Pharma pimps say: Everyone/No one is raising insulin prices

❝ A casual observer of April’s House Energy and Commerce subcommittee hearing might think insulin prices just go up by themselves.

After all, the key industry executives filed opening statements to the congressional panel outlining patient-assistance programs, coupons and discounts — a range of price reductions that might make one think this life-or-death diabetes medication is easily affordable to the patients who need it….

❝ In fact, the price of insulin nearly doubled from 2012 to 2016 alone, triggering national headlines about the resulting hardships — sometimes deadly — suffered by people with the Type I-version of the condition who are left to ration insulin because it is too expensive for them to use as prescribed.

❝ The three drug manufacturers that make insulin — Eli Lilly, Novo Nordisk and Sanofi — joined three pharmacy benefit managers — CVS Caremark, Express Scripts and OptumRx — to testify before the Oversight and Investigations panel at its second hearing probing the corporate maneuvers behind the skyrocketing costs.

They disagreed a lot. All that counted was whose lies were the most believable. For years, no one has owned more members of Congress than Big Pharma. Giving a minimum of $15,000 a year to anyone elected to Congress. House or Senate. Big enough player? You get more. A lot more.

“In 2009, PhRMA spent about $25 million lobbying the government, Bloomberg said.

The trade association spent $6 million in the fourth quarter of 2018 and $10 million in the third, as it lobbied the Trump administration and federal government over a myriad of policies…”

“CNN said the pharmaceutical and healthcare sector spent $194 million lobbying the government in 2018. That amount does not include the lobbying efforts of PhRMA…”

The scary truth about sugar

At risk of being the Grinch who stole Halloween, perhaps we should rethink a holiday built around candy.

Even without that annual fix, we’re already sugar junkies. Each week we gulp or eat nearly three pounds of the white powder — up 43 percent from two pounds weekly in 1959, reports the U.S. Department of Agriculture.

And pound by pound, we’re killing ourselves. The resulting obesity leads to diabetes, heart disease, inactivity and possibly dementia…

“Thanks to obesity, our kids are expected to have shorter life spans than their parents,” says Shreela Sharma, Ph.D…associate professor of epidemiology at UTHealth School of Public Health…“We’re in a health crisis.”

Even though this report is a half-year-old, the word just seems to be getting round to mainstream media. After finally hearing quotes almost every day in the last couple of weeks, I figured it was time to put it up at my personal site.

Break it down and the average American mainlines 32 teaspoons of added sweeteners daily. That’s more than three times the American Heart Association’s suggested levels of nine teaspoons or 150 calories for men, five times the six teaspoons or 100 calories for women and 10 times the three teaspoons or 50 calories for children.

Worst offenders are teens, with about 34 teaspoons of the sweet stuff daily, says a recent National Health and Nutrition Examination Survey.

Stats grow more atrocious for precocious youths. “A child by age 5 has eaten more sugar than their parents did by age 18,” Sharma says. “Before every lunch, they’ve already had more sugar than you need in an entire day, from cereals, sodas, juices, granola bars and yogurt…”

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Scientists reprogram skin cells into insulin-producing cells

Ke LiChris Goodfellow

Type 1 diabetes, which usually manifests during childhood, is caused by the destruction of beta-cells (β-cells). β-cells are a type of cell that normally resides in the pancreas and produces a hormone called insulin. Without insulin, the body’s organs have difficulty absorbing sugars, such as glucose, from the blood. Once a death sentence, the disease can now be managed with regular glucose monitoring and insulin injections. A more permanent solution, however, would be to replace the missing β-cells. But these cells are hard to come by, so researchers have looked towards stem cell technology as a way to make them…

One of the major challenges to generating large quantities of β-cells is that these cells have limited regenerative ability; once they mature it’s difficult to make more. So the team decided to go one step backwards in the life cycle of the cell.

The team first collected skin cells, called fibroblasts, from laboratory mice. Then, by treating the fibroblasts with a unique ‘cocktail’ of molecules and reprogramming factors, they transformed the cells into endoderm-like cells. Endoderm cells are a type of cell found in the early embryo, and which eventually mature into the body’s major organs—including the pancreas, the home of β-cells.

“Using another chemical cocktail, we then transformed these endoderm-like cells into cells that mimicked early pancreas-like cells, which we called PPLC’s,” said Gladstone Postdoctoral Scholar Ke Li, PhD, the paper’s lead author. “Our initial goal was to see whether we could coax these PPLC’s to mature into cells that, like β-cells, respond to the correct chemical signals and—most importantly—secrete insulin. And our initial experiments, performed in a petri dish, revealed that they did.”

The research team then wanted to see whether the same would occur in live animal models. So they transplanted PPLC’s into mice modified to have hyperglycemia (high glucose levels), a key indicator of diabetes.

