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Post by afrezzamiracle on Feb 17, 2017 1:35:21 GMT -5
If MNKD & RLS would get their shit together hopefully we will soon have some Technosphere Cricket inhaler based THC to help us long suffering longs kill the pain. I know I could sure knock back a few of those!
For Gods sake, hopefullly the 3rd time is indeed the charm, and we'll actually start selling significant quantities of Afrezza this time around. Now that would REALLY help kill the pain!
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Post by babaoriley on Feb 17, 2017 1:50:47 GMT -5
It really is shocking to me how little has been done at this point to market Afrezza and raise awareness. I have a family member who is in the health care system in the Northeast and manages various practices. Today is literally the first time someone has come in to introduce one of his practices to Afrezza. The physicians literally have never heard of it before. The questions the physicians were asking (about spirometry and cancer concerns) are issues that were being discussed 2 years ago here. While the physicians came away impressed and are going to try Afrezza on a few targeted patients, it is crazy to me that this is the first time they have been exposed to Afrezza. The person who gave the presentation from MNKD was the regional sales manager because according to him, his team hasn't been fully built out yet. kid, very unfortunately, what you write is not shocking to me. At least it gives some explanation for the extremely disappointing scripts to date. There's a whole world out there that still has never heard of Afrezza.
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Post by lakon on Feb 18, 2017 4:06:16 GMT -5
I wanted to provide a bit more information that has been provided to me regarding my original post. The regional sales manager visited another of the practices that my family member helps run today. While the first practice had one endo embedded in a group of physicians, this practice was solely made up of endos. Though obviously a small sample, I'm hopeful (optimistic even)that a concerted effort is finally being made now that we have our own sales team. One question asked by one of the endos was "Is Afrezza weight neutral"? The sales manager was not able to answer the question and said he would have to get back to the endo on that particular question. I am in sales. The answer is, "Of course it is, does anyone else have any questions?" I like your answer, but again, MNKD is too conservative. Hopefully, someone from MNKD's medical dept. gets back to the endo and schools the salesman. I would have said that according to the trials we saw less weight gain than with Lispro, or whatever was the most accurate with the least information, like yours, but a little dig against the competition. Don't explain why. Refer to medical dept. That said, if he presses, "The answer is YES, theoretically, if titrated properly, and we are working on the trials to meet FDA regulations so that we can say so to a wider audience. If you require further explanation, I can arrange a discussion between you and our medical department. Since Afrezza is monomeric RHI, it follows, but I'm not a doctor..." (Do you see how I said so without saying so?) Once the door was opened, it might be good to draw comparisons with RAA. Then, say according to the trial data and recent anecdotal evidence of patients, we believe that transitioning off RAA to Afrezza could result in weight loss until a patient reaches a new equilibrium. Again, we are looking forward to new trials and data to confirm on a larger scale with the FDA. If you are interested, we can provide more information as this progresses. We are also more than happy to include you and your patients in future trials and papers. Bait the hook so the endo can publish...
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Post by lakon on Feb 18, 2017 9:24:36 GMT -5
One more thing: MNKD needs to convince the endos that they will work with them, like Apple did with the music industry and telcos (cellular networks). After Apple took large enough market share, the tables turned a bit in the negotiations so they could innovate more freely...
I'm a bit concerned that the endos worked a little too closely with the current incumbents long ago before the laws changed. Now, they want to pretend it never happened... Of course, MNKD cannot play the same game because times have changed. Maybe after we make America Great Again!
