Insulin, Genetics, and the Mob: What My Friend Rep. Gaetz Gets Wrong
Biden's move on drugs needs more genetics
I am not an easy person to befriend. I am downright quarrelsome and disputatious. I try as we all do — to try to be more normal — but I have not done a good job of it and as I age it gets harder still. The fucks I have to give diminish and I seek to get the truth out, as best I can, to as many as I can. I’m not perfect nor am I without problems but I have been blessed by this country and it’s that time of my life where I have much to give back even if it makes me friendless.
That much is perfectly clear, and now spending a lot of my time in the Imperial Capital, I’m sure that whoever said, “if you want friends, you ought to get a dog” didn’t understand that most rental agreements bar pets. I’m friendless in the DMV but then again I’d rather be right than popular. I still believe that a man armored with the truth can move the world and that the best sorts of friends love the truth alongside you.
So it’s with some trepidation that I tell my friend — yes, he’s my friend — Congressman Matt Gaetz that he’s wrong about his rationale for voting against Biden’s insulin price controls. I fully expected him to be among the twelve Republicans who voted alongside Biden but, alas, he wasn’t.
I can do on his own terms — political — before moving into a more philosophical dispensation. Gaetz, in my estimation, risks compromising his own brand — that of the scientifically informed Republican.
Gaetz has staked out a reputation as one of the few Republicans to be pro-science and pro-environment. He favors smart environmental policy — in his book, he called for taxing Chinese pollution — and is humane on the treatment of homosexuals and animals where he is decidedly out of step with his party.
What gives when it comes to the fatties then?
The first observation is that it may well be autobiographical. Gaetz has slimmed down as even his detractors have noted. Indeed, unlike Governor Mike Huckabee who claimed to have lost his weight but really got a gastric bypass or Secretary of State Mike Pompeo who shed the pounds through surgery, Gaetz seems to have lost the weight with sheer will power. Not bad in a profession that isn’t known for its discipline. For those suitably interested Huckabee has since decamped to Matt’s district. He has the Florida sun on his skin. No word yet on whether or not he’s still selling fake cures for diabetes.
The dumbest thing happened with all of this is that Trump has an executive order that capped insulin prices. Biden immediately rescinded it — and then cravenly highlighted the price gouging at his State of the Union. Scandalously Biden used a child as a prop.
Diabetes is on the increase not just in the United States but around the world so it makes good sense for governments to restrict insulin’s price to keep its citizens healthy and safe. (With so much “rationing” of insulin, a price cap would be a down payment on preventing future complications arising from T2D, but I guess we’ll just pay more then).
I suspect that there will be a lot more diabetics now that food prices are rising. Everybody knows carbs and fried food are cheap.
When you say you don’t believe in price controls you are telling the world that it’s perfectly fine to gouge Americans and yes, Americans are being gouged.
First their tax dollars are taken and given to universities. Then that money is used to develop the drugs which are produced by publicly traded companies, often bought up by foreigners, namely the Chinese. If you read about the history of Genentech, you’ll know that Tom Perkins and the so-called deep state essentially incubated solving the insulin problem. So Big Pharma is gouging our rednecks and Latinos — and stealing from Medicare and Medicaid. The true cost is like $10/vial and some people pay over $1500.
America’s diabetes rate is roughly the same in Australia and they pay 1/23 of what we do for insulin. If we must ration drugs we ought to do it on the basis of genetics and lifestyle choices. We don’t give livers to alcoholics do we? (Admittedly there’s something of a debate here.)
We could, of course, sequence everyone in this country and tailor their drugs to their ailments genetics occasionally. This is the most obvious way to drastically improve the quality of care in our health care system AND reduce costs.
The Guardian explores this as it comes to the NHS.
About 6.5% of UK hospital admissions are caused by adverse drug reactions, while most prescription medicines only work on 30% to 50% of people. A significant part of this is due to genetics: almost 99% of people carry at least one genetic variation that affects their response to certain drugs, including commonly prescribed painkillers, heart disease drugs and antidepressants. By the age of 70, about 90% of people are taking at least one of these medications.
