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Rosetta Genomics, Ltd. Message Board

  • peter_collin@ymail.com peter_collin Nov 7, 2012 2:50 PM Flag

    A Pathologists Perspective

    Im starting this thread, not to persuade anyone to buy or sell, but to give a bit of clarity to the board here about what CUP TRULY is and why it will take off in certain areas and NOT in others. The market size described on here is so off its shocking.

    In order to understand some of the factors surrounding the sale of ROSG METS2 you need to look at how the diagnostic marketplace functions. Read through a couple of these statements:

    1)Do any of you even understand that the more tests a pathologist performs THEMSELVES to diagnose a CUP, not by sending out to ROSG, the more money they make? They have protocols that they can go through which may take a few weeks but may net the Pathologist a nice chunk of change. And, keep in mind, Pathology has the access to the tissue, not the medical oncologists or surgeons.

    2)There are not 200,000 CUP cases annually in the United States. The number is more like 20,000 to 40,000. This is why: About 200,000 patients with metastatic cancer do not recieve a true diagnosis of the origin of their cancer during the first frozen sections and Pathology review at the time of surgery. While this seems incredibly encouraging, most academic centers and well trained Pathologists can find the diagnosis accurately about 85% of the time. The points where they cant find the true diagnosis is where METS2 actually comes into play, so this is a much smaller percentage of cases and can range from 20k to 40k cases annually.

    3)Medical Oncologists do not just receive payment for treating/seeing patients daily. These physicians are also compensated by selling chemotherapies to insurance companies that they purchase from pharma at wholesale prices. More importantly, the more the medication costs, the more money they are paid. Medical Oncology is one of the few specialties out there that can actually be handsomely rewarded for giving empiric therapy that pays them more! So, while this test most certainly works, Medical Oncology may or may not find the results helpful...and that can affect adotpion nationally.

    4)Academic facilities will not use this test, unless in dire need. All academic facilities are training programs and need their Pathology students in training to learn how to accurately run all of these tests on their own without the help of a reference laboratory and find a diagnosis on their own. This will be modestly used at best. Dont believe me??? Ask Ken how often this test is ordered by MD Anderson, one of the primary study sites and investigation sites for their 'landmark' data...

    Now, while you all may think I am on here, just trying to help a hedge fund or to try and short this stock, you are incorrect. I am still looking at this company as a buy and believe that long term, this is a great value. The value is in the partnership they have in the US as well as their future products which will be heavily used in community pathology clinics, not academic centers. So, just ahd to add my two cents here, but I was getting frustrated reading through the board lately.

    Just for disclosure, I am a Pathologist in a community facility and also invest in companies I believe will have a presence for years to come.

    Sentiment: Buy

    SortNewest  |  Oldest  |  Most Replied Expand all replies
    • Masselgo is right.

      This whole argument is convoluted and I don't think you work as a professional in this field. What you're describing is highly unethical and illegal. Pathologist and an Oncologist make more than enough. Sure, we have a good share of corrupt individuals in every field, but if a product saves TIME and money at the same time to save a life, why wouldn't they use it?

      Your rhetoric is wrong as well. You bash the idea of positive sales whilst minimizing the CUP threshold yet you "buy" into this company and their products. What products? The MiRiview Mets^2 is the pretty much only thing they have going for them. Your ideas are inane. I have spoken with multiple PhD's that work in the diagnostic field and they're very aware of Rosetta. They know the type of technology MicroRNA offers and that the genome future depends on it. Perhaps the price right now as what ROSG should be selling at. Sure. We don't know what the sales are or what the monthly revenues will be. We need more details. But to state that only 20,000 patients would hypothetically needs this test is absurd.

      Medicare coverage, as someone else stated, is the epitome to success for any diagnostic company. You can twist the truth and your "professional" analysis, but we shall find out in the next few weeks/months. This can be a monster stock if they release any positive data. With such a skilled sales force and the will to sell, I don't doubt them. I think we will finally see a huge breakout in 2013.

    • Masselgo is right.

      This whole argument is convoluted and I don't think you work as a professional in this field. What you're describing is highly unethical and illegal. Pathologist and an Oncologist make more than enough. Sure, we have a good share of corrupt individuals in every field, but if a product saves TIME and money at the same time to save a life, why wouldn't they use it?

