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Post by stevil on Oct 5, 2018 15:44:58 GMT -5
This is horrible correct? It's either really good or horrible. Really good because MNKD now has a target to beat and knows who the enemy is. If they can prove safety, adherence, and efficacy over GLP-1s, it's going to be an easy road. Really bad because it'll take a lot of work. GLP-1s are known to help with weight loss and cardiac benefits. They're backed by heavy pockets who can afford to design advantageous trials and have greater resources to reach doctors. MNKD has its work cut out for it. Once you have a concept instilled in your mind, it takes a lot of convincing to change perceptions. MNKD may have to prove weight neutrality and cardiac benefit over time and across many different ethnic groups. They may have to prove adherence is higher and leads to better outcomes. They may have to prove the absolute risk ratio is lower with Afrezza vs GLP-1s etc. If you notice, GLP-1s have been on the market for a long time. Afrezza is different enough from other insulins that it may have to pay its dues and wait until the evidence shakes out to prove superiority. Fortunately, this shouldn't take longer than a year or so to flesh out. Adherence will be there only unknown variable at that point, mostly because GLP-1s can be injected every 1-2 weeks. It's a lot easier to adhere to that simplistic of a regimen.
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Post by stevil on Oct 5, 2018 9:18:12 GMT -5
Am on my critical care rotation and am working closely with the pulmonologist. She wanted to know how TreT compares to the IV PAH meds. Has anyone seen any data on that?
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Post by stevil on Aug 17, 2018 22:58:41 GMT -5
Not all docs are like that. I'd say the majority that I've been involved with are though. By and large, there isn't a whole lot of innovation in pharmacy outside of the new up-and-coming monoclonal antibody drugs. Most of the drugs that have come out in the past several years are "me too" drugs... just different formulations within the same class. Small improvements or supposed fewer side effects, etc of the same general medication. There generally isn't a significant benefit between the new brand drugs and a cheaper generic of an older drug. Some drugs are worth the extra time to get authorized and time will be spent to secure it for the patient. Just depends on the nature of the doc and if the situation warrants the effort. Usually, if there is evidence that a specific drug is needed above others, they'll go the extra mile. If not, they'll just switch it to a different drug in the same class.
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Post by stevil on Aug 17, 2018 22:08:24 GMT -5
Episode 67 of AFP podcast addressed intensive insulin therapy for type 1's and the benefits of tight glucose control. No mention of Afrezza... stevil, I Have a question. when you were in medical school, did you get a course/lecture on how medical (pharmacy) insurance works? Just started my 4th year, so I'm technically still in school, but no... there is so much science to learn that medical schools don't have time to teach students how the real world works. There's a funny video that my classmates passed along to each other that does a good job of illustrating the disparity between each level... It's funny because a lot of the preceptors/attendings concede that we know a lot of the science better than they do, but they know the useful/important information 92834739 times better than we do. Much of the info they teach in medical school is superfluous but it has to be in order to lay a strong foundation. You always lay a foundation as wide or wider than the structure. Long story short, most of that stuff is learned in residency, if it will be learned at all. It depends on the personality of the physician- how much control they want over their practice and how hard they're willing to work to keep as much money as they can. Most docs I've worked with A) are in a group practice and can afford an office manager that does billing/coding for them, B) (the vast majority private practice) outsource it to a company to handle it for them or C) work in a hospital that has an entire division that works on this for them. Docs for the most part don't want to be bothered with not only learning billing/coding rules that change very frequently- and likely will continue to- then have to sit down after all their hard work for the day and make sure they're catching every piece of revenue that they can based on the work they performed. There are probably tens of thousands of codes to learn. Look up ICD-10/CPT codes if you want good bedtime material. Good coding/billing people usually pay for themselves and then some on top of the convenience of not having to perform the work. You would not believe how much paperwork and documentation docs have to do. We spend more time doing paperwork than we do seeing patients more often than not because you have to CYA for malpractice, as well as document properly for insurances to get paid for your work. Pharmacy insurance doesn't get touched at all. That's pharmacy's business to sort out. If a drug isn't covered, you either do a PA, or more often, just switch it to another, cheaper drug that is a generic. Usually the pharmacy helps out with what's on a patient's formulary when they call or fax to change the drug or for a PA request. That and if you ask a patient why they aren't taking their meds and they tell you it's because their medication is too expensive are the biggest two ways I can think of for doctors hearing about pharmacy issues. Otherwise, it's a completely separate field altogether.
