LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Wednesday, December 22, 2010

Merck’s Glass beads

Like anybody, I would like to live a long life. Longevity has its place. But I'm not concerned about that now. I just want to do God's will. And He's allowed me to go up to the mountain. And I've looked over. And I've seen the promised land. I may not get there with you. But I want you to know tonight, that we, as a people will get to the promised land.

---Dr. Martin Luther King, Jr.


Memphis, Tennessee
1968



Back in the year 1626 an enterprising fellow named Peter Minuit made one of the greater real-estate deals in history, and for that act has been variously painted as either a genius or a rouge of the highest order.

Yeah, he’s the dude that bought Manhattan Island from the Natives.

For what it is worth, and totally off subject, this transaction is not what it first appears. I’d been taught in grade school that he got the real-estate for some glass beads worth a few bucks at most (those silly savages). Later, I often read that it was $24 in trade goods. Newer research has shown that, due to a historical translation error, the value was $37.98. Of course, a buck went a lot further in those days. In today’s dollars we’re looking at something like $1,500.

Even at that bargain rate, I still couldn’t afford to buy Manhattan.

But I digress. Did the Natives get swindled? Probably not. They didn’t get just some glass beads. They got the 1600’s equivalent of i-Phones and Dell computers. The trade goods included iron kettles and axe heads, hoes, and metal awls. Some historians have called this history’s first high-technology transfer.

And the money? Well, 384 years later Manhattan is worth something like 8 trillion bucks. Not too bad for a swamp between a couple of rivers. But before you flame me in comments, consider the brilliant compound interest analysis by Jeffrey Strain. He crunched the numbers and said (paraphrasing, of course), “well, what if the money had been cash? And what if the Natives had just parked it in a savings account?” Yeah, I know, no such thing at that time. Still, it is interesting to note that the Natives would be trillions ahead in the deal given the power of compound interest out-stripping the power of the rising value of real-estate.

So why are we talking about this? Because Merck just bought the future of the entire 116-billion-dollar-per-year diabetes business for a paltry 500 million bucks. This move makes the purchase of Manhattan for fifteen hundred bucks look like a bad deal by comparison.

I want you to remember the name Dr. Todd C. Zion. He’s the Dr. Frederick Banting of the future. As part of his doctoral thesis in chemical engineering from M.I.T., he developed something he calls SmartInsulin™.

I call it THE game changer.

So what the fuck is SmartInsulin™, you ask? Well, quoting from his company’s website, it’s “a layered, biocompatible and biodegradable polymer-therapeutic that is bound to an engineered glucose-binding molecule. Insulin is released from SmartInsulin only when the therapeutic is unbound by the presence of a specific glucose concentration.”

Don’t panic, I’ll translate that to English in a moment.

Oh, never mind. I’ll do it right now. SmartInsulin is the ultimate NPH. Remember NPH? In the pre-Lantus and pre-Levemir days it was the closest thing we had to long-acting insulin. It was an insulin suspension. In other words, bubble-wrapped insulin. Once injected, the bubble-wrap dissolved a bit at a time, releasing the insulin to do its thing. Both Lantus and Levemir are higher-tech, improved versions of the concept.

But SmartInsulin raises the bar. Instead of just dissolving at a set rate, the bubble-wrap is glucose sensitive. In effect, it’s insulin that only works when your blood sugar is high. And it stops working when your blood sugar is normal.

In short, SmartInsulin is a bio-chemical artificial pancreas. No pump needed. No CGM needed. No complicated algorithms. No gear at all. It’s an elegantly simple, self regulating system. As billed, it would be a once a day shot. The insulin stays nice and cozy and warm in its polymer blanket until your blood sugar begins to rise. Then the polymer dissolves, releasing some insulin. Which lowers you sugar again. Then the polymer stops dissolving.

Who knows? The next stage might be once a week shots. Or once a month.

Blood sugar automatically controlled. No matter what you eat. No matter how you move. It’ll be a therapy indistinguishable from a cure, except for the monthly payment to stay healthy.

And what will they charge? Pretty much as fucking much as they want. And this time insurance will pay. Because it will be all they have to pay. No more gear. No more durable medical supplies.

No more expensive complications.

If it works, they won’t even have to pay for eye exams any more, as there will be no risk of damage from high blood sugar.

In a Press Release over at PharmaTimes Online and SmartPlanet, Merck’s head of diabetes and obesity a research, Nancy Thornberry, is quoted as saying "if this investigational technology is ultimately approved for use with patients, it could provide an important new therapy [which] holds the potential to significantly impact the treatment of this disease." And reading between the lines, as she wipes the drool from her chin, I could have sworn I heard her add “plus it will make us and our shareholders sticking fucking rich!”

