The New Norm

The New Norm

Ok it’s about time we acknowledge a few pesky facts. First, we need to come up with something different than the wacky world of diabetes as what once seemed wacky has become commonplace. Second, we should acknowledge that just because something can be done does not mean it should be done. Third, building something way cool whiz bang is the easy part getting patients to use the damn thing is and will always be the hard part. Fourth, has due diligence become something old-fashioned and not used anymore. Fifth, can we give Momma Kliff a break as she’s getting some frustrated that people fail to learn from past mistakes.

We mention this as after publishing this morning an across this little news item on the FireceBiotech web site; “Digital health player Amalgam Rx launches with Type 2 diabetes app”. Per the site;

“Amalgam Rx, a new company focusing on digital therapies for chronic diseases, launched Monday with the first FDA-cleared mobile app that automates the titration—or dose—of basal insulin for patients with Type 2 diabetes.

The prescription-only app, iSage Rx, is designed for patients who don’t use mealtime insulin or an insulin pump, the company said in a statement. It allows physicians to choose from a range of clinically validated basal insulin algorithms and adapt them for individual patients.”

Next for grins and giggles we looked at the stock charts for MannKind (NASDAQ: MNKD) and Tandem (NASDAQ: TNDM) and wondered which of the two would be the first to officially throw in the towel and call it quits. Then it dawned on us that MannKind is in a better position than Tandem. That just based on cash on hand it’s more likely that MannKind will see 2018 then Tandem.

Then we started thinking about what would happen if our wine drinking friends followed through and bought the diabetes franchise from Johnson and Johnson (NYSE: JNJ). But we also thought Apple, yes Apple who’s been dabbling in diabetes, is set to report earnings tomorrow and many believe their cash position will move past $250 BILLION that’s a quarter of a TRILLION folks. Should Apple deploy even a small amount of cash they could build a major diabetes presence in a hurry and still have plenty of money on hand.

This in turn made us wonder how our friends in Mountain View might respond. They already have a deal with Dexcom (NASDAQ: DXCM) and a partnership, if you can call it that, with our wine drinking friends. Like Apple they also have a boatload of cash on hand that they too could deploy and build an even bigger diabetes presence. W

Which made us wonder about our friends in Redmond who also have a boatload of cash but as of yet have been silent on the diabetes front. Could Microsoft play follow the leader and join this wacky world?

Think of all the toys these companies could buy. “Smart” insulin pens, apps, implantable sensors, wearable sensors and of course the new Holy Grail non-invasive continuous glucose sensor. What the heck they could buy Tandem just for the fun of it. They too could join the race to have the ultimate diabetes toy a real artificial pancreas.

What have we said all along that when it comes to this wacky world the two most important assets are money and talent. Money is something these companies have in abundance which in turn gives the ability to buy talent. These cash rich companies remind us of the New York Yankees who back in the day spent millions to buy talent which in turn lead to even more World Series titles.

Besides money these cash rich companies also have another quality that’s prevalent in this wacky world, hubris. That belief that they know better and anything they touch will work. That they can throw all this money around and succeed. Momma Kliff would call this chutzpah.

Now before everyone starts believing this is the beginning of new day in diabetes. That Apple, Google or Microsoft can do for diabetes what they have done for smartphones, internet search and software. Think again as money even if wisely spent and good talent is brought in not much will change if they don’t allow these talented people to use their talent. If they do not listen to what these talented people say. If they do not learn from their experience.

Diabetes is one of the most complex disease states which requires a multifaceted understanding of numerous disciplines. As we have said any idiot can build an insulin pump, “smart” insulin pen or app. But it takes real talent to run a successful diabetes company. The future of diabetes management will involve a complex combination of hardware, drugs and apps. Intertwined with this web is the physician, payor and of course the patient. Not to mention the pharmacist, retailer and distributor who dispense the tools to the patient. And let’s not forget those dedicated Certified Diabetes Educators who play a pivotal role.

Take a step back just for a moment and think about what would happen should a company like Apple decide to buy their way in. Yes, there are a plethora of companies to choose from. Choose wisely and this path to success is much easier. Choose poorly and it’s not just wasted resources but lost time and time unlike money is not a renewable resource.

Over the past few years Diabetic Investor has been both thrilled and scared to death as these cash rich companies move into this wacky world of ours. On the positive side, along with their money they bring a fresh more up to date approach to diabetes. They are not encumbered by past mistakes, they bring no baggage. They see patients as consumers of health care, as people who can and will accept help if its delivered in an easy to use format. They understand that design matters and design products not from the engineer’s perspective but from the patient’s perspective.

However, they also suffer from many of the same maladies of the old guard. Failure to execute, corporate bureaucracy and of course the before mentioned hubris and chutzpah. Listen we know we have given the old guard lots of grief but these people aren’t idiots. Their problems mostly steam from the ability to adapt to changing market conditions. They saw the world changing but as the old saying goes you just don’t turn a battleship on a dime.  Change as everyone knows is one the most difficult things for any company to do. It’s even tougher selling the folks in the corporate suite on change when money is falling from the sky.

The new norm in this wacky world is there is no such thing as normal, it just doesn’t exist. The rules of the game are changing as are the players. Just as Chicago Cubs fans are adjusting to being the reigning World Series champions and now being the team to beat. The diabetes world will need to adjust to the changing of the guard, a change that is underway but far from over.

As Momma Kliff used to say; “No one really likes change even when it’s change for the better. Change by its very nature brings with it uncertainty and let’s face facts most people hate uncertainty. But change is unnecessary even when that change brings with it a certain amount of pain and trepidation. The pain and trepidation will eventually pass and a new norm will be established. Until the next round of change comes along and this process starts all over again. Change as everyone knows is the only constant in this world, wacky or otherwise.”