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Post by stevil on Aug 16, 2018 23:32:41 GMT -5
Episode 67 of AFP podcast addressed intensive insulin therapy for type 1's and the benefits of tight glucose control. No mention of Afrezza...
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Post by stevil on Apr 9, 2016 11:24:31 GMT -5
Yes, I made the mistake of not cross-checking my sources. I didn't think it would turn into this, otherwise I would have done so. I was incorrect and my source was not valid. To all who read this, the correct expiration for the Afrezza patent is 2023. My point was that we may only have a limited lifespan for Afrezza of several years. The date wasn't really all that important. It may be in our best interest for Afrezza NOT to become a blockbuster. It may be better for us to be just under the threshold of profitability for a generic manufacturer to compete with us. I would imagine developing this technology would be fairly expensive so if the ROI isn't significant, we would never have competition. I'm unsure if the patent protects from R&D or just sales, but I'm wondering if a generic manufacturer wanted to, if they could start immediately on cracking the code so to speak so that once the expiration is up, they could immediately sell the drug. It would kind of seem likely to me that this is allowed since generic drugs hit the market as soon as the patents expire for nearly every drug I'm aware of. I think you should sell Stevil.. honestly I really do... It isn't that you are bringing facts to the board that people don't like.. it is your attitude or the way you say things.. Just about everything you say is something negative .. I think everyone wants the facts pro and con... but it is all in the way you present it .. You seem to have no belief in MNKD at all.... I mean no disrespect but I don't think the problem is necessarily this board .. Thanks for your post. I considered it when I made my decision to get off the board. I'm clearly not helping anyone and I'm only giving more time to this than I really want to. My apologies if "the way I said things" came across the wrong way. I am fairly negative toward our current status, but I haven't completely lost hope. Matt's hiring spree gives me just enough to keep interest in the stock. May your dad keep finding success on Afrezza. I hope he keeps progressing in his disease.
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Post by stevil on Apr 9, 2016 11:18:12 GMT -5
Reminds me of several managers I've hired fresh out of college. When it came to practical application of their education? Let's just say that they only know this much: |×××××|… but think they know: |××××××××××××××××××××××××××××××××|. Going for the heart. Sort of expected more from a moderator, but that's fine... I am young and I'll find my way. No doctor is molded in their first year. I haven't even entered a hospital in my new capacity. But I have been learning science at a graduate level in a multitude of fields. Not many on here can say that so criticism seems kind of comical, if I'm being honest. Who is the one thinking they know more than they do when they say they know more than someone who is actually being educated to know these things? I've never claimed to know more than I do and I've always welcomed people to counter my arguments. The only responses I get to my arguments are personal attacks and condescending posts. I guess I should expect as much when it comes from the top down... The culture of this board is broken. I came here with the intent to try to share what I knew, challenge false info (Afrezza would cure diabetes) and to temper down the damaging optimism that found more people scooping up even more shares on a continuing basis and encouraging others to do the same. My heart has somewhat hardened towards this board in a way. I don't wish ill upon anyone, but if it comes to some of you, you'll have no one to blame but yourselves. Although I'm willing to bet it'll just be SNY, FUDsters, or hit pieces that take the fall. Nevermind that people have been warning you since the beginning that exactly what happened would happen. I hope for everyone's sake that this does turn around and I'll think back and smile on most of my time here. But I enjoy arguing a little too much apparently and I'd rather focus my time and efforts elsewhere. I envision the scene with William Wallace when he realizes that Robert the Bruce has switched sides on him. When even the moderators jump into the cesspool, what can you expect of the board? This board won't