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Post by sportsrancho on May 17, 2022 22:31:27 GMT -5
A Recent, True Story
Recently, I went to a doctor’s appointment for a personal issue. The physician and I got to talking about my work and I mentioned Vdex and Afrezza, whereupon he disclosed that he takes Afrezza for his Type 2 diabetes. He also takes metformin, Ozempic, Tresiba, Farxiga and one other medicine I can’t recall at this writing. His HbA1c is in the 7s.
I explained that I understood in that appointment setting he was the doctor and I the patient. Then I told him “Respectfully, you’re using Afrezza wrong.” To his credit he was willing to listen to my explanation. Turns out he used Afrezza occasionally for corrections, basically as the last therapeutic agent to control his BG. His physician is a very well-known diabetes specialist in Los Angeles. I explained how he could get far better control, likely in the 5s with no hypos and likely no basal insulin at all. He could also eliminate, or at least reduce, the other medications he was using. He was intrigued.
He asked more questions and by the time I finished, he asked if he could mention my name to his LA physician. I agreed. He clearly appreciated the 180-degree philosophical shift from how his physician was treating his diabetes to what I was advocating. More importantly, he understood “why” the treatment approach I was recommending made more sense than how he was being treated.
Now, while I know he’ll speak to his doctor about it, I’m also virtually certain that doctor will disagree with me and perhaps attempt to discredit me. He will have an impressive-sounding explanation for why Afrezza should be used the way he is rather than the way Vdex advocates. In short, my doctor will not likely change the management of his disease to the Vdex approach.
Why do I relate this story? Simple, the better informed the person, the more difficult to change them. This is counterintuitive on first glance, but I can explain. The better-informed person, let’s say “smarter” as a shorthand, is less likely to believe the highly improbably story that his/her care is exactly the opposite of what it should be. The smarter person “knows” that the consensus cannot be so wrong. The smarter person draws confidence from other smart people.
This is a version of the Emperor’s new clothes effect. It took the naïve child to say, “but the emperor isn’t wearing any clothes.” Out of the mouth of babes…
Ergo, it is highly unlikely that reps can change a physician’s mind in how they should use Afrezza. It’s why at Vdex we eschew talking to the docs. We don’t waste our time. Our goal is simply to get as many people using Afrezza successfully, one “poor, dumb” patient at a time. When we get enough, the docs will follow.
Doctors don’t lead; they follow. Another truism.
I will report back on this as I will be seeing my doc again in a couple months. Anybody wanna bet what I hear?
~ Bill McCullough, CEO Vdex Diabetes
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Post by sayhey24 on May 18, 2022 5:39:58 GMT -5
Bill and Sports thanks for the story. After the V-Go purchase yesterday it is clear afrezza for the T2 market is clearly misunderstood and I would now include Mike in not understanding how afrezza should be marketed and used.
It should be used as a GLP1 replacement. It should not be sold into the T2 market as an insulin. This is a marketing issue and of course a basic misunderstanding. As a T1 drug afrezza as inhaled insulin is perfect. The dosing needs to be fixed but T1s embrace insulin.
As a T2 treatment insulin is a last resort. I suspect this is why the doctor is using it as a rescue device. He views it as insulin. Fixing this marketing mistake is very doable but requires a targeted plan. It is also the difference in MNKD being a $5 stock and not a $100 stock.
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Post by dh4mizzou on May 18, 2022 6:15:14 GMT -5
Sports. A Ronald Reagan quote may apply here. And I'm taking a little liberty with it.
"It's not that 'doctors' aren't smart, it's just that so much of what they know is wrong."
