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Post by ktim on Apr 24, 2019 17:14:56 GMT -5
You said "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. "
In public I'm sure they would say they aren't concerned about control and income. Like in the battle to allow highly qualified nurse practitioners to see patients independent of a physicians practice where (one state example)
"The California Medical Association, which lobbies for the state’s physicians, has vehemently opposed allowing the nurses to treat patients without using standardized medical procedures approved by them."
(https://californiahealthline.org/news/california-nurse-practitioners-lose-battle-for-independent-practice-again/)
The doctors make this out to be entirely looking out for patient well being with their PR machine opposing such reforms. What would they say on a survey? I don't know. Are people more likely to be honest in a survey?
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Post by ktim on Apr 24, 2019 17:32:50 GMT -5
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. Thanks. I appreciate that you've actually read them. I rarely read SO and never other SA or Yahoo, so we do have different perspectives. I've always believed in Afrezza enormous potential, otherwise I wouldn't have stayed invested all these years. Everything I've learned about investing has pointed towards bailing and I've overlooked so many red flags over the years, all because of belief in the potential. Personally, right now I think the most useful thing that could be done among us is trying to send a message to management that increased transparency (not ousting them) would be beneficial. The feel good rehashing of Afrezza's benefits isn't harmful, but doing it here really is primarily preaching to the choir, and some things that are a bit of a stretch from reality pop up again and again. Maybe lack of singing ability isn't the only reason I shouldn't be in a choir. I'd be like "Lord, do we have to listen to the preacher rehearsing his sermon yet again." Most of the time I'm a sober poster, unless it's on a really bad day for MNKD and it's late at night. Thanks again.
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Post by agedhippie on Apr 24, 2019 17:56:38 GMT -5
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. Lantus will behave the same. There is a warning in the label about this if you hit a blood vessel. RAA focuses on getting through the fat layer quickly, long acting focuses on getting through slowly but steadily. Hit a vein and they all insulins behave the same - instant delivery. For this reason hospitals use Regular insulin in IVs, it's cheap and behaves the same as all the others. On a personal note I had this proved to me a few years ago in hospital (RAA vs. Regular IV that is)
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Post by mango on Apr 25, 2019 6:48:29 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. How is a RAA chemically the same as Afrezza when the amino acid sequences are different? Them both being in monomeric form doesn't mean they're the same now. They are still chemically different and they are still not the same.
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Post by BlueCat on Apr 25, 2019 11:09:50 GMT -5
I think those many toes are stalling MNKD until they come up with a better solution, or the patent runs out and they can just clone and sell themselves. Clock is ticking.
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Post by mnholdem on Apr 25, 2019 11:34:42 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. Not true. The insulin (human) in Afrezza is a monomer insulin ready for the body to utilize. RAA insulin is in its hexamer moleculer structure and must first dissolve the zinc bonds: hexamer -> dimer-> monomer.
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Post by ktim on Apr 25, 2019 13:45:48 GMT -5
Human insulin, as well as RAA, would have same profile as Afrezza if given IV. Not true. The insulin (human) in Afrezza is a monomer insulin ready for the body to utilize. RAA insulin is in its hexamer moleculer structure and must first dissolve the zinc bonds: hexamer -> dimer-> monomer. A majority would be converted into monomers within seconds of hitting the bloodstream. It is all dependent on the concentration of the insulin within the solution. In bloodstream it gets diluted to the point that it rapidly disassociates. In the pancreas where endogenous insulin is stored until needed it is concentrated and is largely in hexamer form just as in a vile of human insulin. When it is released into the bloodstream it must also disassociate. It does this very rapidly, just as RAA does if injected IV. Afrezza must be monomer before it hits bloodstream because the capillaries in the lungs are not specialized like those in the pancreas and hexamers will not pass through to get into bloodstream. That was why exubera was slower than Afrezza. It takes a lot of sifting through literature to figure this out. Though Aged pointed out it is very succinctly stated in prescribing info for slower insulins that they act instantaneously if you hit a vein when injecting.
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Post by georgia777 on Apr 25, 2019 15:17:25 GMT -5
Not true. The insulin (human) in Afrezza is a monomer insulin ready for the body to utilize. RAA insulin is in its hexamer moleculer structure and must first dissolve the zinc bonds: hexamer -> dimer-> monomer. A majority would be converted into monomers within seconds of hitting the bloodstream. It is all dependent on the concentration of the insulin within the solution. In bloodstream it gets diluted to the point that it rapidly disassociates. In the pancreas where endogenous insulin is stored until needed it is concentrated and is largely in hexamer form just as in a vile of human insulin. When it is released into the bloodstream it must also disassociate. It does this very rapidly, just as RAA does if injected IV. Afrezza must be monomer before it hits bloodstream because the capillaries in the lungs are not specialized like those in the pancreas and hexamers will not pass through to get into bloodstream. That was why exubera was slower than Afrezza. It takes a lot of sifting through literature to figure this out. Though Aged pointed out it is very succinctly stated in prescribing info for slower insulins that they act instantaneously if you hit a vein when injecting. Very true, have to be careful when injecting thin people.
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Post by hellodolly on May 2, 2019 11:18:51 GMT -5
FROM CCI: Lessons Learned Now as I look back on owning MannKind for so long, it has occurred to me that I knew nothing of what it would take to cause a paradigm shift in diabetes treatment. I naively thought that doctors, insurance companies and diabetics would beat the doors down to get the new breakthrough inhaled insulin. Sam Finta was the only one who understood what MannKind was up against. I couldn’t understand when Afrezza was first approved, why Sam Finta immediately began trying to spread the news via social media. I mean how hard could it be to sell the best meal time insulin of all time. Right. The truth was that even if Sanofi had not stabbed us in the back, this paradigm shift was destined to be a multi year if not a decade long effort. Had I known that then, I would have invested later in the process. What Has Changed - The social media presence has moved well beyond the early days of Sam Finta being the lone voice on the web cheering for Afrezza. There are many personalities that are promoting Afrezza without compensation from MannKind. The videos from Jake and Laura come to mind. - The UTHR partnership legitimized the Technosphere Platform. The Bluehale technology may be validated through them as well. - MannKind has tried several different approaches to marketing Afrezza. Some have been trash canned. That is the beauty of being small, we can adapt quickly until we find something that works. - Unlike many, I do believe we have a great management team. They are just attempting the impossible by going toe to toe with Big Pharma. Here Is What I Believe Now - We are in a dog fight for the survival of the company. There are many that do not want the company to survive. - MannKind has moved beyond bankruptcy concerns for the foreseeable future. - Dilution is still a possibility to ensure the continued push to establish Afrezza as the meal time insulin gold standard. Surviving Means Disruption The longer MannKind sticks around, the more established Afrezza becomes. It will just take time. Let’s add TreT to the mix in the next couple years in terms of income flow. And then other Technosphere products over time. The longer MannKind survives, it becomes a threat in many different treatment arenas. Remarks from the past like “an embarrassment of riches” will become truth. It will just take longer than most are willing to wait. Conclusion I believe that Mike Castagna is the right man for the job. Make no mistake, this is a knock down, bare fisted street fight that will be won by shear force of will, raw grit and good ole stubbornness. Mike will not be deterred by the daily fluctuation of the share price, manipulation by the evil shorts or the trolls that inhabit social media. WE ARE EVENTUALLY GOING TO WIN. PERIOD. Read more: mnkd.proboards.com/thread/11195/longer-mannkind-survives-more-disruptive?page=5#ixzz5mmiuIpiW
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