00:00:00

SISTER PRODUCTIONS

CLOSE UP FILMS

BRAINWORKS

present

 

A co-production with

ARTE FRANCE

RTS - RADIO TELEVISION SUISSE

00 02 24

Toni Wolf

I was shocked to learn that I had diabetes. Suddenly I had to inject myself with insulin.

 

A film written by

Dorothée FRÉNOT

Benoît ROSSEL

Caroline COQ-CHODORCE

 

Karyn

Ever since i was diagnosed it has affected my life. I’m 29, there’s no foreseeable future for children for us because of the finances and because of my health.

 

Directed by

Dorothée FRÉNOT

Benoît ROSSEL

 

In collaboration with

Xavier SAYANOFF

 

Goika Rogic

We are currently estimating something over 400 million people with diabetes today in the world, it is anticipated that the burden of diabetes will continue to rise.

 

Bruce Lee

We like to describe this as a global catastrophy in slow motion, if you put together the productivity losses, the healthcare costs, the medical costs, it’s astronomical.

 

Dr. Philip James

We know that the pharmaceutical industries related to diabetes, make a lot of money. It’s a wonderful world, for the diabetes pharmaceutical companies.

 

Based on an investigation by

Dorothée FRÉNOT

 

In collaboration with

Caroline COQ-CHODORCE

 

With the participation of

Bertrand BURGALAT

 

Frédérique Georges-Pichot

It's the only disease for which everyone readily accepts that there will never be a cure. Why?

 

DIABETES

A Heavy Cost

 

Freely adapted from the book Diabétiquement Vôtre

by Bertrand Brurgalat

 

00 02 02

Bertrand Burgalat

I was born in 1963. In February 1975, I went to a concert. When I got home, I felt tired, and very weak. I spent the night drinking water and pissing. The following day, I did blood tests and was told I had type 1 diabetes.

 

00 02 24

Type 1 diabetes strikes without warning. 45 years ago, the pancreas of musician Bertrand Burgalat stopped working. It is an irreversible failure, for which medicine has yet to find any cure or explanation. This insidious disease brings with it a whole set of constraints that need be managed on a daily basis.

 

00 02 47

- You're testing yourself again?

- I recorded 0.81. As there's a latency period... I'm not thinking about the show, I'm wondering how I'll manage if I take on too much sugar. I'll feel exhausted. It's also silly not to have enough sugar.

- Keep something sweet on stage.

 

Bertrand Burgalat

Musician, author, composer

 

00 03 16

Bertrand Burgalat

In the broad scheme of inconveniences, for a type-1 diabetic, the injection is a relatively minor hassle. Some things have a much greater impact. Ten jabs a day to feel OK is fine. What's exhausting is constantly figuring out if you have too much sugar or insulin. Constantly thinking about all those constraints, trying to think ahead... The insulin you inject acts a lot more slowly than the insulin the pancreas produces. You need to anticipate those things. There's a whole lot of stuff every day that's much more of an inconvenience than the injections.

 

00 04 12

The body needs a small amount of sugar in the blood to function.

 

00 04 18

In everyday life, the slightest exertion requires energy... so the body draws on the reserves of sugar provided by the blood.

If the levels drop, the body suffers hypoglycemia.

 

00 04 37

Conversely, an accumulation of too much sugar can trigger hyperglycemia.

 

00 04 46

The pancreas - a vital organ - helps regulate sugar levels by secreting a hormone: insulin.

 

Type 1 diabetes occurs when the pancreas stops producing insulin and ceases to work properly.

 

00 05 07

Without insulin, sugar builds up in the blood, organs malfunction, and the body becomes poisoned. The patient falls into a coma, and will eventually die.

 

To avoid this fatal outcome, patients must inject synthetic insulin treatment several times a day to regulate sugar levels.

 

00 05 39

In the 1960s, with the advent of the consumer society, another kind of diabetes emerged, known as type 2 diabetes.

Lifestyles and diets were changing.

 

00 05 48

Graphic

Sugar State At rest Exertion

 

00 05 57

- Go on, take it.

- All right Mum!

 

00 06 00

People were consuming more fats and sugars, and exercisingless.

 

00 06 07

Graphic

Hypoglycemia

 

00 06 07

Overwhelmed by carbohydrates, the pancreas secretes too much insulin and eventually wears itself out.

 

00 06 15

Throughout the 20^th century, sugar invaded our diets. It is everywhere, in ready meals, sodas, not to mention the starchy foods we now consume in excess.

 

00 06 16

Graphic

Hyperglycemia

 

00 06 30

Graphic

Type 1 diabetes

 

00 06 31

Within just a few decades, the diabetes figures have exploded, with the number of diabetics worldwide rising from 50 to 430 million.

90% of these patients are type 2 diabetics.

 

00 06 51

Starting from the West - the United States and Europe - the disease has spread across the entire planet.

It is now becoming a problem in emerging countries.

 

Almost non-existent in China 30 years ago, diabetes now affects one in ten adults.

 

00 07 10

This chronic disease is also spreading to the African continent, where it is expected to increase by 150% by 2050.

 

Dusseldorf, Germany

 

Dr. Stefan Martin

Chief Diabetes Officer, VKKD Diabetes Center, Düsseldorf

 

Dr. Stefan Martin

00 07 38

Type 2 diabetes is a disease caused by society, by civilization. In the 1960s in Germany, less than 1% of the population was diabetic. Now the figure is between 9 and 11%.

 

00 08 01

The disease invades stealthily, unnoticed.

Then one day, the serious problems begin.

 

00 08 07

Dr. Stefan Martin,

Hello, Mr. Bussmann. We'll take a blood sample.

 

00 08 24

A high blood-sugar level can bring with it complications. Many diseases develop. Microvascular complications, for the eyes, kidneys, as well as the nerves. Microvascular complications concerning the arteries and heart. The risk of a heart attack in diabetics is as high as it is in non-diabetics. who have already suffered a cardiovascular episode.

 

00 09 04

One dreaded complication is diabetic foot syndrome. When the nervous system is failing, the feat lose sensitivity and can become injured without people realizing. The injury goes unnoticed and becomes infected, which can lead to amputation.

 

00 09 32

- Does that hurt?

- No.

 

00 09 40

As well as being one of the principal causes of amputation in Europe and the United States, diabetes can cause kidney damage and is the underlying reason behind the majority of dialysis treatments and transplants.

 

00 09 57

- Is Herr Forsten here?

- Yes.

- Come in, then.

 

00 10 05                

Faced with the explosion of type 2 diabetes, the pharmaceutical industry stepped up...

 

SANOFI campaign

 

00 10 10

TV Commercial

Science allows man to push back his boundaries... Today, a diabetic like me, thanks to Accu-Chek Mobile, the all-in-one glycemia meter... can... live a normal life!

 

00 10 22

In the 1980s, a wide range of treatments came onto the market, with advertising campaigns that promised a happy and carefree life.

 

00 10 38

Patients were prescribed a whole range of tablets in an attempt to lower blood sugar levels, with medications known as oral anti-diabetics.

