If at first you don't succeed - go straight to the patient's home. After a lackluster attempt to sell doctor's on prescribing Phizer's inhalable insulin, Exubera, the company has decided to begin running television and print campaigns to advertise directly to patients.

The ads will start appearing the second half of 2007. However the main contention from Congress and medical groups is that mass marketing to patients encourages excessive use of costly therapies. Exubera gained a reputation for being an over priced and not-so-discreet way to administer insulin. Doctors say the inhaler is unwieldy. Depending on a patient's health care plan, they can pay about $600 a year more for Exubera than injectable forms of insulin. Clinical trials have found the product can reduce lung function for some patients. Pfizer says the condition is reversible and is conducting a five-year study among users to monitor it.

Why the push, Pfizer? You seem hell-bent on making this one stick. The president of Pfizer's worldwide pharmaceutical operations says the television ads will target newly diagnosed diabetics who may not want to inject themselves daily. Patients who develop diabetes later in life may put off using insulin because of needle phobia. Fair tradeoff: I see your fear of needles and raise you $600 a year, a license to toke (in public), and maybe a little bruising on your alveoli. Puff, puff...give it a shot.

Eli Lilly is introducing a unique insulin pen named the Memoir. It is the first on the market with a memory device to track doses administered. It is designed for use with Lilly's top-selling insulin, Humalog.

The battery-operated pen uses a computer chip to remember the last 16 insulin doses. And while insulin pens are popular in Europe and Asia, only about 800,000 of the 4 million U.S. diabetics who take injections use a pen-- most use syringes. It won't be too surprising if insurers and patients balk at the $100 sticker price for the pen alone. There is a separate fee for the insulin cartridges. I agree, it's a little pricey. Lilly plans to ignite the marketing campaign by offering a $45 coupon. Good start. This pen has been under development for seven years. Lilly plans to introduce two other pens this year to increase Humalog demand. I've got an idea (since nobody asked, but I was a former user). I traded up to Apidra because I became irate every time Humalog clogged my infusion set for my pump. Go back to the drawing board with that quandary while I'll work on my honey do list for product development.

Neither here nor there - my point is this: Eli Lilly you can be everything you want to be if you listen to your customers. The number of insulin-taking diabetics is rising along with the bar on product ingenuity. It's game day, Eli Lilly. I have more ideas to help bring out your A-game. Stay tuned...

If the US wants to slow the spread of diabetes, it should think about coming up with a diabetes prevention program, say researchers who have been assessing the likely benefits of that approach. They predict that such a prevention program, provided to American adults with prediabetes at age fifty cold significantly reduce the diabetes problem.

A successful prevention program would provide "lifestyle interventions" (yikes, would not want to be on the receiving end of that) to push weight loss and exercise.

It makes financial sense, says Tom Hoerger, a health economics researcher. The cost of such a program would greatly reduce the money spent by insurance companies and Medicare on diabetes treatment. And, of course, it would greatly reduce human suffering also.

The results of the study that evaluated this approach was published in Diabetes Care (June 2006). In that article, the researchers predict that diabetes prevention, if made available to Americans with prediabetes at age fifty, could in theory reduce diabetes onset by age sixty-five by thirty-seven percent.