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Post by dreamboatcruise on Feb 21, 2015 14:09:59 GMT -5
mrmookie123... so it appears that your wife visited this doctor before Sanofi has visited him. As we know they have sales reps and even specialists in the medicine/science that they will send to skeptical doctors. So the question is whether having patients like your wife appearing at a doctors office and provoking the type of response she got is going to help or hinder the process of convincing the doctor. My thought is that it would be better to have doctors educated about Afrezza by Sanofi or other doctors rather than from patients saying they read about a drug online. Even if not all, some doctors probably get more skeptical/resistant to new therapies if they're put in a situation where they first start resisting it from lack of education. Some people have a hard time admitting they were wrong. The more they've said "no" the harder to get them to convert to "yes". We've certainly seen that patients online can be VERY resistant to information from non diabetics. Likely same sort of dynamic can set in there as well... hard to embrace what one has become emotionally invested in resisting. And all of this begs the question, do we as investors have better expertise than Sanofi and Mannkind with regard to how and when to educate patients? Sanofi has a lot of expertise, as does Mannkind. Mannkind is a 50/50 participant in the committee that oversees the joint venture. Minimed (prior Al Mann company) captured 80% of the insulin pump market and they were known for a masterful patient centered marketing effort.
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Post by mrmookie123 on Feb 21, 2015 14:47:59 GMT -5
You make some very good points.. Bottom Line From me... I think her doctor's response should have been "No I haven't heard of Afrezza, but I will look into the new treatment"... Not, "No, I've never heard of Afrezza but Inhaled Insulin has been tried before".. Then to send her home with 2 scripts that are terrible drugs with lots of side effects. The whole process of my wife's visit Disgusts me.. Not even, Leave the information with me so I and other doctors in the practice can have a look at it.
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Post by ezrasfund on Feb 21, 2015 16:13:53 GMT -5
I think that in general doctors spend a lot of time fending off wacky ideas that their patients have picked up from the media, their friends,and other unreliable sources. It is probably almost a reflex to be ready to counter the next person who doesn't believe in vaccines or has heard about this new medicine or that diet.
In this case you are well informed about Afrezza which we believe is a significant improvement in treatment. But that is not the norm.
I would also add that most of the buzz on Twitter and elsewhere seems to be from T1's and that T2 interest seems more muted, even if most of the oral treatments have serious side effects.
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Post by savzak on Feb 21, 2015 16:27:27 GMT -5
Personality traits of human beings are not homogeneous. Different doctors will respond differently to such overtures depending on variables too numerous to mention, not the least of which are (1) the physician's own disposition and experience and (2) the perception the physician has of the particular patient who is suggesting the new therapy.
But irrespective of whether, on average, patients raising the possibility of an Afrezza prescription is "good" or "bad" for the rate of acceptance in the prescriber universe, I have ZERO concern that patients advising their doctors of a new, FDA approved therapy that is being marketed by Sanofi would poison the well. This isn't some Internet snake oil.
Were I a patient who believed this therapy presented an improved therapy for me, I would absolutely tell my doctor about it and my doctor would absolutely take me seriously or my doctor would soon find that he is no longer my doctor.
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Post by lfalcon on Feb 21, 2015 17:23:21 GMT -5
I agree with you completely, Mr. Mookie. I would leave the practice and find a better doc -- but tell them exactly what you outlined above because they need to hear it. I firmly believe actions speak louder than words.....but when confronted by the narrow-minded, the action is generally more effective when accompanied by an explanation. JMO!
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Post by joeypotsandpans on Feb 21, 2015 17:34:45 GMT -5
I am a T2 diabetic and I am and will continue to post on these boards, not to promote MNKD but to promote a great product for diabetics. I only invest in products I believe will make the world a better place not in the next handbag trend. Sorry!!!