00 10 54

In theory the drugs help keep diabetes under control. But they are not a cure, rather an increasingly costly lifelong treatment.

 

00 11 04

Faced with this prohibitively expensive health tsunami, the international community sounded the alarm.

Diabetes is expensive. Too expensive... costing $760 billion a year globally.

 

Gojka Roglic

Head of Diabetes Management, WHO

 

00 11 20

Gojka Roglik

There is a UN declaration of diabetes in 2006 because of its potential to cripple any healthcare system, because of its costs, and to actually... the potential to affect the productivity of the country with the number of people with diabetes that need treatment but that are also invalids because of diabetes and unable to work because of their diabetic complications.

They have committed to have national plans for controlling non-communicable diseases, they're committed to have national guidelines, to have an all sector approach to policies to control the rise of diabetes

It is the only other condition apart from HIV Aids that has a UN declaration.

 

00 12 20

Despite this symbolic vote, the epidemic is not subsiding.

More and more voices are speaking out against the inadequate response, which has an equal impact on both types of diabetics.

Bertrand Burgalat is among those who reject the current situation.

 

00 12 40

TV host

Our next guest is a dandy, producer, musician and singer.

Bertrand Burgalat's book, Diabétiquement vôtre, is published by Calmann-Lévy. The book describes the relationship between patients, doctors, pharmaceutical labs and of course the state. You call it an "economic war".

 

00 13 00

Bertrand Burgalat

You're summed it up very well.

 

00 13 05

In 2017 he helped set up an association for diabetics to try to shift the lines.

 

"Diabète et Méchant" Association meeting

 

00 13 11

Bertrand Burgalat

I'm pleased, I wanted the book to produce dialogue and open a debate. There were emails and exchanges, an eagerness to do something. There was a need for expression. We often hear from communications agencies, "My insulin pump is such a joy!" stuff like that. It means diabetics rarely get a chance to express themselves.

 

00 13 36

Female activist

We hear a lot about AIDS, which is fine, but never about diabetes. We could be the Act Up-Paris of diabetes. For me, the message targets four groups: diabetics, to help them, their family and friends, to educate, doctors, to change attitudes, and manufacturers, who we haven't mentioned yet. There's the issue of treatment costs. Some people make a lot of money out of these diseases, both type 1, and especially type 2.

 

00 14 14

Bertrand Burgalat

So I think it's important to have checks and balances and for us to try to act, not only as corporate victims but by going further and having a wider debate on the issues in society that shape diabetes. I set out wanting to say that diabetes costs too much, costs health services too much, and is too high a cost on human lives. For me, it's important to remember that.

 

00 14 48

How did it come to this?

 

00 14 53

The history of diabetes treatments started so well.

 

00 15 01

In 1921, two Canadian researchers named Best and Banting discovered insulin and successfully produced it.

It was a revolutionary development that saved thousands of lives. The impact on young children whose days were numbered was dramatic.

 

00 15 30

After making their discovery, the two Canadian researchers sold their patent for the symbolic sum of one dollar to the American laboratory Lilly.

They began to produce insulin on an industrial scale.

 

00 15 41

Bertrand Burgalat

They sold the patent for a dollar each to save human lives, so insulin could be made all over the world to save all the dying kids made to suffer, starved to extend their lives by a few months. They agreed in order to save lives but all the subsequent advances were patented by pharmaceutical labs. So the brilliant invention of insulin was completely led astray.

 

00 16 09

Mrs. Smith

Could you tell me anything about insulin ? What it is and how is it made?

 

Doctor

Well it's not made exactly, it comes from animal pancreas; the plant works day and night to supply the demand for insulin and uses many tons of pancreas each week. Most of the pancreas comes from abroad and arrives at the factory deep frozen, it is reduced to a paste and mixed with alcohol, which dissolves the insulin. Then follows a long and complex series of processes which gradually remove all the impurities.

 

00 16 40

Over the decades, production techniques have improved. Only three pharmaceutical laboratories remain in the race for new patents:

Lilly in the USA; Novo Nordisk in Denmark, and Sanofi in France.

 

00 16 58

After animal insulin, the laboratories began to produce human insulin hormone using by genetic engineering. The first leap in prices duly followed. Depending on the country, the increase was anything between threefold and tenfold.

 

00 17 14

TV report, male presenter

This new genetically engineered insulin has two distinct advantages: it shouldn't give the side effects that can come with the present form and it shouldn’t begin to run short as the present type will in just twenty years from now.

 

00 17 21

Graphic

Animal insulin

Human Insulin

Price of insulin

 

Mads Krogsgaard Thomsen

Executive Vice-President, Novo Nordisk

 

00 17 30

Mads Krogsgaard Thomsen

It became possible to take the human insulin gene simply cut out of the chromosome of humans, put the gene into a micro mechanism, we use yeast like baker's yeast or beer yeast or little eggs and we put the gene in there and then the yeast starts making insulin.

So that is called ‘gene engineered insulin’ and that means we can deliver insulin to the whole world because we have no capacity problem. If we need to, we just build a new factory.

 

00 18 01

In 2000, French laboratory Sanofi announced that it had developed a new, revolutionary insulin tat was even more effective...

 

00 18 14

Lantus.

 

00 18 20

This is an analogue insulin: the gene has been altered to ensure slower diffusion in the body.

According to the laboratory, this innovation justified a further price hike.

At the time, in France, a vial of Lantus was sold for 46 euros, compared to 18 euros for standard human insulin.

 

00 18 44

According to the laboratory, this technology reduced the number of daily injections, with only one required every 24 hours. It also prevented attacks of hypoglycemia in the middle of the night.

A major step forward, according to Pierre Chancel, the man who orchestrated its launch.

 

00 18 54

Graphic

Animal insulin

Human Insulin

Analogue insulin

Price of insulin

Pierre Chancel

Senior Vice-President, Global Diabetes, Sanofi

 

00 19 04

Pierre Chancel

As an insulin solution, Lantus, was a real revolution. It changed the lives of diabetic patients. Especially type I diabetics who took their last injection at 10pm, for example, and those who had to set the alarm for 5am for another injection. There was always the threat of hypoglycemia striking in the night with fatal consequences.

 

00 19 28

Bertrand Burgalat

The marketing was brilliant, convincing people it was much slower than the others, which it wasn't. 24-hour insulin has been around for ages. Slow insulin existed in 1975, when I only did one jab a day. They convinced people that their insulin lasted for 24 hours, which was not true.

Many diabetics on Lantus need two jabs a day of this slow insulin, which is meant to take their metabolism into account. It isn't at all regular. But that was their argument in the early 2000s to justify selling it at twice the price of the rival product. It's a scandal!

 

00 20 15

With this new insulin, Sanofi was moving on from type 1 diabetics. It now targeted type 2 diabetics, for whom insulin shots are only prescribed when other oral treatments have failed.

