Who has been short? I cashed in long term puts and will do it again. I only pointed this out in response to another insult based message sent earlier and didn't intend to brag. Again, please name any credible source that reviewed this study. The funny part is it never claimed to be a peer reviewed study, but is very clearly a survey study. Everyone past seven grade should be able to distinguish between a survey study and a peer reviewed research study which is more relevant. Only the old and ignorant automatically "embrace technology" because to them it is a sort of magic. Intelligent people use technology as a tool and apply the same principles of professional skepticism and cost benefit analysis that they would use in any other aspect of the economy. Most of the waste in healthcare comes from the baby boom decision makers buying any ridiculous device or software application because they are frightened into it. Wow a magic robot! We don't want to fall behind the times, Hot dog lets do some inappropriate abdominal surgery!
PS I made a killing last year buying Oct puts at the beginning of the year, and will do so again this year. All the hospitals that bought this device now have egg on their face as the depreciation eats away at their income statements as they spend more for the same reimbursement and outcomes. Meanwhile the sales reps push them to try more dangerous experimentation on their patients to grow volume into general surgery. No one in the US, Japan, Northern Europe, Australia, are buying. Only a few hospital left in England and east asia. Even their auditor quit last week, and they will not even offer a guess at sales volumes this quarter.
You have never offered any information on this message board. All you write is personal attacks against people you disagree with. If you have any information that counters what I say, please share it. Exchanging and verifying information with people you agree and disagree with in a civil manner is the purpose of the discussion board. I have no expectation that you will offer any information related to the valuation of this stock, but please do surprise me if you are able.
Yes, I read the annotations and this is not a peer reviewed study. It is only a survey. If you have reference of a peer review, please name any or all of the individuals that reviewed this study.
Yet again the Martino single hospital survey is referred to as a peer reviewed study in the financial press. This time by Motley Fool writer Brian Stoffel. None of these writers seem to know to look for population control to avoid assumptions of causational correlation. Comparing sicker non robotic patients to healthy robotic patients does not mean that the robot contributed to lower readmissions for the already healthier robotic patients. If the financial press wants to follow medicine they should learn the basics of science so they do not become tools for frauds like Martino and intuitive surgical.
Ernst & Young, Intuitive's auditor, declined the audit engagement for 2014. An auditing firm will not continue serving an existing client if they deem the engagement risk too high. The three components of engagement risk are client's business risk, audit risk, and auditor's business risk. This decision likely followed the 2013 audit assessment of client risk which E&Y would have performed following the audit. Since E&Y signed off on the 2013 financials, we can assume that the risk focuses on management integrity and the resulting management assertions. Now Intuitive can engage a non "Big Four" accounting firm and report what they like. Yes, being dropped by a permissive auditor like E&Y is a big deal.
Buy back bull trap ending soon, but jump right into the blades with no razor sales business model.
Total saleholder equity down 3% 2013 after rising over 30% each of the three years prior.
Cash locked up overseas to avoid recognition of US income tax to pad 2013 income statement, so not as much available for buybacks as you might think.
Japan continues to lock out Davinci with regulatory hurdles, and that will not change, it's how they say no.
Misleading "studies" like the recent Pennsylvania roboquack article comparing unlike patient populations fooling fewer and fewer hospital administrators.
More investors will catch on and sell this techno fantasy after each quarter of declining system sales.
I am aiming for a meltdown by 2015. Medical community already over this waste machine.
There have been hundreds of survey studies by robotic surgeons (not a research scientist) claiming to show an advantage in the procedure they sell. This one, like most of the others, has no control for patient selection and will not affect current recommendations. To measure the affects of robotic surgery you have to compare like patients, patients eligible for robotic surgery that received other laparoscopy or vaginal surgery. Patient selection is the cause for the lower complication rate in this single healthcare system review, not the device. Also, his cost analysis is a joke and he "published" in a laparoscope surgery promoting trade rag. This study will only impress the financial press, not the medical.
Robotic surgery requires the morcellating (dicing) of the uterus to get the material out of the small incision. This process spreads the cancer from the affected fibroid and leap frogs the patient from state one to stage four cancer. If you think you might have cancer PLEASE ask that your uterus be removed intact.