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Post by prcgorman2 on May 18, 2022 7:25:19 GMT -5
Bill and Sports thanks for the story. After the V-Go purchase yesterday it is clear afrezza for the T2 market is clearly misunderstood and I would now include Mike in not understanding how afrezza should be marketed and used. It should be used as a GLP1 replacement. It should not be sold into the T2 market as an insulin. This is a marketing issue and of course a basic misunderstanding. As a T1 drug afrezza as inhaled insulin is perfect. The dosing needs to be fixed but T1s embrace insulin. As a T2 treatment insulin is a last resort. I suspect this is why the doctor is using it as a rescue device. He views it as insulin. Fixing this marketing mistake is very doable but requires a targeted plan. It is also the difference in MNKD being a $5 stock and not a $100 stock. It’s been said before, insulin scares the bujeezus out of doctors because it kills patients, literally, and quickly. Afrezza IS human insulin in dry powder form on an inert carrier. The key, I will say it again, is the SAFETY (did I mention SAFETY?) of Affreza as compared to other insulin forms. The pancreas does not carefully measure what the BG is to provide the exact amount of insulin needed. It squirts a bunch when it is triggered to do so and the body uses what it needs and because it is human insulin the body handles it beautifully, wonderfully, not at all like what happens for basal and RAA insulins. I’m a lay person and I know this. The SAFETY is the key! Prove that Afrezza is 100x (or 50x or whatever the number is) than the competitor products and the doctors will beat a path to Mannkind’s door. SAFETY SAFETY SAFETY (gosh damnit) |
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Post by uvula on May 18, 2022 8:45:26 GMT -5
Sayhey, I agree with almost everything you say, but mnkd has to sell afrezza as insulin, because it is insulin. There is no wiggle room here.
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Post by hellodolly on May 18, 2022 8:47:57 GMT -5
Sayhey, I agree with almost everything you say, but mnkd has to sell afrezza as insulin, because it is insulin. There is no wiggle room here. No wiggle room here either...Utra-fast acting SAFEST inhaled mealtime insulin.  |
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Post by peppy on May 18, 2022 8:58:47 GMT -5
A Recent, True Story Recently, I went to a doctor’s appointment for a personal issue. The physician and I got to talking about my work and I mentioned Vdex and Afrezza, whereupon he disclosed that he takes Afrezza for his Type 2 diabetes. He also takes metformin, Ozempic, Tresiba, Farxiga and one other medicine I can’t recall at this writing. His HbA1c is in the 7s. I explained that I understood in that appointment setting he was the doctor and I the patient. Then I told him “Respectfully, you’re using Afrezza wrong.” To his credit he was willing to listen to my explanation. Turns out he used Afrezza occasionally for corrections, basically as the last therapeutic agent to control his BG. His physician is a very well-known diabetes specialist in Los Angeles. I explained how he could get far better control, likely in the 5s with no hypos and likely no basal insulin at all. He could also eliminate, or at least reduce, the other medications he was using. He was intrigued. He asked more questions and by the time I finished, he asked if he could mention my name to his LA physician. I agreed. He clearly appreciated the 180-degree philosophical shift from how his physician was treating his diabetes to what I was advocating. More importantly, he understood “why” the treatment approach I was recommending made more sense than how he was being treated. Now, while I know he’ll speak to his doctor about it, I’m also virtually certain that doctor will disagree with me and perhaps attempt to discredit me. He will have an impressive-sounding explanation for why Afrezza should be used the way he is rather than the way Vdex advocates. In short, my doctor will not likely change the management of his disease to the Vdex approach. Why do I relate this story? Simple, the better informed the person, the more difficult to change them. This is counterintuitive on first glance, but I can explain. The better-informed person, let’s say “smarter” as a shorthand, is less likely to believe the highly improbably story that his/her care is exactly the opposite of what it should be. The smarter person “knows” that the consensus cannot be so wrong. The smarter person draws confidence from other smart people. This is a version of the Emperor’s new clothes effect. It took the naïve child to say, “but the emperor isn’t wearing any clothes.” Out of the mouth of