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Post by mnholdem on Jan 14, 2016 22:20:56 GMT -5
I hate to interrupt this love fest, but I think both of you ( stevil and greg ) contribute immensely to the quality of debates here. Agendas (if there even are any) aside, posts from both of you are quite thought-provoking. Frankly, I consider stevil to be somewhat of a skeptic, but that is something I absolutely expect of a medical professional. I sure as hell don't want my doctor trying every "cool" treatment that comes along. This board is, I think, a microcosm of discussions that may be taking place in the real world. Many diabetics love Afrezza. But more - many more - diabetics and medical professionals are likely to be skeptical of Afrezza because they 1. haven't heard much about it (other than you inhale it) and 2. don't understand how it works. MannKind Corporation has a big task ahead. Perhaps it's fortunate that Sanofi only targeted early diabetics. Now the company can start telling the real story about Afrezza to begin convincing millions who have never heard of an inhaled monomer insulin, including the many skeptical physicians as well. |
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Post by kball on Jan 14, 2016 22:37:23 GMT -5
Thanks for the mildly entertaining exchange Stevil and Greg.
Show of hands, how many here wish they would've taken gregs advice and listened more.....to those that were skeptical long before the bloodbath the last 2 months?
I wish i had.
Even if this company rises from the ashes, how many of us will really make a lot of money?
And how many of us will sell long before any significant rise beyond a couple bucks. Just glad to recoup part of what we suspect may be lost for good?
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Post by Deleted on Jan 14, 2016 23:04:39 GMT -5
When a sales rep sells it as an inhaled insulin that's all the DR hears and he/she makes a judgement based on whether the inhaled component is worth his time and effort. It should be sold as a system to more closely mimic the pancreas and by the way you don't have to jab yourself with a needle. DR's seem to think that the inhaled piece is just a delivery gimmick. In my world there was no selling going on. There was no talking going on! The reps just dropped the pamphlets off at the front desk! And that was only last month. That was the case with my doctor; sample and pamphlets dropped off without any instructions on dosing. |
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Post by traderdennis on Jan 15, 2016 0:45:54 GMT -5
stevil , I disagree, I believe if Sanofi would have given the PWD the opportunity to choose, by advertising just 1 TV commercial so more PWD knew about afrezza, the script numbers would have looked quite a bit different. I also find it completely unprofessional and unexceptable that the very day Sanofi notified MNKD they were ending the partnership, Sanofi Canada flat out lied to a PWD that asked them when afrezza would be available in Canada, (see my thread Sanofi Canada) to view the tweet. Also, keep in mind that I was one that defended the slow launch by Sanofi, and also defended the decision not to advertise via TV until after Healthcare Providers and patients were educated, (boy do I feel stupid !!) I hope sanofis shareprice continues to fall and PWD boycott the company. I wouldn't piss in their ears if their brains were on fire. Just my opinion of Sanofi, I enjoy reading your professional input. Boycott Sanofi Thanks Rick (I think your last sentence was genuine), I'm not a fan of SNY but I don't share the angst many on here have of them. I think they could have handled the process much better and probably should have communicated much better with MNKD. From all we know, maybe they did. Matt gave off the impression that it wasn't a huge shock when SNY cancelled the agreement. If SNY pays for the divorce and gives MNKD a decent chunk of cash, there really isn't much we can complain about in my opinion. We can say that SNY didn't do all they could to market Afrezza. I would agree with that. But it was their prerogative to decide whether they wanted to go forward with it. And as I said earlier, I believe that they figured the juice wasn't worth the squeeze. I don't know how much commercials cost to air, but I have a friend who works in the film production industry and he told me that even cheap commercials cost about $50k to produce from a filming/editing standpoint. Who knows what other costs go into it with the marketing team, the materials, air time on the station etc. You can't really fault them for not wanting to dump more money into Afrezza if they didn't think it would return to them what they wanted. Plus, it didn't fit their business model and vision. It just never made sense to me that SNY would swoop up MNKD to sandbag them when MNKD was never going to take Afrezza all the way on their own anyway. All SNY did was waste their own time and money if they were going to put us right back in the same spot they found us a year earlier. It didn't really hurt MNKD at all except for the tainted reputation we now have and the potential of signing with a better partner. But I believe SNY had genuine interest when the deal was inked. As anyone here who has been following the stories know, the main characters changed, so the plot changed. I don't really see anything evil or malicious about the way SNY conducted their business. They terminated basically at the earliest time that they could. If they'd wanted to, they could have dragged us into bankruptcy. Production was closer to 200K for an online apparel subscription company I worked at. We would buy remnant space at our target market and get a good number of spots per week on cable for about another 200K per week. If you add a spokesman who is an aftra/sag member add 25% to the above prices for residual payments. A 10-20 Million dollar yearly budget would blanket a wide array of spots to the target demo for Afrezza. Less spots during the holidays but that would be the price to pay for remnant ad space. |
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aziz
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Post by aziz on Jan 15, 2016 1:55:48 GMT -5
I am a physician . I get a lot of resistance from my patients when it is time to introduce insulin . Some refuse it even if their sugars are very high . I can say with certainty that the majority of my patients do not like taking insulin especially if they are on 4 injections a day ( one basal and three post meals ). I tried Afrezza on 5-6 patients so far and it is working well and patients love it . No side effects and no complaints . The only obstacle was insurance approval . I have spirometry device in my office , The test can be done by my staff in 5 minutes.
