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It's a dilemma I'd been wrestling with for a couple of months, and friendship was winning over politics. However, neither friendship nor politics had the choice to decide.
The deciding factor was money.
Being unemployed with minimal personal income means that every penny I have must be carefully husbanded against necessities such as food, medicine, diabetes supplies, and the expenses of interviewing for a job should a potential employer show interest. We're also in a tighter spot than usual because of last month's unexpected expenses (antibiotics to treat the Jim Kirk Allergy Hand as well as the emergency replacement of our water filter) and the cost of renewing The Other Half's auto insurance.
There was just not enough money for me to make the round-trip commute, not to mention eating "on the road".
That's pretty much the issue with treating diabetes around the world as well. OK, technology and transportation infrastructure play significant roles, but the biggest obstacle is money.
There's not enough money in the world to treat every person with every type of diabetes to the highest possible standards. In 2010, the world had approximately 285 million adults with diabetes. That's not counting children with diabetes or the diabetic elderly (older than 79 years of age). According to the International Diabetes Federation (IDF), the world was expected to spend about US$376 billion to treat this population, and most of us would be hard-pressed to conclude that every one of us is receiving optimal care -- especially when many of us in so-called "developed" nations cannot get approval for (or afford) insulin pumps, CGMs, or sensors, and some of us are even having trouble getting sufficient test strips, oral medications, and basic insulin! (Let's not even get started on the hunger-poverty-food desert issues that are behind at least some percentage of the population with impaired glucose tolerance, insulin resistance, and/or type 2 diabetes...)
The Gross World Product for 2010 was approximately US$74 trillion, making diabetes expenditures about one-half of one percent of the global economy, to treat approximately four percent of its population of seven billion. Averaged evenly, this comes to about US$1300 per person with diabetes. But this is only half the picture. Raising the minimum level of expenditure to what the average European receives -- US$1900 per person, per year -- would raise global expenditures on diabetes to US$685 billion. Raising it to what is currently received in North America (which includes Mexico and the Caribbean nations) would mean spending about US$1.63 trillion. This is about US$5700 per person, more than half the per-capita world product of approximately US$10,500. Note that while these numbers include the cost of bureaucracy, they do not include the cost of infrastructure, which raises the cost of getting care to the patient in underserved regions such as sub-Saharan Africa and certain areas of Asia and Latin America.
Neither does this account for the costs of food, shelter, and basic transportation that every person requires, whether or not he has diabetes. Or the cost of education, a minimum level of which is required by United Nations charter. Or basic well-person care, which includes vaccinations, disease screenings, and medical care for issues ranging from the common cold to cholera. Or gross transportation and communications infrastructure (i.e., between nations).
There are a number of factors that can inflate or deflate diabetes-specific cost-of-care numbers, ranging from the average compensation of healthcare workers to patents restricting development of generic drugs (or on the flip side, lack of patent protection disincentivizing pharmaceutical research and development), from the economics of scale to the costs of global transportation, to the costs of regulation and bureaucracy. Thereare also a number of factors that can inflate or deflate the purchasing power of a standard dollar in any national or local economy, making (for example) the purchasing power of a $40,000 annual income in Mississipi require a six-digit salary in much of New Jersey. One must also question how much of those care-per-patient numbers are generated by treating the complications of diabetes -- or on the flip side, whether those costs are attributed to the direct symptoms (heart disease, kidney disease, blindness) rather than to the poorly-managed diabetes that causes them.
Some would argue that approximately 2.2% of the global economy is a small amount to pay for the control of diabetes. Others would argue that it's a lot to pay for a single disease, when more immediately-fatal ones might be more effectively treated at lower cost. Some would argue for diverting military expenditures to medical ones, ignoring the amount of medical and transportation technologies that were initially investigated from military necessity. The priorities of resource allocation vary from person to person, nation to nation, and each has implications well beyond the obvious.
What is obvious is that the number of people with diabetes, and the costs of treating diabetes, are rising. The IDF expects the global population of people with diabetes to rise more than 50% by 2030. Barring a series of cures for the various types of diabetes, and a series of vaccinations (and in some type 2 pathologies, lifestyle interventions) to prevent as many cases of diabetes as possible, delivering this level of care to every person with diabetes is going to require the development of significant economies of scale, reduced costs of development and time-to-market, improved transportation infrastructures, and a corps of trained personnel to help people with diabetes manage their health.
This week's UN summit is aimed at getting governments to commit financial resources to these needs. As a libertarian, I'd rather governments stay out of the way of the pharmacists, researchers, and manufacturers whose financial interests lie along the same lines. Either way, if you're on the front lines, current commitments to making our medical care more accessible and affordable are not enough.
Michelle Kowalski, a writer, editor and photography hobbiest living in Phoenix, was diagnosed with Type 2 diabetes in February 2005. In January 2008, as part of her quest to start on an insulin pump, Michelle learned that she actually has type 1 diabetes. (Read More)
Nicole Purcell lists having type 1 diabetes last when she's asked to provide information about herself - because that's where it belongs. (Read More)