Trash Into Treasure? The Afterlife of Insulin and Test Strips
Why focus on a disease for which there is no cure, when there are no resources available to treat it? For many people in poor countries, Banting and Best’s innovation, and development of life-saving insulin, might as well not exist.
Those who pay attention to such things know that diabetes and its complications cost people in the U.S. a lot of money. We spent $245 billion dealing with the disease in 2012, according to a recent American Diabetes Association report.
Is this a big problem? Sure. But, as a percentage of our overall health costs, it’s trivial compared to the potential impact of diabetes on budgets in low and middle-income countries like Bangladesh and Egypt. In the developing world, including China and India, the disease is exploding and treatment costs could consume substantial portions of the entire national budget for health care.
That assumes, of course, that the disease is addressed at all. In many parts of the world, clinics and hospitals are so overwhelmed by the need to treat infectious diseases like tuberculosis – conditions that have been eradicated in wealthier nations – that virtually no attention, or very little, is devoted to diabetes. Why focus on a disease for which there is no cure, when there are no resources available to treat it? For many people in poor countries, Banting and Best’s innovation, and development of life-saving insulin, might as well not exist.
If you understand this Catch-22, then you understand the mission of Insulin For Life, USA (www.ifl-usa.org). An outgrowth of Insulin For Life Australia, a not-for-profit organization started in 1999, IFL USA, also a not-for-profit, collects donated in-date diabetes supplies, including insulin, test strips, and glucose meters, and sends them to clinics and healthcare providers in places like Ghana, India, and the Philippines. Between September 2012 and February 2013, IFL USA collected 20,000 milliliters of insulin to distribute to those in need overseas. That is about 680 U.S. fluid ounces of medicine, a quantum leap over previous 6-month periods for the young organization (in this country, at least), but still a small amount compared to the need. Limited supply means the foundation must decide where the donated insulin can do the most good. With so much need, these are hard choices.
Running Insulin For Life USA isn’t going to make anyone rich (more on this below), but it is the passion of Mark and Carol Atkinson. Mark, a PhD who is a Professor of Pathology and Pediatrics, and Eminent Scholar for Diabetes Research, at the University of Florida in Gainesville, is President of the 501(c)3, organization. He travels constantly for causes related to diabetes including that of raising IFL USA’s profile, while Carol, his wife of 30 years, runs day-to-day operations. The Atkinson’s have traveled widely, and a trip to Haiti more than 15 years ago (they have returned 15 times since) sparked their interest in helping the world’s poor receive quality diabetes health care.
Backed by the Helmsley Foundation, among other supporters, the couple has attracted a blue-ribbon Board of Directors, including Dr. Francine Kaufman, a renowned pediatric endocrinologist who is also Chief Medical Officer of diabetes pump giant Medtronic. Dr. Kaufman also spends much of her time attempting to improve the care of those with diabetes in the world’s poorest countries.
While Dr. Atkinson beats the drum to raise awareness and support, Carol deals with the messy details of finding, verifying, and actually getting supplies to their intended destination. Insulin For Life USA only donates supplies to clinics and healthcare providers, never to individuals. There is a lengthy formal application process required to become a recipient, and in many cases the distribution to those in need is verified by personal visits, either by the Atkinson’s or doctors they work with, which is the case with India. Validating the worthiness of the recipient is just part of a complex, at times frustrating, process. We take instant email communication and guaranteed package delivery for granted. Neither is easy or certain in many parts of the world. “Our conversations with providers are done by email,” says Carol Atkinson. “Often, there are long gaps between a request to them and their response, so I have to be patient and understand the conditions they operate in.”
Supplies Are Just Like Money
A lot of diabetes test strips in the U.S. go unused, for a variety of reasons, (some estimates put the number as high as a million boxes or vials each year) and people who have had diabetes for a long time sometimes show off their collections of old glucose meters. At an ADA-estimated $350 to $900 per month to treat diabetes, insulin isn’t cheap, and the cost is astronomical compared to average incomes in many parts of the world. While still in-date, these supplies are valuable commodities, and there is an active aftermarket for surplus. Enter “surplus insulin supplies” in Google and you will get 6,860,000 results in .26 seconds. It’s obvious that there are many ways to dispose of medicines or testing supplies no longer needed, and there are many legitimate groups, such as ChildrenWithDiabetes.com, to whom donations can be made. There are also many not-so-reputable places, even some with not-for-profit designations, where one person’s surplus becomes another person’s income.
Insulin For Life Australia holds down 9th place on the first page of Google’s display of search results for “surplus insulin supplies.” As a relatively new organization, Insulin For Life USA is barely on search engine radar right now. Yet the work ahead doesn’t dismay either Mark or Carol Atkinson. “We realize we have a very steep hill to climb and have our hiking boots on,” says Carol. “And we are marching upward.”
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