While the growth of the diabetes epidemic has been highest in the West, the population has a lower rate of diabetes (3%) than the relatively slimmer Indians …
Diabetes Close Up, V3, 3 January 20, 2004 JNJ 4Q03 Results and Lit Media Roundup Company Roundup: JNJ reported 4Q / 2003 results this morning LifeScan reported annual revenues exceeding 14 billion in 2003, up 6 year over year Quarterly revenues totaled 387 million, up 12 year over year and 7 sequentially Reported domestic 4Q03 revenues rose 1 and international rose 28 Operationally, worldwide revenues rose 5 and international revenues increased 12 More details below 2 Literature/Media Roundup The Economist on obesity Filling the Worlds Belly, December 13, 2003 Time on diabetes Diabetes: Are You At Risk? December 8, 2003 JAMA on dangers of being young and fat Cardiorespiratory Fitness in Young Adulthood and the Development of Cardiovascular Disease Risk Factors, December 17, 2003 Annals of Internal Medicine on whether six lattes a day keeps the endocrinologist away Coffee consumption and risk for type 2 diabetes mellitus, V 140, 2004 Various government repots on latest healthcare spending more bad news 3 On the Road: Upcoming diabetes/obesity-related conferences of note February 6-8, 2004, ADA 51st Annual Postgraduate Course San Francisco, CA
http://wwwdiabetesorg/main/professional/conferences/defaultjsp February 12-14, 2004 Third La Jolla Conference on Glucose Monitoring and Control San Diego, Ca http://glucoseconferenceucsdedu/indexhtml March 17 20, 2004 Diabetes UK Annual Professional Conference Birmingham, England http://wwwdiabetesorguk/apc/ 4 Diabetes Close Up commercial DCUs Diabetes 2004 Roundup will be published in February; prepublication discount available through February 15 for our first annual diabetes/obesity review Full ordering information to follow shortly on our website If you would like more information, please email info@closeconcernscom The volume will contain: Detailed notes on 20 conferences in 2003, including ADA, AADE, EASD/IDF, NAASO Top ten research articles of 2003 Top diabetes/obesity themes of 2003 DCU High Five Awards the best products of 2003 Key conferences in 2004 _____________________________________________________________________________________ 1 JNJ reported 4Q and 2003 results this morning On a reported basis, LifeScan sales rose 12 worldwide for 4Q03 versus a year ago, reflecting 1 growth in the US and 28 international growth Operationally, worldwide sales grew 5
versus a year ago, while international sales grew 12 IMS data indicates LifeScan volume is up well above than 1 in the US, suggesting that at least some pricing pressure continues to exist we understand mail order continues to grow and now represents 25 of category sales and that product diversion likely benefited international sales of blood glucose monitoring at the expense of domestic sales We believe JJs new distribution policies will help its US blood glucose monitoring business and worldwide business overall in this regard While sales results are undoubtedly influenced by a range of factors, relating to competition, payors, promotions, currency this quarter a big tailwind 1
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was likely particularly helpful, market fluctuations, etc we believe that domestic growth rates would have been higher, perhaps significantly so, in the absence of product diversion o The last edition of our newsletter addressed JJs new policies aimed at thwarting the problem of product diversion JNJ Gets Tough on Wholesalers in DCU, V3, 2, posted on wwwcloseconcernscom There, we reported
that 26 of JJs LifeScan distributors had agreed to only distribute JJ products; as of today, that number has climbed to 40 o The Wall Street Journal commented today on the recent slew of interest in this area check out Mark Ingebretsens Daily Scan for more information Canadian growth rates are of particular interest to us the WSJ quoted a recent Washington Times editorial that noted that Canada does not allow the FDA to inspect its wholesale or distribution operation Canada is a net importer of various treatments, including imports from many countries considered havens for counterfeiters and diverters, such as Saudi Arabia, India, Pakistan, and certain nations in Africa Other LifeScan commentary on todays call was not extensive, probably because JJ hosted an analyst meeting where pharma was a bigger emphasis Management did note that the Ultra franchise continues to achieve share growth in the US, which was offset by a greater decline in sales of older technology likely Basic, SureStep, etc CEO Bill Weldon spoke on product innovation on the medical device/diagnostics front Unsurprisingly, they continue to keep things close to the vest at LifeScan Although history would imply that
