My husband's pulmonologist

[suebeeee1]

My husband had asthma in the past.  Now that we have moved out of the bad air of NJ, his symptoms of asthma have disappeared, but we need clearance from a pulmonologist to be cleared for a prescription for Afrezza.

His lungs are now VERY healthy and will clearly support a prescription, but I chatted with the pulomonologist as our reasons for being there...namely Afrezza.  She happens to be an insulin dependent Type 2 diabetic who lauched into a diatribe about inhaled insulin and all it's "dangers".  According to her, inhaled insulin will make him gain weight and cause him to have severe lows that could cause death....I kid you not. 

I asked her if she knew anything about the drug that was just released..."Afrezza" and she said she had done "extensive" research into ALL inhaled insulins and WOULD NEVER allow any of her patients to take anything but injected insulins.  And of course, since she is a diabetic, we were supposed to believe her.

She is getting some of the research into Afrezza in her email today from me.  It is quite clear to me that she had no clue what she is talking about as she couldn't discuss the studies that are being done to show that Afrezza causes less hypoglycemia or that there is less weight gain, or even the mechanism by which it works and how it clears the system quickly.

My guess is this is what people are finding with doctors when they ask about this drug.  Not facts, just prejudice.  

[jpg]

Jun 18, 2015 12:49:28 GMT -5 suebeeee1 said:

My husband had asthma in the past.  Now that we have moved out of the bad air of NJ, his symptoms of asthma have disappeared, but we need clearance from a pulmonologist to be cleared for a prescription for Afrezza.

His lungs are now VERY healthy and will clearly support a prescription, but I chatted with the pulomonologist as our reasons for being there...namely Afrezza.  She happens to be an insulin dependent Type 2 diabetic who lauched into a diatribe about inhaled insulin and all it's "dangers".  According to her, inhaled insulin will make him gain weight and cause him to have severe lows that could cause death....I kid you not. 

I asked her if she knew anything about the drug that was just released..."Afrezza" and she said she had done "extensive" research into ALL inhaled insulins and WOULD NEVER allow any of her patients to take anything but injected insulins.  And of course, since she is a diabetic, we were supposed to believe her.

She is getting some of the research into Afrezza in her email today from me.  It is quite clear to me that she had no clue what she is talking about as she couldn't discuss the studies that are being done to show that Afrezza causes less hypoglycemia or that there is less weight gain, or even the mechanism by which it works and how it clears the system quickly.

My guess is this is what people are finding with doctors when they ask about this drug.  Not facts, just prejudice.  

Makes you wonder what she knows about her own speciality... Run.

[esstan2001]

Jun 18, 2015 12:49:28 GMT -5 suebeeee1 said:

....

She is getting some of the research into Afrezza in her email today from me.  It is quite clear to me that she had no clue what she is talking about as she couldn't discuss the studies that are being done to show that Afrezza causes less hypoglycemia or that there is less weight gain, or even the mechanism by which it works and how it clears the system quickly.

My guess is this is what people are finding with doctors when they ask about this drug.  Not facts, just prejudice.  

Are you going to give his Dr. one more chance after she has had time to review your package, or are you going to switch to gain access to Afrezza?

[babaoriley]

Suebee, my guess is she doesn't change her mind, for various reasons, the most prominent being to lose face. Get Sam Finta in touch with her! Spiro would go "Mediterranean" on her!

Will look forward to hearing what happens.

Having said that, your husband's past asthma issues may be important here.

[notamnkdmillionaire]

Jun 18, 2015 12:49:28 GMT -5 suebeeee1 said:

My husband had asthma in the past.  Now that we have moved out of the bad air of NJ, his symptoms of asthma have disappeared, but we need clearance from a pulmonologist to be cleared for a prescription for Afrezza.

His lungs are now VERY healthy and will clearly support a prescription, but I chatted with the pulomonologist as our reasons for being there...namely Afrezza.  She happens to be an insulin dependent Type 2 diabetic who lauched into a diatribe about inhaled insulin and all it's "dangers".  According to her, inhaled insulin will make him gain weight and cause him to have severe lows that could cause death....I kid you not. 

