Today I saw in Google news, in my LinkedIn feed, and all over the net that Medtronic just got the first artificial pancreas (AP), well of course more properly a closed loop system, approved by the FDA. This is of course great news! A virtual cure for diabetes (at least if you are willing to constantly monitor and change sensors, calibrate the device, keep the insulin chamber filled etc.)! It has been a long time coming, and will no doubt help many attain better diabetes management, avoiding serious short and long-term complications. This could be fantastic for young children, the elderly, and those who struggle to maintain glycemic control. That being said, in a broader sense I have my concerns. Not because it is a bad idea, but because of the larger context of lifestyle related illness, financial profit, and the role of technology in our lives.
Health as a person with diabetes is much more than getting the right amount of insulin. It is about having a healthy lifestyle, the same as for every living creature on the planet. People all over the world are suffering from lifestyle-associated illnesses related to stress, poor diet and insufficient exercise. Pharmaceuticals are not the solution to all these problems, even when intelligently delivered, and I doubt they ever will be. I have concerns that systems like the AP, especially for those who have lifestyle related illnesses like T2 diabetes could detract from the urgent need to have more walkable cities, healthier foods, more active jobs, and a more sustainable society in general.
Putting the whole world on insulin not to mention anti-depressants, opiates, activity suppressants, etc. do nothing to address the root problems. Study after study has shown lifestyle interventions to outperform medications in treating T2 diabetes and aspects of chronic depression. While the Medtronic AP is being marketed initially to the T1 community, the big money is in T2, and that strategy is already being pushed. We are talking an over $6k device, thousands of dollars a year of sensors and cannulas, and thousands of dollars a year of ever more expensive insulin. Not to mention what Glucagon will cost, when the dual hormone AP gets approved. I fear a society of people slaving away at machines, so they can pay for their complex mixes of injected hormones, antibiotics, and mood enhancers. Some might argue we are already there.
I am not against tech, and as a person with T1 diabetes, I depend on it every day. However, as we develop technologies that integrate deeper into our body processes, there is much to consider. E. M. Forster over a hundred years ago wrote “The Machine Stops.” This dystopian short story proposed a world where inhabitants communicated through video and text messages instead of personal contact, and had all their physical needs met through a smart environment. In time they came to worship the machine as a god, and perished in mass when it stopped functioning.
So is the AP a great leap forward? For some people this device will be life changing. Who knows, in time I might be using one myself. But we must be careful to consider the implication of what we are doing, and to not fix our problems by creating even greater problems. Those of use who seek to design such systems have the responsibility to consider how to preserve user autonomy as we ask users to turn over daily decision making to computational devices.
So onward with technology, and thanks to Medtronic for bringing the first AP onto the market, but we must not become so enamored by what we can do, that we lose sight of where we want to go.