It begins again

It begins again

Yes, it is once again that time of the year when the center of the health care universe conjugates in that beautiful, albeit rainy, city by the bay. The 35th Annual JP Morgan Healthcare conference opens tomorrow which means a few things. Diabetic Investor won’t be getting a that much sleep as once again we have a very full schedule. Second, we’ll do our best to report each day but given our schedule we will write when we can. Just thinking we should really start using that Twitter thing but somehow, we doubt we could adequately describe this wacky word in 144 characters.

Ironic that on our delayed flight, no surprise, had issues with its Wi-Fi connection which got us thinking about all those way cool whiz bang cloud enabled devices, what the heck happens to the way cool whiz bang information when there is no Wi-fi? Does that mean there just might be times in this interconnected world we live that the patient should know a thing or two about the disease they have. That it might not be a bad idea to say educate these people so even when they are connected that they understand why they are being told what they are being told.

Diabetic Investor has been spending a great deal of time reading various posts on Facebook from different groups we have joined. It seems that every diabetes device has some sort of group where patients share stories, grip and help each other. Sites such as TuDiabetes and Children With Diabetes offer similar forums and there are who knows how many patient blogs we which we also pursue from time to time. Our conclusion after doing a lot of surfing these past few days, diabetes technology may be better than it was 10 years ago, but we still have a long way to go.

We weren’t surprised that in general most people who use the Dexcom (NASDAQ: DXCM) system were generally pleased with the device. The same goes for Tandem (NASDAQ: TNDM) patients although the company has some serious customer service issues, which unfortunately will likely get worse as the company is quickly running out of money and may not make it to the second quarter of the year. If Abbott (NYSE: ABT) isn’t concerned about how the Libre will do in the US, they better be. When it comes to Libre there is no third option, it is either that greatest thing since squeezable chocolate or the worst thing invented since the Kardashians.

When it comes to continuous monitoring sensors it’s one thing to develop a sensor but quite another to mass produce these sensors so they work consistently. This in essence is Abbott’s problem; the Libre does work it just doesn’t work consistently. We have seen this same issue with Medtronic (NYSE: MDT) sensors. Sure, sensor performance appears to be improving for Medtronic, they appear to be closing the performance gap with Dexcom but this is somewhat misleading. In a clinical study the company can make sure the sensors they use are the best of the lot. This is far different than mass production sensors.

Now this is hardly shocking and were sure if we went back in time that Dexcom did the same thing. The difference is it’s rare to hear a Dexcom patient complain about performance and quite common to hear Libre and Medtronic patients complain about performance. Which common sense tells us means that Dexcom knows how to manufacture a quality sensor consistently while Abbott and Medtronic don’t. And yes, it is that simple.

Another common sentiment across the diabetes spectrum and this was consistent everywhere, is patients hate health insurance. Unlike the West Coast Mafia, they are not blaming insulin companies for the rising out of pocket cost of insulin, they are blaming their health insurance provider. By default, they blame their employer who has put them into a high deductible plan which means that a greater share of the cost comes out of their pockets. They also aren’t thrilled being told that they can still use Lantus but it will cost them much more out of pocket. Nor are they all that happy being told that due to their plan they must pay more for pump supplies.

In the real world, somewhere the West Coast Mafia has never been, the villain isn’t the insulin companies it’s health insurance providers. Blaming big bad pharma may grab the headlines but most patients aren’t drawing a line between the net wholesale price of insulin and paying more out of pocket. Yep it is that simple.

It’s also very clear that the folk at OneDrop got something right in that it does take a village to manage diabetes. We have long been skeptical of using Facebook or Twitter for diabetes management advice. It’s not that patients cannot help each other, they can and do. Our concern is when it comes to certain questions the information should come from a physician or Certified Diabetes Educator (CDE), i.e. a trained professional. While getting insight into a resort on a site like Trip Advisor might help chose a vacation destination we’re not sure a patient should take the advice of another patient when it comes to insulin dosing or changes to therapy regimen. This advice is well intentioned but there is a reason physicians and CDE’s exist and this is one of them.

This disconnect here is that the mistake being made by all the way cool whiz bang cloud enabled devices is how they communicate with the patient. The simple truth is patients trusts another patient more than they do their physician or CDE. That is of course unless their physician or CDE also happens to have diabetes. We’ve said it before and we will say it again, these companies still do not understand what these patients do every day of their lives. They still do not understand that for the majority of patients, they have a disease they do not want to have, a disease they know needs to be managed but they don’t want this management running their already hectic lives; they want to live WITH and NOT for their diabetes.

Worst of all they fail to understand that diabetes not impacts the body but the patients psyche. Patients are basically sick and tired of being treated like children. They are tired of being told what to do and when to do it by anyone or thing that has no idea what their lives are really like. Why do patients like talking with other patients it goes beyond sharing a common disease, it goes beyond empathy it’s about understanding. Patients talk to other patients because they GET IT.

Someone asked Diabetic Investor the other day if they could do just one thing for patients with Type 2 diabetes what would that be. We were a little taken aback by the question as it surprised us that anyone actually cared about patients with Type 2 diabetes, or at least those that didn’t use insulin. Well if there is one thing to be done it’s quite simple TREAT THESE PEOPLE WITH RESPECT. Listen to them really listen to them. These people want help but they don’t want to be talked AT, they want to be talked TO. They don’t want sympathy they want help in terms THEY understand. Help that will fit into THEIR lives.

The problem with diabetes management isn’t one of drugs or devices. Yes, we could use better of both but what we have does the job quite nicely. The problem with diabetes management remains the same as it was before all these way cool whiz bang cloud enabled devices came along. The problem has been and continues to be getting the patient educated. Educated so they understand why they are doing what they are being told to do.

Momma Kliff used to say that all technology in the world is useless if the damn thing isn’t turned on in the first place. Growing up without the internet or even cable TV, yes, the world functioned before the internet and cable TV came along, Mom said that if a person didn’t read a newspaper, listen to the radio or turn on the TV they would have no idea what the heck was going on in the world. The only way IDM works is if the information being transmitted is not just received but also understood. The only way that happens is when the patient is educated, in today’s interconnected world where the patient has immediate access to the web, they will not do something simply because they were told to do it. The days of the physician being seen as a god like figure are over.

The sooner companies realize that the center of the diabetes universe is the patient the better.