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Healthy Skepticism Library item: 19228

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: Journal Article

Cohen D, Carter P
How small changes led to big profits for insulin manufacturers
BMJ 2010 Dec 15; 341:


In the first of a series of investigations by the BMJ and Channel 4 News, Deborah Cohen and Philip Carter discover why more expensive analogue insulins are increasingly prescribed instead of cheaper human insulin despite lack of evidence of benefit for patients with type 2 diabetes

Diabetes is a market worth fighting for—it’s the fourth biggest global therapeutic class, generating total sales in 2009 of $30.4bn (£19bn; €23bn). 1 In the UK alone, diabetes is estimated to cost the NHS some £9bn—about 10% of its entire budget. 2

In May 2010, Sanofi-aventis briefed investors in London on the emerging opportunity. 3 The company stated that diabetes remains one of the largest growth opportunities in healthcare and one of the fastest growing markets—outstripping growth in the wider drug market by 5% a year for the past six years. It was, said the company, destined to grow to €50bn by 2015. Sanofi laid out the scale of its ambitions clearly: to be the number one firm in the diabetes market. 3 4

The growth in diabetes drug revenue has been caused in part by rising numbers of people with diabetes; partly by more aggressive approaches to glucose lowering; but mainly by increasing unit costs for insulin 5—a cost that can be attributed to the use of more expensive recombinant insulin analogues.

Sanofi’s ambition to be, in effect, the dominant force means wresting control from the traditional heavyweights of the insulin world, Novo Nordisk and Eli Lilly. However, health services and individuals across the world are paying the price for this market drive, which has seen more expensive analogue insulins taking the place of cheaper human insulin.

Added value?
Insulin comes in different forms: short acting, basal (intermediate and long acting), and a mixture of the two types called biphasic insulin. Each of these …


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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909