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Post by compound26 on Jan 23, 2016 15:01:24 GMT -5
Some interesting comments from Alan Brody regarding marketing of Afrezza: Why Sanofi failed with Afrezza: Let's assume Sanofi did not start out with bad faith but they quickly ran into a wall when they talked about "inhalable" insulin. Doctors have become highly paranoid about lung infusion. But, instead of changing their tactics Sanofi kept doing more of the same but less intelligently. They should have been selling the amazing patient experience. Put it this way, a hammer is worth $10 but a beautifully made house that needed a hammer is worth a million. The best way to understand how to market around a prejudice is to go back to the tobacco industry in the 1950s when they faced the first cancer scare. The Sanofis of the time talked about how their cigarettes didn't make you cough such (Old Gold "not a cough in carload" or Camel doesn't make your throat tickle. Then they got a little smarter and found that four out of five doctors preferred Camel "take the T(hroat) test". The really smart company - the big winner - was Philip Morris which side stepped all of that by bringing out the Marlboro Man and Marlboro Country - never once mentioning the product just the experience in their successful years (they too, struggled at the beginning when they talked smoke). That's why they are the number one brand across the world above all other products. Game over. Read my book "Cigarette Seduction". I am not just a pundit here - I am an investor. Sadly, I thought every smart marketer understood this issue. God only knows how wrong I was. If all of these elements are true and they can stay liquid until they kick in, then then the upside potential is immense. There is no question that Sanofi gave it the minimum effort, failed to introduce it as a companion Toujeo and hobbled it with ads that failed to mention it's Unique Selling Proposition ("Surprise It's Insulin" was intended to ANYTHING OTHER than that, and looked like a perty favor). ___________________________________________________________________________ In reality this is a disruptive product that needs unique marketing such as a full Social Media campaign with Insulin challenges, famous name stories and user meetups and so on. Any Social Media professional knows this path but they haven't mentioned it. Ideally a top new Media agency run by an Afrezza user would be the way to go. It is way too important to be left to an intern or Matt getting the hang of Twitter. Also, t hey need a vivid form of PR in a way that captures the world's imagination such as donating a supply to Syrian refugees or to the poor in Haiti. There are many wealthy and famous people who would be inspired by this.While Endos are famously conservative they still need a Sam Finta-type (afrezzauser - a leading independent advocate) with an MD. Any one of these specific issues - along with those mentioned in this thoughtful article - could be massive game changers. Finally, the company has to understand the key element in modern marketing - you don't sell the tool you sell the breakthrough experience. It is not about inhalable insulin it is about making a diabetic's life feel normal again. It is liberation and salvation and user reports make this stunningly clear. The moment they mention inhalable those 4 out 5 doctors who once smoked Camel start freaking about the lungs....and I don't know.... Lungs hate tar not medicine. People have been gaping for over 10 years and there is not a single credit le report of lung malfunction. So this is a new medical prejudice. (Read my separate posting about how the tobacco industry especially Philip Morris dealt with this at the height of the first cancer scare -it is HIGHLY instructive. I know, I wrote a book about it called "Cigarette Seduction".) ___________________________________________________________________________ First, apologies for the typos I'm doing this on a cell phone between meetings. The vids are quality work and they sure need this. Having said that, a true Social Media campaign is something quite different. You need to aggregate videos from real patients showing what a day of dining with Apidra looks like vs Afrezza. They have to Instgram this. You need contests and hooplah. You need real live people to show what a business lunch looks like between the two. You need to bring two patients to the Fancy food Festival and show what the needle patient CAN'T eat vs. what the Afrezza patient CAN eat.
