Transformations in Diabetes Care: Lessons From Commons-Based, Peer-Produced Citizen Science

Medical technologies have historically been the domain of private entities and public institutions. However, this market-state model is being challenged by commons-based, peer-produced citizen science. Here, we present a community of people with diabetes, which has developed life-critical medical devices through open-source innovation, as a case study in the possibilities and constraints of a more commons-centric form of healthcare. We draw on insights from an existing body of social scientific research, as well as the first author's personal experience as a member of this movement, putting them in the context of a theoretical approach in which commoning is viewed as a transformative social paradigm. Drawing on Bollier and Helfrich's patterns of commoning, we offer two linked conceptual contributions which function as an analytical lens. First, we outline what we call the 'diabetes commons' to understand the dynamics of how the community established an alternative innovation ecosystem. Second, we posit 'medical technology provisioning', whereby production, consumption and follow-up care are blended into a holistic whole. We highlight how promoting an open innovation model allowed the community to avoid enclosure and transformed the diabetes device landscape. We also argue that this openness has created challenges for its autonomy and sustainability as a commons.