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Post by peppy on Apr 28, 2016 9:04:25 GMT -5
I believe that Al Mann would have supported the idea of introducing Afrezza to early diabetics who are reluctant to begin insulin injections but might choose an inhaled insulin. However, Sanofi stabbed Al in the back when they tacked on their 30% premium over the price of RAA insulin pens. That virtually guaranteed that no 3rd Party Payer would cover the cost of Afrezza as a transition from orals to insulin. RAA insulins Novolog and Humalog have a tough enough time getting better tier rating over regular (and cheap) human insulins such as Novalin and Humalin. Afrezza didn't stand a chance. IMO, once Afrezza is established and generating enough cash flow to support it, a trial specifically design to re-write early diabetes treatment protocols is warranted. Peppy's graphic of the ADA 2016 Guidelines illustrates how diabetes treatment is dominated by powerful pharmaceutical companies with their ultimately ineffective (and often dangerous) initial treatments. It amazes me how the ADA has turned its back on the multitude of trial results showing 40%-60% drug-free remission of diabetes mellitus following early intensive insulin therapy. In my opinion, the FDA isn't the only organization that may be influenced by a multi-$billion drug industry.
The Heroin epidemic going on in the US today has all started from big Pharma and prescription drugs. People are dying all over the country (good young kids that dont know better)because they get hooked on pain killers from a Dr's prescription and eventually cannot afford them and climb up the ladder to Heroin. It goes so far beyond a better diabetes medication....... "Morphine" as it is commonly referred to, is morphine sulfate. Heroin is diacetyl morphine. That is, heroin is simply morphine with an acetyl molecule attached.
In terms of effects, they are exactly the same -- and medically interchangeable -- except for dosage. In fact, they are both converted to the same form of morphine when they get into the body. www.druglibrary.org/gh/what_is_the_difference_between_h.htm
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Post by kc on Apr 28, 2016 9:05:57 GMT -5
Yes, this was said. Even though Endos prescribed 40% of the TXs, they were a "secondary" focus to primary care physicians who treated T2 diabetics, by the SNY sales force. Endos are 2X more likely to be early adopters of new medications, have more experience working through prior authorization, and have a staff available to teach dose titration.
I do not doubt what has been said. I called every endo office in Minneapolis MN. None of them were writing for Afrezza. There is at least one primary care physician writing in Minnesota as reported in a post. Additionally, primary care physicians have spirometry.
How many of the Endo offices that you called had even heard of Afrezza? It's possible that SNY reps never visited any or most of the endos located in Minneapolis MN. I remember reading a post from a medical worker in N. Dakota who said SNY reps dropped off pamphlets and left, never even talking to the Dr. Salespeople sell what the get paid the best commission for selling. I would guess that was the Sanofi own products. So the salesperson was conflicted.
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Post by peppy on Apr 28, 2016 9:15:22 GMT -5
How many of the Endo offices that you called had even heard of Afrezza? It's possible that SNY reps never visited any or most of the endos located in Minneapolis MN. I remember reading a post from a medical worker in N. Dakota who said SNY reps dropped off pamphlets and left, never even talking to the Dr. Salespeople sell what the get paid the best commission for selling. I would guess that was the Sanofi own products. So the salesperson was conflicted. I can not figure out how these sales people get in to see the physicians? How does a pharmaceutical representative get in to speak to a physician these days?
I do have a great respect for physicians.
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Post by mnkdnewbie on Apr 28, 2016 9:38:10 GMT -5
Salespeople sell what the get paid the best commission for selling. I would guess that was the Sanofi own products. So the salesperson was conflicted. I can not figure out how these sales people get in to see the physicians? How is it done these days? I avoid physicians offices.
my wife (nurse) manages the vaccine inventory for a very large practice and the reps sometimes just show up but the majority of the time they schedule a lunch and bring the whole practice a lunch to be able to meet with the docs and her. I love those weekly lunches because I get the leftovers for dinner.
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Post by peppy on Apr 28, 2016 9:45:08 GMT -5
I can not figure out how these sales people get in to see the physicians? How is it done these days? I avoid physicians offices.
my wife (nurse) manages the vaccine inventory for a very large practice and the reps sometimes just show up but the majority of the time they schedule a lunch and bring the whole practice a lunch to be able to meet with the docs and her. I love those weekly lunches because I get the leftovers for dinner. I got a tetanus vaccination, the bill to the insurance company for the vaccination was $300. There is good money in vaccines. I have heard about the lunches. Liane mentioned the luncheon thesis has changed.
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Post by agedhippie on Apr 28, 2016 9:53:28 GMT -5
Aren't most Type 2s currently treated with a basal insulin only, instead of mealtime dosing?Al: Yes, but that's the wrong way around. The correct therapy should be a good prandial insulin and not long-term insulin — Afrezza in particular because it turns off glucose production and delivery from the liver. Our latest trials of 600 patients are showing even more significant benefits from the product than our original trials; the most recent trial appears to show that this should replace frontline treatment for all Type 2 patients. www.healthline.com/diabetesmine/the-truth-about-afresa-inhalable-insulin-a-chat-with-al-mann#3SF: Some studies or most of the studies have shown that type 2 diabetes starts as a post prandial disease. Would it make more sense to start a type 2 on a post prandial insulin or on a prandial insulin, rather than even a basal insulin? AM: The first loss in type 2 is really the early phase 1 pancreatic spike and that is then followed by loss of the phase 2 prandial insulin. Almost all postprandial issues are from use of current prandial insulins. What is needed first in type 2 should be a very fast acting prandial insulin, not a basal insulin. Afrezza provides insulin kinetics close to the kinetics of pancreatic insulin in response to a glucose spike. Afrezza should be the first insulin employed and that should actually be prescribed in early type 2. www.diabetesincontrol.com/an-exclusive-interview-with-al-mann-founder-and-ceo-mannkind-corp/ Here is the problem, physicians have guidelines. The guidelines need to be changed for mealtime insulin and type 2 diabetes in order for that to happen. screencast.com/t/w4oza32Gc The guidelines are to use a lot of my mouth medications before insulin. The world did not have this type of fast acting insulin prior to 2015. Only the USA has it now.
