Just off the phone with Henry Anhalt about Artificial Pancreas Features

Hi Everybody!! i just got off the phone with Henry Anhalt regarding Artificial Pancreas. He is a stanford Trained Ped's Endo who still does clinical work, but now is heading up Animas Artificial Pancreas project.

We had a THRILLING conversation about artificial pancreas, and I may do some consulting for them to help them with some of the technology aspects of the device and its features.

We discussed the possibility of (of course) remote wireless sync of the device to a central server in which they could provide an add on service on a membership basis of REAL TIME INTERPRETATION by BOARD CERTIFIED ENDO"S AND CDE's with Interventions on the basis to be texted or emailed to you via secure server.

So here is my question for y'all... IF J and J acquired Dexcom AND Omnipod, thus positioning them to have an all in one POD that had this kind of capability, WHAT would you PAY for that monthly interpretation.

HOW would you price the all in one pod?

(Assuming the acquisition I am speaking of, we would be going back to the drawing board of revenue model, but J and J has 11.4 BILLION dollars of cash in the bank, so they could do that)

What would you pay on a monthly basis for the interpretation? CASH, like if you had to put their credit card into their website to sign up and your insurance was not involved ( initially)

Assume that they roll it up in a package that includes hb ac1 kits going out in the mail with your pods to test on a quarterly basis.

Ok, let me know what y'all think??

I will cross post and y'all feel free to cross post in the other groups...


First I want to say that I'm not thrilled with the idea of J&J acquiring Omnipod... or Dexcom for that matter. With that said, the integration of the two is long overdue. I personally would not pay for anyone else to do monthly interpretations of my numbers, especially not without me providing the extra input (Such as: I went to 2 weddings, 3 birthday parties, and a cookout last month so I ate a lot, used a lot of insulin, and still ran a little high). That kind of stuff isn't going to show up on a standard upload. Also, my Endo already gives me input every 3 months, I don't think getting "interpretations" of my data monthly would make that much of a difference. With that said, I know that some insurance companies do require members to go to the Endo regularly and that can be costly on some plans. If this could rival that and be recognized by those plans you'd have a customer base. Including the A1C test kits only helps if the doctors your seeing (and your insurance company) are willing to accept those results. So long story short, it's not a bad idea and I'm glad people are thinking up new things. You will have some market if you can make it cost effective and especially if you can get insurance on-board. But until the insurance is on-board (and maybe even then) I don't think I'd be that excited to take part in it.

I like the idea of one device, but I already have to keep my CGM sensor away from the Pod site. Putting it together seems too difficult. I mind having to poke my skin twice, once for the Pod and once for the CGM, a lot less than I mind having to cart two devices around.

I think that the ideas to which you allude about wireless data synchronization are fantastic, and I would conceivably pay ($50+)for an App, say, that would talk to both Pod and Dexcom sensor and collapse the data onto a single graph (so, you would see the BG levels over the course of the day, overlay that with bolus times, square-wave boluses time courses, and, heck, overlay that with meal times and exercise times), as well as supplying me with data "slices" for mean BG levels, total insulin per day, etc. I do not currently have that all-in-one command center for my diabetes self-care, and I think it is sorely lacking in the market. If I could control both of them from my phone, and they could talk to my phone and have it give me feedback, well, the convenience would be worth some out-of-pocket cost.

The idea of having my data passed back for review is not compelling, to me, at least, because:

  1. Let's say I get feedback to change something about my regimen from these folks. Then I get to my endocrinologist and he disagrees with their assessment and course of action. It would put me in a bad spot.
  2. From the perspective of the business, it seems like the liability for the company and for the endos and CDEs involved would be dangerous. They aren't actually seeing the patients, just a sample of data about them. I love the idea of telemedicine, but I would be concerned about proceeding. I know, it's not my money, but I would also hate to use this service and see it put on hold because of a lawsuit from someone who alleges they were put in danger by an endo recommending a change in basal rate that dropped their BG too low.
  3. I'm also unsure about the idea of constant tinkering with my regimen. If, for example, my results showed something one week, it might not be applicable the next week, because I was sick, for example.
  4. About the real-time aspect: Are you talking about someone texting me if my BG is rising rapidly,and letting me know that I should bolus some insulin? My Dexcom CGM is going to let me know about the rising/high BG, and I've been trained how to deal with it. What might be more useful is more of a "Panic Button" system, where I've got something like an OnStar service so that if my BG has been over 400 for 5 hours and repeated boluses are not bringing it down, it would be nice to have someone walk me through the possibilities after I talk it through with him or her. Or, say, I bolused 3 extra units of insulin because I was unable to finish my meal and am stuck. They might be able to tell me to, say, turn off my basal delivery and work out the math on whether I can take some emergency glucose tablets to head off hypoglycemia, or whether I have to get to the hospital, for example.
  5. So, yeah, something like OnStar for diabetes management would be worth... I don't know, $10-$15/month out of pocket. Maybe less. I could see myself not using it and deciding I could do without it, but other people might get into trouble more often than I do.
  6. Oh! Along this same line, if the central server sees that my BG is super-low, and someone from there tries to contact me and cannot, then sending out a text or call to a designated contact would be a useful thing. I've been at the pool with my kids and gotten pretty low, and if my wife had gotten a text regarding this, no matter how OK I felt, she could have helped out. This would, of course, have to be an opt-in

I think the day J&J (or any other pharma giant) buys Insulet and Dexcom will be a very sad day for all people with diabetes. That would mean the market would be consolidated and manipulated by a few huge corporations.
I think more than this server-based solution (which seems to be a good thing), people with diabetes need a diversity of companies in the market. Competition brings innovation, and small companies bring innovation FAST. Big companies are too slow and too concerned with their profit in the next fiscal quarter. If they have $10 billion, why haven't they released a product like that yet? The internet, as we know it, has existed since 1994- that's almost 20 years.
Also, we need to stop and think about the fact that JDRF gave $20 million to a company that already has $10 billion (J&J). I think people with diabetes should start an "Occupy JDRF" to find out why that money was given to J&J. What was their motivation? That's a very strange way to use donor's money, and a waste in my opinion.
Just my 2 cents...

