Sunday, June 29, 2014

ADA 2014: Non Scientific Summary

This is my non-scientific summary of the American Diabetes Association Scientific Sessions 2014.  I'm also putting together two or more postings to cover the scientific content, which I hope to publish over the next few weeks.  I want to specifically thank:
  • The Juvenile Diabetes Cure Alliance (JDCA) who paid for my ticket to the conference.
  • My employer (a large software company) which gave me paid time off to cover the convention for JDCA, as part of their "service learning" project, which pays for engineers to spend time working for non-profits.  It is a wonderful fringe benefit. 
As you read this, please remember that the meeting ran from Friday to noon on Tuesday, but I was only able to attend on Saturday, Monday, and Tuesday.

Size vs. Applicability

The first thing that hit me, as I was planning my attendance, was how huge it was.  Especially over the weekend, there were often more than eight sessions going on at the same time.  So the initial worry was "where do I spend my time" and "what do I see".  Unfortunately, when I started looking at the session titles and the exact papers, I realized very quickly that, since 90% of the people with diabetes have type-2 diabetes, therefore 90% of the sessions dealt with type-2 diabetes.  Sometimes there would be one session that covered type-1, sometimes none at all.  Suddenly I was looking at each paper, trying to find something that applied to type-1s.  Then things got worse: most of the papers were about treatments and complications.  So while there were a small number of type-1 papers, only a couple of these discussed cures in any way.  

So my planning ended on a profoundly depressing note.  I was at a huge scientific meeting with over a thousand posters, scores of oral presentations, over a dozen symposia, and very little to see!

I also got particularly unlucky, because the three sessions which covered T1C  (Type-1 Cure) most directly were on Sunday, which I could not attend.  (I'll blog more about these in a future blog, but they covered Expanded Polyclonal Tregs, an ATG/GCSF treatment, and the closed loop artificial pancreas.)

One good thing about the scientific sessions, is how broad they are.  While there were only a few cure focused papers, there were a vast number of papers in general, and they covered far more different subjects that I expected.  I often see people asking "has anyone ever studied teenage depression and type-1 diabetes? or seeing a doctor every 6 months rather than every 3 months? or using this insulin rather than that insulin? or taking insulin N minutes after starting the meal or M minutes before? or ....   One thing I realized while attending ADA is that just about everything related to diabetes has been studied at one point or other.

Science Divided from Commerce

The show has a severe case of schizophrenia, which I hadn't realized before.  There are the scientific tracks, which are all about research for the future (but nothing available now), and the exhibition (the trade show) which was all about what is being sold now (but nothing about the future). And there is a very strong division between the two.

I'm used to software shows.  If you walk around the trade show part of a software show, everyone is excited to tell you about their future products.  At the slightest provocation, they gush about the new better stuff that will be available soon.  But the pharmaceutical industry is highly regulated, and apparently they are not allowed to talk about future products (at least not to non-medical professionals).  I would ask the most innocuous questions "what features will be in your next pump/CGM combo product?" or "[pointing at a huge sign for a type-2 drug] aren't you guys testing that on type-1 diabetics?" and their eyes would get big and they would walk me over to a tiny corner of their booth (often called "medical information") where a specialist would deal with me.

The specialist would ask me two questions "Are you a medical professional?" and "Please sign this non-disclosure agreement (NDA)".   Of course, I'm not a medical professional, and I'm not going to sign an NDA because then I could not blog about what I learned.  So they smile nicely and are very polite, but cannot tell me anything.  So frustrating!  It's a little eerie, also.  It's clear that there is some FDA rule about not talking about future products to non-medical professionals; all the reps, in all the different booths, all say the exact same thing when you ask about research or future products.  It's like they are all sharing one hive mind.

At software shows, it's very common to hear some new research talk, and then wander over to a company's booth and discuss how that paper might apply to their product. But it is not done at medical conventions! I heard a really cool research talk on the advantages of U-500 insulin for type-2s (as compared to standard insulin, U-100). I asked a guy in a pump booth about using U-500 in his pump. His eyes got big, and his expression became a mix of awe, fear, and horror: "U-500 is not approved in our pump!", "you cannot do that! [and I can't even discuss it!]".

The biggest single goal of the exhibition was to get type-2s to take more drugs. Not on insulin? Get on insulin! Taking metaformin? Take something else, too (we've got lots of drugs to choose from). Partly this is because type-2 is a large market, but also it is because there is big room for growth. Type-1s already take insulin, and there is not much more for them to take. But type-2s often don't take insulin, so there is room for sales growth. Plus there are several different classes of adjunct drugs, and they generally don't interact with each other, so if you're taking 1 or 2, there's probably another 1 or 2 you could be taking. More revenue growth.

Joshua Levy 
publicjoshualevy at gmail dot com
All the views expressed here are those of Joshua Levy, and nothing here is official JDRF, JDCA, or Tidepool news, views, policies or opinions. My daughter has type-1 diabetes and participates in clinical trials, which might be discussed here. My blog contains a more complete non-conflict of interest statement. Thanks to everyone who helps with the blog.