Category Archives: Patients

Blog posts generally about patients, patient behavior

ACR Poster on Gout Treatment Costs

In late 2013, Aaron Davis presented his poster on Gout treatment costs and regional variations.  Contact me if you want a copy.  Slide1


Poor patient compliance – the great consistent – inconsistency

Years ago when I was a forecasting geek, I could build the best model ever, based on sound data, and well thought through assumptions. Time after time, the most controversial subject would be the patient compliance/adherence assumption. Brand leadership wanting to show a bigger number would always argue that “patients are going to love this drug, they will be incredibly adherent.” A senior VP with deep experience, would always say “Set it at 50%, it is always 50%.” I had to smile today when I read the headline “Half of heart patients don’t stick to their meds” –

I also had to smile when reading the quotes in the article searching for answers to the patent engagement issue, knowing that MEMOTEXT, the best in class compliance/adherence platform, fits that exact need.

For more information about MEMOTEXT, drop me a line at



MEMOTEXT® and Metabolic Markets, LLC announce strategic partnership


MEMOTEXT and Metabolic Markets have entered into a strategic partnership, integrating MEMOTEXT’s best-in-class patient adherence platform into the Metabolic Markets’ client offerings.

“Patient compliance and adherence has long been one of the biggest challenges in chronic disease management.  MEMOTEXT’s unique, customized programs aimed at individualizing and increasing patient engagement, result in improved compliance and provide significant value to the healthcare system by reducing the overall impact and increased positive patient outcomes” stated Metabolic Markets partner Dr. Damon Tanton.

MEMOTEXT CEO Amos Adler commented, “Integrating Metabolic Markets clinical and health system expertise further enhances the delivery of MEMOTEXT’S adherence solution to patients, health care providers and payers.  We look forward to expanding the utilization of MEMOTEXT’s platform throughout the health care continuum with the Metabolic Markets partnership.”

Metabolic Markets will promote { MEMOTEXT’s patient compliance platform across its client base of manufacturers, managed care organizations and government health systems.


MEMOTEXT® integrates behavior modification, patient education and real-time patient support into the everyday lives of patients. This approach improves adherence using interactive multimedia assessment and telecommunications tools.

About Metabolic Markets

Metabolic Markets is the first strategic sale/marketing/reimbursement consulting company to focus on the unique commercial challenges in diabetes, obesity and other metabolic disorders.

Metabolic Markets was founded by Aaron Davis and Dr. Damon Tanton under the belief that bringing commercial and clinical expertise together in a focused consultancy will deliver enhanced value to clients, improving access and increasing treatment modalities in the global healthcare crisis of diabetes and obesity.

Paula Deen, who besides the butter industry will she be representing?

In one of the worst kept secrets and least shocking announcements ever, Paula Deen has confirmed she has been diagnosed with type 2 diabetes for several years.  In the news articles last week, Anthony Bourdain’s quote that “Paula Deen was the most dangerous woman in America” was particularly apt in context of he January issue of Health Affairs and the multi-factorial challenge that the country faces to address diabetes and obesity.

And now we learn that Novo Nordisk and the Victoza team have paired up with Paula.

I would say very well played by Novo Nordisk. Victoza is off to a strong start after two years on the market, already grabbing roughly 50% of the TRx share from  Byetta.  Paula plays to a broad audience and is very well known.  As Victoza and the GLP-1 class have a unique benefit of increased satiety typically leading to weight loss, it will be interesting to see how she and Victoza work this into a diabetes-living platform.  The platform is entitled “Diabetes in a New Light” .  It appears that the message is “you don’t have to change everything in your life to see a benefit”.

The timing of her announcement is interesting as well, post holidays when many patients are “starting the new year resolutions”  (why you are seeing  all of the gym membership commercials and specials).  Byetta is about to grab headlines in a few weeks with the POTENTIAL approval of their once weekly treatment offering.

I would also assume that Paula Deen did not come cheap to Novo Nordisk.  I don’t know the quotes for such an investment, but she is very high profile and a very recognizable name.  A few years ago, Byetta partnered with Delta Burke,  who was years past her prime.  The Byetta / Delta Burke association was appeared very “patient materials” focused, a more narrow utilization of a celebrity.  It appears that Novo Nordisk is going much broader with Paula Deen, we have to wonder if this will be paired to a  DTC campaign.

And not that I am a conspiracy theorist, but isn’t it interesting that a story was “leaked” last week to a pop-culture blog that Paula Deen was going to announce her diagnosis?  The rumors were incorrect that she would be pairing with Novartis, but not too far off in spelling from “Novo Nordisk.”  Makes me wonder if a PR person purposefully leaked the story, but didn’t know enough about the industry to get the name of the pharma correct?  It is fascinating to watch the life-cycle of a story play out in the internet age.

So, what can we guess about Paula Deen’s partnership.  A) Novo invested heavily B) This may be a signal they are seeing some sparks of utilization in the primary care world and this will help drive patients to ask the non-specialist about an injectable agent, c) Novo is playing to win.

NYC Shocker anti-Obesity advertising

A few years ago, NYC subway ads featured a soda bottle pouring out fat. It was disgusting and had people talking, at least for a little while.
They are trying it again, with a “super-size” me type picture of sodas and a man with an amputation. Interesting timing of the ad launch, falling on the same day as a large Health Affairs sponsored diabetes policy meeting in Washington D.C.
What I love about the ad is the blunt force, simple connections. No small print, no caveats. Call it scare tactics and I’m sure will be responded to by the Sugar Water manufacturers, but it is powerful.
I was talking the other day that no single approach will help stem the obesity challenge and a public health push and awareness campaign will be important, like smoking. A key limiting factor will be funding. Tobacco companies were forced to pay for anti-smoking campaigns through one of the large settlements. In the case of obesity, where will the dollars to support the campaigns originate? Soda taxes continue to be controversial, and I am sure those funds would likely be raided for some other government program before supporting an anti-obesity campaign.

