How has Pfizer responded?
With venom. It calls the decision 'perverse and short-sighted' and says NICE is 'disregarding overwhelming need'. In a statement, the company thunders: 'NICE must not be allowed to undermine clinicians' ability to work with their patients to improve management of this debilitating long-term condition.'
Strong stuff. Who's handling PR?
Vicki Trinder, comms manager at Pfizer UK, said the company was receiving UK agency help on Exubera, but refused to say which agency. Lucie Harper, Weber Shandwick UK health practice MD, leads the global Exubera account.
What will be Pfizer's PR approach?
To bring the debate down to a stark choice. In this case, Pfizer says, NICE can either 'force' patients to 'keep enduring the burden of multiple daily injections' unchanged since the 1920s – or offer an alternative.
The company says diabetes is often poorly controlled because patients delay insulin treatment due to fear of – or pain from – injections. In a clinical trial, three times as many patients chose to start on insulin when the inhaled Exubera was made available.
But how will it respond to NICE's cost argument?
Pfizer claims that getting patients on insulin earlier would in turn cut future costs of treatment, including that for diabetic complications such as heart disease, amputation, blindness and kidney failure. It says the cost of this to the NHS is currently a staggering '£158 per second'.
Is anyone on Pfizer's side on this?
Diabetes UK for one. The charity says Exubera is a 'medical breakthrough' and claims it will greatly improve patients' quality of life. The European Medicines Evaluation Agency, meanwhile, granted marketing approval for the drug back in January.
What happens next?
This is a preliminary decision by NICE. A final decision will be made