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Post by dreamboatcruise on May 10, 2018 17:31:09 GMT -5
Yes, there is an argument for immediate decimation of any scientific work Did you really mean decimation? Hmmm... thinking about ADA and MNKD trials... I guess that was Freudian slip. Hopefully we'll be getting some dissemination of the results this time.
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Post by dreamboatcruise on May 10, 2018 16:50:27 GMT -5
Afrezza is better .. when dad was on Afrezza everything was better.. He lost weight.. had more energy.. blood pressure was lower.. as were his numbers.. No one can convince me that sub q is even close to Afrezza when it was obvious that my dad's body was functioning in a much healthier state while on Afrezza.. Endos need to get with it.. They aren't doing a service to PWD by ignoring the benefits of this amazing insulin. If only MNKD had been sitting on a few hundred million to really push trials to show these results. It will come eventually, but because of financial situation it's a slow tough climb. STAT will hopefully be useful but it isn't large/long enough to show the likely cardiovascular benefits of tight TIR. I think some docs will inherently believe in benefits from good TIR... but some likely not, and payers may play dumb until consensus forces them to do otherwise.
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Post by dreamboatcruise on May 10, 2018 16:27:03 GMT -5
Spencer is strictly a numbers guy. He does NOT understand the science but at times he claims he does. That in my opinion greatly diminishes the accuracy (so far) of his forecasts as he shows ignorance and bias. Script growth has been lower than his forecast models (so far). If he understood the science he would have projected slower growth? That doesn't make sense.
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Post by dreamboatcruise on May 10, 2018 15:53:53 GMT -5
Optics aren't great with the target reduction... though once the turn around really hits, this will mean we'll get a target raise sooner
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Post by dreamboatcruise on May 10, 2018 15:45:19 GMT -5
I think it was images of the slides that they didn't allow to be posted. I don't believe Mike tweeting "Wow, we had 200 people at our seminar" would run afoul of ADA rules. Yes, there is an argument for immediate decimation of any scientific work, but most organizations that run conferences like this feel that to have a successful conference they must assure that there are new results being presented. Perhaps they are wrong and could still get good attendance even if study results could be announced early.
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Post by dreamboatcruise on May 10, 2018 15:40:06 GMT -5
For the most part, to me anyway, the difference in the way PWD make corrections when using one or the other products, (Afrezza vs RAA’s), is,,, Using RAA’s, PWD tend to lean towards the “defensive eating” that dbc speaks of, or eat more carbs to prevent going too low. And when using Afrezza, they use more Insulin, (product), to prevent going too high. If I had to choose, I would definitely choose Afrezza to avoid the weight gain associated with trying to keep tight glucose control using RAA’s. How this feature of the ability to use more product prevent highs vs eat more carbs to prevent lows doesn’t prove superiority is beyond me !! It just seems obvious,, There are certain people that are either playing dumb, or just plain stupid. Just my opinion. ✌🏻 In addition to defensive eating eating between meals to counter the RAA tail, I think the other approach that can work with RAAs is to maintain a very low carb diet so that not much prandial is actually needed because of not needing to suppress a carb induced spike... but for many that is simply an unacceptable lifestyle. If they do the trials to show what you and I are speculating on, then that will prove superiority. Just need to have trials with proper dosing regimen. With the one caveat that it seems impossible to optimally dose Afrezza in a double blind trial.
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Post by dreamboatcruise on May 10, 2018 15:31:32 GMT -5
joeypotsandpans... the ignorant one as you call him was skeptical about the label change impact. On the call management admitted that they overestimated the impact of the label change. So the person that got it right is ignorant and the one that got it wrong is brilliant? As I posted earlier I think that he is missing the point of STAT a little, but I also think you are far too critical of someone that in general presents pretty reasoned commentary. No one has a crystal ball about the behavior of doctors, as witnessed by management's self confessed mistake on label change. It may end up that SO's assessment of impact of STAT is off the mark now, but even if that comes to pass I'd put it in the same category as management's mistake on label... i.e. can't read the collective minds of doctors. I'm humble enough that I realize I'm only guessing at what impact I think the STAT study will have, as I was only guessing on label.
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Post by dreamboatcruise on May 10, 2018 14:41:28 GMT -5
On another topic... interesting that MNKD dropped their checklist. Also, no mention of One Drop or RLS.
(deflecting attention from my embarrassingly wrong post above, giving me time to extract my foot from my mouth)
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Post by dreamboatcruise on May 10, 2018 14:36:21 GMT -5
od... you set me up for that one At least Baba will now have something to point to proving I can be wrong.
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Post by dreamboatcruise on May 10, 2018 14:13:39 GMT -5
Novo, Lilly, Merck and Mannkind
Hmmmm... which backstabbing has been diabetes company seems to not be sponsoring a seminar?
Hopefully Mannkind will get good attendance. This should be a gauge of how much interest STAT has stirred up. I assume if attendance is high MNKD will tweet about it.
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Post by dreamboatcruise on May 10, 2018 14:01:16 GMT -5
On the other hand, what if Cipla is still working on its own inhalable insulin and needs more time. US$2 million would be cheap to stop Afrezza in its tracks in India by dragging out approval process as long as possible and then "de-emphasizing" with India sales force (like Sanofi did to us in the US). Do we know that Cipla's inhalable insulin is actually dead? I'm mean really dead -- not just mostly dead. Hopefully that was part of the deal... ceasing development and/or agreeing not to submit an NDA for some period of time. That would be almost negligent on MNKD's part if they didn't get this. I'm assuming Cipla doesn't have an injectible mealtime insulin... that could still pose a problem of repeating SNY even if there were provisions to halt inhaled development.
