My Take: First Impressions, New Type 2 Implant, Test Strip Bidding War, and More

Taking a cue from Kevin, M.D., here’s an “at-a-glance” roundup of my take on some news of the day:

Chewing_pencil 1) Dr. Rob reports on the importance of a physician’s opening remarks. “Saying the right things at the start will make the job much easier.” Ya think?! Nothing is worse than finally making it in to an endo visit only to be greeted with some asinine remark, like the one KK reported last week. Of course, being a primary care physician, Dr. Rob says “I don’t really want my patients to ‘come here often.’” We PWDs have no choice, Buster.

2) This just in: Living Cell Technologies has announced positive results of Phase 1 and 2 clinical trials of its DiabeCell® implant treatment for people with insulin-dependent diabetes. “The cells are introduced into the abdomen of the patient in a simple procedure under local anaesthesia. The encapsulated DiabeCells do not require the use of immuno-suppressant drugs.” Early results at the six-month marker show a significantly reduced need for injected insulin. OK, so the results reported only reflect the experience of a handful of patients — and one of them, experiencing “personal social problems,” still needed to increase her injected doses. But nevertheless this looks hopeful. More hopeful than many of the long-shot cure concepts that make splashy headlines on a regular basis, I’d say.

3) Another implant therapy, but this one is just weird. A hospital in New York is now recruiting patients for a second national clinical research study of “an investigational implantable device” called the The Tantalus® System. It’s designed to Type 2 diabetics who are overweight and do not respond to current oral anti-diabetic treatments by “sensing naturally occurring electrical activity of the stomach in real time and automatically apply electrical stimulation when a person eats.” So it’s like internal shock therapy? The patient gets “buzzed” in the stomach while eating so they’ll immediately start feeling full? Sounds kind of like a “diabetic IUD” to keep the food from taking hold, possibly with all the same health risks — tissue perforation, infection, etc. Gross. Personally, I wouldn’t be willing to take the risk with any implantable device unless it actually did something to replace the lost function of my pancreas. Thoughts?

4) Diabetic Investor David Kliff reports on a test strip bidding war spurred by recent Medicare reimbursement cutbacks. Patients will see a up to
43% less reimbursement on mail order diabetic supplies. In order to stay competitive, test strip manufacturers are now trying to undercut each other to become the major suppliers to the likes of Wal
Mart, CVS and Walgreens, where btw, the lowest name brand product Kliff found was the Accu-Chek Active strips going for $29.34 for a box of 50. The problem is this cost-cutting will not be passed on to consumers. “The problem with the winning bidders is that 64% are
small suppliers with revenues of $3.5 million or less,” Kliff writes. “It’s unlikely
these smaller companies have the resources or sophisticated systems to process
orders cost efficiently and handle the additional burden of customer service… Rather than
encourage more frequent testing and patient education, CMS has done the opposite.
Once again the patient is the real loser here.” Why am I not surprised? I still think we need to create some kind of grassroots campaign to protest the ridiculously high cost of these mission-critical diabetes supplies. Ideas welcome.

5) Finally, another weird development. Did anyone notice that the AADE has put its patient-facing weblog on hold? Why? Due to lack of funding, they say. But how expensive can it be, really, for a national organization of this caliber to run a blog? I mean, they must have hundreds of CDEs out there who’d be willing to write something for the patient community for very little compensation. Too bad. Stay tuned on that one.

More quick looks at headlines in my Weekly Nuggets section, as always :)

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9 Responses

  1. PrintCrafter
    PrintCrafter March 31, 2008 at 9:33 am | | Reply

    RE: the CDE’s. From what I’ve seen, I doubt that many are willing to take the time to do anything for PWDs unless it involves a paycheck! Here in NM the state tried to start a training program for RNs in the sticks and the CDEs all refused to help with trainig with out stipends.

  2. Jenny Ruhl
    Jenny Ruhl March 31, 2008 at 10:18 am | | Reply

    Re strips.

    I wonder if this is something we can ping Senator Charles Grassley on and see if congress might investigate the strip companies for colluding on price setting to the consumer which is illegal.

    Grassley has been on a one man campaign against drug company abuses.

