Last month I was at the American Diabetes Association’s 77th Annual Scientific Sessions learning about everything up-and-coming in diabetes: the potential for new drugs like oral insulin, initiatives to combat stigma, and ways to more efficiently maintain adequate blood glucose levels. However, one of the most interesting things I learned about was the advent and distribution of new technologies like Continuous Glucose Monitoring (CGM) systems. Many of these incredible, and arguably indispensable for some, technologies barely penetrate the market audience: patients who can use this innovation to live happier, healthier, and safer lives.
This discriminatory design, creating a trickle-down model of technology and perpetuating pre-existing health disparities, is unfortunately a property intrinsic to the industry. Life-saving technologies are developed and made commercially-available, but do not become truly available until sometimes decades later when innovation leads to better, more advanced products and hence cheaper prices for these older technologies that have been long inaccessible to many populations. Whether talking about iPhones or cars, this is a common model. However, it is unacceptable when someone’s life depends on access to the product.
Beyond the business models, there are other – and more readily resolvable – barriers to access. On the patient end, pricing and healthcare insurance policies are most directly determinant of access. Rather intuitively, if they cannot afford the product, they will not use it. However, patients may genuinely not want the technology! Some companies produce an impressive product and then think about how people can use it, making many patients ambivalent about the product, desiring the final result but dreading the hassle to achieve it. Similarly, patients consider how others will respond and may imagine a robotic caricature. This indicates the importance in taking a human-centered design approach to product development.
Education is also a key factor for both the patient and provider. If neither understand how the product works or its applications, it is much less likely that the technology will be adopted into medical practice and subsequently used by a patient. Even though it is part of their role as a community expert and provider, some clinicians do not keep abreast of relevant trends that could improve the lives of their patients. And among those who bring innovative technologies into their practice, many see it as a last resort, not a proactive approach.
Acknowledging all of this, we must uphold education and dialogue among healthcare providers, industry leaders, and most importantly students, who are readily accessible and will change the future dynamic in the field. There is a plethora of complex components involved – industry development, insurance coverage, physician willingness, patient access, product practicality – and it is impossible to tackle them all at once. Nonetheless, something must be done. And I personally believe it begins with education.