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Author: Dawgpac Three stars, 500 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 1416  
Subject: Hospitals beginning to tout research results Date: 2/1/2013 12:53 AM
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Nice to see they're looking to back up their claims with data in their direct to consumer marketing.

http://www.schospital.com/SouthCountyHospitalNewsEvents/View...
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Author: captainccs Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 723 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/1/2013 8:46 AM
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Excellent article. The results are entirely as expected, the robotic surgery produces much more accurate placement of the implants than is usually achieved manually. This is not a medical issue as much as one of craftsmanship as any shipwright, joiner, or carpenter can tell you. Knees and hips join long bones which means that any small misalignment in the implant is greatly multiplied by the length of the bone.

Doctors who say they can do it manually as accurately as the RIO robot can are greatly exaggerating their own prowess. The real threat to MAKOplasty is any other placement system that can achieve similar results at lower cost. Beware Biomet's Oxford jigs!

In technology adoption "path dependence" plays an important role. Path dependence essentially means that a technology that gains acceptance is hard to dislodge. Geoffrey Moore called some of it "high switching cost." Once you learn something you don't want to invest in learning something similar unless it provides substantial additional advantages. This is how "disruptive technology" works, how a new technology can break the hold on the market of an older technology gained through path dependence. One important caveat must be kept in mind. It is practically impossible to predict which technology will fail and which will succeed. Pundits attribute causes to success and failure but almost invariably they do so with hindsight. The winning technology is picked at random by the market. Economists have shown that under the law of increasing returns there are multiple potential equilibrium points and no possibility of predicting on which the system will settle. Under the law of decreasing returns (commodities) there is just one point of equilibrium which makes it easy to predict that the low cost producer will likely be the winner.

The point of the previous long paragraph is to point out that even if Biomet's Oxford jigs are as accurate as MAKOplasty and a lot cheaper, that does not make them the automatic winner in the contest for joint procedures. They certainly would have the ingredient of a "disruptive technology" but the proof is in the pudding. As Tinker pointed out, the key metric to watch is the growth in system sales. Everything else, as interesting as it might be, is secondary. The market picks the winner and the market sometimes picks second rate technology as was the case with Windows and the x86, a non operating system until XP (the first versions of Windows were just a graphic overlay on DOS) and a chip that was no match for competitors from Motorola. Yet Mr. Market made Wintel a runaway marketing success that made a few billionaires and many more millionaires. Be careful to hedge your bets!

Denny Schlesinger

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Author: gatorswamp Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 724 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/1/2013 10:08 AM
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I am long MAKO, but I think this is an advertisement more than anything else.

Here is MAKO's bibliography from their site.

http://www.makosurgical.com/physicians/clinical.html

There are no new clinical papers listed, so unless the company's own site is negligent in updates than I don't think there are any new clincial studies, these mentioned are not cited for me to look at even through the "*" link to "more information". There were only 2 papers in 2012, one was a review article, the other a small 20 knee comparison about implant alignment. There were 6 papers in 2011, 3 of which looked at implant alignment and 3 were review articles again.

I searched Pubmed just now and did not find anything new.

It is encouraging that implant alignment may be less variable, and that short term recovery may be better, but neither of those is where the rubber meets the road.

I still think we are years from good data about this. Doesn't mean it won't come, but this article is an advertisement for this group and their hospital.

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Author: Dawgpac Three stars, 500 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 725 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/1/2013 10:55 AM
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Yes, it is definitely marketing for their services using data from two of the 2012 presentations (ISTA and Harvard).

"Clinical Research and Marketing — Efforts to build a strong base of clinical evidence for both partial knee and total hip MAKOplasty continue, with over 70 clinical studies currently in process.

During the third quarter, MAKOplasty was discussed in five presentations at the International Society for Technology in Arthroplasty (ISTA) 2012 Meeting in Sydney, Australia and in three presentations at the Harvard Advances in Arthroplasty Meeting in Boston, Massachusetts. Two MAKOplasty presentations at these meetings were of particular significance. At ISTA, the two year survivorship data on MAKO's RESTORIS MCK onlay medial unicompartmental implant using the RIO system was presented. This four-site study reported on two year post implantation outcomes for 224 patients, and showed a 0.4% revision rate at two years for MCK implants using the RIO, as compared to revision rates for manually placed unicompartmental knees, which are documented at 4.0% in the Swedish and 4.9% in the Australian registries.

