Behind the Bastards - The Bastards That Kill Diabetics for a Profit

Episode Date: December 20, 2018

In Episode 39, Robert is joined by Katie Goldin (Creature Feature) to discuss the bastardful tale of Insulin. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

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exclusive content, and unique items. So enjoy the festive winter weather at I Heartland on Roblox. Head to iHeartRadio.com slash iHeartland today. I'm weird, you're weird, we're all weird about money. I'm Paco De Leon. I'd like to proudly present to you a brand new podcast called Weird Finance, a show to help us all feel a little less weird about money, one conversation at a time.

So if you want to feel a little less weird about money and you also want to hear people have honest and real conversations, tune in to Weird Finance. Available on the iHeart Radio App, Apple Podcast, or wherever you get podcasts. She won fame as the first African-American principal dancer with the American Ballet Theater, and her books are bestsellers.

Now the amazing Misty Copeland is facing a new challenge, being a mom. It's just been a whole new world entering into motherhood. And it's a first for me. So this is a little nerve-wracking. And it's been one of the most rewarding things that I've ever experienced. I'm Carol Sutton-Lewis, host of the Ground Control Parenting Podcast.

Tune in starting February 15th to hear my conversation with the incredible Misty Copeland. You can listen to Ground Control Parenting on the iHeart Radio App, Apple Podcast, or wherever you get your podcasts. Hey, everybody, I'm Robert Evans, and this is Behind the Bastards, the show where we tell you everything you don't know

about the very worst people in all of history. And this was the highest energy introduction I've ever done. Sophie is laughing at me over in the corner. I don't understand why. I thought it sounded pretty cool, a fonds-esque. This is a show where I read a terrible story about history, about someone bad, or someone's bad, or usually a bunch of bad people doing bad things.

To a guest who is coming in cold. And today, that very cold guest is Katie Golden. Might be Katie coming in cold. Anyway, she's Bird's Rights Activist on Twitter, where she advocates for birds, even though, as I understand it, millennials are saying birds aren't real. Those are lies, those are communist lies.

Communist lies. She's also the host of another podcast on the Stuff Network. Creature Feature, great podcast about animals doing weird ass shit, science and stuff. Yeah, science and stuff. Yeah, we talked about animals and drugs. We did.

An episode of it, it was great. And how it's great to do drugs. It is great to do drugs. Speaking of drugs that are great to do, today we're talking about insulin. Which is not a, well, I mean, it's fun in that, if you need to take it, you die not taking it. Right, I think it's fun not to die.

It is fun not to die. Relatively fun not to die, yeah. It's fun not to die of insulin shock. Or diabetic comas and stuff, not fun. So, I'm just gonna get into it. On November 17th, 2018, several parents brought the ashes of their dead children to the doorstep of the offices of Sanofi,

a pharmaceutical company that produces insulin. Sanofi and other insulin producers like Eli Lilly have been steadily raising the prices of their insulin for years. Because of this, insulin can cost as much as $1,000 a month for people without decent insurance. My God, that's, I can't imagine spending $1,000 a month on anything other than like rent, I guess.

But you don't. Yeah, that's rent. Even with rent. In a pretty expensive town. Essentially renting your own body. Like you wanna keep living in your body a thousand bucks rent. Which can get you a decent place like in Culver City, I feel like.

Yeah, yeah, when I lived in Culver, my rent was about a thousand a month. Yeah, yeah. So, it's frustrating, right? It's a little frustrating. It's a little frustrating. Because clearly, I mean, no country on earth can afford something like single payer healthcare.

No, that's never been done. That's why it doesn't exist anywhere. It's never been done. And our government needs its money for stuff like, did you hear about when that hurricane hit the East Coast, the military forgot to remove like an 11 F-22s and they all got destroyed? Oh, yeah.

And that was $1.4 billion? Well, they gotta put. Could have bought a lot of insulin. They gotta put another billion dollar coin in the F-27 vending machine. The funniest thing is, there's no vending machine. We can't make the parts for them anymore. Oh, great.

We stop manufacturing any of the things so they're replaceable. Oh, good. But we can't afford to help people there. 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 is a magical substance that lets sugar not kill us instead of be delicious. I'm a fan of insulin. Yeah, I'm a big fan. Now, when insulin costs as much if not more than rent,

many people stop taking it as often as they should and ration their precious supply so that they can afford to do things like exist in a capitalist society. And pay the aforementioned rent that we've been talking about. Right. Also, food.

