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Post by agedhippie on Mar 3, 2019 12:50:56 GMT -5
Evan Costik. He more or less started the whole #WeAreNotWaiting movement that has lead to the homebrew approach of Nightscout, Loop, and openAPS. I can see this splitting the endo world - if Afrezza upsets some then this is going to give them fits because never mind off-label, in this case there isn't even a label! As we have all seen the medical world changes slowly so the #WeAreNotWaiting crowd are just doing it. (Full disclosure: I use their smart CGM for managing my levels so I am not unbiased in this). Anything which will help "splitting the endo world", count me in. A friend of mine wanted to monitor his mom who is in India. I set him up with glimp and Nightscout. In the next 3 to 5 years everyone will be monitoring blood glucose just like they count steps on their fitbits today. At that point the curtain will be lifted on the ADA and their "Step" program and the disaster it is.
Doctors will never move the ball down the field but the engineers will. The more the curtain is raised the more afrezza awareness there will be.
I heard Dr. Kendall talking about Nightscout in an interview the other week which left me with the impression he is some how involved with the group. It would be good to get these kids on the afrezza so the parents can stop worrying about night time lows and let them sleep through the night.
Nightscout was the perfect example. Dexcom didn't see data sharing as important at the time so people just invented Nightscout. Sometimes it takes so long to get an official product past the FDA that it's easier just to do it yourself. The #WeAreNotWaiting group is the posterchild for how the Afrezza social media campaign should work. Interestingly one of the APS companies, Bigfoot, is doing a version for MDI user, that could definitely include Afrezza.
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Post by agedhippie on Mar 3, 2019 13:14:35 GMT -5
Aged, I am not a pwd, but it seems to me that it would be a lot easier to take one shot of Tresiba per day and manage post prandial excursions with a cgm and Afrezza. I know this may sound a bit naive since I do not have diabetes but based on the success people seem to be having why would a pwd want to be tied to a pump? I know of a boy who at 21, had almost died twice because his pump was miscalibrated and he went into sever hypo. He has since swtiched to Afrezza and a cgm, dropping his pump, at his father's request (father is a doctor by the way) and now enjoys an Hba1c at about 5.9. And most importanty has not had any issues since in the two years he has been on Afrezza. I would not necessarily disagree. Generally people dislike pumps, but they are convenient, and really good at basal management. Beyond that they have familiarity going for them. If they were so wonderful though nobody would ever take pump breaks. Being tethered to a device is annoying and just wait until you drop the pump which comes up short about a foot off the floor because it's anchored in you with a catheter... Afrezza is suffering from the same cycle that pumps went through when they first came out; doctors didn't think people would cope with them, many people didn't entirely trusted them, insurers made you leap through a three ring circus of hoops, and people were happy to keep on doing what they had always done. In the clinic I go to now though if you are a newly diagnosed T1 they automatically put you on a pump. It's the reason I am not stressed about the Afrezza adoption rate - the speed of change in diabetes is slow. I have used a pump in the past, and the only reason I would go back on one is for a closed loop artificial pancreas.
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Post by prcgorman2 on Mar 4, 2019 7:32:20 GMT -5
“the speed of chage in diabetes is slow” - Amen brother!
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Post by sellhighdrinklow on Mar 20, 2019 14:07:33 GMT -5
I had my annual, complete physical endo visit yesterday. This April will be 4-years using Afrezza and I was the first one prescribed Afrezza by my endo who has been in practice for 40+ years. Four years ago I had to talk him in to prescribing for me. Now, the Afrezza pamphlets are front and center, top row of his literature section in the waiting room. In his exam room, he had seven or so wrapped inhalers sitting close by, presumably to offer to patients who might want an Afrezza test run. - My Hemoglobin A1C 5.7. Last year, 5.6 (A1C Now, home tests generally run 5.1 to 5.7) Total cholesterol 179, HDL 82, LDL 84, Triglycerides 57, Non HDL Cholesterol 97 I give all of the numbers because I have no idea how Total Cholesterol is derived. - My doc also had Afrezza sample packs readily available where in the past I recall that samples were no longer being provided to doctors offices. - I didn't want to ask the direct question of how many folks he might be prescribing to, but it came up in our overall conversation and he stated he is prescribing to many now. He did mention that the docs in his field are reluctant to prescribe due to unknown lung function issues that might happen going forward. I told him, "fear of the unknown vs how I feel and quality of life...almost normal A1C, much much easier to manage my BS levels, fewer hypos to get that A1C and it's a no-brainer for me." He stated that he was at a conference where Afrezza was a topic of conversation among colleagues and he stated that he told them about my successes with Afrezza (not mentioning my name of course). Bottom line, he is not reluctant to prescribe now and he has been a top endo in Northern California for a very long time.
