A death in the family

A good friend of mine died today. Actually, my friend was drug outside and executed. Shot in the head. Yep, Smiths Medical today killed the wonderful Cozmo insulin pump.

A tragedy on many fronts. Now less choice among pumps. That means less competition, and thus less innovation.

Among traditional “tethered” pumps it was by far the best of the small pack with two unique features that made it stand out. First, it spoke English, not some convoluted medical device language. The menus were simple to learn, simple to teach. They were straight forward and logical.

But it was the second feature that I love the Cozmo best for, how it calculated “insulin on board,” also called IOB.

IOB matters. It is crucial to how you correct highs. Or lows even, in the case of the newer Model 1800 Cozmo which can suggest how many carbs are needed to save your ass when you are low. All the other players (Med-T, Animas, and the innovative OmniPod) only count correction insulin. This assumes that meal insulin is covered by the carbs you’ve eaten or visa-versa. Uh huh.

OK, will everyone who always counts their carbs right, and has all their insulin-to-carb ratios nailed down perfectly please stand up?

I don’t see anyone standing up.

I’m not either. I “count” my carbs wrong as often as I count them right. I like a pump that keeps track of all the insulin in my system. The stuff used right; and the stuff used wrong.

But innovation and quality are not enough. Health, in America, is all about money. Smiths is vague about why they pulled the plug at both the customer and medical provider websites; but a press release today spells it out better.

First, they say, the diabetes biz is a bad fit for the rest of Smiths. That makes it hard for sales folks to do both pumps and what-ever-the-hell-else Smiths makes and sells. In addition the pump biz requires its own “extensive sales, marketing, reimbursement, insurance and clinical support infrastructure.” Too many people to pay, apparently. That said, 51 folks who had jobs this morning now do not. Hmmmmmmmmmmmm…..hardly seems extensive to me.

Second (the real reason in our Wall Street World) is that “sales and profits for the business have decreased.”

Third, interestingly, CGM seems to have bitten them in the butt. I sure this comes as a bit of a mystery to the thousands of my fellow D-folk who buy insurance Voo-doo dolls on eBay from pure frustration in trying to get CGM covered. Smiths is saying the pump market is changing from “hardware-plus-disposables model” to an “integrated diabetes management model” that would require “significant ongoing investments in continuous glucose monitoring.” They have seen the future, and are afraid of it.

Fourth, they come right out and say the following: “Smiths Medical's shrinking market share has been exacerbated by the aggressive pursuit of market share growth by two large and well-resourced players - Medtronic, which has the largest share of the U.S. insulin-pump therapy market, and J&J.”

And lastly, they are afraid of law suits, and recall that the Cozmo came out the loser in a patent suit filed against them by Med-T sometime back. To be honest, I don’t recall which pump feature it involved. But the press release states “a considerable amount of intellectual property has been established in the diabetes segment, which makes the development of next-generation products very costly, and risky in terms of the potential for future patent disputes.”

The announcement today came out of the blue—a surprise to everyone including the shocked employees I talked to this morning. The ones now out of jobs in the worst job-hunting environment imaginable.

Smiths states their intention to “manage a well-controlled exit from the Diabetes business.” Sounds like an orderly retreat from battle. But unlike the Marine Corps, Smiths is leaving its dead soldiers on the field of battle.

Good bye wonderful friend.
Rest in Peace.
The Cozmo Insulin Pump.
March 25, 2009