A new report, published by the British Pharmacological Society and the Royal College of Physicians, argues that many of these issues could be addressed through pharmacogenomic testing, which allows personalised prescribing according to people’s genes.
“The ultimate goal is to make pharmacogenomic prescribing a reality for everyone within the NHS, which will empower healthcare professionals to deliver better, more personalised care,” said Sir Munir Pirmohamed, a professor of pharmacology and therapeutics at the University of Liverpool, who chaired the report’s working party.
…
Further ahead, patients could be offered a once-in-a-lifetime blood or saliva test to predict their responses to multiple drugs and guide their future treatment. Such testing would cost about £100–£150 per person, but could result in long-term savings to the NHS.
Each year, adverse drug reactions cost the NHS an estimated £650m, but this figure could be as high as £2bn, Pirmohamed said. “Adverse drug reactions as a whole cost a lot to the NHS. Even if we can prevent 30% of those through implementing pharmacogenomics, we’ll be saving a lot of money.”
We could, if we wanted to, sequence every American at roughly $300 a pop. We’d be spending only about $90B, or roughly what was stolen in Covid testing schemes. And like the Internet if we did that we’d fundamentally transform the world.
As America browns and greys, we get more Type 2 diabetics.
“Type two diabetes [T2D] is particularly prevalent in Latin Americans (14.4%, twice as high as for non-Hispanic whites in the US), where it is one of the leading causes of death (2, 3). While different environmental and lifestyle risk factors in Latin America partially explain the increased prevalence of T2D, unique genetic influences also contribute (4, 5)”
So, too, when it comes to America’s aging. You get older and things don’t work so well.
Matt knows all of this. He’s been good on the genetics of human sexual behavior — if only as a way to stop the blackmailing that has become pervasive in politics.
Homosexuality is genetically determined, as so much of our sexual behavior is. We shouldn’t be extorted over consensual sexual conduct. The emphasis here is on consensual, of course.
So, too, are our waistlines genetically determined. Some of us struggle to gain weight; others of us struggle to shed it. Such is life.
Politics, though, is a lot more crass when it doesn’t deal seriously with human nature. We could talk about Manchin’s daughter’s epipen play or Martin Shkreli, who mobbishly increased prices.
All of this obscures the larger point: At no point did the ~1.8m T1D do anything wrong. They have an autoimmune disease. The volatile price fluctuation for people that need that insulin to survive, like those that need epipens or cancer drugs, is on face maddening, but catastrophic when it comes to their wallets. And let’s not kid ourselves. We so rarely understand how these issues really interact as we are learning thanks to covid and diabetes.
A friend, who is a diabetic, writes to me:
There is an argument to separate T1D from T2D and the factors that brought a person to T2D. On the whole though, this $35 number is arbitrary. People would have been happy with $50 or $75 and there would still be a significant profit margin. As the drug manufacturers I've spoken to have told me, there is just no appetite to make more insulin facilities, especially in America, so it seems unlikely that it's a supply and demand issue.
Not capping the insulin price would also continue charging Americans' interest. Think of how if you have a toothache, but don't spend the $50 for a copay on a dental visit, it gets worse and becomes a $1500 root canal. Pharma loves that interest.
We must invest in prevention or suffer accordingly.
What makes my friend Matt Gaetz such a compelling figure is that he is capable of understanding how painful these sorts of things are to ordinary people. He has shown great compassion for those who need medical marijuana, such as the epilepsy sufferers, for example. But when he goes autistic libertarian he loses the plot. We oppose sanctions on Russian oil because the sanctions wind up strengthening the Chinese relationship with Russia and weakening global trade rules as the Russians find ways around them. We oppose sanctions because it’s wrong to punish the weak and not because of some weird Milton Friedman voodoo economics.
And so, too, with the diabetics. It’s difficult to be unbought, unbossed, and unbowed when you’re struggling to live. It doesn’t make you free when you’re enslaved.
Autistic libertarian, ha! Price control on insulin makes too much sense. Also, run away from SAD, standard American diet, and abolish outdated food pyramid that was never based on science.