Kevin, M.D. - Medical Weblog

I'm playing Devil's advocate here.

Do you really think a large reputable pharmaceutical company is going to go all out promoting an inhalable product if it isn't reasonably sure about drug safety and efficacy? After Vioxx?

Seems like the company figures their technology is "good enough" to put it on the market. [VHS was "good enough" compared with the better Betamax.] Once that happens, improvements in drug delivery will undoubtedly happen.

People will do just about anything to avoid daily injections, even with an insulin needle.
 

"But Ruhl, a 57-year-old software developer and author from Gill, Mass., says she thinks Exubera will be hard to use and could cause lung damage. "It looks like a terrible idea," Ruhl says."

...and why do we care what she thinks again?

So she's got a blog and a hobby and suddenly she's a respiratory expert?
 

Actually, I'm far from being just a "blogger". I've been posting substantive messages on alt.support.diabetes for many years under a nom-de-web, and I have written a busy web site, "What They Don't Tell You bout Diabetes" that pulls together a lot of lab research that many busy doctors haven't had time to catch up with.

My site looks at the research that answers questions like "at what blood sugar level does organ damage occur" and explores the history behind the ADA's appallingly ineffectual diabetes diagnostic criteria that ensure that half of all newly diagnosed Type 2s will already have serious complications.

My site has been around for a couple years and comes up high on quite a few Google diabetes searches.

The journalist called me a "blogger", probably because she doesn't quite get what newsgroups are all about. She also didn't bother to quote me, but just summarized what I'd said in a way that made me sound dumb.

Oh well! I was hoping she'd quote me making the substantive point that insulin shots don't hurt and that making an issue about the horror of injection (which is what they'll do to sell this stuff), is going to hurt people!
 

So, at best, you're a dilletente, and lack any credible medical, pharmacological, or physiological training. Great.

Now, what exactly qualifies you to make such sweeping condemnations on something you've never seen or used?

Maybe you like injecting yourself. I know many diabetes sufferers that don't, and look forward to the introduction of new treatment modalities.

What a shame that the internet gives any idiot with a computer a chance to pontificate on things they know nothing about, and the rest of the world lacks critical analysis skills to be able to filter out such BS.
 

What part of "can't control the dosage" don't you understand?

This "idiot with a computer" is far more up-to-date on diabetes research than most the doctors she sees who don't have time to read extensively.

The other important point about Exubera, which I made to the journalist, is the big problem with Exubera and one anyone who uses a bolus insulin will immediately understand, is that it is difficult if not impossible to match the dose to the carb count of your meal because the dose increments are too big, (starting dose is equivalent to 3 units of something, not clear if H or R which are, of course different strengths). Beyond that, there is NOT a straight line relationship between one dose and multiple doses.

This makes it very hard to calculate an insulin/carb ratio, and without that ratio it is not possible to get anything approaching good postprandial control. This is a BOLUS insulin. To have a bolus insulin that can't be titrated carefully is to ensure that people will continue to have poor control and hypos.

Beyond that, with all the scandals in the drug-approval world the past couple years and the FDA run by big-pharma lapdogs, the fact that they approved this drug KNOWING that it diminishes lung function with the lame promise of doing a large aftermarket study of that lung damage should set alarm bells ringing.

Just recently the NYTimes reported that almost none of the post-marketing studies the FDA had ordered were ever done and that there is no enforcement to see that they get done.

People who hate injecting have often been poorly educated by doctors who don't have the time to keep up. Viz, the doctor I went to whose "diabetes educator" taught me to use insulin with a 1 inch thick gauge needle. That WOULD hurt. With a .31 guage 5/8 inch needle it is painless.

A bit more attention to what is already out there from "God Appointed me a Doctor" ignorant "experts" would solve this problem a lot better than this potentially dangerous, expensive new drug that is designed to improve the health only of Pfizer's bottom line.

--An Idiot with a Computer
 

You can really tell who has a financial interest in Exubra here. You can also tell who DOES NOT have diabetes (or well-controlled diabetes) and is playing on the fears of shots.

I won't repeat anything what was said above, except I will make a point. If a person does not like shots, and therefore enjoys using inhaled insulin, will they also be afraid of testing their blood glucose, too?

Imagine this scenario: A person afraid of sharp needles is also afraid of testing their glucose. They go to McDonalds and eat a Big Mac and pulls out their bong-like inhalable device and suck in some insulin.

Recall that they are afraid of testing their blood glucose.

Will you want to be on the road with this person?
 

Flight-ER-Doc will drum up some great business if people are driving around after sucking on some insulin without testing sugar levels.

Maybe he can pay off his college loans with the ER cases she/he starts to see...

Every pharmacist I know think the device looks ridiculous. The drug reps that have come around to the hospital pharmacies don't even have any answers to their questions -- they respond with, "I don't know", as they are only given a script to follow. The device will cost $10 (because they don't want patients to lose them).
 

I don't know much about diabetes, but what I find interesting is that Flight-ER-doc hasn't attacked Kevin for essentially saying the same thing that Janet Ruhl said in this and earlier post.

But just because Janet is a layperson, this doctor feels like attacking her without even bothering to check her sources. Because, well, lay people cannot possibly learn more about conditions they personally have and therefore have a huge interest in than a doctor who is not a specialist in this condition.

Here is a thought. Why don't you specifically respond to arguments by providing some evidence, rather than just attack posters because of their background?
And by the way, I don't know much about diabetes since nobody in my family has it, but I probably know more than you do about POF, and I am not a doctor. If you have a condition, you tend to research it.
 

1. Agreed Exubera is crap
2. Agreed that it is a sad state that patients have to get contrary medical opinions from laypeople, not from a public discussion on the subject.
3. A subscription newsletter "The Medical Letter" independently reviews new drugs that come out on the market. They are not funded by advertising, just by subscriptions from people who want objection advice on new drugs. That is the place I look for medical advice about drugs if I don't want to have to go through the trouble of doing the research myself.
I'm surprised the media doesn't quote the medical letter more. (I have no financial ties to the medical letter, other than the money I send them every year for my subscription.)
b
 

Ok, I don't know who gives Janet Ruhl the right to knock something she hasn't tried, but my guess she is an uncontrolled diabetic who is old!
I am now on Exubera. I have a HgA1c of less than 7 and have been an insulin dependent diabetic for 24 years (yes, I'm a diabetic that was diagnosed as a child, bit because I'm fat and lazy). This is as close to a cure as I will probably ever get and I am so glad to have it. It eliminated 3 shots a day and the embarrasment of having to do an injection in public at a restaraunt. Asthmatics use inhalers all the time in public, so this is no different.
This is a great thing for progressive diabetics. Those who care about their quality of life.