I wish to thank Giugliano et al. (1) for their thoughtful comment on our insulin analog debate. We clearly intended to provoke much discussion about the choices faced by physicians who are implementing intensive insulin therapy in the current political environment.
As I stated in my article: “Clearly, patients are paying for the gamesmanship between the government regulatory bodies and big pharma politics” (2). And, in the current state of affairs, it is mainly the patients in the U.S. who are carrying the brunt of the global insulin costs as Giugliano et al. document. As a physician in full-time private practice, I struggle every day at the ground level with the harsh realities of the ever-increasing cost of all types of insulin my patients are forced to pay. However, as their physician I owe it to them to do my utmost to provide the best and safest way to treat their diabetes. After all, I swore the Oath of Hippocrates (“… I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous …”), which clearly delineates my duty to benefit my patients and not the executives of insurance or pharmaceutical companies.
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Duality of Interest. G.G. has received research funding from and has served on speakers’ bureaus of Eli Lilly, Novo Nordisk, and Sanofi. No other potential conflicts of interest relevant to this article were reported.