Food. Big one. Because here's the thing is, insulin is basically useless if you don't eat. If you're starving to death. Right, because then you don't get any sugar, which without insulin, 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 eat insulin, which is just to not eat. That's right. The no-eat diet where... If they just stop eating. And you won't die of insulin shock,

you'll just die of starvation instead. I do think they'll die of insulin shock. Oh yeah, you're right, probably. Medically speaking, yes they will. Neither of us are doctors. No. You're not a doctor, are you? No, I'm not a doctor.

Okay, fantastic. But I do read Web NB, like, a lot. Well, then you're basically a doctor. Exactly. Fantastic. Now, Alec Rachan Smith was one of the young people who got caught in this deadly dance with a necessary drug.

When he was 26, he aged out of his mother's health insurance. One month after his birthday, he died of diabetic shock. Smith's mom, Nicole, was one of the grieving parents who brought her son's ashes to Santa Fe that November day. She told the Boston Globe, she wanted the company to, quote,

know the price of their product is killing people when it's intended to save lives. Antoinette Warsham, whose 22-year-old daughter, Antavia, died last year while rationing insulin, told another interviewer that, for people like her daughter, it's either pay your rent, pay your car payment, or get your medication.

Diabetes is currently the seventh leading cause of death in the United States. I heard this story of this guy who, cause like, I've heard this thing where people say, well, just go fund me if you can't afford your medication. Use that instead of healthcare. Yeah, there was a guy who did that very thing, and he-

$50 short. Yeah, $50 short of reaching his goal in a way. $750 goal, that was his monthly cause. Right, and he needed insulin to survive, and he didn't have the money to pay for it. And he was like taking care of his ailing mom too, so that's part of the reason he didn't have that high of an income.

So like, he tried to get it. He was $50 short of reaching his goal, so you know how go fund me works, then you get none of that money, and he died. Yeah, he sure did. We will be talking about him a little bit later. Oh, good.

Yay! So clearly this situation is fucked, right? Yes. That seems fucked. Seems like we can all get on the same page there. This is fucked. It seems like a little, like just maybe a smidge fucked. This is to skosh to the old F bomb.

Yeah. So what is fucked? Why is this so messed up? Because people are dying. Well, I mean, I'm saying that's why it's messed up, but like why is this state of affairs? Why would they do this? Because insulin is not a new drug.

Usually when you've got like a case of this where something's incredibly expensive, it's number one, a drug that very few people need, and number two, a drug that's really new, because then, you know, that's the way that these patents work. For most medicines, after about 20 years, after their invention,

a generic patent comes out that's fairly affordable, right? It'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 to the profit motive, but because of the way that this generic drug, like that's the idea, right? That's the promise that we've all bought in this system. Otherwise, poor people or middle class people would never be able to afford medicine. Exactly. Insulin has existed for nearly a century,

but there is no cheap generic insulin available in the United States. That's crazy. Today, we're going to talk about why. But first, we are going to talk about the invention of insulin as a medicine. Most cursory coverage of this will give credit to Dr. Frederick Banting.

Some mentioned a small team of scientists who work with him. When I decided to look into this story, it's because I ran across a tweet about Banting. It stated that he had given the invention of medical insulin to the world, put it in the public domain, essentially, as a gift to humanity,

because he didn't want to profit off it. He wanted people to be able to get medicine. And so the tweet was basically like, this wonderful founder gave insulin to the world and wanted people to have it for free. And then the evil pharmaceutical companies fucked it up, which is true, but not detailed enough. So I wanted to know what that story was.

Let's get the details. So let's get the deets. That's what we are going to be talking about today. Now, like most things you find on social media, that version of events is not quite accurate. Insulin did not have a single inventor. And while pharmaceutical companies are the ultimate bastards here,

the full story is weirder, sadder, and more infuriating than that. In 1921, Dr. Frederick Banting was the first person to isolate secretions from islet cells, the cells that make insulin. He suggested these might hold a treatment for diabetes. And he was basically right. He came up with a plan to tie up

the pancreatic ducts of laboratory dogs and make their pancreases overproduce the cells that contain insulin until everything else in the pancreas dies. So that was the idea, right? Did the dogs die? The hope was they wouldn't. This was actually initially envisioned as like,

oh, this is a beautiful one-two punch because we make these dogs pancreases overproduce the cells. They didn't really know insulin was a, like insulin was a theoretical substance. They called, I think, insulin. There was an E, I don't know how they pronounced it, but it was spelled insulin.