be what I want it to be and I'll accept that and move on. Thanks for all who have shared good info and have argued their points with dignity and grace. Thank you to all who have challenged my thinking and corrected me when I misspoke. Thank you to kball for the laughs Thank you patryn for not being such a homer and being able to eloquently express your thoughts without being rude. Your absence was missed and welcome back. Thank you peppy for all your informative posts, even though I didn't understand what you were saying half the time Thanks to all who privately messaged me and encouraged me to be your voice. I'm tired of wasting my breath. Thanks to sportsrancho for seeming as beautiful on the inside as you are on the outside. Even though I know you disagreed with me, you were always kind. Thank you mnholdem for all the good info you used to bring. For reading all my garbage even when you didn't want to and for finally giving me the push I needed to quit wasting my time on here. Thanks to thekindaguyiyam and nylefty for always making me feel so attractive and never letting me feel like I was alone. And finally, thank you liane for providing a forum for us to disagree on. Hundreds and thousands of people have this opportunity because of you. I'm sorry if this seems dramatic, but I will miss my time on here. I'm not meaning to make a scene for my sake... It just feels appropriate to me to say goodbye. It's been fun butting heads with some of you and learning from others. I'm sure many on here will say good riddance to me and that's OK May we all see the beauty in life outside of money. And may MNKD recover and make everyone at least whole if not multiples more. May this board not be hostile but informative. Maybe it can be realized in my absence. Goodbye all. Thanks for the memories!
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Post by stevil on Apr 8, 2016 13:46:03 GMT -5
Stevil said "But the AP likely wouldn't be the best option for those who were properly educated and motivated to take the best care of themselves. In other words, Afrezza would still be superior, but it'd come down to preference, convenience, and proper understanding of how to use each tool." (I messed up the quote formatting and can't fix it.) The data in the Ted talk video would suggest that this might not be true. It could be that glucagon and slow insulin give the same results as afrezza. Just because the AP will be easier and more convenient does not mean it will inferior to something (afrezza) that requires more effort. This would be great for T1Ds. As someone else mentioned here, there is still a need for afrezza in many T2Ds.
I hadn't seen that post yet. I'll have to give it a listen sometime. I'm curious to hear how it'd be as good... I wonder if they're using incomplete data since the superiority studies haven't been completed. According to what we were taught in class (sorry on my phone and don't care to reference a source), the type 2 market was 4-5 times larger (and growing) so there will still be plenty of people in need of prandial insulin if they can compete with metformin
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Post by stevil on Apr 8, 2016 13:23:39 GMT -5
Her view on Afrezza was that it could make waves, but that it'd have to do so quickly as Lilly views their system as being more favorable to meet DM1 demand. It essentially allows them to forget about taking care of themselves. Everything would be automated. The highlighted section is key. I can live my life without having to think about glucose levels at all. No CGM alerts, no blood monitoring, no insulin bolus (inhaled or injected), no random spikes and drops, no worry about drinking (*cough*) or exercise, I can eat or snack when and what I want - just living. Why would I not want that? The reason I'm sticking with this stock for now is to give diabetics the choice to make the "right" decision. Convenience isn't the best option necessarily. It would be for those who don't place high importance on treating their bodies the best way possible. There is likely a large percentage of diabetics who want to not take their healthcare in their own hands. I think anybody with a chronic disease would be guilty of that- not trying to stereotype diabetics in that respect. But the AP likely wouldn't be the best option for those who were properly educated and motivated to take the best care of themselves. In other words, Afrezza would still be superior, but it'd come down to preference, convenience, and proper understanding of how to use each tool.
