After the iPhone, the Blood-Sugar Meter?

Health care is an important, huge, and growing piece of our economy. But as a reader named Beth Wieder points out, the design of medical devices isn’t always as user-friendly (or, I would add, as cost-efficient or as practical) as one might like.

For instance, we blogged some time back about a very cheap and portable asthma spacer.

Here is Beth’s note in which she passes along one journalist’s good and compelling idea for improving the design of medical devices. Once you finish reading it, you will probably start thinking of all sorts of things that you’d like to put Steve Jobs to work on:

San Francisco-based journalist Amy Tenderich, who has Type 1 diabetes, runs the Diabetes Mine blog, featuring facts, gadgets, reviews, and opinions on all things diabetes. She started getting wider attention last year with her open letter to Steve Jobs calling for better product design for medical devices.

Most diabetics have several medical devices — pumps, syringes, lancing devices, etc. — with them 24 hours a day, and while we are grateful for these life-saving gadgets, most have considerable room for improvement from a user point of view. This year, she’s opened up the contest up to anyone.

I’m looking forward to seeing what happens when you open up a very limited field (industrial designers working for medical device companies) to anyone with a computer and an idea. Any thoughts?

In related news, here’s an article from The Economist about a research project at Berkeley called CellScope that turns the digital camera on cellphones into a microscope,

which means that with the correct stain it can be used to identify the parasite that causes malaria. Moreover, by transmitting an image directly over the mobile network, the CellScope could greatly help with the remote diagnosis and monitoring of many illnesses.


so great! i like iphone!!!


Why are they calling on Steve Jobs? Not that i don't have faith in his abilities cause i do, but isn't he a boomer like grey, and ready to take over. I don't know, is he squeaky? Where are all the young people? The Mark Zuckerberg types? Shouldn't they want just as much to create new devices to help out their ailing and aging boomer parents? Is there money to be made in these things? Or all the young people with a entrepreneurial and altruistic soul busy solving other things?


you can also use the cellphone to swat the mosquito


Medical devices choose not to undergo constant redesign because this costs them tons of money in licences and permits and approvals and super long waiting + red tape and burocracy...

I say they "choose not to" becuase they COULD but they dont..

I simply dont understand their BODs which dont seem to see two great benefits:

Easy to use = more sales

If the sole moral incentive of making it easier for the user is not enough they should at the very least look at the astronomical sales improvement they would experience...

as a VP of sales of any of these companies, this would be my priority..

I dont have tons of experience in the medical device industry, but if someone thinks I am totally wrong, I would appreciate some comments...


Due to a recent head injury, I lost most of my hearing. I've had three hearing tests (Beltone, MiracleEar and a small private firm), all three recommended hearing aids that cost of $3,500.00 apiece.

I look at those aids, the size of a baby carrot, and think "Even Steve Jobs doesn't charge that much for the iPhone that has countless functions!"

I'm 47 and wonder how the hearing impaired, many who are seniors and fixed incomes, can cough up $7,000.00 to hear better.

These companies advertise their compassion for the hearing-impaired and want to help out of the kindness of their heart . . . if they are paid enough. It seems to me those devices could be profitably sold for a few hundred, instead of a few thousand.

My insurance company (Humana) wouldn't cover a cent of the cost - so I remain without.

A hat-tip to The Lions Club for providing affordable, sometimes free, hearing aids/eyeglasses and testing to those who can't afford it otherwise. The next time you see them at the intersection, throw a buck in the bucket and enjoy the "Life Savers".



Anybody who had to use blood sugar meters even just a few years back must admit that the current generation represents a vast improvement allowing most patients to take control of their condition.

My wish is a similar portable device that can measure blood coagulation - cheaply! These devices exist but are not exactly portable and definitely not cheap. Yet patients on anticoagulants have been shown to achieve better control of their blood clotting if they use these devices at home and adjust the doses themselves that if they have hospital based blood tests and the dose is adjusted by their doctor.

Ben Karol

#11 you can hack an Iphone to be a hearing aid since it just needs to be have a microphone, amplification, and speaker. So after everyone goes deaf from listening to headphones too long, that may be the next Iapplication.

I think good design is when every function has it's own button instead of trying to double up
(like trying to set the time on a VCR Menu fastforward to change the hour what is that about) I have to use BGM and stick test strip in then change code with the button that goes though history is not intuitive but then you likely end up with a knobby ugly device. I do like the cartrige BGMs better at least you are less likely to get blood on stuff.

Richard in Connecticut

As mentioned, the entry cost for medical devices is very high, the liability costs are high, and the certification process in the US is, to be very charitable, cautious. By and large, some of these barriers are lower elsewhere, and that's where the action is. Not the least of the domestic problems is the fact that we've abandoned both manufacturing and engineering, so it is that much less likely that a good idea can get developed. Even a great new idea needs an available, and skilled team. The ratio right now in engineering graduates, China plus India vs the US, is around 100:1. Done!


Greg (#1): High-end bicycle design is ultimately funded by advertising & sponsorships at competitions. Perhaps when we start having medical testing/diagnosis/procedure competition on ESPN and physicans use devices with "Coca-Cola" or "Tide" plastered across their surfaces, then we'll get some *real* medical advancement.


Actually, IDEO was involved in this year's DiabetesMine Design Challenge contest. They were judges, and are offering free consulting sessions to the two winners as prizes, to help them refine their design concepts.



