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Post by centralcoastinvestor on Apr 24, 2019 14:19:14 GMT -5
The longer Mannkind survives, the louder it's critics become. I don't believe I have ever (since 2008) seen the level of bashing on all forums that I have seen today! I guess MC is getting under someones skin. If more and more people begin to get their diabetes under control using Afrezza, Tresiba and a CGM, a lot of toes get stepped on. - No pumps needed - Less use of RAAs - Less need for special drinks and foods
- Less need for long term diabetic damage procedures
+Eye surgery
+Amputations
Yep. Lots and lots of toes |
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Post by prcgorman2 on Apr 24, 2019 14:21:37 GMT -5
Mango, is it correct to say that intravenous human insulin has the same pk profile as afrezza? Obviously you can't use IV therapy outside of a hospital, but it should be mentioned if we're trying to be extremely acurate in comparing insulins. Human insulin, as well as RAA, would have same profile as Afrezza if given IV. Really? Injected (into a vein) RAA breaking down into usable monomer form of insulin is instantaneous? |
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Post by uvula on Apr 24, 2019 14:30:00 GMT -5
The longer Mannkind survives, the louder it's critics become. I don't believe I have ever (since 2008) seen the level of bashing on all forums that I have seen today! I guess MC is getting under someones skin. I respectfully disagree. Current critics are attacking the company but not afrezza itself. Years ago they were also attacking the effectively and safety of afrezza. I think even our worst critics now admit the stuff ready works. |
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Post by longliner on Apr 24, 2019 14:36:33 GMT -5
The longer Mannkind survives, the louder it's critics become. I don't believe I have ever (since 2008) seen the level of bashing on all forums that I have seen today! I guess MC is getting under someones skin. I respectfully disagree. Current critics are attacking the company but not afrezza itself. Years ago they were also attacking the effectively and safety of afrezza. I think even our worst critics now admit the stuff ready works. Oh go read again! I believe the exploding lung has returned for todays encore.🙄 |
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Post by longliner on Apr 24, 2019 14:38:56 GMT -5
I would think todays price action would have the shorts jumping for joy! It appears something has their knickers in a wicket!
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Post by ktim on Apr 24, 2019 15:30:44 GMT -5
Human insulin, as well as RAA, would have same profile as Afrezza if given IV. Really? Injected (into a vein) RAA breaking down into usable monomer form of insulin is instantaneous? Yes, the slowish in and elongated tale of RAA is all about the length of time it takes to reach the bloodstream. The hex form diffuses through tissue slower and doesn't cross through capillary walls well, or at all. Insulin molecules in a solution will change between monomer, dimer and hex form depending on the concentration. Lots of hex when concentrated in a vile and basically no hex when diluted in the blood. RAA are "more rapid" than injected "human insulin" because the modifications help swing the natural balance of insulin to contain relatively more monomers than than hex and dimers, as compared to Novolin and Humulin, but it still has lots of polymers and even the monomers have to diffuse through tissue before reaching capillaries. All insulin disassociates into monomer form rapidly when it's concentration drops within the bloodstream. The modications don't slow down disassociation, but rather somewhat prevent the need for it. The pancreas actually releases primarily hex insulin but the capillaries in pancreas are specialized to allow the larger polymer insulin through. Thus despite being hex from the pancreas it starts disassociated immediately upon hitting the portal vein and probably 100% by the time it reaches the heart (i.e. effectively instantaneous) you get the phase 1 pd profile that can only be matched by the combination of inhalation and monomeric form of Afrezza. Long acting insulins I don't know as much about. Perhaps they are modified in a way that slows down disassociation and thus they might be slower acting even if injected IV. I couldn't weigh in on that due to lack of info. There are likely some nuances I'm missing here, but that's a 101 level description. |