interesting work ongoing in various product areas there, Weldon cited only enhanced data management, noting that UltraSmart would be launched in Europe this year Continue to watch the pipeline front for news on compounds related to diabetes or obesity; no doubt JJs slew of impressive scientists are working away on several potential magic bullets wwwinvestorjnjcom/downloads/4Q03websitepipelinepdf o JJ updates its pipeline spreadsheet every quarter We thought we might see news on the potential Topamax obesity indication, though this quarterly spreadsheet represents a select list and doesnt include every drug or indication only Phase III and filed drugs are included At EASD, it was said Topamax would be in Phase III sometime this year, so look for more news on this to follow Well be continuing to watch closely what happens with formulation and side effect profile o For pharma overall, we learned there are 87 projects on which early work is being done, 74 projects in full phase testing, and that 50 applications for new drugs/indications are expected to be filed over the next five years o Note that for the next review 1Q04, JJ will host an RD review in New York, where well learn more
on what JJ is doing on the metabolic disease front, which Weldon did mention as a future area of major focus At an analyst meeting a couple of years ago, management noted that 25 of JJ NDAs were in the area of metabolic disease diabetes, obesity, etc so itll be interesting to get that update next quarter Our focus isnt only on how JJ will build its pipeline; its stellar balance sheet would allow for a multitude of acquisitions both in pharma as well as medical devices if the right fits were found; we will stay tuned on this front Sweet news on Splenda So Ive been watching Splenda for some years now this sweetener is awesome and its starting to get some real traction, having achieved 300 million in sales in 2003 Its now offered in over 32 countries, is in 3000 different brands, and is the top tabletop sweetener Patients love it for two reasons: they can bake with it, unlike the old sweeteners and it tastes great its actually hard to believe the first time you taste cookies made with Splenda, for example it literally has no sort of weird artificial taste We have a truckload of it at our place since it is given out at various diabetes meetings so let me know if you want a sample
mailed to you Postscript on Splenda Viactiv: There are undoubtedly other neutraceutical products that are doing well at JJ that werent highlighted today this is definitely a hot new area Aging expert Ken Dychtwald even talked about it at last weeks JPM conference, in a very entertaining session o JJ has a product for women called VIACTIV these are bite-size soft calcium chews 2-3 squares contains 100 of daily calcium recommended along with vitamin D K and each square is 20 calories each This is a McNeil product
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So the first time I heard about it, some months ago, my response was Yeah, yeah, right most of that sort of stuff has a deadly taste However I tried one chocolate is my favorite but there is something for everyone, even Mochaccino1 and all right, it isnt just that it tastes okay and is healthy it tastes great ital The only downside is that you cant buy these from the otherwise useful Viactiv website http://wwwviactivcom/product_infojhtml - when you call McNeil help line, they urge you to buy at Target, Wal-mart, or a drugstore We all can probably use
the walk required if not, theyre also at wwwdrugstorecom
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Literature/Media Roundup, Part 1 The Economist on Obesity Filling the Worlds Belly, December 13, 2003:
To close 2003 and to mark the arrival of the gluttonous festivities and parties that characterize the year-end holiday season between Thanksgiving and New Years, both Time magazine and The Economist ran December feature stories concerning the rise of diabetes and obesity The December 8th, 2003 Time issue focused on the nuts and bolts of the diabetes epidemic, including a general overview of the genes, proteins, and molecules involved in the etiology of diabetes and the alarming statistics showing its spread in the US see page 4 for more on this while the Economist published an impressive food survey that examined the ways industrialization, globalization, and marketing have revolutionized the availability of food and sedentary lifestyles across the world In light of the immense setbacks a continued rise in obesity would generate in terms of world economies and quality of life, we believe governments have or will soon find themselves compelled to intervene in novel ways The Economists food survey explores the potential
