What's the big deal about insulin?

You've  probably heard the word insulin many times. You probably even know some relatives that talk about going to the pharmacy to buy their insulin. But do you know what it is or why they need it or even how they take insulin? You don’t!!! Well, then this entry is just for you.

Diabetics are the most common group of people who need and take insulin. I’m a diabetic myself, which means I have a chronic illness that causes high blood sugar. High blood sugar is usually caused by resistance to insulin or depreciated production (typically Type 2 diabetes) or flat out no insulin production at all (Type 1 diabetes). I’m a Type 1 diabetic, so my body doesn’t produce insulin at all, which means I need to give myself insulin manually. All Type 1 diabetics and even some Type 2 diabetics need insulin to control their blood sugar.

Insulin is a clear liquid that comes in a vial or sometimes a device that looks a lot like a pen. It even has a cap and button at the top! Starting from this point, I’ll try to answer some questions that people frequently ask me when they see my insulin vial or learn that I’m a diabetic.

HOW DO YOU 'TAKE' YOUR INSULIN? CAN YOU USE PILLS?
Insulin is actually a sensitive hormone made up of amino acids, just like proteins, so we cannot take it in a pill. Just like proteins, insulin has a three-dimensional shape that is important to its activity and ability to work properly in the body. Stomach acid has an incredibly low pH, which destroys the 3D shape of insulin and makes it completely useless to the body. So diabetics can’t take insulin orally without destroying

Diabetic Dining in Korea

My wife and in-laws are Korean and that means we eat a lot of Korean food at home. I love when our home is filled with the smells of hot soups, spicy meats, and steaming dumplings.

We try to visit Korea every other year. When we travel, food is always a major part of our trip and it’s even more important when we travel to Korea. Of course we have a lot of the same food and ingredients at home, but the flavor, quality, and variety in Korea is incomparable. This year, our trip landed right in the middle of the rainy season (June until the end of July). And so I’ve been looking forward to a lot of hot soups and noodles.

As a diabetic, I may seem like a killjoy when it comes to eating out. I’m mentally measuring and questioning each dish, trying to find the integral for the area under the curve of my pasta. In the states, I’ve become pretty adept in figuring out my food when we’re away from home, but cuisine in Korea is particularly challenging. I wanted to share a couple major challenges and offer a few solutions so that people can understand the thoughts of a diabetic eating out in Korea.

Who should be allowed to buy your doctor's data?

 Pharmaceutical companies hold a special niche. With their research, they provide the drugs our nation now rely on for treatment and recovery. On the other hand, corporation’s insatiable desire for profit bottlenecks drug delivery and advancement by creating a system of profit over people. Big Pharma thrives because of their money enables the research and development of new drugs. So how do we balance the power between Big Pharma companies and the people that their drugs are meant to serve?

An interesting story about this struggle has been growing out of Vermont. In 2007, Vermont enacted a law to restrict how Big Pharma uses information bought from pharmacies. These restrictions only applied to Big Pharma marketing. According to §4631 (see Vt. Stat. Ann., Tit. 18, §4631), pharmaceutical companies are forbade from buying prescriber identifiable data for the purpose of marketing. Statute 4631 is meant to prevent a tactic called detailing and the manipulation of drug costs and prescriptions. Data mining companies, as well as pharmaceutical industries and many other agencies, claimed the law infringed on the Freedom of Speech in the First Amendment. The Supreme Court of the United States (SCOTUS) heard the case in April 2011 and a decision was handed down on June 23rd 2011. (Outline of case here) (Decision outlined here)

In the end, Vermont lost the case of Sorrell, Attorney General of Vermont, et al. vs IMS Health Inc., et al.
Justice Kennedy of SCOTUS wrote,
“Vermont argues that its prohibitions safeguard medical privacy and diminish the likelihood that
marketing will lead to prescription decisions not in the best interests of patients or the State. It
can be assumed that these interests are significant. Speech in aid of pharmaceutical marketing,
however, is a form of expression protected by the Free Speech Clause of the First Amendment.
As a consequence, Vermont’s statute must be subjected to heightened judicial scrutiny.
The law cannot satisfy that standard. “

