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Post by dreamboatcruise on Feb 22, 2018 13:18:28 GMT -5
know thyself. what's fun for you isn't for me. I'd like to have a dream boat cruise through the baltics. I've earned it being stuck on a life raft with you; one who whines incessantly. We have dreams of success. You dwell and focus on the negative. And you do make positive contributions at times. You are getting OLD but not as OLD as I am getting having you step on the hopes and dreams of many people here. You are the guy who walks into a celebration and starts talking about herpes or the plague. I bet you were a fun kid to raise; "are we there yet?!" Childish at best or apathetic at worse regarding A Genuine Fix FOR A REALLY BAD DISEASE. forgive for yelling. I digress. End of conversation. If you're yelling about a disease that is very poorly treated in the US... where our healthcare system is failing patients... then by all means, no need to even ask for forgiveness, it will take some yelling to change things. If you're yelling at me about it, you are simply lashing out in bizarre emotional ways. Over and over again here on proboards I've expressed my belief in Afrezza as a major breakthrough, my profound disappointment with insurance companies blocking payment for it. Just today in a thread with some actual useful discussion (no I don't really think the two of you venting that you think I'm a bad person is useful), I was discussing the science of why I thought Afrezza should precede basal insulin in treatment progression. I've actually spent countless hours educating myself on diabetes... way beyond what I'd do if I were only interested in this as an investment. I may not know everything, but I have contributed a lot of information to this board including giving links to scientific articles so people here could understand the disease better. Not only advocating Afrezza, here on proboards I've expressed my outrage over insurance companies limiting the number of test strips and insulin for patients. I've told of my personal experience with a loved one that died in assisted living from outrageously poor diabetes treatment, who's life probably could have been greatly extended if Medicare had only covered Dexcom a few years earlier... advocating that anyone with a family member in similar circumstances not take their proper care for granted, and get a Dexcom if at all possible. So how dare you accuse me of not being concerned, and expressing it, for those suffering with this dreaded disease. Really... childish is you insisting that everyone needs to celebrate with you. That this should be a party for you. If I've somehow crushed your "hopes and dreams"... they were pretty fragile, and don't blame me for that. I think you've just illustrated my earlier point. I appear to have way more conviction than you do about Afrezza if my discussions about finances, here on a forum about investing, has done that to you. The finances of MNKD are actually a crucial aspect of getting Afrezza to patients. If you really care about the disease and patients dealing with it, then you to should actually be concerned about MNKD's finances, not wishing to sweep them under the rug and celebrate. And thank you for the end of the conversation, as when your true feelings eventually come out they are pretty offensive. I would appreciate no further personal comments. I will do the same.
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Post by dreamboatcruise on Feb 22, 2018 12:13:09 GMT -5
Type 2 diabetics still have insulin output. You can use that to meet your basal or your mealtime needs. Basal insulin is really dumb insulin, it fluctuates but not by a huge amount. Mealtime insulin needs to be smart and arrive and leave at the correct times in the correct quantity - this is what your body does well. The thinking on making basal the first line is that it takes care of the dumb role leaving what insulin you have under your control for the smart role where it can have a greater impact. Later when you cannot handle mealtimes with just basal mealtime insulin is added to supplement your own insulin and cover the gap. You can take mealtime insulin alone as a first option, but then you are just consigning your smart insulin to a dumb role. In other words mealtime insulin will work because it's insulin, not because there is something special about it. agedhippie What you said seems correct, but if you just used basal as a T2 would your pancreas / beta cells stop the mealtime spikes, i.e., let you function like someone without diabetes, or would the basal insulin keep your A1c in check, but leave you with wildly fluctuating glucose levels, i.e., leave you with poor time-in-range? That probably depends on how early in the progression of T2 one is started on basal. We know eventually in the progression basal alone is not enough. The open question would be whether starting on basal or starting on prandial (Afrezza) would give better results... short term and perhaps slowing progression. Aged has presented reasoning behind why basal might be better, and I believe with Afrezza the reasoning is linked to whether restoring/enhancing the first phase spike has a feedback effect with the liver. Another argument for Afrezza first is that if there is meaningfully less chance of hypos, which is the main cause of delaying introduction of insulin, that could enable starting insulin sooner. Seems to me there will be no answers until very large clinical trials are run, ideally looking at when in progression insulin is introduced and what type. It might even be complicated by the fact that an individual's dietary habits might play a role in whether basal or prandial would be better to start on. I personally have bought into the idea that Afrezza would be the ideal early treatment, if not before metformin at least right after, but I'm objective enough to realize that since I started studying all of this after becoming a MNKD investor, I may not be fully objective. It doesn't seem like the algorithm in the ADA standard of care is going to change anytime soon without clinical trials. In the meantime hopefully MNKD can start at least winning the battle against RAA where they are currently placed in the standard of care (after basal)... with some practitioners such as VDEX trying a different approach and hopefully leading eventually to a reassessment of the standard of care.