And they need to make it clear what the Old World did wrong and how they are going to show cutting edge New World Marketing. You read more of Alan's comments on this subject at: seekingalpha.com/user/26647063/commentsSome additional comments from Alan Brody: Having consulted for pharmacy companies in the past, I am well aware of the myriad regulations. Having said that I am also aware of some of their workarounds. In the case of Social Media, the really good campaigns are not owned by the company. They are a spontaneous groundswell of the user base. The issue is what is the acceptable cultivation of this base. The story is already there. It just has to be a looked to step out. Insofar the as the messaging is concerned, most of the terms the supporters love such as "inhalable" "breathe" and lungs are trigger words that have reverse effect on the medical community. So, whatever the regulations are, there are plenty of mental impediments to be managed. seekingalpha.com/user/26647063/comments
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Post by agedhippie on Jan 23, 2016 17:24:30 GMT -5
The whole social media idea is a double edged sword. It cannot be a promotion of Afrezza or it will get treated like every other promotion, it gets ignored and the channel (and product) gets discounted. So there has to be something in it for the viewer. At the moment I am not clear what that something is.
Approaches like bringing two patients (I think that should be PWD if you don't want to insult the audience) to the Fancy food Festival and show what the needle patient CAN'T eat vs. what the Afrezza patient CAN eat are just awful. The PWD will tell you there is nothing there that they cannot eat and they would be right. You can eat anything if you bolus for it. So post that video and your credibility hits zero, and you have lost the audience.
The fundamental problem is that diabetics see pharmas, Mannkind included, as parasites leaching off their condition (I might have been a bit harsh there but not by much). Any social media campaign will be thought to be sponsored by Mannkind regardless of the truth because why would a bunch of people suddenly decide to promote a particular drug? The campaign has to be very careful not to look like astroturfing.
Oddly the doctors would probably be a better target for a campaign, certainly less hostile.
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Post by stevil on Jan 23, 2016 19:00:30 GMT -5
I agree with just about everything you wrote, save for the 3rd paragraph. I don't have the knowledge to refute it, but I would hope only those who are entitled feel that way.
Anyway, the best I could come up with is to have ads like the dollar shave club. Find a way to make them funny and leave the consumers wanting the product as much as wanting to see the next commercial. Their story of rags to riches is amazing. It goes to show that you don't need a ton of money to create a successful and sustainable business, AND start chipping away at a significant part of a market that has been around for a long time and has been dominated by just a few giants.
In all reality, we'd essentially be playing the same role. Dollar shave club's claim to fame was that they
1.undercut the competition (which we're doing) 2.they shipped the product right to the patient's house (which we hopefully could... AFAIK, we're not required to keep our product refrigerated- someone correct me if I'm wrong- which is a HUGE benefit that should be capitalized on if indeed we're able to), 3.their commercials are hilarious.
Then, finally, and this is what would be cool if we could implement it with pharma... not sure if there are regulations that would prohibit it... but dollar shave club gives a free month to each person that refers their friends to join the club. So we could encourage people to get several year's worth of free diabetic meds if they start advocating for the company. I'm sure that'd make any diabetic proud...
I have a hard time believing that this would be allowed since somebody else would be doing it already, but if it is... this would be the way to go.
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gz
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Post by gz on Jan 23, 2016 19:15:54 GMT -5
One idea I just had is going to 5K/10K walks/runs that are for diabetes and have Team Afrezza participate in the event. I would gladly donate to these type of events to help the ones who are truly affected by diabetes. These type of events are held all over the place and anyone can join or donate. One event is the JDRF One Walk:
The funds and support raised by JDRF One Walk — our flagship fundraising event and the largest type 1 diabetes (T1D) event in the world — help us turn Type One into Type None.
JDRF is the leading global organization funding promising, life-changing T1D research. It’s our goal to progressively remove the impact of the disease from people’s lives until we achieve a world without T1D.
Maybe we could get Sam out to an event to share his experience with anyone who wants to learn more?
