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Post by seanismorris on Jul 23, 2014 18:50:08 GMT -5
I frequently hear the phrase Doctors got "burned by Exubera" when reading articles and comments about Afrezza.
This is often brought up to defend a belief that Afrezzas sales will be lower than expected, and that Doctors will be reluctant to prescribe Afrezza.
The Question is: How exactly did Doctors get burned?
First off, did Doctors put up money 'out of pocket' to be able to sell Exubera? Did they have to stock tens of thousands of dollars worth of equipment and drug, that expired...?
Did Doctors put their credibility on the line recommending Exubera? Why?
Did they expect some kind off kickbacks that never materialized?
I'd really like to know, because as a layman when I look at Exubera is see a crap product that I'd expect to fail...it was inferior to what was then available (not comparing it to Afrezza).
Did/Do Doctors not do their do diligence on new treatments become available?
I'm especially interested in Doctors/Nurses replies (but anyone is welcome to) because I must be missing something in the process of bringing new drugs (etc.) to market.
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Post by rak5555 on Jul 23, 2014 20:02:29 GMT -5
sean - I'm not certain this is what they are referencing, but the few pioneering Docs that were willing to prescribe something new (exhubera) were left holding the bag when the product got pulled. Their patients had to find alternative treatment shortly after their trusted doctor had guided them to use exhubera. It makes the all-knowing doctor look uninformed.
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Post by savzak on Jul 23, 2014 20:10:49 GMT -5
Sean, the argument that doctors will be gun shy because of Exubera is a non sequitur. The only common factor is inhalation. Applying the same illogic to other therapies would lead one to conclude that doctors won't prescribe pills once they've had a bad experience with some other oral drug.
Inhalation is ONLY the delivery method. I know of no cogent argument that puts forth the proposition that the reason Exubera was unsuccessful was because it was inhaled.
There is absolutely nothing about Exibera's market failure to suggest it was related in anyway to the mere fact that it was inhaled.
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Post by BD on Jul 23, 2014 20:51:04 GMT -5
But perhaps the fact it was inhaled though a big bong may have had something to do with it...
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Post by seanismorris on Jul 23, 2014 20:52:20 GMT -5
I certainly agree that Exubera is nothing like Afrezza and Doctors shouldn't be comparing the two. It should seem obvious to anyone that has spent an hour doing do diligence... I will also agree that a 'few' Doctors probably did get burned by recommending Exubera. But, in my opinion they should never prescribed it in the first place unless it was specifically requested. Some patents probably did prefer Exubera over the other available treatments, but when the product was pulled, the Doctors should have been able to spin the news in a way that didn't damage their reputations to badly. But, for this entire discussion we are talking about a 'few' Doctors and a 'few' patients (Exubera after all was a disaster). This argument being used against Afrezza doesn't seem to hold water, en yet everyone seems to know multiple Doctors that got burned. I don't mind it that much when a regular Joe repeats this nonsense but it's often repeated by people claiming to be Doctors. (We really need a way to verify true Doctors) Mnkd.proboards.com has considerably more credibility than anywhere else (posters have established history). I'm looking for a Doctor that got burned (to explain things) but until I do, I'll have to conclude anyone spouting "being burned" is a fraud. I'd don't mind MNKD shorts, but I would like real arguments.
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Post by seanismorris on Jul 23, 2014 21:07:08 GMT -5
BD,
No question Exubera was destined to fail, it was an inferior product with an inferior delivery system.
The fact that Exubera was inhaled was a weak reason to recommend it. It was slow acting, wasn't effective, and ridiculously cumbersome to use.
With regards to inhaled insulin, I'd call Exubera "Inhaled Insulin 0.5" it was a BETA product.
Afrezza is "Inhaled Insulin 2.0"
All the other inhaled insulin products that were cancelled I'd rate a 1.0. They may have succeeded in the market, but the pharmacokinetic profile of Afrezza torpedoed their chances.
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Post by brentie on Jul 23, 2014 22:18:18 GMT -5
BD, No question Exubera was destined to fail, it was an inferior product with an inferior delivery system. The fact that Exubera was inhaled was a weak reason to recommend it. It was slow acting, wasn't effective, and ridiculously cumbersome to use. With regards to inhaled insulin, I'd call Exubera "Inhaled Insulin 0.5" it was a BETA product. Afrezza is "Inhaled Insulin 2.0" All the other inhaled insulin products that were cancelled I'd rate a 1.0. They may have succeeded in the market, but the pharmacokinetic profile of Afrezza torpedoed their chances. "Exubera and Technosphere Insulin have many, many important differences. In this article, I will highlight two of them. The first major difference between them is the medical advantage. Exubera had no, I repeat, no medical advantages over conventional injected insulin. This gave Exubera real headaches. With no medical advantages, it was hard to get doctors to prescribe it. Doctors figure that there’s no reason to break with the tried and true for a new, relatively untested insulin that doesn’t even claim to offer any medical benefit. Frankly, I agree with them. As a corollary to this issue, the insurance companies generally refused to cover Exubera. Exubera was more expensive than conventional insulin (for reasons which I won’t get into here) and convenience was its only selling point. Insurance companies simply refused to cover a more expensive drug solely for convenience. The national insurance in England only covered it for those patients diagnosed with “needle-phobia”. And being uncovered by insurance doesn’t mean that the patient pays the difference between conventional insulin and Exubera. Being uncovered means that if a patient wanted Exubera, he had to pay for the entire cost himself. Needless to say, this was a huge obstacle to Exubera making it. Whatever your opinion on the present healthcare system, insurance companies (and national insurance agencies in those countries that have them) have a very large say in which medicines make it by their decision whether or not to include particular medicines in their formularies (lists of approved medicines). And insurance companies are looking to see a medical benefit that will translate into lower costs for the insurance down the road." seekingalpha.com/article/81190-mannkind-overlooked-biotech-with-excellent-prospects-part-iii
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