 

00 20 30

Pierre Chancel

For type 2 patients who moved on to insulin, it was the last stage. They were already on death row. They describe it well, they had a fear of insulin. The fact of de-demonizing insulin with a simpler, easier-to-handle approach so as to use it earlier was able to change practices in terms of treatment, notably the use of insulin.

 

00 21 08

- The dosage is set here, I think it's 4. I think you turn it to 4. The figures are here... I need lessons!

- I'll show you what to do, we'll go through it together.

- Yes, please. It scares me a little.

- See you later.

- Thanks, see you later.

 

00 21 33

Pierre Chancel

Insulin was something that was for the exclusive use of endocrinologists and diabetologists. The challenge was to get family doctors involved so they could use this simpler tool. We also set up training workshops, major training programs on the use of insulin by family doctors. We extended it to the USA, Europe, France, Germany... Everywhere.

 

00 22 05

- Just do what you usually do. Just like giving yourself a jab only you use that... Always make sure, even if the needle is new and changed each time, to always set it at two. Push upwards, see if it comes out, to make sure you're getting the right dose.

 

Dr. Stefan Martin

Chief Diabetes Officer, VKKD Diabetes Center, Düsseldorf

 

00 22 34

Dr. Stefan Martin

When Lantus came onto the market, it was promoted among family doctors. They quickly turned to this therapy of prescribing a lot of insulin at an early stage. Patients were told that they didn't need to change their lifestyle as long as they injected enough insulin.

 

00 23 01

It wasn't only doctors that Sanofi was targeting. Patients, too, had to be won over. The laboratory sought to simplify their lives.

 

00 23 10

Nurse

Mr. Alan, are we doing a glycemia test?

 

00 23 20

Blood tests can be used to measure glycemia, the level of sugar in the blood. But the results produced are complex and indecipherable.

So the laboratory introduced a clear and easy-to-use marker.

 

00 23 39

Glycated hemoglobin, otherwise known as HBA1C.

 

00 23 58

To that end, Sanofi launched prevention campaigns aimed at the general public.

The message was a simple and easy to remember.

If your glycated hemoglobin level is below 7, you are fine. Beyond that, complications can arise.

It was a great marketing idea.

 

00 24 16

Pierre Chancel

The marker existed but it wasn't the most widely used. Sanofi was instrumental at these consensus conferences, where the world's leading specialists are gathered around a table so that international experts can develop a diagnostic tool and process for diabetes and its treatment. So alongside health professionals, we developed campaigns saying that life was "better under 7" so that people identified with this idea of 7.

 

00 24 36

Graphic

Glycated hemoglobin

 

00 24 39

Graphic

Glycated hemoglobin

HBA1C

 

00 25 03

Dr. Stephan Jacob

HBA1C shows us the average metabolic control over the past three months. We know that 7% is a high level of HBA1C, hence the notion of "better health below 7". We want sugar levels to be below 7% of glycated hemoglobin because we know it's a way to avoid complications, notably in the vascular and nervous systems.

 

00 25 35

Pierre Chancel

So within three years, Sanofi was able to increase fivefold the number of doctors who could allow their patients to benefit from Lantus. Meaning that in total, the number of patients on insulin who hadn't been taking it before had doubled in four years.

 

00 26 02

Within a few years, Lantus insulin became a blockbuster in the pharmaceutical industry. At the height of its glory, in 2015, just before its patent fell into the public domain, it accounted for almost 20% of Sanofi's turnover, or more than 6 billion euros.

 

Berlin, Germany

 

00 26 46

But amid this triumphal march, a dissenting voice was sounded by a doctor in Germany.

 

00 26 58

At the time he was director of the IQWIG, the Institute for Quality and Efficiency in Health Care.

 

Peter Sawicki

Former director of IQWIG

 

00 27 09

Peter Sawicki

In 2004, the Federal Committee, the highest authority in Germany, commissioned my institute, the IQWIG, to asses this insulin, Lantus. for any benefits over previous types of insulin and see whether the higher cost was justified. This was a great expense for the health service. We wanted to know whether these additional costs - which are ultimately not borne by the health service but by the population - were justified. The result was that three was no difference between the two insulins. The Lantus was not better.

 

00 27 57

From a medical standpoint, the insulin was no more effective than any other.

The manufacturer rejected the conclusions.

 

00 28 04

Pierre Chancel

I'm explaining it badly... If you offer a patient taking insulin to abandon their analogue insulin and go back to the old insulin, telling them not to worry, medical benefits are not compromised, you won't find many takers.

Journalist

You don't think the results were justified?

 

Pierre Chancel

Well, I think it's rather strange.

 

00 28 35

According to the German authorities, the studies provided by Sanofi when licensing the drug were not carried out correctly; the laboratory had used lower doses of traditional insulins to give its own version an advantage.

 

00 28 50

Peter Sawicki

Human insulin, also called NPH insulin, should be injected twice daily, at morning and bedtime. The Sanofi studies were done in such a way that the human insulin was injected only once, at bedtime, so it acted in a deceptive way artificially triggering more bouts of nocturnal hypoglycemia. The pharmaceutical lab presented this as an advantage, but it isn't. The study is deeply flawed.

 

Ursel Sieber

RBB Journalist, Berlin

 

00 29 26

Ursel Sieber

At the time, there was a campaign against him. The manufacturer rejected the claims, saying everything had been twisted, that he was an enemy of industry. Patients associations as well, which are partly influenced by the pharmaceutical industry. So there was a pretty bad atmosphere against the Institute and against Peter Sawicki, as if he wanted to deprive patients of new medications and do whatever it takes to save money for the state health service. But that wasn't the case at all. This was public money, which is not limitless. It has to be used well. For him, it was about good medical practice. The manufacturer didn't like that.

 

00 30 31

Peter Sawicki

The director of Sanofi in Germany invited me to visit their site in Frankfurt, to discuss the results of our study. So I gladly accepted. They started off by showing me the housing where their workers lived, and all the families whose very existence was under threat. Many of the staff might lose their jobs if the assessment was not corrected by our institute.

 

Journalist

They put pressure on you?

 

Peter Sawicki

They tried to. Obviously I don't want anyone to lose their job but we need a system to assess medications that is independent. And not just for insulin. But we didn't have one, no European country has.

 

00 31 26

The German authorities' decision was final - for patients with type 2 diabetes, contributions to the cost of Lantus treatment would be restricted to the price of human insulins.

 

00 31 39

Despite this controversy around Sanofi's drug, sales have not fallen. Once established, prescription habits are hard to shake.

 

00 31 49

Other states - including France - have contested the superiority of Lantus. To no avail. The French manufacturer's flagship product remains the world's best-selling insulin.

 

00 32 07

In 2015, two of Sanofi's rivals: Novo Nordisk and Lilly, began to offer slow analogue insulins, making increasingly bold claims to justify the high prices.

 

John Yudkin

Emeritus Professor of Medicine, University College, London

 

00 32 19

Pr. John Yudkin,

Analog insulins are a big market. New analogs insulins had to be shown to be better as the old analogs. that was like Iphone 6 and the Iphone 5. It might have a better shape, a better camera, but to all intents and purposes it’s not much different. It’s a marketing employ just like Steve Jobs standing with the new Iphone.