babes… Ergo, it is highly unlikely that reps can change a physician’s mind in how they should use Afrezza. It’s why at Vdex we eschew talking to the docs. We don’t waste our time. Our goal is simply to get as many people using Afrezza successfully, one “poor, dumb” patient at a time. When we get enough, the docs will follow. Doctors don’t lead; they follow. Another truism. I will report back on this as I will be seeing my doc again in a couple months. Anybody wanna bet what I hear? ~ Bill McCullough, CEO Vdex Diabetes Holy bucket load of medications. " he takes Afrezza for his Type 2 diabetes. He also takes metformin, Ozempic, Tresiba, Farxiga and one other medicine I can’t recall." Momma Mia that is one spicy meat ball. So Bill's physician, has a physician that put bill's physician on all these medications? This is Bill's physicians problem solving? Hook, line and sinker. |
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Post by od on May 18, 2022 9:34:49 GMT -5
A Recent, True Story Recently, I went to a doctor’s appointment for a personal issue. The physician and I got to talking about my work and I mentioned Vdex and Afrezza, whereupon he disclosed that he takes Afrezza for his Type 2 diabetes. He also takes metformin, Ozempic, Tresiba, Farxiga and one other medicine I can’t recall at this writing. His HbA1c is in the 7s. I explained that I understood in that appointment setting he was the doctor and I the patient. Then I told him “Respectfully, you’re using Afrezza wrong.” To his credit he was willing to listen to my explanation. Turns out he used Afrezza occasionally for corrections, basically as the last therapeutic agent to control his BG. His physician is a very well-known diabetes specialist in Los Angeles. I explained how he could get far better control, likely in the 5s with no hypos and likely no basal insulin at all. He could also eliminate, or at least reduce, the other medications he was using. He was intrigued. He asked more questions and by the time I finished, he asked if he could mention my name to his LA physician. I agreed. He clearly appreciated the 180-degree philosophical shift from how his physician was treating his diabetes to what I was advocating. More importantly, he understood “why” the treatment approach I was recommending made more sense than how he was being treated. Now, while I know he’ll speak to his doctor about it, I’m also virtually certain that doctor will disagree with me and perhaps attempt to discredit me. He will have an impressive-sounding explanation for why Afrezza should be used the way he is rather than the way Vdex advocates. In short, my doctor will not likely change the management of his disease to the Vdex approach. Why do I relate this story? Simple, the better informed the person, the more difficult to change them. This is counterintuitive on first glance, but I can explain. The better-informed person, let’s say “smarter” as a shorthand, is less likely to believe the highly improbably story that his/her care is exactly the opposite of what it should be. The smarter person “knows” that the consensus cannot be so wrong. The smarter person draws confidence from other smart people. This is a version of the Emperor’s new clothes effect. It took the naïve child to say, “but the emperor isn’t wearing any clothes.” Out of the mouth of babes… Ergo, it is highly unlikely that reps can change a physician’s mind in how they should use Afrezza. It’s why at Vdex we eschew talking to the docs. We don’t waste our time. Our goal is simply to get as many people using Afrezza successfully, one “poor, dumb” patient at a time. When we get enough, the docs will follow. Doctors don’t lead; they follow. Another truism. I will report back on this as I will be seeing my doc again in a couple months. Anybody wanna bet what I hear? ~ Bill McCullough, CEO Vdex Diabetes Great (sad) post, Sports. However, I think it is unfair to demonize providers. Remember years ago when most agreed the Afrezza launch was a disaster (not the $$$ but how MannKind executed)? No seeding the community with publications or data, limited opinion leader support, probably minimal market research. MannKind and shareholders, were so enamored with Afrezza, the assumption was why would it not be an instant blockbuster. Experienced Pharma would have spent years pre-launch creating the glide path for market acceptance (I am not talking about bullying ADA). Is it possible that provider’s resistance is as much MannKind’s responsibility as it is treatment/prescribing inertia? |
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Vdex
May 18, 2022 9:35:34 GMT -5
via mobile
cretin11 likes this
Post by sportsrancho on May 18, 2022 9:35:34 GMT -5
To Peppy: Yes… very typical unfortunately.
