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Post by nylefty on May 8, 2019 19:26:43 GMT -5
In other words, anyone who argues with Stevil is a "fool." Got it.
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Post by sayhey24 on May 8, 2019 19:38:14 GMT -5
stevil ... My dad was on Afrezza.. it wasn't that time consuming to get him on it and the doc didn't do most of the educating.. they actually had an RN that spent the time with him. Also if a patient comes in requesting Afrezza I believe it's the docs job to find out about it. It's not that hard. I don't think docs are in the crosshairs unfairly. I also don't ever remember someone accusing them of being malicious. And Sayhey isn't prescribing to anyone that I know of.. I'm not a disgruntled investor.. I saw years ago what the problems were. For some reason I stayed the course.. that's on me.. I understand that and I'm sorry this has been such a stressful time for you. I don't know the particular doctor your dad saw, so I can't really say I know exactly what I'm talking about. However, as a generality, the PCPs (assuming your dad saw a primary care) that I have spoken to said that greater than half of their day is spent just covering overhead. They don't start making money until they hit midday. So what does this translate into? Cramming more patients into a smaller time frame. Also, what does this mean for the doc? He's got less time to look into new medications. He/She sees insulin, looks at the data, sees more units/$ and that it's inhaled. Pretty much stops there because we're trained that insulin is insulin. There is no importance to pharmacokinetic time-action profile for insulin... cause until Afrezza, none of that was really revolutionary or mattered. Honestly, there is nothing in the published literature that distinguishes Afrezza from other RAAs other than it's inhaled. RAAs are still the standard of care. Doctors are compliant with their duties, according to their medical boards, simply by sticking to RAAs. The answers to the questions doctors may have about Afrezza are not readily accessible or do not exist at all because it has not been properly tested. It is still an unknown quantity. RAAs on the other hand, are well known. You know what you have and what you'll get out of them. There have been millions of people on them over the past couple decades compared to the thousands over the past few years with Afrezza. This is where experience comes into play. You see a busy doctor and assume he/she is lazy and/or doesn't care about his/her patients, when in reality, due to the system they're practicing in, they have to be extremely efficient with their time if they want to make money and get home at a reasonable time. The cost of medical education has been rising like college education, so it's not uncommon for your doctor to be 200,000-500,000 by the time they start residency. Then, depending on repayment, that converts to about 400,000-1,000,000 during the lifetime of the loan due to interest. It's easy for specialists to make this money up because procedures like surgeries, endoscopies, colonoscopies, percutaneous coronary intervention, laser therapy, allergy testing, etc, etc, makes a bunch of money. Primary care doesn't typically do that many well-paying procedures. So what do doctors do? They outsource and delegate the remedial stuff to their support staff... If an RN can do the job, there's no need for the doctor to do it. In essence, it's a waste of their time because there are other jobs they can be doing that only they can do. That's why you hire staff- so you can focus on the things you need to do. If I can make $100/patient, I'm not going to spend an extra 15 minutes counseling you because that extra 15 minutes would then cost me $100. If I pay an RN $10 for 15 min ($40/hr), I keep an extra $90 by moving onto the next patient. I am not condoning this behavior, but I do not fault doctors either. I can tell you I don't want to practice medicine this way, but then again, I'm just starting out and we'll see what happens. Debt sucks. Sayhey implied malicious intent to endos because they wouldn't prescribe it out of fear of being out of a job. That sounds pretty malicious to me... "I'm not going to give you the best treatment because I don't want to heal you so you won't need me anymore". In any case, look at the scenario above to see that doctors aren't afraid of being out of a job. There is a huge shortage of physicians and there are plenty of patients to go around, especially in endocrinology and primary care. Stevil - I did not imply anything. I said it straight out and the "almost" direct quote from one of the Endo on the advisory committee board at the afrezza ADCOM point blank said "I (he) am voting for approval of afrezza even though it will probably put me(him) out of a job". I don't remember his name but I was sitting about 20feet from this guy. He understood afrezza inside and out and saw its true potential. That is from one of the top Endos in the country saying that and he is not alone. Without the uncontrolled T2s how big is an Endo's practice? Put the T2 on afrezza day 1 and most of the Endos can hang the out of business sign on the door. At this point in time there are three main groups of endos I run into. Those that do not understand afrezza and those that do and see its true potential and they are not prescribing. The third group is still waiting and seeing. Sooner or later they will do the right thing for their PWDs and prescribe but there is a lot of pressure from their BP sales friends not to.
