How to make bank at the expense of your customers w our bullshit American for-profit healthcare system. A story by @AscensiaGlobal @MDT_Diabetes.

I’ll start by saying this is by no means anywhere near the most egregious conduct by “health care” companies in our for-profit, screw public/customers system of corporate malfeasance. Many companies do worse daily & I’m sure both @AscensiaGlobal & @MDT_Diabetes do worse as well.

For ~15 yrs now I’ve stayed alive, quite healthy using @MDT_Diabetes insulin pumps. Been pleased w their pumps. They keep me healthier by any & all measures than insulin pens/syringes. They also created 1st FDA-approved closed loop CGM/pump system. They do a lotta good.

Over those 15 yrs @MDT_Diabetes has had multiple blood glucose meter partners who manufacture meters that send the blood glucose meter readings to the Medtronic pump. All good right?

But you may ask: why is @MDT_Diabetes, over 15yrs where the tech industry moved fwd by leaps & bounds, still using a proprietary communication protocol such that they need a glucose meter manufacturer to make a specific device to integrate w their pumps?

This is a great question & I can’t claim to know all the reasons that went into it. But I can guarantee that some of the reasons include:
- corporate deal making between the companies that benefit Medtronic’s bottom line
- wanting time keep their system closed to protect profits

So... who cares right? This all sounds good. Glen should just buy the Medtronic-negotiated glucose meter and STFU, right? What’s w these privileged white guys? Why is Glen always who I g about something?

Well, that’s actually fair. As I said, this is not the most egregious for-profit healthcare behavior by any means. But it all comes at the detriment of the healthcare consumer.

Currently @AscensiaGlobal’s the 1-blessed Medtronic glucose meter manufacturer. Previously was @Bayer, I can’t recall who was before that.

So what’s it mean for @MDT_Diabetes pump customers who pay, or hopefully their insurance pays - which is my case, $1000’s for their pumps?

1st it means there’s exactly zero competition. No glucose meter manufacturers’re creating best,cheapest, most durable, most reliable blood glucose meter for Medtronic pump customers.

There is no choice. You want integration, it’s @AscensiaGlobal rn. Next month/year who knows?

The 1-blessed co has very little incentive to create great product. At best they want to maintain their 1-blessed status but that’s btwn @AscensiaGlobal & @MDT_Diabetes. It has nothing to do w Medtronic’s pump users. We can just cross our fingers, hope for best.

Of course there’s no price competition. @AscensiaGlobal is the only one making meters for Medtronic pumps so their price remains the same for years. Most meters cost $20-$40. @AscensiaGlobal’s? $90. Cause why not, right? No competitors.

Also @AscensiaGlobal has almost no incentive to improve their meters. At best they might want to remain 1-blessed Medtronic partner. But even there they may be losing money and not really GAF. At best they can sell to every Medtronic pump user. The market is severely limited.

As a result, @MDT_Diabetes pump users are on their own. We can beg @AscensiaGlobal to lower prices, improve devices, but we carry no weight.

We can beg @MDT_Diabetes to force @AscensiaGlobal to lower prices, improve devices, but that’s not their market. The only weight we carry is if we revolt and stop buying Medtronic pumps (which is my plan, keep reading for details).

So... you’ve been whining for about 187 tweets now @GlenBikes. What do you want? A cookie? Do you have a proposal for a better world?

Well, as is always the case, an open system is better for customers. What we need is an open system. Both @MDT_Diabetes @AscensiaGlobal (who acquired someone or something, I don’t know details or care to google cause they’re screwing me so eff them) been doing this for yrs.

They could have created an open system at any time, but they chose not to, because they are plying in a closed for-profit system that they want to maintain. So at every step, they’ve decided to screw their customers to protect their perceived profits.

That was an accidental tweet of the thread. So apologies for all the typos I had intended to go back and review/fix. Ima take this opportunity to pause and eat an amazing Amante's pizza for dinner. I'll continue shortly.

Who else is at play here? Of course @US_FDA's part of the system that keeps these companies earning record profits @ expense of their customers as well as all the highly paid lobbyists these companies employ to protect their positions & the laws/regs that ensure their profits.

These companies are sure to cry helplessness and say that FDA regs are why they could not do anything to help their customers. But don't buy their cries of impotence. The healthcare industry, along w big auto, big banks are the most powerful entities in the country.

Might it take effort on their part to do right by their customers?

Sure. But isn't that what we all want from our healthcare system? At least those who're not part of profit extraction from healthcare users? Either one of these companies could've changed system if they wanted to

But instead they chose to play w/in a system that maximized their profits & colluded w other companies in the system to maximize that company's profits as well.