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Post by sportsrancho on May 18, 2022 9:47:57 GMT -5
A Recent, True Story Recently, I went to a doctor’s appointment for a personal issue. The physician and I got to talking about my work and I mentioned Vdex and Afrezza, whereupon he disclosed that he takes Afrezza for his Type 2 diabetes. He also takes metformin, Ozempic, Tresiba, Farxiga and one other medicine I can’t recall at this writing. His HbA1c is in the 7s. I explained that I understood in that appointment setting he was the doctor and I the patient. Then I told him “Respectfully, you’re using Afrezza wrong.” To his credit he was willing to listen to my explanation. Turns out he used Afrezza occasionally for corrections, basically as the last therapeutic agent to control his BG. His physician is a very well-known diabetes specialist in Los Angeles. I explained how he could get far better control, likely in the 5s with no hypos and likely no basal insulin at all. He could also eliminate, or at least reduce, the other medications he was using. He was intrigued. He asked more questions and by the time I finished, he asked if he could mention my name to his LA physician. I agreed. He clearly appreciated the 180-degree philosophical shift from how his physician was treating his diabetes to what I was advocating. More importantly, he understood “why” the treatment approach I was recommending made more sense than how he was being treated. Now, while I know he’ll speak to his doctor about it, I’m also virtually certain that doctor will disagree with me and perhaps attempt to discredit me. He will have an impressive-sounding explanation for why Afrezza should be used the way he is rather than the way Vdex advocates. In short, my doctor will not likely change the management of his disease to the Vdex approach. Why do I relate this story? Simple, the better informed the person, the more difficult to change them. This is counterintuitive on first glance, but I can explain. The better-informed person, let’s say “smarter” as a shorthand, is less likely to believe the highly improbably story that his/her care is exactly the opposite of what it should be. The smarter person “knows” that the consensus cannot be so wrong. The smarter person draws confidence from other smart people. This is a version of the Emperor’s new clothes effect. It took the naïve child to say, “but the emperor isn’t wearing any clothes.” Out of the mouth of babes… Ergo, it is highly unlikely that reps can change a physician’s mind in how they should use Afrezza. It’s why at Vdex we eschew talking to the docs. We don’t waste our time. Our goal is simply to get as many people using Afrezza successfully, one “poor, dumb” patient at a time. When we get enough, the docs will follow. Doctors don’t lead; they follow. Another truism. I will report back on this as I will be seeing my doc again in a couple months. Anybody wanna bet what I hear? ~ Bill McCullough, CEO Vdex Diabetes Great (sad) post, Sports. However, I think it is unfair to demonize providers. Remember years ago when most agreed the Afrezza launch was a disaster (not the $$$ but how MannKind executed)? No seeding the community with publications or data, limited opinion leader support, probably minimal market research. MannKind and shareholders, were so enamored with Afrezza, the assumption was why would it not be an instant blockbuster. Experienced Pharma would have spent years pre-launch creating the glide path for market acceptance (I am not talking about bullying ADA). Is it possible that provider’s resistance is as much MannKind’s responsibility as it is treatment/prescribing inertia? I can tell you mnholdem would agree 100% with that. Me…I’m not sure. I’ll ask Bill, he has a family full of doctors and a lot more exposure than I have ever had in my lifetime. |
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Post by scottmnkd on May 18, 2022 9:49:04 GMT -5
Here’s a current, true story. Btw, Sports, thanks for the letter from Bill. Like so many on this board, I’ve been invested in MNKD well before the reverse – about 10 years now. I’ve run out of things to say, so I’ve been a passive reader lately and haven’t contributed much to the conversation until now. When I first joined the MNKD conversation, my blood sugars were in the normal range. Then came the pandemic, foot surgery, some weight gain, and Type 2 diabetes. My dad had it, his dad had it, and it appears that at the tender age of 59 (two years ago), it was my turn to have it. I do a lot of research on my own when something like Type 2 happens in my life. I’m a great internet doctor! I don’t understand how researchers haven’t discovered the direct cause of insulin resistance, but for me it’s being controlled by Metformin – twice daily. For those who may not know, Metformin works by instructing the liver to release less sugar into the bloodstream. My highest A1c to date is 6.5. I was shocked though I’m fairing better than most. Being on Metformin alone, the best way for me to control my blood sugars is to simply reduce carbs. I’ve also lost weight, and can pretty much predict my glucose level now and am able to keep it in the 120-90 range. I had a “small” bowl of cereal the other day and it shot up to 250! That was unexpected, so no more small bowls of cereal.  