 

Geneva, Switzerland

 

00 32 58

To justify price increases, the pharma companies highlight the high manufacturing costs of analogue insulin compared to older versions of "human insulin".

 

00 33 14

But this argument has recently been challenged at the University of Geneva. A team of researchers examined why one in two diabetics did not have access to insulin in the world.

 

Dr. David Beran

Medical Researcher, Geneva University Hospitals, Switzerland

 

00 33 27

Dr. David Beran

We were told that analogue insulin is much harder to produce than human and we wanted to know a little more about the cost of manufacture. So we got together with some colleagues to determine manufacturing costs by looking at each section of the production line.

 

We took the cost of all the raw materials required to make a bottle of insulin, then added the regulatory costs, which are significant. Regulatory costs are the expense of licensing a product. Clinical trials are required, to demonstrate the drug's qualities. We also included a profit for the manufacturer. Then there are the investment costs required for infrastructures. The manufacturing cost for human insulin is between $2.5 and $3.5 a bottle. For most analogue insulins, we're in the same order of magnitude.

 

00 34 13

Graphic

Raw materials

Cost of insulin

 

00 34 29

Dr. David Beran

Looking at the selling price in France, a bottle of human insulin costs around 13, whereas for an analogue insulin such as Lantus the price is almost double: 25 a bottle. There are three conclusions. First, the end price for the patient or for the health system is not justified by manufacturing costs. Second, the difference in manufacturing costs between human and analogue insulin does not justify the end price difference. Third, the profits for the pharmaceutical industry on these insulins is enormous.

 

00 34 33

Graphic

Clinical trials

Raw materials

Cost of insulin

 

00 34 37

Graphic

Manufacturer's mark-up

Clinical trials

Raw materials

Cost of insulin

 

00 34 44

Graphic

Infrastructure

Manufacturer's mark-up

Clinical trials

Raw materials

Cost of insulin

 

00 34 46

Graphic

Human - Analogue

Cost of insulin

 

00 35 17

In this race for profit, the three laboratories monopolize 99% of the market. This oligopoly leaves no room for competition.

Other manufacturers in China, India and Russia, produce cheaper insulins, but fail to break into the Western market.

 

00 35 36

Dr. David Beran

The problem for small companies is the regulatory component. Entering the market in Europe or the USA where regulations are strict is costly. An investment is required and many companies don't have the resources. to enter these markets. Then there's the existing marketing machine. Once on the market, the product has to win over the prescribers - doctors - as well as users, who don't trust products made in India or China.

 

Indianapolis, USA

 

00 36 28

In the United States, this oligopoly has resulted in an ubiquitous and tragic situation.

In ten years, the price of insulin has increased tenfold. While 10% of the population is diabetic, some patients can no longer afford this vital hormone.

 

00 36 48

Not even if they purchase outlandishly expensive private health insurance.

 

Karyn Wofford

Type 1 diabetes

 

00 36 55

Karyn Wofford

I pay $260 premium a month. That’s just to have the right to say that I have insurance and my deductible is $14,000, which means I would have to pay for my insulin and for my doctors visits and my other medical supplies out of pocket until I have reached that 14000 Dollar mark before they’ll help pay for my insulin. Not many people can afford to pay an extra $14,000 out of their income every year it’s almost impossible for my husband and I.

 

00 37 40

Right now, my insulin comes from my doctor and it comes from my friends, my mom has friends that are maybe also like type 2 diabetic and they have an excess of insulin that they don’t use so they have been kind enough to give that insulin to me. And my doctor when he has patients that pass away which has unfortunately happened recently, he gave me over a year's supply of insulin so thankfully I won't be paying that money now because it would have been catastrophic for me if I would have had to pay the money for insulin every month

 

00 38 21

Female interviewer

 And what happens when you cannot manage to get free insulin ?

 

00 38 26

Karen

I really don’t know. I really, really... That’s a thing that I’ve been fortunate not to have to experience that yet but it does sit in the back of my mind

 

00 38 42

Elizabeth Rowley

This is way better than hiking, from down here, right?

 

Elizabeth Rowley

Type 1 diabetes and President of "T1International" NGO

 

00 38 47

Elizabeth Rowley

My name is Elizabeth, and I’m the founder of T1 international. We're a diabetes advocacy organization that takes no funding from pharmaceutical companies. And we’re advocating for everybody with Type 1 diabetes specifically access to the thing that we need to survive.

This company right behind me has raised the price of their insulin over 1000%. And we believe that access to insulin is a human right, this is a global problem, people are dying in every corner of the world, people are dying here, in the United States of America, what’s supposed to be the wealthiest country in the world, with supposedly the best healthcare system in the world. This is not the way that it should be. This company is putting profits over people, and we’re here to say that it is not okay and something needs to be done about that.

 

00 39 44

(chanting)

- Medicines for people!

- Not for Profit!

 

Elizabeth

One more time.

- Medicines for people!

- Not for Profit!

 

00 39 52

Elizabeth Rowley

It truly is a crisis. People are rationing their insulin, so they are taking less than they should take or trying to not take any. They are trying to adjust their diet and their insulin intake and this is so, so dangerous. People are dying because of that and they are cutting years off their life because they just simply can’t afford it.

 

00 40 16

Karvn

My husband and I don’t, in our future we won’t be able to buy a home we can’t afford that right now. We won't be able to have children. That’s an expense that we wouldn't be able to afford. So I would say the biggest things we have sacrificed is just the traditional family life. That’s something that we’re not sure if we’ll ever get to experience. We’ve lived a very untraditional married life for 8 years. Although am very... I’ve loved our time together. It’s been very hard. We’ve had a lot of challenges we don't get to experience the things people at our age are getting to experience and the hardest thing for me is children so...

 

00 41 00

Elizabeth Rowley

The next step here is to deliver some of these insulin vials that we have created. So this is a vial of Humalog with label taken off and a message inside. What we’ve done is we’ve said these are the things that we sacrifice for the cost of insulin. Nicole has brought some of Alec ashes, that are in one of these vials to show the sacrifice, the ultimate sacrifice that they made because he couldn't afford the insulin.

 

00 41 36

Nicole  (Alec's mother)

Alec was facing a cost of $1300 a month, for insulin and diabetic supplies. Alec worked full time as a restaurant manager for a small family owned company who did not provide health insurance for his employees. Alec made decent money and because of this he did not qualify for assistance of any kind. Not from the insulin makers, not from the State and not from the federal government. Without anyone knowing Alec began to ration his remaining insulin, because at the time he went to the pharmacy, he did not have enough in his bank account to spend the $1300 required. Alec began to adjust his diet, take less insulin than his body required to make it to payday. Alec’s body was found three days prior to payday. Alec died from diabetic ketoacidosis due to a lack of insulin in his body.

 

00 42 33

Female interviewer

Who do you blame for these insulin price hikes?