And the theory was like, if we make these dogs pancreases, produce a bunch of these cells, we can take the pancreases out and they will contain concentrated versions that we can extract whatever's in the pancreas, shoot it into a diabetic, it'll make them better. So the idea was we got to take these dogs pancreases out

in order to do this thing, but then we can just give them what we make from it. And if it works, it's a beautiful one-two thing. We don't have to kill the dogs. We'll know that we've got a treatment for diabetes because these dogs won't be able to produce insulin after we've fucked up the pancreases. Seemed like it was like a nice circle

that they had developed. Now, the problem with Banting's plan is that he was not up to date on the work other scientists were doing, testing blood sugar to find diabetes in patients. Banting did urine testing to find out blood sugar levels, which does not work very well. Did he just like taste it?

Cause I know like- He just tasted their pee. Well, one of the things is like, if you taste your urine or smell your urine and it tastes sweet, it's a sign of diabetes. Oh, wow. Cause 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 pee once for my book, A Brief History of Ice, cause I was trying an ancient Mesoamerican treatment where you mix tobacco, garlic and urine as a treatment for constipation. It works, makes you very ill, but functions in its intended purpose. I was not paying attention to the-

To how sweet it was. There was a lot of garlic in there too. Right, the garlic is, well, the garlic's gonna cut the sweetness, as you know, like with cooking, you know, it's gonna- But it sounds like what you're saying is that we should all be drinking our pee every morning to learn if we are very better.

I mean, just a little bit. Just don't drink a lot of it. Don't drink a lot of your pee. A taste, a sample. That's the new behind the bastards motto. Sample your own pee. Sample your pee. Sample your pee.

Right, this'll be marketable. Let's get a T-shirt going. Sample your pee. Can we start that process, Sophie? TM. No, okay. Sophie's shaking her head. She's not happy with that.

All right, let's move on to talking about diabetes and more. So, Bandy was the first guy to start isolating. The islets also contain the hormone insulin, but the amounts he was able to get were too small to really be useful, and his work had a bunch of holes in it. He was good at a couple of things, but he was weak in 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 and overseer of the whole project. His banding was an unstable personality. Oh.

He had an asshole. So, McLeod. You mean some scientists are assholes? Yes. Really? A guy who would poison a dog's pancreas in order to try to solve it as easy. Yeah.

It wasn't great at working with other people. Yeah. Well, I see. Interesting. I mean, not very- Ben or intuitive, but you know. You need to do the research. This horrible thing has to happen.

But the kind of guy who's like, oh yeah, what if we just torture dogs to figure this out? It's probably not fun to work with. And he wasn't. He's maybe just a little too, he's got tunnel vision there. He's just so focused on that insulin. Right, right.

And everyone else is like, but dogs? There's just dead dogs everywhere. I know, but I'm almost there. It's just dog corpses. It's just crumpled up dog corpses. Once we get it right, the dogs won't die. He's just at his desk and he's like, oh, damn it.

And he crinkles up another dog and tosses it in the waste bin. Just a 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, Anderson does not understand what we're talking about, which is the mercy of being a dog.

Right. Now, back to the story. Banting came to hate McLeod because McLeod was good at talking and explaining their work to other people at conventions. Well, Banting was an introvert and a big old nerd. So Banting started to worry that like McLeod was gonna outshine him

and get his credit. I see. Even though, from everything I've been able to read, McLeod was just about, oh yeah, this is a really important cause. I wanna do everything I can do to make sure that this research gets completed. So he goes on Reddit to complain about him.

Like, what a stupid science Chad. Banting would a thousand percent be a Reddit dude. Although, we'll get to, yeah, we'll get to that in a second. So Banting had an assistant, a guy named Charles Herbert Best. Who did it? Charles? Charles. Charles, okay.

I pronounced that weird for no reason. I thought this was a fancy form of, you know, Charles. Charley. Charley. Charley. Charley. No, no, 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 knew that the islets of Langerhans, which is the name of those little cells, produced something that helped regulate sugar. Insulin was at this point still just the name of a hypothetical substance scientists thought existed. So. Just as a quick side note, the islets of Langerhans,

I imagine them as like these little islands. Beautiful little British islands. Stormtoss, the picturesque. That microbial sized Langerham expedition goes out and discovers like little white blood cells and navel hats. Sorry that I just had to get that image out there. I'm the Duke of Langerhans.

Yeah, no, 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 of 1921. It did not go well at first. I found an article in the Journal of Clinical Chemistry

that went into the discovery of insulin in exhausting detail. Here's how they described the first few months of work. After ligation of the ducks, the dogs were expected to recover from the surgery and live more or less normally. After several weeks, the pancreas, enabled a secret fluid into the duodenum,

would gradually atrophy and would be removed in process to extract the internal secretion. The extract would then be administered to other dogs made diabetic by removal of the pancreas. It was a laborious task for someone with no experience in animal work and it did not go well at first as Banting struggled to improve his surgical technique.

