Closer but not yet there

Closer but not yet there

The folks at Medtronic (NYSE: MDT) are riding a pretty nice wave these days. Since the approval of the 670G the company is basking in the glow of something money just can’t buy, lots of positive free publicity that speaks of the 670G in glowing terms. Facebook, Twitter and diabetes blogs are agog over this way cool whiz bang device which is being pegged, incorrectly, as an artificial pancreas. Now we don’t blame the good people in Northridge for this as this isn’t the first nor the last time the media will go agog over way cool whiz bang technology.

Yet lost in all this attention is a simple fact, yes those pesky facts again, the 670G is nice step forward but an artificial pancreas it’s not. Even if it was a true artificial pancreas most people even many who should know better fail to grasp the many issues with such a device. Everyone seems to believe that a patient simply slaps this sucker on, presses a button and bang they are off and running. They seem to believe that this life saving device can also be a life ending device if something goes wrong and as much as we hope this does not happen, the 670G is a medical device and something always goes wrong.

Listen we know that the folks at Medtronic are doing everything they can so this does not happen. But as the late Al Mann, who built MiniMed into a pump power before selling to Medtronic, said anytime a patient is asked to do anything the chances are they will screw it up every now and then. This is what gets lost in all the hype that besides the many technical issues such a device can and likely will have, a human uses the damn thing and humans make mistakes.

This is why design and patient training is so damn important, the better more patient friendly the design, the better the level of patient education it lowers the risk of user error. Think of a smartphone, preferably one that does not explode, simple to use, right? Still even as user friendly as these devices are people the humans who use these way cool whiz bang smartphones make mistakes. There is a reason for the term “user error.”

Keep in mind that the 670G is basically a collection of devices, the two central components being the insulin pump which delivers the insulin and the continuous glucose sensor which measures glucose. The pump has several parts including a reservoir which contains the insulin and is filled by the patient. Think of it this way, the 670G and any attempt at an artificial pancreas is only as good as the hardware and the patient using that hardware.

To our knowledge no one has yet to develop a way cool whiz bang device which measures carb intake, an important piece of information which must be entered manually by the patient so the system does its job properly. Nor are we aware of any way cool whiz bang device which measures stress, which yes impacts glucose levels.

Perhaps a different way of looking at this is to think of microwave popcorn. Throw the bag in, hit a couple of buttons and popcorn. Yes, we’re sure it happens but even diabetes executives, not the brightest blubs on the tree, can make microwave popcorn without screwing it, that’s how simple it is. Even better if there is a screw up it won’t kill anybody. Well an artificial pancreas doesn’t work that way, not even close, and when there is a screw up it can kill the patient, insulin is not just a lifesaving drug, it is also a lethal drug.

Let’s be clear here we in no way want to rain on Medtronic’s parade, as they cannot tell the media how to write about the 670G. Nor can the control how patients, physicians and CDE’s perceive the 670G. And the 670G is a good step toward a true artificial pancreas but even when that day does come it does not come without issues. The biggest of all being this way cool whiz bang device will be used by humans and humans my friends make mistakes. There is just no way to get around those pesky patients.