Sad their officers still think they can compete in benign hysterectomy procedures. This is a ridiculously expensive second tier laparoscopic surgical solution for less able surgeons that refuses to admit it competes with J&J's laparoscopic tools for more able surgeons, and not open surgery. It must compare itself to open surgery because it cannot compete with the first tier laparoscopic tools financially. The makers of firefly are now selling their new color imaging system to J&J.
Lets see if ISRG will expand procedure qualification to include complex patients, or if anyone who is not routine will continue to be called "not a candidate" , so only the healthiest patients show as robotic and the rest dumped into general surgery. Treating surgical patients with higher comorbidities then general surgery to achieve the same patient mix would impress me more then expanding into other procedures. I agree with your depiction of the AARP article and think I described it the same way "pros and cons considered". Of course I include my own opinions in my comments as do you. Enjoy the rest of the waves up to earnings. I expect another lack luster quarter. I expect two more lack luster quarters before the majority catches up with my opinion Intuitive Surgical. I have a head start working in a hospital and hearing the laughter at the "cutting edge" crowd.
Will do. The recent second case is the larger one of course. If you read the 3rd quarter statement of cash flows you will see Intuitive's balance sheet shrank 14% in the third quarter as they sold off investments to buy shares to retire to keep their share price up without affecting their cash balance. Don't know what moved them 8% in one day, could not be the study comparing outcomes between unlike patient populations.. They tried that already, and holders of intuitive stock are hardly viewed as objective analysts. If 1st quarter buyback is the driver, expect more of the incredible shrinking balance sheet 1st quarter. Looking forward to more earnings circus moves for this conference call, but will continue to rely on the actual financials for my long term outlook. Trends show this is a mature company priced as a growth company.
Similar articles found in Poland and Germany. Where is the European growth supposed to come from if not a European nation? Who thinks Europe and Asia are virgin growth markets if they have been selling Davinci there for five years? "County councils takes hit for robot investments" Radio Sweden website
Patients selecting a surgical procedure based on reason and asking the right questions spells doom for the robotic procedure growth at any cost crowd.
Read the article in the DecJan issue in AARP to get an understanding of the limited scope robotic surgery will have in upcoming years and the pros and cons considered. Glad we are past the irrational tech boom phase that cost so many lives, and wasted so many healthcare dollars. aarpDotOrg, then type "robotic" in the search engine to find the article. Sad that the FDA and the surgical profession put patients in this spot. Of course we would expect it from the loving folks at intuitive surgical.
In the latest move to avoid responsibility for their products and down play upcoming legal costs, Intuitive surgical has entered into a mountain of tolling agreements(suspend due date for litigation to buy time) with many of the injured patients awaiting trial. The problem is, they "neglected" to inform their insurance companies of these pending claims when they filled out their applications for coverage. This could potentially leave them on the hook for all the claims and legal expenses when this policies are cancelled because of the misrepresentation by Intuitive. California Case No. 5:2013cv05801 and No. 5:2013cv04863.
When do you think the tolled legal expenses will have to show up on the income statement?
Ha! its even worse then I thought. A new article showing no improvement for Davinci was published in JAMA on 12/18/2013, so this release of a survey study done by a London based group of Pakis is just a feeble attempt to counter that study. Is this how science is supposed to work? Robotic surgery has peaked. It was a nice ride, now get over it.
In their ongoing attempt to create the illusion of a larger benefit from robotic surgery then exists, Intuitive heralds the results of a "study" comparing robotic surgery complications to open surgery complications, with no control group. Since open surgery patients are by definition more complicated then robotic surgery patients, and even include failed robotic attempt patients, comparisons must be made between like patients in order to infer what if any benefit is a result of the robot. They also conveniently leave out non robotic laparoscopic patients, who show greater benefit and less cost to both open and robotic laparoscopy. When will the BS end? Never, Intuitive has a rotten corporate culture.
Is today's drop from the "historic drop in November admissions" news that is hitting Tenent, or is this more tax related selling to offset gains? Still over a 20 PE for a mature company already marketed in Asia and Europe years before the US, whatever the reason.