By the end of the second week, seven of their 10 dogs had died. To resupply the animal cages, they resorted to buying dogs on the streets of Toronto for one to three dollars with no questions asked of the suppliers. No. We need dogs.

We need a lot of dogs. It's just some guy with an overcoat like, hey, I heard you was looking for dogs. This doctor's never worked on dogs. He's killing them left and right. Just like opening up the trench coat and just little rows and rows of dogs. I'll give you nine dollars.

Is that enough for three dogs? 10 dogs a dollar. 10 dogs a day. They're like off brand dogs. Like, no, no, these are dogs. Three of these are cats. Sophie, really not happy with me right now. We should be good.

Sorry, we had to deal with some noise. We also learned something that I'm just coming into, which is that the guy I've been calling McLeod is McCloud. So, everybody have a good laugh? You're a real McCloud, aren't you? I'm a real. Everybody have a good laugh? Good ol' laugh at ol' Robert Evans' expense?

Not knowing enough about Scotsman? So, you may have already noticed that this is horrible, because dogs are good at medically torturing them to death is bad, but the world is a gigantic wheel of pain and brutal crush and cruelty and is sometimes necessary in order to save the lives of billions of diabetics. So, yeah, that's just the way the world works sometimes. 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 appendixes removed. They debuted their work to an audience. It was one of those things you've seen on TV where the doctors do their work in like a big pit surrounded by an auditorium full of other doctors

and pharmaceutical industry people. Old timey, thanks. They had like, instead of bags of popcorn, it was like bags of dead dogs. Bags of dead dogs and those little circle things on their heads that old timey doctors wore. One man present at this early insulin demo was George H.A. Klaus, a research director

for Eli Lilly, the pharmaceutical company. After the presentation, he sidled up to McLeod and asked if his company could work with the scientists in order to get a product on the market sooner. McLeod turned him down, claiming that the work was not far enough along yet. This seems to have pissed Banting off largely because McLeod had spoken for the group.

Banting was also frustrated by the fact that McLeod was a much better presenter than he was, which made Banting worry that other scientists would get the credit and popular acclaim Banting felt he deserved. So like Banting is like watching as McLeod is like riding in on a skateboard and be like, hey dudes, and like,

like he's just like, I'm enjoying you, I enjoy you. Yeah, 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 for me. He's just- He's getting shoved in science lockers. He totally would be an incel. Oh no. I'm calling it now.

The inventor of insulin is an incel. Yeah, yeah. A little too perfect. Involuntary cellular biologist. Nice, nice, nice. Really good. So it took a lot more work and a lot more dead dogs before Banting and his team made more progress on insulin.

By 1922, they were close to a breakthrough and Banting decided that McLeod was the center of a gigantic conspiracy to steal the credit for their immediate breakthrough. Banting and his team started to work with another scientist named Colip. Colip had figured out how to actually purify the pancreatic extracts that they were making

and create usable insulin. In January of 1922, the group carried out a clinical test of their new extract that failed disastrously. The bad results sparked a fight and during a heated exchange, Colip threatened to leave the band and take his purification method with him. He threatened to patent it so that they'd have to pay him to use it.

So was Eli Lilly the Yoko Ono of the situation or? They were just sparking a fight. I see. But they hadn't done anything yet. Colip was kind of the, well no, Banting was the- Banting was the Yoko Ono? Was both Yoko and Lenin. Ouch.

That's a harsh personality to have. He seems like a rough guy to work with. So yeah, here's a quote from that journal article about the invention of insulin. This was a breach of the agreement between Colip, Banting and Best to exchange all results. Banting never showed a righteous anger or noted for meekness or restraint when he felt wronged,

exploded with clenched fists. In a moment, Colip 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 buzzed by Banting in his unpublished 1940 memoir. The other, by Best, in a letter to Sir Henry Dale, dated February 22nd, 1954. So he like beat him with his fists, but he didn't hurt him at all? No, he beat him with his fists, and I think it probably hurt pretty bad, but Colip was too, felt bashful about it

and didn't write about it. Banting's the only one who wrote about it. Cause I'm thinking maybe his fists were like, soft and small as apricots, and it just like was like, I feel bad. Soft and small as apricots. Oh, apricot fist, Banting. Oh, apricot-handed Banting.

That's what they called it. That's possible too, it's possible you just sucked at punching. Right. But either way, I just like this story of like these genius scientists creating one of the most valuable medicines in history, fist fighting each other over the credit at one point.