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Post by cretin11 on Apr 24, 2019 16:18:12 GMT -5
The longer Mannkind survives, the louder it's critics become. I don't believe I have ever (since 2008) seen the level of bashing on all forums that I have seen today! I guess MC is getting under someones skin. I respectfully disagree. Current critics are attacking the company but not afrezza itself. Years ago they were also attacking the effectively and safety of afrezza. I think even our worst critics now admit the stuff ready works. Agree with uvula here. The critics aren't that loud now, compared to in the past. But longliner you said "on all forums" so perhaps you aren't referring to ProBoards, which forum(s) specifically? This is the only forum i follow, things seem basically status quo here. |
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Post by prcgorman2 on Apr 24, 2019 16:35:16 GMT -5
Current critics attacking the company appear to be more frequent on Proboards than in the past. Who'd like to do a count? :-)
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Post by prcgorman2 on Apr 24, 2019 16:38:55 GMT -5
Really? Injected (into a vein) RAA breaking down into usable monomer form of insulin is instantaneous? Yes, the slowish in and elongated tale of RAA is all about the length of time it takes to reach the bloodstream. The hex form diffuses through tissue slower and doesn't cross through capillary walls well, or at all. Insulin molecules in a solution will change between monomer, dimer and hex form depending on the concentration. Lots of hex when concentrated in a vile and basically no hex when diluted in the blood. RAA are "more rapid" than injected "human insulin" because the modifications help swing the natural balance of insulin to contain relatively more monomers than than hex and dimers, as compared to Novolin and Humulin, but it still has lots of polymers and even the monomers have to diffuse through tissue before reaching capillaries. All insulin disassociates into monomer form rapidly when it's concentration drops within the bloodstream. The modications don't slow down disassociation, but rather somewhat prevent the need for it. The pancreas actually releases primarily hex insulin but the capillaries in pancreas are specialized to allow the larger polymer insulin through. Thus despite being hex from the pancreas it starts disassociated immediately upon hitting the portal vein and probably 100% by the time it reaches the heart (i.e. effectively instantaneous) you get the phase 1 pd profile that can only be matched by the combination of inhalation and monomeric form of Afrezza. Long acting insulins I don't know as much about. Perhaps they are modified in a way that slows down disassociation and thus they might be slower acting even if injected IV. I couldn't weigh in on that due to lack of info. There are likely some nuances I'm missing here, but that's a 101 level description. OK. That was awesome. That reminds me of some of the posts I used to elicit from FRAG (aka dumper_humper on Yahoo! Conversations). Blew my mind. The guy was a complete jerk and obvious paid basher (in my opinion) but wow, could he occasionally just write the most amazing useful technical detail. Sorry for the comparison, but if the shoe fits... Anyway, I am complimenting your post if in a left-handed way. Thank you for that information. Genuinely fascinating. |
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Post by prcgorman2 on Apr 24, 2019 16:44:20 GMT -5
Ooh, now we've stumbled into an area where things really get interesting. I work with a bunch of people from other countries which do not have anywhere near the same restrictive regulatory practices. Not sure if they have an opioid epidemic and I wonder if Canada does where Tylenol3 is available OTC. Anyway, health care in general and medication too are both far cheaper. We know this too from our experience with Afrezza and Brazil and India expectations with respect to revenue.
As for "doctor supervision", how much supervision is there really? Most PWDs still don't have CGMs. And from what I can tell it is professional diabetes educators who provide the real care for self-treatment with insulin. That and other diabetics.
The more I think about it and the more we debate this, the more I think the case for Afrezza OTC improves.