Slowly, slowly, Afrezza is catching on.
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Post by hellodolly on Mar 20, 2019 14:19:48 GMT -5
I had my annual, complete physical endo visit yesterday. This April will be 4-years using Afrezza and I was the first one prescribed Afrezza by my endo who has been in practice for 40+ years. Four years ago I had to talk him in to prescribing for me. Now, the Afrezza pamphlets are front and center, top row of his literature section in the waiting room. In his exam room, he had seven or so wrapped inhalers sitting close by, presumably to offer to patients who might want an Afrezza test run. - My Hemoglobin A1C 5.7. Last year, 5.6 (A1C Now, home tests generally run 5.1 to 5.7) Total cholesterol 179, HDL 82, LDL 84, Triglycerides 57, Non HDL Cholesterol 97 I give all of the numbers because I have no idea how Total Cholesterol is derived. - My doc also had Afrezza sample packs readily available where in the past I recall that samples were no longer being provided to doctors offices. - I didn't want to ask the direct question of how many folks he might be prescribing to, but it came up in our overall conversation and he stated he is prescribing to many now. He did mention that the docs in his field are reluctant to prescribe due to unknown lung function issues that might happen going forward. I told him, "fear of the unknown vs how I feel and quality of life...almost normal A1C, much much easier to manage my BS levels, fewer hypos to get that A1C and it's a no-brainer for me." He stated that he was at a conference where Afrezza was a topic of conversation among colleagues and he stated that he told them about my successes with Afrezza (not mentioning my name of course). Bottom line, he is not reluctant to prescribe now and he has been a top endo in Northern California for a very long time. Slowly, slowly, Afrezza is catching on. And this is how it may continue to grow...for awhile. IMHO, these types of patient/doctor dialogues are what gives Mike the drive to keep Afrezza out front and the big reason to hold onto this. It will be there in the end, come hell or high water...whether as a US distributor or as a global distributor (while another pharma buys the rights to the US market). It's success in the US will drive sales around the world, too. MNKD could sell the US rights, maintain some royalties (on sales milestones), manufacture and...take Canada, Brazil, India and Europe for themselves.
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Post by sportsrancho on Mar 20, 2019 14:47:40 GMT -5
I had my annual, complete physical endo visit yesterday. This April will be 4-years using Afrezza and I was the first one prescribed Afrezza by my endo who has been in practice for 40+ years. Four years ago I had to talk him in to prescribing for me. Now, the Afrezza pamphlets are front and center, top row of his literature section in the waiting room. In his exam room, he had seven or so wrapped inhalers sitting close by, presumably to offer to patients who might want an Afrezza test run. - My Hemoglobin A1C 5.7. Last year, 5.6 (A1C Now, home tests generally run 5.1 to 5.7) Total cholesterol 179, HDL 82, LDL 84, Triglycerides 57, Non HDL Cholesterol 97 I give all of the numbers because I have no idea how Total Cholesterol is derived. - My doc also had Afrezza sample packs readily available where in the past I recall that samples were no longer being provided to doctors offices. - I didn't want to ask the direct question of how many folks he might be prescribing to, but it came up in our overall conversation and he stated he is prescribing to many now. He did mention that the docs in his field are reluctant to prescribe due to unknown lung function issues that might happen going forward. I told him, "fear of the unknown vs how I feel and quality of life...almost normal A1C, much much easier to manage my BS levels, fewer hypos to get that A1C and it's a no-brainer for me." He stated that he was at a conference where Afrezza was a topic of conversation among colleagues and he stated that he told them about my successes with Afrezza (not mentioning my name of course). Bottom line, he is not reluctant to prescribe now and he has been a top endo in Northern California for a very long time. Slowly, slowly, Afrezza is catching on. Thank you so much for relaying all this.. you have it going on, you’ve got your health, you have great skills at communicating and convincing your doctor to prescribe. On top of that you obviously picked a great doctor in the first place that has integrity and shares your story!