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Post by falconquest on Feb 18, 2017 10:02:40 GMT -5
I am in sales. The answer is, "Of course it is, does anyone else have any questions?" I like your answer, but again, MNKD is too conservative. Hopefully, someone from MNKD's medical dept. gets back to the endo and schools the salesman. I would have said that according to the trials we saw less weight gain than with Lispro, or whatever was the most accurate with the least information, like yours, but a little dig against the competition. Don't explain why. Refer to medical dept. That said, if he presses, "The answer is YES, theoretically, if titrated properly, and we are working on the trials to meet FDA regulations so that we can say so to a wider audience. If you require further explanation, I can arrange a discussion between you and our medical department. Since Afrezza is monomeric RHI, it follows, but I'm not a doctor..." (Do you see how I said so without saying so?) Once the door was opened, it might be good to draw comparisons with RAA. Then, say according to the trial data and recent anecdotal evidence of patients, we believe that transitioning off RAA to Afrezza could result in weight loss until a patient reaches a new equilibrium. Again, we are looking forward to new trials and data to confirm on a larger scale with the FDA. If you are interested, we can provide more information as this progresses. We are also more than happy to include you and your patients in future trials and papers. Bait the hook so the endo can publish... Quite frankly I'm not sure we understand the question which is why the salesperson should have queried the Doc further. My interpretation of the question is that "weight neutral" means, is dosing the same for someone that weighs 300# as for someone who weighs 150# therefore being "weight neutral"? A good salesperson would have asked for clarification. I don't always know the answer to customer questions but I also can't get the proper answer until I understand the basis of the question. That's how you learn in sales.
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Post by sayhey24 on Feb 18, 2017 10:32:52 GMT -5
I wanted to provide a bit more information that has been provided to me regarding my original post. The regional sales manager visited another of the practices that my family member helps run today. While the first practice had one endo embedded in a group of physicians, this practice was solely made up of endos. Though obviously a small sample, I'm hopeful (optimistic even)that a concerted effort is finally being made now that we have our own sales team. One question asked by one of the endos was "Is Afrezza weight neutral"? The sales manager was not able to answer the question and said he would have to get back to the endo on that particular question. Thanks for the updates, its good some one after 2 years is actually talking to the doctors. It seems that the salesman did not make perfectly clear what afrezza is. That is concerning. afrezza is the exact same insulin which is excreted from the pancreas. It is NOT an analog or some other chemical concoction. It is monomer human insulin. What afrezza does is replace the phase 1 and phase 2(on second dosing) insulin release lost for one of a dozens plus reasons in the pancreas. What afrezza does is provide a natural pancreatic function through the Technosphere inhalation system. With that said, does the pancreas cause weight gain, NO. With typical ANALOG insulin therapy the PWD is always fighting the highs and lows and eating more to offset this imbalance. There is no need to do that with afrezza. If they are not taking another medication which effects liver function, the liver should resync with afrezza and whatever function is left with the pancreas to naturally offset over dosing just like the natural healthy pancreas and prevent the lows. No need to eat more and gain weight. Also, these endos in most cases should be putting these patients on a low carb diet. They don't need to go crazy and they don't need to do exact carb counting but if they reduce their carbs there is a pretty good chance their PWD will loose some weight. Is there a list of the new afrezza sales team some where? Maybe you can get this new sales rep the answer and include the info above from the 171/175 studies.
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Post by golfeveryday on Feb 18, 2017 10:57:32 GMT -5
I wanted to provide a bit more information that has been provided to me regarding my original post. The regional sales manager visited another of the practices that my family member helps run today. While the first practice had one endo embedded in a group of physicians, this practice was solely made up of endos. Though obviously a small sample, I'm hopeful (optimistic even)that a concerted effort is finally being made now that we have our own sales team. One question asked by one of the endos was "Is Afrezza weight neutral"? The sales manager was not able to answer the question and said he would have to get back to the endo on that particular question. Thanks for the updates, its good some one after 2 years is actually talking to the doctors. It seems that the salesman did not make perfectly clear what afrezza is. That is concerning. afrezza is the exact same insulin which is excreted from the pancreas. It is NOT an analog or some other chemical concoction. It is monomer human insulin. What afrezza does is replace the phase 1 and phase 2(on second dosing) insulin release lost for one of a dozens plus reasons in the pancreas. What afrezza does is provide a natural pancreatic function through the Technosphere inhalation system. With that said, does the pancreas cause weight gain, NO. With typical ANALOG insulin therapy the PWD is always fighting the highs and lows and eating more to offset this imbalance. There is no need to do that with afrezza. If they are not taking another medication which effects liver function, the liver should resync with afrezza and whatever function is left with the pancreas to naturally offset over dosing just like the natural healthy pancreas and prevent the lows. No need to eat more and gain weight. Also, these endos in most cases should be putting these patients on a low carb diet. They don't need to go crazy and they don't need to do exact carb counting but if they reduce their carbs there is a pretty good chance their PWD will loose some weight. Is there a list of the new afrezza sales team some where? Maybe you can get this new sales rep the answer and include the info above from the 171/175 studies. Good summary. I can't wait to see some patients be switched from analog to Afrezza and see what happens with weight in real life. Obviously reps can't say this but I can bet these patients will lose weight.
