Who am I? What am I doing here?

Let’s start with the basics: My last major role in the medical world was that of CEO of a medical diagnostics company that made a handheld device for molecular diagnostics. You can see my LinkedIn profile here.

Our product never came to market because of the large capital expenses of manufacturing, so we were acquired by a much larger company that had those resources, which I’m not at liberty to talk about. (It’s easily discovered with minimal effort.)

The novelty of our product that it was a “hand-held” unit that could do the same diagnostic tests that would normally require a full lab. We didn’t test for specific things. Instead, it was a platform where users would use the same chemistry kits that are used in commercial labs, like Quest or Labcorp. The idea was simple: do the same test in the doctor’s office (or at home) that would otherwise require sending the samples to the lab. As such, our business model was to collaborate with other companies that already made existing lab tests.

My role as CEO exposed me to professionals within these partner companies up and down the org chart, from scientists to regulatory experts, from financial and marketing analysts to patients. As a partner to these large pharmaceutical companies, I’ve seen what drives and motivates their product development, their strategic goals and long-term planning, how they choose which diseases to address, and the way they position themselves against competitors. I’ve seen companies take their products from concept to market, struggle with regulatory requirements, pricing, insurance reimbursements, profit margins and patient/provider communications.

If you thought you knew anything about the medical industry, multiply it by 100, and you’re just getting a hint of it. This is a highly complex ecosystem, and few people really get a full picture from the inside the way I did. And the most important thing I learned is that nothing is simple—there are pros and cons to everything, and to think otherwise is more than just naive; you’re fooling yourself.

And that’s what’s so maddening about the T1D space. This is one of the most highly complex diseases that involve an enormously intertwined series of hormones that regulate glucose levels, and yet, there are only two million T1Ds in America. Compare that to the over 30 million type 2 diabetics, with an additional 90 million who have T2D but are undiagnosed, and the additional 100 million who are classified as “prediabetics,” because their A1c’s are still short of 6.4%.

When it comes to financial incentive to participate in the T1D space, it just doesn’t compare.

That said, any intervention that can help T2Ds can also help T1Ds, and vice versa. But it’s also not that simple—how one develops a new drug or technology varies, depending on the target market, and that’s where the various types of diabetes change not just the marketplace, but information about these diseases.

And that’s where my focus lies: How to best communicate highly complex information about T1D to those who have the disease. Most things are greatly oversimplified, whether it’s diets, insulin pumps, drugs, nutrition, and more. It’s not that there’s anyone to blame directly—numerous players have a role to play, from health care providers (who try to streamline patients into therapy protocols) to patients, who get—and share—their so-called “knowledge” online.

In this capacity, I’ve learned what to look for in clinical trials, in studies, in marketing literature, in strategic plans. And this nuanced look also requires understanding the target market. I’ve learned where the hype buts up against reality; there’s a lot of great info out there, but there’s also a lot of flotsam. My goal is to help tease through all the stuff that’s commonly seen, while also bringing attention to research that doesn’t get the exposure it should.

In this sense, none of anything I write should be interpreted as “medical advice.” Yes, I cite research that shows benefits or risks to a particular technology or intervention, which could appear as “advice,” but it’s not, and it’s important to know that.

My articles can get pretty technical, despite my attempts to keep things at a non-scientific level to the degree that I can. Let’s take that funny claim about cinnamon helping to either cure diabetes or at least help normalize blood sugar, which we’ve all heard about (and laughed at) when well-intentioned friends and relatives suggest it.

Amazing as it seems in retrospect, this is rooted in study published in the prestigious Diabetes Journal in 2003 titled, “Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes.” The authors concluded that “intake of 1, 3, or 6 grams of cinnamon per day reduces serum glucose, triglyceride, LDL cholesterol, and total cholesterol in people with type 2 diabetes and suggest that the inclusion of cinnamon in [their diet] will reduce risk factors associated with diabetes and cardiovascular diseases.”

For years, this was the conventional wisdom, and even T1Ds were encouraged to eat cinnamon. Nothing is better than a simple solution to a complex problem, am I right?