At the Harvard meeting, Dr. Henrik Malchau compared acetabular cup placement in 77 MAKOplasty THA cases done at four hospitals to the results presented by Callanan et al in the 2011 Clinical Orthopaedics and Related Research (CORR) Charnley Award Paper. Based on 2D image evaluation of the post-op x-rays, 84% of the RIO cases were inside the Massachusetts General Hospital restricted safe zone compared to 47% reported in the CORR paper, while the 3D image evaluation of the data showed that 96% of the cases were within this restricted safe zone."

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Author: gatorswamp Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 726 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/1/2013 12:13 PM
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I do not see the ISTA paper in publication yet, that looks like a great start for some short term (non-recovery) data. If presented, it should be out around this summer I would guess for review.

I do not mean this in a bad way, but we need to consider the source of things.

http://bir-llc.com/mako-surgical-mass-general/

Malchau's talks are sponsored events for which he is paid, ultimately we need long term outcomes from non-consultants to prove the point. This will be a while yet. Publicity is always good though!

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Author: Dawgpac Three stars, 500 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 727 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/1/2013 1:12 PM
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MAKO's network of consultants, etc is in line with other companies in the industry but point is taken. Quite common and Dr Malchau has relationships with the following companies:

Dr. Henrik Malchau

1. Smith & Nephew (Royalties)
2. DePuy (research/institutional support as principal investigator)
3. Mako (paid consultant; research/institutional support as principal investigator)
3. Biomet (paid consultant; research/institutional support as principal investigator)
4. RSA Biomedical (stock and/or stock options)
5. Zimmer (research/institutional support)

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Author: gatorswamp Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 728 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/1/2013 1:21 PM
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Absolutely, we are on the same page.
I appreciate you pulling the news feeds for us, the publicity truly is what we need.
I just want to make sure that our fellow investors here are critical of the "literature". It is very important to be so in medicine.

When a speaker is compensated for a presentation, they recieve some funds, and often even slides which are very fancy and created by the company. I don't know that in this case, but this is common.

I also have had (not now) consulting relationships but they were related to going and teaching other surgeons techniques. The paid talk circuit needs to be taken with a grain of salt. I went to a course one time to learn the placement of a new device, and the day was organized by their hired gun, a very good surgeon and also now a freind. Funny, a year later, a competing company was rolling out a competing device that does exactly the same thing and required attendance of a training course. I went and the SAME GUY was doing the other one too! Which set of slides am I supposed to beieve!

Articles citing "new reports" from a hospital website and touting the local practice, when there have not been new reports published in a year, need to be taken with a grain of salt. It is an advertisement. For once I guess I disagree with Denny!

I don't want readers here to leave with an impression that there has been any type of long term superiority proven for this robot. That does not mean it ISN'T superior, it just means it is not proven. Right now it is new, expensive, a good idea, and perhaps it is better also, but we don't know that.

Please keep posting these reports, they are the essence of what we need now for our stock, but they are not science for the most part.

gator

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Author: Dawgpac Three stars, 500 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 729 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/1/2013 1:29 PM
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While he may be a paid consultant as he is for others, let's not forget that he is also the principal investigator presenting data from the study and subject to peer review. We'll see how that plays out. In the meantime, I'm looking forward to seeing data from the ongoing Strathglyde, Scotland study.

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Author: captainccs Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 730 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/1/2013 2:04 PM
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I went and the SAME GUY was doing the other one too! Which set of slides am I supposed to beieve!

A good salesman can sell anything. In school I used to take the opposing side in any ongoing theist-atheist discussion. I didn't hold either view but I loved the debate. LOL


Articles citing "new reports" from a hospital website and touting the local practice, when there have not been new reports published in a year, need to be taken with a grain of salt. It is an advertisement. For once I guess I disagree with Denny!

I did not verify whether the information presented was accurate or not, I took it at face value. I'm glad we have Fools here who know how to do research on medical papers. ;)


I don't want readers here to leave with an impression that there has been any type of long term superiority proven for this robot. That does not mean it ISN'T superior, it just means it is not proven. Right now it is new, expensive, a good idea, and perhaps it is better also, but we don't know that.

