It is not a lie if you think about real human behavior, rather than a theoretical rational automaton. There are real, documented cases of people who were prescribed insulin they could not afford, tried to ration it, and died as a direct result. Maybe their doctor told them not to use it, or they didn't live near a Walmart, or they didn't know it existed. Maybe they tried the Walmart stuff and almost died because it's so difficult to manage, so their doctor told them to switch back to the best treatment available. I promise they did not die to make a political point.

One in four patients in the US have rationed insulin because of the cost: https://news.yale.edu/2018/12/03/one-four-patients-say-theyv...

It is simply untrue to say the high cost only forces people to use the cheaper Walmart generic. That isn't what happens. They ration it, and sometimes they die.

Finally, it doesn't make sense to say that the high price is making diabetes harder to manage, but isn't killing people. That's like saying speeding doesn't kill, it just makes the car harder to manage.

Correction

> One in four patients say they’ve skimped on insulin because of high cost

> say they've

^ is the key component. I expect the vast majority of those people had a choice, and they chose not to take it. A poor choice, and a choice they shouldn't have to make, but a choice nonetheless.

The point is, if you're going to fight for positive change, use an argument that can't be trivially dismissed because it isn't true. Fight effectively.

Yes, why did they choose not to take it? Try to empathize with these people. Why did they do something so dangerous? Then follow it one step further. In the case of those that died, why did they die? What factors contributed to their death? If the price of insulin had been lower, and everything else was the same, would they have died?

I would argue these two statements are equivalent:

- My patient was killed by the high price of insulin.

- If the price of insulin had been lower, my patient would still be alive.

I suspect that you accept the second statement, but not the first. What's the difference?

They are two different, but related, things. There are people who die early because they eat extremely poorly; lots of fats and sugars.

1. If the fatty and sugary foods were too expensive for them to buy, they would not have died from those things.

2. They did not die because fatty/sugary foods weren't expensive. They died because they chose to eat fatty/sugary foods. [1]

Just because X (good insulin being cheaper) would have helped prevent Y (deaths) doesn't mean that <not X> caused Y.

[1] I'm ignoring the fact that truly healthy foods tend to outside the price range of the poorer segment. The analogy only really goes so far here.

Ok, I guess that's the core of our disagreement. I do believe that "X prevents Y" means "<not X> causes Y". Thanks for the discussion.

To me, it's the difference between "is a requirement for" and "is the cause of".

- People drive cars.

- Cars are car jacked.

- If people did not drive cars, carjackings could not happen.

- People driving cars is a requirement for carjackings.

- People driving cars is not a cause of carjackings.

I understand that it is possible and truthful to argue that people driving cars is a cause of carjackings; it's just not my view of the meaning of those words.

You're letting pedantry get in the way of the far more important point that making the medication more affordable would save lives.

By claiming that the companies are colluding and have raised the price, the charge is leveled that the companies are behaving immorally.

When people learn that the "old insulin" and "new insulin" are completely different products and that "old insulin" is still available at a low cost, the narrative and goodwill is shattered.

People hate being lied to and they hate being manipulated.

If you want to have a discussion that we should make the "new insulin" available for at low cost of for free, that is great! We can talk about the cost to manufacture and to develop drugs.

There are many smart people here and around the world, when we put our minds to a problem, we can find a solutions.

But by not acknowledging and downplaying the time and effort that companies and people have put into the "new insulin", then you are cheapening the work they have done and are signaling to everyone that you would do the same to their time and effort as well.

Saying that cheap insulin kills people seems like a hyperbolic, but essentially true statement.

It's well known that you need to keep all sorts of things under control with type 1 to avoid long-term health complications. Blood sugar is the most obvious.

I watched my father manage his for decades, starting in the 1980s. The technology improvements were interesting - his first insulin pump (about the size of a VHS tape), the custom software to data-dump his glucose meter, "supply-hacking" to keep the infusion sets affordable...

He still had management challenges despite being a dedicated, disciplined, marathon-running Mormon on the leading-edge of treatment. He was fortunate enough to be involved in the DCCT/EDIC trials at the University of Washington, and took the early lessons about future complications very seriously.

You make Diabetes harder to manage by removing modern improvements to the standard of care, and you are certainly going to see increases in deaths and severe negative outcomes.