Whining patients

Whining patients

One of the
most difficult jobs in diabetes is selling insulin pumps. It isn’t uncommon for
reps to work 80+ hours each week, travel frequently and deal with the ever
increasing pressure from management to sell even more insulin pumps. Granted
the higher producing reps are well compensated for their efforts and that reps
are notorious for complaining still it is a very demanding job.

It is also
true that the insulin pump market is in the first stages of transition from a
medical device market to commodity market. For those non-believers out there
Diabetic Investor suggests looking at the current state of the blood glucose
monitoring market which has fully transformed into a commodity market.

As Diabetic
Investor has already reported it appears Roche will be joining Smiths Medical
as another company exciting the insulin pump market. This comes at time when
Medingo is getting ready to become the second company to offer a wireless/patch
pump. Diabetic Investor is also aware of at least one company who will be
giving away the pump for free and will try and make all their money from the
continual sales of pump supplies. Diabetic Investor is also aware of another
company touting itself as having the system that will forever revolutionize insulin
pump but has yet to come out with a working prototype.

What all
these newcomers seem to ignore is the insulin pump market is the domain of two
rather well-healed companies and one innovative company. Medtronic (NYSE:MDT)
in spite of several missteps still owns the market thanks in large part to the
work done while it was still an independent company known as MiniMed. Animas, a
unit of Johnson and Johnson (NYSE:JNJ), has solidified themselves as the
alternative to Medtronic and is slowly making inroads into Medtronic’s huge
market share. Insulet (NASDAQ:PODD) has been very good at validating the need
for a wireless/patch pump, unfortunately they haven’t been quite so good at
making any money. Still the insulin pump market is now a three horse race and
it would foolish to believe otherwise.

If there is
any hope at all for anyone else it might just lie in some comments made by an
insulin pump rep interviewed by Diabetic Investor. While Diabetic Investor won’t
reveal which company the rep works for, what we can say is it’s one of three
mentioned in the previous paragraph. As happen often during these interviews
there was the usual complaining about how clueless management is and how they
working reps to death. Pretty standard stuff when you talk with reps. The real
shocker came when this particular rep stated that he/she couldn’t wait to get a
jog where he/she didn’t have to deal with “whiny patients.”

Frankly we
shouldn’t be shocked with this comment as we’ve heard it some many times
before. The real shock is how both management and sales have lost their way
when it comes to insulin pump sales. The fact is selling an insulin pump involves
more than just selling systems, that’s only the beginning. The real sale begins
after the patient selects pump therapy which is basically a commitment from the
patient to change their lives forever. Patients don’t just turn the pump on and
go on their merry way. Insulin pump patients require the highest degree of
diabetes education, as they must understand issues such as insulin duration of
action, carb counting, glycemic variability and infusion set site selection
just to name a few. Insulin pumping is a true commitment by the patient and the
patient’s healthcare team.

The fact that
insulin pump reps and even many of the people who manage insulin pump companies
publicly complain about “whiny patients” shows just how bad things have become
for the industry as a whole and why any company who puts the patient first
stands a chance at succeeding. Living with diabetes is tough enough as it is
and being an insulin pump patient is even tougher, especially when you consider
that one top of all the things non-pumpers have to worry about, insulin pump
patients always have to be cognizant that the device that keeps them alive
could fail at any moment. Given all the recent recalls we’ve seen lately this
is a real concern.

So instead of
coming out with pumps in fancy colors or worrying about closed-loop insulin
delivery systems that patients (and most physicians) don’t want or care about, perhaps
it’s time for insulin pump companies to remember that at the end of that tube is
a real person. A person who each day must live with the fact that he or she
cannot go on without their pump, that this device which is attached to their
body 24x7x365 is essential to their lives.  It may be wise to consider that patients
wouldn’t be so “whiny” if insulin pump companies didn’t put patients on hold
for 15 minutes they call customer service. Or it might just be a good idea to
produce high quality systems that don’t need to be recalled every five minutes because
of design flaws that should have never been present in the first place. It
would be even better if when things go wrong, as they often do, not to blame
the patient.

Given this
set of circumstances does it surprise anyone that insulin pump market is moving
towards a commodity market where price is the only concern? The fact is pump
companies are already sacrificing customer service for increased sales. One
only needs to read the FDA adverse event reports to understand just how bad
this situation has become. Seeing adverse event reports that show patients
priming their pump while it is attached is a classic example of poor patient
training. If you don’t believe the FDA’s own database just ask physicians or
nurse educators who can’t get the help they need.

The fact is
insulin pump companies are doing everything they can to reduce overhead in a
business where overhead is difficult to reduce. As Diabetic Investor has stated
on several occasions the difficulty isn’t building an insulin pump, it’s
running an insulin pump company. We have also stated that the insulin pump
market is not large enough, nor is it growing fast enough to support the
existing players in the market, let alone the many who want to enter the

At least
Smiths and soon Roche won’t have to worry about all those “whiny patients” as
they understand the motto “If you build it, they will come” does not apply to
the insulin pump business. The fact is the insulin pump market has changed and
not for the better. When this story is finally written it will be much like
what happened in blood glucose monitoring, expect the insulin pump market could
have prevented the situation by remembering two simple rules; rule number one
the patient comes first, rule number two, reread rule number one.