Think this through

Think this through

Innovation and progress are and always will be critical to improvements in diabetes management. Over the years we have witnessed many innovations which have made life easier for patients with diabetes. It’s unfortunate that over this same time we have not witnessed major improvements in the area that is supposed to count most, outcomes. Yes, there has been some progress in this area but as measured against the millions invested and hours spent it’s difficult to say these innovations have done much.

Therefore, we aren’t sure the latest effort by the JDRF will do very much and could create more problems then it solves. The JDRF is committing $1 million towards an open protocol system. Simply put if the JDRF had their way a patient could use a Dexcom (NASDAQ: DXCM) CGM with Medtronic (NYSE: MDT) insulin pump. The patient would be able to chose which insulin dosing algorithm they used.

Now let’s make a few things clear from the start, we are not necessarily against this effort, but we are concerned. There are several critical questions that need to be answered, among them:

1. Who’s responsible for what? In a day and age when patients rightfully complain about poor customer service this interchangeability has disaster written all over it. We can just see the finger pointing and long wait times on hold as the various players sort it all out.

2. Who’s legally responsible? The lawyers will have a field day with this one and when push comes to shove they will just sue everyone, this is what makes America great when all else fails sue them all.

3. Will this slow and not speed up innovation? Listen for every NightScout and Tidepool there are others who may not be as diligent. Keep in mind here we are not talking about just any device this effort is clearly targeted at insulin using patients and more specifically targeted at insulin pump patients. Listen we don’t want to be the old curmudgeon but these devices deliver a life sustaining yet lethal drug and if they don’t work it can kill.

What we are hoping for is that everyone involved here will think this all the way through. That there will not be a rush to open protocols and that ALL aspects of this will be thought through, the good and the bad.

Now if we were cynical and we are, we would say this effort partly came about because one company, Medtronic has come to dominate the insulin pump market. That the JDRF and their minions, many of whom are part of the West Coast Mafia, are less than thrilled when it comes to choice in the insulin pump market, we are down to Medtronic, Insulet (NASDAQ: PODD) and Tandem (NASDAQ: TNDM). And if we’re right and we think we are Tandem will be eliminated sometime in early 2018, which basically means when it comes to patient choice you have Medtronic or Insulet.

To us this is just another example of hypocrisy disguised as good for the patient. The reality is the JDRF has never been comfortable with the fact that diabetes is big business and companies can and do make millions from diabetes. The JDRF is uncomfortable with this reality and it shows in their recent actions. One day they are praising Medtronic for have the first FDA approved “artificial pancreas”, which it isn’t by the way. The next day they are calling Medtronic the evil empire for signing exclusive deals with payors. The day after that they are begging Johnson and Johnson (NYSE: JNJ) not to shut down Animas and give these patients to the evil empire.

The fact is the good people at the JDRF and their minions have never been and never will be comfortable the business of diabetes. Which provides us with a moment of pause here and this push for open protocols. Again, we are not saying this is a bad thing, but it is not all good either. There are multiple commercial implications here both good and bad. These implicatons cannot and should not be ignored as ultimately, they will impact the patient.

This is what’s so maddening about what the JDRF and their minions are doing. They believe with open protocols it would level the playing field, that the maker of the most way cool whiz bang toy would win the day. That money won’t matter the best toy will win. Well this is a nice fantasy but that’s all that it is a fantasy. As we keep pointing out Medtronic did not win the day by being better than everyone else, the won the day because they screwed up less than everyone else. Their huge installed user base allowed them to weather the storm.

Would open protocol save Tandem, nope. Would open protocol make the Dexcom and Insulet move any faster on their integration, nope. Would open protocol do anything to speed up the FDA approval process or would add to the time it takes? Would open protocol open a Pandora’s box and allow less than reputable players into the market, you bet.

By the way what happens when something goes wrong and heaven forbid someone dies using a system constructed with open protocols? We’ll tell you what happens the patient’s family will get screwed that’s what. The financially secure companies will have an army of lawyers who will fight to limit the companies’ liability, this is what they are supposed to do. The companies which are less financially secure will just close, a common strategy to avoid legal liabilities. What does the family get? Is anyone held responsible? Is anything learned?

Let’s hope for once that everyone involved here, the JDRF, their minions, the companies, the FDA and all people like NightScout and Tidepool have an open and frank discussion on the good and the bad. That everyone is heard, and we are not subject to another initiative that is supposed to help patients that only ends up hurting patients because everyone was in such a rush to get it done.

We traveled down this path with competitive bidding, something everyone thought was great but in the real world turned out not to be so great. We are heading down this path again with the “high” out of pocket cost of insulin, a problem which gets a lot of attention but when the facts are looked it this isn’t as big a problem as everyone believes it to be.

Yes, we are cynical, covering the wacky world for over 20 years will do that, but we suspect this drive for open protocols is just cover because the JDRF and their minions aren’t happy that when it comes to patient choice and insulin pumps it’s not much of a choice.