OTC Insulin: terrible NPR article

This whole article makes me squirm. But one section drives me particularly angry: the story of why Indiana stopped OTC sales of older insulin (the whole article is a hatchet job on patient rights):

"One state does require prescriptions for all insulin. Dr. Kevin Burke, a health officer for Clark County, Ind., led the effort to require prescriptions in his state.

“I didn’t realize that insulin was over the counter in Indiana until two of my patients, who were in good control, suddenly had increased glucoses,” Burke says. He asked them if they had changed their diet, lost weight, altered their workout routines. They had not.

“They both admitted that they had decided to switch to over-the-counter insulin,” Burke says, “which was different from what I had prescribed.”

I find this a boneheaded decision if there is one. This health officer is now able to forbid his patients from using other insulin than what he required them to use. The fact is, most likely they switched because they couldn’t afford their regular insulin. The only outcome of this excess of zeal, imho, is to result in more deaths like Shane Boyle’s.

Sometimes I get really tired of all these people wanting to dictate to me (or anyone) what I should decide for myself.

Note: this was originally part of this thread: Cheapest insulin and diabetes supplies

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That’s a terrible article. Obviously people aren’t choosing to buy cheap OTC insulin because it’s fun or as a big middle finger to the medical establishment, they’re doing it to prevent dying. Why doesn’t that doctor focus his efforts on making his services affordable to his patients and lobbying for fair pricing of prescription insulins if he’s concerned about people buying old school insulin OTC? For a medical doctor, who took an oath to “first, do no harm” to campaign to take away what is some people’s last resort in life is unconscionable.

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without training or guidance from a health care provider, it can be dangerous for a patient to guess at the best dosage and timing from version to version of insulin. On the other hand, being able to afford and easily buy some when she needed it may have saved her life.

This is the core of the issue. The blockheaded and arrogant “doctor” who pushed this Indiana law through seems to have no interest in keeping people alive, just as long as they follow his instructions.

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It made me really angry to read this article – but that section was the worst.

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It’s worth splitting this thread. I had to read this article again and it made me fume…

This article is so wrong I feel the need to go sentence by sentence on it:

As anyone with diabetes can tell you, managing the disease with insulin usually means regular checkups at the doctor’s office to fine-tune the dosage, monitor blood-sugar levels and check for complications.

Hogwash. As most anyone with diabetes can tell you, the doctor knows a lot less than you do about how to manage your own diabetes, and you, the patient, are the one doing both the fine-tune and the not-so-fine-tune. And I don’t need the doctor’s office to monitor my son’s BG either. The fact is, with diabetes, the patient is the doctor.

But here’s a little known fact: Some forms of insulin can be bought without a prescription.
[…]
But it’s still a pretty uncommon purchase.

If it’s so uncommon, why does the article write later:

According to the medical consulting firm IMS Health, about 15 percent of people who buy insulin in the growing U.S. diabetes market purchase it over the counter without a prescription?

And you know why? It’s because they don’t have insurance, or enough money to buy the real expensive insulin!

Dr. Jorge Calles, an endocrinologist at MetroHealth, Cleveland’s public hospital, is alarmed to think that some people are self-medicating with any sort of insulin.

“It’s a very serious situation if they are selling it over the counter — without any control with a prescription, specifically,” Calles says.

Oh, really, “Dr. Calles”? It’s a very serious situation? Is it as serious a situation as when Shane Boyle died because he could not afford the insulin you would have prescribed him, if he had had the money to pay for the doctor’s visit, which he didn’t have?

The broader availability of this form of insulin allows patients with diabetes to obtain it “quickly in urgent situations, without delays,” the FDA says, and is intended to increase patient safety.

Exactly, “Dr. Calles.” Shane Boyle could have survived if he had known that he could buy insulin OTC. He did not have $750 to buy expensive insulin, but he probably would have had $100 to buy NPH and Regular. He did not need, and could not afford you to prescribe him anything. He was a longtime, experienced diabetic. And, even he hadn’t been experienced, it was his right, experienced or not, to try and survive instead of dying needlessly.