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Post by dreamboatcruise on Feb 22, 2018 11:43:26 GMT -5
I'm getting a bit scared of MNKD if technosphere is the first step to "HUMAN PROGRAMMING". It seems especially menacing when all capitalized
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Post by dreamboatcruise on Feb 21, 2018 21:39:55 GMT -5
sayhey24... well you actually seem to know what Dachis would be trying to achieve. It seems quite obvious... make money for his shareholders and himself. So yes, he'd want One Drop Premium to be shown to reduce A1c whether one uses an RAA or Afrezza in this trial. To me that would simply be a given since it is the logical thing he'd want. There could be some other hidden motive, but... Occam's Razor. Hopefully, it's fairly run and his coaches are sufficiently trained with Afrezza to allow Afrezza's benefits to come through.
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Post by dreamboatcruise on Feb 21, 2018 20:20:22 GMT -5
sayhey24... that would seem odd if they are limiting the test strips, since the premium One Drop normally is unlimited test strips. I do see it listed that way. Maybe that is simply the minimum quantity they provide but users can order more as they would normally be able to with One Drop Premium. 150/month might be enough after one learns their own body's reaction with given types of meals, but it does seem initially they should be given the benefit of being able to test whenever they wish.
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Post by dreamboatcruise on Feb 21, 2018 19:03:27 GMT -5
sayhey24 ... many here have speculated that it was the poor design of the clinical trials (dose titration or lack thereof, timing, and lack of follow ups if out of range) that lead to being merely non-inferior with regard to A1c. I would assume that MNKD believes this and would expect with proper coaching from One Drop, the Afrezza arm will show superior A1c results. I do believe that for a given level of hypo risk, a lower A1c is achievable with Afrezza... in a general population, i.e. not withstanding the subset of people willing to closely tailor their food consumption to match pd profile of their RAA.
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Post by dreamboatcruise on Feb 21, 2018 17:30:26 GMT -5
thekindaguyiyam... just engaging in conversation is what I look for. Well, I do find some info here very useful, such as when real news is posted, the weekly script numbers, info about other developments in diabetes, etc. I don't think any of us have enough insight into this complex, opaque and changing business of pharma to have many answers. I certainly don't feel used. Shooting oneself in the foot. Who's that? Me? You know that expression means one is hurting their own interest. Setting aside that I post a lot of positive things about MNKD (I'm assumming they don't register with you)... let's pretend everything I say is skeptical, questioning finances, etc. When I participate in a dialog about a topic such as when and how much dilution is going to be required do you actually think that me talking about it is what is going to make it happen... i.e. I'm hurting my own interest as a shareholder by talking about it? Surely you don't believe that. I sometimes get the impression people here feel that... that the discussion on this board somehow drives the fortunes of MNKD and if only the cautious, the skeptical, the ones wishing to talk about cash flow could be shut up, MNKD would soar. I'll admit to thinking that sometimes, but I also try to dismiss it by giving benefit of the doubt to people here, that they really don't believe MNKD lives and dies by our little proboard discussions. I have confidence people here deep down don't believe talking about dwindling cash reserves causes it to happen. So... no foot shooting, no punishment. I'm actually pretty darn pleased with the options plays I've done this year... I probably deserve a pat on the back for the timing of those, but I'm too modest to do that myself.
