To clarify, the IMMINENT DEATH possibility is also true, in the case of diabetic ketoacidosis, which is caused from lack of insulin. Yes, if it came to it, you could use Walmart's NPH/R to avoid DKA, but then you put yourself at a higher risk of severe hypoglycemia (extreme low blood sugar) due to the way those insulins work, which can also result in imminent death.
My comment previously was referring to the best case, where you only lose some toes or a foot in a decade or two.
This depends on what you mean by "plain insulin". If you are referring to NPH and R, there's a massive world of difference going to, say, Novolog and Lantus. If you're comparing something like Lantus versus Tresiba, sure, it's more "extended release" Or yes, Afrezza is inhalable. But when people complain about the cost of insulin, they're referring to the cost, and especially the huge cost increases, of insulins like Lantus and Novolog (that have been out for a couple decades now), not the cost of new insulins like Afrezza or Tresiba.
Not going to respond on the rest of your comment, but on insulin, I want to rebut the idea that generics are the same as "fancy and more convenient" versions. They are completely different drugs with different (and far worse) clinical outcomes.
You might as well say "infected people won't have amputations like we've been doing forever. They must always have the fancy and more convenient antibiotics instead."
The fact is, because of intrinsic differences in the types of insulin, a regimen of NPH and/or R can not help but have a significant increase in diabetic complications (including amputations, as in my statement above) than a basal/bolus regimen of Lantus/Levemir and Novolog/Humalog -- all of which have been available for something like 20 years and all of which have seen predatory price increases.
You are right, and I altered a comment below to reflect this. I was trying to make a more general point and phrased it poorly.
The general point is: the reason drug costs are high because of two things working together:
1) Pharma continually refreshes patents by making modest, but real, improvements to things that are generically available.
2) Patients will not accept any level of increased health risk, no matter how much the cost increases in exchange for decreased risk.
The result of these two things is that even though we have generics available for almost every major disease, they are rarely used, and we are always using the patented versions which are orders of magnitude more expensive. And then we have people wondering why health care is so expensive.
It would be absolutely bizarre if it were any other area of the economy. Imagine if every person insisted on owning a sports car because they go 20% faster. But because we (the public in general) continue on insisting that no price can be placed on marginal increases human life or health -- despite the huge logical contradictions that result from this -- we cannot have rational discussions about how to actually keep health care affordable.
I totally agree with you regarding drug prices overall, but insulin is different in this respect. A vial of Humalog cost $35 in 2001. The exact same size vial of the exact same insulin -- no refreshed patent, no reformulations, no improvements, no change whatsoever -- cost $270 in 2017. If the price would have only followed inflation, it would have been $48.50 in 2017.
Insulins are biologic medicines, so once patents expire you might get biosimilar drugs which also require FDA approval, not generics as with other drugs. Admelog is the biosimilar for Humalog, approved by the FDA in early 2018.
As I understand it, Sanofi (Admelog's manufacturer) sets the price to be only slightly below that of Humalog.
Eli Lilly, Novo Nordisk, and Sanofi manufacture substantially all of the insulin, and they more or less follow each other price-wise. There's not the competition you would expect that would drive down prices.
EDIT: they compete by offering varying discounts to particular insurance companies to only cover their insulin at the exclusion of the other company's insulins. This often leads to a letter to patients near the end of the year telling them that the insurance company has decided that their treatment plan has now changed, decisions of their doctor be damned. (Yes, you can appeal and what-not, but it's still fundamentally the insurance company's decision, not your doctor.) This, of course, also screws anyone without insurance who is expected to pay list price.
Gracias for the information. I had to look up biologic medicine to understand what the difference is with other drugs like say acetaminophen. This article from forbes laid it out [1].
TLDR:
1) Biologic / large molecule drugs (insulin) are much harder to produce than small molecule drugs like acetaminophen.
2) The FDA thus requires a lengthly, costly approval process to make generic large-molecule drugs. And since often these drugs are not atom-by-atom the same like small
molecule drugs, they are referred to as "bio-similar"
3) Additionally- though least clear from the article, while the patent on a large molecule drug does expire after 20 years in the same way as small-molecule drugs, it appears that the larger-molecule gives a wider area to patents that can be applied to it. The article hints at, but does not make explicit, a mechanism for "evergreening" as I tried to clarify elsewhere in these comments.
Anyways, thought I'd write it up the TLDR because this background info would have been useful to know prior to engaging in this comment section.
No, it’s not a lack of discipline, it’s not normal, and I think you answered your own question why with your last sentence. It sounds like when you first start a task, you subconsciously decide how likely you are to complete it, based on how fun and interesting it is. For boring tasks, you figure there’s no way to finish it, and that will make you feel bad, and that causes the emotional pain now. The more you push yourself, the worse you feel that you are putting in all this effort and will still end in failure.
A suggestion: do the smallest part right now and then look at that as a success. Meaning, don’t worry about planning the whole thing out, with pomodoros and imagination exercises. Those are hurting you because they are keeping your focus on what your mind perceives as a huge mountain of work. Instead, ask yourself, “what is the most stupidly small thing I can do right now?” Have a task to write a new website? First task is to log into your laptop. Once that’s done, next stupidly small thing? Open your text editor. Start with ‘<html>hello</html>’ saved in “index.html”. Keep just doing to most obvious, tiny thing.
Then afterwards, the hardest but most important part: perspective. Don’t look at how much more you could have done if you weren’t procrastinating —- look at how much you got done over a baseline of doing nothing. Hey, I got rails stood up saying “hello world”, but with postgres behind it and it all checked into git. That’s several more things done than if I had done nothing at all. Go me!
> Why would a person with the skill set of an entire team want to work for a company, rather than starting their own?
I've completed an entire product cycle by myself, more than once, but still work for a company.
Working for a company means I don't have to go out and find the customers, I don't have to do sales and marketing, and I don't have to do the hiring, firing, and day-to-day management of employees. Basically, there's more to running a company than the parts of a product cycle, and insofar as I might be capable of doing all of those other things, I don't enjoy it as much as focusing on solving problems.
We (lulu.com) already do this, including printing from Word docs. And, putting a print book or ebook up for sale is free (including going to the iBookstore and the Nook store).
Note that while I work at Lulu, I don't officially speak for them.
