An Apple A Day

An Apple A Day

Yes, it seems that a day doesn’t go by when there isn’t yet another story about Apple’s jump into the diabetes pool. Social media is all agog over a story that Tim Cook Apple CEO has been personally test driving Apple’s latest way cool whiz bang toy a wearable glucose monitor. Now before we go on here let’s be clear we do not know Mr. Cook and have never meet him. Nor do we care very much that he is personally test driving his company’s latest gadget. Yet we are obviously in the minority here as everyone seems to believe that since Mr. Cook is test driving Apple’s latest toy that it works and it will be a major hit.

As we have been noting these past few days Apple worshipers those Apple devotees who awake each morning and pray at the Apple altar believe the company has succeeded where everyone else has failed. That this way cool whiz bang toy will succeed because it’s coming from the all mighty Apple.

Now we hate to be the worm in the apple but a few facts, yes, we know facts are pesky little things but it may be wise to consider them. First and foremost, this way cool whiz bang toy has not been approved by the FDA, heck as far as we know it hasn’t even been submitted to the FDA. This may seem inconsequential to some but getting any device through the FDA is no small feat just ask our friends at Abbott (NYSE: ABT) who are have dickens of time getting their way cool whiz bang Libre through the FDA.

Ok let’s say Apple makes it through the FDA, this is no way means that they can manufacture these way cool whiz bang toys in scale and do so consistently. Why do we bring this up? Well it seems our friends in Northridge Medtronic (NYSE: MDT) are having some issues manufacturing their new sensor. Social media is filed with stories of patients who have been told that they must wait months for new sensors, that these sensors are on back order. It seems that Medtronic is having a fairly serious scalability issue.

Of course, Apple won’t have scalability issues because they are after all Apple. And it goes without saying they won’t have any issues selling this way cool whiz bang toy either. That Apple pickers will line up at the Apple orchard to buy this latest way cool whiz bang toy. Never mind with a little thing called reimbursement, something this device will not have unless it’s approved as a replacement for not and adjunct to conventional finger sticks. No in the Apple orchard Apple pickers pay cold hard cash for their way cool whiz bang toys.

What about competition yes, we know that Apple pickers don’t think such things but we certainly do. And while these pickers may believe Apple has no competition there is this little company located a few hours south of Apple that just so happens is partnered with a slightly bigger company that’s right in Apple’s backyard. Dexcom (NASDAQ: DXCM) not only has the best damn sensor on the market and is widely considered the gold standard for glucose monitoring they also are working on a neat new slap it on turn it on forget about Band Aid like sensor with Google.

Dexcom has PROVEN they know a thing or two about glucose monitoring, they also know how to get a device through the FDA plus they don’t have any scalability issues. Now they may not have the cash hoard to match Apple’s massive pile of cash but Google is no slouch when it comes to having cash on hand. And while Apple pickers seem to ignore this pesky fact Google’s Android operating system is now the dominate operating system leaving Apple’s operating system in the dust.

We’re likely the only ones who see it, likely because we do not awake each morning and pray at the Apple altar, but the Dexcom/Google sensor has another advantage over the way cool whiz bang Apple toy. An advantage that may seem ironic – design. Now there is one area where we violently agree with Apple pickers Apple is outstanding when it comes to design, there is no disputing this fact. However, it is also equally true that they no experience whatsoever in this wacky world and while that may seem like a plus to Apple pickers it’s not a plus here.

Let’s assume just for a moment that Apple and Dexcom/Google go head to head. Let’s assume it’s a choice between the Apple way cool whiz bang wearable toy and the Dexcom/Google Band-Aid like sensor. Let’s also take away the issue of reimbursement, something Dexcom/Google will likely have and Apple won’t. While we’re at we might as well take away the issue of cost even though the Dexcom/Google Band Aid sensor will be priced on par with conventional finger sticks and the Apple way cool whiz bang wearable toy will cost hundreds of dollars.

Think for a moment just about usability, how these devices will be used in the REAL world. The Dexcom/Google Band Aid sensor is truly a slap it on turn it on and forget about it device. It does not require calibration, it does not need to be charged and it delivers readings to a smartphone. The sensor is very discreet and is disposed of every few days. Compare that to the Apple way cool whiz bang wearable toy which as far as we can tell must be worn on the patient’s wrist, must be charged and who knows about calibration or a small thing like accuracy. Something Dexcom has consistently PROVEN is there sensor is very accurate.

