I don’t think it has to be. Being here together was a pipe dream two months ago!
Of course, this is a harder dream to realize 
This is where crownfunding can help. In this day, it is possible the “someone” could be the diabetes community. Of course, this is still a dream – but a closer one than it was 20 years ago. We have all the pieces to make it true. It is just hard.
Would you make the insulin yourself? Somebody else would be making it. Why would you expect them to be a better company than Lilly?
The only reason companies make insulin is because they make a profit. Nobody is doing it to be nice.
As soon as it is not profitable, there is no more insulin.
Creating a new insulin from scratch costs millions or billions. We have to pay for that cost now. Otherwise they wouldn’t make it.
I was envisioning a non-profit crowd-sourced model wherein some foundation with a little largesse contributes at the outset, the rest of the D community pitches in for further development, and then they either outsource to a manufacturing company (possibly a generic drug manufacturer), or license to another firm with agreements on price caps. The initial development costs would be considered sunk costs that would not attempt to be recouped. So all you need to ensure is that your production costs (i.e. the physical inputs, the manpower for quality control, etc.) can be met by the sale price of the insulin. There is a consortium working on a TB vaccine with just this model.
Also I guarantee you can make a decent amount of insulin using relatively old-school techniques (vats of E.coli, etc.) with a decent-sized factory. It wouldn’t be cheap to produce but probably not billions either.
@Eric THIS! Nobody does a life’s work for free. Cut off the profits you cut off the innovation.
The best way to control the greed being displayed by some pharma companies is to tear down the government sanctioned and enforced rules enabling their greed. Let the free market control the greed. Consumers are good at that.
well, I agree that no one is going to develop a drug from scratch, top to bottom, without getting paid.
But a) many scientists would happily work for a nonprofit over a drug company, which doesn’t necessarily mean no one’s getting paid; it just means the initial investment has to be essentially philanthropic in its goals. b) you use NightScout and various open-source technologies to manage your Diabetes. Some of that is someone’s life’s work too, and people get paid quite handsomely for these projects in the private sector. You don’t think Apple has about 2 dozen people working on similar projects? And yet somehow, when people decide they want to see something in the world more than they want to make a profit, things can get done surprisingly quickly.
I don’t believe someone will produce insulin at a loss indefinitely. I do believe there are people with deep pockets out there who might be willing to sink millions of dollars into a project’s development if, at the end, the result was a decent insulin whose manufacturing costs are offset by its sticker price. Once you’re at that stage, the profit margin doesn’t have to be huge – 3 to 5% would probably do nicely for some folks. That’s a huge ways away from the 30 percent profit margins pharmas currently enjoy, but if market share could be large enough, manufacturers might still make a tidy pile of cash.
Robert Space Industries crowd funding of, so far, $165 million dollars (with an M) to fund a flight simulator game (star citizen), shows the power of crowd funding for an idea that people believe in.
Ford motor and many other large companies started off in someone’s garage…As just a passion.
well it jsut depresses me that people will spend $165 million on a flight simulator but not on insulins 
If Humalog is so expensive, why would people not just switch to NovoLog? Because a lot of people are not allowed! Their insurance won’t cover NovoLog. They are stuck being only able to choose one!
If you remove that, and let people pick what they want, there is no way Lilly could raise their prices dramatically. People would just choose NovoLog instead.
It’s the same reason two gas stations across the street from each other always have practically identical prices…
@TiaG This sounds nice, but is highly impractical. Getting something like this off the ground would take at least a decade. In that time frame the current analog insulins will be just as outdated as Lente and Regular are today.
If there are no profits, there are no innovations. There is NO way around that. Banting and Best may have discovered how to make insulin, but it took Eli Lilly’s wealth and willingness to take a risk for a return to bring it to market.
That was just an example of the power of crowd funding. I’m sure many, me included, would contribute to both.
I don’t think it’s as dire as you say. Like I’ve said, the manufacturing costs for insulins are pretty low on the scale of things (making Humalog and making NPH and R is not dramatically different and the latter cost $25 a vial so how expensive can it be?). So you really just have to get to the point that it’s FDA-approved… the trials are the big cost hurdle. A trial does not need to take 10 years though. If you start with something that died at stage 2 or 2b and purchase its patents and continue to develop it, you really just need to do a phase III study.
Insurance dictates which they will compensate. Period
I was told by my insurance company I HAD to go to a 3 month prescription. I had no choice. Fine, no problem. I got the 3 month prescription.