“Importantly, just one week post-transplant, the animals’ glucose levels started to decrease, and gradually approached normal levels,” continued Dr. Li. “And when we removed the transplanted cells, we saw an immediate glucose spike, revealing a direct link between the transplantation of the PPLC’s and reduced hyperglycemia.”

But it was when the team tested the mice eight weeks post-transplant that they saw more dramatic changes: the PPLC’s had given rise to functional, insulin-secreting β-cells.

“These results not only highlight the power of small molecules in cellular reprogramming, and are proof-of-principle that could one day be used as a personalized therapeutic approach in patients,” explained Dr. Ding.

Bravo. I imagine pretty much everyone knows someone with Type 1 diabetes. I had friends in elementary school with what was then called childhood diabetes. I have friends since – who spent their childhood battling to get to something approaching normalcy in adult life.

All the symptomatic treatment in the world ain’t going to make folks’ lives easier than the potential of this cellular reprogramming.

Four drugs cause two-thirds of hospitalizations in older Americans

Warfarin “flower”

Blood thinners and diabetes drugs cause most emergency hospital visits for drug reactions among people over 65 in the United States, a new study shows.

Just four medications or medication groups — used alone or together — were responsible for two-thirds of emergency hospitalizations among older Americans, according to the report. At the top of the list was warfarin, also known as Coumadin, a blood thinner. It accounted for 33 percent of emergency hospital visits. Insulin injections were next on the list, accounting for 14 percent of emergency visits.

Aspirin, clopidogrel and other antiplatelet drugs that help prevent blood clotting were involved in 13 percent of emergency visits. And just behind them were diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations.

All these drugs are commonly prescribed to older adults, and they can be hard to use correctly. One problem they share is a narrow therapeutic index, meaning the line between an effective dose and a hazardous one is thin. The sheer extent to which they are involved in hospitalizations among older people, though, was not expected, said Dr. Dan Budnitz, an author of the study…

As Americans live longer and take more medications — 40 percent of people over 65 take five to nine medications — hospitalizations for accidental overdoses and adverse side effects are likely to increase, experts say…

A common denominator among the drugs topping the list is that they can be difficult to use. Some require blood testing to adjust their doses, and a small dose can have a powerful effect. Blood sugar can be notoriously hard to control in people with diabetes, for example, and taking a slightly larger dose of insulin than needed can send a person into shock. Warfarin, meanwhile, is the classic example of a drug with a narrow margin between therapeutic and toxic doses, requiring regular blood monitoring, and it can interact with many other drugs and foods…

One thing that stood out in the data, the researchers noted, was that none of the four drugs identified as frequent culprits are typically among the types of drugs labeled “high risk” for older adults by major health care groups…

Dr. Budnitz said that the new findings should provide an opportunity to reduce the number of emergency hospitalizations in older adults by focusing on improving the safety of this small group of blood thinners and diabetes medications, rather than by trying to stop the use of drugs typically thought of as risky for this group.

Dr. Budnitz thinks it is critical that patients tell their physicians everything they’re taking. Well, presuming that the digitizing program put in place by President Obama is proceeding at least as quickly as anything else that hasn’t been roadblocked by the Party of NO – seems to me it soon should be practical for that physician to have someone on staff run a database check on his patients for exactly these conflicts and dangers.

Leaving the responsibility up to a patient who may not even be able to spell the crap he’s taking ain’t the most reliable approach. Involving doctor and pharmacy database records makes as much sense or more.

Insulin directly linked to core body temperature

A team led by scientists at The Scripps Research Institute have discovered a direct link between insulin — a hormone long associated with metabolism and metabolic disorders such as diabetes — and core body temperature. While much research has been conducted on insulin since its discovery in the 1920s, this is the first time the hormone has been connected to the fundamental process of temperature regulation…

The scientists found that when insulin was injected directly into a specific area of the brain in rodents, core body temperature rose, metabolism increased, and brown adipose (fat) tissue was activated to release heat. The research team also found that these effects were dose-dependent — up to a point, the more insulin, the more these metabolic measures rose.

“Scientists have known for many years that insulin is involved in glucose regulation in tissues outside the brain,” said neurobiologist Manuel Sanchez-Alavez… “The connection to temperature regulation in the brain is new.”

In addition to suggesting a fresh perspective on diseases such as diabetes that involve the disruption of insulin pathways, the study adds to our understanding of core body temperature — the temperature of those parts of the body containing vital organs, namely the trunk and the head. Normally, core body temperature stays within a narrow range so that key enzymatic reactions can occur. When core body temperature goes outside this range for prolonged periods — higher as in fever, or lower as in hypothermia — the result is harm to the body…

“Our paper highlights the possibility that differences in core temperature may play a role in obesity and may represent a therapeutic area in future drug design,” added Olivia Osborn.