sold for $18. Analog insulin reduced the number of times a diabetic would have to inject to just once every 24 hours.
Pierre Chancel oversaw the launch of Lantus and believes it was a breakthrough. As an insulin solution, Lantus, was a true revolution. Changed the lives of diabetic patients. Especially Type I diabetics who received their last injection at 10 p.m. for example, and then they had to set the alarm for 5 am. m. to receive another injection. Hypoglycemia that strikes at night had always been a threat, with fatal consequences. The marketing was brilliant, convincing people that it was much slower than everyone else. Slow insulin existed in 1975, when I only did one injection a day. Sanofi also wanted type 2 diabetes patients to benefit from what they called their wonder drug.
Traditionally, these diabetics were only prescribed injections if diabetes pills no longer worked. For Type 2 patients who moved on to injections, it was the last stage. They were on death row. The simplicity of Lantus reduced their fear of insulin injections and they started using it sooner. These patients were also able to benefit from the drug. Results for blood glucose, or blood sugar, levels are too complex for non-physicians to understand. That's why Sanofi introduced an easy-to-use dialer. Glycosylated hemoglobin, or long-term blood sugar, tests for HbA1c. The company launched a major prevention campaign with a simple message that anyone could understand.
Long-term blood sugar levels below seven percent are fine. Above seven are problematic. A stroke of marketing genius. In just a few years, Lantus became a pharmaceutical blockbuster. In 2015, the year of its highest sales and just before the patent expired, Lantus accounted for 20 percent of Sanofi's sales, more than six billion euros. But a doctor from Germany threw cold water on Lantus' victory lap. Peter Sawicki was Director of IQWIG, the Independent Institute for Quality and Efficiency in Health Care in Germany. In 2004, the joint committee, the highest body that oversees medical care in Germany, commissioned IQWIG to evaluate this insulin glargine, Lantus, for potential additional benefits.
The objective was to determine if the higher cost of the drug was reflected in higher benefits. It cost the healthcare system a lot and they wanted to know if it was justified, because ultimately everyone was paying for it, not the health insurers. The result was that there was no significant difference and that Lantus was not superior. Medically speaking, analog insulin was no more effective than other drugs. Pharmaceutical representatives disagreed. am I explaining myself wrong? If you ask a patient taking insulin to go off their analog insulin and go back to their old insulin, and tell them not to worry, there are no downsides, not many would agree.
Is the statement unjustified? I think it's quite strange. The head of Sanofi Germany invited me to visit the company in Frankfurt to discuss the results. I was happy to go, but at the beginning of the tour, he showed me apartment buildings where many people depended on Sanofi and said how much of their stock would be at risk if we complied with our institute's assessment because then all Sanofi workers would lose their jobs. . Do they pressure you? They tried. I don't want people to lose their jobs. But we still need an objective evaluation of medicines, not just insulin, but all of them, and we don't have that, in any European country.
The German authorities stood their ground. Patients with type 2 diabetes using Lantus would only be reimbursed for the cost of a corresponding dose of human insulin. But Sanofi's drug continued to sell well. Sales remained high and patients became accustomed to paying more. Other countries, including France, have also questioned the superior efficacy of Lantus. But nothing has changed. Sanofi's blockbuster remains the world's best-selling insulin. Since 2015, Sanofi's competitors Novo Nordisk and Lilly have also been marketing long-acting analogue insulin and also justify the high price with attractive promises. The companies say higher production costs contribute to analog insulin being comparatively more expensive than human insulin.
But researchers at the University of Geneva disagree. They looked at the question of why one of two diabetes patients in the world does not have access to insulin. They told us that analog insulin is much more difficult to produce than human insulin.and we wanted to know a little more about the manufacturing cost. We met with some colleagues to determine manufacturing costs by looking at each section of the production line. We take the cost of all the raw materials required for a vial of insulin and then add the regulatory costs, which are significant. Regulatory costs are the license fees for a product.
Clinical trials are required to prove the efficacy of the drug. We also include a profit margin and investment costs for infrastructure. The manufacturing cost of human insulin is between $2.50 and $3.50 per vial. For most analog insulin products, it's about the same. Looking at the retail price in France, a vial of human insulin costs around 13 euros, while an analogue insulin like Lantus costs almost double: 25 euros per vial. There are three conclusions. First, the final price for the patient or for the healthcare system is not justified by manufacturing costs. Second, the difference in manufacturing costs between human and analog insulin does not justify the price difference.