Well, I'm a gambling man and would give you 10 to 1 odds against it. How much do you want to wager? I guess for practical purposes we'd need to set a date so the bet could be settled. Key thing is, we aren't a 3rd world country. I've been to countries where basically everything is OTC. We aren't headed in that direction. You are correct that physicians often utilize certified diabetes educators for the heavy lifting of patient education. Conceivable a pharmacist and on staff diabetes educator at a pharmacy could manage a patients care, but I don't see the business model working for the pharmacy. Additionally, doctors' unions are some of the strongest in the US. There are many things that are prescription only that have far smaller risk profiles than insulin, such as allergy medications. Doctors are good at rigging the system to protect their roll as gate keepers, even for these very safe drugs. I believe that more medications should be OTC (or behind counter with pharmacist consult), but not insulin. Anyway, I'll draw this conversation as to a close as you are only one of a long string to want to try to hype that to distract from reality. I don't need to prolong this discussion. Though as for wishful stories, yours kinda negates the more plausible on of pediatric approval moving the needle. In your scenario a parent would simply see their kid peeing too much, run down to the pharmacy and buy a BG meter. A finger stick later and back to the pharmacy to grab some Afrezza next to the cough syrup. Yikes! <iframe style="position: absolute; width: 35.74000000000001px; height: 9.960000000000036px; z-index: -9999; border-style: none;left: 15px; top: -5px;" id="MoatPxIOPT0_60443364" scrolling="no" width="35.74000000000001" height="9.960000000000036"></iframe> <iframe style="position: absolute; width: 35.74px; height: 9.96px; z-index: -9999; border-style: none; left: 1715px; top: -5px;" id="MoatPxIOPT0_11758271" scrolling="no" width="35.74000000000001" height="9.960000000000036"></iframe> <iframe style="position: absolute; width: 35.74px; height: 9.96px; z-index: -9999; border-style: none; left: 15px; top: 433px;" id="MoatPxIOPT0_83630273" scrolling="no" width="35.74000000000001" height="9.960000000000036"></iframe> <iframe style="position: absolute; width: 35.74px; height: 9.96px; z-index: -9999; border-style: none; left: 1715px; top: 433px;" id="MoatPxIOPT0_99914669" scrolling="no" width="35.74000000000001" height="9.960000000000036"></iframe> I'm really enjoying your posts today. I was amused that you correctly identified that I was yanking your chain about Afrezza OTC although I do still wonder if it won't someday be possible - either that or "somebody" should pull human insulin OTC from the market.
Your characterization of doctors as being nearly as concerned about control and income as they are patient outcomes is depressing, but I assume you know more about this than I do. I am curious what a survey of doctors who were told this would say. |
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Post by cretin11 on Apr 24, 2019 16:50:57 GMT -5
Current critics attacking the company appear to be more frequent on Proboards than in the past. Who'd like to do a count? :-) I think a count would reveal that current critics here now are less prevalent than they were in the dark Sanofi days, and more prevalent now than they were in the FDA approval days. In other words, it is based on what's happening with the company and specifically the share price. I would assume a similar dynamic exists on forums of most stocks. |
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Post by prcgorman2 on Apr 24, 2019 16:50:59 GMT -5
Maybe Afrezza should be marketed for what it is vs a rapid acting analog and people would understand when you're pancreas quits producing enough human insulin you inhale some to make up the difference vs RAA you know the stuff you got to question what it is. Both RAA and "human insulin" are produced by genetically modified microorganisms into which human derived DNA has been inserted. Once Afrezza disassociates from the FKDP and RAA disassociates into monomers, they are chemically the same in the bloodstream. People here love to talk about this distinction in chemical composition, but most people that take these medications couldn't care less. Most diabetics that know about "human insulin" know that it as medium term acting insulin that really is poorly suited for much any purpose these days (when used as an injection). Marketing Afrezza as somehow special because of being "human insulin" would require marketing/education to distinguish from the long sold human insulins (Novolin and Humulin) and then RAAs. That would be a 3 minute commercial no one would pay attention to and likely wouldn't be allowed by FDA. Average Joes don't care about the chemical details of their pharmaceuticals. Afrezza should be marketed on the differences in it's efficacy (with existing data if FDA allows it or the backing of new trials), not some distinction that no one would pay attention to. I think you're probably right about "Average Joes" but I completely disagree about marketed on the differences in it's efficacy. I think as much as that can be done, fine, but from everything I've seen on videos with T1s, and CGMs, the key product differentiation and benefit is the speed baby, speed. (Where speed is onset of effective action, and time to peak action and elimination.) |