options Although a less direct approach than the more mass-market focused Time piece, the Economist survey, with eleven separate pieces, is a literal treasure trove of education relating to obesity: Filling the worlds belly Fatter than other animals Making it cheaper, and cheaper: how technology pushes down price Selling to the developing world: its tough but worth it The feel good factor: tasty food is sugary, fatty, and salty Make it convenient: that tends not to mean healthy Fancy that, healthy ketchup: food as medicine Organic? Dont panic: what the birds and bees say In search of the good: but even that can make you fat Outflanking the enemy: can governments make people thin? How sugar gets into schools: battle of the vending machines
In addition to these pieces, the website lists and links some fantastically interesting documents, including the following: Why Have Americans Become More Obese? by David M Cutler, Edward L Glaeser, and Jesse M Shapiro, Harvard University, 2003 The full text of this 56-page treatise is available, which reviews the implications of technological change ie, mass preparation of food2 Tackling the weight of the nation, by Susan Jebb and
Toni Steer, Medical Research Council, 2003 The full text of this piece addresses how to approach obesity in the UK its the Economist
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Currently, a sold-out flavor on drugstorecom wwwdrugstorecom/search/searchasp?searchviactivsearchtype1trx28198tr xp160srchtree1 2 One excellent take-home point: the authors highlight that on average in the US, average daily time for food preparation has declined by 20 minutes from 1965 1995 Over the same period, average weight gain was ten pounds This represents about 100 calories per day, or about 1 mile of daily exercise If it takes 15 minutes to walk or job a mile, the time cost of the 10-pounds gained is about 15 minutes per day Of the 20 minutes saved in food preparation, people could spend 15 minutes exercising, lose the weight gained, and still have five minutes left over Well, when you put it that way
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after all It struck us that the UK seems far more concerned over obesity problems that are somewhat less prevalent than in the US So lets get down to brass tacks: how far are we from a fat tax? Free-market advocates maintain the
conviction that freethinking people are capable of weighing the relative risks of consuming high-fat foods and choosing their diets accordingly, without the undue interference of government Corporations in the fast-food industry insist they simply are serving an existing market demand and thus themselves are not to blame for current obesity trends Indeed, the readiness with which the market has picked up on the demand for organic and health foods demonstrates its plasticity and equal ability to promote health-savvy trends A story in the January 14th edition of the Wall Street Journal, Now Low-Carb: Unilevers Skippy, Wishbone, Ragu showed how rapidly the food industry is responding to the low-carb diet craze started by the Atkins revolution, proving that the business world can serve healthier products even without government pressure In the next DCU, well have a report on how Atkins is revising its recommendations in response to pressure from competition and the healthcare community However, in the eighties, obesity shot up along with the popularity of Slim Fast shakes, proving that it will take more than stocking shelves with diet products to reverse the obesity trend Thus, one
lingering question is, to what extent should the government and private sector formulate policies from fat taxes to differential health insurance rates to provide sufficient incentives for people to exercise and eat healthier foods in order to properly manage their weight and health? The Economists editorial answered bluntly: If people want to eat their way to grossness and an early grave, let them, reflecting a deep libertarian reluctance to draw government further into the private domain However, while fax taxes may arguably go too far, no responsible government can sit back and watch obesity and its related disorders continue to erode much of the worlds quality of life and economic vitality without considering other less intrusive strategies If we think the West is bad While the growth of the diabetes epidemic has been highest in the West, the Economist article points out that its potential spread is even graver in the developing world, especially in Asia, where the population may be more genetically susceptible The fact that the heavier British population has a lower rate of diabetes 3 than the relatively slimmer Indians 55 supports the notion that diabetes arises from causes