My point was that "proven superiority for this robot" is not necessarily the determinant issue in the prosperity of MAKO, the company; MAKOplasty, the surgery; and MAKO, the stock.

Denny Schlesinger

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Author: dumaflotchie Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 731 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/1/2013 3:19 PM
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I don't want readers here to leave with an impression that there has been any type of long term superiority proven for this robot. That does not mean it ISN'T superior, it just means it is not proven. Right now it is new, expensive, a good idea, and perhaps it is better also, but we don't know that.

Agreed Gator and I point I made numerous times on the old NPI board. There is no proof of superiority in performance and one might surmise that the "proof" is years away as the joint failure rates are not very high with standard joints as it is.

But that said, it also seems pretty clear that the MAKO delivers more "precision" in joint replacement (hips or knees). I wonder on what basis this "precision" is measured......is there a reproducible measurement that any observer would agree is the very definition of precise? That would every orthopedic surgeon preplan the exact replacement/resurfacing such that there is no inter-surgeon variability?

Also, are you in academics and if so:

1) Why do you believe more academic institutions are not all over the MAKO?

2) Do you personally know anyone doing MAO and their experience with it?

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Author: gatorswamp Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 732 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/2/2013 2:01 PM
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Yes I am in academics,

1) I am not sure. They are probably targeting community physicians as early adopters. What they do is come and meet, and offer training, and lots of times money for things like conference rooms for presentations, sometimes advertisements, radio ads, speaking fees, consultant money, etc.: all to help get you going. At my place, we are not allowed to participate in any of those things anymore. If I ask for support for a new device trial of some sort, about 50% of money is lost to the "Dean's Tax" as they call it, a cut the university takes. I have found they don't ask me as much anymore, probably because we are not allowed and because they tax the grant. The community guys are not restricted by such.

2) I know several ortho surgeons from training. They are all from a high level place where we were residents together, they have all poo-pooed partial knees as not durable when I have asked them about this company. They may not be the early adopters, as Denny commented when we spoke in past threads about their comments. They are all very busy, and do not need any more patients, so maybe they aren't the young gun type that Tinker was talking about coming out of training and shooting for a niche. That definitely happens. I do not see on my own institutions website that any of them are doing it. Many of them care for the local Div I collegiate teams, NBA, NFL, etc, so they are pretty go to for Ortho stuff, but it doesn't look like any of them are doing it right now. Not sure why, don't know guys here as much since they have a separate building.

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Author: dumaflotchie Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 733 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/2/2013 8:45 PM
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Gator:

It is odd that MAKO just hasn't made much splash in academics. One would think from the company's perspective, they would be incentivized to practically give them away to academic sites if not for any other reason that to train a huge next gen population of orthopedics doctors. I don't buy the pragmatist TALC argument for academics adoption.......these doctors live in a malpractice mitigated world, seek any publications and fame they can get.......makes no sense they would deliberately avoid a new paradigm in joint surgery.

I would suspect MAKO's cost to build a robot at around $500,000 so pick 20 academic sites and donate them for total cost of $10 million......what the heck.

But I would point out that contrary to what many here have suggested, there are reams of various quality studies on DaVinci.......can toggle through a few here:

http://link.springer.com/search/page/1?facet-journal-id=1170...

Despite this being a Journal of Robotic surgery......no real mention of MAKO in the reams of studies.

I have suspected all along that the lack of sufficient studies for MAKO was reflective of their strategic misstep to concentrate entirely on unicompartment disease which practically every orthopedics doctor seems skeptical of regardless. The population is also too few to build a center of excellence concept.

Now with their seminal strategic shift to total hips, total knees and uni/bicmpartments........we should see a huge shift in interest.

I was able to speak with a surgeon who does MAKO last year and one can see the need to expand indications......if MaKO has any chance of success or survival.

It has been a while since I looked at their cash burn rates but they don't seem that close to cash positive.

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Author: RHinCT Big gold star, 5000 posts Ticker Guide SC1 Red Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 734 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/2/2013 11:29 PM
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It is odd that MAKO just hasn't made much splash in academics.