 

00 42 36

Bernie Sanders

in the last 25 years, the pharmaceutical industry, major companies have been fined some 35 billion dollars for collusion, for fraud and for other legal behaviour. What we are seeing right now in terms of insulin, is the prices are skyrocketing, and just coincidentally it happens that the three major suppliers of insulin seem to be raising their prices at the same exact time, at the same level. So i think you have to be very nave not to believe there is no collusion.

 

00 43 09

Female interviewer

The drug companies have said that there are various reasons for the price increases. That there are changes in their drugs, that the drugs are better, that they have enhanced them, and that patterns changed, I take it from the look on your face that you’re not buying it.

 

00 43 24

Bernie Sanders

No, the drug companies, the five major drug companies last year made 50 billion dollars in profit. There are over a 1000 lobbyist in Washington here, they provide 100 millions of dollars in campaign contributions. Their job and what they do is charge the highest price they possibly can and it’s the highest prices in the world. Their business model is greed, their policies are literally killing people who cannot afford the medicine that is needed. We need major reform in the pharmaceutical industry.

 

00 43 59

Are manufacturers in the United States guilty of forming illegal cartels to inflate insulin prices?

In early 2019, the US Congress asked laboratories to justify these sharp price increases. The three main pharmaceutical laboratories blamed the American health system, and its many intermediaries.

 

00 44 22

Congressional hearings

Chairwoman

Today the sub committee on oversight investigations is holding a hearing entitled quote: “Price stat of a live saving drug, getting answers on the rising cost of insulin.”

 

00 44 32

Raul Ruiz

So Mister Mason from Ely Lilly, who’s making a profit from this increase in insulin prices

 

00 44 39

Michael Mason

I think... First of all we don t want anyone not be able to afford their insulin...

 

Raul Ruiz

Who’s making a profit with these increases in insulin prices that the patients have to pay for?

 

Michael Mason

Our net prices are the price we receive, are going down...

 

Raul Ruiz

Are you making a profit? Or the CEO of your companies making these

profits?

 

Michael Mason

Our net prices, the prices we receive are going down since 2009

 

Raul Ruiz

Well somebody is making a profit, somebody is getting richer on the back of the patients. Mr Langa from Novo Nordisk, what entity in this supply chain is prioritizing affordability and access of insulin for patients?

 

00 45 15

Mr. Langa

We like to think we participate as many formula as we can and that is critically most important, we have patients assistance program, as well as a co-pay system program...

 

Raul Ruiz

So who's making a profit then?

 

Mr. Langa

Our nets are going down as well but there’s a small profit... (Cut)

 

Raul Ruiz

Your nets... but your overall profits, for the company and CEOs have been going up, haven't they?

 

Mr. Langa

No our profits...

 

Raul Ruiz

Take-home pay, for your CEOs?

 

Mr. Langa

Our profits have been relatively stable

 

Raul Ruiz

Your CEO’s pay has not gone up in the past several years?

 

Mr Langa

His pay has increased, yes

 

Raul Ruiz

OK.

 

00 45 52

Following the hearings, the three pharma giants undertook to reduce prices for the poorest section of the population in a measure in what was something of a public relations exercise.

 

Unlike in European countries, Americans do not enjoy generous public support for health care costs. For the majority of them, insulin is still a luxury product.

 

00 46 21

The price of this synthetic hormone is only one of the problems associated with treatment of the disease. Another factor can have a serious - or even fatal - impact.

 

00 46 38

The fact is that the increasing number of medications taken by many type 2 diabetics to keep their sugar levels below the recommended 7% ceiling touted by the pharma companies is actually putting their lives at risk.

 

Wilfried Stränger

Type 2 diabetes, in remission

 

00 46 50

Wilfried Stränger

I learnt about my condition from my family doctor, near here. He gave me my annual checkup and said: Your sugar levels, your HBA1C, is much too high. You will have to take medication. So that's how I lived for several years. But after a while, the sugar level began to rise, as high as 11%. That was the peak. My weight had gone up too, as high as 114-115 kilos. It was always medication, more and more medication. I took insulin for around 7 years. Then there were the early symptoms, whereby I noticed I had the shakes in my body and circulation problems. Then I measured my glycemia and realized it was under 60. The glycemia meter was flashing red, saying the level could no longer be measured. It was below 60. Then in late August, I almost slipped into a coma.

 

00 48 21

A severe bout of hypoglycemia that almost cost him his life. It was a consequence of the obsession to bring his sugar level below the famous 7%.

 

00 48 33

A study published in 2008 shook the certainties of diabetologists.

It showed that the greater the efforts to lower blood sugar levels using drugs, the higher the risk to patients.

Use of treatments to reduce HBA1C increases the risk of hypoglycemia and cardiovascular disease.

 

00 48 57

Dr. Stefan Martin

The people in the study were treated with lots of medications: up to five. The study showed us that it was probably the wrong approach. Intensive decreases in glycemia could reduce complications in the nerves and eyes but what we really wanted was to reduce the risk of heart attacks and strokes. But that didn't happen. That's why the correct approach is not to focus on the study of blood sugar levels, rather on the study of diabetes. You need an overall picture of the cardio-metabolic syndrome, with all the risk factors, and that's how we succeeded.

 

00 49 31

Graphic

Sugar

 

Pr. Vincent Renard

President of CNGE (Collège National des Généralistes Enseignants)

 

00 49 42

Pr. Vincent Renard

Hyperglycemia is toxic. The evidence is incontestable. The more sugar you have in your blood, the greater the vascular toxicity. But it does not follow that if you have hyperglycemia, lowering the level will reduce the risk.

 

00 50 05

If you have a risk marker - the higher it is, the greater the risk - a linear or automatic reduction does not necessarily reduce risk. Major studies have shown that striving too hard to lower glycemia increases risk

 

00 50 24

So paradoxically it has been shown that if you use intensive treatments to reduce glycemia by too much to reach a figure as close possible to that of a non-diabetic, you might think you're as well as a non-diabetic person. Actually, you're worse off than if you had left the glycemia high. Not only do patients have more complications than non-diabetics, they have more than people with higher blood sugar. They end up in hospital with serious hypoglycemia. It's iatrogenic, due to medication, and can be severe. Mortality has been increased.

 

Peter Sawicki

Former director of IQWIG

 

00 51 06

Peter Sawicki

Among diabetes sufferers, most suffer from type 2 diabetes. It's worth a great deal of money. The pharmaceutical companies and professors paid by manufacturers want patients' blood sugar levels to be as low as possible, so they prescribe more medications, insulin as well as other drugs.

 

00 51 37

The fear that doctors, manufacturers and some professors instill in patients with high blood sugar - especially elderly patients - is ethically very questionable. In theory, it is a doctor's duty not to scare patients into taking a medication. But drug manufacturers exploit that and I think it is morally reprehensible.

 

00 52 14

This obsession with blood sugar led to a huge health scandal in 2007. The case concerned Avandia, the best-selling anti-diabetic treatment in the world at the time.

It all started in the United States...

 

00 52 30

Female TV presenter

A study in the journal of the American medical association Monday links GlaxoSmithKline Avandia diabetes drug to heart risk.