Biggest issue I find is the tritration which I'm not articulate enough to explain properly. I sort of understand it but many diabetics especially T1 get caught up on the 4 unit is too much and will cause them to consume a larger meal to justify the dosage. And I agree with Papihoyos... Here is one reason why. My wife had an appointment with her PCP on Thursday. I loaded her up with Afrezza information to take with her. She is a Type II diabetic. When the question about her current and future treatment was brought up, My wife asked her doctor, "Have you heard of the new Inhaled Insulin, Afrezza?? Doctors answer: "No, and that Inhaled Insulin was tried before in the past." Not even taking the time to look at any of the information I sent in, My wife proudly came home with scripts for Metfromin and Onglyza. So, my point is the more educated the Diabetic Community is about the advantages of Afrezza the better, even if this includes well educated posts to forums etc.. on the Internet. Of course, as her husband I will not take this treatment regimen and I will actually schedule an appointment with her doctor to discuss Afrezza, either that or a switch to an ENDO for treatment. So, the Hurdle with older physicians and the 2007 Exeubera debacle needs addressed by patients themselves when visiting. The old days of "Well the doctor knows best, so I'll take what scripts they've given me" are over. All patients need to do their own due diligence about new Diabetic Treatments. I see nothing wrong with letting the diabetic community know about Afrezza, as long as it posted with Facts and reasons to ask about the drug. Good Luck Everyone, Thanks for reading !! Thoughts, Comments ?? If you/she has a history and really likes this physician (which I would now question why) I would say, listen in all honesty I am taken back a little that you're not up with the times and it concerns me that you haven't taken the time to research what I mentioned regarding this new inhalable ultra rapid acting insulin. I've felt comfortable coming here in the past and in order to continue to do so would like for you to seriously take the time and effort not just for me but for your other potential candidate patients to do your due diligence and keep an open mind (would offer some links ie., Sam's etc). At which point if you have some concerns, I would be open to hearing them and then we can make a mutual decision based on all the information and your concerns. Thank you!!
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Post by jpg on Feb 21, 2015 19:27:54 GMT -5
Do all keep in mind that this drug has been on the market for much less then a month. I would not judge an MD by not knowing much or anything about a drug launched a few days... If so we would quickly run out of MDs... As a side note patients bring us 'flavors of the day' on a regular basis and the ratio of good to bad info is rather depressing. My 'favorite' was Coenzyme Q a few years ago. Everyone seemed to want to take it or have a loved one in the ICU on the stuff. One family brought me a 200-300 page document on it and asked me to read it. Coenzyme Q is now old news. Gluten, or removal of gluten (maybe more logical then Q) is the new thing.
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Post by silentbob on Feb 22, 2015 5:36:49 GMT -5
I am a T2 diabetic and I am and will continue to post on these boards, not to promote MNKD but to promote a great product for diabetics. I only invest in products I believe will make the world a better place not in the next handbag trend. Sorry!!!
Biggest issue I find is the tritration which I'm not articulate enough to explain properly. I sort of understand it but many diabetics especially T1 get caught up on the 4 unit is too much and will cause them to consume a larger meal to justify the dosage. Here's my take on it mnkd.proboards.com/thread/1729/post-on-diabetic-forums-cases
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Post by mrmookie123 on Feb 22, 2015 10:44:25 GMT -5
Just a Patient (My Wife) in this case, that should be on Afrezza, that is not, due to an unwilling doctor to be open minded to anything I sent in with her, Nothing but facts is what I sent in. I just love her taking Metformin and her new drug onglyza every day. And this story will repeat itself across Dr.s offices over and over again, Until SNY stops by the practice or actually does some advertising to Open up some of those Closed minds to the NEW INHALED INSULIN. Don't worry I won't give up on her treatment, but I shouldn't have to be the one to Open a closed mind of a physician. Bottom line is I should have gone to her appointment with her. So, This household is very frustrated. I'll just watch her take Metformin and Onglyza...
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Post by hankscorpio7 on Feb 22, 2015 11:32:56 GMT -5
Just a Patient (My Wife) in this case, that should be on Afrezza, that is not, due to an unwilling doctor to be open minded to anything I sent in with her, Nothing but facts is what I sent in. I just love her taking Metformin and her new drug onglyza every day. And this story will repeat itself across Dr.s offices over and over again, Until SNY stops by the practice or actually does some advertising to Open up some of those Closed minds to the NEW INHALED INSULIN. Don't worry I won't give up on her treatment, but I shouldn't have to be the one to Open a closed mind of a physician. Bottom line is I should have gone to her appointment with her. So, This household is very frustrated. I'll just watch her take Metformin and Onglyza... Wouldn't go as far as closed minded. This is the age of obamacare, PCPs have different guidelines- mainly don't over refer to specialists who get better reimbursement- and are swamped with people new to insurance. Our first line of medicine. No appt. necessary- request a call to discuss treatment. Voice concerns but also listen to their professional opinion. Then request referral if need be. I would be impressed if a PCP new every drug that was put quietly on the market in the last two months for the broad spectrum of people they treat. I see a specialist for another illness. I fired off every clinical trial and quack Internet cure- specialist didn't even have to answer- the nurse had all the bases covered. Some smart people out there.
