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One diabetic’s take on Google’s Smart Contact Lenses

One in 19 people on this planet have diabetes. I am one.

About four to six times a day I am reminded of many things — my genetics, my disgusting smoking habit (which I have kicked) and my (now modified) terrible eating habits that have led me to where I am today. I prick the skin on one of my fingers, take a droplet of blood, put it on a tiny strip that is attached to my AccuCheck Glucose meter, and make a note in a little black book. At some point during the day I have to take insulin shots so I can get through my day; doing the things that 18 of 19 people get to do without that extra help. I have to watch everything I eat: one extra macaroon or not taking a walk before going to bed can cause mood swings and lead to other complications. But like I said, it is a mess of my own making.

Just to give you a size and scope of the diabetes problem, I quote from a recent report from  Credit Suisse Research Institute which estimates that “close to 400 million people worldwide are affected by type II diabetes alone – a number that is quickly rising” and the “associated costs for the global healthcare system are estimated at a staggering $376 billion every year, representing over 10 percent of all healthcare costs.” By 2020 this could be a disease that impacts 500 million people and the costs “could rise to a whopping $700 billion,” the study said.

So when I read about Google’s “smart contact lens project,” which allows these lenses to measure blood sugar levels, for a very brief instant I was excited. It seemed like that finally we are getting to a place where needles, blood-soaked alcohol swabs and cotton balls are going to be history.

Over the years, many scientists have investigated various body fluids—such as tears—in the hopes of finding an easier way for people to track their glucose levels. But as you can imagine, tears are hard to collect and study. At Google[x], we wondered if miniaturized electronics—think: chips and sensors so small they look like bits of glitter, and an antenna thinner than a human hair—might be a way to crack the mystery of tear glucose and measure it with greater accuracy.

We’re now testing a smart contact lens that’s built to measure glucose levels in tears using a tiny wireless chip and miniaturized glucose sensor that are embedded between two layers of soft contact lens material. We’re testing prototypes that can generate a reading once per second. We’re also investigating the potential for this to serve as an early warning for the wearer, so we’re exploring integrating tiny LED lights that could light up to indicate that glucose levels have crossed above or below certain thresholds. It’s still early days for this technology, but we’ve completed multiple clinical research studies which are helping to refine our prototype. We hope this could someday lead to a new way for people with diabetes to manage their disease.

Google glucose testing contact lens

Reality Check

But after the initial excitement was over, cold reality set in. It also prompted me to ask the question: why is it that a company with such good intentions fails to ask itself very basic of questions, something a normal human being would ponder before embarking on a scientific quest?

For example,  why would they ignore the fact that as a diabetes patient, it is generally recommended that I not wear contact lenses. Yes, I understand that there are many different opinions about this, but it is generally thought of as smart to not wear contact lenses, as they always carry the risk of increased complications for diabetics. And on top of that if you have say, astigmatism (like I do), then contacts are less of an option.

racediabetesnumbers

Never mind the big fact that most of the people who do suffer from diabetes (Type II) tend to get it because of poor diet, most often because of lack of better diet options due to increased economic and financial stratification of our society. Diabetes is a growing problem in countries in South Asia and parts of Asia and Latin America, especially among those who fit in the lower income category; you know, the kind of people who might find contact lenses an expensive luxury. The less financially fortunate among us are very same group who are much more likely to not monitor their blood sugar levels due to work conditions and financial limitations.

I emailed Google’s press relations department — about 12 hours ago — asking them to elaborate on why the researchers took this specific approach. Yes, as a diabetic, I appreciate the efforts of Google in general and specifically Brian Otis and Babak Parviz, the project smart contact lens co-founders, just as I appreciate every effort made by every scientist and doctor around the world trying to tackle one of the worst diseases to afflict the post-industrial society.

Tone deaf?

And yet, I cannot get over what seems to me a tone-deaf approach by Google’s scientists. It also highlights Google’s fundamental challenge: it fails to think about people as people, instead it treats them as an academic or an engineering problem. Instead of trying to understand the needs of actual people, they emerge with an elegant technological solution.

