An Open Letter to Eli Lilly & Co. Chairman & CEO Sidney Taurel

Amy Tenderich's open letter to Steve Jobs certainly created something of an electronic storm. Whether it results in material changes remains to be seen, but its well known that political advisors and increasing numbers of businesses are measuring opinion via the blogging universe (or as I call it, the blogosphere). I am directing my own letter to Eli Lilly and Company's Chairman and CEO Sidney Taurel:

Dear Mr. Taurel,

I write to you as both a shareholder, and a former customer. Recently, The Wall Street Journal's health blog posted a note to board members, executives and others at Eli Lilly and Company saying "You're No Johnson & Johnson". That was a comment on the fact that Lilly benchmarks your salary based on an average of so-called competing companies, including the diversified health care giant Johnson & Johnson, which operates in three separate business segments through more than 250 operating companies. The comments were not pretty, as your company has not exactly delivered superior returns to investors in recent years. Nowhere is this more evident than in your insulin business, which has seen its market share plunge from 82% in 2000 to 43% in 2006 according to data from IMS Health! I don't need to remind you that insulin still accounts for just under one-third of your revenues. In addition, you have recently shelved plans for a Virginia factory to make insulin because executives now believe that existing plants can meet demand.

Although I prescribed a method for Lilly to restore its insulin business, so far, no one has even acknowledged my comments, let alone taken any of my suggestions to heart. As Allie Beatty recently discovered, although her focus has been directed towards the American Diabetes Association, no one at Eli Lilly and Company would even entertain the notion of speaking to her about commercializing C-Peptide in spite of a growing mountain of evidence to support its utility. Instead, Lilly has responded by developing more medicines to treat type 2 diabetes, as well as with drugs to treat diabetes complications, at least according to a letter to the Indianapolis Star from your Chief Operating Officer, John C. Lechleiter. Does he really think we we are going to be thanking Lilly for the company's response to the diabetes pandemic when that consists of trying to sell us more drugs for complications that you might actually have prevented? Sorry, but that just won't fly with me.

Then there is the little issue with the company's reported fix for the sagging insulin business, notably the introduction of several new insulin pens. The Humapen Memoir pen is quite nice, but does not dose in 1/2 unit increments. The Humapen Luxura does dose in 1/2 unit increments, but has no memory. If Matt Beebe, Humalog brand team leader at Lilly USA is reading this, or even if J. Scott MacGregor who handles public relations for the Humalog brand at Eli Lilly and Company is reading, you guys might want to check into an official company response on the issue of why your company has knowingly decided to abandon its research into possibly including C-Peptide in its insulin formulations. I would remind you that nearly a decade ago (back in July 1997), Lilly helped fund a joint study with Washington University at St. Louis and the National Institutes of Health, and your company's own researchers discovered that in diabetic rats, treatment with C-peptide reversed vascular and nerve damaged blood vessels and helped to repair them. In the rats treated with C-Peptide, the nerve cells worked normally and vessels almost completely stopped leaking. Since then, additional studies have confirmed the usefulness of this element in humans, but instead of commercializing it, Lilly has responded to the diabetes pandemic by developing more drugs to treat complications.

The blogosphere is rumbling about your insulin business, but the tone is not one of praise. (For more recent comments, just check out some of the posts by looking at the "Recent Diabetes Headlines" sidebar if you need direction.) For one thing, Lilly has almost nothing in its new drug pipeline for type 1 diabetes, not even a long-acting analog that would put the company on a competitive footing with rivals Novo Nordisk and Sanofi-Aventis. The impression seems to be that the ADA, Lilly and its competitors don't really care about the needs of people with type 1 diabetes. For example, no long-acting analog is in development at Lilly according to recent investor presentations (certainly not in phase II or III trials), so patients are forced to buy products from your competitors. But these days, managed care often has "preferred" brands, and on some healthplans (I'm thinking of the massive United Healthcare account), Lilly is not a preferred brand.

I would also add my own recent posting about why are insulin manufacturers not working to resolve the issue of mixing their insulin analogs (or for that matter, adjunctive therapies such as Symlin, which your company jointly markets with partner Amylin Pharmaceuticals) in the same syringe or pump reservoir? This is a patient need that your company has not bothered to consider. Looking for a way to increase market share in insulin? Why not work on a Humalog/Symlin combination drug? We know that the development timeframes are usually shorter on these, and Lilly seems to like selling premixed insulin formulations (Humulin 70/30, Humulin 50/50, Humalog Mix 75/25, Humalog Mix 50/50, etc.) anyway, in spite of the evidence to suggest these don't really deliver superior glycemic control for patients with diabetes. But you ARE marketing two popular products which cannot presently be mixed, which is surely a lost opportunity. Consider funding studies like the one done at the Barbara Davis Diabetes Center in Colorado that showed that Humalog could indeed be mixed with Sanofi Aventis' Lantus long-acting insulin analog without adversely impacting glycemic control. After all, if you cannot offer a full product portfolio, at least you can make a compelling argument as to why its ok to use your insulin with one from a competitor, thus mitigating some advantages rivals have.

The bottom line is that the opportunity for Lilly to restore your insulin business does not necessarily mean more salespeople, although I realize you must restore those that were cut in 2001 when the patent for Prozac expired and to respond to Novo Nordisk's announcement to expand its salesforce by another 800 people. But the fact is that the Associated Press recently reported that New Hampshire has already, and other states (including my home state, New York) are also moving to ban pharmaceutical companies from using physician-level sales data in marketing to physicians. Besides, our doctors now have so many salespeople that they don't know what to do with them. And patients suffer by waiting a month or more for an appointment while your salespeople are consuming our doctors' time trying to sell your products.

I won't even comment on your Zyprexa business other than to note that this business may not have such an easy turn-around as Lilly's sagging insulin franchise. But in order to turn the insulin business around, you need to start listening to the needs of your customers!

Yours Truly,
Insulin Dependent

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