I asked her if she knew anything about the drug that was just released..."Afrezza" and she said she had done "extensive" research into ALL inhaled insulins and WOULD NEVER allow any of her patients to take anything but injected insulins.  And of course, since she is a diabetic, we were supposed to believe her.

She is getting some of the research into Afrezza in her email today from me.  It is quite clear to me that she had no clue what she is talking about as she couldn't discuss the studies that are being done to show that Afrezza causes less hypoglycemia or that there is less weight gain, or even the mechanism by which it works and how it clears the system quickly.

My guess is this is what people are finding with doctors when they ask about this drug.  Not facts, just prejudice.  

Sounds like she has a lot of smog in her head and its clogging her ability to think clearly.

[suebeeee1]

If she had said something like she was concerned because of his past asthma issues, I would have at least understood her response. It was all about ignorance. Since we do not need to see her ever again (and this was a first time), clearly, we will not. However, if anyone has any recommendations as to what I should send her, I will be happy to do so. I also plan to send her the new Afrezzapro site link and the Sanofi presentation from the ADA conference. Whether she will even read it, even if it would benefit her, I doubt it, but I will try.

Some people are just stuck where they are. Fear is a powerful motivator. My husband understood saying her life has depended upon the shots for 16 years and she is terrified of change. I'm not so generous. Doctors should be able to change their minds based upon the science!

[thekindaguyiyam]

It is human nature for many (anal retentives) to think they have all the answers. As the physician; her extensive research apparently did not include understanding the difference of medication and delivery and did not want to appear to be ignorant... taking a stronger stance. Find another doctor.

[longnoob]

I read this topic about Inconsistency-Avoidance Tendency in Poor Charlies Alamanack, a book about Charles T. Munger.

"So strong is Inconsistency-Avoidance Tendency that it will often prevail after one has merely pretended to have some identity, habit, or conclusion.

While Inconsistency-Avoidance Tendency, with its "status quo bias," immensely harms sound education, it also causes much benefit. For instance, a near-ultimate inconsistency would be to teach something to others that one did not believe true. And so, in clinical medical education, the learner is forced to "see one, do one, and then teach one," with the teaching pounding the learning into the teacher. Of course, the power of teaching to influence the cognition of the teacher is not always to benefit society. When such power flows into the political and cult evangelism, there are often bad consequences." p.463

[Chris-C]

Jun 18, 2015 13:28:43 GMT -5 suebeeee1 said:

If she had said something like she was concerned because of his past asthma issues, I would have at least understood her response. It was all about ignorance. Since we do not need to see her ever again (and this was a first time), clearly, we will not. However, if anyone has any recommendations as to what I should send her, I will be happy to do so. I also plan to send her the new Afrezzapro site link and the Sanofi presentation from the ADA conference. Whether she will even read it, even if it would benefit her, I doubt it, but I will try.

Some people are just stuck where they are. Fear is a powerful motivator. My husband understood saying her life has depended upon the shots for 16 years and she is terrified of change. I'm not so generous. Doctors should be able to change their minds based upon the science!

It's difficult to know how amenable she will be to new information. Thomas Kuhn made it clear that dogma is alive and well in all scientific professions; and habits of thought and attitude are burdens we must all bear, so she is hardly unique. New paradigm shifts are difficult. Providers practice under difficult conditions, and in this nation, must practice defensively; so anything new will be viewed as a potential liability hazard. This paradigm shift will take time, and yet I believe it will eventually prevail as one provider at a time recognizes its value.

As safety concerns abate with widespread use, providers will be less concerned about liability; and seeing others adopt will make it seem safer to prescribe. But then there will still be a learning curve, and on top of their 16 hour days, providers also have families and lives that make it difficult to carve out sufficient time for reading and continuing education. I think we're beating up on this provider a little too harshly. Under the circumstances, I'd avoid irritating her; at most I'd send her educational materials with appropriate deference, and move on to a more amenable or sympathetic provider. That said, she is absolutely right to be concerned about a Hx of asthma. Why upset the "apple cart" if it is doing well as it stands? Primum, non nocere.