Still, some people with diabetes, as well as some doctors, doubt that the benefits of that greater availability outweigh the risks, especially for patients who switch from one type of insulin to another without telling their doctor.

“This is not something that should be done without the help of a professional,” says David Kliff, who has Type 1 diabetes and writes the Diabetic Investors blog. Kliff has followed and written about the expanding business of diabetes for years.

I am sure that this David Kliff has plenty of insurance. He may write a blog but, if he does not have enough common sense to learn how to use NPH from a couple of questions on a forum like ours, it is laughable to think that he would be ready to give advice to others. Clearly he is just in it for the money with his investors’ blog.

One state does require prescriptions for all insulin. Dr. Kevin Burke, a health officer for Clark County, Ind., led the effort to require prescriptions in his state.

“I didn’t realize that insulin was over the counter in Indiana until two of my patients, who were in good control, suddenly had increased glucoses,” Burke says. He asked them if they had changed their diet, lost weight, altered their workout routines. They had not.

“They both admitted that they had decided to switch to over-the-counter insulin,” Burke says, “which was different from what I had prescribed.”

They probably switched because they could not afford the insulin you prescribed them, you prick. So now, instead of being able to use the insulin they can afford, they are bleeding themselves white to be able to pay for the insulin you are compelling them to use. Or dying because they can’t afford it, all of that because a micro-manager like, you “Dr. Burke,” wants to be able to tell others what to do, because he thinks a doctor has the right to make decisions for his patients.

I don’t swear very much in my life, “Dr Burke,” but it gives me great satisfaction to do so in reference to you and to “Dr. Calles” above, who “is alarmed to think that some people are self-medicating with any sort of insulin.”

The fact is, “Dr. Burke”, “Dr Calles,” each one of us knows much better than you what we need to do to manage our own diabetes in most circumstances. And, even when we don’t, it is our right to decide whether we want to die by your unaffordable rules, or try to live by the ones we can afford.

In fact, the AMA’s board noted, getting insulin without a doctor’s prescription may be an important way for some insulin-dependent patients to get access to the medicine they need.

Exactly, “Dr. Burke.” The AMA understands, in this case, that affordability of a lifegiving drug like insulin is a little more important than your ability to micro-manage the world around you. And the fact that you were able to convince the state of Indiana to outlaw OTC sales of insulin makes me sick.

Because, by doing so, you probably condemned a good number of people to death. Like Shane Boyle.

And this article, which tries to justify your supercilious attitude and that of “Dr. Calles” makes me sick too.

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Thank you for writing this Michel. You have captured my very thoughts, and the things I have been fuming about the past couple of hours.

The arrogance of these “doctors” is just infuriating. It would be like me telling a patient they needed a crown on a tooth, and then telling them that I wouldn’t treat the tooth worth a filling if they couldn’t afford the crown.

I took an oath to first do no harm. But that also requires me to take responsibility for my patient’s health without my ego getting in the way, and to be non judgemental. It seems that “Drs.” Burke and Calles still need to learn what being a doctor is.

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I suggest these doctors be invited to defend their position in the first FUD live interview

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BTW, I looked up “Dr.” Kevin Burke, and as I suspected he is an internist. Besides the fact that I have never seen an internist who knows his rear end from a hole in the ground about diabetes, for him to fight vociferously to make insulin rx only is breathtakingly arrogant and demonstrably ignorant.

He seriously needs to be censured by his state board.

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Unfortunately, the Indiana State Medical Association supported him:

The requirement was strongly supported by the Indiana State Medical Association, whose doctors told lawmakers that diabetics who try to manage their condition without proper medical advice often choose the wrong insulin or administer an improper amount.

They put their financial interest before the life of their patients.

This article, btw, explains that many Indiana residents drive into Illinois to buy insulin OTC. I wonder why…

So now if these same patients cannot afford expensive analogs, they should go into DKA and die? That would be considered a “better outcome”? I am now seeing red, boiling mad! Does this idiotic doctor own a funeral home, looking for more corpses to embalm? ( I needed to rant on this one.)

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