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Post by od on Jan 23, 2016 19:18:47 GMT -5
I agree with just about everything you wrote, save for the 3rd paragraph. I don't have the knowledge to refute it, but I would hope only those who are entitled feel that way. Anyway, the best I could come up with is to have ads like the dollar shave club. Find a way to make them funny and leave the consumers wanting the product as much as wanting to see the next commercial. Their story of rags to riches is amazing. It goes to show that you don't need a ton of money to create a successful and sustainable business, AND start chipping away at a significant part of a market that has been around for a long time and has been dominated by just a few giants. In all reality, we'd essentially be playing the same role. Dollar shave club's claim to fame was that they 1.undercut the competition (which we're doing) 2.they shipped the product right to the patient's house (which we hopefully could... AFAIK, we're not required to keep our product refrigerated- someone correct me if I'm wrong- which is a HUGE benefit that should be capitalized on if indeed we're able to), 3.their commercials are hilarious. Then, finally, and this is what would be cool if we could implement it with pharma... not sure if there are regulations that would prohibit it... but dollar shave club gives a free month to each person that refers their friends to join the club. So we could encourage people to get several year's worth of free diabetic meds if they start advocating for the company. I'm sure that'd make any diabetic proud... I have a hard time believing that this would be allowed since somebody else would be doing it already, but if it is... this would be the way to go. Stevil, more often than not I am aligned with your thinking. I get that patients are people too, but I think using humor to market a medication to patients with a lifelong chronic and potentially devastating disease comes with significant risk. If it works, great, but if not the backlash will be a genie that is not going back in the bottle. Razor blades -- life changing medication...comparison does not work for me.
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Post by stevil on Jan 23, 2016 19:30:32 GMT -5
I see your point and you're probably right. It might still be offensive to the people who have to poke themselves and those who aren't candidates for Afrezza due to labeling restrictions.
But, even if we want to avoid the potential for offense, there are a number of any other identities we could take. We could take the approach of really doing it "for the patient" talk about how "we could charge you as much as the other guys... but we won't" and "We could make you wait as long as the other guys, but we won't" etc. Make it look like we're a gentleman courting a girl. Make us the knight in shining armor. Again, not sure if these are allowed... all drug commercials seem boring to me and there's probably a good reason for that.
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Post by agedhippie on Jan 23, 2016 19:41:19 GMT -5
I agree with just about everything you wrote, save for the 3rd paragraph. I don't have the knowledge to refute it, but I would hope only those who are entitled feel that way. Anyway, the best I could come up with is to have ads like the dollar shave club. Find a way to make them funny and leave the consumers wanting the product as much as wanting to see the next commercial. Their story of rags to riches is amazing. It goes to show that you don't need a ton of money to create a successful and sustainable business, AND start chipping away at a significant part of a market that has been around for a long time and has been dominated by just a few giants. In all reality, we'd essentially be playing the same role. Dollar shave club's claim to fame was that they 1.undercut the competition (which we're doing) 2.they shipped the product right to the patient's house (which we hopefully could... AFAIK, we're not required to keep our product refrigerated- someone correct me if I'm wrong- which is a HUGE benefit that should be capitalized on if indeed we're able to), 3.their commercials are hilarious. Then, finally, and this is what would be cool if we could implement it with pharma... not sure if there are regulations that would prohibit it... but dollar shave club gives a free month to each person that refers their friends to join the club. So we could encourage people to get several year's worth of free diabetic meds if they start advocating for the company. I'm sure that'd make any diabetic proud... I have a hard time believing that this would be allowed since somebody else would be doing it already, but if it is... this would be the way to go. Stevil, more often than not I am aligned with your thinking. I get that patients are people too, but I think using humor to market a medication to patients with a lifelong chronic and potentially devastating disease comes with significant risk. If it works, great, but if not the backlash will be a genie that is not going back in the bottle. Razor blades -- life changing medication...comparison does not work for me. Done with care the humorous approach might work best. It's a lifelong chronic illness but it still has it's funny moment that you can laugh about like eating everything you can find during a bad low - if a glass of OJ is good then a gallon is even better, ooh and all the ice cream, wait add that bar of chocolate... Plus just what you do when low! A couple of the other points, Afrezza needs to be kept refrigerated, it has a ten day life out of the fridge which is less than other insulin (28 days). It doesn't matter though as the insurer ships is it overnight in an insulated container with an ice block and we could do the same. Generally diabetics hate pharmas because diabetes is an very expensive disease to have and they feel that pharma isn't make an effort to cure it since they would lose a market. I think it's paranoia since it would be almost impossible to suppress the discovery of a cure and there are a lot of institutions try to find a cure. There are charities like the DRI that solely concentrate on finding a cure, a lot of other charities also sponsor investigation of treatment as the JDRF does.