I'm no expert in process of bringing insulin pumps/blood glucose meters to market, but have been involved in parts of process. I was one of first ~50 retail users of Medtronic's 670G closed loop pump/CGM system & helped Medtronic validate/improve their systems for broad rollout.

Again, the Medtronic 670G closed loop pump/CGM is a great product. It was groundbreaking. I'm not trashing @MDT_Diabetes @AscensiaGlobal's products or their R&D.

I'm criticizing them for not working to change the system so their users will be prioritized. They did not.

So how does this collusion between these corporate profit mongers work in insulin pump/BG meter market work?

Let's get back to my story to help those not familiar with the market machinations understand.

@MDT_Diabetes spends yrs developing new insulin pump, investing tens of million$. It's a good pump. But one of most important keys to effective management of diabetes is data. Most importantly blood glucose (BG) data. Also, pump has features that require input of BG data to work.

To ensure pump users have all the data they & their healthcare providers need, Medtronic sensibly decided they needed a BG meter that sends BG readings to the pump wirelessly.

Good decision. Great for their pump users. But Medtronic does not make BG meters so what to do?

If Medtronic had their pump users best interests @ heart, they'd've created an open standard for sending data between BG meters/insulin pumps. Likely they'd work w multiple other big players in market to do this. Players like @AscensiaGlobal.

Did they do this? No.

Instead Medtronic has out-of-public-view negotiations w 1+ BG meter manufacturers.

End result: choose 1 BG meter manufacturer for 1 & only BG meter to send BG data to Medtronic's pump.

Odd how these titans of capitalism/free markets/competition closed markets, ain't it?

OK, Glen but this doesn't sound so bad.

Medtronic customers get an insulin pump that you say is great & a BG meter that interoperates w it, so pump users have all their data.

Win win win win, right? What. Are. You. Whining. About?

That's somewhat true. I'll repeat that this is not the worst problem in our healthcare system by any stretch of the imagination.

We've come a long way from me dipping sticks in piss when I was 12 & it's companies like @MDT_Diabetes @AscensiaGlobal who got us here from there.

But @MDT_Diabetes @AscensiaGlobal collusion ensures Medtronic insulin pump users (w very few options) have 1 & only 1 BG meter that can send BG data to it.

Users can certainly use other meters, but integration btwn pump/meter is important for effective diabetes management.

With no competition, @AscensiaGlobal has exactly zero incentive to lower prices. 1st one I bought in 2013 was ~$100. Both Contour Link meters for 530G & 630G/670G are $89 today despite drastic price reductions for meters since 2013.

Which brings up another issue for consumers. When Medtronic released 630G pump, Contour Link meters for 530G pump didn't work. Closed system so no open standards that increase chances of interoperability.

All 530G pump users moving to 630G/670G need new @AscensiaGlobal meters.

Medtronic even switched bleed BG meter companies w no new insulin pump, sending existing meter $$ .

OK Glen but everyone has health insurance so this means @AscensiaGlobal is making bank off of those evil health insurance companies we to hate. Why do you care?

1st of all, not everyone has healthcare since we have @senatemajldr @GOP. Those w/o insurance're paying out of pocket & many likely can't justify $89 BG meter when most cost < $30.

Also many are on public insurance, paid for by all of our taxes (me incl). So yes, we should care.

Also I don't think I've ever had health insurance that covered BG meters. So every Contour Link I've purchased for $89, I paid 100% out of my pocket.

Lost access to corp e-mail account in 2018 so can't say how many I've purchased, but it's definitely more than 8. Likely 12+.

So at least $712 on BG meters which remember, for the most part cost < $30.

Why so many BG meters Glen? That sounds crazy?

Well yes, it is crazy. There are several reasons. First I've a BG meter @ each home/work location cause carrying around w me everywhere means:
1) They die more frequently
2) I often end up w/o a BG meter which is A Bad Thing (see above trip) - BG data is key to diabetes mgmnt

But most of all:
3) They die

Recall we are talking about a market which has no competition.

These meters die. And @AscensiaGlobal has no incentive to improve their durability/reliability other than fact they may not be the Medtronic-blessed BG meter manufacturer for next pump.

The reason I am creating this thread rn is cause a couple weeks ago I was on a 2 wk trip to NE WA State. I brought 2 of my @AscensiaGlobal Contour Next Link meters w me. Good planning right? Be safe. Just in case one dies...

Both died w/in 2d period. The 2nd one died in the evening & I was in a small town in Method Valley w no pharmacy. So for more than ~16h, incl overnight I had no idea what my BG was.

If @MDT_Diabetes @AscensiaGlobal'd done right by their customers, pushed for open communication protocol between pumps/BG meters & pushed @US_FDA to allow, I'd've long ago switched to different BG meter.

$700+ out of pocket for $30 devices is tough pill to swallow. Enough to .