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Post by stockwhisperer on Jan 5, 2019 20:54:58 GMT -5
Since this thread is titled "thinking differently".... What if MNKD downsizes to conserve cash, continues working on the other molecules, and continues selling Afrezza to anyone who wants it, but gets rid of the sales force and sales senior management. Kendal keeps working to get Afrezza listed in the SOC for T1D and T2D and also keeps publishing the "gold mine" of data. Mike keeps talking to insurance companies to get Afrezza on the lists. CGM use will continue to increase as time goes on. After the SOC situation improves, after CGM use is more widespread, and after more insurance companies cover Afrezza, then MNKD can partner with someone who has a salesforce and aggressively pushes Afrezza. Probably the only way that MNKD can do this is if it goes private. I would not be happy if MNKD actually did this but I am not happy now anyway. Do not know that they could afford to take it private - could they? |
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Post by uvula on Jan 5, 2019 20:55:05 GMT -5
We (the investors) need to keep in mind that we are learning and evolving along with mnkd. A few years ago I was expecting to get rich from this company and now I would be thrilled if I someday break even. That doesn't mean that mnkd is in worse shape now than it was several years ago. It just means that now I have more realistic expectations.
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Post by agedhippie on Jan 5, 2019 21:46:08 GMT -5
Since this thread is titled "thinking differently".... What if MNKD downsizes to conserve cash, continues working on the other molecules, and continues selling Afrezza to anyone who wants it, but gets rid of the sales force and sales senior management. Kendal keeps working to get Afrezza listed in the SOC for T1D and T2D and also keeps publishing the "gold mine" of data. Mike keeps talking to insurance companies to get Afrezza on the lists. CGM use will continue to increase as time goes on. After the SOC situation improves, after CGM use is more widespread, and after more insurance companies cover Afrezza, then MNKD can partner with someone who has a salesforce and aggressively pushes Afrezza. Probably the only way that MNKD can do this is if it goes private. I would not be happy if MNKD actually did this but I am not happy now anyway. Do not know that they could afford to take it private - could they? At the current market cap I doubt that would be a problem. Push the tender offer high enough to unlock a lot of the warrants who would support you - there are 40M votes if you priced it at $2.50. That's before the arbitrage funds turned up... |
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Post by sportsrancho on Jan 5, 2019 22:26:18 GMT -5
Hellodolly, nice work in taking the baseball analogy to greater heights. You're knowledge of the game is superior. However, I have to disagree with you about what you characterize as singles. I notice in the list you made, only increasing Afrezza scripts is what matters. I get your point that the other things like hiring Kendall are preliminary to getting more scripts.But, the point I made that none of the Mike defenders responded to, was judging his performance against the metrics he set for himself and the company: guidance. Nobody made Mike put out guidance. He did that himself. Don't you think when he mentioned at the beginning of 2018, the $25-30 million range for Afrezza revenue for the year that he picked a number he thought he'd exceed? Think about what you'd do in the same situation. You'd say $25-30 thinking you'll exceed $30 and look like a hero. Maybe get the cash-machine BOD to give a special bonus. Mike's not dumb. That's what he was thinking. It's ego and it's inherent in CEOs. So, he was thinking $30+ and got $16+. My math's not great but that's a little better than 50%. That SUCKS! Come on now. Mike's done some good things, but my focus is the future not the past. What have you done lately is good, but what will you do upcoming is better. I listened to the call. I didn't hear great insight. I didn't hear much of a plan. Mostly more of the same. This is why I say Think Differently. He's not. It's straight forward stuff that he's planning and we already have seen how that worked out: not very well. Last point on thinking differently: change comes as a result of dissatisfaction. If 2018 isn't dissatisfaction, please tell me what is? But, I've never heard Mike acknowledge mistakes, screw-ups or anything like it. He always sounds so in control. Reminds me of what the captain of the Titanic is reported to have said: we're fine, we just bumped an iceberg. The issue with Mike's metrics is he is still struggling to understand how to sell into the diabetes market or so it appears to me from yesterday's call. More focused sale guys knocking on doors is not going to do it. Neither are TV commercials. Past experience says spend a lot of money on TV and you will get 10, 20, 50, maybe 100 additional scripts over 2 months. We want 1000, 2000, 10,000 not 100.