    I find it impossible to believe that I can buy a desktop computer for 1/5 the cost of what I paid for a system in 1998 while strips now cost 33% MORE. And are no more accurate.

    We are a captive audience but the problem is too big for one person. If you want to start collecting names for a petition, etc, count me in!

    –Jenny Ruhl

  3. MoHo
    MoHo March 31, 2008 at 10:58 am | | Reply

    What was most significant with the DiabeCell trails so far is that they are using a minimal amount of cells to produce an effect, at least that’s how I read it. Perhaps when patients get a “full dose” the results will be more profound? Another wait and see…

  4. CALpumper
    CALpumper March 31, 2008 at 10:58 am | | Reply

    I like the grassroots idea for this test strip issue that seems to never get better. I have a few contacts that could help launch something, possibly, within my state too.

    Keep us posted Amy. There are enough of us to have our voice heard, somewhere at least!!!

  5. Scott
    Scott March 31, 2008 at 11:28 am | | Reply

    I read the AADE notice last week about putting its patient-facing weblog on hold and asked the same thing (not that I found the site terribly useful, but still …) Operating a blog costs nothing, and I’m sure they could find willing writers. The key, I think, is that the AADE carefully edits their pages to make them fully HIPAA compliant, in spite of the fact that they could cover themselves with a simple disclosure, and they also try to avoid posting anything remotely controversial. Perhaps the solution would be for management to rethink their blog strategy?!

    LCT is an interesting development, but small trials are nevertheless still too small to draw any real conclusions from, but lets wish them continued success.

    Re: test strips, I think the real issue is the games the manufacturers play with product designs to keep them continually covered with patents. Every few years, they make marginal design changes to get themselves a new patent and cover the product for another 7 years — in effect, preventing generic competition from ever emerging. Also, why is it that in 2001, J&J was able to acquire Inverness Medical Technology (a onetime generic manufacturer) and the USDOJ didn’t even raise their eyebrows?

    I’m all for a grassroots campaign, but I’m not sure how much we’ll realistically be able to accomplish without the help of lawmakers.

  6. Dr. Rob
    Dr. Rob March 31, 2008 at 12:02 pm | | Reply

    No question my diabetics, etc. come to my office on a regular basis – but my goal is to have them well-controlled enough that their visits are not problem-focused, but preventive and managerial. I tell them I love to have “boring” visits. There are plenty of patients I see quarterly or even more (all type 1′s are q 3 months), but I find good communication makes it much easier to make the visits no more frequent than this.

  7. Hannah
    Hannah March 31, 2008 at 2:58 pm | | Reply

    2 Comments on #3, one not necessarily suited for the PG-13 audience so I’ll side-step as much as possible:

    Family-friendly #1: We already have access to something that helps us feel full. It’s called Symlin. I think Byetta has similar results, but as an insulin-resistant type 1, I only have experience with Symlin. And that doesn’t involve any scary and costly surgery!

    NON-family friendly #2: The “Tantalus” is definitely the name of a “marital aid” I purchased once. :X

  8. Adam Greene
    Adam Greene April 1, 2008 at 9:47 pm | | Reply

    It used to be possible to cut the FreeStyle strip into two to get twice the usage out of it, but then abbot changed the design by placing the electrode on one side only. Grrrrr. Does anyone know of any other strip that can be cut in two?

    Amy, my first thought about your strip cost issue was that if aviva strips are the cheapest, lets buy that meter (or ask our insurance companies to support it) and if the others are losing market share they’ll fall in line. But I think Jenny Ruhl has a really good point. Another senator who is (starting to be?) involved in diabetes health maters is Senator Charles E. Schumer of NY. Jenny, what if we joined forces and wrote a few letters? If you are interested, amy, could you play the middle-woman and exchange our email addresses?

    Thanks!
    Adam

  9. camille johnson
    camille johnson April 4, 2008 at 5:21 am | | Reply

    Re #4 – I just have to join in the fight for reasonable costs for test strips. I’ve often thought of developing my own strips (and making $millions) while selling the strips at something like $5/100. You’ve got to know that they cost about $.5/100 to produce (or less) so how they get away with charging these rediculous prices is beyond me.

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