The Big Diabetes Meeting: Your Roundup
15 CommentsBy Ed Silverman // June 23rd, 2007 // 1:33 pm
These dispatches are from the American Diabetes Association meeting in Chicago:
1 - Actos may lower the risk of heart attack and death by 44 percent in diabetic patients with kidney disease, according to one study. Another study found that the Takeda Pharmaceuticals drug reduced inflammation and blood clots more than a placebo, Bloomberg News reports.
Actos, of course, is Takeda’s drug is in the same family as Glaxo’s Avandia, which was shown in a study last month to increase patient’s chances of having a heart attack by 43 percent. Takeda hopes the data will convince docs that the problems with Avandia aren’t tied to similar meds and will convince them to favor Actos as they switch patients from Avandia.
2 - Januvia lowered a key measure of blood sugar when taken in combination with another common diabetes drug in patients followed for a year. Merck’s study marks the first time one-year Januvia data is being released. Previous data involved patients with type 2 diabetes who were followed for six months. In light of Avandiagate, docs want more long-term data.
3 - Exubera caused only small declines in lung function that occurred early in treatment and didn’t get any worse over time, according to results from two ongoing trials involving 1,200 people. Lung function is an issue with the inhaler, because the insulin is absorbed by the lungs rather than under the skin. Given Exubera’s bong-like size, however, it’s not clear whether this data will sway many docs or patients to try Pfizer’s poor-selling device. You can read more about the Merck and Pfizer studies in The Wall Street Journal (subscription required).
Melody
Wow! I’m overwhelmed with all these wonderful treatment and innovations. But where’s the the time-tested mantra: “A cure is only five years away.” They (ADA and sycophant MDs) have been using this old bromide since at least 1956. Is this disease, indeed, just Too Profitable to Cure???????
Laurie
YES, diabetes is to profitable to cure. My diabetic husband has been saying that for years. I used to tell him how wrong he was…today my opinion is much different.
jason
Why would a company want to find a cure for the largest malady facing our obese population? I am sure there is no money to be made by finding a cure……..
Since a majority of Type 2 diabetes is caused by inactivity, poor diet, and obesity - I think the cure has already been discovered. It just happens that most lazy people would rather compain about the evil of the health care industry instead of taking responsibility for their own health and taking a walk. So instead of complaining about the $100 Actos script - lose weight, get healthy and you can get off the meds.
The whole conspiracy theory about not curing a disease so drug company’s can profit forever is fun to discuss on the surface. But now that there are so many generics and impending generics, where is the incentive to keep “hiding” the cure? You don’t think one of these small upstarts or academic centers wouldn’t want to be known as the people who cured diabetes. Again, if you can find a cure for heart disease, diabetes, or cancer you would market the heck out of it and make some money.
The pharma industry, like every company in a free market society, is driven by investors. Investors want to make money. Instead of complaining about the evil industry - invest in it. Compare it to the oil industry. You can complain about gas prices all you want, but if you owned a piece of Exxon at least you made some money along the way.
anniepema
One way diabetes could be prevented in non-familial cases is for men with no family history of autoimmune disorders to end their fathering of babies by 31. Type 1 diabetes rises with the age of the father at conception and does autism, Alzheimer’s, MS, prostate cancer in non-familial. For studies on diabetes, autism, MS, prostate cancer, Alzheimer’s, schizophrenia and paternal age please read the http://how-old-is-too-old.blogspot.com/ For other studies showing that all kinds of genetic disorders increase with paternal age at conception you can look at the abstracts here:http://fathersageandsinglegenedisorders.blogspot.com/
Melody
I think the cure has already been discovered. It just happens that most lazy people would rather compain about the evil of the health care industry instead of taking responsibility for their own health and taking a walk.
Jason–
You fall into the same trap as I do. Where I believe SOME pharmaceutical companies are indeed evil, it is easier to paint with a broad brush and claim all PHARMACEUTICAL COMPANIES ARE EVIL. Likewise, you depict ALL diabetics as “fat and lazy” and responsible for their own ill health. This, too, is an easy depiction, but largely untrue. Some–perhaps many–Type 2’s could approach a “cure” as you say, by taking a walk.
Your solution–invest in it (the industry)–merely perpetuates the current paradigm . . . profits before patient welfare. Maybe you can salve your conscience with your ROI, but quite frankly, I find it morally objectionable to partner with an industry that preys on the vulnerable.
Chronic disease (from an industry persepctive) IS too profitable to cure–but you would at least think good treatment or effective treatment would be worthy corporate-goals. Instead, we have a continual parade of me-too drugs, repackaged and heavily promoted, presented under the guise of concern for patients. Until patients awaken to the abuse, and investors consider more ethical vehicles, nothing much will change.
jason
Melody - you are right that the industry has been touting “potential cures” for many diseases for many years. But this isn’t the only industry to do that - where is my flying car, why can’t I vacation on Mars, why can’t I watch TV wherever I want in my mind, why aren’t all movies 3-D. WHY ARE WE STILL DEPENDENT ON FOSSIL FUELS?!?!?!?!
