March 19, 2010

Poke a Finger on the Invisible Hand

Mrs. YDMV and I have been splitting shifts between the home front and the hospital where they managed to pull Connor’s appendix out of a hole they cut in his bellybutton. Nice trick! Beats the heck out of a rabbit in a hat.

On my home shift I was helping the other boy edit a paper on Adam Smith’s Invisible hand. He did a nice job. I was particularly happy to see him using This American Life as a reference. I love that show.

For those of you who would rather have your appendix pulled out of your bellybutton than try to remember what a long dead economist had to say here is a quick A. Smith refresher; individuals acting in their own self interest lead the market to outcomes that are good for everyone. OK maybe that is taking old Adam a little loose but probably not much.


At the hospital it took both the Charming Mrs. YDMV and I three, maybe more, separate and fairly emphatic tries to make it clear we would manage Connor’s blood sugar with his pump and the 'log he is used to using rather than them hanging a slower insulin with their pump in his IV.


In my spare time I have been reading tweets and blogs on blood glucose meter accuracy. As usual my friend Scott has a nice bit. He advocates for lower accuracy margins of error. Another other good friend of the blog (I am shamelessly steeling that good friend of bit from Colbert even at the risk of getting on his list for swiping it) Kerri also writes on the topic today as did Kelly. Careful YDMV readers will recall I wrote a bit the other day that questioned what the heck accuracy is anyway.

I had a conversation on meters just hours before dragging Connor into the ER.  In that chat I said I was sure there are folks, like Kerri, who work at diabetes hard enough that the meter accuracy matter in her (and the soon to be adorable BSparl’s) life makes a difference.



If you have read this far without bailing out you may be asking, “What the heck does this have to do with Adam Smith?” Seriously if you are thinking that you need a life - no wait I mean - Good question! Stand by for the kind of BS (not the blood sugar kind) that made me love writing essay question’s in blue books back in college. (Do they still have blue books?)



Don’t just tell the FDA you want accuracy in your diabetes care. Tell the market. Take an invisible 2x4 in Adam Smith’s invisible hand and smack the market up side its invisible head. You want more accurate meters  - buy them. Well their strips - Never buy a meter. Let them give you the meter itself.

The market seems to be trying to supply cheap cr*p meters. The FDA has given the OK to boat loads of meters from firms over seas that may or may not meet our desired goals for accuracy. They probably don’t have the same level of phone support and who knows how issues with adverse actions are tracked. I don’t see these things as in myself interest and so we don’t use them.

Scott point out that there is a meter on the market at +/- 10%. We happen to use it. We started for the aesthetics, they made a pink meter and that mattered to a tween girl. We stay for the low blood draw, compact meter size and easy to read screen. In short they (a word that here means WaveSense) made a better product and we for our own self interested reasons use it. If a big wave (nice pun eh?) of people did too then maybe the market would move to something like WaveSense's form factor, accuracy, usability and pinkness. By then I expect WaveSense will have moved on to even more innovative products.

We didn’t let the Doc’s manage Connor’s blood sugar because we felt we could do it better. We didn’t want an insulin we didn’t have experience with in him. We didn’t know its effective time frame in him. We choose to managed his blood because doing so is in our self interest, We stayed with what we know works. Speaking of what we know, we know his pump well. If lots of parents of T1 kids also decline the hospital’s type 1 sugar management and do it well maybe the market (a.k.a. doctors there) will come to see that as a good care option and give up after the second clearly stated decline of their suggested treatment.

Choose well, as we each live Our American Life we are Adam Smith’s invisible hand.


PS speaking of invisible stuff. I have no relationship with WaveSense other than we use their stuff. Well OK I follow them on Twitter too if that counts as a relationship but they don’t say a lot and I am a highly incompetent twitter user. I did once look to see if they were publicly traded and was thinking about buying into their stock but they weren’t public so I was SOL. I have been to the Hospital’s community fundraisers and probably will go again. They did a very nice piece of surgery. They are right to be cautious about BG management. Side effects of reading this blog may include headache, blurred vision. Your dDiabetes May Vary.

5 comments:

Ellen said...

1. How is Connor today?
2. How is Mrs. YDMV?
3. How are YOU?
4. Do you use Tweetdeck?
5. Have you read Mashable's guide to Twitter?

Bennet said...

1. How is Connor today?
Bouncing back nicely the issue today will be to keep him from doing too much. Thanks for asking.

2. How is Mrs. YDMV?
Nothing like 12 hours of sleep. That puts the average over the last 4 days at 3.25 hour a night Thanks for thinking of her too, Nice of you to get the stuff this takes a toll on everyone bit.

3. How are YOU?
Nothing like 12 hours of sleep. That puts the average over the last 4 days at 3.5 hour a night. LY/MI

4. Do you use Tweetdeck?
I tried it. I didn't much like the desktop app. The text was too freaking small for my old guy curmudgeon eyesight. The iPhone app didn't float my boat much either. I still have it on the phone but it moved to page 4 from page 1.

5. Have you read Mashable's guide to Twitter?
Nope. URL welcome.

tmana said...

Recently ran through the same insulin-drip issue with my T2/oral-meds-only mother... why do they even bother adjusting for meals when they drip Lantus -- by the time it peaks, T2 blood glucose levels would be well past their peak...

Scott said...

I hope Connor is doing better after all this, and perhaps as importantly, I hope you and the Mrs. are as well. While conceptually, I agree with the Adam Smith bit, the way the U.S. healthcare "system" works does not really enable us as consumers to vote with dollars as much as we should. I have to rely on finger-sticks to the tune of about 12 per day. There's no way in hell I could afford to pay for that out-of-pocket, so I'm effectively forced to choose between preferred brands on my insurance formulary, or I'd spend every penny I earn on testing supplies (very literally). I must make a value judgement about whether to preserve my health as best as I can, or go rogue and vote with healthcare dollars. I choose my health. I have asked repeatedly about if AgaMatrix products are covered and asked that they be, and I have contacted people at AgaMatrix and informed them they need to get their products on more healthcare plan formularies (truth be told, if they could land WellPoint, United Healthcare, Aetna, Cigna and maybe Kaiser, they'd cover an overwhelming majority of PWDs). But the story is a bit more complicated than simply voting with our dollars alone!

Scott said...

Bennett, one other point I forgot to mention that you should be aware of. Regular insulin infused via an IV is far faster and has a shorter time-activity profile than even the most rapidly-acting insulin analogue. In fact, IV infused regular works within 5 minutes while subcutaneously infused insulin takes hours and may hang around for hours more (depending on the size of the dosage), it is that dramatically different. This is why there is ONLY 1 type of insulin available by IV, as its the only type the human body uses naturally, and it's the only type that is really needed in an IV. However, the control of the IV is left up to nurses on hand (in fact, parents or patients are forbidden by law in many states from touching it), and it is widely acknowledged that they neither have the time to manage blood glucose as intensively as they really should be, and therefore patient recovery is usually slower and longer than it should be. But if you as the caregivers are willing to manage it more intensively, the clinical literature very clearly shows recovery can occur much faster and with better outcomes, so you were probably right in fighting that particular battle! Congrats on a job well done!