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Post by tayl5 on Jan 23, 2016 20:07:24 GMT -5
Why is it impossible to suppress a cure when it seems pretty easy to suppress a drug like Afrezza that goes a long way in that direction? All you need to do is have your minions keep hammering home that no one likes it and it doesn't work, ensure that doctors are motivated to stick with the status quo (not much effort needed there), and use your market presence to lock in non-cure reimbursement decisions. The cure for ulcers was cheap antibiotics but the doctor who discovered that had to drink a flask of bacterial culture and deliberately give himself an ulcer before anyone would listen.
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Post by robsacher on Jan 23, 2016 21:53:01 GMT -5
Robert, Very good recap of the movement in the MNKD camp within the last three weeks. I like that you are a long and a true believer as well. Alas, that is not enough. However your article did manage to flesh out some ideas as to how to reach people through social media. There are some great points made and I certainly hope Alan does send Matt a proposal. This is perhaps the best use for seeking alpha articles. Thanks for taking the time to submit an articulate, well thought out, positive article! Thank you for your compliment. I agree with you in regard to Alan Brody's comments. He has some brilliant perspectives. And thank you too for hanging in there through these most difficult times. I always pay attention to your commentary. Best wishes, Rob
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Post by agedhippie on Jan 23, 2016 23:11:30 GMT -5
Why is it impossible to suppress a cure when it seems pretty easy to suppress a drug like Afrezza that goes a long way in that direction? All you need to do is have your minions keep hammering home that no one likes it and it doesn't work, ensure that doctors are motivated to stick with the status quo (not much effort needed there), and use your market presence to lock in non-cure reimbursement decisions. The cure for ulcers was cheap antibiotics but the doctor who discovered that had to drink a flask of bacterial culture and deliberately give himself an ulcer before anyone would listen. Suppressing a cure is impossible because it would be such a big deal for the countries with national health systems so those countries have a huge incentive to find a cure. On top of that there is the fame and revenue - the cost of a cure could be highly priced but still justifiable in cost savings, and you get to destroy your competitors revenue as a bonus. Nobody is suppressing Afrezza, Mannkind did it to themselves. In hindsight I now realize this was inevitable once Mannkind designed the trial for non-inferiority rather than superiority. They took the safe route and assumed the non-invasive nature of Afrezza would make it preferred in a head to head with the incumbents, and let Afrezza be cast as just another delivery mechanism. This is a losing proposition because insulin users don't care that much about injecting, and doctors saw a new delivery mechanism with the potential for lung complications that gave the same results as the current treatment. Until the market is educated the perception of Afrezza as simply another delivery route is not going to change. The science needs to be sold to doctors and that may well mean trials which takes money and time.
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Post by tayl5 on Jan 24, 2016 8:44:32 GMT -5
It's easy to say that in hindsight, but keep in mind the regulatory paradigm that MannKind was facing at the time. If they pushed for superiority and had to run something like the same trial design, it would have been game over in 2014. An even better way to prevent a cure than suppressing it in the market is to make sure it never gets approved.
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Post by agedhippie on Jan 24, 2016 10:41:03 GMT -5
It's easy to say that in hindsight, but keep in mind the regulatory paradigm that MannKind was facing at the time. If they pushed for superiority and had to run something like the same trial design, it would have been game over in 2014. An even better way to prevent a cure than suppressing it in the market is to make sure it never gets approved. There isn't a right or wrong answer to what they did. If they had gone for superiority they may well not have got it and fallen flat, they went the more certain route which carried the lower immediate risk. That decision had consequence that I don't believe they anticipated though.