PS= You might also mention that contrary to the perceptions of many, Exubera was not removed from the market because of safety concerns, and it was very different in several respects from Afrezza.

[bradleysbest]

Sounds like you need to get out of New Jersey fast (air is effecting everybody). She needs an education in Afrezza fast!

[EveningOfTheDay]

Most doctors are totally allergic to receiving suggestions from their patients. It is a bit of a shame, but in this day and age of the internet I guess it is somewhat understandable, since many patients probably go to their doctors with all kind of suggestions and ideas obtained by reading up in the net. Do not get me wrong, I think patients have the obligation of being proactive about their own healths, even if that inconveniences doctors by now having to do a bit more of research or spend a bit more time talking with their patients. Doctors are not gods, there are good ones and bad ones, just like in every other profession or occupation, but the good news is that as a patient you can always fire your doctor and find another one. Please understand I am not advocating anybody changes doctors just to find one that will say yes to whatever you want, but to find one that will take the time to look at your concerns, take them seriously, and talk them up with you in a way that is logical and reasonable.
Having said this, Nate Piles has a great quote about analysts detractors of MNKD. He always says that the same analysts that hate MNKD at $6 will like it a $12 and love it at $20. I expect something similar to happen to all these doctors that claim they will never prescribe inhaled insulin. In a year or two, when supporting numbers are clear enough and thought leaders in the medical community have expressed support, all these doctors will embrace Afrezza like there was nothing else in the world.

[mnkdorbust]

It's also possible this is what the competitors Sales Force is educating her on.  Its a dog eat dog world form some in the industry and they'll do anything they have to to protect their check.

[dreamboatcruise]

One slight observation. Obviously we all know suebeeee1 as a long time participant here and by virtue of that fact and the context provided in her post we have no doubt what is being said is true. The observation is that if someone new here or perhaps on a different forum had reported going to a doctor and getting that response, there would be MNKD investors jumping all over them as lying paid cronies of hedge fund shorts. Just goes to prove not everything negative said regarding adoption of Afrezza is the work of evil... or at least not the direct result of evil. It might be once or thrice removed from those wishing to hinder Afrezza adoption, such as Novo reps spreading FUD.

At least she didn't bring up the "cancer" FUD. 

[suebeeee1]

Jun 18, 2015 15:26:51 GMT -5 bradleysbest said:

Sounds like you need to get out of New Jersey fast (air is effecting everybody). She needs an education in Afrezza fast!

We ARE now out of NJ....hence my husbands improved breathing.  This is a Virginia doctor.

[suebeeee1]

Jun 18, 2015 16:52:24 GMT -5 dreamboatcruise said:

One slight observation. Obviously we all know suebeeee1 as a long time participant here and by virtue of that fact and the context provided in her post we have no doubt what is being said is true. The observation is that if someone new here or perhaps on a different forum had reported going to a doctor and getting that response, there would be MNKD investors jumping all over them as lying paid cronies of hedge fund shorts. Just goes to prove not everything negative said regarding adoption of Afrezza is the work of evil... or at least not the direct result of evil. It might be once or thrice removed from those wishing to hinder Afrezza adoption, such as Novo reps spreading FUD.

At least she didn't bring up the "cancer" FUD. 

Thank you DBC.  I have posted a number of times in our search for the elusive Afrezza prescription.  This was just another hoop.  Our insurance doesn't even have it in their formulary, but we are willing to pay for it ourselves (with the help of the discount card until they add it).  There was a real concern about my husband's past history of asthma that his doctor had, and we have overcome that now, despite the negative feedback from the Pulmonary doctor about "inhaled insulin".  

I just want to point out what patients' real experiences are.  We are clearly fighting for the script because we have been following this drug for a long time.  What happens to people who aren't as confident, or those sad minions who just believe what their doctors tell them?  It makes me as mad as hell!  

With the internet, it has become abundently clear that medicine is simply an "art" and they call doctors practicing physicians because they are still practicing.  While I admire my doctor because he works with me and will accept information and questions I find about our health from the internet, most doctors are not so willing to be challenged.  These are our bodies and in a day of revolving door health care, we need to be our best advocates!  We need to be a team.