We ain’t stupid

We’re not exactly sure what a PR person does but in our wacky world but they are doing it very badly. When the bruhaha over the high out of pocket of insulin began the insulin companies missed an opportunity to explain themselves, allowed the narrative to be determined for them and as we noted it had no choice but to play defense. Not sure exactly what they were thinking but given the topic – high prescription drug prices – combined with the fact that real people died the insulin companies didn’t stand a chance.

We have to give Lilly some props for after a very bad response they recovered and have now put the pressure on Novo Nordisk and Sanofi to respond. Half price Humalog may not be what everyone wants but it is a positive step forward as was the company releasing the more detail about insulin pricing and the effect rebates and discounts have.

Listen no one will ever feel sorry for the insulin companies as there is no question, they are part of the problem, but they are not the lone villains here. The mistake they made which seems to be common in diabetes these days is they were afraid to meet the issue head on, acknowledge their role, admit past mistakes and make corrections. In simple terms they attempted the ole Texas two-step and frankly they don’t dance that well.

We thought of this while reading a post on the Drug Delivery web site entitled: “Medtronic responds to usability concerns for its MiniMed 670G insulin pump”. By now everyone knows about the problem with the 670G and the report which was released at the Endo conference in New Orleans. A report which basically said 40% of the patients stop using the 670G after 9 months because the damn thing doesn’t work.

Now this didn’t come as a surprise to anyone who reads Diabetic Investor on a regular basis as we have noted for some time the issues associated with the 670G. Issues which has caused the FDA to open an investigation and issues which are driving customers away from Medtronic into the arms of Tandem and Insulet. Issues which ultimately could do what we thought was impossible, kill the goose that lays all those profitable golden eggs.

To be very clear Medtronic has been well aware of these issues for some time they just didn’t know how to deal with them. The big problem was and still is the sensor that works with the 670G, a sensor which is unreliable. Sensors which deliver highly inaccurate readings which according to the FDA’s MAUDE database have led to several deaths. In typical Medtronic fashion the company attempted to cover up the problem by classifying the underlying cause for many of these deaths as a problem with the pump reservoir. As we noted the FDA became aware of the cover up and hence began their investigation.

Internally the company was struggling to come up with a solution but ran into another common problem at Medtronic. Since there was no quick cheap fix any solution would hurt the bottom line something that went against management’s focus. Again as we noted this team cared about one thing and one thing only; making their number. Something that went against the grain of some good people working inside the company people like their ex-medical director Dr. Fran Kaufman. Dr. Kaufman figured out she was being set up as the fall guy and rather than be thrown under the bus ultimately resigned. Once again Medtronic tried to cover up the real reasons for Dr. Kaufman’s resignation saying she was retiring. We knew this was BS and with Dr. Kaufman now at Senseonics again we have been proved right.

The reality here is the company didn’t need this report to know there was a huge problem with the 670G all they had to do is look at the many posts on social media. As we have said all along when the damn thing worked it was great, but the problem was and is it when it doesn’t work patients hated it. A fact also known by many endo’s who also shared their concerns with the company. Concerns which fell on deaf ears.

So in response to the report we now get this, per the post on the Drug Delivery web site;

“In response to the BCH study, Medtronic said in an emailed statement that the company has updated the software in the MiniMed 670G’s transmitter that sends sensor data to the insulin pump.

When the system was first launched in 2017, it included a safety feature that prompted a “continuous request for blood glucose entries,” the company noted.

“To improve the patient experience, we created a software enhancement that removes all additional safety check without compromising patient safety. All MiniMed 670G systems shipping today have this enhanced transmitter, and we are replacing the transmitter for anyone experiencing an issue,” Medtronic added.”

This is so damn Medtronic and does point to an even bigger problem we have also noted. Unlike the new Tandem pump which can be updated without a hardware replacement, any fix with the 670G means the entire pump the hardware has to be replaced because the geniuses who designed the 670G did so with NO connectivity features. Yet the real issue is and continues to be the sensor itself and no software enhancement will make them more accurate or reliable.

What the company should do but likely won’t do is make so the pump works with the Dexcom G6, a sensor that is accurate and reliable. Heck let it work with the FreeStyle Libre another sensor that actually works. Even better allow the we aren’t waiting people access to the pump so they can get it to work with any sensor. But this will not happen, and it won’t happen as it would be an admission by Medtronic their sensor sucks.

As we noted Medtronic’s CEO Omar Ishrak has been very public that their stand-alone CGM system will be a billion-dollar franchise. Even though he has been told by his own people this will never happen he continues to make this claim. Even though Dexcom and Abbott are gobbling up patients faster than McDonalds serves hamburgers he continues to make this claim. Even though the Medtronic sensor is despised by every key opinion leader he continues to make this claim.

Therefore we have a message for Medtronic and their head in the sand CEO – WE AIN’T STUPID. Try as you might to cover up the well-known problems with the 670G the truth has great knack for making you look like a fool. A fool surrounding by court jesters who are complicit in this crime against your patients. We’d ask you to do the right thing to go back to the heritage of what made MiniMed great, to put the patient first but we know this won’t happen that Medtronic really has become the evil empire putting profits ahead of patients.