Going his current path he will continue to see slow but steady growth. With the T1 SOC updates we should see a small bump in weekly scripts. It will not be until significant changes happen we will see the 1000+ new scripts per week.
His current approach may work in other markets. More sales calls should equal more sales. In this space more calls gets you little.
What Mike needs to remember is what I told him when I first met him. Endo's are not your friend. If afrezza catches on many PWD's will not need an Endo as much, if at all. Most T2's if treated with the AFAL protocal will never see an Endo. What Endo wants 1/10th the client base?
While Dr. Kendall is plodding with SOC changes what options does Mike have? He is trying with more focused sales and TV commercials. This will not significantly increase sales. The one which can really sell afrezza in the near term is the VDex approach with well funded clinics. Mike said he is going to sell direct. Good, these clinics can then buy direct from MNKD which will add more to the bottom line.
If done properly Mike has the potential of totally changing diabetic care. I am just not sure he understands this. Look, when I was talking CGMs and their importance to afrezza almost 3 years ago he had no idea what I was talking about. He listened but I got the look like this guy is a nut. Then I told him Endos are not his friends and I really got the look.
Does anyone think Endos want afrezza front and center in the SOCs,? Ha! And Dr. Kendall said its the easiest job he has ever had. I say he will get there but he will be bloodied on the way.
Ten 👍🏻 Up!! |
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Post by vdexdiabetes on Jan 6, 2019 4:00:13 GMT -5
I have commented in another post on another thread that I think the sales of Afrezza will struggle. I said that in Jan of 2018 and I reiterated it for 2019. Sayhey is right in much of what he writes. We at Vdex have encountered loads of resistance to Afrezza and in particular our use of Afrezza, from those most immersed in the diabetes communities. Yes, the endos will be the most resistant. They know it all, they think. Consider this story that happened in our Espanola, NM office: We had a patient come in with an HbA1c of 14+ (our in-office meter only goes that high - with CGM you can actually get higher readings). We put the patient through our protocol and in a little more than a month had her down to an HbA1c of 7. The patient was thrilled. She went back to her endo and that endo took her off Afrezza, said what we were doing was irresponsible, and forbade her coming back to us. Yes, forbade her. The patient called us and told us all this. Remarkably, that patient wouldn't return because she was afraid of her doctor.
I naively thought the doctor might be happy to see his patient drop 7+ points in HbA1c with no hypos, sleeping and feeling better. I thought that endo might call us asking how we were doing it. He might ask us to see others of his patients. He might refer us to others. I couldn't have been more wrong. The doc never reached out to us and in fact, bad mouthed us to other physicians in the community. Espanola's small so we eventually heard all about it.
Its heart-breaking to be witness to stories like this, but its out there. There is just so much resistance to Afrezza. This is why I'm skeptical about more TV advertising suddenly causing script numbers to soar.
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Post by agedhippie on Jan 6, 2019 6:42:09 GMT -5
I have commented in another post on another thread that I think the sales of Afrezza will struggle. I said that in Jan of 2018 and I reiterated it for 2019. Sayhey is right in much of what he writes. We at Vdex have encountered loads of resistance to Afrezza and in particular our use of Afrezza, from those most immersed in the diabetes communities. Yes, the endos will be the most resistant. ... This comes down to what I keep saying - that there need to be more large scale trials. I suspect (and this is pure speculation I freely admit) that a lot of the resistance comes from the idea that approximate dosing is safe with Afrezza. Certainly it is the bit that I struggled with the most as a long time insulin user as it runs counter to everything I had learnt which is that you have to be exact with insulin. The only way I see to fix this is a large scale trial to demonstrate (a) superiority, and (b) statistically significant hypo reduction. Given that data you can get the SOC changed, but data without that it isn't going to happen regardless of what Dr Kendall says. Once the efficiency and safety of Afrezza is established then the rationale for AFAL for Type 2 becomes easier to make since it becomes a low risk treatment rather than the high risk treatment it appears to be today. This is still non-trivial because insulin has such a bad reputation with Type 2 patients, but if the doctors are supporting it this becomes an easier sell. |
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Post by golfeveryday on Jan 6, 2019 7:44:01 GMT -5
