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If the old insulin works just as well, and is basically free, why is everyone paying through the nose for the newly patented stuff?

"old insulin" pre-~1980 was made from grinding up animal (cow, pig) pancreas and extracting a tiny amount of pure insulin through a chemical extraction process. Wikipedia posts a ratio of 2 tons of animal matter to 8 oz of insulin. It was "easy" but didn't scale up very well.

because they dont make it anymore

They do, you can still buy it for cheap. It's not the same though, the new stuff works much faster.

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