None of my diabetic patients knew about inhaled insulin option or even heared about it., TV ads are a must to increase patients awareness about this option and then they will demand their doctors to prescribe it .
I believe from my experience so far that it will make dramatic change in the treatment of diabetes and it will improve control and compliance
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Post by suebeeee1 on Jan 15, 2016 2:42:51 GMT -5
Ok, I had to post this in the main area because at best it's laughable not to mention what lengths they are going to go to to discredit Afrezza. Meet the Doctors of Dinosaurs... who most will hopefully fall to the wayside. www.medpagetoday.com/Cardiology/Type1Diabetes/55663?utm_source=dlvr.it&utm_medium=twitterLast week, drugmaker Sanofi pulled out of its agreement with MannKind Corporation to sell the inhaled insulin product called Afrezza. The device, cleared by the FDA in June of 2014 on its third try, apparently flopped when it hit the market, earning only a few million dollars in 9 months on the market. MedPage Today spoke to several doctors about whether, and why or why not, they prescribed Afrezza. Jennifer Holst, MD, University of Pittsburgh School of Medicine: "I did prescribe Afrezza to some patients. Inhaled insulin is a nice option for some patients with diabetes who prefer to inhale a medication than to inject. This is the second time that inhaled insulin has come out to market, and then been pulled off. Afrezza was much easier to use than the previous inhaled insulin." Lee Green, MD, MPH, University of Michigan Health System: "I never did prescribe it; just didn't see a need for it." Filip Knop, MD, PhD, University of Copenhagen: "I guess the well-established long-term safety of injected insulin outweighs the -- in my opinion -- questionable benefits of inhaled insulin. My patients with diabetes basically NEVER complain about insulin injections. The gauge of modern needles is so small that you basically can't feel the injection. Maybe needle-phobia is a problem among US patients, but -- really(!) -- it's not a problem that my patients mention very often -- despite my often asking them." Howard Weintraub, MD, New York University Langone Medical Center: "I have not used inhaled insulin. I have been more comfortable with basal insulin preparations. This would not represent any major loss for me or any of my patients." David Armstrong, MD, PhD, University of Arizona College of Medicine: "I know about this and it is an enormous shame. This is a drug with wonderful promise that will now not likely be realized. As a surgeon who specializes in preventing some of the end stage complications of this disease, I do not have occasion to prescribe it, but I do see the devastating results of diabetes and therefore am something of a customer myself!" Joel Zonszein, MD, Albert Einstein College of Medicine: "I was perplexed when Sanofi made the decision to market it and I hope they've learn a lesson. As a clinician that treat individuals with diabetes I can attest that inhaled insulins, no matter how good ... have only a small place, if at all, in the current market. "Inhaled insulins are not good for management of type 1 diabetes (where a basal and prandial regimens needs to be properly crafted for each patient by either multiple injections or CIIS pumps). Inhaled insulins are not good for T2DM as these patients need a basal regimen ... The pen syringes and needles used nowadays are excellent and almost painless -- thus, there is no need for inhaled insulins to replace these. "Physicians often have a dark cloud in their mind with regards to large amounts of insulin in the lungs and if they can cause malignancy after years of use. There are also issues with the inhaled insulin as far as problems with the lungs, bronchitis, asthma, pulmonary function, etc." I find it extremely ignorant of many of the doctors quoted that they saw no need for Afrezza ad no one ever complained about needles. Yet, Dr Armstrong from above talks about how he sees the results of non compliance. Geez, the needles are so tiny!. Why would people NOT use these painless, easy injections? The answer is that people don't like needles regardless of the size. They fear of dying from hypos in their Sleep. Can these doctors be so pompous and lacking in insight? Duh! |
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Post by LosingMyBullishness on Jan 15, 2016 3:07:02 GMT -5
Changing standard of care: some medics actually prescribed Afrezza despite not being proven superior in trials. Why did they leave the standard and how could they justify it? Just the needlephobic argument? Is there some publication mechanism that is quicker and cheaper than a superiority study but more convincing than annectodical evidence?
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Post by traderdennis on Jan 15, 2016 3:27:49 GMT -5
Changing standard of care: some medics actually prescribed Afrezza despite not being proven superior in trials. Why did they leave the standard and how could they justify it? Just the needlephobic argument? Is there some publication mechanism that is quicker and cheaper than a superiority study but more convincing than annectodical evidence? I think so. Non regulatory. Go to a large Health Care Provider and run an A/B test Afrezza vrs standard insulin for type 1's. Over the course of x number of months compare the amount of costs incurred for emergency room hypos control vs test. During the A/B test give the Afrezza away. In exchange for giving it away, MNKD is allowed to show the study to Health Care Providers in their sales presentations. Once the results are in, and if the results show reduced Health Care Costs in Afrezza's reduction of emergency room visits then we now have ammunition. The idea is that if there is a substantial cost savings for the Health Care Providers, they will make Afrezza the Tier 2 and move injectables to Tier 3. |
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Post by LosingMyBullishness on Jan 15, 2016 3:32:50 GMT -5
Interesting. So you go via health care providers and not medics. SNY did not do this but charged premium. How could they sell anything at all?
