4
COMMUNITY
THE WEST END NEWS | MAY 2020
The High Cost of Insulin – A Case Study By Dr. Oren Gersten
The Corona Virus is getting plenty of media attention these days, and rightly so. However, life goes on and all the ailments that were present before Corona are still present now. Instead of rehashing old points about COVID this column is dedicated to a different subject—the high cost of insulin. To illustrate a few points, I will be using a patient of mine as a case study. This is done with her permission. This person (we will refer to her as “M”) has type 1 diabetes. This is also known as insulin dependent diabetes, because without insulin a type 1 cannot survive. People become type 1 diabetic when their pancreas stops working. It has nothing to do with diet, or exercise, or being overweight. It is simply a combination of genetics and poor luck.
the monthly insulin expense for diabetics at $35. The problem here is that the law only applies to people with “state regulated commercial insurance.” Unfortunately, “M” is one of the many Americans who is currently un-insured. The other day we ran into another medical systems problem. “M” needs an endocrinologist—or diabetes specialist— to manage her insulin pump. Most type 1 diabetics are co-managing this way with a specialist and a primary care doctor. Despite her clear need it was difficult to find a specialist willing to help us. There is at least one private practice locally that refuses to take any un-insured patients (even those willing to pay for the service with their hard-earned money). Mercy apparently has a policy where they don’t accept “outside referrals,” meaning that they will only help patients with a primary care doctor who works for their system. We finally found an office willing to help on our third try.
“M” controls her blood sugars using an insulin pump. This piece of equipment is a small computer that delivers insulin to a patient, approximating what a healthy pancreas would do.This pump needs to be I have spent hours helping to coordirefilled with insulin a few times a month. As a primary care doctor part of my job nate care for “M” for things that should be is to write the prescription for the insulin. built into our system. Delays in care lead to patient harms. We know that patients This month I sent the prescription to just like her are forced to ration mediWalgreens and the patient was surprised cation because the cost is unaffordable. to find the cost to pick it up was $304. Although progressive laws like LD 2096 Remember, this is a life sustaining pre- are a step in the right direction, they often scription that the patient will need every leave out those who are most vulnerable month for the rest of her life. As a doc- to high costs—the uninsured. tor I know that this is not a fair price for We need to do a better job as a health this medication. I was able to contact the system to make affordability the norm, pharmacy and pull a few strings and recnot the exception. We need to increase ommend that the pharmacist apply a couthe cooperation among health systems so pon to reduce the cost to $68, something people are not excluded based on who the pharmacist should have been able to they work for. We need to support pawork with the patient on without my intients with chronic disease, so they don’t tervention. face the additional stress of navigating an Episodes like this happen every day in un-necessarily complicated health system pharmacies across the country. It is such a on top of taking care of themselves. We problem that Maine joined several other owe this to our patients and the people states in passing legislation to put a cap on who are doing their best to take care of out of pocket insulin costs. LD 2096 caps them. Oren Gersten is a board-certified family doctor who brings his passion for connecting and caring for people to his private practice, Portland Direct Primary Care, at 27 Ocean Street, #3, South Portland. Reach him at (207) 618-9792 or visit the website at PortlandDirectCare.com.
LA VIDA LOCAL: IRREGULAR NOTES ON WEST END LIFE
VIEW FROM THE THIRD FLOOR By Rosanne Graef I’ve been spending a lot of time at home lately (no surprise). I’m lucky to live on a corner on the side of a hill, affording both near and distant views from the various windows of our apartment. This being The West End News’s annual garden issue, I’ll start with some botanical observations from this perch. Fortunately, the stay-at-home order came in spring rather than the darkening days of November. Looking out in all four directions at the brightening parade of plants of an awakening spring is always uplifting, especially so during times like these. First to unfurl its buds is the pink star magnolia in our backyard. Along come the brilliant blues of glory-of-the-snow and scilla, royal purple and golden yellow of crocus, and next the splashy hyacinths, tulips, and daffodils. Then buds of forsythias and flowering crabs expand into clouds and fountains of pink, white, and yellow blossoms. Several windows face south toward bird feeders still hanging in the magnolia tree. Surprisingly, we’ve been visited lately by the first tufted titmouse since winter 2019. Maybe it’s that tuft, but they always seem to be such chipper and perky little birds. Pigeons have newly appeared in our yard, perhaps because a roof top is accessible next door since the removal of a large tree last fall. On fine afternoons, a dozen or so pigeons congregate along the ridge pole and down the slope of the roof to sunbathe out of the wind off the Fore River. Meanwhile, the seagulls just circle, climb, soar and glide effortlessly, no wing flapping necessary. What fun to sail through the air, go bob along the waves in the river with your pals, and cap it off with a spell of squawking from a chimney top!
First Geranium bloom of spring.
-Photo by James Fereira
other climbers, and others with assortments of flowers, vegetables, and artfully placed decorative items and edgings. The installation and maintenance of gardens and their accoutrements results in what I call The Gardener’s Stare (TGS). TGS is not limited to denizens of this community garden, rather it is shared by gardeners everywhere and is a particularly endearing behavior to observe. Exhibited often in the early gardening season, TGS is characterized by the arrangement and rearrangement throughout the garden plot of plants still in pots or removed from their containers, but not yet planted. Each short flurry of activity is followed by an extended period of time spent standing and staring at what has just been accomplished. After a suitable contemplative assessment, plants may be installed in the soil, or, if found unsatisfactory, the whole exercise may be repeated several times. TGS continues throughout the gardening season for some practitioners, however, and consists primarily of making some minor adjustment to the placement of a rock or garden gnome. Be on the lookout for TGS in your neck of the woods.
This is the city and there are people to watch as well, especially in the community garden across the street. Every gardener has their preferred methods, plants, and sense of style.There are permaculture Rosanne Graef is a West End resident. plots, some plots feature intricate and im- Readers may reach her by email at pressive sculptural supports for beans and lavidalocalwen@gmail.com.
SUBMISSIONS WEN is a community newspaper and we need your voice!
Community Leaders Business Owners Artists & Other Interesting Folk of Southern Maine
Podcast available on Apple Podcasts Google Podcasts and Spotify
Share your submissions with thewestendnews@gmail.com or send to: West End News Attn: Editor 795 Congress Street Portland, Maine 04102 • Letters to the editor should be no more than 300 words. Include your name, neighborhood, and phone or email for confirmation. • Op-eds should be no more than 650 words and include a brief biography of 1-2 sentences. • WEN also accepts poetry and photo submissions. Deadline for publication is the fourth Friday of every month. Our column space is very limited, publication is not guaranteed, and submissions may be edited for length and content. Thank you for your voice!
