Have the inmates taken over the asylum

Have the inmates taken over the asylum

This morning a U S District Court judge ruled in favor for Pfizer (NYSE:PFE) and against Novo Nordisk (NYSE:NVO) when he denied a request to immediately halt distribution of Exubera. Even with this ruling Novo intends to pursue their patent infringement lawsuit against Pfizer. This is one case where Diabetic Investor is at a loss to explain Novo’s actions. Exubera is failing badly, as Diabetic Investor predicted it would, and Novo’s own version of inhaled insulin is well behind Exubera in coming to market. Even if Novo’s version makes it all the way to market it’s doubtful it would do much better than Exubera.

What continually surprises Diabetic Investor is that anyone at all believes inhaled insulin, Exubera or the many other forms of inhaled insulin under development will be commercially successful. Let’s say for the sake of argument that someone develops an inhaled form of insulin with a user friendly simple to use delivery device. Even better this new form of inhaled insulin won’t require patients to convert inhaled units of insulin to their injectable equivalent. No conversion tables to learn, 1 unit of inhaled insulin equals 1 unit of injectable insulin. Let’s also assume that the inhaled insulin works as well as injectable insulin. Simply put the only difference the two forms of insulin is one is injected the other inhaled.

Even if such an inhaled form of insulin existed, it would still be insulin and that really is the issue here. Physicians understand that patients are not afraid of insulin injections they are afraid of insulin. Compounding the problems with any form of insulin but especially with inhaled insulin, which is being targeted at type 2 patients, is the majority of physicians who treat type 2 patients lack the time or infrastructure to properly educate patients on the proper use of insulin therapy.

When analysts look at inhaled insulin they concentrate on one issue, the fact that patients would not have to inject the insulin. As if this is the only reason insulin therapy isn’t widely adopted by physicians for their type 2 patients; physicians who are already well aware that insulin therapy is extremely effective. This view also ignores the success of Byetta, an injectable therapy, with type 2 patients. This view further ignores the success of Lantus, the world’s number one selling insulin, also an injectable. The success of Lantus is in large part due to type 2 patient usage.

Inhaled or injected, insulin is still insulin. Improperly administered insulin can cause hypoglycemia, a potentially serious even life threatening condition. It would be almost criminal for a physician to prescribe insulin therapy without making sure the patient receives the proper amount of education on the proper insulin usage. Besides understanding the role food, physical activity and stress plays with insulin therapy, insulin using patients must monitor their glucose levels on regular basis. It is a well known fact that type 2 patients fail to check their glucose levels on a regular basis and the majority fails to check their levels at all. While effective the fact of the matter is insulin therapy isn’t simple and requires effort from the patient and his entire healthcare team. If insulin therapy was as simple as the analyst community seems to believe it is sales of oral medications would be a third of what they are today as insulin therapy has proven its superior ability for treating type 2 diabetes.

The sooner the Street wakes up to these facts the sooner investors will stop investing in this sector of the diabetes market. Inhaled or injected, insulin is still insulin and nothing will change that fact.

David Kliff
Diabetic Investor
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