Despair, Hope, and the Innovator's Dilemma

A little over a year ago, our daughter was diagnosed with Type 1 Diabetes, a lifelong chronic condition that requires she receive four or more daily injections of insulin. Type 1 diabetes is distinct from the much more prevelant type 2 diabetes, in that with type 2 diabetes, the beta cells in the pancreas still produce insulin -- but the body is not efficient at using it. With type 1 diabetes, however, the pancreas no longer has working beta cells with which to produce insulin. And they're not coming back. People living with type 1 diabetes need injected insulin to survive, and there's currently just no getting around that fact. We've since joined a number of support networks, and two related topics come up over and over again: cost, and cure.

The current state of affairs introduces some despair -- the costs are high and there is no cure.

My family spends about $1500 per month to manage our daughter's care (including insurance premiums) - just to keep her alive. That's comparable to our food and housing costs, and the vast majority of that cost is for insurance premiums, followed by insulin -- without which she would almost certainly die within days of a condition known as diabetic ketoacidosis (DKA). DKA was almost universally fatal prior to the discovery of insulin therapy. It's a little scary to think about that, but I try to think of insulin like I do water - it's just something we need to stay alive.

Only our water bill isn't $1500 a month.

That's my own little sliver of the world, but more broadly, the American Diabetes Association estimated the annual cost of diabetes at $245 billion per year. That's for both type 1 and type 2 diabetes, but that was the number way back in 2012. In the U.S. alone. Now I'm going to set my official DOD (Dad Of a Diabetic) hat to the side for just a second and put my ruthless capitalist hat on. You know what we capitalists call that? We call that a market. A pretty darn good sized market, in fact. Feeling a little blindsided? Well, please bear with me, keep reading...

Back to Despair, Hope, and the Innovator's Dilemma - Well I certainly think we've covered despair: Insulin therapy is very expensive and without it, those with type 1 diabetes die quickly. Let's move on to hope. Quickly. Before I start crying again (yeah, we DODs cry, too - not just MODs!).

A lot of folks have lost hope. I hear that loss of hope so very often in the support groups that I'm in. Many folks see that same market I described above, and look at the profits of the insurance companies and pharmaceutical companies, and correctly deduce that:

1. Pharmaceutical companies have a strong incentive to charge as much as the market can bear for their products.

2. Insurance companies have a strong incentive to pass on as much of the cost as possible to the consumers.

It's easy to get that far, then give up and assume those two factors mean there's no incentive for a cure. Once you see #1 and #2 play out, this next step is a doozy - it requires a leap of faith. People living with diabetes have seen those two forces at work for YEARS, and have experienced a great many hopeful attempts at a cure or less expensive care -- only to then see those dreams fall apart or be squashed AGAIN by those two market realities.

I'm sure it sounds like there's even more despair brewing here, but in fact this is where the hope comes in: The assumption that there's no financial incentive for a cure, is dead wrong. 180 degrees wrong. The opposite of true. Taxi cab companies made that exact same assumption about their own market - until Uber and Lyft came along and Spanked. Them. Hard. It's called disruption - a term popularized by Clayton Christensen in The Innovator's Dilemma.

The author observes that many (most) organizations over-focus on the market forces like the two I mention above, and stick to their current technology and business models, since those drive quarter-by-quarter growth and profitability. Those organizations then lose sight of the fact that their customers have a long-term future need - in this case: a cure, or much more affordable treatment options. Eventually someone ELSE almost always comes flying out of the blue from way out in left field and just nails the hell out of it - just like Uber and Lyft are doing with ridesharing, right this exact moment.

So I, the ruthless capitalist DOD, have hope. Not so much for a glorious magical press release from one of the current players, but more likely from some scrappy little organization we might never have even heard of, passionately founded by an entrepreneur with type 1 diabetes (or a MOD or DOD), full of hope and vision.  It probably won't happen today or tomorrow. It likely won't happen next week or next month or next year. It might not happen next decade. And honestly, it may not even happen in my lifetime. But it WILL happen. I can almost hear the company's tag line now - "We're like Uber, but for beta cells"


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