 

00 52 40

Male TV presenter

They are new questions this morning about the safety of GlaxoSmithKline diabetes drug Avandia.

 

00 52 44

Woman announcer

If you or someone you know have had a heart attack, stroke or even died while taking A vandia, call attorney Jim Adler right now.

 

00 52 52

Jim Adler

I’m Jim Adler, the tough, smart lawyer. If you or your loved ones have taken this drug, call me right now.

 

00 52 58

The scandal broke thanks to Professor Steve Nissen, a cardiologist in Cleveland.

 

00 53 03

Female TV presenter

The bottom line: should Avandia be pulled?

 

Pr. Steve Nissen

Cardiologist, Cleveland Clinic, USA

 

 

00 53 06

Steve Nissen

I think it’s time. We have twelve classes of drugs to treat diabetes, we have another drug that’s exactly the same class as Avandia...

 

00 53 20

Steve Nissen

I was searching for more information about the drug and I found this website where GlaxoSmithKline had disclosed all of the information. We found 42 clinical trials, 35 of which were unpublished

 

00 53 43

What we had found was about a 40% increase in both myocardial infarction - that’s heart attacks - and a slightly smaller increase in the risk of death, cardiovascular death.

But it was enough to make us believe that there was a high likelihood that this drug, the number one selling diabetes drug in the world, was causing people to have heart attacks and possibly prematurely dying.

 

00 54 22

Female TV presenter

Avandia is a commonly prescribed diabetes drug that according to the study increases the risk of heart diseases, stroke and death.

 

00 54 30

Steve Nissen

About 80,000 people had heart attacks unnecessarily because of Avandia.

And so I realized that there was extreme urgency in getting that information out because people's lives were at stake.

 

00 54 50

So the Senate Finance Committee, they did a thorough investigation of the entire affair. They, by subpoena, obtained the internal emails within GlaxoSmithKline that revealed that they knew exactly what was happening. And they did not tell physicians, they did not tell patients. They simply put the information in a file drawer and told no one. That was truly shocking.

 

00 55 31

How could the side-effects of this leading anti-diabetic treatment have slipped through every drug evaluation system in Europe and the United States?

 

00 55 40

A former official at the American public health watchdog, the Food and Drug Administration, is one of the few to speak out against the lack of transparency.

 

Thomas Marciniak

Former Food and Drug Administration inspector

 

00 55 52

Thomas Marciniak

The majority of drug trials are handled by the companies themselves.

What we get, or what the FDA gets, I should say now, I'm no longer there, is you get a submission from the company. They're statisticians and their lawyers have gone over every word of that submission, every number in it. The record was fairly typical. They paid for the entire trial

 

Typically in a clinical trial at the sites where the patients are seen, detailed information is collected on the patients. For example, there were specific case report forms to report if the patient had a suspected heart attack. Interestingly enough, GSK in the initial submission to the FDA didn't even send those in, which, I think it's well, it's completely unacceptable.

 

There is an obligation, but if they don't send them in and the accepting division does not call them on that. There's no policeman to enforce that.

 

 

00 57 04

Avandia prescriptions have since been restricted in the United States.

Europe has gone even further, banning the drug completely.

This scandal has above all highlighted a problem specific to anti-diabetic treatments.

The health authorities focus on a single criterion when licensing medications: a lowering of blood-sugar levels.

 

00 57 28

Steve Nissen

The standards for approval of diabetes drugs in that era required very limited amount of data. All you had to show is that you lowered blood sugar. But it doesn't necessarily mean that the drug doesn't have an adverse reactions in another organ system.

And so to ignore that and to be completely glucose centric was irrational.

 

Pr. Rémy Boussageon

Professor in General Medicine, Lyon1 University

 

00 57 58

Pr. Rémy Boussageon

These drugs were not correctly assessed. Naturally that is worrying. Shocking, even. Other drugs, other health issues, have to be properly assessed. Not type 2 diabetes though. The standard now is a randomized, double-blind clinical trial. It's an experimental study whereby you take two groups of patients. To one you give the medication you wish to assess, to the other, you give a placebo. Not for type 2 diabetes, though. That's what is so stupefying. Why aren't the drugs correctly assessed? It seems to be linked to the fact that today's experts think that as long as a medication reduces glycemia, it must be beneficial. That's all the proof they need to be convinced that the drug should be prescribed. Effectiveness against glycemia suffices. They think that makes it beneficial.

 

Copenhagen, Denmark

 

00 59 14

With an increasing awareness of glucose-centrism, the health authorities toughened their demands.

To get a new drug approved, pharmaceutical companies must now be able to show that their medication does not have a marked negative impact on cardiovascular risk.

 

00 59 33

Fortunately, the pharmaceutical industry has developed a new family of compounds that seems to meet these requirements: GLP1, a hormone that stimulates the body's natural secretion of insulin.

 

00 59 46

Mads Krogsgaard Thomsen

If you are someone overweight and you start eating and having a healthier life and you take this medicine you will be very dose and it has proven this in the studies so having a normal blood sugar level and a risk of heart disease that is going down and a weight lose.

GLP1 it is not only maybe the director of the diabetes orchestra it maybe be a director of several orchestras in the body and we are trying to investigate in all of this because I really think GLP1 is the biggest breakthrough diabetes since insulin back in 1922.

 

01 00 25

Novo Nordisk has developed its own GLP1: liraglutide.

This new compound has quickly won over many diabetes experts, who are working hard to convince doctors to adopt it.

 

01 00 43

Male announcer

It is our great pleasure to welcome you to this 44th SFD congress.

 

01 00 48

Each year, the Francophone Society for Diabetology assembles a range of recognized experts in diabetes, who gather to present their latest recommendations for treating the disease.

 

01 00 52

Graphic

Randomized clinical trials

Double blind

 

01 01 00

For pharmaceutical laboratories, events like these conferences are unmissable.

At the 2018 gathering, Novo Nordisk organized a "lunch debate".

 

01 01 08

Bernard Charbonnel

Thank you, Freddy. Thank you, Novo Nordisk.

 

01 01 11

On stage is Bernard Charbonnel, a pillar of the Francophone Society of Diabetes.

He is presenting his findings on liraglutide to an audience of physicians.

 

Pr. Bernard Charbonnel

Doctor in Endocrinology and Metabolism, University of Nantes

 

01 01 20

Bernard Charbonnel

In 2018, liraglutide is the only medication in this category available in France. That's why I must conclude that liraglutide is the antidiabetic to prevent secondary cardiovascular complications. Thank you very much.

 

01 01 41

Bernard Charbonnel

Right now, in 2020, there are two new classes of therapy. There's GLP1, which is injected. Injections taken weekly, not daily. It is very powerful in reducing glycemia and makes patients lose weight. It does not cause hypoglycemia, plus it offers cardiovascular benefits: preventing strokes, myocardial infarction and cardiovascular death. These therapeutic classes represent major progress.