      Your rhetoric is wrong as well. You bash the idea of positive sales whilst minimizing the CUP threshold yet you "buy" into this company and their products. What products? The MiRiview Mets^2 is the pretty much only thing they have going for them. Your ideas are inane. I have spoken with multiple PhD's that work in the diagnostic field and they're very aware of Rosetta. They know the type of technology MicroRNA offers and that the genome future depends on it. Perhaps the price right now as what ROSG should be selling at. Sure. We don't know what the sales are or what the monthly revenues will be. We need more details. But to state that only 20,000 patients would hypothetically needs this test is absurd.

      Medicare coverage, as someone else stated, is the epitome to success for any diagnostic company. You can twist the truth and your "professional" analysis, but we shall find out in the next few weeks/months. This can be a monster stock if they release any positive data. With such a skilled sales force and the will to sell, I don't doubt them. I think we will finally see a huge breakout in 2013.

    • Masselgo is right.

      This whole argument is convoluted and I don't think you work as a professional in this field. What you're describing is highly unethical and illegal. Pathologist and an Oncologist make more than enough. Sure, we have a good share of corrupt individuals in every field, but if a product saves TIME and money at the same time to save a life, why wouldn't they use it?

      Your rhetoric is wrong as well. You bash the idea of positive sales whilst minimizing the CUP threshold yet you "buy" into this company and their products. What products? The MiRiview Mets^2 is the pretty much only thing they have going for them. Your ideas are inane. I have spoken with multiple PhD's that work in the diagnostic field and they're very aware of Rosetta. They know the type of technology MicroRNA offers and that the genome future depends on it. Perhaps the price right now as what ROSG should be selling at. Sure. We don't know what the sales are or what the monthly revenues will be. We need more details. But to state that only 20,000 patients would hypothetically needs this test is absurd.

      Medicare coverage, as someone else stated, is the epitome to success for any diagnostic company. You can twist the truth and your "professional" analysis, but we shall find out in the next few weeks/months. This can be a monster stock if they release any positive data. With such a skilled sales force and the will to sell, I don't doubt them. I think we will finally see a huge breakout in 2013.

      Sentiment: Strong Buy

    • Masselgo is right.

      This whole argument is convoluted and I don't think you work as a professional in this field. What you're describing is highly unethical and illegal. Pathologist and an Oncologist make more than enough. Sure, we have a good share of corrupt individuals in every field, but if a product saves TIME and money at the same time to save a life, why wouldn't they use it?

      Your rhetoric is wrong as well. You bash the idea of positive sales whilst minimizing the CUP threshold yet you "buy" into this company and their products. What products? The MiRiview Mets^2 is the pretty much only thing they have going for them. Your ideas are inane. I have spoken with multiple PhD's that work in the diagnostic field and they're very aware of Rosetta. They know the type of technology MicroRNA offers and that the genome future depends on it. Perhaps the price right now as what ROSG should be selling at. Sure. We don't know what the sales are or what the monthly revenues will be. We need more details. But to state that only 20,000 patients would hypothetically needs this test is absurd.

      Medicare coverage, as someone else stated, is the epitome to success for any diagnostic company. You can twist the truth and your "professional" analysis, but we shall find out in the next few weeks/months. This can be a monster stock if they release any positive data. With such a skilled sales force and the will to sell, I don't doubt them. I think we will finally see a huge breakout in 2013.

      Sentiment: Strong Buy

    • It is the MD's responsibility to the patient to explain alternatives. It is the patients responsibility to examine tests and decide. A doctor that refuses a patient this test can be sued, though winning that would be difficult due to the patient's ability to drop the doctor like a F'n roock.

      Example. Deming vs Thomas Weisman, MD Tucson, AZ. Weisman refused to order basic chest x-ray after Deming complained (had been complaining to doctors for over 4 years). Weisman said he did not order the x-rays because patient(s) did not smoke. Wrong decision for the doc.

      Deming was found with a thoracic aortic aneurysm (very serious). Required immediate surgery by Coselli in Houston.

      In 2004 Deming was at same hosp that did prior x-ray but it was not reported though it was apparent on the x-ray. Deming was at the hospital late at night when staff is limited and less experienced.