more complex than merely putting on body fat This divergence in susceptibility may arise from differences in genetic material as well as in Asias exceedingly swift adoption of the Western diet and lifestyle One theory is that the development of the metabolic system is highly influenced by the intrauterine environment, suggesting that those exposed to stresses in the womb may be even less equipped to deal with the modern plenty Thus, the populace and the budgets of these developing countries may be particularly afflicted by the global surge of diabetes cases A section titled Fatter than other animals attributes the genetic propensity of humans towards obesity to the greater survival of a thrifty gene during intense agricultural famines While most animals avoid getting fat even when food is abundant, geneticists theorize that the great instability of the agricultural lifestyle promoted human genes that stored fat during hard times, while less thrifty genes died off In the early 1960s, anthropologist James Neel theorized that the Pima Indians of Arizona became particularly susceptible to diabetes because 19th century white farmers cut off their water supply, resulting in widespread
malnourishment and subsequent selection of thrifty genes However, the article fails to mention that the Pima Indians that currently live in Mexico and maintain a traditional diet are not experiencing the current epidemic of diabetes of their Arizona brethren Thus, thrifty genes result in high rates of diabetes only when combined with a modern high-fat diet and sedentary lifestyle In addition, the thrifty gene hypothesis does not account very well for the different genetic propensities for diabetes among such racial and ethnic groups as Japanese and African, who were not exceedingly wedded to agricultural lifestyles compared to white populations Huge costs face us and await us: The global diabetes epidemic is certain to inflict costs at many levels of society: for the individual footing health bills, for state and private health insurance industries, as well as for companies losing productive workers to illness Given these costs, the inevitable question involves the assignment of blame and responsibility to lazy individuals, neglectful governments, the domination of imperial Western culture across the globe, greedy corporations peddling products detrimental to public health, and
perhaps even the disappointment of research efforts to produce effective therapies While the recognition of the joint responsibility of all these players may generate the cooperative initiative vital to the
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checking further spread of diabetes, the potential for the issue to degenerate into a political blame-game bodes ill for all the worlds beta cells –By Martha Nelson and Kelly Close 2b Literature/Media Roundup, Part 2 - Time, Diabetes: Are You At Risk? The December 8th Time cover story Diabetes: Are You At Risk? covered the American diabetes epidemic from a number of different angles in several interrelated stories The cover, Why So Many Of Us Are Getting Diabetes highlights the gap that persists between the huge growth of scientific understanding of the diabetes condition and the relatively limited translation of this research into clinically effective treatments In addition, some more interesting, some less interesting supplemental stories were covered: The nuts and bolts of the biological mechanisms underlying the disease in The Bodys Sugar Factory; A Stars Smart
Cookbook, an account of famed singer Patty LaBelles personal struggle with type 2 diabetes and her enterprising diabetes-friendly soul food cookbook; A Body Making War on Itself, a reminder that while type 2 diabetes absorbs much of the medias attention for the immensity of its rise and health burden, type 1 still inflicts over 1 million Americans and represents another critical health issue; and What You Can Do offers the relative dietary, exercise, lifestyle, and medical interventions that lower the risk of developing type 2 diabetes While much of the material covered in the Time piece should be relatively familiar to those who follow diabetes in the news including the usual glum forecasts for future incident rates spanning all ages, genders, races, and nationalities, the article touched upon a few newer, more notable developments These include 1 a shifting focus towards identifying an expanding cohort of pre-diabetics with abnormal glucose levels who may represent a critical target group for preemptive medical interventions; and 2 a growing body of evidence associating diabetes to an inflammatory response, which may represent a new area for research and treatment In sum, the