Knowing nothing about the subject leaves me free to speculate...

I wonder if joint replacements are too mundane to appeal to the academic side of medicine. Knees and hips are generally well-defined high-volume procedures, good for paying the bills but not exotic. In fact, I have heard the part that RIO deals with resembles carpentry, just with bone instead of wood.

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Author: dumaflotchie Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 735 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/3/2013 4:32 AM
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I wonder if joint replacements are too mundane to appeal to the academic side of medicine

Maybe these academic centers being referral centers for more complex cases would be unlikely to see early disease to begin with and therefore sized up the lack of volume to justify effort for unicompartment disease.

On top of that, most orthopedics are skeptical of durability of a unicompartment repair.......and it's very expensive mistake if not durable since it costs 2/3 rds of a total knee. The durability issue transcends just the alignment issue because implant materials are not as familiar as would be the big national companies.

Anyway.....these were the issues I believe that stunted academia getting on board.

Which of course gets back to the issue of MAKO's radical strategic shift to include total knees and total hips.........they dramatically expanded their addressable market........the ONLY reason I am still interested in the stock.

.......and of course that ISRG is gonna buy them and put the RIO in the DaVinci ;)

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Author: gatorswamp Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 736 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/3/2013 9:59 AM
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Yes Duma, there are indeed reams of papers.

A quick look at those posted show almost all are case reports. These are not meaningful, this is what I call "show and tell". Do a neat case and your resident who is fired up to bulk up a CV and send off the case report to a minor journal and everyone is happy. These type publications are not really useful, and most major journals don't accept them anymore. I work on 2 surgical journal editorial boards, and neither takes case reports.

I have still not seen much meaningful literature that robot surgery is "better". It may be equivalent. In general, the "total room time" (wheels in to wheels out) is greater with robotic surgery.

I have no other explanation for why academic places are doing it, but you are right, they are not. My friends fairly quick dismissal speaks to that maybe, for some reason they don't consider it an advance right now. That does not mean it won't be, or that people seeking niches and expsoure won't do it until it is proven, and we are all banking on that happening in some fashion.

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Author: gatorswamp Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 737 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/3/2013 10:01 AM
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I don't think it has anything to do with it being mundane either. I do lots of hard stuff, and with that stuff you still see lots of mundane things like hernias and gallbladders. There are a great many people that like to go to academic places for care, I guess because there is a name with it. Academic places may have higher capacity to do exotic things, but those things don't apply to very many people's care for regular procedures.

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Author: Dawgpac Three stars, 500 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 738 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/3/2013 11:16 AM
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I think MAKO is looking to grow their academic presence and have made strides in that area. HSS (Cornell/Rockefeller) is the #1 ortho specialist in the US and purchased 2 RIOs in Dec 2011 after using a MAKO for research for a number of years. USC (Keck Medical Center-Dorr Institute), Ohio State, Wake Forest, University of Wisconsin, NYU (Langone Medical Center and Columbia University Medical Center), and UT Health (Univ of Texas Memorial Hermann) all offer Makoplasty.

Of note, The Mayo Clinic (Univ of Minnesota)offers Makoplasty at the Mayo Clinic Florida but not at the main campus in Minn.

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Author: tamhas Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 739 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/3/2013 11:27 AM
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Like many other comparisons with ISRG, this issue of academic penetration is one where it is a mistake to compare MAKO now with ISRG now because ISRG is many more years farther through their TALC. Compare MAKO now with ISRG at a comparable point in their development and the comparison would be much more meaningful.

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Author: dumaflotchie Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 740 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/3/2013 3:34 PM
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Compare MAKO now with ISRG at a comparable point in their development and the comparison would be much more meaningful

Ok... Go ahead and make the comparison. MAKO has been around for a good while now and for the same timeframe, there is no comparison.

ISRG was well ahead......they have over 2,000 installs for Pete sale and many more year for year than MAKO had.

Very different animals with MaKo trying to create a market until its recent strategic change.

But I invite you to go back in time if you wish to when each company was formed.