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Post by dreamboatcruise on May 10, 2018 13:56:16 GMT -5
mango... I know all the ways Afrezza it IS and ISN'T the same as a pancreas. I've probably researched insulin physiology in more depth than anything other than my own dissertation topic. I am not creating deception. Some people manage to have very good results with RAAs... it basically requires eating to match the profile of the insulin. And if you actually READ what I say I mention "weight gain" as a likely result if trying to optimize TIR for RAA. If one has a CGM, which this study uses, more agressive dosing of RAAs can be done if one is willing to keep on top of the CGM and do defensive eating to avoid hypos. Bottom line, Afrezza isn't a working pancreas, but I'd certainly rather use it if I ever need mealtime insulin. Hence why I've made a huge financial bet on Mannkind. You are paranoid by the way.
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Post by dreamboatcruise on May 10, 2018 13:42:52 GMT -5
It would be great if we ended in green today after a clear short attack this morning that fizzled pretty quickly. So I’m on the sidelines cheering for the good guys to win the day. Cmon green! Given that I missed buying the bear attack this morning, I'm hoping they strike once more
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Post by dreamboatcruise on May 10, 2018 13:35:22 GMT -5
Well, Spencer is about MNKD as an investment. If what you are about is all the other things you say, then ignore Spencer and rail against the insurance companies not covering it and the doctors unwilling to prescribe. Spencer certainly has nothing to do with decisions being made by PBMs and doctors. When it comes to taking investment advice from people, their track record is certainly relevant. As we've seen over the past few years... having a great insulin doesn't mean the company has been a good investment. That said I do think Spencer is a bit off the mark on STAT. It is small trial, which may blunt it's impact, but I'd side with you that it will show what is possible with Afrezza that would be more risky with RAAs and/or result in weight gain with defensive eating. With STAT Endos should realize Afrezza achieves something that it would be very tricky to pull off with RAA. Recalcitrant payers may claim it too small, etc. Investing in early stage pharma companies is all about the belief of its product. If he doesn't even understand the difference between Afrezza and other RAA, what gives him the credential to write articles about MNKD investment. His articles are just about reporting Afrezza scripts which is totally useless to members of this board. He also does a pretty good job of keeping track of the finances and summarizing them... that info is available in the financials from the company if one keeps track of it. He also models sales growth, which is also easy enough for one to do on their own. I have not been a regular reader because I do these things and have access to the scripts here, so fully agree that he doesn't add anything beyond what I already have access to. I don't believe he is trying to make himself useful just to MNKD proboards members... I think you are judging him from an egocentric standpoint... i.e. if he's not useful to you then he serves no purpose. Of course by your standard, someone like Nate or MK would be redundant as well for Proboards members because lord knows we've got multiple people here hyping the stock, so they aren't adding anything in that department that isn't available in abundance here. Bottom line, all of these people writing about MNKD aren't doing so for an audience limited to you, me and other proboards readers. As for belief in a product, that may be the only thing your investing decisions are based on, but it is probably a flawed strategy. Not all good products ever succeed in the market, and certainly even those that do may not end up being a good investment. It is safe to say, someone buying MNKD shares near the all time high will NEVER recoup their investment. It may well be that people buying right after FDA approval will never recoup their investment. Someone cautious like Spencer pointing that out at that time would have been more useful than someone offering nothing but belief in the product. I suspect Spencer will change his tune if he sees scripts significantly breaking above his slow growth script model... and quite frankly that may be a very smart way of playing MNKD, avoiding the heartache and dilution we've endured over the years and jumping in when there is really a signal that the medical profession is getting on board.
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Cash
May 10, 2018 13:17:55 GMT -5
Post by dreamboatcruise on May 10, 2018 13:17:55 GMT -5
Ok let’s assume sales pick up. Sales need to pick up to hit guidance. Hitting guidance still means 40m-50m more needed. Will the share price jump when/if sales jump? Will it jump enough to use warrants? We will have 150m outstanding shares at that point. 1b market cap will be under 7 bucks. Will publicizing select trials of the 65 help? Were those comparing afrezza to injectables? Will there be a trep partner this year after phase 1? That seems Early short interest is going to go back up as the cash decreases. If sales growth starts to accelerate in a greater and consistent fashion, that will start to drive share price. Current growth is inadequate. STAT study needs to have a dramatic and timely impact on Rx volume. Mike has also mentioned a cash program and such a program makes PA less of a hassle but the cash cost to the patient may or may not be a barrier. Part of what the market is trying to understand is if Afrezza will be commercially viable in the US. If it becomes clear the company will hit guidance and the growth rate will get the company to $150mm in 2019 then SP will respond. New HHS Secretary is Alex Azar. One of his mantras is value based medicine which supports the transition from fee for service to fee for outcomes which plays into the need for CGMs vs A1c. Adoption rate of fee for outcomes will be interesting. If we start to see the economy slow rapidly in late '18 / early '19 and the debt escalates at a more rapid rate (we just past $21T) value based (fee for outcome) medicine may take hold quicker than anticipated. www.forbes.com/sites/leahbinder/2018/03/08/surprisingly-bold-policy-speech-from-trumps-new-hhs-secretary/#2286c2fa1b6aMedicare already has performance based fees, but unfortunately the way they are structured does not reward minimizing long term progression of a disease such as diabetes. It is focused on short term outcomes and cost containment.
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