The Iron Throne

7Now that Game of Thrones is over the void we thought could not be filled has been filled by our very own wacky world. As it turns out our wacky world shares many of the characteristics of GOT complete with conniving, backstabbing, narcissistic rulers battling for who will ultimately sit on the Iron Throne. Like the real GOT our wacky world comes with some noble rulers who do care more than about their own personal interest and/or wealth. Rulers who understand fundamentally that it’s all about the patient.

With that being said let’s take a look at what’s happening in Westerlands. (Hey we can’t call San Francisco Winterfell could we, maybe next year when the conference moves to the city with the big shoulders, Chicago.) Let’s start with some big news as Medtronic the evil empire has finally surrendered to the rebel forces doing a deal with Tidepool. Per a post on the Tidepool blog yesterday;

“Tidepool Loop will work with a future Bluetooth-enabled MiniMed™ pump from Medtronic.

Today, we are excited to announce that Medtronic joins the team of innovators collaborating with Tidepool to develop and deliver Tidepool Loop. Medtronic will be developing a new, Bluetooth-enabled MiniMed™ pump that will be a fully supported delivery device for Tidepool Loop once both are approved. Tidepool and Medtronic will also collaborate on regulatory and software processes.

Previously, Tidepool announced our collaboration with Insulet to make Tidepool Loop compatible with a future version of the Omnipod® DASH system. We’re now excited to add Medtronic as a second pump to the Tidepool Loop ecosystem, further expanding choice.”

Now before everyone starts doing the happy dance let’s look at what this deal really means. Medtronic once king of the insulin pump castle has awoken to some harsh facts.

1. The way cool whiz bang 670G isn’t all that way cool whiz bang.

2. Their CGM sensor isn’t and likely never will be on par with the Dexcom G6.

3. They are starting to see some serious erosion to their installed user base which as we all know is the goose that lays all those golden eggs.

4. This is further confirmation to what we already knew when it comes to patients starting pump therapy, not those switching from one system to another, Tandem and Insulet are beating the crap out of Medtronic.

5. Last but not least this signals that the mothership is planing to divest itself from diabetes.

Staying in the insulin delivery area the march of the White Walkers otherwise known as the plethora of companies developing a Tyler lots of news. There are lots of moving parts so we’ll do our best to cover all the aspects we can without getting overly confusing. Let’s start with the Bigfoot who based on the social media onslaught would seem to be on the brink of bringing Tyler from concept to reality. Now Bigfoot at one time claimed to not just to have a Tyler but an insulin pump too. Well as it turns out the pump has been put on the back burner and we’d be shocked if this thing ever saw the light of day.

Their “Tyler” also has several issues. The initial version really isn’t a true Tyler and is designed for patients using a long acting insulin only. Version two is designed for multiple daily injection (MDI) patients but has a very serious problem. (More on that in a second.) Version one really isn’t all that special and is only connected with a conventional blood glucose meter made by AgaMatrix. There are lost of companies who have built algorithms for these patients based on a single BGM test per day but we just don’t see a big market for what we’ll call Tyler lite. Most of these patients using a long-acting alone or in combination with orals don’t bother to check their glucose levels simply injecting the dose their physician has recommend. While an algorithm might help outcomes the harsh reality these patients aren’t going to change their behavior. In simple terms we see this product as nothing more than window dressing.

The problem with version two isn’t necessarily Bigfoot’s problem but a problem with the Libre. As we noted the other day the Libre 2.0 which is supposed to have connectivity and receive iCGM designation is delayed at the FDA. Based on what we’ve learned the problem isn’t so much with accuracy although the Libre system has a known issue in the low ranges. The problem centers around connectivity and could jeopardize the vaunted iCGM designation Abbott seeks.

While we believe Abbott will eventually solve this connectivity issue which will then lead to an FDA approval. We remain highly skeptical that even with this connectivity problem solved they will receive the iCGM designation. It’s possible they will but if the FDA uses the current standards meet by Dexcom for iCGM we don’t see how Abbott will get this.

Before we leave Sasquatch that mythical hairy beast that is supposedly roaming somewhere inn North America, we are beginning to believe that Bigfoot is a mythical company. Besides making more promises than Minnesota has lakes the company which is a quasi member of the West Coast Mafia and tided to The Godfather, actually the godmother, is not just backstabbing their competitors they are actively burning bridges.

Frankly we expected better but then again as a member of the Mafia this two-faced hypocritical behavior is par for the course and follows the behavior of the godmother. Folks we have no interest in a kumbaya moment, what we care about is doing right by by the patient and stakeholders in the companies. All the mafia cares about is self enrichment and will use any means to get what they want. These people aren’t patient advocates they are narcissistic, two-faced hypocrites seeking to fatten their own pocketbooks.

When we first sighted Sasquatch we had hoped that this wasn’t a mythical creature that finally at long last we had a company that understood that you can out the patient first and still makes gobs of money. We really didn’t care all that much about the toys they made but liked the idea of the Shave Club for Men pricing model. Unfortunately as so often happens in this space that lake in the desert in reality turned out to be a mirage. That Sasquatch was not in fact real but just a myth.

Finally a comment for all those who believe we should look at our world through rose colored glasses. That every toy in the toy chest is great and every drug in the medicine cabinet will lead us to the promised land, better patient outcomes. Harken the words of Matthew 7:15;

“Beware of false prophets, which come to you in sheep’s clothing, but inwardly they are ravening wolves.”