Thursday, July 14, 2011

Technology: Benifits and Drawbacks

So I'm a biomedical engineer (BME). When I started college, I really wanted to be playing with stem cells, but I picked the school who's BME program was all biomechanics, aka movement analysis and prosthetics, because they gave me lots of money to go there. As I took more and more classes, I realized I really enjoyed bioinstrumentation, aka fancy medical devices, because on any given day, I can be found carrying at least three of them on my person.

I was psyched when I saw that the DSMA (Diabetes Social Media Advocacy) was hosting a discussion week about medical devices. Unfortunately, because my social life is sideways and upside down in the summer, I haven't been able to join in to any of the convos. but I read the transcripts and try and listen in on at least some of the radiotalk on Thursdays. Then, I found out that it was this month's blog carnival, and I've been scheming about what to write about since I saw it. **I go back and forth with a lot of these issues because while I understand why they exist, I still think it sucks**

Because I'm on the up and up (I think) on how device development works, I know that bringing serious innovation forward to existing devices is hard. Partly because of how the FDA approves changes and partly because of how big business works. After that comes all the cool stuff I'd like to see happen with our current D technology.

Regulation of medical technology is hard. Period. It's a little backward in the US but it's not always better in other countries either. EACH country has different approval mechanisms. Some are easier and believe it or not some are harder to gain regulatory approval. So yes, while I'm jealous about the Animas Vibe coming out in the UK, I understand why they started there.

Regulatory approval is like those car seatbelt alarms. While they annoy the daylights out of you and they're pesky, the ONLY reason they're there is to help keep you alive. They're not really trying to hold back innovation and cool new technologies. They exist to keep us safe from medical fiascoes like the Pinto (read car that burst into flames) for the car industry. Also keep in mind, while some of what they do and their procedures make no sense, NOTHING in the medical or political world is close to perfect.

So the big bad world of big business makes it really hard for a basement tinkerer to come up with something really cool in terms of D-technology. They have lots of money and lots of resources. When larger companies absorb smaller companies, sometimes awesome things happen and sometimes awful things do. This goes back to the previous point but it's really tough and expensive to win regulatory approval as a small firm between the amount of money for the trials and the amount of paperwork to ensure you actually thought the idea through. A lot of times people have to sell their ideas to bigger companies so that they make it to the hands of everyday people like us. I was a little sad when I read the Deltec Cozmo pump (pump with meter attached) was going out of business because I was so psyched at how different it was from the other major pumps in the market. While I don't know their reasons, I do understand the pressures from a very competitive market.

As far as my hopes for D-technology, I'll break it up in 2 ways: Near Future and WAYYY out there. Everyone thinks that smaller is better when it comes to technology (see anything about cell phones and mp3 players). While smaller is cooler in some cases, bigger is also better too (especially for the older peeps with D). There are some populations of people with D that don't get as much attention as they nearly need. The two in my mind are the uber-technophiles like me and those kids who are diagnosed early on (because if I see a commercial selling my diabetes supplies with medicare once more, I may scream at the TV about how I'm not old enough for that by decades).

As far as technophiles, there's tons that we wish we could do with our D-technology. 1 integrated device to carry around instead of 3 or 4 would be awesome (are there security concerns? sure, but can't we decide our data risks personally?). Looking at our data in different forms and playing with it find trends that important to us. Customizing our devices sometimes plays a big role (see bg meter via iphone). I think someone brought up the incredible point of putting a light where the strip goes and the blood gets sucked in so we can test in the dark (think movie theaters, bedrooms, camping trips). Even some fluorescent or glow in the dark action on strips (I know you're supposed to keep them in a cool dark place but still) would be cool. It amazes me that not all pumps come with remote controls and there aren't smartphone widgets for inputting d-numbers to track. I HATE that I have to put carbs and bgs into my pump and then my dexcom. If tracking is SO important, why do they make it so impossible? I want more options. Can't we decide how complicated or simple we want our medical devices to be? I can get a less powerful version of an iphone for less money than the brand new one, but I can't do that with my medical devices? Can't I upgrade the processor or order more software to tinker with it myself at MY OWN RISK? (Although to be honest, I think that's more the FDA then the companies)

For kids? It's been a while and I was diagnosed close enough to puberty that I've always been pretty much the same size. But I met a d-dad at an interview who was telling me about how disappointed he was that his son couldn't live with an insulin pump because it's too big for him. With all of these miniaturization and customization skills that companies have, they haven't figured out how to make pumps and devices sized for kids. Ones that have smaller reservoirs and fewer options than the regular-sized adult ones would make their lives that much easier. They've started coming out with cellphones for kids that can gradually be transitioned to real phones. Why don't they have grow with you insulin pumps targeted to the ages of 0-12 years?

There are also things that most diabetics are disappointed and confused by. Like the accuracy of our testing devices. Why can two identical meters be so far off? (Variables. Temperature. Test strips. Tolerances in device specs. Testing locations. Blah blah blah. Seriously?) If we can send people to space, why can't I test my blood sugar when I'm snowboarding because my meter is too cold or at the beach because its too hot?

As far as the future, I'm right there with everyone for a cure or at least an implantable pump. I understand the difficulties with reservoirs and batteries as well as scar tissue and glucose monitoring physiology. I just would love something that would make me worry less 24/7. I'd be happy to forget that I have diabetes for more than an hour (most days, not even that).

I know that technology isn't instant like microwave noodles. It takes time and money and a lot of innovative minds. But I can't lie and say that I don't want more. More accuracy. More options. More simplicity. More sizes. I want more, and I want it soon.

This post is my July entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at


  1. Maria-

    You brought up great points. You really hit the hammer on the nail when you said pumps are too big for little kids; I never thought about it. I wonder why they don't make pumps specifically for children-cost.

    Meter and CGM accuracy is my biggest grip. We depend on these devices to help us manage diabetes. I hope this is at the top of the meter manufacturers list.

    The PDM for the Omnipod has a light were you insert the strip. The light could be a lot brighter.


  2. I love love love that you are in a position to give us both sides of the d-technology story!!! It's very important to understand why advancements don't move as quickly as we'd like them too. It's also very important to get our needs and wishes out there. Thanks for doing both!

  3. You have an incredibly valuable perspective to give here, and thank you so much for sharing it! The analogy "Regulatory approval is like those car seatbelt alarms" is probably the best I've ever heard on describing the FDA... that solidifies it so completely well. You're right that the devices are too big for kids - just look at the current Omnipod attached to a small child, and you can see this perfectly. Future versions and developing patch pumps are supposed to be smaller, but it's somewhat disconcerting it's taken this long for that to be addressed. Anyhow, thanks for sharing all this and can't wait to read more!