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Post by mrmookie123 on Feb 22, 2015 14:48:33 GMT -5
Yep, A Physician that answers with "Inhaled Insulin has already been tried before" isn't closed minded at all about a newer
much improved Inhaled Insulin.
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Post by papihoyos on Feb 24, 2015 6:29:33 GMT -5
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Post by ezrasfund on Feb 24, 2015 10:04:39 GMT -5
I have to say that I am disappointed to read these forums and see that the discussion leaves unchallenged many false underlying assumptions. The first is about the lungs. Smoking does not cause cancer; tobacco does. Chewing tobacco also causes cancer of the mouth, but this does not suggest anything about what else we should put in our mouths. And who would inject tobacco or any other foreign substance under the skin? Which brings up the next point. The lungs are seen as a pristine sanctuary that should only be exposed to the purest air, while injecting something under the skin is no big deal. This is exactly backwards. SC injections introduce foreign substances into a sterile part of the body that is not designed to encounter the outside world. Who would use a dirty needle? Our lungs encounter the entire outside world, even in the most purely natural environment, from dust and pollen to bacteria, to anything we slurp down our throats, and everything we smell. The healthy lungs support huge and diverse colonies of bacteria. One poster brought up coal miners (many of whom smoke.) Imagine for a minute how much coal dust they inhale in a year. Injecting that dust subcutaneously probably would not be a good idea either. The second misconception is that insulin acts on glucose, so insulin doses are proportional to reductions in blood glucose. Insulin does not act on glucose, but rather enables the cells to metabolize glucose. This means that while insulin doses are sometimes proportional to reductions in blood glucose levels, this is not always the case, much in the way that more catalyst in a chemical reaction will not always have a proportional effect or any effect. I think my restaurant analogy is actually more accurate than the catalyst example. What is interesting is that many poster on the thread you cite relate the experience of injecting insulin without then getting the expected glucose lowering results. They have seen in real life that insulin dosage is not directly proportional to glucose reduction, but cannot imagine that this fact could be used to advantage in diabetes treatment. The main point here is that it is often underlying assumptions that lead the discussion astray. Sometimes the false assumption is so subtle or seemingly so innocuous as to go unnoticed. Addendum: I cannot resist adding an example of another of my favorite rants about those underlying assumptions and the harm they can do. Dietary cholesterol should be avoided because blood serum cholesterol is bad. The assumption that dietary cholesterol is related to cholesterol in the blood is as easy to gloss over as it is obviously false. The dietary recommendations this idea spawned probably hastened the deaths of millions. The obvious logical fallacy of the idea was pointed out by Henry David Thoreau almost 200 years ago. “One farmer says to me, 'You cannot live on vegetable food solely, for it furnishes nothing to make bones with;' and so he religiously devotes a part of his day to supplying his system with the raw material of bones; walking all the while he talks behind his oxen, which, with vegetable-made bones, jerk him and his lumbering plow along in spite of every obstacle.” To the same point those oxen eat only vegetable matter and no cholesterol, yet their muscles and blood are full of cholesterol. Who could imagine that a simple logical fallacy combined with a strong dose of good intentions could kill millions?
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Post by BlueCat on Feb 24, 2015 10:39:33 GMT -5
You make some very good points.. Bottom Line From me... I think her doctor's response should have been "No I haven't heard of Afrezza, but I will look into the new treatment"... Not, "No, I've never heard of Afrezza but Inhaled Insulin has been tried before".. Then to send her home with 2 scripts that are terrible drugs with lots of side effects. The whole process of my wife's visit Disgusts me.. Not even, Leave the information with me so I and other doctors in the practice can have a look at it. It is new. Any chance you could contact SNY and ask for a local referral? Or - perhaps your local pharmacist can recommend a doctor that's written a script against it? Not sure if that breaks confidentiality or not - as long as they don't mention patient names? Dunno. I've seen this at times with different doctors - you learn more about thought process and personality when the right test is presented. They are all just people too. Wish you and your wife best of luck.
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Post by mrmookie123 on Feb 24, 2015 20:27:20 GMT -5
Thanks Q2U !!
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