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Post by prcgorman2 on Mar 20, 2019 15:39:17 GMT -5
I had my annual, complete physical endo visit yesterday. This April will be 4-years using Afrezza and I was the first one prescribed Afrezza by my endo who has been in practice for 40+ years. Four years ago I had to talk him in to prescribing for me. Now, the Afrezza pamphlets are front and center, top row of his literature section in the waiting room. In his exam room, he had seven or so wrapped inhalers sitting close by, presumably to offer to patients who might want an Afrezza test run. - My Hemoglobin A1C 5.7. Last year, 5.6 (A1C Now, home tests generally run 5.1 to 5.7) Total cholesterol 179, HDL 82, LDL 84, Triglycerides 57, Non HDL Cholesterol 97 I give all of the numbers because I have no idea how Total Cholesterol is derived. - My doc also had Afrezza sample packs readily available where in the past I recall that samples were no longer being provided to doctors offices. - I didn't want to ask the direct question of how many folks he might be prescribing to, but it came up in our overall conversation and he stated he is prescribing to many now. He did mention that the docs in his field are reluctant to prescribe due to unknown lung function issues that might happen going forward. I told him, "fear of the unknown vs how I feel and quality of life...almost normal A1C, much much easier to manage my BS levels, fewer hypos to get that A1C and it's a no-brainer for me." He stated that he was at a conference where Afrezza was a topic of conversation among colleagues and he stated that he told them about my successes with Afrezza (not mentioning my name of course). Bottom line, he is not reluctant to prescribe now and he has been a top endo in Northern California for a very long time. Slowly, slowly, Afrezza is catching on. And this is how it may continue to grow...for awhile. IMHO, these types of patient/doctor dialogues are what gives Mike the drive to keep Afrezza out front and the big reason to hold onto this. It will be there in the end, come hell or high water...whether as a US distributor or as a global distributor (while another pharma buys the rights to the US market). It's success in the US will drive sales around the world, too. MNKD could sell the US rights, maintain some royalties (on sales milestones), manufacture and...take Canada, Brazil, India and Europe for themselves. I'm not against what you're saying per se, but I like the flip side of that better. And, Mike C has said the US is Mannkind's, and the world beyond (or perhaps including?) Brazil and India is where they're actively seeking Afrezza marketing partnership.
Also, want to give a shout out to sellhighdrinklow for sharing their story. Posts like that make my day.
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Post by stevil on Mar 20, 2019 17:25:06 GMT -5
I had my annual, complete physical endo visit yesterday. This April will be 4-years using Afrezza and I was the first one prescribed Afrezza by my endo who has been in practice for 40+ years. Four years ago I had to talk him in to prescribing for me. Now, the Afrezza pamphlets are front and center, top row of his literature section in the waiting room. In his exam room, he had seven or so wrapped inhalers sitting close by, presumably to offer to patients who might want an Afrezza test run. - My Hemoglobin A1C 5.7. Last year, 5.6 (A1C Now, home tests generally run 5.1 to 5.7) Total cholesterol 179, HDL 82, LDL 84, Triglycerides 57, Non HDL Cholesterol 97 I give all of the numbers because I have no idea how Total Cholesterol is derived. - My doc also had Afrezza sample packs readily available where in the past I recall that samples were no longer being provided to doctors offices. - I didn't want to ask the direct question of how many folks he might be prescribing to, but it came up in our overall conversation and he stated he is prescribing to many now. He did mention that the docs in his field are reluctant to prescribe due to unknown lung function issues that might happen going forward. I told him, "fear of the unknown vs how I feel and quality of life...almost normal A1C, much much easier to manage my BS levels, fewer hypos to get that A1C and it's a no-brainer for me." He stated that he was at a conference where Afrezza was a topic of conversation among colleagues and he stated that he told them about my successes with Afrezza (not mentioning my name of course). Bottom line, he is not reluctant to prescribe now and he has been a top endo in Northern California for a very long time. Slowly, slowly, Afrezza is catching on. He didn't mention anything about it putting him or his colleaguesout of a job as a reason not to prescribe?
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Post by peppy on Mar 20, 2019 17:31:05 GMT -5
I had my annual, complete physical endo visit yesterday. This April will be 4-years using Afrezza and I was the first one prescribed Afrezza by my endo who has been in practice for 40+ years. Four years ago I had to talk him in to prescribing for me. Now, the Afrezza pamphlets are front and center, top row of his literature section in the waiting room. In his exam room, he had seven or so wrapped inhalers sitting close by, presumably to offer to patients who might want an Afrezza test run. - My Hemoglobin A1C 5.7. Last year, 5.6 (A1C Now, home tests generally run 5.1 to 5.7) Total cholesterol 179, HDL 82, LDL 84, Triglycerides 57, Non HDL Cholesterol 97 I give all of the numbers because I have no idea how Total Cholesterol is derived. - My doc also had Afrezza sample packs readily available where in the past I recall that samples were no longer being provided to doctors offices. - I didn't want to ask the direct question of how many folks he might be prescribing to, but it came up in our overall conversation and he stated he is prescribing to many now. He did mention that the docs in his field are reluctant to prescribe due to unknown lung function issues that might happen going forward. I told him, "fear of the unknown vs how I feel and quality of life...almost normal A1C, much much easier to manage my BS levels, fewer hypos to get that A1C and it's a no-brainer for me." He stated that he was at a conference where Afrezza was a topic of conversation among colleagues and he stated that he told them about my successes with Afrezza (not mentioning my name of course). Bottom line, he is not reluctant to prescribe now and he has been a top endo in Northern California for a very long time. Slowly, slowly, Afrezza is catching on. He didn't mention anything about it putting him or his colleaguesout of a job as a reason not to prescribe? Hello Stevil. We have talked about prescribing decisions in the past. I have a question. Were you aware in the past that manufactures rebate 50% of pharmaceutical product costs to the pharmacy purchasing managers if prescribers target volumes were hit? This was stated openly by Pfizer, Sanofi, johnson and johnson, etc at the senate hearings last month. Just wondering the awareness of the medical prescribers.