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Post by stevil on Apr 8, 2016 11:20:04 GMT -5
Lilly is working on something similar. My cousin works in the research department there and was sharing something very similar with me when I saw her a couple months back. Her view on Afrezza was that it could make waves, but that it'd have to do so quickly as Lilly views their system as being more favorable to meet DM1 demand. It essentially allows them to forget about taking care of themselves. Everything would be automated. Pretty tough to get an Artificial Pancreas System to react to your every meal, (and snacks). Mealtime glucose spikes will always need special attention in my opinion. Afrezza is here to stay. ya, I'm curious to see how it works. From what she said, it'd be linked to your phone and you'd have a few options... you'd pick small meal, snack, large meal and it'd shoot a bolus of insulin, probably larger than needed because the glucagon could always correct on the over and as agedhippie said, it's much faster than insulin, so it'd be better to shoot too much rather than not enough. There was also talks of being able to take a picture of your food and the device would somehow figure out how much to release. I'm not trying to dissuade anyone from investing in Afrezza. It's just wise to be aware of what else is on the horizon with the competition. I have only talked to 3 diabetics, but their faces light up whenever they talk about it, but that's probably because they're already educated on the AP. I just think that Afrezza might require too much education for diabetics to really get excited about. I'm not sure they understand the science behind it all too well... Hopefully we'll get everyone hooked on Afrezza before all this stuff comes out so that they won't even want an AP
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Post by stevil on Apr 7, 2016 23:37:00 GMT -5
How can the beta bionics device work so perfectly? Does the glucagon make up for the non-ultra-fast insulin used with the device? The graph in the Ted Talk video looks so good it looks like afrezza isn't necessary if you use this device. Kudos to you for watching the Ted Talk! The guy is brilliant. Yes, the glucagon is largely responsible for the performance. It mimics what the body does and causes excess insulin to be neutralized. Glucagon works extremely fast, far faster than even Afrezza, so it catches you the moment you begin to drop. This allows you to dose the insulin aggressively locking your level into the range you saw. Some of the AP systems use FIAsp which is Novo Nordisk's faster acting insulin (FDA approval expected mid to later 2016). While faster than Novolog it is not as fast as Afrezza. Other than a mechanical failure it is very difficult, borderline impossible, to become hypoglycemic with this system. I want one, as does almost every Type 1 I know! Lilly is working on something similar. My cousin works in the research department there and was sharing something very similar with me when I saw her a couple months back. Her view on Afrezza was that it could make waves, but that it'd have to do so quickly as Lilly views their system as being more favorable to meet DM1 demand. It essentially allows them to forget about taking care of themselves. Everything would be automated.
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Post by stevil on Apr 7, 2016 16:26:53 GMT -5
I'm curious to hear why it isn't done for every drug... Even though I'm usually not swayed by peer pressure, I'd much rather hear about medicine from one of my favorite athletes than all of those boring commercials that play with the awful music. Although my age group probably isn't the target audience for most drugs....