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Post by stevil on May 8, 2019 19:44:18 GMT -5
Stevil - I did not imply anything. I said it straight out and the "almost" direct quote from one of the Endo on the advisory committee board at the afrezza ADCOM point blank said "I (he) am voting for approval of afrezza even though it will probably put me(him) out of a job". I don't remember his name but I was sitting about 20feet from this guy. He understood afrezza inside and out and saw its true potential. That is from one of the top Endos in the country saying that and he is not alone. Without the uncontrolled T2s how big is an Endo's practice? Put the T2 on afrezza day 1 and most of the Endos can hang the out of business sign on the door. At this point in time there are three main groups of endos I run into. Those that do not understand afrezza and those that do and see its true potential and they are not prescribing. The third group is still waiting and seeing. Sooner or later they will do the right thing for their PWDs and prescribe but there is a lot of pressure from their BP sales friends not to. Notice he did vote for its approval though! And I highly doubt he was being serious... Probably was saying it tongue in cheek. Endos do a ton more than just diabetes. They also handle the pituitary, hypothalamus, pineal gland, adrenals, reproductive organs, etc. There will always be a need for an endocrine. Would they notice a hit to their business if diabetes becomes well-managed? Absolutely. However, they'll still be managing diabetes. Not every referral is because a doctor doesn't know how to manage therapy. There is still a lot of business to share because PCP's don't want to deal with stuff. One of many reasons PCPs chose not to specialize is because they don't want to get sucked into seeing only one patient population. Someone still has to write the scripts for diabetics. Endos will be fine.
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Post by sayhey24 on May 8, 2019 20:04:08 GMT -5
Stevil - I did not imply anything. I said it straight out and the "almost" direct quote from one of the Endo on the advisory committee board at the afrezza ADCOM point blank said "I (he) am voting for approval of afrezza even though it will probably put me(him) out of a job". I don't remember his name but I was sitting about 20feet from this guy. He understood afrezza inside and out and saw its true potential. That is from one of the top Endos in the country saying that and he is not alone. Without the uncontrolled T2s how big is an Endo's practice? Put the T2 on afrezza day 1 and most of the Endos can hang the out of business sign on the door. At this point in time there are three main groups of endos I run into. Those that do not understand afrezza and those that do and see its true potential and they are not prescribing. The third group is still waiting and seeing. Sooner or later they will do the right thing for their PWDs and prescribe but there is a lot of pressure from their BP sales friends not to. Notice he did vote for its approval though! And I highly doubt he was being serious... Probably was saying it tongue in cheek. Endos do a ton more than just diabetes. They also handle the pituitary, hypothalamus, pineal gland, adrenals, reproductive organs, etc. There will always be a need for an endocrine. Would they notice a hit to their business if diabetes becomes well-managed? Absolutely. However, they'll still be managing diabetes. Not every referral is because a doctor doesn't know how to manage therapy. There is still a lot of business to share because PCP's don't want to deal with stuff. One of many reasons PCPs chose not to specialize is because they don't want to get sucked into seeing only one patient population. Someone still has to write the scripts for diabetics. Endos will be fine. Stevil - most of the business Endo's do is out of control T2s. You get a good T2 and they are a gold mine. The out of control sugars have destroyed all kinds of things from the eyes to the toes. I can tell you with 100% certainty the Endo at the ADCOMwas completely serious and he was right. As you approach 40 and your thought process matures what you will realize is there are only about 15 years left to make the money to live the dream. For the Endo every PWD is a pay day. Once PCPs start prescribing afrezza day 1 instead of metformin and have their patients sign up for a connected care service the big Endo pay day is gone.They will go the way of the flip phone, they are still around.
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Post by sayhey24 on May 8, 2019 20:14:33 GMT -5
Stevil - here is a little history for you www.nytimes.com/2006/01/11/nyregion/nyregionspecial5/11diabetes.html"It's almost as though the system encourages people to get sick and then people get paid to treat them," said Dr. Matthew E. Fink, a former president of Beth Israel. Is this guy kidding me its not "ALMOST" thats reality. PWDs are gold mines for these people.
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Post by brotherm1 on May 8, 2019 20:57:20 GMT -5
Follow the money. Let’s hope pay for outcomes catches fire.
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Post by agedhippie on May 8, 2019 20:59:53 GMT -5
Stevil - here is a little history for you www.nytimes.com/2006/01/11/nyregion/nyregionspecial5/11diabetes.html"It's almost as though the system encourages people to get sick and then people get paid to treat them," said Dr. Matthew E. Fink, a former president of Beth Israel. Is this guy kidding me its not "ALMOST" thats reality. PWDs are gold mines for these people. You rather skewed that article. The basis of the article is that it is extremely hard to keep a diabetes clinic open because of poor reimbursement by the insurance system. Nothing to do with good treatment putting clinics out of business. Diabetes clinics lose money on every patient, and the hospitals they are attached have to look at the overall good. In New York, and possibly elsewhere diabetes clinics are primarily kept open by continual fund raising. As it happens I knew the Friedman Diabetes Center at Beth Israel, I briefly went to an endo there, and used to go to support group meetings there as well. It no longer exists. The Beth Israel hospital group was taken over by the Mt Sinai hospital group and that diabetes center was closed as part of the cost savings. Hospital diabetes centers lose money, they are definitely not gold mines.