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Post by stevil on Mar 20, 2019 18:49:47 GMT -5
Peppy,
I admit, I sometimes have difficulty looking away from a pot that's calling to be stirred, especially when I got tarred and feathered so much in the past for no jumping onto the conspiracy theory bandwagon. This site is much more readable now that those theories are starting to become more and more scarce.
I won't argue that money corrupts, nor will I argue that there aren't parties interested in the failure of Afrezza, although I don't think they feel threatened yet. I think it's interesting that MK says that posters on SA and message boards don't influence stock prices, and that he has instant credibility simply because he is pro Afrezza and for no other reason. It's been an interesting lesson in human behavior on here, for sure. People choose to hate people they'd otherwise like in real life if not for their perspective on Afrezza, and admire people who might otherwise be scumbags only on the basis of their commonality on one issue. It's just really interesting...
In response to your post, I won't argue with your post. I will say, though, that I don't think it matters. Medicare should far and away be MNKDs biggest insurance entity to go after and they have made little to no headway there thus far. I don't think it matters what rebates are being given out because scripts haven't grown appreciably with increased coverage. Co pay cards should help with the discrepancies between tiered coverage. Prescribers just aren't prescribing for the reasons that were shared in the OP.
Again, just been super interesting watching things come full circle on here and watching truths become so only after being validated by a friendly voice.
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Post by peppy on Mar 20, 2019 18:57:13 GMT -5
Peppy, I admit, I sometimes have difficulty looking away from a pot that's calling to be stirred, especially when I got tarred and feathered so much in the past for no jumping onto the conspiracy theory bandwagon. This site is much more readable now that those theories are starting to become more and more scarce. I won't argue that money corrupts, nor will I argue that there aren't parties interested in the failure of Afrezza, although I don't think they feel threatened yet. I think it's interesting that MK says that posters on SA and message boards don't influence stock prices, and that he has instant credibility simply because he is pro Afrezza and for no other reason. It's been an interesting lesson in human behavior on here, for sure. People choose to hate people they'd otherwise like in real life if not for their perspective on Afrezza, and admire people who might otherwise be scumbags only on the basis of their commonality on one issue. It's just really interesting... In response to your post, I won't argue with your post. I will say, though, that I don't think it matters. Medicare should far and away be MNKDs biggest insurance entity to go after and they have made little to no headway there thus far. I don't think it matters what rebates are being given out because scripts haven't grown appreciably with increased coverage. Co pay cards should help with the discrepancies between tiered coverage. Prescribers just aren't prescribing for the reasons that were shared in the OP. Again, just been super interesting watching things come full circle on here and watching truths become so only after being validated by a friendly voice. stevil allow me to zero in on the question more closely. were you aware prior to the senate hearings last month, that formulary drug coverage placement involved 50 % of pharmaceutical cost as rebates to the pharmacy purchasing managers for say, Lipitor? or the last drug you prescribed that wasn't prednisone?