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Author: captainccs Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 741 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/3/2013 4:59 PM
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Ticker Founded IPO Age

MAKO 2004 2/20/2008 9
ISRG 1995 6/23/2000 18


Denny Schlesinger

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Author: dumaflotchie Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 742 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/3/2013 7:45 PM
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Founded IPO Age
MAKO 2004 2/20/2008 9
ISRG 1995 6/23/2000 18


LOL......unusual for you not to be objective Denny!

OK so let's look from IPO to profitability shall we:

ISRG IPO 6/2000
March 2003 had 163 cumulative daVinci's sold (2 1/2 years after IPO)
June 2003 first quarter of profitability (3 years after IPO!!)


MAKO IPO 2/2008
Jan 2013 had 156 RIO's installed worldwide (5 years after IPO)
Jan 2013........at least 2 years from profitability.........likely 7 years after IPO.

Adoption of MAKO has been substantially slower than DaVInci by any measure.....approximately twice as slow.

Furthermore, this after it has tried to blaze the trail that the pioneer of robotics (ISRG) already laid forth.

Compare MAKO now with ISRG at a comparable point in their development and the comparison would be much more meaningful

Yes indeed it is........as the above timeline clearly demonstrates. I know ISRG.....ISRG is a friend of mine and MAKO is no ISRG.......not yet anyway.

That said.....I am very encouraged by their strategic shift to total knees and hips along with their original unicompartment and bicompartment markets. This expanded addressable market make get them to DaVinci type growth after all.

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Author: tamhas Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 743 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/3/2013 8:36 PM
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by any measure

Especially ones measuring apples and oranges ...

Point being that you were comparing academic adoption of ISRG now with MAKO academic adoption now. If you don't compare at the same point in the TALC, it is a meaningless comparison. Indeed, any point in time is likely to be meaningless without the curve to look at.

As for your "by any measure", there are many kinds of comparison that one can make and it is very clear that you aren't making them. They are different devices to different markets with different drivers. ISRG had a nice help coming out of the gate because of the "sensitivity" of the ED issue, which MAKO doesn't have. As they move into different markets, they don't have that same edge in other markets. To me, any comparison that doesn't look at the overall curve is going to be a crapshoot as to what it might say, especially if one compares different points in each company's TALC for each product ... hips being brand new for MAKO, for example.

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Author: dumaflotchie Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 744 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/3/2013 9:14 PM
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Especially ones measuring apples and oranges ...

LOL...you have triewd for years to tell us how MAKO is the next ISRG and now you are trying tell us that its apples and oranges???

Point being that you were comparing academic adoption of ISRG now with MAKO academic adoption now. If you don't compare at the same point in the TALC, it is a meaningless comparison. Indeed, any point in time is likely to be meaningless without the curve to look at.

There is no comparison with academic adoption for ISRG vs MAKO as well. Look it up yourself. By practically any measure.....ISRG has been adopted faster. Go ahead and find the data yourself since you question it.

As to comparing to the same point on the TALC????? Me thinks you just want to argue for argue sake.

The TALC IS the issue.......adoption........you CANNOT look at the same point on the curve without making the mistaken assumption that both technologies will be adopted to begin with.

As for your "by any measure", there are many kinds of comparison that one can make and it is very clear that you aren't making them

OK so again.....what measure would you like to look at??? Show me where adoption of MAKO has been greater, faster, profitable, etc. as compared to ISRG over time.

To me, any comparison that doesn't look at the overall curve is going to be a crapshoot as to what it might say, especially if one compares different points in each company's TALC for each product ... hips being brand new for MAKO, for example.

You do not seem to understand that ISRG has grown by numerous TALC's......prostate, then GYN, then whatever is next. MAKO has gotten stuck at the chasm with its unicompartment strategy.

ISRG had hit the screws (and continues to do so) years before MAKO over the same timeframe.......by practically any measure.

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Author: captainccs Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 745 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/4/2013 2:07 AM
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LOL......unusual for you not to be objective Denny!

What objects are you objecting to? I just gave four dates so you guys could go at each other.

