Refugees of the American Dream

by Howell J. Malham Jr.


It's 600 miles to the border.

And to the promise of a healthier, happier life for themselves, for their children — a life they can afford.

Unlike the journeys of other hopeful refugees around the world, this is not a one way trip. These refugees, in their own, makeshift "caravan," according to a recent article in Newsweek, will cross the border, find the nearest pharmacy, purchase a supply of affordable insulin pens, then turn around to make the 600 mile-trek back to their own state, in their own country:: The United States of America.

While other refugees are dying — quite literally — to cross the southern border into the United States with expectations of a better life, other refugees, American refugees, are dying to cross the northern border into Canada to escape the tyranny of the pharmaceutical industrial complex in the U.S.

Who can blame them?

Many of these folks suffer from type 1 diabetes. If they aren't sufferers themselves, then they're in search of insulin at affordable prices, humane prices, for someone in their family with type 1.

“Some have struck a deadly compromise:: ration their insulin. As a result, many of them have died. “

The group behind these insulin missions is known by its hashtag, #Insulin4All. The website,, has a disturbing litany of facts on its homepage. Perhaps the most shocking data point: "Since the 1990s, the cost of insulin has increased more than 1,200%."

Yes. 1,200%.

How does this break down in terms of dollars and cents? According to one of the sources in Chantal De Silva's excellent piece in Newsweek, five insulin pens can cost around $700 [in the United States.] In Canada, the same amount of insulin costs $65. It's even cheaper in countries like Italy, Greece and Taiwan.

As 40,000 people receive a type 1 diagnosis every year in the United States, according to the American Diabetes Association, more and more Americans are being forced to make an impossible choice:: spend a chunk of their monthly nut on insulin or pay their rent and buy their food.

Or make a run to Canada.

Some have struck a deadly compromise:: ration their insulin as one in every four diabetics has had to do to cover costs. As a result, many of them have died.

Needlessly. Pointlessly.

It’s a cruel irony. Frederick Banting, Charles Best and James Collip, the trio who discovered, designed and refined insulin therapy, each received a single dollar from the Board of Governors of the University of Toronto in 1923 in exchange for the full patent rights to the drug itself. Their collective intent was to make sure all not some who suffered could access this miracle cure.

It was a noble gesture. And a wasted one.

Some fifty years later, the price of insulin began to rise sharply once Big Pharma figured out how to produce something known as “synthetic insulin.”

Insulin is now a billion-dollar industry, redounding to the profit of the few, and the bane of the many.

Price matters for a couple of important reasons. According to the T1 site, 8.8% of Americans are, at present, uninsured. Nearly half of Americans hold high —  very high — deductible plans.

It’s not hard to see how spending on insulin for type 1 diabetics doubled from 2012 to 2016. The difference between spending $2900 and $5700, according to T1 International.

Price matters for another reason. Something we call Limits.

It’s one of the six innovation lenses we use to design better, smarter questions that allow us to identify social norms in an effort to understand how to deviate from those norms to drive innovation. Limits, as we define them, are the formal, explicit constraints related to a social problem. They are all around us:: Budgets. Deadlines. Calories. Target heart rates. And, in this case, the astronomical market price of insulin for Americans.

Limits — regulations of any kind — are rarely seen as something to be added to a social challenge. Yet when we dare to imagine alternate or new kinds of limits, we can begin to imagine new kinds of behavior that will help us tackle and solve a social problem.

In this case, a limit has already been imposed by Eli Lilly, Novo Nordisk and Sanofi, known as the “big three” insulin producers, who, according to T1 International "dominate more than 90% of the world insulin market by value."

And the new behavior that is emerging as a result of this crushing limit? Americans fleeing their country, for now temporarily, in search of another dream. A better, more affordable dream:: the dream of five insulin pens for $65 instead of $700.

For now, we would consider this to be a deviation from the old norm of biting the bullet and paying full market price at a chain drugstore in one's own country.

But as nobody sees the cost of life and living it for T1 sufferers and their families going anywhere but up, we may very well be witnessing the birth of a social innovation in response to a limit that is offering Americans no other choice but to flee the country albeit temporarily, as this behavior diffuses among members of the growing diabetic community.

A tiring and time-consuming innovation to be sure, but one that is highlighting the need for another kind of innovation, more remarkable than the one Banting, Best, and Collip gave to the world when they invented insulin, and “sold” it for a mere three Canadian dollars.

It requires removing a limit; namely the need for that particular drug at any price. The question then becomes, How do we treat T1 in America without insulin? Remarkably, scientists at the Penn Institute for Diabetes are working with that new constraint to find an answer:: Pancreatic islet cell translations.

According to an article in Penn Medicine News, “transplanting purified human pancreatic islet cells into type 1 diabetics can lead to nearly normal glycemic control.” Further, those who undergo the procedure will no longer be reliant on insulin.

In Australia, Great Britain, the European Union, and, not surprisingly, Canada, this is already standard operating procedure for T1 diabetics. It has yet to be approved by the Federal Drug Administration in the United States.

But if it is approved, and once again priced well out of the reach of those in need, the refugees of the American dream will still be crossing into Canada in search of affordable insulin in a country where social values are the bottom line.

Not because their own country can't fulfill the dream of a healthier, happier life for them and their children in America, but because it won't. ::

—Howell J. Malham Jr.