Looting as a window into our healthcare system

When pharmacies are looted, what do people take?

Protests over the past few weeks about racism and police violence have inspired reflection and behavior change across the country (and hopefully continue to remain a catalyst for more change). One of the common objections to the protests focuses on looting - perpetuated by only a tiny percentage of protesters - that seems to be considered a mark of a peaceful protest that’s become a riot.

Before the last few weeks, I hadn’t really spent much time considering looting as anything more than a crime. It seemed obvious that looting was bad and that was all the thought I gave to it.

It turns out that like most things in life, if you dig even a little bit below the surface, you’ll quickly learn that there are layers of depth and nuance to something seemingly straightforward.

This article from the Atlantic noted a few different phenotypes of looters:

  • Looting to send a message - destruction of property or theft as a symbolic exercise

  • Looting as lashing out - anger manifesting as behavior

  • Looting to balance the scales - the stores have insurance and will be fine whereas the people on the ground have been taken advantage of by society

  • Looting as empowerment - a small way of taking power back when the predominant emotion is an overwhelming loss of control over a situation or a system

  • Looting to be heard - when peaceful protests don’t grab attention, violent ones always seem to get on the news

In Baltimore, impact on a CVS seems to have become a flashpoint that drew lots of attention. I’ve seen article after article describing pharmacies across the country have been impacted.

But this article on pharmacy looting in Philadelphia really struck me because of what it says about our healthcare system and our country’s medical issues. In Philadelphia, more than a third of pharmacies were looted. So when a pharmacy gets looted, what do people steal?

Insulin and suboxone.

I would have guessed that people would steal things like oxycodone and Xanax. Things that you can sell on the street and that get you high.

Why are they stealing insulin?

Stealing insulin? Come on, that can’t be.

Well, we live in a country where there are over 100 million diabetics and striking inequality. The price of insulin keeps increasing and is becoming unaffordable for many people who need it.

And we cannot ignore the fact that there are real racial differences when it comes to diabetes.

The epidemic of metabolic dysfunction is a real part of why people even need insulin and certainly why they are stealing insulin from pharmacies. I wrote in this newsletter last week about metabolic syndrome and how less than 1 in 8 Americans have excellent metabolic health. Diabetes and the need for supplemental insulin is just the end result of uncontrolled metabolic syndrome.

So we live in a country where we have millions with diabetes - 1 in 3 Americans! - and insulin becomes increasingly unaffordable. We have worsening financial inequality and racial stratification. Diabetes is concentrated among the poor and among racial minorities.

As I think about it more, the only surprising thing about the theft of insulin is that I was surprised at all. It’s a microcosm of our state of health and the state of our healthcare system.

And what about Suboxone?

Suboxone is a combination of two medications - buprenorphine and naloxone - and is one of the most important treatments for opiate addiction.

Its theft is just as illuminating as the theft of insulin.

I know that article after article has been written about the opiate epidemic in America. But when you think about the numbers for even a few minutes, it becomes a bit numbing to consider.

More than 70,000 Americans died of an opiate overdose in 2017. Those numbers are surely higher today.

This is more people than die of every cancer except lung cancer. It’s about half as many as die from stroke. More than twice as many as die in car crashes.

And while opiates tend to get covered in the media as a problem of rural white America, addiction is a color blind medical problem that has its own set of racial disparities.

Just like insulin, it’s a microcosm of the state of our health and our healthcare system uncovered through looting.

Time for us all to wake up. Rather than just criticizing the looters (and I want to make it clear that I’m not defending them!) we should also use this as a teachable moment to catalyze real change.

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