Comparing MAKO to ISRG without taking into account some apparently extraneous events will give you a distorted result. For example, while ISRG took only one more year from founding to IPO than MAKO that year happens to represent a 25% difference, from 4 to 5. In addition, MAKO didn't have a competitor at IPO. ISRG did, Computer Motion, a company that failed, was bought out by ISRG and its equipment discontinued:

As of June 30, 2003, Computer Motion, Inc. was acquired by Intuitive Surgical, Inc. In March 2003, Computer Motion, Inc. and Intuitive Surgical, Inc. agreed to merge into one company. Under the terms of the definitive merger agreement, Computer Motion's equity holders would receive 32% of the combined company on a fully diluted basis. Each outstanding share of Computer Motion common stock would be converted into approximately 0.52 shares of Intuitive common stock. Intuitive would issue an aggregate of approximately 15.39 million shares in exchange for all of Computer Motion's outstanding common stock, preferred stock, options, and warrants.

http://investing.businessweek.com/research/stocks/private/sn...

Computer Motion was founded in 1989 which then adds six more years to ISRG. True, there were some orthopedic robot companies as well but they all disappeared in 2008. Not having a competitor to beat can be bad news indeed!

Denny Schlesinger

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Author: captainccs Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 746 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/4/2013 8:31 AM
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You do not seem to understand that ISRG has grown by numerous TALC's......prostate, then GYN, then whatever is next. MAKO has gotten stuck at the chasm with its unicompartment strategy.

Duma, I think that's a mistaken view of "TALC." The "T" in TALC stand for technology not for specific applications of the technology. You would not talk about the "TALC" of "narrow city trenches for last mile optic fiber to the home." That might be a bowling pin in the hydraulic excavator's TALC. Also TALC is not company specific but technology wide.

Of course, in real life things are much more messy than in text books. Are we talking about the "robotic surgery" TALC or is there separate ones for soft tissue and bone surgery. If so, the CyberKnife Robotic Radiosurgery System which is aimed at soft tissue is not doing so well while da Vinci is. What might be holding back CyberKnife? Complexity? Is CyberKnife just a bowling pin that has not yet fallen or is it a different technology altogether?

Denny Schlesinger

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Author: dumaflotchie Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 747 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/4/2013 10:27 AM
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Duma, I think that's a mistaken view of "TALC." The "T" in TALC stand for technology not for specific applications of the technology.

I am well aware of what TALC is but I made the case on another board (the old NPI) that in medicine in contrast to other industries, each specialty become in essence a new TALC event. Their instruments are different, their approaches are different and their adoptions are different.

It isn't as though the robot accepted in urology necessarily connotes any ease of being accepted in general surgery (or even any indication to use it to begin with).

Each specialty has its onw TALC.

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Author: tamhas Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 748 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/4/2013 10:31 AM
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you have triewd for years to tell us how MAKO is the next ISRG

You obviously have me confused with someone else ... or, as was the case, you are just making things up to suit your preconceptions.

Go ahead and find the data yourself since you question it.

I think the burden is on you to find relevant data. Comparing the two at the present time is clearly inappropriate, so to make a contention that there is even a difference, we need relevant data.

Of course, one doesn't know the future of MAKO ... otherwise investing would be a lot easier ... but that doesn't keep one from putting academic or general adoption curves side by side and comparing adoption from date of release. And, as I said, one should look at the whole curve since it may be that ISRG had some early advantage because of the ED issue that would not carry over into later indications.

The point is that you are making assertions of how poorly MAKO has done in comparison and are providing no relevant data to support that assertion. Seems likely, even, that MAKO is not being adopted as quickly, but that doesn't make them a failure.

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Author: captainccs Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 749 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/4/2013 10:59 AM
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I made the case on another board (the old NPI) that in medicine in contrast to other industries, each specialty become in essence a new TALC event.

Interesting, but, is it really? Maybe it's that the pins are thinner and farther apart making is more difficult to get a strike in the bowling alley. An ortho robot might have a different TALC than a soft tissue robot but once you have a robot in house it makes sense to find new uses for it: knees, hips, shoulders; prostate, gyn, heart.

Denny Schlesinger

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Author: tamhas Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 750 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/4/2013 11:22 AM
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And, having had a robot prove itself for three indications, the chasm for the fourth might be quite narrow.

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Author: dumaflotchie Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 751 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/4/2013 11:35 AM
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You obviously have me confused with someone else

Not at all.....you are the same person who makes wild unsubstantiated statements.

I think the burden is on you to find relevant data. Comparing the two at the present time is clearly inappropriate, so to make a contention that there is even a difference, we need relevant data.

