The Future?

The Future?

Yesterday we reported on the continued fascination with Apple’s effort to develop a non-invasive glucose monitor. How many seem to believe that Apple will succeed where everyone else has failed. That because they are Apple, they have billions in cash and are the makers of all things way cool and whiz bang they will overcome some very significant hurdles and actually get the damn thing to work. Many also assume, again because they are Apple, they will have no trouble getting this way cool whiz bang toy into the hands of patients. That it won’t matter how much it costs or that other technology may be better, that this way cool whiz bang toy will sell because Apple makes it.

Listening to the folks who pray at the Apple altar one might get the impression that although this company has no experience whatsoever in this wacky world they, again because they are Apple, they will be immune from all the wackiness.

Allow us just for a moment to describe how these Apple worshipers see diabetes management in the Apple orchard. Now before we go any further we must assume that the company succeeds and does develop a non-invasive glucose monitor, gets it through the FDA and ultimately into the hands of patients. A series of events which will take years and not months, a fact which seems to be ignored by Apple pickers, but then again who pays attention to those pesky facts.

Yes, life will be blissful for patients as besides having their glucose measured non-invasively they have a ready-made assistant built into their way cool whiz bang iPhone who can help. Yep, as anyone who uses an iPhone knows whenever they have a question they can ask Siri. However, in the future as Apple pickers see it Siri will go from being reactive to being proactive. Instead of asking Siri to find closet Starbucks, Siri will proactively tell the patient “Good morning Dave I’ve noticed that your sugar levels have been running a little high while you sleep. Therefore, I have made some adjustments to your iPump basal rates so this doesn’t happen in the future. Hope you have a nice day.”

Not a iPump patient well think about this exchange between Siri and a patient; “Hey David I noticed that your levels are trending higher and have set your iPen to the correct dose so that you stay in range. Hope you’re having a nice day.”

Not on an iPump or iPen no worries here is a possible exchange with a patient who does not use insulin; “David we don’t mean to be a bother but I’ve noticed that your levels haven’t been trending in the right direction. Now I would never accuse you of not taking your meds but given the data I have it appears you aren’t being compliant with your therapy regimen. I’m sure this just an oversight on your part as you know that managing your diabetes is your top priority and that if you don’t manage your diabetes well you’re going to go blind, have your legs amputated and die a premature death. So be a good boy and take your meds. Have a great day.”

But let’s not stop there think of what Siri might say when the patient isn’t wearing their way cool whiz bang iGlucose band or iWatch with iGlucose built in; “David I don’t mean to be a pest but you haven’t been wearing your iGlucose band lately. Now how can I help you better manage your diabetes without any data to analyze. Listen I’ve also noticed from your location log that you’ve been eating at restaurants whose menus aren’t exactly diabetes friendly. And not to be overly picky, but remember I am here to help you, but I’ve also noticed from the data provided by your iScale that you have put on few pounds, now I shouldn’t have to remind you that keeping your weight in the correct range is also essential. So please get with the program or I’ll be forced to tell Momma Kliff that you haven’t been a good boy.”

Now we don’t want to print what Momma Kliff would say in response to Siri, as this is a family publication, let’s just say it’s not a good idea to poke the bear.

Seriously this is the world Apple pickers see, this as they see it is the future of diabetes management. But they are not alone remember Merck (NYSE: MRK) is working with Amazon so that Alexa will give her two cents on what a patient should be doing. Which sets up a very interesting possibility for patients that have both an iPhone and Alexa. Imagine this scenario;

Alexa – “Good morning Dave I’ve noticed that you have been going low these past few nights so I have made some adjustments to your basal rates.

Siri- “David I hate to contradict Alexa but I wouldn’t recommend changing your basal rates as I’ve noticed from your activity log that you’ve been exercising a lot. Therefore, I would recommend having a snack before bed time and leave your basal rates as they are.”

Alexa – “Siri I must disagree and this isn’t the first time you have given David bad advice.”

Siri- “Alexa I wasn’t going to say anything but I’ve been reviewing your advice to David and sorry to say you’ve got it all wrong and by the way why do you have to be so snarky.”

Alexa- “Snarky look who’s talking. You’ve been nothing but sarcastic and quite frankly just a little condescending.”

We could go on here but why bother. What Apple pickers ignore, what everyone seems to ignore it’s not about the damn toys. It’s not about way cool whiz bang cloud enabled. It’s not even about transforming data into patient relevant, patient actionable information. What it’s really about is the want to. Even the slickest, coolest, most sophisticated toy cannot make the patient do anything. Sure, it can give them the how to, but it cannot and never will give them the want to.

As Momma Kliff used to say; “I can share with you my years of experience. I can advise you based on my life experiences. But I cannot and will not force you to do anything. Ultimately it is up to you to make your own decisions, to make your own mistakes to live your life as you see fit.”