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Post by agedhippie on Jan 7, 2019 19:02:33 GMT -5
Six or nine months is not going to cut it, they need to get this moving now! Within the next three months. Or I suspect they have some decisions to make. @sportsrancho Are you expecting hokey stick growth for Afrezza? I am with mannmade on this isue. At this point, I am do expect hokey stick growth for Afrezza at all. If it comes, it is a bonus for me. I do not count on it. As long as we can grow at current pace (2018's TRx over 2017 is about 159%; in other words, the growth rate is about 60% annualized), I think we will be fine. I recall reading that Dexcom CGM's annual sales grew at about 50% annually before it finally break even. Dexcom have never broken even.  Right now the market is happy with that because historically CGMs have looked like a two horse race in a growing market, Medtronics and Dexcom, with Medtronics keeping their CGM to themselves and Dexcom supplying everyone else. The expectation is that in the end this will pay off for Dexcom. The problem for Mannkind is that they are in a mature market and have not even been able to hit their own reduced revenue targets for Afrezza so in WS eyes they now have zero credibility. The share price is going to lag sales for some time because of the credibility gap. |
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Post by sportsrancho on Jan 7, 2019 19:39:55 GMT -5
My answer is no I am not expecting hockey stick growth. Sad to say.
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Post by mnholdem on Jan 7, 2019 20:07:23 GMT -5
I plan to withhold judgment until I see what the new marketing plan looks like.
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Post by brotherm1 on Jan 7, 2019 21:34:44 GMT -5
That’s right. Like Planet Fitness. The judgement free zone.
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Post by sportsrancho on Jan 7, 2019 21:36:40 GMT -5
That’s right. Like Planet Fitness. The judgement free zone. :-))👍🏻 |
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Post by golfeveryday on Jan 7, 2019 21:56:37 GMT -5
My answer is no I am not expecting hockey stick growth. Sad to say. I am expecting that growth but MNKD also needs to do some basic things they are not doing right now. Promised a lot last week and I have not seen anything. Pipeline update on website, new marketing campaign. |
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Post by stevil on Jan 8, 2019 0:15:23 GMT -5
I’m with vdex. I don’t see hockey stick in the near future. Consumers will not drive that type of growth. Every doctor I’ve spoken to that knows about Afrezza has told me it’s unsafe, ineffective, and “expensive garbage.” It would take patients demanding Afrezza from doctors and that rarely ever happens. No ad campaign will change that. If you want hockey stick growth, you need to win the doctors over. That’s the only way forward to exponential growth- once they have great success or are shown the road to success.
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Post by boca1girl on Jan 8, 2019 9:11:15 GMT -5
I’m with vdex. I don’t see hockey stick in the near future. Consumers will not drive that type of growth. Every doctor I’ve spoken to that knows about Afrezza has told me it’s unsafe, ineffective, and “expensive garbage.” It would take patients demanding Afrezza from doctors and that rarely ever happens. No ad campaign will change that. If you want hockey stick growth, you need to win the doctors over. That’s the only way forward to exponential growth- once they have great success or are shown the road to success. Stevil, I understand expensive, but why do they think unsafe and ineffective? |
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Post by stevil on Jan 8, 2019 9:40:40 GMT -5
I’m with vdex. I don’t see hockey stick in the near future. Consumers will not drive that type of growth. Every doctor I’ve spoken to that knows about Afrezza has told me it’s unsafe, ineffective, and “expensive garbage.” It would take patients demanding Afrezza from doctors and that rarely ever happens. No ad campaign will change that. If you want hockey stick growth, you need to win the doctors over. That’s the only way forward to exponential growth- once they have great success or are shown the road to success. Stevil, I understand expensive, but why do they think unsafe and ineffective? Mostly related to exubera. They think it might cause pulmonary fibrosis or cancer. But they sort of wrote it off as soon as they heard about it and didn't follow any safety updates... Without being confronted with new information, they're not going to seek it out. In medicine, for better or worse, doctors learn about medications in classes - ace inhibitors, ARBs, atypical antipsychotics, etc... The reason for this is that it allows for greater ease when picking a therapy. Whenever there is variation in a certain class- if one performs better in certain situations than the rest in their class- those unique characteristics are committed to memory, but they're still limited to their specific class because the mechanism is essentially the same. The problem as I see it is almost entirely in the way Afrezza has been explained to prescribers. This may be unfair because I've never seen an Afrezza drug rep on any of my rotations, but I'm the literature, they've done little to nothing to distinguish themselves from exubera. So it unfairly gets lumped into the same class as inhaled insulin. Next, the trials haven't displayed Afrezzas superiority. It takes more insulin to do less. So not only are you spending more money, but you're lowering your A1c to a lesser extent than RAAs. Part of that is packaging... But what's done is done there... Hard to change that now. But doctors haven't been trained to know that you need to dose more aggressively. There's a graphic on the prescriber page that you should dose 1.5 :1 but that gives off a feeling of ineffectiveness to the doctors I've talked to. So you're paying more per unit of insulin as well as having to dose 1.5 times as many units. They don't see the benefit. I really think it will take convincing trial data to turn the tide. I feel even more strongly about it when I consider they've been trying to sell Afrezza for 5 years and still haven't gotten far. It's not coincidence. I also don't think it's fear of losing money. I've met some bad docs that are only in the business of making money, but I know for certain that docs are looking for a way to better manage diabetes. They hate it and what it does to their patients. They just need good data to show them the solution is already out there. |