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Post by agedhippie on May 8, 2019 21:18:29 GMT -5
Stevil - most of the business Endo's do is out of control T2s. You get a good T2 and they are a gold mine. The out of control sugars have destroyed all kinds of things from the eyes to the toes. I can tell you with 100% certainty the Endo at the ADCOMwas completely serious and he was right. As you approach 40 and your thought process matures what you will realize is there are only about 15 years left to make the money to live the dream. For the Endo every PWD is a pay day. Once PCPs start prescribing afrezza day 1 instead of metformin and have their patients sign up for a connected care service the big Endo pay day is gone.They will go the way of the flip phone, they are still around. That is flat out wrong. Endos make no money from complications. That is all handled by other specialists; surgeons, dialysis clinics, ophthalmologists, and cardiologists. So an out of control T2 is definitely not a gold mine for the endo. The last paragraph is the most ill-informed. Typically a PCP will deal with any non-insulin using Type 2, early treatment of Type 2 is a PCP and not Endo decision. Endo's usually only get involved after metformin and a follow on has failed. The purpose of an SoC is to distill the body of knowledge so a PCP can follow the flow chart to treat the patient knowing he is following the the current best practice.
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Post by mango on May 8, 2019 22:13:16 GMT -5
I second that! I think someone has taken over stevil’s ID🤣 this is not how I remember him. Sayhey knows of what he speaks I’m just gonna leave it at that. Are you still a physical trainer, Sports? Do you ever get frustrated with people who think they know your job better than you because they have a gym membership and can lift a few weights but don't know what they're talking about? Now that you have experience, you can pretty easily spot the pretenders from the ones who know what they're talking about? That's pretty much where I'm at now. I think if I went into the gym, bad mouthed all the trainers and said they're all idiots and are horrible at their job that you'd get extremely annoyed at them and you'd try to set them straight. Am I right? I don't usually engage with those kinds of people because ignorance is hard to cure, especially when you're unable or unwilling to admit it, but when the board keeps getting littered with this kind of dialogue, again, no one else will defend it except me, so I have to engage it. You have spinned and distorted numerous posts in this thread to fit your narrative--- so much so--- that I have decided to call you out on it. I'm really disappointed by the grand level of immaturity you have demonstrated, but nonetheless, I forgive you. Anyways, maybe you will find it ironic that your medical education and training was designed, standarized and monopolized by a man from Kentucky by the name of, Abraham Flexner, who had a degree in ancient Greek literature---with no professional or educational experience in medicine whatsoever.
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Post by wildpig on May 8, 2019 22:33:51 GMT -5
so in your view afrezza should replace or could replace metformin? I don't buy that thinking for a second- would you elaborate and justify your thinking?
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Post by sellhighdrinklow on May 8, 2019 22:40:10 GMT -5
so in your view afrezza should replace or could replace metformin? I don't buy that thinking for a second- would you elaborate and justify your thinking? Maybe you should explain your thinking first as to why metformin is superior to Afrezza. Afrezza's superiority has been explained over and over here based on A1C outcomes and TIR.
