ONE WILD WORLD — NEWSLETTER

Issue #017  |  Things Companies Don’t Want You to Know  |  April 2026

In 1923, three Canadian researchers sold the patent for insulin to the University of Toronto for one dollar each. They believed it belonged to the world. A century later, three pharmaceutical companies control 90% of the global insulin market — and Americans are rationing the drug, and dying, because they can’t afford it.

BY THE NUMBERS

In the winter of 1921, in a cold attic laboratory at the University of Toronto, a young surgeon named Frederick Banting and a medical student named Charles Best pulled off one of the great medical breakthroughs of the twentieth century. Working under the supervision of Professor John Macleod, and joined later by the biochemist James Collip, they isolated a hormone from the pancreas of dogs that could be used to treat diabetes. They called it insulin.

Before insulin, type 1 diabetes was a death sentence. Children diagnosed with the disease typically lived for a few months on starvation diets that hovered around 400 calories a day. Most died within a year, emaciated, before puberty.

In January 1922, the team injected a dying 14-year-old boy named Leonard Thompson at Toronto General Hospital. Within 24 hours, his blood sugar normalised. Within weeks, he had gained back the weight he’d lost. He lived another 13 years — not from diabetes, but from pneumonia. The age of insulin had begun.

And then Banting, Best and Collip did something almost unthinkable by the standards of modern medicine. In 1923, they sold the patent for insulin to the University of Toronto for one dollar each.

For the first sixty years after Banting’s gift, insulin was relatively cheap. The original drug was extracted from the pancreases of cows and pigs slaughtered for meat — a by-product of the meatpacking industry. By the late 1970s, a vial cost only a few dollars.

Then, in 1978, scientists at Genentech successfully used recombinant DNA technology to produce synthetic human insulin in genetically modified bacteria. Eli Lilly licensed the technology and brought the first synthetic insulin, Humulin, to market in 1982. It was a genuine medical advance — cleaner, more consistent, and free of the allergic reactions that occasionally plagued animal insulin.

It was also the moment the patent gates reopened. Each subsequent reformulation — long-acting insulin, ultra-short-acting insulin, premixed insulin, insulin pens, insulin pumps — came with new patents and new exclusivity periods. The result is what economists call “evergreening”: a steady stream of small, patentable modifications that each restart the monopoly clock for another decade or two.

Today, three companies — Eli Lilly, Sanofi, and Novo Nordisk — manufacture roughly 90% of the world’s insulin. Between them, they hold the active patents on virtually every modern analog insulin in clinical use. They have, between them, repeatedly raised the list price of insulin in lockstep with each other. Between 1996 and 2017, the price of Humalog in the United States rose from $21 a vial to $275 a vial — an increase of more than 1,200%, during a period when the underlying drug remained, chemically, almost unchanged.

Alec Raeshawn Smith was 26 years old when he died on the floor of his apartment in Richfield, Minnesota, on 27 June 2017.

He had been diagnosed with type 1 diabetes at the age of 24. He was a restaurant manager. He had a job, an income, and — until shortly before his death — employer-sponsored health insurance. When he turned 26, he aged out of his mother’s plan. The cheapest insurance he could find had a $7,600 deductible. The list price of his monthly insulin and supplies came to about $1,300.

He decided to ration. He stretched his last vial as far as he could while waiting for his next paycheque. He died of diabetic ketoacidosis three days before payday. His mother, Nicole Smith-Holt, found him in his apartment. The empty insulin pen was on the floor next to him.

Here is the part that is hardest to defend. The same vial of Humalog that costs around $98.70 in the United States costs roughly $7.50 in the United Kingdom, $12 in Germany, and $11 in Canada. The drug is identical. The factories are often the same. The companies are the same. The only thing that changes is the country it’s shipped to.

The reason is simple. In every other wealthy country on Earth, governments negotiate drug prices directly with manufacturers, and they refuse to pay American prices. In the United States, until very recently, federal law explicitly prohibited Medicare from negotiating drug prices at all — a provision inserted into the 2003 Medicare Modernisation Act after intense pharmaceutical-industry lobbying.

Things have shifted slightly. In 2022 the Inflation Reduction Act capped insulin co-pays at $35 a month for Americans on Medicare. In 2023, under public pressure and a wave of state-level lawsuits, Eli Lilly, Sanofi and Novo Nordisk announced they would voluntarily cut list prices on several insulin products by up to 70%. It was a meaningful concession. It was also, in the words of one healthcare economist, “about a quarter-century late.”

None of this changes the underlying fact. The list price of insulin in the United States is still multiples of what the rest of the developed world pays. The companies that produce it still report tens of billions of dollars in annual revenue from a drug whose original inventors gave it away.

Frederick Banting died in a plane crash in Newfoundland in 1941, at the age of 49. He never made meaningful money from insulin. He spent most of his career as a research scientist on a modest salary, was knighted by the British Crown, and donated much of his Nobel Prize money back to research.

In the archives of the University of Toronto, there is still a copy of the original patent assignment from 1923. It is signed by Banting, Best, and Collip. The transfer fee is recorded in the document, in plain handwriting:

That is the entire price they charged for the most important diabetes drug in human history. They believed, correctly, that they had been entrusted with something that did not belong to them. They believed, also, that the world would honour the spirit of the gift.

It did, for about sixty years. Then it didn’t.

A dollar bill from a Toronto attic. Three companies controlling 90% of a global market. A 26-year-old dying on his apartment floor three days before payday. And a century-old promise, in handwriting, that almost nobody honoured.

Insulin doesn’t cost $300 a vial. It costs whatever the people who own the patent want it to cost.

SOURCES

Bliss, Michael — The Discovery of Insulin (University of Chicago Press, 1982; reissued 2007)

Nobel Prize Committee — “The Nobel Prize in Physiology or Medicine 1923 — Banting & Macleod”, nobelprize.org

Greene, Jeremy A. & Riggs, Kevin R. — “Why Is There No Generic Insulin? Historical Origins of a Modern Problem”, New England Journal of Medicine (2015)

Cefalu, William T. et al. — “Insulin Access and Affordability Working Group: Conclusions and Recommendations”, Diabetes Care, American Diabetes Association (2018)

Herkert, Darby et al. — “Cost-Related Insulin Underuse Among Patients With Diabetes”, JAMA Internal Medicine (Yale, 2019)

Centers for Disease Control and Prevention (CDC) — National Health Interview Survey data on insulin rationing (2022)

Smith-Holt, Nicole — testimony to US Senate Finance Committee on insulin pricing and the death of Alec Smith (2019)

T1International — #insulin4all advocacy data and US insulin price comparison reports

RAND Corporation — “International Prescription Drug Price Comparisons”, prepared for the US Department of Health and Human Services (2021, updated 2024)

Eli Lilly, Sanofi, Novo Nordisk — list-price reduction announcements and SEC filings (2023)

US Inflation Reduction Act of 2022 — Public Law 117-169, insulin co-pay provisions