Got questions about navigating life with diabetes? Welcome to our weekly advice column, Ask D'Mine -- the place to get some colorful answers from veteran type 1, diabetes Ask-DMine_buttonauthor and educator, Wil Dubois.

This week, Wil takes a look at the perennial question of a "diabetes conspiracy": does Big Pharma really have our best interests in mind as it goes about the business of selling treatments?

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

George, type 1 from Wisconsin, writes: Hello Wil, I'm 78 years old and have had type 1 for about 25 years. As an aside, on my first visit to a dietician, she told me that it was impossible to have been diagnosed with type 1 at my age [Editor's note: it sure as hell isn't!], that I definitely must have type 2. What a start to this 25-year voyage! But the above is not the real reason for this e-mail. When it comes down to it, the real reason for this e-mail is my "diabetes cure pessimism." I wonder how many millions, or billions of $$ are made directly and indirectly by companies, corporations, etc., that would be traumatized by a cure for diabetes?? It's just my rare pessimistic side that's showing. Thank you Wil for listening, and a sincere thank you for your articles!!

Wil @Ask D'Mine answers: Thank you! Personally, I'm not a pessimist at all. I was, however, recently accused of being "one cynical son-of-a-bitch," which was probably an accurate assessment.

News nuggets from around the diabetes community

American Diabetes Association Names New CEO
Non-profit leader Kevin L. Hagan named as new chief exec of national diabetes org after six-month search.
FDA Approves New Basal Insulin
Sanofi's Troujeo has 'flatter profile' of action that helps to avoid lows.
Daytona Win for Racecar Driver with Diabetes!
Type 1 driver Ryan Reed wins first NASCAR series race at Daytona on Feb. 21.

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Anyway, I'm not sure there's any way to answer your question accurately to the dollar, and it depends on what we're counting—more on that in a minute—but we can get close.

In a detailed study back in 2009, the International Diabetes Federation (IDF) put the global diabetes price tag at 376 billion US dollars, and noted that we D-folk gobble up around eleven-and-a-half percent of world's healthcare expenses. Last year, they updated the figure to $471 billion. They rather dryly note that diabetes imposes "a large economic burden" on individuals, national healthcare systems, and economies.

Diabetes Profits

On the home front, the latest data from the Centers for Disease Control is from 2007, and it put the price tag at $116 billion for direct medical costs at that time. A more recent study by the American Diabetes Association (ADA) puts the tab at $176 billion in our country, a stunning 41% increase since their landmark 2007 analysis.

But wait! There's more! What about indirect costs? Paying for metformin, test strips, syringes, and amputations is just part of the real cost of diabetes. Diabetes also takes a bite out of the workforce's productivity and "costs" the economy in terms of missed work days, reduced productivity, disability expenses, etc., etc., etc. In the USA, the ADA estimates that these "shadow" costs added $69 billion to the tab last year, putting our nation's diabetes bill at $245 billion—more than $1,200 bucks out of the pocket of every working-age American citizen, both those with and those without diabetes. That works out about to about 20% of the nation's healthcare spending.

And it gets worse. Despite the detailed analysis, the authors of the 2007 study freely admit they likely underestimated the cost by tens of billions of dollars. They didn't include the cost of the increased use of over-the-counter meds by D-folk. Nor the cost of eye and dental care. Nor the cost of prevention and wellness programs. Nor the cost to administer the health plans, and to process the insurance claims of those of us who actually have insurance. Nor the cost of medical and pharmaceutical research. And they point out that they didn't even attempt to estimate the economic impact suffered by the family members of Persons With Diabetes (PWDs). For instance, most D-Moms of little type 1s can't work because caring for the kiddos is a full-time job. Many working-age adults lose work days caring for elderly and ill type 2s. Spouses miss work as caregivers, taxi drivers, and medical-visit cheerleaders and translators. And on it goes.

The World Health Organization, God bless them, even goes a step farther. They acknowledge both the direct and indirect costs, but also pose the question of intangible costs. What is the financial impact of pain, anxiety, or discrimination that diabetes generates? How do we quantify the "cost" to personal relationships? To leisure activities?

And I'd add another financial impact from my personal experience: A dollar here means no dollar. If I didn't have diabetes, all the thousands I've spend on my health could have been spent in some other way. Diabetes has effectively lowered my standard of living.