It is not just this one time. Google+, their social network, is a fail because it fundamentally isn’t social or about people — it is an effort to solve Google’s need for social data for better advertising using machines. Similarly, Google Glasses are a cringe-worthy assault to the social interactions of normals, but because a certain subset of Googlers — including co-founders Sergey Brin and Larry Page — have a cyborg fetish, it is okay to make that design. It is frustrating for me to keep repeating this, because Google is a company with huge resources and those resources could be deployed more effectively and have a much more positive impact, more quickly. And to do that, the company needs to learn to be human and develop compassion for human condition.

As a diabetic, the only solution I am looking for is non-invasive and one that keeps me in a state of constant alertness about my blood sugar levels while matching that data with advice about what I should do.

Instead of trying to develop a contact lens that will still be quite expensive for many of the world’s poor, diabetic patients, why not focus all monetary and intellectual energies towards developing a more simpler solution that can be built at scale, very cheaply? Why not take the open source ethos and develop a product that actually be given away to anyone — say, emerging world pharmaceutical companies — who wants to manufacture it cheaply? The licensing terms could/should include the Tom’s Shoes Principle: buy one, give one away for free to someone who cannot afford them.

Instead of contact lenses, how about Google’s mighty X-machine focus its microscopic chip approach that Otis and Parviz are taking on a patch that can be applied to the skin — akin to a nicotine patch. The patch could carry the chip and send data to nearest phone — be it a smartphone or a cheap feature phone — and alert diabetics when there are major spikes or declines in blood sugar levels. These would be easier to use, cheaper to product and much more easily distributed.  It is a moonshot, and totally worth it.

Sure, it would lack the whiz-bang nature of the smart contact lenses, but it would be something I would welcome with a big grin and a credit card while thanking my stars and Google for having developed that. It’s not that I am not unappreciative of the impact that these contact lens breakthroughs might have in a few years. But another few years would mean another 100 million fellow humans suffering from something I live with everyday.

sweetworld

172 Responses to “One diabetic’s take on Google’s Smart Contact Lenses”

  1. Carlos Steinbruch

    Yes, all products should be perfect on the first try. And there is no room for expermental products. And I want a bunny that is a perfect companion, brushes my hair, and knows my insuline needs without touching me.

    Geeez.

    Carlos
    Also diabetic.

  2. I’m ok with the lens, it means the discussion is there and someone will probably out google, google. I wish we could get the artificial pancreas through FDA, that would definitely help.

    As far as being economical, diabetes isn’t cheap. How expensive are each test strip? I use an insulin pump, how expensive are the components I have to change out twice a week? Still cheaper than the complications from diabetes.

  3. Just because google’s contact lenses don’t cut it for you is no reason to go on a tirade about Google’s failings.

    You could argue that the contact lenses don’t solve a problem you have — I personally don’t care for them too, since I don’t use nor feel comfortable with contact lenses, but it is not hard to imagine someone who will find them useful. Secondly, this is an addition to the array of options that a diabetic has at their disposal: pick your poison. The cost is merely one factor you take into consideration when picking said poison. Most new technologies start out relatively expensive.

    Finally, I’ll address the irrelevant swipe at Google+ which you made. If you use an android device like I do, Google+ is very useful. I find the fact that my good friend +1’d an app for android a very strong incentive for me to try it out because I trust that friend’s judgement. I don’t really care if the rest of Google+ is just an attempt to gather social data, it’s clearly being put to good use. I don’t really care if it is not as popular as Facebook for spamming each other with party pictures, I already have facebook for that.

  4. Thank you for pointing to this interesting study.

    It is a good study but the authors make a logic mistake using the amalgamation argument when they state based on vague data that fructose is metabolized identically as glucose: the only fact they provide to support this theory is a statement that has nothing to do with fructose since sucrose and HFCS have about the same content in fructose: “The American Medical Association has weighed in on the debate and concluded that it does not believe there to be any difference between HFCS and sucrose when it comes to causing or aggravating conditions such as obesity or diabetes type II.” So they use a true statement about something else, to imply that their first statement is also true, which is a deception (they probabky believe it this deceiving themsleves).

    Until the data in the book “The Sugar Fix”, and the in presentations by Robert Lustig are proven wrong, fructose is still the number 1 suspect in the epidemy, together with excess calories consumption.

  5. laxidasical

    The issue (that I can see) for another type of wearable monitor is the access of the monitor to body fluids in a non-invasive manner. I don’t think sweat will fit the bill as there seems to be more inconsinstancies in how to measure it (evaporation, humidity, etc).