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Post by dreamboatcruise on Feb 21, 2018 14:03:53 GMT -5
yeah. If only we could time travel. but then again that would be having information then which is different than we know now. Your mention of why it wasn't thought of sooner to recognize "the missing piece" is part of the evolution of the story. You know there are no certainties when understood leading to re-evaluation. Change. Movement. All within resolving complex issues and recognizing the Powers That Be who don't want this companys success. This is the Time. This is the Man. But all we know now is that the credentials of Kendall are significantly more inline with diabetes than were Urbanski's. If strictly from those credentials one is now declaring him the missing piece, then all the information was there previously to have recognized that we were missing someone with Kendall's credentials. It seems like we've had a lot of things declared "the thing" that was the final piece to fall into place... Mike coming on board, Mike getting promoted to CEO, label change, and now Kendall (probably a few I missed). I wonder how many more missing pieces we may have. I certainly didn't identify what all of these missing pieces were before, so I won't claim to have any ability to know what they are or how many there are. I'll simply wait and see, and be willing to give credit for success. His hiring does help boost my confidence in MNKD, even if right now I see no evidence to re-evaluate that a few months ago the only missing piece was replacing Urbanski.
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Post by dreamboatcruise on Feb 21, 2018 13:44:49 GMT -5
False confidence is self deceit. I think most inverstors here would agree with you when you say "I'm confident that Afrezza is a significant advance in diabetes treatment, and will try to wisely figure out how I shall profit from it. I don't have confidence that the road will not still be rocky." For the years we've been into this there have been many unknowns that have shaken "confidence". Most of us here who speak up can get angry from time to time with what we perceive as BS from others who have strong agendas. You and I might both be thought of in this way by others. What matters most is how we see ourselves. When I step back from the drama of this investment I can clearly say that I haven't made the best choices along the way and even gave up at one point in time. Now; for me, there is a difference from when I was feeling that way. I don't sweat the day to day rollercoaster; I have adapted to it. My "expectations" thinned with regard to timing because of trying to catch the falling blade like so many others. Still, I'm in the game with 3X the shares I had after the reverse split which speaks to my genuine confidence. For me it's not a matter of IF rather than WHEN. And when it happens... the awakening that Afrezza is the Superior Insulinsi and BP though they continue to try will not stop the momentum of the success of Afrezza and Mannkind. You hit the nail on the head when you speak on the topic of CONFIDENCE. For you, you think that for some of us it's an illusion or a lie. For me it's real. I will be rewarded for my DD though it has required patience and humility to accept that my timing isn't always the greatest. This because, I don't know all the pieces of the puzzle as I'm not on the Board of Directors. I support the Board to do what they do to get past the hurdles. And because I'm not nostradamus I can only make the best choices I can with what information I have at the time. All my chips are on the table; I've made my own choices and will see how this unfolds in a very personal way. Just like most of us. Read more: mnkd.proboards.com/thread/9587/grabbing-eyeball-value-investors-mannkind?page=1#ixzz57hsMDXvyRather than "it's an illusion or a lie" I would say that I believe for some it is emotionally based at this point. That's not even to say that they might not also have a more analytic bases for their confidence as well. But if someone lashes out with a blatant personal attack on someone with a point of view that may challenge their confidence, I take that as perhaps they are tilting towards the emotional confidence. Someone with the analytical confidence could refute the point of view rather than attacking with "he's a short", "he's ruining the board", etc. Someone that simply stated "I have confidence Afrezza is the best insulin on the market, and have faith that management will make us all rich from it"... belief in a technology and a team... that's pretty much the investment thesis that has gotten every billionaire VC to where they are today. But the VC rarely shoots the messenger when the accountant points out that there is a cash flow problem.
