The Scan by 2 Minute Medicine®: the New Cost of Insulin, Beyond IVF, the Spotlight on RSV and Influenza, and Theranos Founder Sentenced to 11 Years!

The Scan by 2 Minute Medicine® is a pop-culture medical newsletter and exclusive benefit for 2 Minute Medicine Plus subscribers.

$8 and Blue Check Mark, the New Cost of Insulin

The Story: Ever since Elon Musk bought twitter, it has been going through a massive overhaul. In a recent attempt to improve funding for the social media website, Musk announced that you could pay $8 US for a verified profile. For just $8, you can get that little blue check mark beside your name that is typically reserved for celebrities, politicians, and companies. Possibly as a prank or maybe in an attempt to enact social change, many twitter users created fake accounts of people like Musk or LeBron James and massive corporations like Eli Lilly, got them verified, and started tweeting false information.

So why does a fake account matter to Eli Lilly?

Here’s why. One twitter user created a fake account for Eli Lilly, a US-based world-supplying pharmaceutical company, and paid for it to be verified. They then tweeted that “We are excited to announce insulin is free now”. This single tweet had a drastic impact on the pharmaceutical company’s stock and re-highlighted the inequities faced by millions who have insulin-dependent diabetes but have difficulty affording their medication due to the incredibly marked up price determined by companies, such as Eli Lilly. A single tweet reignited a flame, urging individuals to call out the disparity in accessing a medication crucial to the management of diabetes, a disease that affects over 537 million people globally.

Tell me more about Diabetes…

Diabetes can be broken down into three main subcategories: type-1 diabetes, type-2 diabetes, and gestational diabetes. As a broad definition, diabetes refers to the body’s inability to breakdown sugar, either because it does not produce enough insulin or because the individual cells stop responding to insulin, ultimately leading to very high blood sugar levels. Insulin is a naturally derived hormone produced in the pancreas, which helps to breakdown sugar in the blood for energy. Having too much blood sugar can have a devastating effect on other organs including the kidneys, eyes, heart, and brain. Type-2 diabetes (T2DM) is the one we typically think about when we hear the word “diabetes” and is usually lifestyle related, and gestational diabetes (GDM) refers to the diabetes some women develop in pregnancy. In these two types, the body is producing insulin but not enough to control the level of blood sugar. Not all patients with T2DM or GDM will require insulin to control their sugars, many will respond to diet or other medications. However, all of those with type-1 diabetes (T1DM), the autoimmune kind of diabetes or the diabetes we see develop mostly in childhood, do require insulin. That’s because their body destroys the cells in the pancreas that are responsible for producing insulin, so they ultimately cannot produce it on their own. Millions with T2DM or GDM will also require insulin because they cannot make enough naturally to keep up with the amount of sugar in the blood.

Why is insulin so expensive?

1.3 million Americans ration their insulin due to the cost. This figure does not include the millions more outside of the USA who are insulin-dependent and cannot afford their medication. Rationing insulin and undertreating diabetes means they are at a higher risk for life-threatening complications of diabetes, including kidney disease, heart disease, eye disease, stroke, and diabetic ketoacidosis. So, if millions cannot afford their insulin, their lives are at risk. This isn’t the first instance where people are calling out companies for overpriced medication. For example, the same was done with the EpiPen which is lifesaving for anaphylaxis, Daraprim which is used to treat the parasitic infection of toxoplasmosis, and a drug called Zolgensma for severe spinal muscle atrophy. But maybe some good has come from this twitter prank. Eli Lilly just announced that the price of insulin needs to come down!

Beyond IVF

Jennifer Aniston was recently featured in Allure magazine and caused quite a commotion. The 53-year-old opened up about her personal life and spoke about why she never had children. According to the article, Aniston wanted children and even tried many cycles of IVF but without success. Aniston isn’t alone in her experience either. There are many celebrities who have used IVF with varying degrees of success, including Gabrielle Union, Sharon Osbourne, Aisha Tyler, and Michelle Obama. And these celebrities are not alone. Worldwide, over 2.5 million cycles of IVF are performed annually, resulting in the birth of approximately 8 million children via IVF since 1978.