I have commented in another post on another thread that I think the sales of Afrezza will struggle. I said that in Jan of 2018 and I reiterated it for 2019. Sayhey is right in much of what he writes. We at Vdex have encountered loads of resistance to Afrezza and in particular our use of Afrezza, from those most immersed in the diabetes communities. Yes, the endos will be the most resistant. They know it all, they think. Consider this story that happened in our Espanola, NM office: We had a patient come in with an HbA1c of 14+ (our in-office meter only goes that high - with CGM you can actually get higher readings). We put the patient through our protocol and in a little more than a month had her down to an HbA1c of 7. The patient was thrilled. She went back to her endo and that endo took her off Afrezza, said what we were doing was irresponsible, and forbade her coming back to us. Yes, forbade her. The patient called us and told us all this. Remarkably, that patient wouldn't return because she was afraid of her doctor. I naively thought the doctor might be happy to see his patient drop 7+ points in HbA1c with no hypos, sleeping and feeling better. I thought that endo might call us asking how we were doing it. He might ask us to see others of his patients. He might refer us to others. I couldn't have been more wrong. The doc never reached out to us and in fact, bad mouthed us to other physicians in the community. Espanola's small so we eventually heard all about it. Its heart-breaking to be witness to stories like this, but its out there. There is just so much resistance to Afrezza. This is why I'm skeptical about more TV advertising suddenly causing script numbers to soar. I expected social media to be used more proactively rather than a passive approach waiting for patients to post about Afrezza. The reality is the company has a lot of very vocal users who think highly of the product. A highly orchestrated social media and influencer campaign would have a huge impact, more so than TV ads, but I do think TV is a necessary tool in this population for awareness. I will be very surprised if the new marketing campaign does not have a social media component to it. |
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Post by uvula on Jan 6, 2019 9:20:28 GMT -5
Patients can do social media. Mnkd is extremely restricted by the fda in what they can say on social media.
Maybe activist investors ( i. e. We) can create an app that makes it easy for patients to create testimonial YouTube videos.
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Post by sportsrancho on Jan 6, 2019 9:25:09 GMT -5
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Post by gamblerjag on Jan 6, 2019 9:34:05 GMT -5
I have commented in another post on another thread that I think the sales of Afrezza will struggle. I said that in Jan of 2018 and I reiterated it for 2019. Sayhey is right in much of what he writes. We at Vdex have encountered loads of resistance to Afrezza and in particular our use of Afrezza, from those most immersed in the diabetes communities. Yes, the endos will be the most resistant. They know it all, they think. Consider this story that happened in our Espanola, NM office: We had a patient come in with an HbA1c of 14+ (our in-office meter only goes that high - with CGM you can actually get higher readings). We put the patient through our protocol and in a little more than a month had her down to an HbA1c of 7. The patient was thrilled. She went back to her endo and that endo took her off Afrezza, said what we were doing was irresponsible, and forbade her coming back to us. Yes, forbade her. The patient called us and told us all this. Remarkably, that patient wouldn't return because she was afraid of her doctor. I naively thought the doctor might be happy to see his patient drop 7+ points in HbA1c with no hypos, sleeping and feeling better. I thought that endo might call us asking how we were doing it. He might ask us to see others of his patients. He might refer us to others. I couldn't have been more wrong. The doc never reached out to us and in fact, bad mouthed us to other physicians in the community. Espanola's small so we eventually heard all about it. Its heart-breaking to be witness to stories like this, but its out there. There is just so much resistance to Afrezza. This is why I'm skeptical about more TV advertising suddenly causing script numbers to soar. . Terrible shame. Maybe someone can call the medical board that oversees Espinola, and report the doctor. The allegation may not be as obvious a violation as in a wrongful death malpractice but it could light a fire under this dr. Unfortunately another doctor playing God, and we know how that usually turns out. |
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Post by mnkdfann on Jan 6, 2019 11:12:57 GMT -5