    As a side note, Microsoft is also funding research on this solution to glucose monitoring, but with the sensor communicating with an internal pump.

  6. Tim Shea

    When I saw the headline my first question was “who still buys contact lenses?”. Most people today will get their eyesight corrected by a number of different procedures (I had mine corrected in 1999).

    When I think of these stunts from Google I can’t help myself draw parallels with Microsoft. Both have cash cows (although Microsofts is more threatened today than googles is). Both have very bright scientists and engineers working for them. Both spend a ton of money on R&D. But neither can kick out products that anyone wants to buy or solves a problem on a wide scale outside their core competencies. Or make money doing it.

    I really think this is behind the purchase of Nest. Google doesn’t have the DNA to kick out meaningful products. Nest does. And has proven it.

  7. Also a comment to Om personally: have you tried a calorie restricted diet? Some studies have had it *cure* some types of Type-II diabetes. If you haven’t, I would recommend giving it a go; it’s as risk-free a procedure as it gets and the gains could be enormous.

    See this article:

    http://www.theguardian.com/society/2011/jun/24/low-calorie-diet-hope-cure-diabetes

    “Eleven people with diabetes took part in the study, which was funded by Diabetes UK. They had to slash their food intake to just 600 calories a day for two months. But three months later seven of the 11 were free of diabetes.”

    600 calories is pretty small; it works out to like one relatively small meal a day. It takes some getting used to, but once you do it’s no trouble at all. I started a similar thing, having only 600 calories a day on weekends, and I’ve got to say it’s really improved my general well-being. I’m not at all obese and don’t have diabetes, so it’s good advice for anybody.

  8. Here to offer an anecdote: one of my lecturers at Uni worked with the team that invented the first electrochemical glucose meters.

    The team consisted of chemists, biologists, electrical engineers. The devices worked by pricking a small amount of blood on to a test strip (coated with glucose oxidase to oxidise the glucose), and then measuring the glucose with the device (which used ferrocene to bind to the product of that reaction, and directly produce an electric current from it). They were incredibly proud of it – it was an elegant solution that treated biological molecules as variable resistors in a circuit, which meant you got a perfectly linear current vs. amount of glucose relationship.

    Anyway, they proceeded to miniaturise the device – thinking that the smaller and more portable the device, the more convenient it would be for diabetics. The reading gadget ended up being no thicker than a pencil.

    The device was a flop.

    Unfortunately, that team didn’t actually have any diabetics on it. If they had had, they’d have known that people with diabetes can develop peripheral neuropathy, which compromises their fine motor skills. Making the device so small meant that it was extremely impractical for many diabetics. The devices only really took off after they _increased_ the size of the reading gadget.

    That story taught me an important lesson: you design products for people. It’s tempting for an engineer to strive to miniaturise everything; to refactor and simplify it to its essentials and strip everything else out. However, we live in a world of imperfect human animals, and they impose practical constraints that separate what you *could* build from what you *should* build.

  9. They invent a new technology that measures your blood glucose without actually taking any blood and your reaction is to bitch about it only being beneficial for some diabetics?

    WTF???

    Do you go to restaurants, have a delicious meal and then complain that the cutlery was in the wrong place?

  10. It is cool not just in and of itself, but hopefully it will nudge current makers of CGMS to move forward also. I find it ridiculus that in this day and age I cannot get my 9yr old type 1 son’s real-time CGM data on my phone. Unfortunately current companies are enwrapped in proprietary standards and charge huge amounts of money for a simple parent monitor to get CGM data across an apartment (and forget the internet).

    Go Google.

    • This is disappointing. I use a Dexcom G4 CGM and it’s much much better than what I tried out 10 or 12 years ago. But yes they should figure out some way to get the data to parents, or more generally to allow multiple devices to access the RF output. Do you think one limitation is the transmitting power of the sensor unit? The previous generation Dexcom sensor could broadcast to the handheld receiver at 5 ft or so (reliably). The new one is about 20ft. The new one sensor is much larger, I assume because it has a bigger battery to power the RF range. I know Minimed has a bedside display for CGM, but again I think that only works because it’s close to the sensor. Are you looking for something you could monitor, say, while your son’s out playing? (Perhaps they could allow a waistband/handheld receiver to pick up the sensor feed and then relay it via cellular technology? That way you could have the power-eating broadcasting function provided by a rechargeable device.)