IVF, or in vitro fertilization, refers to the process in which a mature egg is fertilized outside of the womb in a lab and then the embryo is implanted into a woman’s uterus. Ideally, the embryo will properly implant, and the process of pregnancy begins. There are many reasons why people use IVF as a means for reproduction, whether it’s unexplained male or female infertility, damage to the reproductive structures, fertility preservation, or if there is a genetic concern. But IVF is expensive, costing up to $35, 000 US for one cycle, and it does not always work, as we’ve learned, was unfortunately the case for Jennifer Aniston. It’s a long and arduous process, fraught with physical and emotional symptoms. The process takes, at minimum, four to six weeks and involves daily hormone injections for approximately 8-14 days prior to egg retrieval. Then, the eggs are retrieved using a small needle and fertilized in a laboratory by injecting sperm into them. If this is successful, the embryo is transferred back into the uterus. But even once the eggs are collected, the hormone replacement continues to help prepare the uterus for pregnancy. IVF can take a massive toll on a person, and when it does not result in a child, it can be devastating.

Even when successful, IVF increases risks in pregnancy. Those who conceive with IVF are more likely to go onto experience ovarian hyperstimulation syndrome, multiple gestations, preeclampsia, or premature labour, to name a few. There are many factors that contribute to whether or not IVF will be successful, and while we can’t control them all, we can focus on lifestyle behaviours by quitting smoking, eating a healthy balanced diet, decreasing caffeine intake, exercising regularly, and reducing stress as much as possible.

The Spotlight on RSV and Influenza

It’s finally here, not just holiday season, but flu season, the time of year when influenza virus rates are on the rise, not to mention other respiratory viruses, including rhinovirus, which causes the common cold, andrespiratory syncytial virus (RSV).  In 2019, there were an estimated 33 million cases of RSV-related infections and over 100,000 RSV-related deaths in children 5 years and under. But this year in particular, children’s hospitals are being bombarded with viruses and hospital capacities are limited. But if this happens every year, why is this year so different?

There are a few reasons why this year is different from the past. First, the outbreak of RSV has started earlier, which means our hospitals are seeing more children with RSV than usual at this time of year. Secondly, the RSV outbreak has coincided with an increased number of children presenting with influenza earlier than usual. Plus, Covid-19 is still having an impact. Typically, RSV is seen in children less than 2 years, but now we’re seeing it in older kids also. The reason for that is likely because we have seen very few cases of RSV in 2020 and 2021, in part because we were all isolating and masking from Covid-19. While this trifecta of viruses is swarming and we can’t get rid of it completely, we can take steps to keeping ourselves and our children protected. Thoroughly and frequently wash your hands, cough or sneeze into your sleeve or a tissue, stay home if you’re sick, and get your flu shot. Ultimately, if you are concerned that you or somebody that you know may have RSV, influenza, or another virus, please contact your primary care physician.

Theranos Founder sentenced to 11 Years

The Dropout, staring Amanda Seyfried as Elizabeth Holmes, is a miniseries telling the story of a young woman who drops out of university to start a healthcare technologies company, Theranos. Holmes ultimately claims to have developed a revolutionary blood testing technology that will change the entire US healthcare system. Allegedly, the blood test would be able to detect many diseases, from diabetes to cancer, with just a few drops of blood. Throughout the series, we see Holmes rise to the top and be declared the youngest self-made female billionaire and then her ultimate downfall as she gets caught having stolen other’s ideas and defrauding investors out of nearly $1 billion. The ultimate demise of Theranos and Holmes comes when whistleblowers, led by Tyler Schultz, come forward to denounce the practices at the lab. While the story seems fascinating and even unlikely, it is, in fact, based off the true story of Elizabeth Holmes. And this week we learned the story is not over, as Holmes was sentenced to 11 years in federal prison for multiple counts of wire fraud and conspiracy to commit wire fraud, to begin in April 2023.

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