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Post by sayhey24 on Mar 20, 2019 20:29:16 GMT -5
I had my annual, complete physical endo visit yesterday. This April will be 4-years using Afrezza and I was the first one prescribed Afrezza by my endo who has been in practice for 40+ years. Four years ago I had to talk him in to prescribing for me. Now, the Afrezza pamphlets are front and center, top row of his literature section in the waiting room. In his exam room, he had seven or so wrapped inhalers sitting close by, presumably to offer to patients who might want an Afrezza test run. - My Hemoglobin A1C 5.7. Last year, 5.6 (A1C Now, home tests generally run 5.1 to 5.7) Total cholesterol 179, HDL 82, LDL 84, Triglycerides 57, Non HDL Cholesterol 97 I give all of the numbers because I have no idea how Total Cholesterol is derived. - My doc also had Afrezza sample packs readily available where in the past I recall that samples were no longer being provided to doctors offices. - I didn't want to ask the direct question of how many folks he might be prescribing to, but it came up in our overall conversation and he stated he is prescribing to many now. He did mention that the docs in his field are reluctant to prescribe due to unknown lung function issues that might happen going forward. I told him, "fear of the unknown vs how I feel and quality of life...almost normal A1C, much much easier to manage my BS levels, fewer hypos to get that A1C and it's a no-brainer for me." He stated that he was at a conference where Afrezza was a topic of conversation among colleagues and he stated that he told them about my successes with Afrezza (not mentioning my name of course). Bottom line, he is not reluctant to prescribe now and he has been a top endo in Northern California for a very long time. Slowly, slowly, Afrezza is catching on. He didn't mention anything about it putting him or his colleaguesout of a job as a reason not to prescribe? Stevil - why would the endo at this point in time be concerned about afrezza putting him out of a job? He already has the PWDs a patients.
The endo at the Adcom who made the comment about afrezza putting him out of a job was saying so because he saw a future where the PCP would prescribe afrezza as Step 1 for the T2s. He knew afrezza would stop the progression and by doing so the T2 PWDs would never need an Endo which were 90% of his business.
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Post by sportsrancho on Mar 20, 2019 21:16:36 GMT -5
Every stock has its own personality because of the people who choose to invest in it. Likewise the people that are invested in the stock have a lot of the same personality traits, and when you get to know them you have got tons more things in common than just the stock. We don’t choose to like each other or hate each because of Afrezza. We trade Biotech stocks, we’re diehards, we’re passionate, we like a good story, and we’re probably all attracted to drama. Or maybe a conspiracy theory or two. Lol But there’s a lot of us that are also very pragmatic. MK has gained the respect of quite a few of my friends, it was not instant, far from it. We are a tough crowd:-) He knows what he’s talking about and you might not be able to see if you’re only looking at the tip of the iceberg. If you don’t know his clients or his followers you wouldn’t have anyway to know. Signed..a friendly voice😎
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Post by stevil on Mar 21, 2019 1:22:13 GMT -5
He didn't mention anything about it putting him or his colleaguesout of a job as a reason not to prescribe? Stevil - why would the endo at this point in time be concerned about afrezza putting him out of a job? He already has the PWDs a patients.
The endo at the Adcom who made the comment about afrezza putting him out of a job was saying so because he saw a future where the PCP would prescribe afrezza as Step 1 for the T2s. He knew afrezza would stop the progression and by doing so the T2 PWDs would never need an Endo which were 90% of his business.
PCPs manage insulin already, not sure why an easier insulin would put endos out of a job. No one can predict the future with any certainty, but my crystal ball is telling me that Afrezza may eat a little into the endos schedules, but they've got lots of overflow to take from before they notice the difference. Afrezza seems nuanced enough that it may put off PCPs from trying to master it. If there's a sizeable market for VDex, endos have nothing to worry about, especially if Afrezza becomes first line (which I don't see happening). If that scenario played out, there would only be millions more to treat. PCPs probably wouldn't want to manage diabetes all day and would just refer out to the endos to take care of it. Prevention is the biggest threat to endos. If the dirty secret about how unhealthy the FDAs food pyramid is gets out, then they'd be in trouble. Otherwise, there will likely never be a shortage of patients, unless they saturate the market with NPs, PAs, or PCPs. All indications are pointing to that not being the case for the baby boomer generation and Gen X'ers. Even my generation of millennials still increased the growth rate. The demand for PCPs is higher than is currently being filled by the data I have seen. All signs are pointing to a shortage. Long story short, a shortage of PCPs means they're not going to want to turn into an endo and manage diabetes all day long. There will be plenty of job security for all parties involved.
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Post by mnholdem on Mar 21, 2019 5:02:21 GMT -5
Two points:
Many PCPs refer patients to an endocrinologist and prevention is exactly what can result from early short term intensive insulin (STII) treatment, which enables over worked pancreatic beta cells to recover and for the pancreas to repair itself before it gets damaged beyond repair.
Their have been several major that show 50% drug free remission for up to two years, during which time the patients will adopt additional preventive lifestyle changes.
Prevention begins with early STII therapy, yet the ADA puts insulin as the last step of treatment. Often, by that time, the pancreas may have degraded to the point where it cannot be repaired. Then the patient has no choice but to take insulin for the rest of his/her life.
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