On medical memes and bad advice.
About 7.4 million
people in the U.S. require manufactured insulin to stay alive.
I’m one of them. I’ve lived with Type 1 diabetes for over 15 years and inject
two kinds of insulin every day. These insulins are notoriously expensive,
and even with health
insurance, people with diabetes regularly struggle to make ends
meet.
The price of some
insulins is now seven times more
expensive than it was two decades ago. Studies find that
upwards of one in four
people with diabetes ration their insulin to stretch
prescriptions, putting themselves at risk of dying.
As a result, advocacy groups ranging from the American Medical
Association to T1International are
calling the situation a crisis.
Older insulins have been thrust into the spotlight because
of a widely circulated meme that suggests people could manage their disease
better if they simply purchased these products.
In place of political
or corporate action that would make insulin readily available, an unusual
social media phenomenon is developing that puts the onus on people with
diabetes to stay well. Those with diabetes are being confronted with
“alternatives” to high-priced insulin. The most widespread of these appears to be
so-called Walmart insulin,
an older and much cheaper insulin.
These older insulins have
been thrust into the spotlight because of a widely circulated meme on social
media that suggests people could manage their disease better if they simply
purchased these products. Such insulins cost US$25 a vial and can be obtained
without a prescription. However, these insulins do not present a solution to
the current health care crisis. Worse, they may put some people’s lives at
risk.
I’m a communication
scholar who specializes in the rhetoric of health and medicine. My research
focuses on how public understandings of diabetes affect political and cultural
responses to the disease.
I recently published
a book-length
study about competing conceptions of diabetes “management” and
how that term guides our thinking about the disease, which can be seen as
easily controlled or at other times, fatal. In that work, I detail the ways
management is often reduced to a set of individual choices and, in the process,
covers over more difficult exchanges about access to care and insulin
availability.
Conversations
about Walmart insulin follow
a similar pattern by subtly encouraging people with diabetes to make fraught
choices while deflecting focus on systemic changes that would improve their
lives.
The limits of ‘human’ insulin
Walmart sells older
versions of “human” insulin, which were once the best option for staying well.
“Human” insulin is a synthetic substance that is engineered through recombinant DNA technologies
to mimic insulins produced by the body. These insulins were widely used from
the early 1980s until the
mid-1990s. They differ from newer “analog” insulins, which absorb
more quickly and give people with diabetes greater control over their bodies.
People who resort to
Walmart insulins, especially those who transition to it after years of using
analogs, often struggle with the lack of flexibility and more precise timing
required when using older forms of the substance. If insulin does not absorb
quickly enough, it leaves people imperiled.
This is exactly what
happened to 27-year-old Josh Wilkerson this
past summer. The Washington Post reports that after aging out of his parent’s
insurance, Wilkerson transitioned to Walmart insulin to afford treatment. But
the older insulin did not take. He suffered multiple strokes, went into a coma
and eventually died. His blood sugar was reported to be 17 times higher than
normal.
Although it is
difficult to assess how many people have experienced complications from
adopting these insulins, we do know that the price of analogs
continues to rise, as do rates of
diabetes. As such, the number of people pursuing Walmart insulin as
an alternative is likely to increase.
Of course, changes to
a lifesaving medication like insulin should be made in consultation with a
physician. But access to medical care holds the same challenges that
prescriptions do. It requires
money and time.
And if people are
transitioning to Walmart insulin, they likely
don’t have either of those.
Medical memes and bad advice
With November being
Diabetes Awareness Month, the occasion offers us an opportunity to be more
aware of the medical advice we post to social media. Those who share
information about these older insulins are inadvertently putting the onus on
people with diabetes to stay well, even as such insulins are not effective for
everyone. Diabetes
advocates have repeatedly warned about the limitations of
Walmart insulin but such messages continue to circulate unabated.
I believe Walmart insulin magnifies a class-based system of
health care access, where people with insurance or money can access insulins
that others cannot.
These memes regularly
appear on my own social media, but they are never accompanied by a critique of
insulin prices, the health care industry or the alleged price-gouging practices of
pharmaceutical companies. In my analysis, these posts suggest that insulin is
accessible, and if a person with diabetes does not pursue a cheaper option,
it’s their fault, not the fault of opportunistic insulin manufacturers.
I believe Walmart
insulin magnifies a class-based
system of health care access, where people with insurance or money
can access insulins that others cannot. Advocates like Laura Marston
contend that the U.S. is the only developed country that pushes patients to
utilize antiquated insulins rather than work to make analogs available.
Policy experts who
study insulin contend that the best way to help people with diabetes is to cap
the amount that can be charged for analogs. Colorado has recently moved to do
just that, though the law does not appear
to cover everyone. Two of the three corporations that manufacture
analog insulin claim they are moving toward generics, but those are yet to have any
effect on the market and are still four times more expensive than
analogs sold in Canada.
When I was diagnosed,
a nurse educator warned me to watch what advice I take from people. Everyone
thinks they know something about diabetes because everyone knows someone who
lives with, or died from, the disease.
Conversations about
Walmart insulin reproduce this logic by subtly suggesting that people who do
not live with the condition have vital information about the disease that
people with diabetes do not. People like me know what we need to live: insulin.
And if we know there are better forms of the medicine that would keep more of
us alive, why not advocate for those possibilities?
Jeffrey Bennett is
Associate Professor of Communication Studies at Vanderbilt University.
This article is
republished from The Conversation under a
Creative Commons license. Read the original article.
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