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Post by agedhippie on Jan 15, 2016 12:44:28 GMT -5
I think so. Non regulatory. Go to a large Health Care Provider and run an A/B test Afrezza vrs standard insulin for type 1's. Over the course of x number of months compare the amount of costs incurred for emergency room hypos control vs test. During the A/B test give the Afrezza away. In exchange for giving it away, MNKD is allowed to show the study to Health Care Providers in their sales presentations. Once the results are in, and if the results show reduced Health Care Costs in Afrezza's reduction of emergency room visits then we now have ammunition. The idea is that if there is a substantial cost savings for the Health Care Providers, they will make Afrezza the Tier 2 and move injectables to Tier 3. It's possible on a case by case model but how do you get the participants? You need to find large numbers of Type 1 diabetics prepared to move off their current treatment to get a statistically valid result because ER visits for hypos are rare. There is not a lot of incentive to change, especially if they are on a pump. |
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Post by dictatorsaurus on Jan 15, 2016 13:05:57 GMT -5
There are good plumbers and $hit plumbers, good engineers and $hit engineers, good doctors and $hit doctors.
The nay saying doctors above are part of the $hit doctors pool.
Never met a single diabetic that felt tearing the skin and inserting a sharp object into the flesh multiple times a day as something non painful or "normal".
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Post by harryx1 on Jan 15, 2016 13:36:16 GMT -5
Comments from the article, keep in mind that Victor is a health care professional, not sure if that means Dr/Nurse/CDE etc. Also I noticed that the article was commissioned (in partnership) by the AACE  |
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Post by dudley on Jan 15, 2016 13:43:27 GMT -5
Changing standard of care: some medics actually prescribed Afrezza despite not being proven superior in trials. Why did they leave the standard and how could they justify it? Just the needlephobic argument? Is there some publication mechanism that is quicker and cheaper than a superiority study but more convincing than annectodical evidence? someone would write a scholarly article which is then peer-reviewed that article can be used in marketing. I have thought for quite a long time that one of the leading endos like Dr. Bode or Edelman (both of whom have a lot of experience and /or patients on Afrezza) are strong candidates to write such an article. I am actually mystified that they have NOT, particularly Dr. Bode who is a prolific writer. He HAS to know about the superb results - Sam Finta has been his patient for years. Maybe getting screwed over by Sanofi will awaken the "underdog sympathy" in these guys and prompt them to write just such an article. There cannot possibly be a bigger story in the entire diabetes world than this - and I don't mean that as hyperbole. Name any product, any device, ANYTHING that has shown the ability to allow such virtually non-diabetic lives for long-suffering patients like Afrezza has. It is unbelievably frustrating to see NOTHING from anyone other than the very enthusiastic users who are enjoying those benefits. It is unbelievably stupid that Sanofi did NOTHING to advance this when there is no conceivable way they did NOT know the efficacy. It most certainly lends credence to "conspiracy" stories - how in the world has this not been picked up by SOME writer SOMEWHERE? |
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Post by rozale on Jan 15, 2016 13:46:45 GMT -5
There are good plumbers and $hit plumbers, good engineers and $hit engineers, good doctors and $hit doctors. The nay saying doctors above are part of the $hit doctors pool. Never met a single diabetic that felt tearing the skin and inserting a sharp object into the flesh multiple times a day as something non painful or "normal". I completely agree with you. I have been sticking myself with needles since I was 4 years old... and I definitely am looking forward to stopping the injections completely. Injecting yourself 5-6 times a day 365 times a year for over 20+ years definitely helps contribute to scar tissue build up in those injection spots. In my case I look buffer than I am because I stick myself in my arm continuously  . Another positive side effect of using an inhaler is the the reduction of potential infections. All diabetics are supposed to change out their pen needles after 1 use... I doubt anyone who has to use short acting injections does this. What traditionally happens is we stick a new pen needle on top of our humalog/novolog pens once a day and typically use it throughout the day. While definitely not sanitary, this is a case were convenience supersedes logic. I am sure there are a few very sanitary diabetics who are meticulous on doing this... but I haven't met a type 1 who does this after every injection yet. I wonder if Mannkind/Sanofi also brought up the cost savings associated with not having to purchase needle caps to insurance companies. While the cost is minimal for the caps to insurance companies... there is still definitely a savings there. Ok done with my rambling . |
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Post by pktrump on Jan 15, 2016 13:54:00 GMT -5
Dudley
My respect for the Society of Endocrinologists is nonexistent: in general these folks must be an apathetic bunch. To not have at this point some objective analytical research papers, conferences regarding, assessments whether neutral, negative or positive of AFZ is truly amazing and IMO negligent.
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