 

01 02 14

To what extent can we trust the words of Professor Bernard Charbonnel when he lauds the merits of liraglutide? This diabetologist, recognized by his peers, readily acknowledges his links with manufacturers. According to his public statements, in the last 8 years he has received nearly 480,000 euros from pharmaceutical companies like Novo Nordisk.

 

01 02 39

Bernard Charbonnel

I do not believe that serious discussion on progress in diabetology should be constantly polluted with the suggestion that the mere act of taking apart in a study - which is the only way scientific progress can be made - immediately undermines the legitimacy of your opinion. If people think certain recommendations are biased, and say so, explaining why... I hope I can influence people not in a personal capacity but on behalf of the SFD, which reflects a consensual opinion of the best French experts.

 

01 03 28

This consensus is not, however, unanimous. According to the HAS, France's national health authority, GLP1 only provides a minor benefit compared to other treatments. The drug should be given only to patients who respond poorly to other medications.

 

01 03 47

According to medical insurers, prescribing older, less expensive treatments would save 6 million euros a year.

 

01 03 56

Bernard Charbonnel

I would never presume to argue - that would be ridiculous - with the HAS, the French health authority. What can be said is that the recommendation in question, which in effect advises against the use of GLP1, dates back to 2013. So it is obviously the case that the recommendation is obsolete. We are impatiently awaiting new recommendations from the HAS, based on recent science. That's down to the French administrative bodies. Science-wise, the regulation is obsolete.

 

Dr. Pierre Gabach

Head of Good Professional Practices Department

Haute Autorité de Santé, France

 

01 04 40

Dr. Pierre Gabach

We should not rush into making a recommendation as soon as a new compound reaches the market. Recommending a treatment that affects 4 million people in France is a real issue. There is disagreement about what is the best way to treat diabetes, between the English, Germans and French, between the national cardiology and diabetology associations, despite some members being part of both bodies. So it's a complex issue and we should not rush into making recommendations. A great deal of literature is available, which needs to be analyzed for contradictions. One study might say one thing but we need others to confirm or contradict its conclusions. So we wait till we have enough literature to allow a critical analysis.

 

01 05 34

There is another reason why the French health authorities are so cautious:. In order to draft these recommendations, the HAS must assemble a group of experts with no conflicting interests with the pharmaceutical industry. Something it clearly struggles to do.

 

01 05 49

Female journalist

Is it hard to find independent experts?

 

01 05 53

Dr. Pierre Gabach

It depends on the specialty. Sometimes it's hard to find experts with zero conflict of interest. In the case of diabetes, we'll see if we can find candidates. I can't say right now, the process is underway, we'll see if we can find any.

 

01 06 13

With such contradictory guidelines on how to treat type 2 diabetes, patients find it hard to form an opinion.

 

All the more so since another method of treating this disease would appear to reduce the reliance on medication, and potentially offer a permanent escape from drug treatments altogether.

 

01 06 32

In Germany, Wilfried Stränger successfully experimented with this method after many years of intensive treatments that nearly cost him his life.

 

01 06 41

Wilfried Stränger

Because I almost fell into a coma, I said to myself: Never again. It sounded like a great idea, I decided to do whatever it takes. On the Monday morning, I called Professor Martin, and went to his office.

 

01 06 59

Dr. Stefan Martin

Mr. Stränger, come with me.

 

01 07 07

Wilfried Stränger

And surprisingly, he said some very positive things after the blood tests. He said my pancreas was still working and he thought I could get better on my own, without insulin.

 

01 07 38

While Wilfried Stranger no longer takes any medication, his blood tests brook no argument. After 30 years of type 2 diabetes, he is in remission.

He achieved this using a radical method, suggested by the physician: a strict diet developed by a team of British researchers.

 

01 08 02

For three weeks, this diabetic consumed a very low calorie soya drink, before embarking on a carbohydrate-free diet with zero sugar intake.

Remission of type 2 diabetes necessarily involves a significant loss of weight.

 

01 08 20

Dr. Stefan Martin

So how are you? How is your heart?

 

Wilfried Stränger

My heart is fine. I've been doing a lot of work at home and in the garden. My 90 rose bushes often need watering.

 

01 08 38

Dr. Stefan Martin

With type 2 diabetes, it was long believed to be a lifelong affliction. Then a team of English researchers produced a sensational study. They took people who had suffered from diabetes for a few years, made them lose a lot of weight, and were able to show that 50 to 80% of them, depending on how much weight they lost, went into remisson from diabetes without any surgery, just through radical weight loss. Very precise studies have shown us that fat accumulation in the pancreas cause insulin production to fall. But it doesn't stop. The cells that produce it are merely damaged. When the pancreas is free of fat, the cells that produce insulin work again, insulin production increases and blood sugar levels drop. We made the same observation here at Düsseldorf. We have managed to wean some patients off insulin and even stop all medication in some patients who are in remission. I really think this is the way forward.

 

01 10 07

With a lifestyle change and loss of weight, you can stop taking diabetes and blood-pressure medication and avoid the need for knee surgery. So we have range of costs, for suffering in different areas. If you add together the cost of treatment for all these illnesses, savings made could be much better invested. But the general opinion is that this doesn't help, that there is no point. It's a problem that needs to be addressed by politicians. But the vested interests of the pharmaceutical industry and universities means they have no interest in taking that route. That makes me very sad and very wary.

 

01 11 02

Several thousand patients have already followed this method in the United States and Europe.

But it only works at the cost of considerable effort and great motivation. Only a third of type 2 diabetics who embark on this program can hope to be completely cured.

 

The majority of patients will have to carry on with the treatments that are such a heavy financial burden in wealthy nations and inaccessible to sufferers in emerging countries.

 

01 11 55

On the African continent, diabetes is a time bomb. According to the International Diabetes Federation, it will affect 47 million people within 20 years. A lack of medical monitoring means half of all diabetics in Africa are not listed.

 

Dr. Gounegé Babou

Medical Intern

 

01 12 11

Dr. Gounegé Babou

Unfortunately globalization is leading us to emulate a western lifestyle. People are increasingly sedentary, they don't work in the fields, they travel around in vehicles. Lifestyles and eating habits have changed: we eat more fat, more sugar, more salt. So it's hardly surprising that we are affected by these diseases.

 

Centre Marc Sangalé, Dakar, Sénégal

 

01 12 42

Senegal seems to have acknowledged the scope of the problem. Five percent of the population there is already diabetic. Lacking the resources to take care of too many patients, the health authorities are gambling on prevention.

 

01 12 56

In Dakar, the public hospital offers workshops teaching people how to eat better.

 

Dr. El Hadji Assane Ndiaye CISSE

Dietician, Diabetology Educator, Abass Ndao hospital, Dakar

 

01 13 02

Dr. El Hadji Assane Ndiaye Cissé

Some types of milk contain a lot of fats, while others contain few. Some don't contain any. Diabetics can drink this milk, the blue one: semi-skimmed. This is OK for diabetics. The color of the lid is blue? Yes, blue. The label says: Semi skimmed.