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Post by stevil on Apr 7, 2016 16:20:03 GMT -5
peppy et all, The following is my opinion. I hope you choose not to take it personally or take offense to anything, although the following might be offensive. There is no conspiracy going on with Afrezza. There are no paid bashers for this stock. There might be people who come on here with the intent to rile you all up because you're so passionate about Afrezza and some people really enjoy pushing buttons to get a rise out of people, but I can assure you, even if these minions existed, they're not nearly as plentiful as you think. These "FUDsters" would maybe gain a dollar for their efforts in the stock market if they caused you to sell your shares. MNKD is where it is because Afrezza sales are lacking and we have no real cash flow, and currently, no communicated plan for how we're going to survive past the end of the year. Paid bashers would not be responsible for this. I know the sentiment here is that there is this massive campaign out to smear Afrezza, and while that might be partially true, it's not unique to MNKD. Every company has hit pieces against them. I think you all notice them so much more regarding MNKD because you follow this stock so closely. Every stock that I have followed in the past has people who complain about manipulation, hit pieces, MM corruption, etc. It's just the system we are forced to play in. Where there is money to be made, people will do what it takes to make money. MNKD had a target on its back from the start because the shorts correctly identified all the "FUD" early on. It was much clearer to them long ago than it is to some of us even today. Kudos to them for figuring it out. Shame on some of us for still being too stubborn to try. I think it's dangerous to assume this massive conspiracy exists because it becomes the scapegoat for all the negative things about this stock. Facts and truths have been mislabeled as FUD instead of facts and truths. Sometimes people just express their opinions about things, especially analysts who get paid to do it. The trick is to dissect truth from lies, and so far the MNKD faithful hasn't done a tremendous job of that and the "FUDsters" have. The Street doesn't tell doctors how to prescribe. The Street doesn't tell diabetics not to be interested in inhaled insulin. The Street is the effect of both of those things, not the cause. I'm not saying that this can't all change and we won't have our day in the sun. But I find that good information sometimes falls on deaf ears around here and it's really sad. This board has been interesting in the sense that people have assumed a battleground identity. It's an "us against them" mentality. You're forced to pick a side as either long or short and that stance defines who you are and whether someone will like you or not. You're not allowed to be a hopeful long with questions about how MNKD will solve this issue or that issue that are actually causing you to be a short because you're not seeing enough evidence of effective problem solving from management and/or a viable market for your drug. And heaven forbid, if you make a mistake or miscommunicate a point, you get eaten alive. Ha, can't we all just get along? Can't we all have opinions and have civil discourse? Can't we exchange viewpoints and challenge each other with our assertions? I don't take issue with anyone whose viewpoint is different than mine as long as they have solid reasoning to back up their beliefs. I wish others felt the same... Stevil: Among your recent expressed concerns: Lilly’s artificial pancreas on the horizon Endless management mistakes Patent expiration Credibility of Afrezza user social media posts Obsolescence via generic encroachment No TS market – MNKD a one trick pony MNKD’s failure to stand is completely isolated and 100% their own doing. There is no oppositional & concerted effort from FDA, BP, GS, M Fool, The Street, etc SNY did not sandbag Afrezza = Afrezza was just not worth their effort Stem cells will cure diabetes “before too long.” Two of your recent summations >>We don't just need money to survive because if we get just a little, we'll just prolong the inevitable and die a slow and miserable death.<< >>And just because the lights are still on in the business doesn't mean it's actually really alive. It just means it hasn't died yet.<< Pervasive pessimism to the point of assuming (patent, etc.) things are worse than they are. Yet, you’re still long on MNKD! If you were my doctor and equally long on my health, I hope you’d not take personally my strong desire to get a second opinion. Again, no offense taken. And I completely understand where you're coming from. I think I've finally crossed over into the 'emotional' camp where I want so badly for this company to succeed that I feel like it's my duty at this point to do all that I can. And there's still enough hope left in me to give it one last shot. I feel like if there isn't a suitable plan in place next month, it'll be too late (if it isn't already) to get this thing straightened out. To be fair, you must have also missed the posts where I said that I'm still young, this is in my "risky account" and that I was going to go down with this thing as low as I felt I could. I didn't want to sell until I knew that there was no hope because the difference between where we are now and how much farther we can go isn't that large. For me, only a couple thousand more dollars. With my student debt mounting up and collecting interest by the day, money has sort of become devoid of value. I won't invest with borrowed money, but I also don't mind if I lose everything I have, either. Investing is fun for me because I try to not allow money to hold too much value in my life. It's more about how much can I earn, how much can I grow. I don't necessarily view money as something to spend, but more of a game to see how much I can acquire. I'm sure my girlfriend and future children will take care of all of that for me... Also, to be even fairer, all of those posts have come within the last couple weeks. I've been down on this stock for a long while, but now that I'm seeing April 5 wasn't really the turnaround date... that it won't come until much later... my patience is growing even thinner. I was aware that Matt wasn't able to make any deals until he got Afrezza back, but I was hoping for a little bit bigger of a splash as far as updating everyone with where we were and where he's planning on taking us. Even saying this is what I hope to accomplish by next CC would have been welcomed so that we know he's making progress... because I can already hear it now... we need more time, hang in there with us... we'll get it straightened out... just like always. Some men just don't know the ends of themselves. I'll give Matt an A+ in determination, but sometimes it takes more than willpower to make things happen. I'm hoping we're not past that point, although I fear we might be. I'll be waiting until next month to find out...
