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Post by Deleted on Oct 5, 2016 13:39:20 GMT -5
Most PCP offices have a spirometer. At least the ones around here where I live do. I don't know about the endo offices. Also, unless the patient is a mod-severe COPDer, having a current asthma attack, has dementia, or is currently experiencing an illness that effects their breathing, like having an acute exacerbation, they should be able to perform the test and more than likely pass. There are different ways the bedside spiro can actually be done and have accurate results. They are suppose to perform it 3 times and you take the better of the 3. Seriously, the spirometry test is a non-issue. If someone cannot pass they are more than likely an advanced COPDer or someone too old to comprehend how to even do it. It is so simple, and requires absolutely no special training to administer the test. I've seen plenty of asthmatics do it and perform better than people who don't even smoke or have asthma or any type of lung problem. The office will generate money off of this small investment, which is literally couch change for an endo practice. 🙄
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Post by Deleted on Oct 5, 2016 13:53:50 GMT -5
How does the saying go -- "sh_t happens"? And who's there to take advantage when it does? The malpractice lawyer. Doctors are not allowed to blame machines for faulty interpretations. EKG machines offer interpretations, but see what happens if the doctor takes the machine's word, it's wrong, and the patient suffers iinjury. Lung function test is far simpler than EKG, both in knowing how to perform the test and interpreting results. Details matter. Doctors do typically understand details. A reasonable doctor is not going to have a patient try to do an EKG at home, but they will have them take BG readings at home... and use those home generated results in clinical decisions. This is because the BG test is simple and results in a simple number that can be conveyed easily without any need for patient "interpretation" built into what is conveyed. A false good reading on a lung function test is probably even less likely than erroneous BG readings. I believe lung function is something that some patients are instructed to do at home. This is a simple, reliable test. I agree 100% concerning the spiro test. I have never seen a false "positive" result, only false negative results (from lack of trying/not giving the test 100% of their attention and/or effort), which even then, resulted in acceptable %s within that person's predicted norms. |
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Post by dreamboatcruise on Oct 5, 2016 14:23:25 GMT -5
Lung function test is far simpler than EKG, both in knowing how to perform the test and interpreting results. Details matter. Doctors do typically understand details. A reasonable doctor is not going to have a patient try to do an EKG at home, but they will have them take BG readings at home... and use those home generated results in clinical decisions. This is because the BG test is simple and results in a simple number that can be conveyed easily without any need for patient "interpretation" built into what is conveyed. A false good reading on a lung function test is probably even less likely than erroneous BG readings. I believe lung function is something that some patients are instructed to do at home. This is a simple, reliable test. I agree 100% concerning the spiro test. I have never seen a false "positive" result, only false negative results (from lack of trying/not giving the test 100% of their attention and/or effort), which even then, resulted in acceptable %s within that person's predicted norms. And I'd guess that if a doctor didn't accept a sprio test that someone brings in, such as ones performed at diabetes events by MNKD staff, the likely reason would be that the doctor owns a device himself and wants to bill for it rather than true lack of trust of the readout from the patient provided one... and in that case no harm with a second one, other than needless expense transferred into the insurance system. |
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Post by Deleted on Oct 5, 2016 15:07:51 GMT -5
I agree 100% concerning the spiro test. I have never seen a false "positive" result, only false negative results (from lack of trying/not giving the test 100% of their attention and/or effort), which even then, resulted in acceptable %s within that person's predicted norms. And I'd guess that if a doctor didn't accept a sprio test that someone brings in, such as ones performed at diabetes events by MNKD staff, the likely reason would be that the doctor owns a device himself and wants to bill for it rather than true lack of trust of the readout from the patient provided one... and in that case no harm with a second one, other than needless expense transferred into the insurance system. I honestly have no idea how that situation would work—If someone qualified to sign off on the spirometry results were to be present at the said event, it would be more sound. All you have in this senario is a person with a spirometry result that now that provider would be responsible for if he/she signs off on it. Basically, taking responsibility of something they did not order/were not present for. If the results were printed while at the event, and a physician were present and signed off on the results, then the results are valid and could hypotherically be used if said provider were comfortable doing so. I'm sure some of it comes down to liability issues. I'm just guessing with all of this, honestly have no clue. |
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Post by gonetotown on Oct 5, 2016 16:27:21 GMT -5
I read the black box differently:
Before initiating AFREZZA, perform a detailed medical history, physical examination, and spirometry (FEV1) to identify potential lung disease in all patients.
I see that as putting the burden on the doctor not only of diagnosing lung disease, but also of recognizing the potential for lung disease. Endos aren't trained to do that and I can see where they wouldn't want to accept the responsibility for doing it. I believe that's the real source of resistance, not the spirometry.
