Opinionated- Damn Right

Opinionated- Damn Right

Last night while the Lilly spokeswoman was tying to rip Diabetic Investor a new one for publishing information we received from HER COMPANY, she continued her rant saying that Diabetic Investor is …wait for it … opinionated. Damn right we are and we have no intention of changing. Although our wine drinking friends Serge and Olivier may disagree this isn’t personal.  Or as Momma Kliff used to say; “If you want a friend get a dog.”

It always amazes Diabetic Investor how the west coast mafia, otherwise known as the diabetes blogging community, just can’t stand it when someone has the audacity to disagree with them. Frankly this affliction is not limited to the west coast and is endemic throughout the country. We should note before working at Lilly this spokeswoman was .. wait for it .. a diabetes blogger.

Yep Diabetic Investor got called every name in the book because we dared to say that Afrezza while a good drug would not be commercially successful. This trash talking extends to our belief that the artificial pancreas is another product which has many therapeutic benefits but has a dubious chance of being commercially successful. And heaven forbid that we imply that all these way cool whiz bang cloud enabled devices are me-too copycat products that are merely tools to deliver data and that no one so far has been able to transform this data into patient relevant patient actionable information on a mass scale.

We really got reamed when we defended Medtronic (NYSE: MDT) for doing an exclusive pump deal with UnitedHealthCare. We were told this would limit patient choice and stifle innovation. Now never mind that this deal only impacts 2,500 patients and that only impacts choice if one of these 2,500 patients wants a new pump after their current pump is out of warranty. Never mind that even under that scenario they can get a note from their physician stating there is reason for them to remain brand loyal.

Does it limit choice for patients new to pump therapy yes in that scenario it does. But even here can someone please explain to Diabetic Investor exactly what’s wrong with a Medtronic system, is it somehow inferior. Does it not do the exact same thing as an Animas or Tandem (NASDAQ: TNDM) pump? Perhaps there is a reason Medtronic has a 70%+ market share.

The one place we do see an issue is with sensor augmented systems as the Dexcom (NASDAQ: DXCM) sensor is superior to the Medtronic sensor, but even here choice is not limited as the policy does not say that a patient can’t use a Dexcom CGM with a Medtronic pump. And guess what that’s something that’s actually going on in the real world. Imagine that.

What about stifling innovation, wonder how the people at Bigfoot BioMedical or Beta Bionics feel about that. Or how about Roche, Insulet (NASDAQ: PODD), Tandem and Animas who are also developing new pumps. Stifling innovation my ass.

But these cheerleaders who have never meet a diabetes device they did not like, also seem to believe that every new diabetes drug is great. Seriously do we really need 5 yes 5 long-acting insulin, 3 short-acting insulins, 3 once-weekly GLP-1’s, 3 SGLT2’s and 4 DPP4’s. Let’s not stop there as more are on the way.

They scream long and loud that insulin is too expensive, that Lilly, Novo and Sanofi are raping patients by raising the WHOLESALE price. They ignore rebates, discounts and the role payors play in determining the true out of pocket cost of a patient’s insulin.

Yet in the same breath they scream for new and better insulins. Ignoring the high cost of developing these new therapies they claim are desperately needed. Heck if you listened to these folks it’s a miracle any patient with diabetes can achieve good control given the poor quality of drugs we have available and all these way cool devices patients can choose from.

They fail to grasp that like it or not diabetes is a business and these companies are doing what they do for the benefit of their stakeholders. This does not mean they do not care about patients, they do. What it means is that decisions are made for business reasons. Why do they think Sanofi terminated their partnership with MannKind (NASDAQ: MNKD), everyone knew that Afrezza worked and there was a place for it in the treatment paradigm. The reason Sanofi dropped MannKind was Afrezza was an awful business model.

Last time we looked this was America and there is something called a free press. We’re not sure what that means to the west coast mafia but what it means to Diabetic Investor is to write what we believe to be the truth. We view this as our duty to hold this wacky world accountable. Anyone who reads Diabetic Investor knows that we are not a shill for industry merely accepting what they say as the gospel. We extend this courtesy to the diabetes blogging community, a community which on balance has been great for patients. However, this does not give them a pass when they screw up.

Folks this isn’t just big business this is a very serious business. With all the way cool whiz bang cloud enabled devices that come in pretty colors combined with multiple drugs in each class the fact remains far too many patients are not achieving good control. Should we blame industry for this, are they responsible? Could it not be argued that these cheerleaders who have never meet a new device or drug they didn’t like, should be harsher critics and demand more than just way cool whiz bang.

Should they not be true patient advocates and push these companies to help better educate patients. They claim to put patients first something we find hard to believe when they like everything that comes off the assembly line. They talk about patient empowerment when in reality they treat patients as victims, that somehow the patient bears no responsibility at all.

Now we know this going to piss off a lot of people but seriously having been in this business 20 years we just don’t care. Diabetes is NOT a disability – Diabetes is a serious chronic disease that CAN BE managed – yes it requires work but it can be done. Why is it when physicians are asked what’s the biggest obstacle to better patient outcomes they don’t say we have bad devices or inferior drugs. Universally without hesitation they talk about therapy compliance or lack thereof, does not the patient bear some responsibility here.

Are better drugs and devices needed, for sure. But these better drugs and devices are useless if they aren’t used by the patient. That all this whiz bang way cool cloud enabled technology that comes in pretty colors means nothing if the data that goes to the cloud does not come back to the patient as relevant actionable information.

Opinionated Damn Right!