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Post by sayhey24 on Feb 18, 2017 11:15:51 GMT -5
Thanks for the updates, its good some one after 2 years is actually talking to the doctors. It seems that the salesman did not make perfectly clear what afrezza is. That is concerning. afrezza is the exact same insulin which is excreted from the pancreas. It is NOT an analog or some other chemical concoction. It is monomer human insulin. What afrezza does is replace the phase 1 and phase 2(on second dosing) insulin release lost for one of a dozens plus reasons in the pancreas. What afrezza does is provide a natural pancreatic function through the Technosphere inhalation system. With that said, does the pancreas cause weight gain, NO. With typical ANALOG insulin therapy the PWD is always fighting the highs and lows and eating more to offset this imbalance. There is no need to do that with afrezza. If they are not taking another medication which effects liver function, the liver should resync with afrezza and whatever function is left with the pancreas to naturally offset over dosing just like the natural healthy pancreas and prevent the lows. No need to eat more and gain weight. Also, these endos in most cases should be putting these patients on a low carb diet. They don't need to go crazy and they don't need to do exact carb counting but if they reduce their carbs there is a pretty good chance their PWD will loose some weight. Is there a list of the new afrezza sales team some where? Maybe you can get this new sales rep the answer and include the info above from the 171/175 studies. Good summary. I can't wait to see some patients be switched from analog to Afrezza and see what happens with weight in real life. Obviously reps can't say this but I can bet these patients will lose weight. Its concerning that this whole Analog point is not being driven home and all the problems they create at meal time. Mannkind should never have agreed to the 171/175 to compare afrezza against RAA's. Analogs are analogs. They are not human insulin. Now people want to call afrezza Ultra rapid acting. Ultra to what Analogs? Its not Ultra to the pancreas its the same. Analogs are not Rapid when compared to the pancreas, maybe slow but more like a BIG mess. IMO, they need to start beating down on the Analogs as not natural and concerning and a BIG mess. The only thing a bigger mess are all the other concoctions they are giving the PWDs because they don't want to give them insulin because the Analogs are such a mess.
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Post by saxcmann on Feb 18, 2017 11:26:47 GMT -5
I like your answer, but again, MNKD is too conservative. Hopefully, someone from MNKD's medical dept. gets back to the endo and schools the salesman. I would have said that according to the trials we saw less weight gain than with Lispro, or whatever was the most accurate with the least information, like yours, but a little dig against the competition. Don't explain why. Refer to medical dept. That said, if he presses, "The answer is YES, theoretically, if titrated properly, and we are working on the trials to meet FDA regulations so that we can say so to a wider audience. If you require further explanation, I can arrange a discussion between you and our medical department. Since Afrezza is monomeric RHI, it follows, but I'm not a doctor..." (Do you see how I said so without saying so?) Once the door was opened, it might be good to draw comparisons with RAA. Then, say according to the trial data and recent anecdotal evidence of patients, we believe that transitioning off RAA to Afrezza could result in weight loss until a patient reaches a new equilibrium. Again, we are looking forward to new trials and data to confirm on a larger scale with the FDA. If you are interested, we can provide more information as this progresses. We are also more than happy to include you and your patients in future trials and papers. Bait the hook so the endo can publish... Quite frankly I'm not sure we understand the question which is why the salesperson should have queried the Doc further. My interpretation of the question is that "weight neutral" means, is dosing the same for someone that weighs 300# as for someone who weighs 150# therefore being "weight neutral"? A good salesperson would have asked for clarification. I don't always know the answer to customer questions but I also can't get the proper answer until I understand the basis of the question. That's how you learn in sales. "We" understand the question. Weight neutral is about weight gain or loss in patients. No clarification needed for this endo question.