I have commented in another post on another thread that I think the sales of Afrezza will struggle. I said that in Jan of 2018 and I reiterated it for 2019. Sayhey is right in much of what he writes. We at Vdex have encountered loads of resistance to Afrezza and in particular our use of Afrezza, from those most immersed in the diabetes communities. Yes, the endos will be the most resistant. They know it all, they think. Consider this story that happened in our Espanola, NM office: We had a patient come in with an HbA1c of 14+ (our in-office meter only goes that high - with CGM you can actually get higher readings). We put the patient through our protocol and in a little more than a month had her down to an HbA1c of 7. The patient was thrilled. She went back to her endo and that endo took her off Afrezza, said what we were doing was irresponsible, and forbade her coming back to us. Yes, forbade her. The patient called us and told us all this. Remarkably, that patient wouldn't return because she was afraid of her doctor. I naively thought the doctor might be happy to see his patient drop 7+ points in HbA1c with no hypos, sleeping and feeling better. I thought that endo might call us asking how we were doing it. He might ask us to see others of his patients. He might refer us to others. I couldn't have been more wrong. The doc never reached out to us and in fact, bad mouthed us to other physicians in the community. Espanola's small so we eventually heard all about it. Its heart-breaking to be witness to stories like this, but its out there. There is just so much resistance to Afrezza. This is why I'm skeptical about more TV advertising suddenly causing script numbers to soar. . Terrible shame. Maybe someone can call the medical board that oversees Espinola, and report the doctor. The allegation may not be as obvious a violation as in a wrongful death malpractice but it could light a fire under this dr. Unfortunately another doctor playing God, and we know how that usually turns out. I'm not a medical doctor, but some quick googling turns up reasons why a doctor could be upset with a one month drop in HbA1c from 14+ to 7. E.g., on a page at forum.diabetes.org.uk, there are comments that going "totally over the top and reduc[ing] your HbA1c too quickly" may be very bad "as the sudden changes can cause problems particularly in the microvascular area (i.e. things like retinopathy or nephropathy, even neuropathy". What I think (remember, I'm not a medical doctor) are related journal references are given below. If the above is accepted medical wisdom in the U.S. (IDK, is it?), then a complaint might backfire. www.ncbi.nlm.nih.gov/pubmed/29217386bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-017-0213-3This may suggest that a gradual lowering would be better received by the medical community. |
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Post by Clement on Jan 6, 2019 11:17:01 GMT -5
This is very interesting. Someone with A1C of 14 is already having all sorts of microvascular problems.
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Post by goyocafe on Jan 6, 2019 11:17:27 GMT -5
. Terrible shame. Maybe someone can call the medical board that oversees Espinola, and report the doctor. The allegation may not be as obvious a violation as in a wrongful death malpractice but it could light a fire under this dr. Unfortunately another doctor playing God, and we know how that usually turns out. I'm not a medical doctor, but some quick googling turns up reasons why a doctor could be upset with a one month drop in HbA1c from 14+ to 7. E.g., on a page at forum.diabetes.org.uk, there are comments that going "totally over the top and reduc[ing] your HbA1c too quickly" may be very bad "as the sudden changes can cause problems particularly in the microvascular area (i.e. things like retinopathy or nephropathy, even neuropathy". What I think (remember, I'm not a medical doctor) are related journal references are given below. If the above is accepted medical wisdom in the U.S. (IDK, is it?), then a complaint might backfire. www.ncbi.nlm.nih.gov/pubmed/29217386bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-017-0213-3This may suggest that a gradual lowering would be better received by the medical community. Gee, imagine what would happen if they ever find a cure for diabetes, but the downside is normalization of blood sugars in 2 weeks. What a conundrum that would create. |
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Post by sportsrancho on Jan 6, 2019 11:47:07 GMT -5
Conversation on StockTwits this morning when you Google “insulin treatments” Afrezza is nowhere to be found.
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Post by agedhippie on Jan 6, 2019 11:48:44 GMT -5
This is very interesting. Someone with A1C of 14 is already having all sorts of microvascular problems. The problem is that if you have been running high levels for a while your body adapts and sees that as the new normal. If you reduce your average value markedly as in this case you get apparent hypos because your body is trying to maintain that higher level. The trick is to bring it down over a period rather than with a big bang so your body adjusts. Given that we are talking about an A1c of 14 to 7 and A1c tests cover the last 3 months I would think this was probably done over a period of weeks. The flip side to this is that if you consistently get hypos your body thinks that is where it should be and you end up losing hypo-awareness which is dangerous. The advice then is to run higher than normal for a few weeks. |
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