Wednesday, February 07, 2007

Persistance Pays Off ... Sometimes

As patients with diabetes know, living with this condition can be frustrating. Sometimes, even when we follow the rules, we end up with unpredicted results. Likewise, occasionally, it seems that there is widespread perception that diabetes is a self-inflicted condition, and for those of us with type 1, it also seems that all the new treatments are for type 2 (in fact, the only new treatment for type 1 since the discovery of insulin in 1921-22 was Symlin, which received FDA approval in late 2005). To survive, it requires persistance, (some would even call it faith) that its really worth the effort (especially since new evidence suggests that some type 1 diabetes complications have little to do with glycemic control, but are caused by autoimmunity). However, in some cases, our persistance pays off.

For example, last June, I attended the ADA Scientific Sessions in Washington, DC and got to see the massive vendor presentation. At the time, Eli Lilly and Company was demonstrating a new insulin pen called the Humapen Memoir. I was impressed with it, but when I asked the representative why the device only permitted dosing in 1 unit increments, she did not have an answer for my question. I then gave her an earful about the fact that the device only enabled dosing in 1 unit increments, and that 1 unit is often much too large for insulin-sensitive type 1 patients (especially children). Quite literally, for me, a half unit could mean the difference between hyper and hypoglycemia. Today, the pistons of most insulin pumps are threaded finely enough to deliver insulin in increments of 0.10/unit or even smaller. Yet pumps are not for everyone (I previously wore an Animas R1200 pump but for a variety of reasons, I returned to injections), while others cannot afford an insulin pump and some (like me) simply do not like them. The real issue is why should people who, for whatever reason, choose injections be denied the same dosing precision? There really aren't technical reasons for this, these are largely marketing decisions made by the syringe and/or insulin manufacturers. I expressed my concerns to the Lilly representative and she courteously told me that she would convey my concerns to the company's product development team. She also gave me the name and address for the relevant individuals whom I could have my endocrinologist write to about this issue. In addition, I started a very small letter-writing campaign among my CDE and a few other people to write to Lilly commenting on their FDA application for the Humapen Memoir. At the time, I expected that they would basically ignore my comments, but I felt that at least I was able to communicate with the appropriate parties about an issue I felt was important but overlooked.

Last week, when I posted an update I called "Sneak Preview of Lilly's New Humapen Memoir" which highlighted the device, my main gripe was still that the device still did not enable dosages in 1/2 unit increments. I didn't realize it at the time, but it seems that Lilly's market share loss in the insulin business (which I discussed here) has indeed made the company much more receptive to this type of important input. After all, if dosing in 1/2 unit increments means the difference between a doctor prescribing Humalog or Novolog, then its in the company's best interest to consider such genuine patient needs.

The good news is that on Tuesday, I received an e-mail from Lilly's PR agency, and was informed that another version of the Humapen would be introduced later this month which does enable dosages in 1/2 unit increments. Specifically, this is what the message from the PR firm said about this subject:

"In your 1/31 posting about Memoir, you mention that the pen 'still' does not enable half-unit dosing. While that is true about Memoir, I wanted to let you know that Lilly will announce the launch of another pen specifically for that purpose later this month. If you'd like, I would be happy to update you with materials (press release, fact sheets, photos) as soon as they become available."

I asked to be added to the PR list, and when I receive notice, I will pass along any relevant information. I certainly cannot claim that I accomplished this alone, and sometimes outside factors change the dynamics of the situation (as was the case here). But the moral to all of this is that persistance can sometimes pay off. For patients with type 1 diabetes, it appears that Lilly will very soon be offering another pen, very similar to the Humapen Memoir, except that the new one will enable dosages to be given in 1/2 increments. I'd call that a victory for all of us!


Michko said...

Sometimes it's the small victories that matter most. Good for you for standing your ground and doing something about this.

Scott K. Johnson said...

That is AWESOME news!!

And don't count yourself short - you have a very strong and well spoken way about your communications, and I would bet you and your campaign had a fair amount to do with this.

Way to go!!

Chrissie in Belgium said...

Oh Scott, there are two Scott Johnsons! This I did not get! You are the one that visited Finland! I had to remark about this posting. I only use 14U per day - I could never return to a pen b/c of the fact that the increments were too large. I think it is fabulous what you have done to get Lilly to provide a pen with 0.5U possibilities! I have now added you to my bloglines. Please let's keep in touch. Maybe you want to send me an email??? I would like that. Oh that I could be so stupid about who is who!!!!! Love your site!