The Slide

The Slide

Ok, before we get started this is a post you can Share. No that we got that out of the way onto today’s rant.

Last night we attended an event here my beautiful albeit very cold city of Chicago put on by the ADA. Called the Venture to Stop Diabetes Challenge, six start-ups showed off their way cool whiz bang toys that are supposed to help patients with diabetes. Now we will not name these companies, but we will say that none of them will do much of anything to stop diabetes. Yet you can bet your first-born child that a few of them will raise money allowing them to play with their toys.

You can also take it to the bank that none of them have any idea on how to do anything beyond coming up with way cool whiz bang toys. That the thought of being able to run a commercial viable company has never crossed their minds. No to these people and so many others it’s all about the toys in the toy chest.

But what really got us going was “The Slide” a slide we have been seeing for over 20 years. A slide that hasn’t changed one bit over these past 20 years. You know the one we’re talking about, the one that states diabetes is growing at epidemic rates, that diabetes is a global epidemic, how diabetes is not just a healthcare crisis but also a financial crisis. The reason for this slide is obvious as everyone knows these stats already, what these start-ups are showing is this is a huge market.

Sometimes the slide also contains another stat that unfortunately hasn’t changed in 20 plus years, that most patients are not under good control.

Another popular slide is all the stakeholders involved in our wacky world. All the people who will benefit from or pay for all these way cool whiz bang toys. Sadly, the patient, the person who has diabetes is always listed at the bottom of the stakeholder list, when it’s the patient who should come first and everyone else after. Believe it or not there was a time in a galaxy far, far away that patients were put first. Where the needs of the patients came before any other stakeholder.

Way back before Medtronic (NYSE: MDT) bought MiniMed it was one of those companies. We consider Dexcom (NASDAQ: DXCM) one of those companies today, which is hardly surprising given the team that built Dexcom also built MiniMed. Believe it or not we would consider Johnson and Johnson (NYSE: JNJ) to be on the list but not for the normal reasons. We put them on the list because when they decided to shut down Animas they did not leave their patients out in the cold, they made sure they were taken care of.

Compare that to what’s happening at Tandem (NASDAQ: TNDM) a company that will be forced out of business by their creditors. Creditors who only want to get repaid and could care less about Tandem patients. As it stands now the likelihood that Tandem will be shut down without making any provisions for their patients is very strong. Management may say they care about their patients and they would not let this happen, but the fact is management will not be in control, it’s the creditors who’ll be in charge.

Sadly, we now live in a time when making or raising money is more important than putting the patient, the person with diabetes first. Even more maddening is that if these toy makers would put the patient first chances are they would make boatloads of money. Putting the patient first does not just mean coming up with better drugs or devices, putting the patient first also includes knowing how to run a company so that it does not get shutdown leaving patients out in the cold.

We just love it when the West Coast Mafia gushes over the latest way cool whiz bang toy and fails to realize that the toy maker may not be here to support the patients who use these toys. This is happening right this very moment with Tandem. Making matters worse is the damn hypocrisy, condemning JNJ for closing Animas, insulting Medtronic (after praising them for the 670G) and claiming to be patient advocates. Either these people are blind, stupid or both.

Recently we’ve spent a great deal of time talking about the money cycle. How everyone but the patient comes out. Millions, more like billions have been spent over the past 20 years and still “The Slide” hasn’t changed and an argument can be made that things have gotten worse. Patients are not only not getting any better they are having a more difficult time managing their diabetes due to cost. They cannot afford not just all the way cool whiz bang toys but basic drugs which keep them alive. Far too many patients must choose between putting food on the table or having the drugs they need to stay alive.

So naturally what does everyone do, lead of course by the Mafia. They blame the insulin companies. They write about big bad pharma. What they don’t do is understand the facts, but heck why let the facts get in the way of pretending to be patient advocates. Complicit in this charade is the ADA and JDRF, who have sat on the sidelines twiddling their thumbs while patients suffer.

Listen when a company like OneDrop, one that the Mafia just loves, continues to peddle snake oil and does not get called out you know something is wrong. Yet everyone ignores this self-reported non-verified data backed up by fuzzy math and gives OneDrop a pass. Again, nothing like ignoring the facts to support a fellow Mafia member.

Here are some facts:

1. We are now down to just two viable insulin pump companies – Medtronic and Insulet (NASDAQ: PODD).

2. The SMBG market is dead thanks in large part to competitive bidding which the Mafia wanted because the price of test strips was too high which prevented patients from testing. Which is complete nonsense but like we keep saying never allow the facts to get in the way of a myth.

3. We have some great drugs which if used as prescribed would go a long way towards helping patients achieve better outcomes. The problem is access to these drugs which has nothing to do with big pharma and everything to do with payors, PBM’s and a screwed-up healthcare system. Yep it makes good copy to pick on big bad pharma, but good copy won’t solve a damn thing.

4. Yes, all these way cool whiz bang toys COULD help patients but none of these toys will do jack if they aren’t used or if they do not deal with patients on their terms.

5. Nothing much will change until outcomes matter to everyone. Everyone talks about outcomes, but the reality is money is all that matters, and this includes the patient. We would bet our first and second born child that IF patients had a financial incentive, a vested interest in achieving better outcomes we would not have nearly two-thirds not under good control.

The problem as we see it is perspective or put another way are priorities. Instead of being last on the list of stakeholders PATIENT’S SHOULD BE ON THE TOP OF THE LIST PERMANENTLY. And not just insulin using patients but EACH PATIENT WITH DIABETES REGARDLESS OF WHAT DRUGS THEY USE. This bias towards Type 1 patients is another thing that must change.

When people ask me what type of world I hope my still unborn grandchild will grow up in, I say when it comes to gramps wacky world all I want is to see is the patient put first. If that were to happen everyone wins, and we’d be thrilled to see these companies making billions and management making millions. We have consistently stated that we have no problem with capitalism. What we have a problem with is hypocrisy and waste. What we have a problem with most of all is that after more than 20 years NOT A DAMN THING HAS CHANGED ON “THE SLIDE”.