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Post by liane on Oct 5, 2016 16:41:24 GMT -5
Any physician (even an endo) can detect basic problems that would impair lung function. We all learn general medicine before we specialize. This applies to all drugs prescribed. A physician needs to know if a patient has impaired renal or liver function because this is how drugs are eliminated. A physician needs to know how a particular drug will affect any system in a given patient. Of course any physician will refer a patient when the issue is beyond the scope of his/her training. gonetotown, it's clear you know nothing about the practice of medicine. Your comments are getting quite tedious. I suggest you refrain from posting about topics you know nothing about. |
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Post by gonetotown on Oct 5, 2016 17:50:52 GMT -5
Any physician (even an endo) can detect basic problems that would impair lung function. We all learn general medicine before we specialize. This applies to all drugs prescribed. A physician needs to know if a patient has impaired renal or liver function because this is how drugs are eliminated. A physician needs to know how a particular drug will affect any system in a given patient. Of course any physician will refer a patient when the issue is beyond the scope of his/her training. gonetotown , it's clear you know nothing about the practice of medicine. Your comments are getting quite tedious. I suggest you refrain from posting about topics you know nothing about. "...know nothing about the practice of medicine..."? Really? Well, considering I scored in the top 7% on all three sections of the NBME exams -- which, when I think about it, probably puts me perhaps in the top 1-2% of the MDs in the entire country -- perhaps you should write to the NBME and complain about the lack of rigor in their testing process. |
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Post by liane on Oct 5, 2016 18:48:57 GMT -5
gonetotown, You don't say that you actually practice medicine.
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Post by Deleted on Oct 5, 2016 21:29:11 GMT -5
Any physician (even an endo) can detect basic problems that would impair lung function. We all learn general medicine before we specialize. This applies to all drugs prescribed. A physician needs to know if a patient has impaired renal or liver function because this is how drugs are eliminated. A physician needs to know how a particular drug will affect any system in a given patient. Of course any physician will refer a patient when the issue is beyond the scope of his/her training. gonetotown , it's clear you know nothing about the practice of medicine. Your comments are getting quite tedious. I suggest you refrain from posting about topics you know nothing about. "...know nothing about the practice of medicine..."? Really? Well, considering I scored in the top 7% on all three sections of the NBME exams -- which, when I think about it, probably puts me perhaps in the top 1-2% of the MDs in the entire country -- perhaps you should write to the NBME and complain about the lack of rigor in their testing process. After glancing at your past posts, it appears you are here to create FUD. |
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Post by gonetotown on Oct 6, 2016 10:34:55 GMT -5
gonetotown , You don't say that you actually practice medicine. Indeed, residency trained, board certified, licensed in two states -- just another pathetic example of American medicine going to hell in a hand basket, I suppose. |
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Post by sweedee79 on Oct 6, 2016 14:25:00 GMT -5
Gonetotown said "The ultimate test of whether spirometry is a "minimal barrier" is the number of endos doing them to prescribe afrezza. However, posted here when talking about the shareholder lawsuit was some testimony by a former afrezza rep saying that spirometry was a major barrier to getting endos to write scripts. Has anything changed? If it was a "major" barrier a year ago, why would it not be a major barrier now? And if it's so "simple," then why exactly is it a major barrier? "
I don't believe what this former Afrezza rep said... The spirometry test is not a barrier... the true barriers are the attitudes of docs.. lack of insurance coverage.. trust me... the first walls we ran up against were docs not wanting to change what they are doing ... the spiro was a snap.. a slight inconvenience .. no big deal and certainly not what has caused all of the problems.. Mike talked about docs having a small spiro machine right in the office and I would think that would be sufficient.. if not they can still order a test from lab and x-ray using the bigger machine.. NO BIG DEAL ..
Every single doc we have had contact with while trying to get a script for Afrezza had an attitude about it .. and said the insurance wont cover it anyway.. blah blah blah or they don't want to hassle with pre authorization.. etc etc etc .. Afrezza isn't established... that is the barrier we need to break.. anything we can do now to streamline the process and make it easier will help.. but the big problems are with insurance and docs.. particularly general practitioners.. docs order labs and x-rays everyday .. why would a spiro be such a big deal.??.. ITS NOT ..
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Post by compound26 on Oct 6, 2016 15:38:35 GMT -5
www.tudiabetes.org/forum/t/afrezza-as-a-correction-bolus/56490/50?u=charles5Terry4 (replying to gonetotown) gonetotown: And, curiously enough, almost invariably around 3-4 am! Always amazes me how diabetics always manage to crash between 3 and 4 am! This comment reeks of condescension and self-righteous judgment! You are obviously not here to participate in a peer support group. You choose to frequent our forum and come off as somebody who might bestow diabetes pearls of wisdom from someone who doesn't know squat about living with diabetes. Why don't you take your offensive and patronizing remarks someplace else?
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Post by peppy on Oct 6, 2016 15:44:29 GMT -5
Did the afrezza booth have blood glucose testing? strips?