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Post by stevil on Apr 7, 2016 16:08:06 GMT -5
I'll admit, a lot can be left to interpretation. No one really knows all the facts except for maybe MNKD. That was a very good post... And I, like you, hope that there's still enough time for us to try on our own and see if it was really SNY's fault or if they gave up early to quit while they were still ahead. Also, just because SNY didn't think Afrezza was worthwhile doesn't mean that's the truth.... I'm refreshed to hear that the diabetics you're talking to have interest. While the diabetics I know all fit on one hand, they're all pretty content with how their care is being handled and don't want to switch. It's that whole, they don't know how sick they are because they've never felt good idea. I feel like diabetics would probably only listen to people they have good relationships with so the people sharing stories about online discussions probably shouldn't be expected to go any other way. I'd imagine it'd be hard for me to listen to someone who wasn't suffering with my disease tell me how to take my medication. I truly just want a chance... just a chance to really do this thing right. I'm not as trusting of Matt as you are... management has been overly secretive in the past and nothing ever came to fruition. Matt is too skillful with his words to be trusted. It's not a bad thing... it's what you want when your company is doing well, but it's awful when it's not. I have just enough hope left to last until next CC. After that, I'm not really sure what I'm going to do. I know the right thing to do would be to capitulate, but I really really want this company to succeed. And for all of you longs who have held out for so long. Forgot about the AF point you'd raised... I can't remember what another poster had said about him, but I vaguely remember someone saying that the beef between AF and MNKD was something personal. I think it might have been in regards to Al. But even with that, another one of the companies I'm invested in has extremely strong fundamentals (unlike us ) but has hit piece after hit piece come out against it for who knows why. It beats earnings every quarter and carries a hefty dividend on top. But it's still down almost 20% from its high at the beginning of last year. The whole market is corrupt. Even the products that sell well and produce great margins are struggling in this market.
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Post by stevil on Apr 7, 2016 15:55:59 GMT -5
Don't know what other thread I should put this in and didn't want to start one just for this, but I ran into a 1st year pharm student on campus today and they'd said they'd learned about "this new inhaled insulin" in class recently. I'd asked if they'd been taught the PD/PK profile and they didn't seem to know much about it... I thought that was odd, but at least they're being taught about it in school! Even pharmacy school can't get us any added exposure beyond it's inhaled! Really need some studies!!! Hi. Interesting experience, would you be able to post more detail on the conversation? Would be good to know what message students get and how. Thanks She had a test tomorrow and was panicking about having to know the top 175 drugs for her test tomorrow. I didn't really get to talk much about Afrezza... she was just sharing some of her stories and venting a little bit. I threw in a question about prandial insulin to see what she was getting taught and she told me that "there's this new inhaled insulin that just came on the market last year". That's when I'd asked if she'd seen the PK/PD graph, and she said that she couldn't remember, that they didn't spend a lot of time on it, just that they'd mentioned it when they were doing the rapid acting insulins. I took a quick minute to tell her that the profile nearly identically matched the pancreas, but she was like, "cool story, bro". It wasn't really all that informative of an encounter. She was stressed out and it was just a quick conversation in passing. My girlfriend is sitting for her dietitian certification exam this summer when she graduates and I've already started to work on her She can't prescribe, but she'll work closely with patients and physicians in many diabetes cases. I'm doing my part!
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