This shouldn’t be so complex

This shouldn’t be so complex

One of the more amazing aspects of the wacky world of diabetes is the unseemly endless need to over think things, to make things more complex than they really need to be, to turn gold into sand. The other uncanny aspect of this wacky world is how people lose focus and forget what’s really important. Even better is how little so many companies and people who watch this wacky industry actually listen to patients. Here is a perfect example;

“We have to have an artificial pancreas.”

Honest to goodness listening to the proponents of this technology one just might think it’s the greatest piece of diabetes technology ever invented. That once this miracle of technology actually makes it to market, the diabetes world will sing it’s praises as if it’s the greatest thing to come along since the invention of the transistor. Well this may eventually be true let’s take a look at that the real world, yes we know this is difficult but humor us for a moment.

Today there are approximately 750,000 insulin pump patients WORLDWIDE. The insulin pump market is growing at single digit rates and as we have noted far too often the insulin pump market is not large enough, nor growing fast enough to support the existing companies in the market let alone the many who want to be in the market. Pesky facts we know, but facts none the less. Oh and did we mention that pumps like BGM is dealing with competitive bidding, yet we digress.

Now even the staunchest supporters of the artificial pancreas acknowledge that only about 10% of insulin pump patients, 75,000, will use this technological marvel. These zealots also acknowledge that this miracle of modern technology will cost a small fortune, but no matter the cost this is so good the people who really need it will find a way to pay for it. By the way did we mention that this technological marvel doesn’t really exist, that we are still years and we mean years away from seeing this wonder become a reality. Again we digress.

So here we are spending millions to develop a product that will benefit less than 1% of the diabetes population. According to the American Diabetes Association there are approximately 30 million people in America with diabetes, according to the World Health Organization there are more than 300 million patients outside the US. Most everyone agrees that diabetes both here in the US and around the globe is growing at epidemic rates that the number of patients with diabetes will double by 2025. Most everyone also agrees that diabetes is not just a global healthcare crisis but also a global economic crisis.

The diabetes is epidemic is also occurring when the number of endocrinologists are declining. The epidemic is occurring when the number of primary care physicians, physicians who treat nearly 80% of all patients regardless of how they are defined, are also declining. This epidemic is occurring at the same time governments around the world are going broke, cutting funding for research and looking for every conceivable way to CUT COSTS.

So it makes perfect sense that we should spend millions to develop a system that has no regulatory path, has limited market potential and may never actually work. But again we digress.

Listen we get it a true artificial pancreas is the ultimate in way cool technology and yes if the damn thing actually worked it would be way cool. But as much as the zealots see this as the answer to their prayers Diabetic Investor sees it as one huge waste of time and resources GIVEN how many patients would actually benefit from its arrival. We haven’t been against a true artificial pancreas per se for if it helps just one patient with diabetes live a better life it’s ultimately worth it. However we do not live in lala land and understand that, to quote Spock, the needs of the many outweigh the needs of the few.

But let’s give these zealots their day in court and let’s assume for a moment that all the technological hurdles are overcome, by some miracle the ultra-conservative FDA actually approves such a system and even more miraculous payers agree to pay for it or at least part of it – is there a sustainable business model here.  What these zealots seem to conventionally forget is this way cool system needs to be supported. So what happens if the company or companies who make this system cannot at minimum break even? Are the stakeholders in these companies supposed to say it’s ok NOT to at least break even?

Diabetic Investor constantly hears the calls from zealots that not everything in the diabetes world is about money and there is truth to this. However the last time we looked this is still America and it’s not yet illegal to make a buck. That without the profit motive we wouldn’t have many of the drugs and devices we have today. The fact is diabetes is not just a chronic disease but a HUGE business with billions of dollars at stake. That the stakeholders in these companies, most anyway, could care less about way cool whiz bang technology but give serious thought to whether they are getting a return on their investment.

So let’s see if we’ve got this right- we should spend millions (actually when this is all over it will be more like billions) to develop a system that will benefit a miniscule portion of the patient population, more than likely won’t be affordable when it gets here and doesn’t have a sustainable business model? Yet again we digress.

Years ago many questioned the need to land a man on the moon. Why they asked is the government spending billions just so we could beat Russia to the moon. Yet to those of us who watched Mr. Armstrong take one small step for man and one huge leap for mankind, cost didn’t matter. Yet lost in the pride Americans felt that July evening across the nation were the many ancillary benefits of the space program. Microwave ovens, cellular phones are just two of the many real world benefits to come out of the space program.

Now it is quite possible that this quest, more like crusade to the zealots, technology developed for the artificial pancreas will somehow trickle down to help millions of patients.  That today’s patients would see better, easier to use, more reliable insulin pumps or better, more accurate glucose sensors.  While we would agree that glucose sensing technology is vastly improved it’s an open debate whether today’s insulin pumps are that much better.

Although the zealots won’t admit it publicly these folks believe that only patients with Type 1 diabetes need better tools. Listening to their arguments it’s almost as if Type 2 patients really don’t matter, that they really don’t have diabetes. Diabetic Investor has long been aware of this bias towards Type 1 patients and quite frankly finds it disturbing. The fact is Type 2 patients also need better tools, they also suffer from costly complications and they too would like their lives made easier. But most importantly Type 2 patients vastly outnumber Type 1 patients and common sense, something not used by the zealots, tells us this large group of patients should not be ignored.

Let’s be clear here Diabetic Investor is NOT against the pursuit of developing a true artificial pancreas, that we do believe many patients will BENEFIT when this technology actually gets here, whenever that may be. However a true artificial pancreas as great as it could be will only have a minimal impact on the diabetes population.  What we’re against is this belief, more like propaganda being spread by the zealots that the artificial pancreas is THE most important project in diabetes and nothing else matters. This is not just plain false but a very dangerous way of thinking. Millions of dollars are being thrown into this project, millions of hours are being spent developing it and yet everyone just assumes that this investment is worth it, that the payoff no matter how far away it is justifies the hype.

Folks it’s time for EVERYONE and we mean EVERYONE to understand that diabetes is not just a healthcare crisis but a major economic crisis. That there are two types of diabetes Type 1 AND Type 2, both sets are growing at epidemic rates. That resources are at a premium and we can ill-afford to concentrate these precious resources on just one project which in all reality will only impact a handful of patients. This doesn’t mean this project should not be pursued however it should not be the ONLY project pursued.  It’s time some balance and perspective to be brought to the system as the diabetes problem isn’t getting better and will likely get worse in the future. Ignoring the needs of millions of patients is not just foolish but very, very dangerous.