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Post by dreamboatcruise on Feb 21, 2018 13:13:38 GMT -5
Don't need the ads anymore ... Dr. Kendall is calling all his endo friends personally and informing them that ... THEY HAVE TO TRY IT !!! YOU'LL LOVE IT !!! And your patients will love you. Definitely the missing piece, I hope this works out for the rest of us I'm not saying this isn't a good hire, but... It's really interesting that NO ONE ever said we had a missing piece with our previous CMO. I don't remember any one of the people now saying Dr. Kendall is the missing piece, previously saying "You know everything at MNKD seems almost perfect. There is only one problem and that seems to be Dr. Urbanski. I'm sure scripts would just soar if we got in a better CMO. This really is the missing piece in my opinion." Just curious, how is it obvious (definite) now that this was a missing piece but not obvious back then? I think it's an undoubted step up since Kendall has the diabetes expertise. I would think he'd be better at overseeing trial design because of that career expertise. Will he significantly change the probability of getting better formulary with any given insurer... heck if I know. It seems like as investors over the years we've had little insight into the real barriers that Afrezza faces in the marketplace. Which of those barriers this new CMO could make a substantial change with... that would be adding another unknown into the equation. He's a really good hire though.
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Post by dreamboatcruise on Feb 21, 2018 12:40:07 GMT -5
Am I understanding it correctly -- "or (2) One Drop | Premium 'On Track' plus their current rapid-acting insulin" -- so they're trying to track down 200 type 2s who are also taking a RAA? That seems like it would be difficult since relatively few reach the RAA stage. It's still a huge population due to how many people develop T2.
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Post by dreamboatcruise on Feb 21, 2018 12:35:09 GMT -5
Amazon cover all insulin, including Afrezza, at the same tier and without prior authorization. That's interesting because their plan is administered by Express Scripts so they obviously are not using Express Scripts formulary which makes it a good example of a company directing it's PBM not to take the cheapest path. Amazon may well be self insured, and the PBM is thus merely acting as a plan administrator. Especially in that situation, the PBM will pretty much put whatever drugs the company wants on the formulary. Doesn't surprise me that Amazon has top notch coverage. At their headquarters don't they provide unlimited custom made gourmet donuts delivered right to your desk... along with the insulin.
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Post by dreamboatcruise on Feb 21, 2018 12:28:51 GMT -5
True dbc ... but, I said we may not need a "heavy" ad campaign. And, I didn't say to eliminate the sales force. I also didn't say that Dr. Kendall has to contact every endo. Getting the ball rolling is all we need. You've been working too many hours dbc ... take some time off so you'll be able to see and read more clearly. BTW ... stat study. If they ever wish to become one of the big brands they can't stick with brief spotty advertising. It will require national and sustained. That is very expensive. And as for my reading ability. I'm so good at reading I can actually notice someone's posts in multiple threads. Such as yours in another thread. "Don't need the ads anymore ... Dr. Kendall is calling all his endo friends personally and informing them that ... " It's fine if you're backtracking now.
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Post by dreamboatcruise on Feb 20, 2018 21:12:37 GMT -5
From a different point of view, with the stat study coming out and the hiring of Dr. Kendall ... we may not need a heavy ad campaign. Dr. Kendall will be contacting endos and presenting at conferences ... we all know that patients can ask for Afrezza, but it's the endos that will do the prescribing. Having the endos on board will be a major drive. (Note that I put in "stat study" to stay on the thread !!!) One person doesn't negate the need for advertising and a sales force. He's a great hire, but Lilly isn't in the top spot for either basal or prandial. He may have some influence in the market, but he certainly doesn't know ever endo in the US and he doesn't wave a wand and get all insurers to carry Afrezza. All these things will take time... and money.
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Post by dreamboatcruise on Feb 20, 2018 21:00:50 GMT -5
Actually I made far better choices with MNKD when I dropped the false confidence that had been emotion driven and became much more calculating. I had been chasing the falling knife like a confident fool. Since then I've done much more wise options plays, with pretty good timing. I'm confident that Afrezza is a significant advance in diabetes treatment, and will try to wisely figure out how I shall profit from it. I don't have confidence that the road will not still be rocky. I am holding a fairly large position right now from the confidence that I'm again looking at MNKD as an investment where I can make rational decisions as I see things unfold without emotional baggage of past dreams or losses.
I find my mindset pretty easy rather than difficult. Personally I suspect that some others here that talk the confidence game are really way more conflicted about their MNKD investments, and sometimes show their anger.
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