April 8, 2014

Of Automobiles and Insulin Delivery

I applaud the New York Times for caring to write about type 1 technology. I would encourage them to take a little more time to better understand the subject next time. I'll try to help. Since we are all Americans here, lets use a metaphor we all understand - cars. Fuel efficient small foreign cars, so maybe not something we all understand.

In the 1970s I drove a VW Beatle. It had been my mom’s. It would go anywhere, including places my friend Ric broke his jeep. One year for Christmas I got a hand full of Craftsman tools and rebuilt the engine and clutch. Bugs were easy enough to fix anyone with tools could do it.  

Coming home from college one weekend, I was cut off on a highway and skidded into a gas station sign. The car was totaled. I was nearly so too. The impact of my face cracked the steering wheel and popped the windshield out. The Glass flew across the service station and landed unbroken. I remember the gas station guys talking about seeing the glass fly and marveling that it didn’t break, from my semi conscious state waiting for the ambulance. 

I still like small cars. I have a Mini. It has a host of features my Bug lacked; anti lock breaks, a host of front and side air bags, crumple zone construction, good seat belts, power steering and much more.

I bring all this up to point out the value of current automotive technology verses 1970s technology. It would be easy to say that both the Beatle and the Mini do the same job. They get me from point A to point B in relatively the same mix of shifting, steering, breaking and being a little weary of bigger vehicles. In that context the newer car’s significantly higher cost could be seen an extravagance. 

Modern cars are significantly safer (even if they don’t go up Jeep trails like a Bug.) 

I think there is a parallel to diabetes technology. Modern diabetes technology looks like it is doing the same job as the 70s stuff. 

It isn’t.

Modern insulins allow a better if not perfect parallel of physiologic insulin. Pumps provide a better delivery system and allow delivery to be programed to daily rhythms. Continuous sensing can alert patients to changes and prevent dangerous lows and highs. 

Yes, this stuff cost more than 1970’s stuff. Cost isn’t the question, value is. Air bags are mandated because some cars are gonna crash. Antilock breaks, crumple zone construction, side impact doors, safe fuel systems etc all cost more. The value is in safer roads, lives saved. 

See where I am goin’ here? 

The story of technology is the value it brings. Computers cost more than pencils, ruled notebooks and movable type presses. The New York Times assembles the paper with computers, because they bring value. We drive safer cars for the value. People with type 1 diabetes can be more productive members of society due to the value of effective technology.

Sent via email to: Elisabeth Rosenthal NYT. (without the cool images, what can ya do.) 

ps. Neither my Bug of Mini looked the good but the colors are right. 


  1. Wonderful discussion of the topic, Bennet. Your car analogy really makes sense.

  2. Probably the best, most reasoned reaction to this story I've read so far. Thank you.

  3. Well said. I liked the photographs especially because they do point out the differences between old tech and new tech.

  4. Thanks for the well written response using analogies most people without Type 1 can relate to... I have had diabetes so long that blood meters, pumps, and sensors were not even on the drawing board yet (I was 6 and diagnosed in 1970). I went to the doctor once a month to have a fasting blood test where they took tubes of blood rather than a prick. I had to act as a chemist and test urine in a test tube with reagents. Consequently this was not the best care, but it was what was available. To equate the life sustaining technology with gadgetry is nothing more than ignorance showing its ugly face. Thanks to these newer, better, fine tuned technology, my quality of life has changed for the better and I am still here! Finally, quality of life is priceless.

  5. I don't think Ms Rosenthal did such a bad job actually. You say cost isn't the question, but that's exactly what her piece is about, and in a system where part of the costs are paid by insurance (ie other people), I think that's fair game. A lot of other interesting points are left unexplored in her article: how does one put a value on quality of life improvements, why does medical stuff cost so much, are there better ways of financing R&D etc.

    According to the some internet source the average new car cost about 1/3 of the average annual income, now it's about the same, so cars got more expensive too :-)

  6. Thanks Erik.

    Fair points, well made. Valuing R&D is a very good questions as is valuing quality of life.

    Valuing is the process of benefit for cost thinking and that is what I found missing from the NY Times piece.

    I think you are suggesting that lower cost would improve the benefit cost ratio. Agreed.

    I think the benefit of good diabetes care is the saving of significant costs of complications, such as end stage kidney failure, blindness, amputation etc. Those are dollar costs, quality of life costs and shortened life span costs.

    Diabetes care is about managing time in range, one can't just look at the tools and say those are expensive gadgets without looking at the significant lifetime benefits they facilitate.

    I think that is the kind of value you are alluding too.