article re-emphasizes the ever-alarming extent of the diabetes epidemic, the pressing need for further research and new treatments, and the immense market for drugs, devices, and various products and services from cookbooks to personal trainers that will market themselves to this surging inflicted the population Earlier interventions targeting a larger cohort of pre-diabetics: The American Diabetic Associations recent recalibration of the pre-diabetic category, which describes individuals at-risk for diabetes, to include those whose fasting glucose levels exceed 100 mg/dL versus the previous 110 mg/dL standard reflects the medical professions growing acknowledgement of the need to identify and address metabolic problems prior to the actual onset of diabetes This growing cohort of 20 million pre-diabetic Americans represents a critical target group for preemptive intervention to thwart the current surge of diabetes cases Part of the Time article focused on the latest 2002 Diabetes Prevention Program DPP study, which, as industry followers know, was a 3,000-plusperson trial across 27 US centers that demonstrated how interventions aimed at a pre-diabetic cohort can forestall the
further progression of insulin resistance that results in diabetes In this extensive clinical study, people identified as pre-diabetic were either 1 given the drug metformin; 2 enrolled in a nutrition and exercise program with the reasonable aim of 7 weight loss; or 3 given a placebo After three years of the trial, 30 of the placebo group had developed diabetes, versus 22 of those who had taken metformin and only 14 of the nutrition and exercise group Although researchers considered the initial results so remarkable that they halted the study a year early, they wish to continue examining whether this apparent reversal of fortunes is truly enduring or whether such interventions merely delay the inevitable development of the disease In addition, skeptics wonder how cost-effective these intervention strategies may be, given the high expenditures associated with the personal trainers and nutritionist guidance that may be needed to replicate these subjects weight loss Perhaps the real question is how to get exercise into the
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mainstream one recent step in Canada was the recent
propensity for exercise prescriptions, which alas are just like drug prescriptions, but cheaper and maybe better3 Role of inflammation in diabetes new avenues for diagnosis and treatment: The article also highlighted a growing body of new evidence linking development of type 2 diabetes to an inflammatory response as indicated by high levels of C-reactive protein CRP We believe that confirming this link between inflammation and diabetes would 1 improve doctors ability to identify pre-diabetic patients, as inflammation is much more easily detected than insulin resistance, which is not simply signified by abnormal glucose levels; 2 potentially steer future research efforts towards identifying the root origins of this inflammation to identify novel factors that cause diabetes; and 3 suggest new treatment strategies that target the inflammation directly, such as aspirin and other anti-inflammatory medications When studies first began associating type 2 diabetes to inflammation several years ago, the results were received rather skeptically However, since then, at least a dozen studies have verified the link, although scientists have yet to determine what is causing the inflammation
Theories abound, including various possible metabolic culprits associated with obesity, such as free fatty acids Researchers also do not know for certain whether the inflammation is merely a sign of the diabetic condition or whether it actually contributes to the development of the disease itself
Selected Raw Data: Global problem: Over the next couple of decades, diabetes prevalence is expected to triple in Africa, the eastern Mediterranean, the Middle East and Southeast Asia, to double in the western Pacific and to nearly double in Europe; India currently has the most worldwide cases 33 million, while China has 23 million Current problem: 182 million Americans with either type 1 or type 2 diabetes note that this is 63 of the population; of this 182 million, 52 million remain undiagnosed Rising problem: 13 million new cases diagnosed last year up from 878,000 in 1997; epidemiologists predict the incidence of diabetes will double by 2025 Deadly problem: This year more than 200,000 Americans will die of complications arising from the diabetic condition to boot, thats likely a huge underestimate since many death certificates cite conditions other than diabetes that were actually