It's beautiful. Now, the four scientists did eventually work out their disagreements enough to allow them to get back to work. Banting and Best would depan-creatize dogs, Colip wouldn't extract insulin, and McLeod would coordinate everyone's research. Everybody doing, playing to their strengths.

Playing to their strengths. It's like you're great at depan-creatizing. Depan-creatizing, is that what it is? He was the best depan-creatizer. Nobody's questioning Banting's ability to take out dog's pancreas. You can do pan-creatize 10 pancreas per minute. If you've got a dog with too many pancreas,

yeah, this is your man. He's got 10 ppm. So, Banting developed a hatred for the professor that made his life unbearable. Banting became an alcoholic, regularly drinking himself to sleep. Since it was prohibition, he had to steal liquor, 190 proof alcohol from the laboratory. He later said, I do not think there was one night during the month of March 1922

when I went to bed sober. Well, that seems like a not great practice. It just seems like March. I mean, March is my birthday month, so I rarely go to bed sober on March. When he says he was making life unbearable for the other scientists, was he playing drunk in pranks on them? No, he's just being a really angry asshole.

I see. Yeah. Throwing dogs at them. Trossing dog corpses left and right, you sons of bitches. Yeah. But their work bore fruit. On May 3rd, 1922, McLeod presented a paper to the Association of American Physicians, the effect produced on diabetes by extracts of pancreas.

The paper described the discovery of insulin and it's by now clear therapeutic success on treating diabetes. McLeod received a standing ovation, the first one given in the entire history of the society's existence. Banting and Best weren't there to see it. Banting had refused to go, because he was a caddy bitch, and badgered his colleague in not going as well as a protest against McLeod. Geez.

Yeah, it's pretty. You miss that rare scientist standing ovation, which are radical, because they're just like air horns, boozles. So, at this point, the team reached out to Eli Lilly for help figuring out how to produce insulin in large quantities. So they'd figured out how to extract insulin. They'd proved that it was a thing, that it had a therapeutic effect, but they were like, we don't actually know how to produce a medicine for a shitload of people, we're just torturing

dogs over here. At some point, there was a horrible note in the story I was reading, they were using cows at one point, and they needed the fetuses of young cows to get the pancreas out, and they were like, thankfully, lots of slaughterhouses get the cows pregnant before they kill them to make them fatter. So there's tons of cow fetuses. Oh, well, isn't that nice? Well, it really worked out for us.

We're swimming in cow fetuses, up to our eyeballs in cow fetuses. Three dollar docks. They just have cow fetuses in a bowl at the front desk of these farms, like take a cow fetus. Grab me a cow fetus. We have plenty. We have too many cow fetuses. Too many cow fetuses.

I'm going to be going into sausage. It is sausages. It's just cow fetuses and pig assholes. That does seem like a turn of the century movie, like, too many cow fetuses. Too many cow fetuses. Starring Jameson and Jameson. Speaking of cow fetuses, wonderful products that help people, it's ads time. During the summer of 2020, some Americans suspected that the FBI had secretly infiltrated

the racial justice demonstrations, and you know what? They were right. I'm Trevor Aronson, and I'm hosting a new podcast series, Alphabet Boys. As the FBI sometimes, you get to grab the little guy to go after the big guy. Each season will take you inside an undercover investigation. In the first season of Alphabet Boys, we're revealing how the FBI spied on protesters in Denver. But the center of this story is a raspy, voiced, cigar-smoking man who drives a silver

hearse. And inside his hearse was like a lot of guns. He's a shark. And not in the good and bad ass way. He's a nasty shark. He was just waiting for me to set the date, the time, and then for sure he was trying to get it to happen. Listen to Alphabet Boys on the iHeart Radio App, Apple Podcast, or wherever you get your

podcasts. In the summer of 1999, a young woman in South Carolina disappeared in the middle of the night. Her name was Brooke Henson. Seven years passed. She was presumed dead. And then a tip came in that would turn the entire investigation on its head. He said, I think I found your girl.

She's alive. She's in New York. And I said, really? According to this tip, Brooke was now a student at Columbia University. With a small town detective on the case in South Carolina, he didn't believe it. So he kept poking around. I said, I'm calling about a girl you might know named Brooke Henson. And he said, I wondered when you were going to call.

When my son brought her home, I knew she was troubled. The detective ultimately became convinced that she was a master of deception, a spy. But who was this woman really? Find a deep cover on the iHeart Radio app, Apple Podcasts, wherever you get your podcasts. Standing at 8 feet 2 inches tall, Charles Byrne was the tallest man in the world. In fact, it earned him the nickname the Irish Giant. And when Charles arrived in London in 1782, he caused quite a stir. But by May the following year, death came calling for Charles in the form of tuberculosis.