And third, the profit margins for the pharmaceutical industry on these insulin products are enormous. The dominance of the pharmaceutical giants has tragic consequences in the United States. In a decade, the price of insulin has increased tenfold despite the fact that one tenth of the population suffers from diabetes. Many of them can no longer afford the vital hormone despite expensive health insurance policies. I pay a premium of $260 a month. That's just for the right to say that I have insurance and my deductible is $14,000, which means I would have to pay for my insulin, doctor visits, and other medical supplies out of pocket until I hit that $14,000 mark before I to help me pay for my insulin.
Not many people can afford to pay an extra $14,000 out of their income every year, it's almost impossible for my husband and me. Right now my insulin comes from my doctor and it comes from my friends my mom has friends who maybe also have type 2 diabetes and they have excess insulin that they don't use so they have been kind enough to give me that insulin . And my doctor, when he has patients who pass away, which unfortunately happened recently, gave me over a year's supply of insulin, so luckily I won't be paying that money right now because it would have been catastrophic for me if I had had to pay the insulin money each month.
And what happens when you can't get free insulin? I really do not know. Sorry. I really,? That's something I've been lucky enough not to experience that yet, but it sits in the back of my mind. My name is Elizabeth and I am the founder of T1 International. We are a diabetes advocacy organization that is not funded by pharmaceutical companies. And we are advocating that all people with Type 1 diabetes have specific access to what they need to survive. This company right behind me has increased the price of their insulin by over 1000%. And we believe that access to insulin is a human right, this is a global problem, people are dying in every corner of the world, people are dying here in the United States of America, which is supposed to be the richest country in the world. , with supposedly the best health system in the world.
This is not the way it should be. This company is putting profits before people, and we're here to say it's not right and something needs to be done about it. Medicines for the people! Non profit! Once again. Medicines for the people! Non profit! It really is a crisis. People are rationing their insulin, so they are taking less than they should be taking or trying not to take at all. They are trying to adjust their diet and their insulin intake and this is very, very dangerous. People are dying from it and they are cutting years off their lives because they just can't afford it.
My husband and I don't, in our future we won't be able to buy a house that we can't afford right now. We won't be able to have children. That is an expense we could not afford. So I would say the biggest thing we've sacrificed is just traditional family life. That's something we're not sure we'll ever get to experience. We have lived a very non-traditional married life for 8 years. Although I am very? I have loved our time together. It has been very hard. We've had so many challenges that we can't experience the things that people our age are experiencing.
The next step here is to hand out some of these insulin vials that we've created. This is a vial of Humalog with the label removed and a message inside. What we've done is say that these are the things that we sacrifice for the cost of insulin. Nicole has brought some of Alec's ashes, which are in one of these jars to show the sacrifice, the ultimate sacrifice they made because she couldn't afford insulin. Alec was facing a cost of $1,300 a month for insulin and diabetic supplies. Alec worked full time as a restaurant manager for a small family business that did not provide health insurance for its employees.
Alec made decent money and so he didn't qualify for assistance of any kind. Not from the insulin manufacturers, not from the state or the federal government. Unbeknownst to anyone, Alec began rationing his remaining insulin, because by the time he went to the pharmacy, he didn't have enough in his bank account to spend the required $1,300. Alec began to adjust his diet, taking less insulin than his body needed to make it to payday. Alec's body was found three days before payday. Alec died of diabetic ketoacidosis due to a lack of insulin in his body. In early 2019, the US Congress required pharmaceutical companies to justify huge price hikes.
The big three insulin producers blamed the US healthcare system and the large number of distributors. Today, the Oversight and Investigations subcommittee is holding a hearing titled Quotation: Price of a Life-Saving Drug, getting answers about the rising cost of insulin. So, Mr. Mason of Ely Lilly, who is benefiting from this increase in insulin prices? I think? First of all, we don't want anyone to be unable to pay for their insulin? Who profits from these increases in insulin prices that patients have to pay? Our net prices are the price we receive, are they going down? Are you making a profit?
Or the CEOs of their companies reaping these profits? Our net prices, the prices we receive are going down since 2009. Well, someone is making a profit, someone is getting rich off our patients. Mr. Langa from Novo Nordisk, which entity in this supply chain is prioritizing affordability and access to insulin for patients? We like to think that we participate in as many formulas as we can and that's the most important thing, we have a patient assistance program as well as a co-pay system program. So who is making a profit then? Our networks are also going down, but is there a small gain?
Your networks? But your overall profits, for the company and the CEOs, have increased, haven't they? No, our earnings? Net pay for your CEOs? Our earnings have been relatively stable. Has your CEO's pay not increased in recent years? His salary has increased, yes. OK. After the hearing, the three companies pledged to reduce prices for the poorest patients. But it was nothing more than a public relations stunt. Patients in the US, unlike their European counterparts, are not supported by generous reimbursement systems. For most American diabetics, insulin remains a luxury item. The price of the synthetic hormone is just one of the problems diabetics face.