I will define a few key vocabularies so that we can fully appreciate the case and the verdict. First, when doctors write a prescription, the patient goes to the pharmacy. It is then the pharmacy’s responsibility to record the prescription, including the drug, the dose, and even the name of the prescribing doctor. This info identifies the doctor and what the doctor prescribed. In many states, this info can be legally sold by pharmacies as prescriber-identifiable (PI) data. Many times, the data is sold to data mining companies, such as IMS Health. Data mining is the detailed sorting and analysis of the information. Mined data is a valuable source of information for many purposes, such as clinical research and marketing. The mining companies can then be turned around and sell this precious info to other businesses and agencies, such as pharmaceutical companies. And so to reiterate, Vermont statute 4631 was created to prohibit pharmaceutical companies from purchasing this data for marketing, while other forms of use by other groups was allowable.

It’s important to note at this point, that the laws allow the legal gathering and sale of PI data and that it only restricted Big Parma from buying the information marketing. The reason the Vermont Attorney General and petitioners wrote the statute was to limit a process called “detailing”. Many legislatures felt that allowing Big Pharma to purchase the data would lead to companies targeting specific doctors with visits and invitations for lectures and meeting, all of which would encourage them to use their drugThis is a process called “detailing”. By this detailed marketing approach that targets the prescribers, Big Pharma could potentially raise drug prices and manipulate the drug market at the physician level.

However, companies that mine the data and agencies that use the data claimed that the restriction was an unfair discrimination and infringed on the right to Freedom of Speech. In this context, the respondents (IMS Health, et al.) claimed that communication and therefore speech was being restricted unfairly due to assumed interests and actions of the pharmaceutical industry. SCOTUS agreed with IMS Health in the case.

Each side had several major supporters (see the list and the briefs written by the groups at the Vermont Office of the Attorney General). Supporters of §4631 argue that limiting Big Pharma protects patient identifiable data that could be backtracked by the PI data and prevents the manipulation of the medical system of prescription. Opponents of §4631 question the legality of the reason for limiting Big Pharma and worry that the statute could lead to limiting other groups as well.

On example is clinical research. Clinical researchers routinely use data from pharmacies and hospitals to evaluate efficacy of drugs and benefits of therapies. The data goes into the planning process of new clinical trials so that clinicians are not constantly reinventing the clinical wheel by repeating work that was already done. To reduce the waste of unnecessary repetitive clinical trials, many believe it would behoove the general public to allow clinicians access to PI data, which could give valuable information in the types of prescriptions being used in the public and how it might impact therapeutic approaches. If Big Pharma is restricted from using PI data because of a negative assumption then a door may to opened to enable the restriction of many groups, including clinical research.

On the other hand, Big Pharma is big business. Billions of dollars are used annually to market and manage the drugs doctors already prescribe. Big Pharma routinely encourages brand name pharmaceuticals even when generic versions are available. By allowing access to PI data, many groups argue that we are allowing Big Pharma access to a very direct form of info for marketing groups to specifically and more efficiently target doctors. Even though the doctors have the final say in what they prescribe, Big Pharma could dramatically influence their decision and foster a system where the patient’s best interest isn’t the highest priority and public health is second to the quest for higher profit.

Overall, SCOTUS decided that the state of Vermont could not restrict the use of legally obtained information for only Big Pharma companies. Simply put, IMS Health argued that you can’t restrict just one group from an otherwise open and legal system – that’s discrimination and it’s unconstitutional. This case was a benchmark for many questions and cases to come as legislation starts to tackle healthcare in the US as a major issue. Several policy programs are centered on assessing current treatment and therapies and the accessibility of database information to clinicians, which returns us to similar questions of who should have access to what kinds of information.