The interactive agency Adaptive Path in San Francisco responded to the call for a well-designed BGM earlier this year with their Charmr project. Its a fairly elegant design with a lot of thought put into the way diabetics live their lives on a daily basis. It only exists as a concept at the moment but the ideas behind it are a testament to the power of user-centered design to alleviate real-world problems in the medical field.


The reason medical devices suck is that every variation of them needs to be FDA certified for use with humans. Even a silly change like the layout of the buttons or a menu requires recertification. This is very very expensive and companies aren't going to do iterations to perfect a design. Once one is made they do the least they have to to keep up. I worked as a software engineer at a medical device place and the FDA part of the cost of our device was about 70% of the retail cost.

But have you noticed lately all the commercials for free blood sugar meters? My guess is that all the relevant patents have run out, so they're switching to the razor/blades model where they give you the meter and you have to buy the specific test strips that only fit in that one meter.


Why is it that some industries experience much more rapid design evolution than others?

High-end bicycles, for example, are designed and re-designed so often and by so many people that the technology is always at the cutting edge. But medical devices don't receive that kind of attention from would-be designers. Both industries have sufficient profit-motive, don't you think?

Is it because sports equipment offers competition in another sense: the race to be faster/lighter/stronger than the other guy? Perhaps under-designed products like medical devices need a competition to motivate designers; something like the X-prize?


@ MPD, #2- so is this cue the Regulation Booing chorus?

Seriously- the FDA has done less regulation in the last 7.5 years than the previous 30. Who can forget the pet food scare where our best friends were dying from chinese made plastic pet food? Or how about the long delay in the FDA warning the public about Vioxx? No, I'd say this FDA is about as business friendly since the Reagan FDA.

In terms of medical device design- what is more profitable? Multiple units with single purposes or an all in one product that does it all? Well, perhaps if there was competition in the medical device field, the latter. But if not? Probably the former. Capitalism isn't all about innovation- many times, its about milking the public and staving off new innovations simply because the owners of production can. It's called a symptom of a calcified economy- where capital (or owning the means of production) has accumulated in vast quantities in relatively few hands.

Still, I'd rather have an FDA than none; after all, it was TR reading Sinclair's "The Jungle" which blew the lid on the Chicago slaughterhouse industry and what exactly (excrement) went into sausage... TR was at breakfast and threw out his plate, then demanded that someone find out if Sinclair was right.



The major functions of the FDA regulatory system as far as medical devices are concerned are to ensure the following:
that a products made under that system is safe and effective,
that the processes developed to manufacture the product always produce the intended product,
that the raw materials, tools, and equipment used in the manufacture of the product are safe for the product's intended use,
that all the people involved in the manufacture of the product and its raw materials are trained to the procedures above and follow those procedures for every individual product made,
and that traceability is established so that for every single finished product, all the components of that product down to raw materials, every facility involved in the manufacture of the product or its components, and every individual person who was part of any process in the manufacture of the product, its components, or raw materials can be identified.

Working under such a regulatory system is very time consuming, requiring massive amounts of documentation. As a result, it is not only extremely costly to develop new products, but changes to existing products are far more expensive than in an unregulated system (such as for bicycles), especially considering that any changes must be shown to not interfere with the safety or effectiveness of the product.

Add to this that most medical devices require deep knowledge of and expertise in a variety of different fields and technologies, rarely contained within one company. So most companies that make medical devices (even the largest companies) rarely make a device without subcontracting out some of the work. This makes changes even more difficult as two (or more) companies must coordinate closely to make and document any changes.

Overall the regulatory system exists to ensure that the medical devices used on your body are safe and effective. Good design, while enjoyable to the user, is a tertiary priority to saftey and efficacy.

Liability concerns offer another major obstacle to making design or process changes. But that's a whole other issue...



Dubner should write a story on IDEO, the design firm. They do a lot of work with medical devices. I once toured their facilities and their approach to design is really interesting.


MPD (#2), blood glucose monitors have always been free. Once you're committed to that inexpensive machine, you'll be buying that company's expensive test strips every month for the life of the machine. The continued high cost of test strips, about $1/each, is a constant complaint in the diabetes community. Many diabetics use 4-10 of these a day, so it's a high cost.


I have an iPhone, insulin pump(deltec with cozmonitor), and obviously way too much time to day dream about technology and my diabetes. I too wondered about my archaic pump/ tester when the iPhone came out. But the reason mountain bikes and iPods keep getting updates and diabetic devices don't(or just take much longer to come out ) is That is it. Steve jobs and every other business owner knows that millions and millions and millions of people across the world will buy an iPod. Millions and millions of bikes are sold around the world year after year. But even with great technology how many insulin pumps are sold every year? How many are even out there? The customer base isn't exactly large.
So if someone could please spend several billion dollars and develop a blood tester / insulin pump / iphone that scans my blood and oh about a cure or a digital pancrease with a built in iPod so I can listen to music while I shoot up?



Gonna have to second scottj comment about an all in one iphone/ diabeties management software tool. Imagine being able to control all the info insulins intake, bg level, carb intake plus make notes about what you eat, not to complex but no one seems to be able to get it right or even close. :(
but definately a digi-beta cell that can regulate insulin. A man can hope :)