All the time spent on looking at various aspects of Diabetes care during Diabetes Awareness Month made one thing very clear, which was massively accentuated by the Insulin for All campaign and new interactions with people from different areas of the globe. There is a huge disparity in the availability of treatments globally, and for no good reasons.
Setting aside the very real issues that the Insulin for All campaign seeks to address regarding access to insulins for those in the poorest areas of the world and those in areas where there is war or other strife, who should not be having to pay extortionate amounts for a patent that was given away by Banting, there are also a number of issues with simply getting access to updated treatment in various parts of the world. Some of it comes down to the Primary Care system and its funding – look at the disparity between the UK and the US in terms of pump penetration and CGM distribution if you want a clear example – but equally, simple availability of options is also strictly limited.
But what am I talking about? Well let’s take a look at some options you can get in the US, but not in other parts of the world to treat T1.
Dexcom G4 Share
And how about going the other way? What’s available in Europe and not in the US?
Abbott Freestyle Libre
Medtronic 6xx series pumps with Smartguard(the 5xx series has only just been approved in the US!)
Tresiba (Insulin Degludec)
Then let’s take a look at Australia, where you can’t get hold of:
Abbott Freestyle Libre
The worst of all worlds…
But why? If you can use these diabetes technologies (and that’s what they all are) in one very large territory with many participants, why not globally? There seem to be a couple of reasons for this, but the biggest (and possibly most stupid) is that we have a bunch of regional regulators that don’t act together. They are arrogant enough to think they all know best and not to trust what one regulator says is okay (does this sound familiar) and that they therefore must keep their part of the global population safe from the rampaging demands of extra-regional producers. Or they are acting to protect the business interests of local providers by stopping access to their market by a form of trade restriction.
Why else is Tresiba not available in Australia or the US? We know it works, we know it has undertaken Phase 3 Clinical Trials and been released into the wild in Europe and yet it’s just not safe enough because trials haven’t taken place in the US or Oz on Homo Sapiens that have a physiology that is completely different from that of the same species in Europe. Oh? It isn’t? Will someone tell the regulator please?
While I get that cost of treatments, in certain cases, is an issue, keeping the option off the list of possibilities because you simply believe that your regulatory regime is better than someone else’s is completely screwed up. Once a technology is licensed in a Developed Country with a proper licensing system, then it should be available globally. No question. So, you bureaucrats in the EMA and FDA, plus any others out there, get your collaborating hats on better. Stop kowtowing to the pharma industry and work for us, the patients, to make sure we have access to licensed products globally, quickly.
Why do we have to suffer as you puff up your chests and state “I know better” on everything? We’ve said it before and we’ll say it again. We are not waiting. This is the war cry of the affected. Your approach simply means that people will find ways around it (as they are already doing). It is fundamentally flawed and needs revision. Please listen to us.