I did not compare them at the present time.......I used their IPO date. My burden is not to continue to relentlessly spoon feed you. Keep making your wild assumptions.....none of my business.

but that doesn't keep one from putting academic or general adoption curves side by side and comparing adoption from date of release. And, as I said, one should look at the whole curve since it may be that ISRG had some early advantage because of the ED issue that would not carry over into later indications.

Of course you are talking in confused riddles so I will not address this again.

The point is that you are making assertions of how poorly MAKO has done in comparison and are providing no relevant data to support that assertion. Seems likely, even, that MAKO is not being adopted as quickly, but that doesn't make them a failure.

You seem to remain reading challenged. Where did I say MAKO was a "failure"?

The comparison between each company's IPO date is fair and it in indisputable that MAKO's adoption has been slower by neat any measure.

I really don't care if you want to throw out as many straw man arguments to cloud the issue.....doesn't change the facts for those that are intellectually honest.

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Author: dumaflotchie Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 752 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/4/2013 11:48 AM
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Interesting, but, is it really? Maybe it's that the pins are thinner and farther apart making is more difficult to get a strike in the bowling alley. An ortho robot might have a different TALC than a soft tissue robot but once you have a robot in house it makes sense to find new uses for it: knees, hips, shoulders; prostate, gyn, heart.

It was my understanding that Moore used the bowling metaphor to describe the the process of creating a tornado of adoption by knocking off the first few easier pins.

What I am suggesting and did before is that what happens in Urology has little impact on mass adoption in Gynecology or General Surgery or Cardiac surgery or Neurosurgery.

Each of these specialties behaves like its own TALC. Knocking off the Urology pragmatists had little affect on general surgery or gynecology. These specialties have their own wants, needs, etc.

In the case of MAKO, it was originally charged with "creating" a need instead of solving a need. That is......it was trying to tell patients and orthopedic doctors that instead of toughing out some pain from unicompartment disease (using Motrin, getting steroid injections, rehab treatments, etc.)........you should go under the knife.

As we discussed ad nauseum.......I believe that market was limited and did not classify as a huge unmet need in the Moore sense.

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Author: HueWhite One star, 50 posts Old School Fool CAPS All Star Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 755 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/5/2013 4:02 PM
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Of note, The Mayo Clinic (Univ of Minnesota)offers Makoplasty at the Mayo Clinic Florida but not at the main campus in Minn.

I do not believe Mayo is connected with the University of Minnesota, unless you're referring to some specific association.

Hue

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Author: Dawgpac Three stars, 500 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 756 of 1416
Subject: Re: Hospitals beginning to tout research results Date: 2/5/2013 4:10 PM
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Mayo Clinic is an academic medical center significantly intertwined with U of M.:

"Thursday, December 15, 2011

ROCHESTER, Minn. — Mayo Clinic today hosted University of Minnesota President Eric Kaler, Ph.D., to sign a renewal of a memorandum of understanding, tour Mayo Clinic, and meet with University of Minnesota students who are training and practicing at Mayo Clinic. During the visit, Mayo Clinic and University of Minnesota leaders stressed a long and cherished tradition of collaboration.

According to research released by the Battelle Technology Partnership Practice in 2010, Mayo Clinic and the University of Minnesota have a combined $18.5 billion economic impact on the state of Minnesota. Mayo Clinic, an academic medical center, is the state's largest private employer, and the University of Minnesota is the state's largest institution of higher education.

"Truly, the histories of our institutions are intertwined. Mayo Clinic's collaborative partnership with the University of Minnesota began in 1907, representing our first external collaboration, and remains a priority today," says John Noseworthy, M.D., president and CEO of Mayo Clinic. "We are proud to work with the University of Minnesota to educate and conduct groundbreaking research. President Kaler's visit today is the continuation of a relationship that has flourished for more than 100 years and that will continue to be important for our institutions for generations to come."

"The University of Minnesota's partnership with Mayo Clinic represents an incredibly powerful combination that is and will be a force for improving health outcomes in Minnesota and around the world," says Dr. Kaler. "I am deeply gratified to renew this partnership that builds on our shared history and invites a future of imagination and innovation."

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