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Post by mango on May 8, 2019 23:03:57 GMT -5
so in your view afrezza should replace or could replace metformin? I don't buy that thinking for a second- would you elaborate and justify your thinking? Metformin Triple Therapy
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Post by ktim on May 8, 2019 23:55:56 GMT -5
Mike backed away from giving revenue guidance. The ability to guide revenue comes before giving guidance of break even. From the script projections we're still many years (6+) from break even. Given that you seem to think it is "magic" phrase, and others may agree, he may throw that phrase in for you. "We are very confident as we move towards break even". It does seem like he occasionally picks up on things said by investors here and works it into his presentations in positive sounding but non committal sort of ways. If he actually talks about WHEN we will reach break even, I'll be so shocked I'll probably need cardiac resuscitation. ktim, I have been enjoying your posts. I think you are correct about Mike throwing that particular phrase around and how and why he did it. 6+ years? That's the longest estimate I have seen posted for breakeven. So, is that projection just looking at scripts for revenue, and no other pipelines? How did you calculate that, ktim? btw, the "couple years" I referred to was the maximum that I am hoping for the stock to stop being diluted and start turning around ... not for breakeven (although I have not made any formal calculations, I expect (probably hope is a better word) for breakeven to be closer to 2 years than 6). I do believe that there may be news at anytime (partners, pipelines, etc.) that can initiate that elusive inflection point. And even just considering Afrezza sales, I don't expect it to follow a linear progression in the future, which may also expedite that two years. And our sales graphs have had a much nicer trajectory than the script growth graph (although I am not quite sure why that disparity between sales and scripts graphs is as drastic and ongoing as it is). Anyway, ktim, I'm interested to know how you did your calculations. I don't recall anyone here ever posting any calculations any more than as has been described as "back of napkin" calculations, but even those are always interesting. It's the ideas that are interesting, not necessarily formal financial bookwork. I'm thinking maybe this would be a good new thread to start, so I'm going to challenge you to start a new thread with your response to this. C'mon, ktim, I'll egg you on because I think this will be a great new thread and I would love to see it. If NRx is stagnant, the projection for TRx is linear (excluding price hikes, etc. that aren't sustainable). Linear script growth is much more like 6 years than 2 to break even, maybe even longer. And YES, if non linear growth becomes apparent this stock will take off. There are a bunch of reasons why revenue growth is outstripping script growth, but hopefully you realize that is not sustainable. The price per prescription can't keep rising indefinitely... right? We're not going to become a $3B company with insulin selling for $15,000 per prescription fill, right?
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Post by ktim on May 9, 2019 0:05:34 GMT -5
Stevil - I did not imply anything. I said it straight out and the "almost" direct quote from one of the Endo on the advisory committee board at the afrezza ADCOM point blank said "I (he) am voting for approval of afrezza even though it will probably put me(him) out of a job". I don't remember his name but I was sitting about 20feet from this guy. He understood afrezza inside and out and saw its true potential. That is from one of the top Endos in the country saying that and he is not alone. Without the uncontrolled T2s how big is an Endo's practice? Put the T2 on afrezza day 1 and most of the Endos can hang the out of business sign on the door. At this point in time there are three main groups of endos I run into. Those that do not understand afrezza and those that do and see its true potential and they are not prescribing. The third group is still waiting and seeing. Sooner or later they will do the right thing for their PWDs and prescribe but there is a lot of pressure from their BP sales friends not to. Notice he did vote for its approval though! And I highly doubt he was being serious... Probably was saying it tongue in cheek. Endos do a ton more than just diabetes. They also handle the pituitary, hypothalamus, pineal gland, adrenals, reproductive organs, etc. There will always be a need for an endocrine. Would they notice a hit to their business if diabetes becomes well-managed? Absolutely. However, they'll still be managing diabetes. Not every referral is because a doctor doesn't know how to manage therapy. There is still a lot of business to share because PCP's don't want to deal with stuff. One of many reasons PCPs chose not to specialize is because they don't want to get sucked into seeing only one patient population. Someone still has to write the scripts for diabetics. Endos will be fine. I'm a non-diabetic endo patient and couldn't manage to get one for regular care under my health plan because they are all too busy and not accepting new patients. I'd look forward to some freeing up. Agree, they will do well, as all specialists tend to even with less people with uncontrolled diabetes. Sadly, there is an over abundance of patients with diabetes. Special thanks to those docs that go into primary care. Look forward to hearing where you end up Stevil.
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Post by stevil on May 9, 2019 0:08:54 GMT -5
Are you still a physical trainer, Sports? Do you ever get frustrated with people who think they know your job better than you because they have a gym membership and can lift a few weights but don't know what they're talking about? Now that you have experience, you can pretty easily spot the pretenders from the ones who know what they're talking about? That's pretty much where I'm at now. I think if I went into the gym, bad mouthed all the trainers and said they're all idiots and are horrible at their job that you'd get extremely annoyed at them and you'd try to set them straight. Am I right? I don't usually engage with those kinds of people because ignorance is hard to cure, especially when you're unable or unwilling to admit it, but when the board keeps getting littered with this kind of dialogue, again, no one else will defend it except me, so I have to engage it. You have spinned and distorted numerous posts in this thread to fit your narrative--- so much so--- that I have decided to call you out on it. I'm really disappointed by the grand level of immaturity you have demonstrated, but nonetheless, I forgive you. Anyways, maybe you will find it ironic that your medical education and training was designed, standarized and monopolized by a man from Kentucky by the name of, Abraham Flexner, who had a degree in ancient Greek literature---with no professional or educational experience in medicine whatsoever. What did you call me out on? Ha, mango, that's not how it works. You have to give me examples...
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