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This article appears in the Summer issue of The American Prospect magazine. Subscribe here. On June 22, , Alec Raeshawn Smith, a recently promoted restaurant manager with Type 1 diabetes, left his local pharmacy empty-handed. He and Smith-Holt had combed through Minnesota's Obamacare marketplace for months in search of a decent plan, but the affordable ones all had sky-high deductibles.

Breaking Free (How Chains From Childhood Keep Us From What We Want)

That meant that he'd be paying full price for his insulin for months before his junk insurance kicked in, on top of hundreds of dollars in monthly premiums—sucking up some 80 percent of his take-home pay once he paid the rent. So he made a rational decision: He'd go uninsured, save the cost of the premium, and just pay for his meds out of pocket, while racking up work experience that could serve as a springboard to a better position with health insurance.

Perhaps he felt embarrassed, too proud to borrow money so soon after finally moving out of his parents' place. Perhaps he didn't want anyone to worry about him, and figured he could keep his blood sugar down until payday. So he left. He never told his mother and he never told his girlfriend. Five days later, he was dead. The autopsy later determined the cause of death to be ketoacidosis, a complication of diabetes typically brought about by not taking insulin. Recounting hearing the news of her son's death, Smith-Holt didn't quite put everything together at first, wondering if Alec had inadvertently taken too much insulin, inducing hypoglycemic shock.

And he was amazed by how many pens looked like they had been tampered with … like he was trying to extract whatever little bit was left in them. In the two years since her son's death, Smith-Holt has fought alongside diabetes patients and their allies to make insulin the public face of the drug-pricing crisis. It's a story of what happens when a country delegates both the provision and financing of lifesaving drugs to an oligopolistic private industry, and then prioritizes that sector's business interests above patients.

If the grassroots organizers of the insulin4all campaign get their way, it will become the story of how the diabetes community can force a political reckoning with the ever-rising prescription drug costs that dominate their lives. Likely cases—judging by a telltale constellation of symptoms including weight loss, frequent urination, and insatiable thirst—are speckled throughout medical texts dating back to antiquity, but were virtually untreatable until the 20th century.

Fortunately, a modern diabetic's outlook is far sunnier. A patient can expect to live for decades if their disease is properly managed. For seven million Americans, treatment entails several daily doses of insulin, a synthetic version of the hormone excreted by a healthy pancreas. For Type 1 diabetes patients, uninterrupted access to insulin is especially critical. Their health outcomes depend heavily not only on taking proper doses, but on minimizing variance between blood sugar levels—an imperative that demands a vigilant routine of measurement and monitoring, often facilitated by supplies and multiple variations of insulins.

It's not a game that T1 patients can opt out of: Just a few days without insulin can be deadly, or trigger severe complications like gangrene or renal failure. But its crippling cost makes a mechanized routine increasingly difficult to pull off. Most T1 diabetics use two or three vials of fast-acting insulin a month, plus a secondary basal insulin, on top of any necessary supplies.


But the wholesale prices of the most common insulins tripled from to The three pharmaceutical companies that manufacture insulin—Lilly, Novo Nordisk, and Sanofi—rake in billions in profits annually from insulin sales alone, with the U. Media coverage tends to frame skyrocketing insulin prices as a betrayal of the miracle drug's origins, the definitive account of which was offered by historian Michael Bliss in his classic The Discovery of Insulin.

That included a pharmaceutical company in Indianapolis called Eli Lilly and Company, which had expressed interest in manufacturing insulin for humans as soon as they caught wind of the Toronto team's research. Having refused to cooperate with Lilly, Banting and his colleagues believed they were protecting future access. Determined to prevent insulin from becoming a business racket, the Toronto team kept Lilly at bay through months' worth of repeated attempts to collaborate.

The university had been doing its best to manufacture insulin on its own, but struggled to meet the demands of even the small group of patients participating in early trials. Last week, the World Health Organisation formally recognised the existence of complex post-traumatic stress disorder, a condition from which it is thought many survivors of childhood abuse suffer. They may struggle with managing their feelings, trusting others, and with feelings of shame and inadequacy holding them back in school or working life.

Four in 10 had difficulties with relationships, with some avoiding sexual intimacy altogether, while others had multiple sexual partners; some suffered difficulty eating or sleeping, were dependent on alcohol, or were drawn into crime.

One in five had tried to kill themselves. Surprisingly, other research has shown survivors are at greater risk of illness, including heart disease and cancer, with years of chronic stress taking a physical toll on their bodies. But if a new technology, drug or junk food were doing such damage, it would be classed as a public health emergency. It is striking, then, that the toxic legacy of child abuse gets less attention than theories about whether social media makes teenagers anxious or skinny models fuel anorexia.

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Kaiser remembers clearly the bedroom where it all started; at the top of the four-storey house she shared with her mother and five siblings her father died when she was a toddler. After an older sister ran away from home, the room was left empty — and supposedly out of bounds — but she would sneak up. One on the train robbery, and a book about Tutankhamun.

Over the next six years, she told the Truth Project, she was assaulted by three other men, both in Britain and when visiting Pakistan. She always felt that to tell would put her mother in danger. Those lines were not blurred at any time. Nobody saying stop. That was a no-go area. It was as if there was a place for men, and those men have their reasons.

As she got older, she drew on her experience as a British Asian straddling two cultures to separate herself from what was happening. The girl at home enduring unspeakable things — withdrawn and always frowning — became separate from the popular, more assertive girl at school. It was a school sex education lesson at 13 that finally provided words for what was happening.

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She walked out in the middle of it, and not long afterwards summoned the courage to tell her mother. I sat down on this little cushion by the gas fire and started to tell her. That way I have something easy to start out with, and I'm less tempted to do something else first.

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Several Redditors highlighted the importance of exercise for beating laziness, particularly when you do it first thing in the morning. As hackday puts it , "Once you get your blood pumping, you will realize that you feel wakeful and energetic instead of sleepy and lethargic. That could potentially explain why we're less inclined to log onto Twitter while sitting in a coffee shop full of people who seem super-focused. For example: "If you schedule time at the gym with a friend, you'll have more motivation to actually get up.

If you're thinking about getting an accountability buddy or group, take a few tips from productivity expert Laura Vanderkam. Writing in Fast Company , Vanderkam recommends picking people with a track record of achieving difficult things and communicating with them frequently.

Here's a tip that's particularly useful for those who work remotely. If you can't find the energy to stop futzing around on Facebook and start writing your project proposal, consider changing out of those stained sweatpants. Shoes and all, as if you were going out, even if you don't.