New York Times Article on Diabetes Costs Provokes Backlash

A front-page article in The New York Times that began by focusing on one woman's struggle to deal with the high cost of caring for her Type 1 diabetes in last Sunday's New York Times has gotten a number of people upset. Apparently many felt that the Times' story portrayed many of the newer and more expensive medical devices as frivolous luxuries.

All those angry tweets and comments have prompted an post about the article on diabetesmine.com. Author Amy Tenderich wrote that "While the story was one of the best we've seen in describing the challenges of insulin dependence and the huge cost barriers that exist for patients in our convoluted American healthcare system, some felt that it actually disses innovation in diabetes tools..."

All this unhappiness was centered on just a few lines in an article that was overall more an indictment of the big business that the diabetes management industry has become.

Elisabeth Rosenthal ended the second paragraph of her original Times article with the sentence, "But as diabetics live longer, healthier lives and worries fade about dreaded complications like heart attacks, kidney failure, amputations and blindness, they have been replaced by another preoccupation: soaring treatment costs."

Rosenthal explained that, "More than 1.5 million Americans have Type 1 diabetes and cannot survive without frequent insulin doses, so they are utterly dependent on a small number of producers of supplies and drugs, which have great leeway to set prices."

She then proceeds to take those suppliers to task. "Diabetes experts say a good part of what companies label as innovation amounts to planned obsolescence," Rosenthal wrote. "Just as Apple customers can no longer buy an iPhone 3 even if they were content with it, diabetics are nudged to keep up with the latest model."

The Times article also prompted a somewhat more reasoned response from JDRF, formerly known as the Juvenile Diabetes Research Foundation. The JDRF blog post acknowledged an unidentified "recent study (that) documented such advances helped add roughly 15 years of life" for those with Type 1 diabetes (T1D).

But, the blog post continues, "The New York Times story suggests that some medical advances for T1D that could mean a longer life and better health for some people with T1D are not worth the cost -- a premise JDRF completely rejects."

Rosenthal's text does refer to some "dubious improvements" - "colored pumps; talking, bilingual meters; sensors reporting minute-by-minute sugar readouts." And she quotes Joel Zonszein, MD, director of the Clinical Diabetes Center at Montefiore Medical Center (New York City) as saying, "People don't need a meter that talks to them. There's an incredible waste of money."

But only those few lines in an article of about 3800 words suggested that some of these newest improvements might be unnecessary. And for many, they are doubtless just expensive bells and whistles.

But for a few they may be essential. Amy Tenderich wrote, "Does this Dr. Z have the slightest idea what it's like to live with a broken pancreas that can set your sugar levels swinging at a moment's notice? And that bit about 'talking meters' -- as if they were just high-tech toys, and not vital life tools for those with vision impairment!"

Still, those upset by Rosenthal's article seem to have missed her main point - that it is primarily the suppliers and US healthcare system that are at fault for the ever-higher costs. She contrasts the experiences of American diabetics with those in European healthcare systems. The same vial of insulin analogue that costs $200 at an American pharmacy is typically bought by British pharmacists for under $30, Rosenthal says, and is dispensed to the patient free.

"To some extent, Europe is getting a free ride from the United States," Robert J. Shapiro, an economist and chairman of Sonecom LLC, a Washington-based financial advisory firm, told Rosenthal. "Drugs and equipment makers operate in a global market, and our costs are higher because every other country applies price controls, and we don't."

While Rosenthal's article centers around Type 1 diabetes, it is Type 2 that has been creating the most media attention of late. According to a study published earlier this year by NIH, Type 2 diabetes affects 25.8 million individuals in the United States. NIH's National Diabetes Education Program says that more than 90 percent of adults with a diagnosis of diabetes have Type 2.

Stephen Levy is a contributor to Qmed and MPMN.