Now at this point we have a major advantage over Mr. Cook for as far as we know he is not a diabetic and we are. To the best of our knowledge he has never worried about a major hypoglycemic event or worse actually experienced one. Nor to our knowledge does he worry about the many issues we think about each and every day. No disrespect to Mr. Cook but he’s pretending to be a diabetic he is not living with diabetes every day of his life, when his test drive is over he’ll go back to his shiny new corporate headquarters, his private jets and healthy compensation package. We on the other hand are not so fortunate and must continue the daily grind of diabetes management.

Although there are times when we hate having a sensor attached to our body it is a bonus over having to wear device. We do not worry about making sure the sensor is charged. Nor do we have to worry about taking a shower with our sensor on or taking a swim in the pool. Listen we do have the way cool whiz bang series 2 iWatch which is water resistant but we don’t sleep with it. This may seem inconsequential but it’s not especially when our iPhone, yes, we have one of them too, starts beeping in the middle of the might when we are going low. It is not an overstatement to say that our sensor is a life saving device.

Considering the future, a time when Apple’s way cool whiz bang toy may be here, our choice will likely be wearing the Dexcom/Google Band Aid sensor or wearing the Apple toy. Given everything we know combined with our real-life experience of living with diabetes we’ll take the Dexcom/Google sensor without hesitation. It will be a pleasure not having to worry about calibration or making sure anything is charged or not. It will also be sweet, excuse the expression, slapping the damn thing on and then forgetting about it. We won’t say changing the current sensor every 7 or 10 days is a painful experience but it’s not something we’ll miss either. Here too given the choice of changing the sensor every 7 or 10 days or slapping on a new sensor every 3 days or so we’ll take the slap.

Again, no disrespect to Mr. Cook but we’ll also feel very secure with our choice because Dexcom has PROVEN itself. We know the sensor will work and will be very accurate. While it’s possible the way cool whiz bang Apple toy will also be very accurate however to date, they have proven NOTHING.  As we have stated with insulin pumps any idiot can make an insulin pump that is not the hard part. Well this statement is not true when it comes to glucose sensors as it takes real talent not just to make one but to manufacture them in scale. The non-invasive glucose monitoring landscape is littered with companies who seem to have cracked the code only to find there are more locks that stand in their way.

Is it possible that Apple has done what no other company has been able to do.; sure. Listen the Chicago Cubs won a World Series last year and this country elected a buffoon Vodka guzzling reality star as President so anything is possible.  But even if Apple has cracked the code this is just the beginning of a long and very difficult journey. Will Apple pickers buy this device? For sure heck, these Apple pickers would buy almost anything that comes out of the temple of Apple. Is there a major need for this way cool whiz bang toy? Not really. Will it improve the lives of patients with diabetes? Maybe. Will patient outcomes, what really counts, improve? That’s debatable.

Listen we understand all the hoopla surrounding this latest way cool whiz bang toy. We understand the hype because unlike previous attempts at non-invasive, all of which have failed, this one comes from the all mighty Apple. A company that has gobs and gobs of money. But as we keep saying this isn’t about the toys in the toy chest. This isn’t about which toy gathers the data. This isn’t even about transforming this data into patient relevant, patient actionable information. This is and always will be about accepting the fact that we can give patients the how to but we cannot give them the want to.

We applaud Apple for their efforts and welcome them to this wacky world of ours. We honestly believe their presence in this wacky world on balance is a major plus. Heck look at all the attention brought to our wacky world and the company has proven NOTHING. As an experienced and wise diabetes device executive once noted that halo that’s over our head today is only a few inches away from being a noose.

Right now, the halo is over Apple and everything seems great. Apple is all about the promise of tomorrow not about the realities of today. Just like their shiny new multi-billion dollars headquarters it all looks so damn cool. Eventually the luster of their new digs will wear off and it will just be another fancy corporate headquarters.  Our experience tells us that even if they can succeed where everyone else has failed that this latest way cool whiz bang toy will also be just another toy in the toy chest. That like everyone else who is fascinated with way cool whiz bang toys they will miss the point. This isn’t about the toys in the toy chest.