And while most people were ready to mourn his passing, one man was plotting with gleeful excitement for a chance to dissect the Irish Giant's remains. This January, Grim and Mild Presents will shift focus from the great wide world around us to the universe inside us all. In a journey that will span thousands of years and countless borders, we plan to unpack the dark and twisted history of healing medicine. So wash your hands, set out your tools, and prep for surgery. Grim and Mild Presents Bedside Manors is available now.

And Grim and Mild Presents, wherever you listen to podcasts, learn more at grimandmild.com slash presents. We're back, we're back, ads are done, ads has happened, ads has happened, back to insulin. Banting Cullip and Best were awarded a patent on January 23, 1923. They did not give their patent to the public domain as a gift to mankind, but they did sell it for a dollar each to the Board of Governors of the University of Toronto. That's a bargain. That's a bargain, great price for all of the insulin, solid.

Their goal was for the medicine itself to be used for the benefit of mankind and not pure profit. They deserve credit for 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. Now they basically gave the patent to the university so that they could restrict the production of insulin to reputable pharmaceutical companies. They wanted to stop quacks from trying to make their own products and then selling people poison branded as insulin.

Just like liquefied dog and a syringe. We're just killing dogs. The patent also made it impossible for drug companies to produce a weaker version of the drug and still use the name insulin, so that's good. As messy as they were, it does seem like these guys' hearts were in the right place. Eli Lilly got a non-exclusive licensing contract and for a while, insulin was a reasonably affordable medicine. After a couple of decades, the University of Toronto's patent expired and any pharmaceutical

company was allowed to produce it. This is the point at which the market should have been flooded with cheap generic versions of insulin, but something else happened instead. Eli Lilly and other pharmaceutical companies started tweaking insulin, making minor improvements or alterations to the delivery system, tiny changes that made it work slightly better here and there. They timed these updates strategically so that insulin has remained, for all of these different companies, a patented medication from 1923 to today.

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. If you have a patent and you want to extend it beyond what the law intends, what you do is you can tweak it very slightly, like you said, minor improvements, or you can even not tweak it, but say it's useful for something else, like anti-depressant medications being used for postpartum depression or PMS. That's clearly different. Then you can cling on to that patent for much longer than what is the spirit of the law,

which is... 20 years. Right, which is a long time too. That prevents other companies from creating biosimilars, which are not the exact same formulation, but kind of a similar one. It's really terrible because, well, let's continue with horrible stories. It's not impossible. It's important to say one of the differences with the case of insulin is that it's not

impossible for a company to go back to the original recipe and make a generic version of insulin. That is something that's totally possible. What these companies are doing is that they're just never releasing a generic. They just keep tweaking their insulin every time it comes up. It gets old enough. Basically, any pharmaceutical company could try to make their own insulin, but any organization that could afford to do so would be a pharmaceutical company, and in that case, why not just whip

up their own kind of insulin, tweak it a little bit, and charge a lot of money? Why make a generic? Why help people? Why help people as a pharmaceutical company? Right. Now, this is the conclusion reached by doctors Jeremy Green and Kevin Riggs, who published a study in the New England Journal of Medicine accusing the pharmaceutical industry of using a process called evergreening to extend their patents, particularly the patents, for 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 make a version of insulin that doctors perceive 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 at the history of medicine at Johns Hopkins University

School of Medicine and a practicing internist. And we see the progression from patented drug to generic drug is almost automatic, but the history of insulin highlights the limits of generic competition as a framework for protecting the public health. Now, Riggs and Green were both inspired to study this problem because so many patients were coming into their Baltimore area clinics with blurred vision, weight loss, thirst, and other symptoms of unmedicated diabetes. They realized that a ton of people who should have been on insulin were opting to suffer

instead of go broke. Green and Riggs set out to learn why generic insulin wasn't a thing, and they traced out a legacy of evergreening. In the 1930s and 40s, pharmaceutical companies developed long-acting forms that allowed most patients to take a single daily injection. In the 1970s and 80s, manufacturers improved the purity of cow and pig-extracted insulin. Since then, several companies have developed synthetic analogues. Biotech insulin is now the standard in the U.S., the authors say.