But then I learned I had to pay more per bottle for the 3 month prescription. Why? Because 3 month prescriptions HAVE to go through mail-order, and the cost per bottle is higher for mail order. Again, I had no choice.
I am not getting it mailed to me. I learned that even though I am still picking it up from the local pharmacy, they HAVE to charge me the higher mail-order price.
So I was required to go from 1 month to 3 month, even though I didn’t want to. And then I was required to pay the higher mail-order cost, even though nothing is getting mailed to me.
You can blame Eli Lilly all you want. That’s the easy thing to do. But clearly there are other factors at play in all this stuff.
These kind of crap arrangements are a big part of the problem.
THAT is a big problem!
@ClaudnDaye Do you think, say, Dexcom could have been crowd funded and produced a CGM, developing improvements all the way along? It’s been eleven years and Dexcom is barely turning a profit. It would have taken a crowd fund of over $1B to take them to this point
Thankfully, there are entrepreneurs willing to take a risk in return for a possible profit.
Actually, what we are talking about is something a bit different. If you fund someone, you have some control over what happens to the discoveries. The question is – how far down the pipeline is it possible to fund?
So possibly we could be talking about funding for manufacturing – eventually. Or working with foundations etc. to make it happen.
One of the largest research and manufacturing institutes in Europe, Institut Pasteur, is non-profit.
Yes. But what we are saying - and what you were saying too - is that it is clear that this constant price increase is not related to being able to just make a profit. It is related to being able to make huge margins because we can’t do without the drug.
@docslotnick, but they produced a marketable product years earlier. – and their investors or founders were somehow *willing to lose money for years because their product was so important. By 2007 – I’m not sure when they first incorporated but certainly they were able to get something to market much earlier than a decade and a billion in investment.
Also, keep in mind that most of pharma’s new drugs (for about the last 10 years) are not developed start-to-finish in-house. They usually are piggybacking off some promising research taken from a university. Sometimes the technology is licensed straight from the U or sometimes the profs develop their own biotech companies in hopes of being acquired or partnering for the later-stage drug trials – but the critical compound discovery, idea development and up to stage 1 data is for the most part being produced on the government’s dime, by people with NSF or NIH grants who, yes, are getting paid, but have no true profit motive in the traditional sense (their grants are a foregone conclusion and what largely propels them is curiosity, belief in their product or publish-or-perish, none of which is purely “free market”).
So all I’m saying is that the profit motive doesn’t always ensure great technological development, and a lot of great work can proceed with much more altruistic goals propelling it pretty far. Eventually, yes, you have to sell a product, and the balance sheet needs to work out. But I think you’d be surprised how far a technology can get on a shoestring budget.
The big roadblock is the FDA, honestly. It’s those phase III trials that are killer. And the ways to slash those costs are more off-the-beaten-track (possibly illegal).
The more I think about it, the more I feel that it would be possible today to create a massive crowdfunding initiative around an insulin manufacturing project.
We are talking probably $1B over 10 years, so it’s a huge amount of money, and a very difficult project. But society is not what it was 20 years ago.
I am not sure you would need that much money. If you could develop a process and make it available to a generic manufacturer and help offset some of the regulatory $, I bet you could find a partner.
Ah, good old “Eat Now Or DIE!” insulin. I still remember the day, sometime during the week I finally got off of that stuff, when I dared to eat a late lunch for the first time in twenty years… and nothing happened! I keep seeing this “slightly better” in articles about expensive analogues being only “slightly” an improvement over “older” ones, meaning… well, what? R? NPH? They never actually say. I’d suggest that the difference between humalog/novolog and R might conceivably be described that way, but between Lantus/Levemere and N not so much. Those are really what made basal-bolus MDI possible. That N peak was just so far out from when you injected and SO hard to predict exactly when it was going to hit, so you had to try to be as regimented in your habits as possible to avoid getting plunged into an out-of-the-blue low, and life is just never that predictable. So maybe I could get by with Lantus plus R if I had to, but it would be a very test strip-intensive way to go. Be a lot easier with a CGM, but I take it that’s not an option in this scenario (couldn’t afford retail for one of those).
Well, what’s the current retail price? Something like $300-400? It’s really kind of a notional price since they don’t expect any individual to actually pay it. Has more to do with benefit managers than actual human beings. Hard to know what the price point would end up being if those guys were out of the loop and we all had to pay retail. But for the purposes of the question let’s say $350. So $700/mo for me, roughly. Assuming the same deal for pump supplies and the rest–retail out of pocket–nope, couldn’t do it, nowhere near. So I guess it would be “R/N Or Die.”