caused by diabetes in many respects, particularly many conditions prompted by macrovascular complications of diabetes, such as cardiovascular disease and stroke Costly problem: Annual direct and indirect treatment are costs expected to rise from 132 billion to 192 billion in 2020 excluding inflation Again, we believe this estimate may be conservative since, among other reasons, many people are developing the disease at a much younger age, meaning that complications will endure longer and may develop into more acute, more costly conditions –By Martha Nelson and Kelly Close 2c Literature/Media Roundup, Part 3: JAMA on being young and fat In the December 17, 2003 edition of JAMA, researchers observed a 3- to 6-fold increase in diabetes, hypertension, and the metabolic syndrome all main risk factors for cardiovascular disease CVD in participants exhibiting low levels of activity in the lower 20th percentile versus those who were more active in the 60th percentile or above Although the strength of these associations diminished to 2-fold upon adjustment for body-mass index BMI, and to only a 50 reduction following multivariate adjustment age, sex, genetics, etc, this still represents a
significant protective value for physical exercise against CVD risk factors independent of the contribution of fitness to observable weight loss Researchers attribute the association between exercise and fewer CVD risk factors to the role of exercise in promoting many chemical processes in the body related to diabetes and metabolic syndrome Fitness enhances muscle insulin sensitivity and insulin-mediated transport of glucose to muscles, lipoprotein lipase
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In an upcoming issue we will focus on the response to Canadas new guidelines
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activity in skeletal muscle and greater clearance of plasma triglycerides, increases HDL cholesterol, and lowers heart rate, among many other biological benefits The study did find, however, that exercise has a negligible effect on LDL cholesterol levels, which appears to be more genetically fixed Increased fitness over seven years resulted in significant decrease of diabetes and metabolic syndrome, suggesting that later changes in exercise regimens can produce immediate health benefits The authors of the study conclude that exercise imparts both
direct health benefits, as well as indirect benefits arising from the relationship between fitness and weight loss, and thus should be particularly emphasized for protection against CVD risk factors –By Martha Nelson and Kelly Close 2d Literature/Media Roundup, Part 4: Six Lattes a Day Keeps the Endocrinologist Away? The media jumped all over the findings published in the latest edition of the Annals of Internal Medicine4 that surveyed subjects who reported the highest consumption of coffee had significantly fewer diagnosed cases of type 2 diabetes Although the text behind the bold headlines qualified the findings as clearly inconclusive and requiring further investigation into the precise metabolic effects of caffeine, perfunctory readers may imagine that excessive caffeine consumption could potentially ward off diabetes At minimum, the story may have reaffirmed pre-existing suspicions that we really have no clue what might be good or bad for the body we may be exaggerating for effect, but does this further encourage people to ignore the stream of seemingly ever-modified medical advice and simply consume what they wish? Indeed, even those who look beyond the headlines and
scrutinize the study itself may find themselves more confused by the wide range of scientific findings and opinions regarding the relationship between caffeine and diabetes On one hand, the majority of past studies5 describe the negative impact of caffeine on glucose tolerance and insulin action, linking caffeine with decreased insulin sensitivity, a hallmark of the diabetic condition However, these studies tend to examine only the immediate effect of caffeine on metabolism, rather than more significant long-term effects In fact, this Annals of Internal Medicine study and a recent Dutch study6 that observed an inverse relationship between caffeine intake and development of type 2 diabetes are longer-term studies that suggest the reverse of the short-term studies: that caffeine may have long-term beneficial effects by stimulating fat metabolism, uptake of glucagon in the muscle, and free fatty acid release from peripheral tissues However, although tests on monkeys link caffeine to decreases in weight, in this Annals study there was no significant association between body-mass index and caffeine intake The study also noted that insulin sensitivity generally is restored a few days