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Post by ktim on Apr 24, 2019 16:56:00 GMT -5
Current critics attacking the company appear to be more frequent on Proboards than in the past. Who'd like to do a count? :-) You might also be seeing an effect that when the share price is down, there tends to be a surge in wishful thinking (such as OTC Afrezza) and positive hyperbole by those wishing to bolster spirits (giving benefit of the doubt so I'm not using other possible descriptors). Those sort of posts then can generate posts that may be critical. The criticism might be about the tone/content of the post being commented on rather than criticism of Afrezza or MNKD. I know I've made comments that are critical (as in refuting) posts recently, but I'm in no way critical of Afrezza, and fairly balanced on my criticism/praise for MNKD management. What are you wanting to count? I haven't seen people here recently say Afrezza isn't a superior prandial insulin, or has any meaningful risk of long term health consequences (other than good ones). I have seen a few people be very critical of management. Even though that seems to have hit a peak a short while ago, that is something newish here, at least for this management team. There have been a few long term posters here that were supportive for a long time and now seem to be souring on management to one degree or another. I lost my unconditional love for MC much earlier, so I think I bottomed out not nearly as negative as some that allowed the honeymoon to last much longer. |
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Post by prcgorman2 on Apr 24, 2019 16:56:36 GMT -5
Current critics attacking the company appear to be more frequent on Proboards than in the past. Who'd like to do a count? :-) I think a count would reveal that current critics here now are less prevalent than they were in the dark Sanofi days, and more prevalent now than they were in the FDA approval days. In other words, it is based on what's happening with the company and specifically the share price. I would assume a similar dynamic exists on forums of most stocks. Fair enough, stock price bad, must be the management. Stock price good, must be the management. I am very glad the stock price is as good as it is all things considered, but am looking forward to more success and a better stock price under the current management, but, if we're still stuck at this price or lower in 2022, I will not be very glad and will agree the management (CEO) would probably need to change. I won't say absolutely because God only knows and Lord forbid what bad may befall this little company that is beyond the control of management between now and then. |
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Post by prcgorman2 on Apr 24, 2019 17:04:42 GMT -5
Current critics attacking the company appear to be more frequent on Proboards than in the past. Who'd like to do a count? :-) You might also be seeing an effect that when the share price is down, there tends to be a surge in wishful thinking (such as OTC Afrezza) and positive hyperbole by those wishing to bolster spirits (giving benefit of the doubt so I'm not using other possible descriptors). Those sort of posts then can generate posts that may be critical. The criticism might be about the tone/content of the post being commented on rather than criticism of Afrezza or MNKD. I know I've made comments that are critical (as in refuting) posts recently, but I'm in no way critical of Afrezza, and fairly balanced on my criticism/praise for MNKD management. What are you wanting to count? I haven't seen people here recently say Afrezza isn't a superior prandial insulin, or has any meaningful risk of long term health consequences (other than good ones). I have seen a few people be very critical of management. Even though that seems to have hit a peak a short while ago, that is something newish here, at least for this management team. There have been a few long term posters here that were supportive for a long time and now seem to be souring on management to one degree or another. I lost my unconditional love for MC much earlier, so I think I bottomed out not nearly as negative as some that allowed the honeymoon to last much longer. I'm starting to like your posts more and more. Disagreement with equanimity I can handle all day everyday.
To your point about "positive hyperbole by those wishing to bolster spirits", I'll stipulate to preferring a positive outlook on Pro-boards because I get more than enough negativity from SO on SA, Yahoo! Conversations, et cetera. And yeah, I might indulge in a little chain pulling but less with you now. You're a sober poster and you've written some very good posts today and I am grateful. Thank you. |
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