I realized the significance of SmartInsulin when I first read about it a few years ago. I just figured that if it worked, it would never see the light of day. Too many people had too much to lose. And actually, this is where Merck will come to our rescue. You see, of all the big players, Merck really doesn’t have much going on the diabetes arena. Right now all they have is the DDP-4 Inhibitor class med Januvia, which will be generic by the time SmartInsulin is ready for market. They haven’t got a product line to sell for the plague of the 21st century. They have nothing to lose and everything to gain by getting their mitts on a game-changing med.

If SmartInsulin gets approved, what does Merck get for their 500 million? Instant access to 30 million customers overnight. And if the CDC is right in their projections, fully one third of the US population could be Merck customers by 2050.

SmartInsulin will destroy the diabetes industry. All the other companies will go down in flames, their CEO’s will be running hot dog carts on Wall Street or pan-handling in Times Square.

If SmartInsulin lives up to its promise, there will be no need for other medications for our blood sugar.

There will be no need for meters. Or strips. Or lances.

There will be no need for CGMs.

Or pumps.

Or diabetes educators.

In short, SmartInsulin will be a de facto cure, but one with a perfect pharma edge. With their product we’ll live normal, healthy lives. Without it we’ll die. It’ll be the final evolution of insulin, probably just in time for the 100th Anniversary of its discovery. If it works, there will be no motivation, no incentive, for a real cure. We’ll forever be medicine addicts. Trapped like vampires.

It’s slavery, I think. Still… I would use it in a heartbeat.

If I were you, I’d sell the rest of your diabetes portfolio and buy Merck stock.

6 Comments:

Blogger Jonah said...

What makes you think smart insulin is going to work?
From what I've read (and I'm going to come back and post another comment when I have time to go find what I've read) smart insulin is nowhere near giving us all euglycemia.
I got really excited about this idea years ago (maybe only two years ago? I'm not sure) but have been disappointed to see how it hasn't been developing.

8:57 AM  
Blogger Scott said...

Wil, I certainly agree with the sentiment about the catch-22 logic this development could put patients with diabetes in (assuming it ultimately receives regulatory approval), whether it proves so "permanent" on the death to a cure remains to be seen. As you may know, I interviewed Todd Zion back in 2006 (see http://goo.gl/49H9z if you're interested in reading that); the issue of approval remains uncertain at this juncture, and insurance reimbursement over existing treatment protocols is by no means assured. Still, the idea of a superior treatment could put the diabetes management conundrum to rest and make patients' lives infinitely easier. As for Merck stock; the question on that is whether it's fully valued, and many analysts believe it may be given the uncertainty that remains in spite of having a more attractive development pipeline than several rivals. Incidentally, were you aware that Merck is already one of the world's leading insulin manufacturers today? It's true, when the company acquired Schering-Plough, they also acquired one of the world's largest contract manufacturers of insulin (Organon) not to mention one of the largest veterinary insulin suppliers. This might be seen as a small investment that ensures the next phases of development are guaranteed to have sufficient funding, but I wouldn't call it a done deal until FDA approval for it is in-hand!

8:58 AM  
Anonymous Bernard Farrell said...

Despite the possible promises of SmartInsulin, I'm not holding my breath. Assuming it ultimately works, it still has to be approved, which could take us to 2015 easily.

Then there's the issue of speed of action and duration of action. It's still going to be an insulin molecule that I'm guessing still has to be broken down after its release before it gets going.

I was excited/interested when I first read about it, but I'll wait until it safely gets through phase 3 trials. At least with Merck's money behind it, the trials should progress more easily.

5:27 PM  
Blogger Nancy said...

It will be exciting to see what develops. I can't imagine it will be the perfect solution to 100% of PWD - the pump and CGMS isn't currently and that is our most sophisticated solution yet.

I would think, too, that we'd still need to maintain a glucose meter - what if the SmartInsulin goes bad? What if we run out at an inconvenient point? We're still going to need our back-ups and I would hate to be 100% relient on one thing.

10:12 AM  
Anonymous Anonymous said...

Well I do hope it works, I haven't read anywhere about their large animal study and I have a lot of questions of how it is going to work. For example at which number will the insulin be released? Some people are good at 80 some at 120. Also there are I think two other companies that are trying something similar though for basal insulin. I am very happy though to read such a positive opinion! Thanks!

2:25 AM  
Anonymous Anonymous said...

Hmmm, Hadn't heard about this, but will be watching closely, I hope this comes through and can be implemented without a catch 22 scenario. Sounds too good to be true.

Its funny how I even found this post, I am an avid beader and I googled "beads" and came upon this article. Who knew it would pertain to me, but in a different way. I can't buy beads here but maybe this "Merck's Glass Beads" post will change my life someday

8:10 AM  

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