Back to where it all began

Back to where it all began

As we head to New Orleans for yet another ADA confab our thoughts turn to some history. Although it seems hard to believe the very first ADA we ever attended was in NOLA. Yes, way back in the day, back when Diabetic Investor was a print publication, and yes that’s how we started, NOLA was our very first ADA.

To illustrate just how long ago that was here is a short list of what WASN’T around back then:

Alternate site testing was just getting off the ground.

There was no such thing as continuous glucose monitoring, “smart” insulin pumps, GLP-1’s, Lantus, SGLT2’s, Interconnected diabetes management, wireless pumps, sophisticated insulin dosing algorithms or competitive bidding.

Back then the hottest company going was a glucose monitoring company called Amira, one of the first companies to tout alternate site glucose testing.  We can remember it like it was yesterday as their booth was overflowing which was great for us as our booth was next to theirs. We kept hearing over and over how these guys would forever revolutionize glucose monitoring. Speculation was that one of the major players would surly buys these guys.

The company had just one little problem, the damn thing didn’t work. Like everyone else we ventured into the booth and asked for a demo. Much to our surprise, after several attempts, the rep demonstrating the device gave up desperately trying to laugh off this embarrassing experience. Although we had yet to hear our now famous phrase that a company can steal more money with a good PowerPoint than with a gun, our experience was the first taste of that.

This experience also shaped much of how we went about analyzing companies and their products. How big companies and investors who should know better could be coned into investing into a company. This is where we learned that due diligence isn’t what everyone thinks it is. That far too many buy into the hype and fail to do their homework. Although we didn’t coin the phrase the wacky world of diabetes until later this experience was also the genesis of that phrase.

Our first ADA also taught us that most of the companies in this market were clueless as to what a patient goes through each and every day. They failed to grasp the daily burden of managing diabetes. Many believed that patients actually listened to their physician and cared about what their HbA1c was. It was enlightening to listen to this not just from a journalistic perspective but also a patient perspective. All we could think about is these people have no idea what’s going on in the real world, that this ivory tower unenlightened perspective would one day come back and bite them squarely in the ass.

Yet we also meet many who got it, who understood what a patient goes through each and every day, that managing diabetes is a job, a job that’s done every day with no days off. These enlightened folk knew it wasn’t about whiz bang way cool devices or drugs, it was about putting the patient first. It’s not surprising that many of these people went on to become giants in the industry.

Today as we return to NOLA no longer the new kid on the block but as a seasoned veteran of this wacky world we can’t help but wonder what the next 20 years will be like in diabetes. Will an artificial pancreas be as common as a cellphone? Will the beta cell regeneration be a common treatment option? Will implantable sensors that measure more than just glucose levels be used by patients? Which companies will be leading the charge? Will it be Lilly (NYSE: LLY), Novo Nordisk (NYSE: NVO) on the drug side and Medtronic (NYSE: MDT), Dexcom (NASDAQ: DXCM) and Johnson and Johnson (NYSE: JNJ) on the device side? Will Google, Apple, Samsung and the rest of Silicon Valley still be part of this wacky world?

And what about a cure, the true Holy Grail of diabetes, in 20 years will we have a cure? On this point I can only share an interesting discussion we had with two very respected researchers back at our very first ADA. Both were gloating over some new therapy that they were working on and how this would a cure, yes a cure, for diabetes. After going through their PowerPoint one of the two leaned over, looked me straight in the eye and said; “David, mark my word five years from today we’ll have a cure for diabetes. If it’s not us someone else will have it, there are just too many smart people working on this.”

In typical Diabetic Investor fashion, we asked this notable researcher if he cared to place a wager on this statement. If he was right I would buy him a bottle of his favorite scotch, if not I got my case of Miller Lite. I then leaned over and stated; “This is one bet I hope I lose.”  All I can say is that Miller Lite sure tasted great but would have rather been buying him that bottle of scotch.

The reality is from the moment I started Diabetic Investor my one hope was to be put out of business, that someone would find a cure. Sadly, that day has not come and sadly we seem no closer to that moment than we were some 20 years ago. Yes, we have come a long way but we still have a long way to go.