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Post by peppy on Jan 8, 2019 9:41:53 GMT -5
I’m with vdex. I don’t see hockey stick in the near future. Consumers will not drive that type of growth. Every doctor I’ve spoken to that knows about Afrezza has told me it’s unsafe, ineffective, and “expensive garbage.” It would take patients demanding Afrezza from doctors and that rarely ever happens. No ad campaign will change that. If you want hockey stick growth, you need to win the doctors over. That’s the only way forward to exponential growth- once they have great success or are shown the road to success. Stevil, I understand expensive, but why do they think unsafe and ineffective? Stevil, as a favor in your observations, these same physicians that quoted the above.... what are they prescribing? How are their patients doing? These physicians must be very good, they can determine garbage from non garbage. it would be fun to follow these physician patients and their outcomes. (Garbage in, Garbage out?) I'll get real, I have seen their prescribing alternatives..... so they believe in..?... SGLT2's? GLP-1? and their patients look like? Additionally, what unsafe ineffective cheap prescription medication do they prefer? More importantly, how are your patients doing? How many times do you see people? once, twice, three times? How many patients have you managed and followed for years to see how well the prescription medications work in real life? You know what I mean. Love your numbers miss your legs. Load them up. As a physician you get to see some ugly situations huh? |
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Post by mnkdfann on Jan 8, 2019 10:19:34 GMT -5
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Post by vdexdiabetes on Jan 8, 2019 10:32:11 GMT -5
The problem with that is that De Blasio doesn't probably know anything about it so he'll seek the input of doctors and end of story for Afrezza.
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Post by mnholdem on Jan 8, 2019 11:05:51 GMT -5
So, send him your studies and notify CMO David Keny.
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Post by sellhighdrinklow on Jan 8, 2019 11:18:29 GMT -5
I’m with vdex. I don’t see hockey stick in the near future. Consumers will not drive that type of growth. Every doctor I’ve spoken to that knows about Afrezza has told me it’s unsafe, ineffective, and “expensive garbage.” It would take patients demanding Afrezza from doctors and that rarely ever happens. No ad campaign will change that. If you want hockey stick growth, you need to win the doctors over. That’s the only way forward to exponential growth- once they have great success or are shown the road to success. Stevil - EVERY doctor? I highly, highly doubt this. How many doctors have you spoken to? |
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Post by mango on Jan 8, 2019 11:56:13 GMT -5
Stevil, I understand expensive, but why do they think unsafe and ineffective? Mostly related to exubera. They think it might cause pulmonary fibrosis or cancer. But they sort of wrote it off as soon as they heard about it and didn't follow any safety updates... Without being confronted with new information, they're not going to seek it out. In medicine, for better or worse, doctors learn about medications in classes - ace inhibitors, ARBs, atypical antipsychotics, etc... The reason for this is that it allows for greater ease when picking a therapy. Whenever there is variation in a certain class- if one performs better in certain situations than the rest in their class- those unique characteristics are committed to memory, but they're still limited to their specific class because the mechanism is essentially the same. The problem as I see it is almost entirely in the way Afrezza has been explained to prescribers. This may be unfair because I've never seen an Afrezza drug rep on any of my rotations, but I'm the literature, they've done little to nothing to distinguish themselves from exubera. So it unfairly gets lumped into the same class as inhaled insulin. Next, the trials haven't displayed Afrezzas superiority. It takes more insulin to do less. So not only are you spending more money, but you're lowering your A1c to a lesser extent than RAAs. Part of that is packaging... But what's done is done there... Hard to change that now. But doctors haven't been trained to know that you need to dose more aggressively. There's a graphic on the prescriber page that you should dose 1.5 :1 but that gives off a feeling of ineffectiveness to the doctors I've talked to. So you're paying more per unit of insulin as well as having to dose 1.5 times as many units. They don't see the benefit. I really think it will take convincing trial data to turn the tide. I feel even more strongly about it when I consider they've been trying to sell Afrezza for 5 years and still haven't gotten far. It's not coincidence. I also don't think it's fear of losing money. I've met some bad docs that are only in the business of making money, but I know for certain that docs are looking for a way to better manage diabetes. They hate it and what it does to their patients. They just need good data to show them the solution is already out there. Stevil, you cannot compare units of human insulin dry powder to units of insulin analog solutions. They are two completely different biologics. One is human insulin the others are not. Different routes of administration, different molecular weights, different amino acid sequences, different formulations, and different effects. |
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