Insulin is the most intimate of medications. Each day, you inject it or pump it into your body, on blind faith that it will keep you alive to do the same tomorrow. If any drug would have powerful brand loyalty, surely it is insulin.
Yet Eli Lilly’s announcement on January 11 that it would cancel construction of its $425 million insulin factory – after installing the foundation and steel beams – is the latest reminder of how the company has lost its dominant position in insulin. Eli Lilly was once the most hallowed name in diabetes, responsible, literally, for saving the lives of countless diabetics. But even revered companies can squander good will – and in my case, break ties with the most loyal of customers.
Five years ago, Eli Lilly controlled 82 percent of the U.S. insulin market; last year, its market share had fallen to 43 percent, according to IMS Health, a drug-sales tracking firm (which was cited by the Indianapolis Star.) Those numbers won’t turn around anytime soon: longer-lasting “basal insulins” – Lantus (from sanofi-aventis) and more recently Levemir (from Novo Nordisk) – have given many patients a superior therapeutic option because they are more stable and longer lasting. Eli Lilly has no product in that category. Eli Lilly was also beaten to market on inhaled insulin, which Pfizer introduced last year. (Eli Lilly’s version is still in clinical trials.)
The fortunes of companies rise and fall all the time, but few companies ever had more devoted customers than Eli Lilly’s diabetic consumers. And for good reason. While insulin was discovered by Toronto researchers in 1922, they could not mass produce the drug. But Eli Lilly, through vision, brilliance, and relentless work – the company tested its new product on more than 100,000 rabbits the last six months of 1922 – manufactured the drug that transformed a fatal disease into a chronic illness. Insulin raised the living from “the erstwhile dead,” as Elliott Joslin put it, and Eli Lilly was rightfully crowned a savior.
The company basked in its own glory. “Insulin: An Epoch in the History of Medicine. A Boon to the Human Race,” ran one of its first ads for the product, which improved over the years – from animal-based insulin, to genetically engineered, biosynthetic human insulin, to insulin analogs. These drugs earned the gratitude of millions of patients, including me.
I took my first insulin shot in 1977, so I’m not indifferent to a company that’s kept me alive for three decades. I’ve also been fortunate enough to page through the company’s voluminous insulin archives at its headquarters in Indianapolis, and several top executives helped me in my research for my book about diabetes.
But my research also taught me something else. At some point, Eli Lilly’s commitment to diabetes was eclipsed by that of other companies, particularly Denmark-based Novo Nordisk. Selling insulin is not only about how many sales reps are in the field or how large the advertising budget is (though those are both important). It’s also about making connections to families. For example, I interviewed Carol Lurie, one of the founders of the JDRF. She hailed Novo’s generous support, financial and moral, sustained since the organization’s early days in the 1970s. Novo’s top executive cared about us, she said. When I asked about the JDRF’s support from Eli Lilly, she looked at me sternly and said, “Eli Lilly doesn’t care about children with diabetes.”
When my family and I went to the Children with Diabetes Conference in Orlando in 2005, virtually all of the major diabetes vendors had large exhibits – and why not? The conference drew 2,200 people, with every parent eager to learn what products could help their children. But Eli Lilly was absent. When I asked CWD founder Jeff Hitchcock about the company, he said, “I don’t mind that they aren’t here, but I just wish they would return my phone calls.” (Eli Lilly did show up last year, seven years after the first CWD conference and long after Novo ranked first in the CWD online poll for favorite insulin companies.)
Eli Lilly, to be sure, remains in the insulin business. Among other things, it’s introducing three new insulin pens this year, including one with a memory chip. But in our own family, the company’s recent efforts to improve the bottom line had unfortunate consequences.
When my son was diagnosed in 2004, he began on Eli Lilly’s Humulin NPH, but its sharp “peak” caused him to plunge too low before lunch; so he switched to Humulin Lente, which has a “softer peak.” It worked beautifully, and I was grateful – again – to Eli Lilly. But the following year, the company announced that it was discontinuing its Humulin Lente and Humulin UltraLente insulins, which combined were used by about 66,000 patients. Garrett’s nurse told us that most of these patients were children.
I’m not naïve. I know that Eli Lilly’s top priority is to its shareholders, not to my son, so if it can make more money by eliminating these insulins, it will do so. We were able to extend Garrett’s use of Lente by scrounging for some remaining bottles, but we just emptied our last vial. In seeking a new insulin regimen, we moved Garrett to Novo Nordisk products. It wasn’t personal. We were just doing what’s best for Garrett’s health. But because it makes sense for Garrett and me to use the same insulins, I’m switching as well – a change that will mean far more to me, I suspect, than to Eli Lilly.