Come on, there will always be dreamers with a vision. They have to sell their vision to get funding. Dreams are not always fulfilled.
Again, if someone discovers a cure for anything (especially diabetes), they will be wealthy and famous. There is no industry mantra not to try, it is just a little harder than people think. Sorry, research is slow. You can’t always just throw money at a disease to make it go away. You can however be healthier and take some sense of responsibility for yourself. Ask any primary care physician what the major problem with the general health of the population is. Get back to me if you find any who don’t immediately say “pts. that I care more about their health than they do”.
Melody
Jason–
Sadly, I must agree with most of what you say. In our “society of instant gratification” it is much easier to take a pill than to commit to a daily walk around the block . . . and to take another one if the slice of apple pie is just irresistible!
But, if you consider that Banting & Best–when they discovered insulin–GAVE THE RIGHTS away for the handsome price of $1, you can see why hope lingers. My biggest beef with the industry is the intentional manipulation (by Eli Lilly) to control market forces by removing needed, time-tested drugs (natural insulins) and leaving only patented, higher-priced insulin & analogs on the market. Their PR people did a fine job educating physicians about the “newer and better” product . . . which were never proven to be better, nor as safe as the products they replaced. That kind of manipulation–in my opinion–IS EVIL!
Type 1 and Type 2 diabetes are very different animals; Type 1’s cannot control the disease by “living healthier and accepting responsibility for their health.” Most T1’s I know follow these principles . . . yet must rely on pharmaceutical products TO SURVIVE.
jason
I think we are in the same place. For those that depend on pharma to survive we are in the same place.
My disagreement is that these older insuling (pork and beef) did cause some allergic reactions in people that I am guessing were anaphylactic and fatal in a few cases. I know that the people that they worked well in, hated to see them leave and had a hard time titrating to the new synthetic analogs. But in this day and age of litigation, to keep producing something you know exists a safer alternative is not a smart move.
As you know, insulins are easy to regulate. A simple protein that can be analyzed and approved by the FDA. If there was a market for a better product, it would be produced. For instance, it was acknowledged 2-3 years ago that inhaled insulin would be a huge hit and a life changing med for diabetics. As you know, concerns plague this product and it will never live up to its potential.
If all physicians were duped by the pharma industry as you say, then we have much bigger issues in health care than big pharma. The entire medical education system has failed us miserably, and for that I don’t think all blame can go on the pharma industry. Everyone loves life saving/changing medication, but then gets upset if anyone makes money off of a good idea.
Melody
some allergic reactions in people that I am guessing were anaphylactic and fatal in a few cases
Jason–
This is one of the myths that is perpetrated to further Lilly’s market dominance and validate current treatments. Studies have shown that there are probably an equal number of diabetics who suffer allergic responses (including anaphylaxis) to synthetic HUMAN insulin! (But this information never makes the headlines.) Equally disturbing are studies that now show some Type 1 diabetics became diabetic because they were allergic to their own insulin–HUMAN insulin. How insulting is it to be forced to use a product that caused the disease to “treat” the disease, however ineffectively?
And like you, I recognize that Big Pharma isn’t the only villain. As with all medications, the final decision to get a drug into a patient’s hand (body) rests solely with physicians. There’s plenty of villainy (including politicians, regulators, “educators”) to go around. And I’m not anti-capitalism . . . market forces are probably appropriate to drive the pharmaco/medical paradigm–if such forces were not manipulated. But the willingness of Big Pharma (again, I use a broad brush) to imperil patients merits the cynicism and disdain with which the industry is viewed.
jason
Again, the entire medical field has been duped. Admittedly my memory is faded more and more each day - but I believe I learned that in school. And it makes sense, if you are using other proteins as a base, it stands to make perfect sense that those proteins could trigger an allergic reaction more often. I don’t remember small details, but that is the big picture that I took of med school.
If the older insulins truly were better, they should have promoted them differently. In this business if you have a good product there is no reason, say the endocrinology dept would endorse pig insulin. If an independent orgranization such as that endorsed animal insulins it would have made a big difference. Did that happen? Did any indie organization fight for the other insulins? Or were they happy with the new rapid onset insulin (Humalog) and the different release characteristics of the other new analogs? Just wondering why if this was such a big deal, why the entire medical community missed it.
Melody
Jason–you ask “why the entire medical community missed it.”