Couldn't hurt. I wonder how many people want to know?
I'd get a blood glucose. Especially would like to know after eating, like at a fair.
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Post by gonetotown on Oct 6, 2016 19:11:50 GMT -5
Gonetotown said "The ultimate test of whether spirometry is a "minimal barrier" is the number of endos doing them to prescribe afrezza. However, posted here when talking about the shareholder lawsuit was some testimony by a former afrezza rep saying that spirometry was a major barrier to getting endos to write scripts. Has anything changed? If it was a "major" barrier a year ago, why would it not be a major barrier now? And if it's so "simple," then why exactly is it a major barrier? "
I don't believe what this former Afrezza rep said... The spirometry test is not a barrier... the true barriers are the attitudes of docs.. lack of insurance coverage.. trust me... the first walls we ran up against were docs not wanting to change what they are doing ... the spiro was a snap.. a slight inconvenience .. no big deal and certainly not what has caused all of the problems.. Mike talked about docs having a small spiro machine right in the office and I would think that would be sufficient.. if not they can still order a test from lab and x-ray using the bigger machine.. NO BIG DEAL ..
Every single doc we have had contact with while trying to get a script for Afrezza had an attitude about it .. and said the insurance wont cover it anyway.. blah blah blah or they don't want to hassle with pre authorization.. etc etc etc .. Afrezza isn't established... that is the barrier we need to break.. anything we can do now to streamline the process and make it easier will help.. but the big problems are with insurance and docs.. particularly general practitioners.. docs order labs and x-rays everyday .. why would a spiro be such a big deal.??.. ITS NOT ..
"the true barriers are the attitudes of docs..."? You are EXACTLY correct. Spirometry is likely a "red herring" which makes a good excuse to refuse to use afrezza. Like everyone else, physicians develop "grooves" -- routines that they feel comfortble with. Lispro has a very, very deep groove with endos. It doesn't require worrying about spirometry or pulmonary function tests. It doesn't require dealing with insurance companies prior authorization forms and filing appeals. They know lispro's physiology inside out, have memorized every medication interaction, and could recite appropriate dosing for any patient backwards and forwards. Mannkind could make spirometry as cheap and easy as taking a drink of water and odds are endos will still use it as an excuse not to prescribe afrezza. Forget spirometry reimbursement as a carrot since endos rake in more than enough loot with lispro and with fewer headaches. Indeed, like it or not, from the endo's perspective, afrezza has nothing going for it except that it doesn't require an injection. For the endo, the "rapid in/out" that so many treasure just creates management complications that he/she would just as soon not deal with. And the patient can threaten to go elsewhere, but since practically every endo in the country has a waiting list several pages long, it's simple enough for him/her to say, "go ahead." The only way to overcome this is a clinical trial clearly demonstrating that afrezza produces superior clinical benefits -- superior A1cs, fewer ER visits, less complications, etc. |
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Post by gonetotown on Oct 6, 2016 19:25:43 GMT -5
www.tudiabetes.org/forum/t/afrezza-as-a-correction-bolus/56490/50?u=charles5Terry4 (replying to gonetotown) gonetotown: And, curiously enough, almost invariably around 3-4 am! Always amazes me how diabetics always manage to crash between 3 and 4 am! This comment reeks of condescension and self-righteous judgment! You are obviously not here to participate in a peer support group. You choose to frequent our forum and come off as somebody who might bestow diabetes pearls of wisdom from someone who doesn't know squat about living with diabetes. Why don't you take your offensive and patronizing remarks someplace else? Well, to be fair, you should quote my entire response to this patient who has taken upon himself the task of self-diagnosing his condition and then self-treating in a manner that is in fact quite risk endowed: using intramuscular injections of RAI and then stacking another RAI -- afrezza -- on top. My original recommendation was simply to call his primary care physician to discuss the appropriateness of his conduct. For reasons I don't understand, he took great umbrage at this and produced a long, typically type 1, exposition about how the medical sysytem failed him, his providers were incompetent, and it was only through his own deep insight acquired by vast experience that he has managed to survive the past 33 years. My response was: "And I've spent almost as long dragging type 1s unconcious with hypoglycemia or DKA from the back seats of cars, beds of trucks, backs of ambulances, etc, into my ER! And, curiously enough, almost invariably around 3-4 am! Always amazes me how diabetics always manage to crash between 3 and 4 am! And once they've regained conciousness, I've had to listen to some variation of the line about "most doctors and many other medical staff do not have the depth of experience that I do" more times than I can count! And THEN I've had listen to their endos gripe and refuse to admit them because they're non-compliant and the endo doesn't want to mess with them anymore! So do all the ER docs in the world a really, really SMALL favor and call your endo! Can't HURT, can it?" And perhaps it is "self-righteous" and "condescending," but dealing with the consequences of seizures, vomiting, and failed sphincters can do that to some people after 30 years. |
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