What will his world be like?

What will his world be like?

This past Tuesday the Kliff family welcomed Tyler Dylan into the world which got us thinking when it comes to our wacky world what will Tyler see. Will Tyler see a cure for diabetes? Or what about a real artificial pancreas? Will Tyler live in a world where patients with diabetes come first? A world where outcomes really matter? Or will he be as frustrated as his granddad that after all the time and money spent nothing changes?

Looking back when my kids were born some 32 years ago we lived in a world with multiple insulin pump companies and more on the way. Back then SMBG ruled the world, the market was growing organically at double digit rates, new technology was coming, and the companies were racking in the profits. Back then the pipelines of drug companies were full of promising innovative therapies which we take for granted today. Patients did not have to worry high deductible plans and payors were not yet determining how patients were treated. Back then physicians could actually be physicians.

Tyler comes to us in a world with just three insulin pump companies, soon to be just two. He will never see a conventional glucose meter which will be replaced by CGM. He may see innovative new drugs, but he’ll wonder if patients will be able to afford them or if physicians will be allowed to prescribe them. There may be a real artificial pancreas, but he’ll ask the same questions as his grandad, just how many patients will use it or even be able to afford it.

Today Tyler arrives with Lilly (NYSE: LLY) and Novo Nordisk (NYSE: NVO) as the top two diabetes drug companies, with AstraZeneca (NYSE: AZN) and Sanofi (NYSE: SNY) struggling to remain relevant. He arrives with Abbott (NYSE: ABT) and Dexcom (NASDAQ: DXCM) getting to set to do battle in the CGM space. More than likely he will mature at the same time Google, Apple, Amazon and all the other cash rich high-tech companies who are making the deep dive into diabetes also mature.

Sadly, he will also likely grow up with lots of toy makers who make way cool whiz bang toys but are clueless about running a commercially viable toy company. (Stupidity is a constant that spans from when Momma Kliff was young to Tyler and beyond.)

More than likely Tyler will spend little if any time going to Walgreens or CVS to get any prescriptions as Amazon will deliver them right to his home. Unfortunately, he’ll also have to listen to snarky Alexa and Siri.

His friends with diabetes will have slap it on turn it on CGM sensors which talk to their smartphone (or whatever device they use) which along with apps will help them manage their diabetes. He may even see patients incentivized so that they too get something for managing their diabetes properly. His granddad is praying that he’ll see patients put first.

Maybe Tyler will see the JDRF and ADA transform into organizations which do more than pontificate. Perhaps he’ll witness a new world where industry and these organizations work together so everyone wins rather than watch them be at odds. His granddad is hoping that whoever makes up the West Coast Mafia will begin to understand that way cool whiz bang is meaningless and that the ability to run a commercially viable toy company helps patients. That there is nothing wrong with companies making billions or executives making millions provided patients are getting better.

Yet for right now Tyler could care less about any of this and will leave the wacky world of diabetes to his granddad. As Momma Kliff used to say we ain’t got any dumb children in this family. So welcome to our world Tyler Dylan your granddad is thrilled to have you and your grandmother will always be an angle on your shoulder.