Pattinson, the first synthetic insulin, expired in 2014, but these newer forms are harder to copy, so the unpatented versions will go through a lengthy food and drug administration approval process and cost more to make. When these insulins come off the market, they may cost just 20% to 40% less than the patented versions, Riggs and Green, Wright. Now, generic versions of medication often bring the price down to something like 80% cheaper. So, when cheaper insulin comes in, it's going to be this kind of biotech insulin that's

just 20% to 40% cheaper as opposed to... I see. So, essentially, still twice as much as it ought to be, at least. So, companies could be making these generics, but there's just no monetary incentive for them to do so. Exactly. It's not profitable. What would you need to do?

I mean, you might get a profit, but it's not as profitable. Right, because if you're a small enough company that you would want to maybe do it, then you'd couldn't... You don't have the resources to make insulins. You don't have the resources. So, if you're a bigger company, you're like, well, there's more demand than would mean people wouldn't be voting with their wallets, so they'll still sell it. Yeah.

And insulin has improved a lot over the years. To give some credit to the pharmaceutical companies, we no longer have to torture dogs to make it. It's not all derived from animals anymore. Human insulin can be produced using recombinant DNA technology that basically turns bacteria and insulin factories. It's pretty cool. They deserve to be rewarded for the innovations, or at least the scientists do, for the innovations

that have been made to insulin. But with each innovation, essentially older but still working forms of insulin, stop being used as opposed to just being sold as generics, because it's not profitable to run them. I read a Business Insider article on exactly this problem. It notes that the number of Americans with diabetes has tripled since 1980. You might expect that to make insulin cheaper, since it's now easier to make and being produced on an economy of scale. Instead, the price is soared astronomically.

Some insulin products have seen their price triple since 2002. Wow. Geez. Yeah. Levamir, one popular medication made by Novo Nordisk, cost $120 for 100 units in 2012. Today the same amount costs $300. Jesus Christ. Yeah.

Yeah. Now, as we noted, generic versions of medication often help lower the price. I could buy so many dogs with that. You could. You could buy $3 dogs. Even a $3 dog, which is an expensive dog in the insulin market. You could buy $103 dogs and make your own insulin. $300.

Yeah. So earlier generic versions of medication can lower the price by as much as 80%. This would be life-changing for some with diabetes, struggling to deal with an extra $570 a month in insulin bills. Yeah. That's what the average diabetic American plays. Jesus Christ. So you're talking $400 that could be back on their budget.

That could be spent on dogs. Could be spent on dogs. Or maybe food and your rent. Or maybe food and rent. But yeah, there is no generic insulin. And Riggs and Green suspect that this is because no pharmaceutical company considers making such a product to be a worthwhile investment. Jesus.

On February 17th, 2017, Shane Patrick Boyle posted a GoFundMe to raise enough money for one month of insulin. For him, this meant $750. As we already discussed, he came up $50 short and he died a couple of weeks later of diabetic ketoacidosis. The current secretary of Health and Human Services, appointed by Donald Trump and confirmed by Congress, is Alex Azar. Before he got into politics, Mr. Azar had a different job.

He worked for Eli Lilly from 2007 to 2017. Starting in 2012, he was the president of Lilly USA, the company's largest division. I'd like to quote from an article in The Nation. During Azar's tenure, Eli Lilly raised the prices on its insulins in the United States by 20.8% in 2014, 16.9% in 2015, and 7.5% in 2016. Eli Lilly's biggest seller, Humalog Insulin, is now off patent. But rather than becoming cheaper, Humalog costs more now than when it first came to market in 1996.

When Azar started working at Eli Lilly in June 2007, the list price for a vial of Humalog was $74. When he quit in January 2017, it was $269. So have they made changes to Humalog? Nope. They're just jacking the price up. Oh my God. It's like, shouldn't that be sort of like a crime, murder?

I mean, the health and human services secretary did it. So how could it be that bad? Well, you know how people get so worked up when they see stores jack up the prices of water before a disaster? This is like that every day. Every single year for 20 years, and then you become a secretary of health and human services. Oh my God. Oh, that is really depressing.

It's horrible. Yeah. That's the whole story. Oh boy. It's just awful. 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... And terrible. And Alex, Azar, and everyone else involved in these companies and changing the prices of them as a piece of shit. Yeah, 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 thing that they do. Yeah, type one.

They're born with it. You just random chance. Shitty spin of that big roulette wheel. Mother nature just dicking around, but I mean, that's not to say people with type two deserve it or anything like that, 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 just creating these high incidents of diabetes. And then the medicine that can save your life is also just the price is jacked up.

Jesus Christ, if that isn't an indictment of our society, I don't know. Yeah, it's pretty horrible and gross. So if you're diabetic, sorry you're dealing with this, if you happen to know where Alex Azar's car is, I'm not going to say commit a crime on Alex Azar's car, but maybe key it. Do crimes. Do crimes. Not maybe.

