On April 5, 2014, the New York Times published an article that had enormous potential. But poor execution left anger and outrage in the type 1 diabetes (T1D) community. As a person living with T1D, I felt some of that outrage. But I also found some value in part of what the author has to say.
The excessively long article, titled “Even Small Medical Advances Can Mean Big Jumps in Bills,” is filled with points and one-liners that leave the T1D reader feeling misrepresented, and the amazing technological advances in diabetes care seeming like a trivial waste of healthcare spending. The article claims that:
• A captive audience of Type 1 diabetics has spawned lines of high-priced gadgets and disposable accouterments.
• A steady stream of new models and updates often offer dubious improvements: colored pumps; talking, bilingual meters; sensors reporting minute-by-minute sugar readouts.
• “People don’t need a meter that talks to them,” and “There’s an incredible waste of money.”
On the other hand, the article does attempt to make an important point that I would like to clarify. That point, to quote the author, is this: “Today, the routine care costs of many chronic illnesses eclipse that of acute care because new treatments that keep patients well have become a multibillion-dollar business opportunity for device and drug makers and medical providers.” It is amazing how much money is out there, floating around in the pockets of big pharma. The technology is incredible; the improved quality of life for a T1D patient in recent years is unfathomable; the people who have made these amazing advances are our heroes. That should be clearly stated. But the financial strain can be painful.
The Real Problem
The problem is not technological advancement; its value has been sorely understated as a “gadget” providing “dubious improvement.” The problem is the business model. I am looking for improvements. The quality of my life depends on it. But it seems like the devices we have should not be so quickly outdated. We have seen Apple and Google both upgrade operating systems for multiple generations of mobile devices to bring greater capability and more reliable functionality. When that happens with a pump/meter combo, I have to go buy it again, and that price is simply too high for me. But the industry tells me how much greater and more “normal” my life will be if I can get my diabetes management that much tighter. Why not sell me a device that is as powerful as an iPhone, comparably priced, and capable of a software upgrade?
At this time, we have what is available. I suppose it comes down to how valuable this quality of life is to us. For those who can afford it, there’s hardly a second thought. But for the T1D who struggles to make ends meet, who stops testing to avoid using up the last few strips, or discontinues a healthy meal plan to reduce eating in order to make insulin last longer, the $5,000-plus cost per year, after insurance, can absolutely cause the individual to question that value. Patients will walk a dangerous path of increased risk of complications, compromised health, and frequent, costly hospital admission. And that just doesn’t seem right.