Wednesday, November 7, 2007

November musings: Diwali, Diabetes and Exubera (will it make a come-back?)

Albert Einstein, American scientist: "We owe a lot to the Indians, who taught us how to count, without which no worthwhile scientific discovery could have been made."

Diabetes in India

Madhumeha (diabetes mellitus) has been documented from 1500 BC in India. The first description of diabetes is in the Atharva veda. Charaka samhita the Ayurvedic text dating back to 1st century AD has also descriptively dealt with madhumeha. The ancient text had recognized that diabetes was indeed a metabolic disorder.

Diabetes a metabolic disorder affects carbohydrate metabolism. The metabolic derangement results in elevated blood sugar levels. Although the signs and symptoms of prolonged elevated blood sugar levels are giddiness, irritability, burning or tingling sensation in the extremities, excessive thirst and hunger, fatigue, cramps in the calf muscle area, itching, impaired wound healing, fungal and other persistent skin infections, skin allergies, blurring of vision, sudden loss of body weight, susceptibility to infections and fever,…the real danger of diabetes are the diabetic complications.

Diabetic complications include vasculopathy (disease of the blood vessels), cardiomyopathy (disease of the cardiac muscle), neuropathy (disease of the nerves), dermopathy (disease of the skin), nephropathy (disease of the kidneys), retinopathy (disease of the retina)… Diabetic individuals are more susceptible to osteoporosis, dental and gum related problems, infections, silent heart disease, diabetic liver, erectile dysfunction, sexual problems, urinary problems, and impaired wound healing. It is these frightening complications of diabetes that add to the morbidity (loss in quality of life) and mortality. Diabetic complications can cause absolute despair in sufferers.

The worst thing about diabetes is the fact that it can be asymptomatic too. Many diabetics do not find their signs and symptoms to be very serious and start to neglect or take it easy. This apathy and careless attitude can then cause exacerbation or worsening of the condition and leads to the diabetic complications.

In that sense, diabetes is like AIDS. The HIV infection causes weakened immunity and the person finally succumbs to the complications of HIV infection, such as gastrointestinal infections, TB etc. Diabetes too is dangerous, not because of the elevated blood sugar levels, but due to the complications of diabetes that causes morbidity and mortality.

Diabetes in India

Much has been written about India being the diabetic capital of the world – ahead of even China.

It has been projected that 300 million individuals would be affected with diabetes by the year 2025. (About 35 million individuals are estimated to be diabetic in India). The reasons for this escalation are due to changes in lifestyle, people living longer than before (ageing) and low birth weight could lead to diabetes during adulthood. Diabetes related complications are coronary artery disease, peripheral vascular disease, neuropathy, retinopathy, nephropathy, etc. People with diabetes are 25 times more likely to develop blindness, 17 times more likely to develop kidney disease, 30-40 times more likely to undergo amputation, two to four times more likely to develop myocardial infarction and twice as likely to suffer a stroke than non-diabetics.

The booming antidiabetic and cardiometabolic market for India is characterized by a lack of public awareness campaigns on diabetic complications

Even though racial susceptibility, lifestyle changes (increasing sedentary lifestyle), stress, and faulty diets/obesity are increasing the incidence of diabetes in India, there is a peculiar lack of public awareness campaigns on diabetic complications in general. Unless, the public are made aware on diabetic complications, rather than dangers of diabetes alone, the true gravity of the situation will not be understood.

November is the sweet month for Indians – the festival Deepavali or Diwali in the month November is celebrated with crackers, new clothes, and sweets. Yes! The famous variety of Indian sweets is an important component of Diwali celebrations. Ironically, November 14th is the World Diabetes Day and America observes November as the diabetes awareness month. Maybe it is apt that diabetes awareness campaigns and Diwali should run parallel.

Public awareness campaigns on Diabetes and Diabetic complications are the need of the hour

It is high time that the GOI sets up a NATIONAL DIABETES INFORMATION RESEARCH AND EDUCATION MISSION; this mission is not about researching about a diabetic cure; it is about researching the information and propagating messages on diabetes and diabetic complications. One of the most important tools of diabetes management is education, and the emphasis should be on diabetic complications. This would help the public perceive the disease as a grave challenge and needs to be managed through lifestyle modification, exercise, Yoga, good habits, diet control, and medication.

The awareness campaigns for diabetes and diabetic complications ought to be on the same scale as that of the Pulse Polio campaigns.

Diabetes day random blood glucose check camps

The Central and State Govts., in India can have diabetes day random blood glucose check camps at Govt. PHCs, special camps, private clinics on the lines of Pulse Polio campaign and in collaboration with private sector companies and HRD depts. of large organizations.

Such camps will create vibrations and consciousness about diabetes and diabetic complications.
Please click here for a great site to check the diabetes risk aspect. Another link here gives comprehensive information on diabetes with hyperlinks. Indian researchers have discovered that fat cells have the property of producing insulin. It is interesting to read about this development please click here!

Will Exubera make a comeback?

The attractiveness of the diabetes management market has seen companies invest billions to develop and market products. Very few fail in this market. One interesting recent failure has been that of Exubera. It is very unusual of Pfizer to suffer such a setback. Perhaps it could have done better on the front of brand engagement and persuasive clinical documentation. It is too na├»ve to think that Pfizer will let go off a powerful concept such as inhaled insulin (with its abundant market potential and first mover advantage). Pfizer has a history of being an aggressive marketing tiger in the Pharma market. One cannot forget how piroxicam was a dud molecule when launched by Indian companies in the Indian market. Pfizer’s Dolonex (piroxicam) however, created history by being a blockbuster Pharma brand in the Indian market. Exubera will make a comeback – this is my gut feeling. The withdrawal was only strategic. A new avatar of Exubera may be back in action.



Sunil S Chiplunkar said...

I am imagining a strategy session at Pfizer (please note this is strictly hypothetical - but possible?!):

Person 1: Hey! The offtake of Exubera is lacklustre. It needs to be rebooted, we need a buzz.

Person 2: Let us try attitude change through dissonance. Let us announce Exubera withdrawal and watch for market reactions. After all doctors too want new drugs that are safe, efficacious, and convenient. So we can actually engage the target audience to reconsider Exubera with this announcement - isn't it?

Person 1: May be we should try it. After all the worst case scenario is that the sales will not go up and if sales continue the way it is going on now, we anyway have to withdraw Exubera.

Person 2: Right, let us try attitude change through dissonance! Let us announce withdrawal of Exubera.

Person 1: If this strategy of attitude change through dissonance does not work, we can relaunch Exubera after some more clinical studies, and innovative design.

Person 2: Right let us do it!!

Sunil S Chiplunkar said...

A very positive and interesting reading is here at -

It is a far cry from what has happened to Exubera.