Nada...I'm a Regional Manager for a well respected medical device company and have been in the industry for some time including a 2 year stint in Hospital Administration. We gave our doctors less than 20 minutes and it was offset by NP and PA so it was more like 10. The pharma sales industry is crap now. All the good talented reps are begging me to hire them into devices so they can have a meaningful discussion with HCP's again. Or, they are going into other industries. The pharma companies are partially responsible for this, skimping on good training, hiring a lot of bimbo's with large boobs and spending hoard's of cash on lunches, dinners and "entertainment". Now with no ability to spend money on them and with their time constrained, older physicians no longer want to talk to a rep...especially those with little experience and can't debate without looking at their cliff notes. None of them really know their industry well anymore, move companies every 2 years or commit the time to be great consultants. I'm sure your father would agree with this. Even with devices, things are changing. We used to walk right by the pharma reps and into the procedure areas without hesitation. 10 years ago, I could walk right into the O/R locker room, change into scrubs and mask, and go right to my physician I was targeting and catch them before their case at the scrub sink and get a good 10 minute meeting. Many times I'd be invited into the case. Now, we have to make appointments and clear our access ahead of time which is 50/50 successful.

The only way to do it now, and it takes longer to seed the market, is to convince residents, fellows and midlevels. Their minds are open to education, they are accessible and spend more time with the patient now anyway. They also have the ability to influence those older decision makers in a way the medical sales reps no longer can. The second way is to go direct to consumer as you mention. Both take more time than they used to and why every drug launch today is slower and more expensive than expected before rapid adoption. MNKD cannot do this on their own. It will be way too expensive and dilutive. We also don't need a run of the mill sales force that markets to primary care...they are the least talented. I would love to see a Diabetes specific sales force like Medtronic Diabetes, Novo or Lilly Diabetes who know the disease state well and have the inroads to the right physicians (specialists) and can make access.