Discussion in 'General Discussion' started by Jeff, Oct 28, 2007.
Interesting stuff. Thanks for sharing. What was up with the keynote speaker (of all people )?!
Thanks for posting. I see a few things that interest me.
VIAject sounds like a cool idea for pumpers, in that the shorter the duration of your insulin, the more potential for treating hypos by administering less insulin.
The glycemic variability thing, if true, is major.
I don't like that grid. It implies that diabetes management is simpler than it is.
That normal hba1c goes up with age is interesting; are higher A1cs safer for older diabetics? Or is this more along the same lines as that there are more diabetics and prediabetics among the elderly?
The most interesting presentation was by enGene -- imagine a genetic engineering cure!
Years away, I know, but very interesting.
That was very interesting -- and exciting.
What strikes me as most immediately useful is the viability of a CGM combined with the insulin cannula. Aaron can't be the only kid who would like the continuous glucose readout but isn't impressed with the thought of two different insertion sites (he barely has enough meat for one).
What inappropriate thing did the keynote speaker say? I searched for a transcript but couldn't find one.
"Keynote speaker Richard Kahn, Ph.D., the Chief Scientific and Medical Officer for the American Diabetes Association, read from a prepared speech and chastised everyone working in diabetes technology, saying in effect that insulin pumps and continuous sensors were of no value and that people with diabetes would be better served if doctors simply reminded them to take their medications on time. His speech was simply appalling."
I would love to have that transcript as well - He sounds like a complete moron!
O.M.G.!!!!! I cannot believe a representative from the ADA would make such ignorant remarks. I'm speechless!
I've asked for a transcript,
and optionally an actual REPLY to Jeff's scathing review, within the ADA "type-1" forum. I know Jeff to be very careful with "unkind" words, so I'm guessing that it must have been really awful.
I have the full text of the speech, but it is not my place to publish it.
Also, it is very different to hear a speech read and to read the text of a speech after the fact. When you hear a speech read by someone who has a history of controversy, and you hear your life's work dismissed, it is difficult to remain dispassionate and listen objectively to the rest of the speech. Such was clearly the case here, and I was not alone in my feelings.
I will gladly post any rebuttal from ADA.
Hello CWD Friends,
I am Mary Pat King, Director of National Youth Initiatives at the American Diabetes Association. I have met many of you at past Friends for Life or other CWD events.
Here is the link to the text of Richard Kahn's speech, Diabetes Technology in the 21st Century, which was delivered at the Diabetes Technology Meeting this past weekend:
I hope you read the speech. My personal opinion is that Richard represented our constituents -- patients and health care providers -- by making a call to action to industry and researchers to develop more efficient, cost-effective and evidence-based technologies that improve the systems of delivering high quality patient care.
Thanks for taking the time to read it.
I look forward to seeing you again at CWD's Friends for Life Conference in July!
Mary Pat King
Mary Pat is wonderful ... just so you all know :cwds:
I just read the speech and I really don't understand where the interpretation of "chastised everyone working in diabetes technology, saying in effect, that insulin pumps and continuous sensors were of no value and that people with diabetes would be better served if doctors simply reminded them to take their medications on time" came from. I didn't see that in the speech at all.
Rather than give my interpretation (and it is an interpretation because those actual words do NOT appear in the speech), I'd suggest everyone read the thing themselves.
I see it: "A technology that gets the 70% or so of people with diabetes who are not taking their medications as directed, to start taking their drugs like they should, would much more likely have greater benefit than another monitoring or insulin delivery device"
I think that the added technologies really benefit us T1s more than they do T2s, and that this speech had more to do with T2, which is what the ADA is all about.
Dr. Kahn sounds like an Insurance Company executive....
warning: long, viscious, and nasty post. I think he deserves it. If you're easily offended, DON'T READ THIS.
He talks just like a paid astroturfer, ala "Thank You for Smoking"-- denying ALL new diabetes treatment and diagnostic products, suggesting that denial of medically necessary and effective FDA-APPROVED treatments is desirable whenever "there's no long term, randomized controlled study showing benefit".
He then specifically says that self-monitoring by T2 pts. on oral drugs is UNJUSTIFIED.... he means that we should take their meters away, because we don't have sufficiently "robust proof" that they provide any "benefit". I guess that "robust" and benefit" are to be defined by for-profit insurance companies, it's almost totally undefined here. He has nothing to say about the measurement of "benefits"-- I guess he thinks "low A1c good, high A1c bad" is good enough to explain everything.
The requirement that studies must be "Long Term" seems to be presented as Fait Accompli: no treatment should EVER be covered until years and years of studies have been completed. (Small, innovative companies like Dexcom would probably go out of business before getting approval to sell anything from "innovative" HMO's.... but this doesn't seem to be about companies like Dexcom, or the attendees of the conference, this seems to be ALL about lowering Health Care Costs and protecting insurance profits.)
Instead of having these "robust proof" requirements set on a case-by-case basis by FDA expert panels, which BTW consider comments from ANYONE who has relevant and competent comments to make, it is proposed that these requirements be set a magical cabal of HMO's and Insurance Company payers. Most of whom have never given a dime of their "hard-earned" profits towards actually paying for any these "robust" studies to be done. (Meanwhile, he bemoans the "influence" of Universities, and MD's who are willing to actually spend time and money to deliver good care, and even the "greedy" Pts. themselves.) He says,
"A technology that gets the 70% or so of people with diabetes who are not taking their medications as directed, to start taking their drugs like they should, would much more likely have greater benefit than another monitoring or insulin delivery device."