  11. I think Google is being brief on details as they’re trying to get glucose monitoring working with Google Glass.

    All it would take is to shine a polarised light source into the eye from the glass frame and then capture the reflection and with a calculation of the rotation you could get a proxy of glucose content of fluid in the eye and from there calculate an approximation of blood glucose.

    Fda (and basic patient safety) is going to require more accurate readings from seamlessly connected glucometers like that developed/marketed by Telcare.com so perhaps Google is keeping quiet about that so that it can buy such a company as it’s probably only ‘beans and toast’ on the menu this month at Google HQ after they paid $3.2 Billion for Nest.com

  12. I think Google is being brief on details as they’re trying to get glucose monitoring working with their Google glass.

    All it would take is a polarised light source shone into the eye from the glass frame and then captured on reflection. By calculating rotation you could get a proxy from glucose content on fluid in eye and from there calculate an approximation of blood glucose.

    fda (and basic patient safety) is going to require more accurate readings from seamlessly connected glucometers like that developed/marketed by Telcare.com so perhaps Google is keeping quiet about that so that it can buy such a company as it’s probably beans and toast this month at Google HQ after they paid $3.2 Billion for Nest.com

  13. Om, as a mobile technology pioneer in the real estate space I have enjoyed and appreciated your insights very much over the years. This article though hit home hard. I have been type 2 diabetic for 15 years and lost my mother way too early due to complications from diabetes. The hours spent bathing her gangerous legs in the later stages of her life still give me nightmares. I turn 55 this month and have determined that I want to spend the rest of my productive work life addressing the root causes of this disease. While I agree with your comments about better glucose monitoring devices, ultimately, the disease will persist as long as we continue to consume ridiculous amounts of refined cane sugar and high fructose corn syrup in our diets. We need a healthy alternative sweetener to replace these products. The artificial sweeteners that the food industry has developed, from dubious source stocks, are arguably worse. But even if a healthy alternative could be created, bringing the industrial food complex on side will be an enormous challenge given that refined cane sugar costs are so low ($0.30-$0.40/lb.) with HFCS about 30% less. My research to date leads me to believe that one promising avenue that could be pursued is using dehydrated honey and blueberries as primary ingredients. The target would be to bring the GI of the product down around 50 or less. I have strong partners on the production side to work on the development of such a product but would be interested in your thoughts as to a promotional strategy and potential VC partners supportive of a health and wellness agenda (assuming our product development efforts are successful). Having financed early stage food products in the past that achieved national and international distribution I am under no illusions as to the immensity of the challenge. That being said, the problems created by existing sweeteners have reached the stage of a national health emergency. Surely, if Silicon Valley can help entrepreneurs like Elon effectively challenge the pollution spewing auto industry, can’t we take a run at the industrial food complex that is quietly poisoning us all?

    Ken Galpin
    [email protected]

    • Hi Ken,

      Interesting approach. May I ask why you single out cane sugar and HFCS? What about other carbohydrates like white bread, rice, pasta or potato chips, just to name a few items?

      Thanks.

      • B Nog:
        Good point. I read his comment as picking out foods with a high glycemic index. Processes foods, in general, tend to have a higher index due to breaking down of grains (e.g., in white bread) or addition of fructose or other simple sugars. Depending on the type, rice, pasta, etc. could be included in this.

  14. Renu Raman

    I am with you OM.

    Most google products show technology first, people (or use case) second – except for Search. Apple is the reverse. While its interesting to innovate in the open, at some point users will not be patient with this approach.

    Having said that, I am hoping with Tony Fiddell buyout, things will change. What a loss for AAPL. Tim Cook as CEO and Tony as Chief Product Officer would have been the killer combination to counter Larry Page + Googlers… Cannot believe Tim did does not see that. But I digress…

  15. Diabetes runs in my family, so I know exactly what you are talking about. If the lenses are using the tears, then why can’t skin moisture or saliva be used instead? More readings lead to better control because you know if you can eat and you know the direction that you are trending.
    PS : Don’t be surprised to find out some day how many non-invasive testing solutions have been bought and shelved by the test strip companies.

