“Diabetes is Not Curable”

It’s amazing what you can find on the internet nowadays.

Just the other day, for example, I was musing further about healthcare and what it means for diabetics, when I came across a slideshow that perfectly exposed the elephant in the room of diabetes care and medical device development.

Let me explain: the slideshow, likely seven or eight years old, was a presentation of the great gain possible for Roche Diagnostics if it acquired the insulin pump manufacturer Disetronic. It is a very telling slideshow, and definitely worth sliding through: http://www.docstoc.com/docs/24505054/Shaping-the-future-of-diabetes-care. This is what I learned:

– At the time, Roche already had brand name recognition with its AccuCheck meters.

– But blood glucose monitoring was only 30% of the diabetes market; the future of diabetes care was even then clearly in combining blood glucose monitoring with insulin delivery.

– Roche in 2003 had no big player in the insulin pump category, but Disetronic had the second most popular pump in the world.

– And boy were there a lot of diabetics out there, and boy did they want insulin pumps: the diabetic market was far from “saturated,” and insurance companies were becoming increasingly willing to pay for pumps.

– In other words, there was lots of money to be made. And pumps were good for making money. Disetronic had a profit margin upwards of 30%, and that was just the beginning. After all, pumps have two profitable elements: the device itself, which generates a nice upfront payment, and then all the consumables! A whole host of consumables! “Glass and plastic cartridges, batteries, carrying systems, various infusion sets (catheters changed 3-4 days)”– in sum, buy Disetronic, and you’re not just buying a product line; you’re investing in your future!

Now, don’t get me wrong. Sarcasm aside, I get the Gillette business model, and I am a full-blooded capitalist, and I understand how important the profit-motive is in driving medical innovation. I have my inulin pump and my continuous glucose monitor and all their expensive, disposable parts, and I love them. I don’t fault the medical device companies in any way for charging handsomely for their products, and I greatly prefer expensive medical innovation to being stuck in 1920, where as a technology-poor diabetic my life expectancy would always be “Today?”

But I hate the flip-side of the Gillette business model when it comes to my health: if the best thing for any company to make is something that we have to keep buying, than no one will invest in finding the one-time-fix. In other words, as one Minimed employee, herself a Type 1 diabetic, sadly told me back in 2005:

“They’ll never cure diabetes; it’s too profitable to keep treating it.”

Or, as the Roche slideshow states on slide 27 of 28:

“Diabetes is not curable, but it is manageable.”

It’s the tense of that sentence that just kills me. In context, it makes sense– they mean, presumably, “Diabetes has not yet been cured, but it is not terminal, and can be managed and treated well by individuals who have the right tools.” But what the statement makes abundantly clear is: the money is in slow, perpetual fixes– catheters, test strips, sensors, disposable parts– and so that’s where the research and the focus of medical professionals will go.

Sigh. So what do we diabetics do? Fight and cry and despise the medical device companies? Heavens, no. Instead, I suggest we be as lovable and as visible as possible. We’re unlikely to convince anyone that the real pot of gold is in a one-time-fix for diabetes, because they already know the profit comes from dragging out care. So instead we have to plant ourselves in the hearts of the people working at medical device and pharmaceutical companies, so that one day, this scene can play out:

A young, dashing research assistant from a small lab approaches the head of product development of the large pharmaceutical behemoth. He says, nervously, “I know the final results from our trial are yet to come in, but I think we can all see at this point: we’ve done it. Our lab has developed a single pill that will cure Type 1 diabetes!” (Trite, I know, but a girl can dream, can’t she?)

The head of development, sitting behind her large mahogany desk brings her pen to her lips. “Really? Tell me more,” she says, but she’s just buying time. She’s not listening as the researcher continues; instead, she’s calculating: one pill per Type 1 diabetic, even at a very high price, would pale in comparison to one pump every five years per diabetic, plus an infusion set every three days, plus a dozen test strips a day every day for the rest of each diabetic’s life plus–

“Well?” the researcher finishes. “How quickly will your company be able to get it out to people?”

“It’s not that simple–” she says, beginning to build her defense, her explanation as to why it would never work, her dismissal of the researcher before she would proceed to bury him and every record he had of what he had discovered. “You see, there are complications to introducing a product like this to the market so suddenly, and–” she paused. She tried to begin again, but could not; all her calculations and wordy formulations slipped, and all she could think about was the clerk she had seen at the department store, stopping mid-shift to measure her blood glucose, and explaining sadly to a patron that she would have to get someone else to assist her right then. And in that recognition and humanization, the head of product development forgot for a moment the dollars and the sums, and remembered the human cost, the social burden, the daily pain of chronic illness.

She cleared her throat, and began again: “There are complications, but we’ll do it. One pill for every diabetic in America and worldwide, as fast as the FDA horses can carry them.”

And they lived happily ever after. The End.

Okay, I know it’s unlikely to happen exactly like that. But because the dollar value is so heavily in favor of eternal management, rather than curing, we diabetics are going to have to rely on something other than buying power to tip the research and development scale in our favor– and as I see it, getting every member of the medical product development process to know and love at least one diabetic is a really good start.

Incidentally, Roche successfully acquired Disetronic early in 2003. And indeed, Roche has successfully enlarged its portion of the rapidly growing diabetes care market. Their meters and pumps are great, I’m told, and I have nothing against them– I just wish we had a cure already!

Karmel Allison

Karmel was born in Southern California, diagnosed with Type 1 Diabetes at the age of nine, and educated at UC Berkeley. Karmel now lives in San Diego with her husband, where she is loving the sunshine, working in computational biology at the University of California, San Diego, and learning to use the active voice when talking about her diabetes.

Karmel Allison

Karmel was born in Southern California, diagnosed with Type 1 Diabetes at the age of nine, and educated at UC Berkeley. Karmel now lives in San Diego with her husband, where she is loving the sunshine, working in computational biology at the University of California, San Diego, and learning to use the active voice when talking about her diabetes.