As an Insulet investor, I would have no objection to J&J buying the company at, say, $60 per share. Many analysts believe that PODD is a takeover target. As a diabetic, I think deep pockets will benefit the company. It has a lot of debt, and I would hate for innovation to suffer because of funding. Not all takeovers destroy innovation. Integrating my pod with a CGM would be fantastic. I think it would give me much better control. I've never used a CGM, but I would like to. What I would really like is smartphone integration with my pods. I hate carrying so many devices.

Just make sure they know to get FDA approval BEFORE the merger.

My son never got his Navigator CGM because the company was sold without FDA approval and they were not allowed to sell it in the US until the merger was approved. They lost all of their US sales force in the interim. The start up costs to re-train everyone and gain a base of new customers was just too great. They called us and said that they would not be selling it in the US and that we should pick another CGM from another company. We really wanted the Navigator because it had a long range and my son could leave it on the bench during hockey. Our CDE has one that she wears to swim laps and leaves it inside inside her back door.

Yes, Gil I agree big companies cannot innovate, they can only acquire innovative disruptive startups... I suspect they do not have a patch pump in progress, anyone know?

I also agree that giving them 20 mil when they have 10 bil was an incredible mistake. They SHOULD have given it to YOU.

What do you think about the "Onstar for Diabetes" concept of remote monitoring though? As a safety feature for artificial pancreas, it is an exciting concept, don't you think?

what would that cost then, at 60 per share? J and J has about 700 million slated for innovation and r and d on the device side, BTW, from their investors last preso.. I am buying some insulet stock as well, btw...

Yes, sad story, would not want an acquisition to do ANYTHING to slow progress, I didn't think of that!

Thanks for the thoughts everyone! Perhaps they could partner with endo's and give them a percentage of the money for DOING the monitoring. It could be a good revenue stream for endo's and academic departments who are beaten down by fee for service reimbursement decreases... and would not leave our endo's and cde's out of the loop...

for the real time advice to be meaningful the blood sugars would need to have tags I think, right? like with a low " forgot to eat all carbs" or with a high " high glycemic index meal" we try to tag so our endo will have context when they are looking through the data later... Onstar for diabetes, I like that...

Well, $60 was a bit of an exaggeration. Shares are currently just over $20, which gives the company a market cap (or total value of outstanding shares) of $960 million. Generally, an acquring company would offer some kind of premium to the current share price, up to 50% or more. A 50% premium would value the company at about $1.5 billion. Of course, an actual offer could be more or less.

Totally agree with Gil. Would not like to see a pharm giant buy Insulet. Bad idea. Gil, I also agree with you about the whole JDRF thing.

Hi Jo Jo! Thanks for jumping in... I am a student of disruptive innovation as well, and always a fan of a not quite perfect, yet, disruptive and undeniable advantage over the outdated product. That's why we chose omnipod, and are willing to troubleshoot to help move patch pump forward. I am just trying to visualize the features of artificial pancreas, from the standpoint of a MOM and also the standpoint of a clinician and the features that it must have... IF Animas were to launch a version of a tubed pump with dexcom, could you talk your kid into tubing? I don't think I could talk kennedy into a tubed pump at this point, even that new cell novo pump has a little 4 inch tubing, I think she wouldn't even do that!

What are the features of artificial pancreas, in your mind? Both the device combo AND the safety, software, platform connectivity ( text, emr integration, etc...) features you'd want?

OK, smartphone integration with pod, there is so much talk ( and concern about) smartphone integration because of potential FDA delay, but the approval of the first GM that uses Iphone ( I forgot the name??) is proof that is CAN be done...

Perhaps integration with smart phone, yet duplication with the traditional controller as a backup device... ( in case you drop your phone in the toilet, etc...) The fact is you have an equal chance of dropping YOUR CONTROLLER in the toilet as well... so that argument really doesn't hold up, in my mind...

You know what it would take to buy dexcom too?? Curious... They'd clearly have to buy both for it to matter... and they already have that loose partnership which is not exclusive...

Dexcom is a little less than $800 million. Clearly, JNJ has the resources to buy both, if they could get the respective boards to agree to a buyout. All in would probably be $2.5 billion or so, but that’s just a guess.

Hi Natalie,
Not necessarily to Pancreum, but to any company that doesn't already have a large amount of cash in the bank.

An "Onstar"-type system would be a great improvement. The ideal scenario would include all diabetes management device makers "connected" via this system, which could be provided by a separate, "diabetes online services" company.
For an artificial pancreas system, I think integration, connectivity and mobility are essential for today's technology and user's familiarity with the web, etc.
I hope someone comes up with such system soon.

To get through the FDA, it will probably be necessary to offer a non-smartphone solution, along with an app for a smartphone. The non-phone PDA could be a Dell (Android), Microsoft Zune HD or Apple iPodTouch. As a 3rd option, a custom PDA that could be Android-based and have the same look-and-feel of a smartphone, like the CellNovo PDA.
The product you're talking about was developed by Agamatrix, is marketed by Sanofi Aventis and is called the iBGStar blood glucose meter, for an iPhone or iPod Touch.

what happens if you dont own a Smart phone and cant afford one? out of luck. This needs to work for everyone , not just people who are obsessed with the latest and greatest technology and have the ability to go out and get it.