70% or so ??? Let's talk ROBUST: What's the p value for the 91% and 95% confidence intervals on that study? "more likely have greater benefit" ??? Gee, that sounds like a really "robust" finding. And BTW, how was this sample population selected, how did they adjust for drop-outs, how did we measure their non-compliance "ROBUSTLY"? And what about those 30% (or so ???) of pts. who apparently ARE taking great care to follow their instructions, but could benefit from improved and already approved technology? Apparently the Robust-Proof-Required answer for them (including nearly all of us here), is:
"Just drop dead already-- those expensive treatments eat into our $$profits and we've not found any of these new-fangled gizmos to be ROBUSTLY proven "cost effective" for even 1/3 of diabetic Pts.. We think that "pissing papers" are plenty good enough for you, now stop arguing with your Internet-researched "study documents" and non-ROBUST FDA Approvals and Journal Reprints and University Studies. It's up to us-- you pushy Woodstock-generation people, with your oh-so-personal Medical Records and your "treat, treat, treat" money-spending MD's really ought to leave these decisions to the experts. Which is us. We don't care about YOUR medical records, we've got cool statistics from studies WE LIKE BETTER, which say that we don't have to spend the money. (Even if the study explicitly excluded people like you from the Trials, we get to say it's relevant. We say the 70% don't get any benefit, so we ain't gonna bother with you insignificant minority people.) Anyway, diabetics are really all the same, it makes our profit/loss spreadsheet math a lot easier to make the "ROBUST" assumption that your body works exactly like the Median person in our favorite study-- humankind is just like a factory, every widget is exactly the same, and hey, no one lives forever! It's nothing personal, you're just being rejected by QA, you're just too expensive to bother with trying to repair or maintain in such a NEEDLESSLY sophisticated way.
SO you see, I don't find your medical records, or your MD's statement of medical necessity, or the FDA's approval for pts. exactly like you, to be "robust" enough for me. And it's my money now. I don't have to spend it on you, because your evidence isn't "ROBUST". Regardless of what an insurance contract should say about medically necessary and effective treatment, my reasonable reward for making the "hard decision" to keep you from driving up Health Spending is to let me spend the money on a new LearJet. That's much more productive for the economy, you sick people are just a WASTE AMERICA'S MONEY. Oh, and have a nice day.
He goes on for many paragraphs about how we're spending so much money, but not reaching the bottom half of our society. He blames the Woodstock generation, the Internet, the MDs, the FDA, Social Security-- just about everybody except the HMO's and Insurance Companies, on whom the Diabetes Technology folks should focus their skills (helping them to improve "delivery methods" and "efficiency", instead of working on mere diabetes treatments and diagnostic gadgets and biologicals.)
But I disagree with this, and the facts are on my side. You're not gonna make care BETTER by simply taking all the "expensive" treatments away from the top half. The first thing which all of the HMO's in my city do, to control their costs, is to cherry-pick their members. "Efficient, Cost-Effective Managed Care" is made efficient by ruthlessly avoiding delivery of ANY care to exactly the people Dr. Kahn seems to be presenting as the beneficiaries of their cost-cutting! These cost-management tools and strategies aren't the solution, they're one of the very BIGGEST parts of the problem. (BTW, my State is either #49 or #50 for children without ANY Health Coverage.)
What $^#%$&@$# planet is he living on???
Jeff is a lot more diplomatic than I am, obviously. Take bG meters away from 70% of diabetic patients? Well, I'm kinda disappointed that the ADA's Chief Medical Officer proposes this "innovative" strategy to keep pts. and MD's from spending "too much" money on Health Care.
Thank you Rick, you said it better than I would ever be able to say it. I read the speach and gathered exactly what you did.
"Why are glucose meters still costing over $5000? Isn't it fair to ask that question?"
I certainly hope you aren't talking about glucose meters? Perhaps you meant insulin pumps? I can certainly steer you towards free or almost free glucose meters.
I couldn't have disagreed with Kahn more. There was a study in England put out this year that said BG testing by people with type 2 was not beneficial. You should have seen the uproar from us with type 2. Testing is vital for all people with Diabetes whether a person uses insulin or not. I depend on my meter to let me know what is happening with my blood sugars and how the food I eat is affecting my blood sugars, to tell if I am low and to see if the medication is working. Clearly this guy doesn't know what he is talking about at all and that includes both types 1 and type 2
My take on his speech
My personal opinion is that he did not represent patients at all.
In my opinion his speech surmised that the history of doctor care was better before we as patients (or parents of patients) demanded better care. Not to mention that we have the audacity to ask questions about treatments and want better. What I understand from Dr. Kahn's position is that the person that lives with diabetes daily should not research their condition or look on the Internet for information. Because that can be construed as shopping for health care. It is much better that a patient do as they are told.
As far as laying the blame of the health care crisis at my feet or any other patients feet. I would ask Dr. Kahn and people making their income in the health care sector to look in the mirror. Does anyone want to throw stones while standing in that glass house? Because I doubt any person with a chronic condition has asked for out-dated information or inferior medication to stem cost. " In other words, the technology, medications and information are all there—but they are not getting to the patient. We seem to have what we need, but putting it into routine practice seems to allude us." I wonder who is making those decisions? The Patient?
Finally, I believe in every fiber of my being that there will be a cure for Diabetes. Because Dr. Kahn, I have a young son that was diagnosed with it at the age of 16 months. I will not accept, pay or support you or anyone else that thinks technology should only be improved upon or made available only to make a hospital or physicians job easier. "But we need, and will move toward, a new equilibrium between investing in new treatments and investing in delivering what we have. I concede that solutions that make the delivery of quality care more systematic are not as sexy as implantable closed loop islet factories, or new devices to make insulin delivery more convenient, but technology that improves systems of care are apt to save and improve more lives—and such technology will be amply rewarded in coming years." Who exactly reaps those rewards?
Thankfully all do not believe as you do and have the foresight and vision to strive for better. Those are the people I will seek out and support.
Separate names with a comma.