Monday, May 22, 2006

An Artificial Pancreas?


Last week, Long Island Newsday published an article entitled "Perfecting a 'Pancreas'" which was about the long-promised "artificial pancreas," a closed-loop system which promises to dramatically improve patients' control of blood glucose levels using a glucose meter, an insulin pump and proprietary algorithms to deliver insulin in a manner that is supposedly more physiological than anything short of a complete pancreas transplant. The article is correct in that I have been hearing that these devices were around the corner since I was diagnosed as a 7 year-old child in 1976, but something always seems to get in the way of these miracle devices from making it to commericalization. Now, 30 years later, the artificial pancreas is still not here, but the promises remain.

Even JDRF has made this a key research objective, with an article on the organization's website entitled "The JDRF Artificial Pancreas Project: A Goal Within Reach". Huge sums of money have been spent on this project, and countless medical studies have surmised that these devices will deliver what doctors have thus far failed to deliver: improved treatment of type 1 diabetes. Companies are motivated primarily by the possibility of making vast sums of money on the device, which would likely be priced at somewhere close to double the cost of $5,000-$6,000 for today's current insulin pumps.

To be sure, such a device could make the minute-by-minute management of the condition vastly easier, and while I may be just a bit cynical, but I'm really not getting too excited or racing to get the first one available. Why? I cannot help but recall Alastair T. Gordon, the President of the Islet Foundation's Congressional testimony in April 1998:

Now you, this well-informed diabetic consumer, read the NIH strategic plan and you see that millions of dollars are available for such high priority research goals as:

"Mechanical approaches to metabolic control." This is a good one. Let's develop a mechanical pancreas that hangs outside the body and is connected by a catheter and secretes insulin as directed by a continuous glucose sensor. Let's not use islets that have evolved over millions of years to accurately monitor blood glucose and safely secrete precise amounts of insulin. Let's risk mechanical failure that could send a patient into a sudden stupor while he's driving his car, or kill him in a diabetic coma while he sleeps. Sorry, the diabetic consumer doesn't want to buy that one either.

There are some other comments in his original testimony that are well worth reading if you are so inclined (see 1998 Congressional Testimony), but I think the message is clear from just this tidbit.

Don't get me wrong. I am not necessarily a big islet transplantation fan, either, but there IS something to be said for the comment on why doctors and big pharmaceutical companies remain so fixated on trying to outdo nature, rather than just fixing the problem instead. They see it as a challenge, something that they can accomplish, marking a triumph over all of us so-called noncompliant patients. While a closed-loop system may very well improve diabetes management and therefore improve our long-term health outlook, it actually does little more than alleviate the symptoms of our condition, but does little to actually make us better. They remain unwilling to discuss an actual cure, which remains one of medicine's most monumental failures.

No offense to all of the scientists who spent years developing this stuff, but I don't want to wear all of this crap ... a catheter (called an infusion set, which costs about $10 each and needs to be changed every 3 days), plus another external device which will measure our blood glucose levels, which again requires a special, costly device be replaced with regular frequency and still buying insulin which can cause hypoglycemia and other effects when dosed in excess of the body's physiological needs. This "solution" sucks. Go back to the drawing board, you have failed us yet again, and you do not deserve honorable mention in the medical textbooks for your efforts. Next time, try asking patients what they really want. You may be surprised to learn that what they want is surprisingly basic: make us well again, which is what the Hippocratic oath is all about.

5 comments:

Lyrehca said...

Scott, I am so with you, in terms of being diagnosed when you were, around the same age, and having the same sort of, well, I say cynicism but perhaps you wouldn't agree, about talks about curing diabetes. I'll frankly believe it when I see it, and I too wouldn't want to be the first round of people trying this so-called cure.

I want to see that an artificial pancreas works without problems, works without tinkering, and works for everyone.

And even then, an artificial pancreas still wouldn't fix the underlying problem of what causes a pancreas to stop working effectively in the first place.

Scott K. Johnson said...

Amen man. Very well stated.

Scott said...

Glad I'm not the only one who sees things this way!! Thanks to both of you for your comments!!

Bernard said...

Scott

Ditto from me. If you took the huge amount of money that was being spent on the research for the artificial pancrease, and invested this in the type of research that Denise Faustman is doing we'd see some significant progress that might surprise everyone.

ADA and JDRF are you listening out there?

Bernard

Scott said...

Thanks, I agree, although its worth noting that JDRF has not really funded anything for the artifical pancreas project. They have, however, played matchmaker with commercial entities (pharmaceutical companies, insulin pump manufacturers, etc.) to accelerate the progress. However, I believe that too much focus is spent on reducing blood glucose levels while ignoring the fact that the counterregulatory system is also damaged in all patients with type 1 diabetes, making patients at frequent risk for hypoglycemia (which is only partially due to insulin not being delivered in a physiological manner).

Personally, I am partial to the efforts being undertaken by a company based in Beverly, MA called SmartCells, Inc. They are still in preclinical trials, but have received significant venture capital funding as well as funding from the NIH. Their website is at: http://www.smartinsulin.com/