Another may have fatal consequences for patients. To keep their blood sugar levels below the famous 7 percent limit, many type 2 diabetics take a lot of medications, putting their lives in danger by doing so. I found out from our doctor. He had an office near here. He did an annual check and said my blood sugar, the long-term average HBA1C level, was too high and I had to take medication. And I lived with that for many years. But then, during that time, my blood sugar levels spiked, to around 11 percent. And my weight was at its highest point at about 250, 250 pounds.
It was really just pills, though I gradually took more and more of them. And then I injected myself with insulin for about seven years. That was after I first noticed my body shaking and my blood pressure not quite right. When I measured my blood sugar, my device said it was below 60, it was flashing red, and it said it was no longer measurable, it was below 60. And then there was the incident at the end of August, where I almost ended up in a coma. Severe hypoglycemia could have cost the patient his life. It was the result of an obsessive attempt to keep his blood sugar below seven percent.
In 2008, a study shook what had been established in treatment protocols. It showed that the higher the level of drug use to keep blood sugar low, the greater the risk to patients. Regularly taking drugs to lower HbA1c levels increased the risk of hypoglycemia and heart disease. The people in the study were treated with many drugs: as many as five. The study showed that it was probably the wrong approach. Intensive blood glucose lowering might reduce nerve and eye complications, but what we really wanted was to reduce the risk of heart attacks and strokes. But that didn't happen.
Therefore, the correct approach is not to focus on blood sugar levels, but on the study of diabetes. An overview of cardiometabolic syndrome, with all the risk factors, is needed, and we did. Hyperglycemia is toxic. The evidence is indisputable. The more sugar you have in your blood, the greater the vascular toxicity. But it doesn't mean that if you have hyperglycemia, lowering the level will reduce your risk. If you have a risk marker (the higher it is, the higher the risk), a linear or automatic reduction does not necessarily reduce risk. Major studies have shown that working too hard to lower your blood sugar increases your risk.
So, paradoxically, it has been shown that if you use intensive treatments to lower your blood glucose too much to get as close to a non-diabetic number as possible, you might think you are as healthy as a non-diabetic person. But you're worse off than if you'd left your blood sugar high. Patients not only have more complications than non-diabetics, they have more than people with higher blood sugar levels. They end up in the hospital with severe hypoglycemia. It is due to medication and can be serious. Mortality has increased. I had this near coma experience and I said I never want to have that again.
Mr. Stränger, come with me! Wilfried Stränger is no longer on medication and blood tests show that after three decades with type 2 diabetes, there has been a kind of remission, a regression of the disease. His doctor suggested a radical approach developed by a team of British researchers. It was a strict diet. He stopped eating carbs for three weeks and instead drank a low-calorie soy-based drink. Strong weight loss is usually needed for type 2 diabetes to go into remission. For a long time it was believed that if he had type 2 diabetes, once he was diabetic, he was always diabetic.
Then an English research team published a sensational study. They went and found subjects who had been suffering from diabetes for a few years and made them lose weight radically. They were able to show that this could cause remission in almost half to eighty percent of the subjects, depending on how much weight a person had lost. And that without a serious operation, just radically losing weight. They have learned from very deep MRI exams that if there is too much fat in the pancreas, then insulin production drops. But that doesn't mean it's broken, just that the cells can no longer make insulin.
If the fat is removed from the pancreas, the insulin-producing cells can again produce more hormone in response to stimulation. And then the blood sugar levels drop. We have carried out similar experiments and have had comparable experiences here in Düsseldorf. We have succeeded in allowing people who were taking insulin to be dependent on pills only, or on pills to complete remission. And I think that's where we're headed going forward. If a patient loses weight, he can stop taking diabetes medications and blood pressure medications. And maybe he can prevent knee operations. We have discovered a universal lifestyle remedy and it works in many different areas.
If you took all these diseases together, you would save a lot of money that you could later invest in this area. But the opinionGenerally, that won't work. So we don't have to. And that is a problem for politicians. And then there are the associations that represent the interests of the pharmaceutical industry, and other than the universities, which have no interest in this. And that always makes me suspicious and sad. A few thousand patients in Europe and the United States have already tried this method. It requires strict discipline, a lot of motivation, and only a third of type 2 diabetics can hope to be cured by it.
Most will have to continue taking medication. Looking ahead, I think we will win. The problem is knowing when. What we are saying will become incontrovertible evidence in a few years. Meanwhile, many diabetics will die needlessly. Some will have received poor medical treatment and too much senseless spending on expensive treatments. But the diabetic-industrial complex will be swept away. Diabetes is more than just a matter of blood sugar. The disease has revealed ills in the food and pharmaceutical industries. And if governments don't react, diabetes will continue to spread.

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