Shall we talk patents? Shall we talk recovery of capital expenditures? Shall we talk pay-offs for professionals, educators and other promoters who were provided incomplete and/or inaccurate information to form the base for the promotion of the product? Shall we talk subtle, quiet, headline-avoiding manipulation and removal, one at a time, of needed animal products? Shall we talk the birth of an entire new device industry? It supposedly empowered Type 1’s to better monitor their disease/treatment. In effect the tools were industry ESSENTIALS because the “new and better product” came with inherent dangers. Shall we talk big lies–the new insulins WEREN’T cheaper, there was NEVER a shortage of raw material for natural insulins, and there was NO particular immunological advantage over purified pork preparations? Shall we talk analogs? The new synthetic analogs are NOT just like the human body makes; in fact, they are synthetic hormones that fool with Mother Nature. Natural (animal insulin) analogs were perfectly formed by a biologic animal and had accrued an 80 year safety profile which, in essence, did not fool with Mother Nature. Shall we talk analogs, in terms of purity, where natural analogs (pork/beef insulins) after purification could boast 99% purity. The best that could be achieved by synthetic products that began life in an E coli brew, and are somehow “better” can only achieve 97% purity?
You can fool some of the people some of the time; in the case of genetically-engineered insulin, I would have to say you can fool most of the people most of the time. While studies are coming to light that expose some of the misconceptions about the natural vs. synthetic products, once a product has become entrenched, it is difficult to change the thinking of prestigious, well-reimbursed thought leaders. Admissions that previous assertions may have been flawed would be unacceptable to most of these “experts”.
jason
I believe you made my point. It seems like this is only a big deal to you. I was in school at the time this happened, you obviously know more about this subject than they teach in school. So I can not go back and even try to counter any points because it really won’t change the practice of medicine either way.
Betamax was better than VHS - but we don’t have a choice anymore so who cares.
But honestly I go back to : Why didn’t any top “unbuyable” endocrinologists lobby for the pig insulin? Why didn’t any endocrinology groups boycott synthetic insulin? Why didn’t anyone see the points you bring up? You can’t tell me there were many docs in that camp - otherwise there would still be a choice.
If Lilly fooled everyone who treats diabetes - I guess good for them, but bad for diabetics. But since the big boys didn’t protest, I have to side on the specialists side. I have enormous respect for specialists. These endocrinologists make good money, they are not going to boycott an entire class of insulin to make $500/night at the time. Again, if the pharma industry can buy docs for $2000/year - there is something wrong with who you see for a physician!
Yes it is also hard to change something once it is entrenched - such as animal insulins……………. There was obviously a reason to change at the time, and if there was an obvious need to change back it would happen. Slowly, but it would happen.
Melody
Jason–
Thanks for the conversation. Because I am NOT a doctor nor an insider, the “reasons” you ask for are only suggested by past events. Synthetic insulin was the FIRST rDNA drug–a very big deal at the time! Doctors were TOLD it was just like the human body makes, but they were also told (over time) that animal insulins would be withdrawn. As a practicing endo, what would you do? Boycott, or seek to transfer your patients to this “new and better” product? Because the withdrawal of all animal insulins occurred slowly, it wasn’t until well into the process that some (patients and doctors) recognized that the option to switch from one animal insulin to a different type was disappearing. Also, because there WAS another alternative available now, animal insulin did not fall in the “orphan drug” category. And, as FDA has stated: the government can’t MAKE a manufacturer continue producing a drug–however much it might be needed.
There was an internationally-known endocrinologist specializing in diabetes within a university setting. In 1993, he published a research article comparing various new and older (animal) insulins. In that paper he stated Beef Ultralente was the gold standard of basal insulins. An editor’s note at the end of the article stated that Beef Ultralente stated that Beef Ultralente had been withdrawn from the marketplace. Did this endo have a choice?
As you must know, university research, independent research and government studies all rely on corporate dollars for major funding. The referenced doctor stood up for a much-needed product only to find Lilly and Novo streamlining their insulin availability, forcing everyone–including doctors and researchers–to choose from the “best of what’s left.” BTW, at the time, Lilly was coming forward with a new Human Ultralente–which they admitted in their patent applications was not the equivalent of Beef Ultralente. In fact, you will now find that Human Ultralente is not available in the marketplace because of its inferiority. This is just one example of a forthright individual doctor being “forced” by industry to embrace substandard/inadequate protocols.
One other point which should be considered is the fact that now human insulin is losing patent protection and if generics are allowed to enter the marketplace, soon the insulin cartel will be “forcing” everyone to switch to newer, patented analog protocols.
Just think about what would happen in the marketplace if Big Oil and automakers got together and decided that ONLY gas guzzlers would be produced and sold because the price and use of oil was declining. Essentially, this is what happened to the electric car, although there were many test-drivers of electric cars who would have paid almost any price to buy them..
jason
I think I have officially beat the dead horse. Thanks for the dialogue, you offer an insightful point of view. Good luck!
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