  16. The announcement of Google’s new endeavor is fairly new. I can not believe that, with the limited information regarding the technology (price, how it will even work, would insurance cover any portion, etc), one could be such a pessimist about this new technology. You make a lot of assumptions in this article – no one knows if this technology will even go anywhere, no one can even speculate the price, or even the potential positive impact this could make.

    Ugh, this article could have much better presented the excitement of this/and other new technology for diabetics, but instead it sounded like a big whine-sesh about something we know very little about. It was far from a “reality-check.” So dramatic. The buzz about this new technology could spark interest for other companies to research alternate methods for glucose monitoring (which many are doing). If this, or similar technologies were successful, it would be in a companies best interest to make it more affordable given the overwhelming number of people affected by diabetes. Also, if proven successful – could this be technology covered by insurance in the future? Insurance companies are highly motivated to help diabetics control their diabetes as PVD/amputations, kidney disease/dialysis, disability, and the plethora of other diabetes complications cost them endless money in the end. There is so much potential in this technology, and so much yet to be determined….

  17. Samir Shah

    Dear Om, you are just jealous of the glory Google got with this news.

    The only things more wonderful than the research are

    0) Insulin pills.

    1) Genetic manipulation so type I so cured.

    2) Genetic manipulation so type II does not occur.

    And let me remind you Om that people that people who can not afford these contact lenses can not afford insulin either.

    I am a borderline type || and my father had diabetes from very young age (it ran in the family)
    so that I know diabetes first hand,

    We, South Asians in particular, can not give credit where credit is due because of our ambitious nature. Grow up Om. You are a resounding success in my eye because of your GigaOm empire.

  18. Can an astigmatic person wear contact lenses? Yes …
    Can a diabetic person wear contact lenses? Yes …

    See http://www.uihealthcare.org/2column.aspx?id=225651

    The cost of the instrumented lenses is not discussed in the Google news release; this is an R&D project, not a commercial project. Perhaps this device is not the best answer for every person with diabetes … but it would certainly be appropriate for many.

    Similarly the patch which is proposed above has costs, and would perhaps work for many. It is another R&D project. There have been many research projects for non-invasive blood glucose testing … they are all interesting concepts, but all of them depend upon technology, and all would have a cost.

    It seems that your concern here is that you would have made a different choice … but there is no clear evidence that your favorite choice would be more effective or cost less.

  19. the last two sentences of the abstract you linked read…

    “Contrary to previous reports, the response of the diabetic eye to contact lenses–as observed clinically–does not differ appreciably from that of the non-diabetic eye. These results suggest that current generation daily wear soft contact lenses can be a viable mode of vision correction for diabetic patients.”

    In what way does that study support your position regarding diabetics and contacts?

  20. Google’s revenue engine is, has been, and will be “monetizing eyeballs.” This was the Web 1.0 promise which only they delivered on in a sustainable way. Their business strategy is to turn as many people as possible into advertising units to sell in reverse auction to their advertisers.

    Most of their movements in the last 10+ years can be understood through this frame.

    Therefore, the lack of motivation to cover serious problems like access to water, vaccines, and diseases like diabetes become obvious: the market isn’t big enough. Once they have 7B ad units (each living human) they may value diversifying their model. But right now, 1 in 19 humans suffering from diabetes is not as motivating as capturing every human with a vision impairment of any kind… because an order of magnitude more people means an order of magnitude better monetization of those eyeballs.

  21. Amy Hearn

    You had me interested until you kept flogging about the stupid weight charts (cause you KNOW only FATTIES get diabetes, right? WRONG, it’s about genetics, and 1 in 3 people with Type 2 diabetes is normal weight)
    Also, why NOT be happy that ANY breakthrough is viable? Instead of whining about ‘it’s generally considered smart not to wear contact lenses if you have diabetes’, why not merely talk about the world wide options for third world countries where people sometimes don’t even HAVE the option for life saving INSULIN? THAT is far more important. *rolls eyes*

    PS: I have type one diabetes (3% of all people with diabetes). I am NOT a ‘diabetic’ (as in I do not define myself as a disease) which is vastly different than the folks with Type 2 (the other 97% of the population who have diabetes).

  22. Austin Wang

    Just because Google has the resources to do something, does not mean it should. Their actions need to be aligned with shareholders expectactions, their existing business as well as what their core staff are interested in / are passionate about doing. It wouldn’t really make sense for them to be spending massive resources building a diabetes related part of their business.