I'm just saying. Be diabetic. Do crimes. Generally do crimes. Generally do crimes. I mean, my goal is to train a flock of birds to follow them around and give those birds a real healthy but very high in fiber diet and just have them follow his car, a lot of like wheat husks, chia seeds.

If you train birds and live in the DC area, we have a gig for you. We got a job. Listen. We'll crowdfund this like we would crowdfund someone's insulin payment. Yeah. And if we fall $50 short though, we won't die. We won't die. Yeah.

His car will just not be filthy. His shirt will not be shitted on. If you train birds in DC, drop a line. If you practice falconry in the DC area, the greater metropolitan DC area, DM Robert. Or if you're Oswald Tomolkins, the greatest car keer in the East Coast, everybody knows Oswald Tomolkins. Oh, really? Yeah.

Absolutely. He's fantastic. Maybe key this guy's car. Do it. I don't know. Maybe key in an image of an urn with a dead 27-year-old diabetic stashes in it. It's so heavy because it's one of these things where we freaking found the cure to this. We found it.

It shouldn't be a problem. It shouldn't be a problem. You know, we talk about things like how terrible cancer is and how we crave a cure so much. And of course we do because cancer is awful. But then we have a freaking cure for diabetes that will keep people from dying, from eminently dying, and just to dangle it above them, like, oh, oh, you want this cure? Oh, oh, try and get it. Oh, oh.

And the people dangling it are only using one hand because they're getting paid tens of millions of dollars in bonuses for doing the dangling. Ow. What a great system. I know. Super gonna last forever and not collapse in fire and death. Yeah. But does it feel good when you get your second luxury yacht?

You might as well just why not skip all of the middleman stuff and just make it out a dead diabetic people. Yeah, just make it out a course. Make a giant boat. Have a bone yacht. A boat, a bone yacht made out of the bones of dead diabetic people. If Alex Azar was sailing up to Kenabunkport, Maine in a bone yacht, well, okay, he's terrible, but this guy at least has some panache.

At least he's forthright. Yeah. He's honestly a bone merchant. Cut the metaphor. Skip the symbolism. Elron 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 Azar. That's my threat to the secretary of human services. We will train a flock of birds. Train a flock of birds to shit on your car. A constant stream of shit flowing as much as insulin should be flowing to patients who mute it. The shit will flow like insulin until the insulin gets cheaper. That is the terroristic threat we are making on this episode of Behind the Bastards.

Great. Cool. I'm glad you put a label to it so it'll really make DHS. You gotta make it easy for those birds. Yeah, for their search engine to go like, oh, there we go. I'm gonna get an interview like, how many birds are in your bird cell? How many birds do you have? What kind?

Let me see your keys. This is their paint on them. Now, Katie, you got any pluggables to plug? Well, of course, my show, Creature Feature, where we talk about creatures who are more human-like than you expect and humans who act in animal ways, like the frickin' barbaric animals who deny people insulin. Well, actually, animals would never do anything that fucked up. No, they wouldn't.

I mean, animals do some fucked up things. They'll mind control spiders into weaving them a little nest and then killing them. Then exploitation and get behind. Right, right. There's something like metal about that. There's nothing cool about just depriving people of insulin. No, that's just murder. And so you can follow me at katiegolden on Twitter.

You can follow my bird Twitter at pro-bird rights. And yeah, please do check out my show. There's a great episode with Robert in it called, uh, I thought it was something like, Reef for Madness. Reef for Madness. There we go. It's moving from the name of that movie. Reef for Madness.

Hi, Robert Evans. This has been Behind the Bastards. Uh, you can find me on Twitter at irideok. You can find us on Instagram and, uh, Twitter at, uh, at Bastards Pod. You can find us online with all the sources for this article at behindthebastards.com. We have a t-shirt shop. You can buy cups there, mugs, phone wraps and stuff with cool logos made up and catch phrases and stuff from the show.

Neat images, so. Like, taste your pee. Sample your pee. Like, taste your pee. Sample your pee. Like, go to T-Public, look up behind the Bastards for that stuff. More like T-Public. Oh, look, maybe this week, instead of buying a shirt, donate some money to somebody's

GoFundMe if they're trying to buy insulin or something. They clearly need the help. It's fucked up right now. Or vote. Or vote. Hopefully you just voted. There's no voting to do immediately. Well, soon.

Keep voting. Yeah, keep voting. Constantly vote. And look out for your, your diabetic friends because shit's rough. Yeah. Yeah. All right. That's about 40% of you.

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