      After fact, Weisman was celebrating that "he" had found the problem after many doctors tried. Wrong again doc. Doc was pretty embarrassed after letters were sent to his "peers". Also Deming made sure that the doctors patients knew he lied. He put up a billboard in Tucson (legal).

      Point. If the patient is aware (most are not) the patient can request the doctor order the test. If the doctor refuses the patient can drop the #$%$" and go to a professional. There isn't a good reason that this test or tests like it to be declined by the doctor. It saves time and time is a doctors enemy.

      The days of the ill informed patient are about over. Most patients have a computer or know someone that does. Therefore the patients have the ability to study their illnesses (and they do).

      Patients need to be aware of their rights when it comes to their PCP. A PCP will lie to "save face" as did Weisman.

      Sentiment: Buy

      • 1 Reply to mesaleggo
      • Masselgo is right.

        This whole argument is convoluted and I don't think you work as a professional in this field. What you're describing is highly unethical and illegal. Pathologist and an Oncologist make more than enough. Sure, we have a good share of corrupt individuals in every field, but if a product saves TIME and money at the same time to save a life, why wouldn't they use it?

        Your rhetoric is wrong as well. You bash the idea of positive sales whilst minimizing the CUP threshold yet you "buy" into this company and their products. What products? The MiRiview Mets^2 is the pretty much only thing they have going for them. Your ideas are inane. I have spoken with multiple PhD's that work in the diagnostic field and they're very aware of Rosetta. They know the type of technology MicroRNA offers and that the genome future depends on it. Perhaps the price right now as what ROSG should be selling at. Sure. We don't know what the sales are or what the monthly revenues will be. We need more details. But to state that only 20,000 patients would hypothetically needs this test is absurd.

        Medicare coverage, as someone else stated, is the epitome to success for any diagnostic company. You can twist the truth and your "professional" analysis, but we shall find out in the next few weeks/months. This can be a monster stock if they release any positive data. With such a skilled sales force and the will to sell, I don't doubt them. I think we will finally see a huge breakout in 2013.

    • bump. Just a reminder of the most worthwhile post in weeks.

    • So you are into med. Then you know the VA's position on new products. The VA is undecided about this product.

      The VA is usually on top of new items. They are of course the test bed for drugs.

      I am quite familiar with the VA process. It could take years for them to make a decision. However, Regional VA Centers can use the item without approval from National HQ.

      It will be interesting to see what the VA does. It isn't just the VA "veterans", it is CHAMPA and its relation to the family members.

      But like you mention, 200K possibles. But market share is another story. ROSG does not point this out.

      And "Saul Suster" a leading Pharmacologist in Wisconsin has not put his seal on the product. Google him.

      Sentiment: Hold

    • Hi Peter, thanks for your post. I have a few questions/points if I may?

      In relation to point one: From what I understand, pathologists base their procedures for tumour classification on IHC staining. They identify the tissue, whether cancer is present, the type of cancer and then the proteins associated with them. So if you found breast proteins in a biopsy of a tumour found in the bowl you would be inclined to say it metastasised from the breast. I appreciate this is a very simplistic view but is this right?

      If so why would you see the molecular assay as a replacement rather than an additional assessment? It would not affect a pathologist's pay check. From my knowledge of the medical profession, any doctor would welcome further testing that provides another viewpoint. Scientific reasoning is based on the premise that the more research and evidence you have to support a conclusion, the more likely it is to be accurate. And if the insurance companies are willing to cover the test then surely doctors would be even more likely to order it in conjunction with your own? Especially if it will take you a few weeks whereas Rosetta suggest they could return it to anywhere in the world in 5-7 days?

      To point two - I believe the 200,000 market opportunity is inclusive of approx. 30,00-50,000 cases of cancer of unknown primary and 150,000 cases of cancer of uncertain primary (as described by Rosetta). I don't think anybody here would expect them to capture the entire market; so even if they succeeded in having only 20k to 40k that would be a 10-20% market capture, which sounds very possible, or $60-$120 million (based on a test price of $3000).

      Aside from that, in a paper by Tong et al they suggest that in many cases of CUP the identification is a strong, educated suspicion rather than a definitive answer, based on the pathologist's results, knowledge and experience. They also suggest there could be many thousands of cases in which, as it is highly likely it will be what the pathologist suspects, the doctor will report the primary as the suspicion rather than CUP (if they concur with the doctors own examination). Can you provide further light on this please?