 

01 13 25

Dr. El Hadji Assane Ndiaye Cissé

We always start by telling the patient that diabetics need a special diet because the rest of the population eats so badly. It encourages the patient to follow the diet. Initially, they have the idea that the diet is very strict. The feeding regime is not easy to apply. It's meant for wealthy people, not poor people, etc. That isn't actually the case. What we ask diabetics to do is maintain a balanced, healthy diet. The objective is to help the patient to understand what a healthy diet is.

 

01 14 12

Diet sodas don't contain any sugar. They contain sweeteners: sugar for diabetics. But they have no nutritional value. They are not made from fruit. Enjoy them but don't overdo them.

 

Dr. Maimouna Ndour

Director of Marc Sangalé Diabetes Center

 

01 14 27

Dr. Maimouna Ndour

We do not have the resources to supply this curative medicine. Actually no one has. A few years ago we estimated the cost of amputation from a diabetic foot lesion. The cost was estimated to be 1.6 million FCFA, not including prosthetics. That's about 3000 euros. It is practically impossible for the average Senegalese household to afford an amputation. The cost doesn't include orthopedic equipment. Many of the complications from diabetes weigh too heavy on patients and families and health systems in general. So we must focus on prevention. Primary prevention, to stop the disease from gaining ground. If we don't stop this progression now, we never will.

 

01 15 26

These prevention campaigns are no match for the seductive power of the food industry, both in Senegal and all around the world.

 

01 15 36

In 2018 in France, the total spent on advertising fast-food restaurants, sugary drinks and candy bars amounted to 300 million euros, 20 times more than the sum allocated by the state for its health nutrition plan.

Is the quest to conquer diabetes doomed to failure?

Whatever happens, the victims cannot be left to carry on the battle alone.

 

Frédéric Pierru

Sociologist, CNRS

 

01 15 57

Frédéric Pierru

It's as if the prevention campaign wanted to make people players in their own health. Then if a pathology such as diabetes develops, it's because the victim has not adopted the best practices in terms of diet, lifestyle, sedentariness, etc. So it's about blaming the victim. Stressing the actions of the individual pushes into the background or blanks out to some degree the social determinants of health: everything linked to environmental stresses.

 

01 16 37

Any action on conditions relative to life, the environment, work, housing or diet now means challenging society's fundamental choices, such as intensive agriculture. These lobbies frighten politicians. They would now rather define prevention as action on individual behavior.

 

Gojka Roglic

Head of Diabetes Management, WHO

 

01 17 02

Goika Rogic

There is a lot of strengthening to be done at the country level, provided that there is political will to do so. And progress has not been as we had hoped... it would be. There will have to be more effort, more investment into the control of non communicable diseases. and especially from donors and development agencies that so far have not really committed to non communicable diseases.

 

01 17 30

It is futile to rely on individuals alone to try to curb the disease. Over and above behavior, our environment is in need of fundamental change.

 

01 17 46

An extreme example can be found in Baltimore.

It is one of the poorest cities on the east coast of the United States, and a third of its population is diabetic.

Here, in the deprived neighborhoods, access to healthy food has disappeared completely.

Supermarkets have been replaced by convenience stores: several hundred neighborhood grocery outlets that offer only processed foodstuffs, very little fresh produce, and no vegetables. A veritable food desert.

 

Ashley Yates

Artist, Baltimore

 

01 18 15

Ashley Yates

You can walk down the street, you can see a liquor store. You can see a corner market. You can find maybe a Burger King. Grocery stores are not around. But more businesses are being created and it’s extremely shocking that you can’t walk down the street to get food. But you can walk down the street to get alcohol, cigarettes, whatever is needed. And that shows me how people view us. How the systems that are creating stores that are creating capital in our cities based on, your choosing to put this in our communities.

 

Bruce Lee

Executive Director, Global BC Prevention Center

John Hopkins University, Baltimore

 

01 18 57

Bruce Lee

One of the biggest myths is that this is the result of people being lazy or making bad decisions, or just not making the right choices. If that were the case, you wouldn't see so many people start struggling with this problem and it’s consistent rise. So what’s really happening is the fact that people are conditioned and affected by what’s around them. You can’t just tell someone in low-income neighbourhood: "Oh, go join a gym!

Pay for an expensive gym membership!" Or "go shop at this expensive food market." They may not be able be afford it, so junk food tends to be a lot less expensive and you can keep it longer. Certainly you want to do everything that you can to try to improve your lifestyle, you want to make that effort. But everyone needs help. They always say it take a village to raise a person. Same thing here. We like to think of ourselves as independent people and we can do whatever we want. But that is not the case. We are affected by things around us.

 

01 20 11

Abandoned by the public authorities, a few local initiatives are now trying to make up for the lack of healthy food. Residents organize community vegetable gardens, handing out vegetables for free.

 

Matt Burk

Director of Food Rescue project, Baltimore

 

01 20 28

Matt Burk

We collect donations of unsold food from iocal grocery stores and distributors. Right now, we ’re taking in about 4-5,000pounds of food every week, it still is a project of the Baltimore Free Farm, um, which is a community center in Hampden, a collective of individuals, artists, activists, farmers... Um, basically, just people coming together to solve problems... in their community that aren’t being addressed by, um, by local officials, or people in higher up positions.

 

01 21 05

Matt Burk

- These are summer squash, you want to peel the gord off first and dry the gord

- Oh, cute!

 

01 21 18

Matt Burk

if you just wanna live, yeah, you can eat junk food your whole life... You can eat McDonald’s, things like that - which is, the type of food that is predominantly available in, uh, food desert neighborhoods. However, I would argue that the need for healthy food is universal - it’s something that even if you don t know you need it, your health is affected by the lack of it, so... Everybody. Everybody needs and everybody deserves access to healthy food.

 

01 21 53

But these initiatives are very fragile given the scale of the health disaster. And they only take into account diet, which is only a part of the problem with diabetes.

 

01 22 08

Bruce Lee

So a health problem is not strictly a health problem. It’s an economic problem, it’s an environmental problem. And the same thing goes in the other direction. Economic problems or economic decisions, environmental decisions are not devoid of health issues. So everything has a health impact. One of the things we would like to see, is more incorporation of health considerations when making many different types of decisions. So for instance, if you make a city planning or a city design decision, like if you put a highway in the middle of the city, that’s going to affect access to food, healthy food, that’s going to affect how people can walk and interact. But many times that is not considered when that’s made at the city planning level. So, we have got to really start incorporating a lot of these health issues into that type of decision making.

 

01 23 01

Bertrand Burgalat

Looking ahead, I think we will win. The problem is, knowing when. What we are saying will be some kind of biblical evidence within a few years. In the meantime, many diabetics will die for no good reason. Some will have had poor medical treatment, there will have been a great deal of pointless expenditure on overpriced treatments, etc. But the diabetic-industrial complex will be swept away.

 

01 23 42

Diabetes is much more than a blood-sugar problem. It is symptomatic of the dysfunctional nature of our societies.

And while the apathy of governments goes unchallenged, it will continue to gain ground.

 

GENERIQUE FIN

 

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