But then, reality sets in. Years of further research found that this simple, easy, miracle cure really didn’t do anything at all. A series of studies found that it was all bogus. One of dozens of studies that tried to replicate the findings, “The effect of cinnamon on A1C among adolescents with type 1 diabetes,” ended with a conclusion statement (which is usually quite long) that was as short and simple as it gets: “Cinnamon is not effective for improving glycemic control in adolescents with type 1 diabetes.”

The rumors about cinnamon represent the type of false information that, in practice, is not all that harmful. But add up a lot of bad information—or worse, malinformation, the type that has some kernels of truth, but is largely incomplete or misleading—and you get the information universe that most T1Ds live in.

My Background

If you’re reading all the way to this point, I’m both amazed and frankly, surprised. This has gone on way too long.

But, in my defence, I like writing. So if you also like reading, we’re going to get along just fine. So, shall we continue?

When I got my undergraduate degree in computer science at the University of California, Santa Cruz, I was eager to be part of the new generation of solutions driven by artificial intelligence.

The problem was timing—it was 1985. The enthusiasm back then, as it is today, was headline-grabbing. Back then, the buzzword was “expert systems,” where computers would aggregate personal and medical from people so that AI could make predictions, spanning everything from financial investing, auto-driving cars, and medical diagnostics. Believe it or not, surveys at the time showed that most people were highly receptive to the idea that vast computer networks would pull all their personal information to personalize everything in your life: advertisements you saw would be custom make to fit your interests; you would be able to read the ‘truth’ about political and economic events, rather than trusting biased news organizations and politicians; and best of all, AI was going to magically diagnose medical problems (and share it with a variety of providers), so you didn’t have to rely on the untrustworthy medical patriarchy.

Yes, all that was actually what people hoped and expected from AI in the 1980s. So, after my graduation, I interviewed with a company whose mission was the use AI to make medical decisions better than doctors. That company—Teknowledge—was valued similarly to how Google is valued today. It was the future. So, as a young, naive, techie-geek T1D, I was all too eager to participate.

Turns out, that idea was too ambitious, and the company crashed and burned, along with most AI companies of the day.

But, “The Internet” was also an emerging technology, and it showed signs that it might become interesting. I worked in the industry for a few years before I started my first (of many) tech companies. We made one of the first commercial email systems for the internet, and yet, no venture capital firm would invest in us, believing instead that Microsoft’s proprietary network would dominate the domain. They foolishly believed that the Internet (yes, capitalized) would become obsolete. That lasted until the Netscape browser came around in the mid-1990s. Along the way, I grew the company on sales alone, not needing venture investment anyway. As more and more companies were adopting the internet—despite VCs still denying it would materialize to anything meaningful—our sales skyrocketed. (In case you’re wondering, MicrosoftNet never materialized, and it crashed and burned, along with their “NT” operating system, which most people thought was also going to run the world’s networks.)

For the next twenty years, I either started (or was involved with) many other startups. In 2010, I returned to UC Santa Cruz to found the Center for Entrepreneurship, where I designed (and taught) courses that helped students learn how to start and grow viable business models.

In my capacity in the University of California ecosystem, I also engaged with professors and other researchers to help turn their core inventions into viable commercial products. UCSC was one of the leading universities for research into genomics and other areas of the life sciences, so my exposure to top research and talent was endless. It was also here that I learned a great deal about biology, bioinformatics, genomics, and the technique of communicating complex technical material into language that consumers (and investors) could understand. That, and the fine art of writing patents.

I helped launch many biotech companies within that program, one of which I co-founded and led (as CEO). We made a device that could detect a range of pathogens, antibodies, genetic material and other analytes using a small single-test kit (something like a glucometer). Over the course of eight years, we partnered with large pharma companies to develop “companion diagnostics” devices to assist with disease treatments, ranging from cancer to the common cold. These collaborations exposed me to the highly technical and difficult cycle of product development; there was no better learning experience than being on the inside of groups of researchers and scientists in my own company and those of our partners.

After our company was acquired by another medtech company that does genome sequencing, I moved onto other things. As a T1D, I decided to become more engaged in the community, where I would see huge disparities between what the general public knew about the disease, and the reality that lies within. As my engagement evolved, I decided to write about it, which lead to this newsletter.

You can sign up for free, and I also hope you encourage others to read as well. You are welcome to contact me with thoughts, ideas, and stories of your own.