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Post by lakon on Feb 18, 2017 11:40:44 GMT -5
Quite frankly I'm not sure we understand the question which is why the salesperson should have queried the Doc further. My interpretation of the question is that "weight neutral" means, is dosing the same for someone that weighs 300# as for someone who weighs 150# therefore being "weight neutral"? A good salesperson would have asked for clarification. I don't always know the answer to customer questions but I also can't get the proper answer until I understand the basis of the question. That's how you learn in sales. "We" understand the question. Weight neutral is about weight gain or loss in patients. No clarification needed for this endo question. I think that the endo was referring to weight gain. Weigh neutral or loss would be clear advantages for Afrezza that may not be said directly. "Everyone knows" insulin causes weight gain, but not really insulin, rather excess insulin, especially insulin that lingers on and on w/o outsulin... In light of falconquest providing clarification, I prefer her original response with the plausible deniability as a response to any endo trying to trap her...good job falconquest, you get my salesman of the year award...add that one to the undocumented training manual...(we need some street smarts)...
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Post by thekid2499 on Feb 18, 2017 12:05:45 GMT -5
Yes, the endo was referring to whether Afrezza is weight neutral or if it has been shown to cause weight gain or weight loss. Unfortunately, I don't know the Mannkind regional sales rep at all so I'm not in position to provide him any information. I know the manager who manages some of the practices that he is now visiting, but would never put him in the weird position of providing information to pass along to his doctors.
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Post by lakon on Feb 18, 2017 12:23:05 GMT -5
Sometimes you have to fight stupidity with stupidity. I must have been stupefied by the question. That should keep the regulators at bay.
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Post by agedhippie on Feb 18, 2017 14:59:36 GMT -5
As I remember the trials data for Type 1 supports the weight gain/loss in Afrezza's favor and it was statistically significant so the salesman can state it. The problem is the sales material they are usng assuming the salesman was properly trained.
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Post by sayhey24 on Feb 18, 2017 17:18:35 GMT -5
As I remember the trials data for Type 1 supports the weight gain/loss in Afrezza's favor and it was statistically significant so the salesman can state it. The problem is the sales material they are usng assuming the salesman was properly trained. You are correct and Compound26 posted the trial info on the previous page. Pages 85 and 89 of the Afrezza FDA briefing documents: www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/EndocrinologicandMetabolicDrugsAdvisoryCommittee/UCM390864.pdfBut think about the question. Does human insulin cause weight gain? This suggests to me either the sales rep did not impress upon the doctors what afrezza is and how its pharmakinetics mimic the pancreas or the doctors do not know what insulin does or do not understand the importance and uniqueness of having the same pharmakinetics as a healthy pancreas and why that is so important for proper liver function including preventing hypoglycemia.
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Post by agedhippie on Feb 18, 2017 18:42:27 GMT -5
As I remember the trials data for Type 1 supports the weight gain/loss in Afrezza's favor and it was statistically significant so the salesman can state it. The problem is the sales material they are usng assuming the salesman was properly trained. You are correct and Compound26 posted the trial info on the previous page. Pages 85 and 89 of the Afrezza FDA briefing documents: www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/EndocrinologicandMetabolicDrugsAdvisoryCommittee/UCM390864.pdfBut think about the question. Does human insulin cause weight gain? This suggests to me either the sales rep did not impress upon the doctors what afrezza is and how its pharmakinetics mimic the pancreas or the doctors do not know what insulin does or do not understand the importance and uniqueness of having the same pharmakinetics as a healthy pancreas and why that is so important for proper liver function including preventing hypoglycemia. Human insulin causes weight gain. If I was a salesman I would avoid getting into mechanisms because that can invite disaster - it is sufficient to say Afrezza does not seem to according to the trials data and to give that data to the doctor. It answers their question and shuts down an objection which is the result you want. Once you get into mechanisms you are on very shaky ground because insulin is only one corner of the glucose metabolism and diabetes is a disorder of the entire glucose metabolism, not just insulin. For example an insulin release it accompanied by a glucagon release and an amylin release amongst others, and when you take insulin rather than using your own insulin all of this is missing. People focus on glucose levels because they are easily measured but they are just one aspect of diabetes. In addition to the combo releases and counter-regulations above you find if you have diabetes taking vitamin D is pretty much mandatory because in most cases you have a deficiency. Likewise B12 is a good idea. Exactly why these vitamins are deficient or now play an outsized role is a research topic, it's just that they do. These are some of the problems a salesman is going to walk into if they attempt to get debate this with endos - my bet is that most salesmen are not up to this debate so stick to the trials data and sell off that because it is defensible.
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