What do Washington state ferries and “It’s a Small World” have in common?

Obese Americans.  That is what they have in common.

According to The Log, a southern California boating newspaper, ferry operators have had to adjust the number of people approved to ride aboard due to new US Coast Guard rules.    Most of the ferries operating in the U.S. were built many years ago, and the assumed rule for an “average passenger” was 160 pounds. The Coast Guard has adjusted their official “average passenger” weight to 185 pounds.  This will have a material revenue impact on the ferry system at large, as they will not be allowed to take as many passengers on popular and often sold-out routes.

This reminds me of the often discussed/urban legend about the “real reason” that Disneyland closed “It’s a small world” for over a year.  “It’s a Small World” was built in 1965 and the size of the little boats was not designed to handle today’s size of visitor. According to a few disney-watching blogs, Disney closed the ride to build new boats with more room and floatation.

I hear giggles at stories like these, but it also reminds of the economic consequences of obesity.  We typically measure the obesity problem in healthcare costs with the myriad, and seemingly increasing number, of issues for which obesity is a known risk factor.


Mobile this, mobile that, do you need a diabetes app?

There is no shortage of diabetes-related apps out there.  And whenever there is no-shortage of something, that usually means there are a handful of good ones, and many, many bad ones out there.  Some are healthy habits related, some are glucose value related, some are weight loss related, in general they are all over the m(app).

I read on tech crunch that Omada Health had raised some angel funding to support further development of their prevention focused app. Omada is a spin-out from the incubator IDEO, the leading edge consumer design firm. This follows a unique contest led by Sanofi, the 2011 Data Design Diabetes.  The contest provided $10k in award to the winer, , but more importantly, considerable publicity and validation of their approach integrating behavior analytics in chronic disease management.

Despite a multitude of diabetes/disease management apps out there, there continues to be considerable interest by investors and leading edge pharma to support the best technologies.  Much like all other aspects of disease management, no one specific action/tool will guarantee success, but the rise of mobile technology provides another piece of the puzzle.  That being said, is there a role for a manufacturer to be developing a proprietary app, or is the regulatory hurdle involved so high as to remove any clinical and commercial benefit?


Medicare paying for obesity counseling, a step forward or $$$ down the drain?

CMS recently announced that Medicare will be paying for obesity counseling.

Reading through the regulation, it is specific and in our opinion, reasonably robust.  We don’t know the payment rates yet, which will truly show CMS’ commitment toward obesity management.  As we all know, it all comes down to money and politics, or am I too much of a cynic?

The benefit now involves: Beneficiaries with body mass index values of 30 or more can receive weekly in-person intensive behavioral therapy visits for one month, followed by visits every two weeks for an additional five months, fully paid by Medicare with no copayment.  There is language about showing progress towards a goal to continue the benefit.

As commented in the MedPage article, will commercial insurance follow suit?  “Healthcare Reform” demanded insurers to cover preventative services, but not as explicitly as the new Medicare provision. And as most of the damage of obesity is done prior to Medicare eligibility, will any investment in obesity counseling by Medicare improve anything but the revenue for disease management companies who know how to work the system?

So we challenge you, dear reader, is Medicare paying for obesity counseling a step forward in taking the obesity epidemic seriously, or a Medicare “bridge to nowhere” (for our friends in Alaska)?


Social experimentation with obesity: “big brother” or “big idea”


It is almost impossible to separate obesity issues from political minefields.  A study published this month in in NEJM will do nothing to diffuse those issues.

In short, University of Chicago researchers looked at the movement of people using housing vouchers out of low income housing (I’m paraphrasing, and please read the article for the exact design), and followed their weight and HbA1c over time. Essenitally, if people moved away from low income neighborhoods, they became less obese and improved glycemic control, although somewhat modestly.

A few years ago, I had the amazing Dr. Anne Peters speak for me to a group of Indian health physicians.  She talked about the challenges of diabetes control within the inner city, but really about the challenges of trying to eat something healthy in the inner city.  It is somewhat late on the West Coast, particularly for a father of two young ones, and I can’t remember the study she cited, but if memory serves, Dr Peters and USC’s mapping experts looked at the availability of grocery stores in lower income areas, a simple concept. And guess what they found?  You will be SHOCKED, SHOCKED, to learn that it is really hard to buy decent quality food in low income areas of Los Angeles. It was an amazing discussion, in that the simplest things of potentially finding a way of providing decent access to non-processed foods would likely have a profound effect on the obesity/diabetes crisis.

A recurring theme: is this leveragable?  can we move people to healthier areas?  what is the role of government?  should there be a role for government intervention or is the Invisible Hand at work? With such a publicly borne health care burden, can the government not afford to become involved?

On a concordant note, some day soon we will talk about government cheese, white flour and the Native Americans, but not tonight.




People see what they want to see, and physicians aren’t pushing the issue

A recent emergency room survey of patients found that only 19% of patients with a self-characterized “unhealthy weight” had ever discussed weight with their health care professional.  You can read the US News & WR article here.

As we have seen time and time again, generally speaking there is a very odd dynamic between provider and patient when it comes to weight issues.  Without doing an exhaustive pub-med search, I will guess that the data will suggest both providers/patients have their heads in the sand about weight, both providers/patients are frustrated, and consequently, an unwritten rule of the provider / patient relationship is “I know you are heavy, you know you are heavy. I know that you know you won’t likely do anything about it, so we are all going to not talk about it.”  Am I too cynical?