after the immediate reduction caused by high caffeine intake, suggesting that the negative effects of caffeine on insulin sensitivity may indeed be transient In conclusion, the authors of the study extrapolated no recommendations for caffeine intake from their results However, the findings are certainly intriguing and encourage further investigation into this observed linkage For example, early signs of impaired-glucose tolerance and diabetes include frequent urination, which might discourage excessive consumption of coffee, which would exacerbate these symptoms Thus, the reason why those who heavily consume coffee have less diabetes may reflect selfselective processes that eliminated from this cohort people with impaired glucose tolerance and a preexisting elevated risk for diabetes Many such explanations may account for the surprising findings of this study However, while researchers further probe this area, the publicity the study received will only encourage convictions that the medical community remains largely unable make definitive claims regarding the relative health benefits of many foods alleged to either help cause or prevent disease
Hu FB, et al Coffee consumption and
risk for type 2 diabetes mellitus Annals of Internal Medicine 2004; 140:1-8 Please let us know if you would like a copy 5 Keijzers GB, De Galan BE, Tack CJ, Smits P Caffeine can decrease insulin sensitivity in humans Diabetes Care 2002; 25:364-9 6 van Dam RM, Feskens RJ Coffee consumption and risk of type 2 diabetes mellitus Lancet 2002, 360:1477-8
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The Raw Data: of cups of coffee consumed daily 0, men 1, men 1-3, men 4-5, men More than 6, men 0, women 1, women 1-3, women 4-5, women More than 6, women adjusted for age and BMI –By Martha Nelson and Kelly Close 2e Literature/Media Roundup, Part 5: Recent Trends in Healthcare Spending More Bad News Healthcare spending totals 15 of the economy according to recent government reports Some quick stats on some trends seen in the industry, especially in pharmaceuticals: Healthcare spending has seen the largest jump in 11 years–93 in 2002–a total of 155 trillion Hospital care and prescription drugs contributed to the majority of the increase–it has surpassed economic growth for the past 4 years In 2002, 105 cents of every
dollar spent on healthcare in the US was due to prescription drugs– 1/6 of the increase in health spending In terms of out-of-own-pocket expense for healthcare, Americans spent 23 on prescription drugs–a 51 increase in 2002 to 486 billion from 61 billion The government predicts that by 2012, health spending will account for 177 of the GDP –By Janet Ng and Kelly Close 3 On the Road: Upcoming diabetes/obesity-related conferences February 6-8, 2004, ADA 51st Annual Postgraduate Course San Francisco, CA http://wwwdiabetesorg/main/professional/conferences/defaultjsp February 12-14, 2004 Third La Jolla Conference on Glucose Monitoring and Control San Diego, Ca http://glucoseconferenceucsdedu/indexhtml March 17 20, 2004 Diabetes UK Annual Professional Conference Birmingham, England http://wwwdiabetesorguk/apc/ Relative risk of type 2 diabetes 100 100 092 070 046 100 110 090 067 075
4 Diabetes Close Up commercial DCUs Diabetes 2004 Roundup will publish its first annual diabetes/obesity roundup in February Ordering information to follow shortly on our website Please let us know if you are interested by e-mailing info@closeconcernscom Discounts on pre-orders received before February
15, 2004 The volume will contain: Detailed notes on 20 conferences in 2003, including ADA, AADE, EASD/IDF, NAASO Top ten research articles of 2003 Top diabetes/obesity themes we saw in 2003 DCU High Five Awards the best products of 2003 Key conferences in 2004
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Special thanks to Holly Lanham, Martha Nelson, and Janet Ng for their contributions to this issue of Diabetes Close Up — Kelly L Close Diabetes Close Up is a newsletter highlighting notable information and events related to selected companies with diabetes/obesity businesses This newsletter is put forth as an unbiased commentary on the industry If you have any suggestions or comments regarding content, please contact info@closeconcernscom If you would like to 1 unsubscribe; 2 receive a monthly digest rather than realtime updates; 3 add a name to the DCU mailing list; or 4 offer any suggestions or comments regarding content, please contact info@closeconcernscom Disclosure: Kelly L Close is a specialized
consultant to the medical technology/pharmaceutical/biotech industries Companies 1 in which Kelly Close has a personal investment; 2 that are clients of Close Concerns, Inc; and/or 3 on which Kelly Close serves on a speakers bureau, including Abbott, Animas, Amylin, Aventis, Johnson Johnson, SimpleChoice, and TheraSense All observations expressed are the opinions of Close Concerns alone and should not be viewed as recommendations to investors on any companies in the industry
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