There are quite a few papers on this dating back to the UKPDS and ORIGIN studies. There are also a lot of papers out of China published in Western journals looking at this. The evidence is compelling but the upside for Afrezza is not so clear. ORIGIN used Lantus and got their remission results, the Chinese found the fact you used insulin was the key, but which insulin and how it was delivered was irrelevant. Aldo you can stop taking insulin after a few months, the initial phase is the important part, after that there seems to be no real recovery. You see this in Type 1 where initial insulin treatment can put the person into a honeymoon phase where they need very little or even no insulin. Sadly the honeymoon ends though. Application of this is going to be more difficult. Doctors do not like prescribing insulin generally, and in the US in particular (US doctors have one of the worst records globally). Secondly you could use NPH or Regular since you need insulin since these are very cheap and the type is unimportant according to the research. NPH and Regular insulins are OTC drugs - Walmart sells them!
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Post by mnkdnewbie on Apr 28, 2016 10:41:06 GMT -5
my wife (nurse) manages the vaccine inventory for a very large practice and the reps sometimes just show up but the majority of the time they schedule a lunch and bring the whole practice a lunch to be able to meet with the docs and her. I love those weekly lunches because I get the leftovers for dinner. I got a tetanus vaccination, the bill to the insurance company for the vaccination was $300. There is good money in vaccines. I have heard about the lunches. Liane mentioned the luncheon thesis has changed.
I just messaged her and that is how they always do it through bringing lunches. The docs love free lunch. She also said she purchased an epi pen kit for each of the 18 exam rooms and since she pays for it out of pocket they are outrageous, the kit comes with 2 pens a large and a junior pen for up to 80lbs. She also keeps vials of epinephrine as well. She also said the cost of tetanus is no where $300 but the provider can bill for the administration fee on top of the cost of the vaccine but insurance hardly ever pays out what the provider bills.
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Post by dreamboatcruise on Apr 28, 2016 17:54:34 GMT -5
Here is the problem, physicians have guidelines. The guidelines need to be changed for mealtime insulin and type 2 diabetes in order for that to happen. screencast.com/t/w4oza32Gc The guidelines are to use a lot of my mouth medications before insulin. The world did not have this type of fast acting insulin prior to 2015. Only the USA has it now.
There are quite a few papers on this dating back to the UKPDS and ORIGIN studies. There are also a lot of papers out of China published in Western journals looking at this. The evidence is compelling but the upside for Afrezza is not so clear. ORIGIN used Lantus and got their remission results, the Chinese found the fact you used insulin was the key, but which insulin and how it was delivered was irrelevant. Aldo you can stop taking insulin after a few months, the initial phase is the important part, after that there seems to be no real recovery. You see this in Type 1 where initial insulin treatment can put the person into a honeymoon phase where they need very little or even no insulin. Sadly the honeymoon ends though. Application of this is going to be more difficult. Doctors do not like prescribing insulin generally, and in the US in particular (US doctors have one of the worst records globally). Secondly you could use NPH or Regular since you need insulin since these are very cheap and the type is unimportant according to the research. NPH and Regular insulins are OTC drugs - Walmart sells them! For efficacy perhaps. But Afrezza may well have advantage both in patient acceptance at an early stage, compliance and risk of hypoglycemia. We're likely a long way from having standard of care change, but Afrezza does seem the ideal, if not only possible, form of insulin for early intervention.
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Post by agedhippie on Apr 28, 2016 19:20:19 GMT -5
There are quite a few papers on this dating back to the UKPDS and ORIGIN studies. There are also a lot of papers out of China published in Western journals looking at this. The evidence is compelling but the upside for Afrezza is not so clear. ORIGIN used Lantus and got their remission results, the Chinese found the fact you used insulin was the key, but which insulin and how it was delivered was irrelevant. Aldo you can stop taking insulin after a few months, the initial phase is the important part, after that there seems to be no real recovery. You see this in Type 1 where initial insulin treatment can put the person into a honeymoon phase where they need very little or even no insulin. Sadly the honeymoon ends though. Application of this is going to be more difficult. Doctors do not like prescribing insulin generally, and in the US in particular (US doctors have one of the worst records globally). Secondly you could use NPH or Regular since you need insulin since these are very cheap and the type is unimportant according to the research. NPH and Regular insulins are OTC drugs - Walmart sells them! For efficacy perhaps. But Afrezza may well have advantage both in patient acceptance at an early stage, compliance and risk of hypoglycemia. We're likely a long way from having standard of care change, but Afrezza does seem the ideal, if not only possible, form of insulin for early intervention. The problem is that the since basal insulin has a low hypo rate (very low if titrated properly) and only needs to be taken once a day rather that at least at every meal I think the doctors will go with that. The single daily rather than multiple dose is a huge win for compliance.
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