    Instead i think this is more like a technical demo – a longshot, something to prove what can be done with contact lenses and miniaturized computing. Diabetes data collection just happens to be probably the only realistic/useful application possible at the moment. Also, this project was probably worth it for google just to hire/retain the person behind it. I mean contact lens computers?

    In any case, all big problems should be approached by many people from many approaches. Mainstream, longshots and experiments.

  23. Hamranhansenhansen

    > Instead of trying to develop a contact lens that will still be quite expensive
    > for many of the world’s poor, diabetic patients, why not focus all monetary
    > and intellectual energies towards developing a more simpler solution that
    > can be built at scale, very cheaply?

    Because this is not really a “diabetes contact lens” — it’s a data gathering device, akin to a Street View car or Google Glass. Future versions of the contact lens would gather much, much more data about your body than just blood sugar levels, and Google would have access to that data. An airline might require that pilots wear them when flying to ensure they are not intoxicated.

    If it were really about diabetes, it wouldn’t have Wi-Fi and so on. It would just be a little strip across the bottom of your vision that turned redder as your sugar levels rose.

    In fact, if it were really about diabetes, it would be a cure for diabetes, not another way to live with it.

  24. Mr. Malik,

    I am a diabetic like you. And I find it exciting and commendable that Google, is spending their own money, to come up with a nice and painless solution to monitor glucose level in our body.

    As you have pointed out, contact lenses may not be for everybody. That however, does not justify that innovation not be made in the field. Had Bausch and Lomb (or some other Medical company) come up with the same idea, would you have opposed it the same way?

    Lets discuss cost, how many of these “poor South Asians” have you seen using a AccuCheck Glucose Meter? In India, my home country, AccuCheck Glucose Meter retails for about INR 1,500. 100 strips + lancets costs another INR 2,000. This is the discounted price, you can look it up on their website (http://www.accu-chek.in).

    Last year, I purchased a set of 6 disposable soft contact lenses for INR 600. Which of the two can they afford?

    With mass production, even with extra cost of chips and circuitry, I believe it will become cheaper.

    Back in 1997, when I saw a cell phone for the first time, the store owner told that the local calls cost, per minute, would be between INR 8 and 12.

    The cell phone was huge and the weight would be more than 2 pounds (I guess from the way he was lifting it, I was a student with no money, not his customer, and the electronics store owner never really allowed anybody to touch it).

    I thought, this would never take off; who the hell can afford this exciting technology, and boy was I wrong. Do you know how high the cell phone usage is among “poor South Asians” now? The point I am trying to make is – we don’t know for sure how this will work out in future.

    I am not pro or anti Google (or any company for that matter, well, except Apple) and I think the Google+ or Google Glass discussion were out of place for this piece, and I think your take is unfair.

    Thanks,
    Manas

  25. Om, this story would have been a lot more credible if you left this out:

    “Google+, their social network, is a fail because it fundamentally isn’t social or about people — it is an effort to solve Google’s need for social data for better advertising using machines. Similarly, Google Glasses are a cringe-worthy assault to the social interactions of normals, but because a certain subset of Googlers — including co-founders Sergey Brin and Larry Page — have a cyborg fetish, it is okay to make that design.”

    It’s really hard to take an article like this seriously when the presence of bias is so clearly evident. None of that furthered your argument at all. Instead, you destroyed whatever sense of objectivity might have been present here. This whole article is nothing more than a rant against Google, veiled under a lame attempt to use your self inflicted disease as a moral podium.

    This is very poor journalism at its finest folks.

    • Jd88

      You can say whatever you want, it is yet another sign of a company that is tone deaf, The two other examples only reinforces the problem they have had and will continue to have. Feel free to skip reading what I have to say — but not going to be an apologist for one of the biggest companies of our time for being unable to think with compassion.

      • The fact that they are considering any sort of project to help diabetes is more than can be said for any other major company. I don’t see you calling anyone else out. How much of your own earnings from this website do you donate do diabetes research?

        I smell hypocrisy.

        Again, had you not attempted to bash Google products in the article, it would be a lot easier to believe you are concerned about “compassion” and not simply using this as an opportunity to bash the competition of your favorite technology companies.