I get my healthcare from the VA. In some respects, they’re world-class despite what you hear on the news, and in other cases, there is definitely room for improvement. At the VA, my experience has been that Nurse Practitioners handle the Primary Care duties for Veterans. I think that’s appropriate because modern medicine in the US is all about “following” (as one person put it in this thread) than taking the time to actually treat a person as an individual. We use the cattle approach. Studies, studies, studies… So what’s good for the masses, must be good for you! Naturally I asked about Afrezza. I’ve done it twice with two different Nurse Practitioners. They didn’t have a clue. There’s an instruction sheet that the VA puts out that anyone can get online and it outlines the protocol for Type 2s. Both NPs were outstanding in being able to Parrot back what was in that instruction sheet. Otherwise, the conversation didn’t stray into other possibilities. In a nutshell, the instruction sheet says that we Type 2s will not progress onto better drugs until our disease progresses. My takeaway was… “Well once nephropathy sets in and maybe an amputation or two happens, it might be a good idea to spend a little more money and provide the Veteran with a better drug”. Seriously, that was my takeaway. There was a period to where I wasn’t taking good care of myself (6.5 A1c). I have felt the initial affects of nephropathy. I could feel it in my fingertips and I could feel it in my feet. Tingling… Numbness… I cannot get a better treatment from the VA and probably anywhere else in my area. Doctors would say the same. I’ve seen the standard of care. I’m supposed to get worse before I can get a new treatment. It’s not geared for me to get better; it’s geared for me to progress further into the disease. It simply doesn’t make sense. Bastards! I would venture to say that most of the doctors on the “American Diabetes Association” are not diabetics. I would think that it should be a requirement. So, the only way to combat my disease today is to take Metformin and control my carb intake. I’m in Washington State; there are no other options right now. … just saying. |
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Post by stevil on May 18, 2022 10:26:18 GMT -5
Sorry to hear you’re struggling with your disease. Hopefully your issue with your neuropathy is just a vitamin B12 deficiency, which can be a common issue with metformin- make sure you had your blood levels checked.
One thing everyone needs to remember who hates the need for more data, until Afrezza, insulin was a last resort because the risks outweigh the benefits until you literally have no other choice than to use it. The current SOC is built on old data. Afrezza hasn’t demonstrated it is different than previous insulins in the data, meaning it improves outcomes without increasing risk. I get that this inherently makes sense when they publish small studies with fewer episodes of hypoglycemia. One hurdle is that basal insulin is currently listed before mealtime insulin in the SOC. Thus, you’re still going to have the fear of hypoglycemia due to a combination of basal+ bolus. MNKD has not proven that earlier use of Afrezza is superior to the GLP-1s and SGLT-2s, especially when they keep coming out with more and more beneficial side effects of weight loss and renal/cardio protection. They’re constantly getting the spotlight as the new and shiny toy because they seem to be giving better benefits beyond A1c control.
MNKD needs head to head studies, or at the very least, needs long term data to show that earlier intervention with Afrezza would produce better outcomes than the current standard of care. It would have to be a retrospective study based on Afrezza users. I really think that is the only path forward in such an established treatment plan. Doctors have not been educated on the advantages of Afrezza. When I spoke to a mannkind rep, it was explained more as a treatment of convenience to avoid needles and not having to worry as much about hypos because it’s in and out so quickly. They can’t speak about better outcomes and metabolic effects because they have nothing to point to.
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Post by sweedee79 on May 18, 2022 10:51:22 GMT -5
Yes Mnkd needs to spend money on a long term trial to collect data proving how amazing Afrezza is... Hope this is happening with the peds trials...
I don't understand why they bought V-Go when they need to be spending on the problems we already have marketing Afrezza.... How can we now afford to market V-Go as well, which uses a competitors insulin?
I'd like to think that Mike has an ace up his sleeve.. wait and see...
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Post by sportsrancho on May 18, 2022 13:06:19 GMT -5
I don’t see it as a problem of affordability as far as marketing goes it’s another tool in the reps tool kit. They already hired a massive amount of reps in the last seven months.
I don’t think there’s an ace up anybody’s sleeve but who knows🤷♀️
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Vdex
May 18, 2022 13:53:12 GMT -5
Post by od on May 18, 2022 13:53:12 GMT -5
If MannKind would get on board with RxVantage, representatives and medical liaisons would have the quality time they need with engaged providers to tell the Afrezza story.
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