But whatever number we choose, everyone agrees that as soon as you read what I wrote, it will have gone up. Healthcare costs, thus diabetes bucks, rise faster than my blood sugar does after eating pecan pie with ice cream. Not that I ever do that.

For perspective, on the money—not the pie and ice cream—the population of the entire frickin planet is around 7 billion people. So using the IDF's global price tag estimate, diabetes is costing every man, woman, child, and baby $68 a year. Oh, and don't forget that the average annual income in Somalia is only $112 per year, according to the United Nations. The citizens of Congo, Burundi and Niger are doing a little better, but not by much. In fact, the next time any of you are feeling sorry for yourselves when adding up your checkbooks, remember that, according to the International Monetary Fund, there are at least 31 countries in which the typical citizen brings home less than a thousand dollars of bacon per year.

Of course, the spending on diabetes is lopsided. The citizens of Somalia aren't required to fork over 60% of their annual income to the world diabetes fund. And you would be forgiven for assuming that the country with the most diabetes would have to fork over the largest slice of the money pie, but you'd be wrong. India has more D-folk than anyone else. But according to the IDF report, India only spent 1% of the global total, while back home in the USA we forked over more than half of the total. Are our health outcomes better than those of our cousins in India? Are we getting our money's worth? Well, I couldn't find any data that was diabetes-specific, but looking at overall health rankings, Bloomberg ranks the USA at #33 in the world, behind Cyprus, Costa Rica, Slovenia, Cuba, and Kuwait (among others); but above Bahrain, Mexico, Panama, Tunisia, and Estonia. Where did India come in? Way the hell down at #103. So while money can't buy happiness, maybe it can buy health. Or maybe not. As we spend more than anyone else on health, shouldn't we be at number one?

Speaking of bringing home the low-carb bacon, how much does diabetes cost those of us it who have it, in terms of our out-of-pocket expenses? Well, that number has been skyrocketing over the last few years with premiums, deductibles, and copays going up, up, up. But the best current guess, according to Consumer Reports, about six grand a year. What percentage of take-home pay does six grand work out to?

Well, so much for cost. But that was only half your question. Does all this money create an incentive to avoid a cure? You know, if only one company was raking in all that money, I might be willing to believe that. For instance, it looks like the three keep-calm-and-cure-diabetescompanies in the world are Exxon Mobil, Shell, and Walmart. All of them rake in between 469 billion and 482 billion a year—just about the same amount of money the world spends on diabetes. Not to accuse any of these three companies of not being good cooperate citizens, but do I think they might suppress a cure in order to double their annual income?

Yeah, I would be willing to concede that possibility, but the diabetes ecosystem is widespread and diverse. No one company "owns" it. Hell, no one industry owns it. Diabetes spending runs the gamut from the small-town doc, to device companies, to pharmacy supply middlemen, to big pharma, to insurance plans, to hospitals, and more. It's a hell of a lot of money, but it isn't centralized. And I'm not smart enough to figure it out, but remember there is a difference between gross dollars and net dollars. That's our 471 billion, or whatever the number really is. The is the profit, how much you earn after subtracting your expenses in making it, marketing it, and selling it. It's still a shit-load of money, but no doubt some spheres of the diabetes space are heaps more profitable than others.

And consider that, in terms of suppressing a cure, secrets are damn hard to keep in today's world, and a whole lot of people would need to collaborate to make that happen. So while I'm a cynical son-of-bitch about many things, I don't believe that "the cure" has been found and hidden to protect cooperate profits.

All of that said, I'll actually join your "cure pessimism," but for a different reason. A scientific reason. I think diabetes hasn't, and won't be, cured because diabetes is so damned complex. In fact, recent research we covered here indicates there may be many more types of diabetes than we previously thought. For years, people used to ask when the cure for cancer would be found. Well, the problem is that there are at least 200 kinds of cancer. You can read about each one here, if you want to. No one pill can fix that many ills. And I think the same thing may prove to be true of diabetes.

But there is one bright side to all of this. Diabetes, unique amongst illnesses, stands poised to devastate the global economy if it keeps growing both larger and more expensive, as it has over the last decade. Whether we can cure it or not, we had better start thinking outside the box about how we are going to deal with it, or the outlook will be very pessimistic indeed.

 

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

 

 
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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.