      I am quite confused and alarmed by your suggestions in point three. Firstly, we all know insurance companies to be solely focussed on their profit margins. Why would they pay doctors a premium for medicines instead of ordering from pharmaceutical companies and distributors (or perhaps even hospitals?) directly and enjoying the wholesale savings themselves?

      I find your suggestion that doctors would happily prescribe the wrong medication as quite worrying - whilst it is known that doctors in the US can prescribe and fill a patients requirements in their surgery at a considerable mark up, the drugs themselves are the correct treatment. Are you suggesting that doctors are prescribing any old chemotherapy just for a profit? I know many who would consider that a gross dereliction of their duty to a patient's care, not to mention the kind of malpractice that would see them struck from the General Medical Council's register and most probably land them in court (I'm English, remember, but I imagine the result would be quite similar in the US).

      To point four - I don't think that Rosetta would market to academic institutions who are educating pathologists. It would seem counterintuitive to train others in the techniques and technologies they have spent years designing and perfecting. That is why they have patented their Intellectual Property. If they taught every pathologist how to do it, what would stop them from producing a generic in house replication? In addition, pathology reports will vary greatly in their accuracy due to the skill of the pathologists preparation, preservation and identification. In requesting a 'second opinion' from the Mets test, the doctor would greatly reduce these effects.

      Finally, a pathologist does not diagnose. That is the preserve of doctors. And as I have previously said, the doctor would do so from not only the pathology reports, but from his or her own clinical examinations. In trying to identify CUP it would be a tumour that best fits all the evidence. Another tool in this difficult process would surely be welcome.

      Sentiment: Strong Buy

      • 1 Reply to stevesmith0606
      • peter_collin@ymail.com peter_collin Nov 7, 2012 6:56 PM Flag

        Steve- thank you for your post. Im going to keep mine shorter, but Ill respond to you in the same fashion.

        To your first point. Your understanding of the situation is correct to a point. But, Pathologists also run mutational analyses, can do micro arrays and utilize a variety of other methodologies to diagnose a tumor. The steps along the way are how they are compensated. They can also sign pathology services agreements with third party labs that do testing they are interested in and then mark that product up or charge for the TC/PC of that test. This is a money maker for Pathology and something that ROSG limits. The premise of timing is also not of that much concern. Following a major surgery or debulking a patient will have to wait a minimum of 2 to 3 weeks before they even consider chemotherapy. SO, getting a result in 7 days doesnt really matter.

        To the second point. All of your points are correct, however, you need to exclude academic centers from the 20 to 40k. That should account for at least 1/3. Then, this product does have competition; 2 other companies. Biotheranostics is hiring a sales force and Pathwork has been the market leader. This will account for at least 1/3 of the business as well. So, in my opinion, that market looks a bit more like 6 to 13k cases. That diminishes the opportunities greatly. Your knowledge of a paper published by Tong is nice and I would not disagree with the findings; I have not read the paper myself. What I would say is that the profession as a whole looks at specimens independent of other physicians and if multiple physicians concur independent of each other it is more than likely correct. This is not perfect, but it does not create a 'massive' market for the test.

        To point three. Insurance companies are NOT treating physicians and are not Pharmacists. They are not allowed to purchase chemotherapy. Its the system we are in. As to the fact that physicians would knowingly prescribe a medication that will not work, that is not what i was saying. Where I was going with that is that in combination to the clinical trials, lab results, toxicity of a patient and many other factors, revenue is part of the equation for the medical oncologist which opens the door to swayed opinions of certain medications.

        To point four, pretty sure I addressed it above. If they dont market to academics you ahve to remove at least 1/3 of the possible cases you can go after.

        Oh and finally. PATHOLOGY is the MD OR DO that DIAGNOSES PATIENTS. We are physicians who went to medical school and trained in residency and fellowship. The oncologist takes what the Pathologist says as the diagnosis. Thats pretty bad my friend. But I do hope I answered some of your questions.

        Sentiment: Buy

    • Thank you for an insightful post.

      Sentiment: Hold

    • Thank you for the thoughtful, intelligent post. Much appreciated. Accepting what you have stated, how can the co. accelerate the uptake of its tests.

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