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Post by mnholdem on Jan 24, 2016 11:00:08 GMT -5
Why is it impossible to suppress a cure when it seems pretty easy to suppress a drug like Afrezza that goes a long way in that direction? All you need to do is have your minions keep hammering home that no one likes it and it doesn't work, ensure that doctors are motivated to stick with the status quo (not much effort needed there), and use your market presence to lock in non-cure reimbursement decisions. The cure for ulcers was cheap antibiotics but the doctor who discovered that had to drink a flask of bacterial culture and deliberately give himself an ulcer before anyone would listen. Suppressing a cure is impossible because it would be such a big deal for the countries with national health systems so those countries have a huge incentive to find a cure. On top of that there is the fame and revenue - the cost of a cure could be highly priced but still justifiable in cost savings, and you get to destroy your competitors revenue as a bonus. Nobody is suppressing Afrezza, Mannkind did it to themselves. In hindsight I now realize this was inevitable once Mannkind designed the trial for non-inferiority rather than superiority. They took the safe route and assumed the non-invasive nature of Afrezza would make it preferred in a head to head with the incumbents, and let Afrezza be cast as just another delivery mechanism. This is a losing proposition because insulin users don't care that much about injecting, and doctors saw a new delivery mechanism with the potential for lung complications that gave the same results as the current treatment. Until the market is educated the perception of Afrezza as simply another delivery route is not going to change. The science needs to be sold to doctors and that may well mean trials which takes money and time. You've never read the ADCOM transcripts, have you? I posted (somewhere within these boards) the dialogue between an advisor physician and the FDA official, who was cornered into admitting that he was the person responsible for selecting the non-inferiority protocols even though superiority studies were warranted after eight years of trials. When the FDA's lead trial physician explained his excuse for not using double-blind with placebo injections as immoral or unethical (I forget which word was used) the advisors almost laughed him out of the room, since placebo injections are common in drug trials. There's little doubt that the lead trial physician "doctored" the protocols to prevent superiority from being established. That is easily interpreted as suppression. You may be correct that non-inferiority trial led to inevitable difficulties for marketing Afrezza, but your statement that "MannKind did it to themselves" is clearly incorrect or at least a conclusion that has been made without knowledge of all of the facts.
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Post by wildpig on Jan 24, 2016 12:54:58 GMT -5
brilliant blog if I say myself-- I actually agree with the majority of the post.
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Post by agedhippie on Jan 24, 2016 13:14:20 GMT -5
You've never read the ADCOM transcripts, have you? I posted (somewhere within these boards) the dialogue between an advisor physician and the FDA official, who was cornered into admitting that he was the person responsible for selecting the non-inferiority protocols even though superiority studies were warranted after eight years of trials. When the FDA's lead trial physician explained his excuse for not using double-blind with placebo injections as immoral or unethical (I forget which word was used) the advisors almost laughed him out of the room, since placebo injections are common in drug trials. There's little doubt that the lead trial physician "doctored" the protocols to prevent superiority from being established. That is easily interpreted as suppression. You may be correct that non-inferiority trial led to inevitable difficulties for marketing Afrezza, but your statement that "MannKind did it to themselves" is clearly incorrect or at least a conclusion that has been made without knowledge of all of the facts. I have never read them until now! The FDA doctor completely missed the point about placebo shots which is stupid since they effectively did just that with the Type 2 trial. He may have been confused (or not very bright) and answering a different question; can you give a Type 1 a placebo rather than insulin, which you obviously cannot do. Rereading the trial data I realize that it wasn't specified as a non-inferiority trial, but rather Afrezza fell within the non-inferior band. I think I maligned Mannkind unfairly. In trials the clinical protocols though are defined by the sponsor, not by the FDA.
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