Saturday, January 31, 2009

Sangeeta Bhatia: The Future of Cancer Diagnostics & Therapy at Davos

Friday, January 23, 2009

Starbucks listens to Obama's Call to Volunteer

I'm going to Starbucks to find out what the buzz is all about. Are you in ?

Monday, January 19, 2009

On MLKs Birthday: A Speech Worth Hearing

Barack Obama spoke in Philadelphia on Race Relations. This remarkable speech should be heard by all.

Sunday, January 18, 2009

Men or Women: Who's a better driver ? A better CEO?

The verdict is in. Women are better drivers according to stats:

Women have less accidents
Women have less traffic violations (68% women have no traffic violations; 64% of men)
Women are less likely to get killed traveling over the same distance) (men are 77% more likely to die than women)

These stats do not account for average speed of travel and highway driving; there may be something in those numbers; people are less likely to die from car crashes in the suburbs than on highways. I wonder what the data shows if only highway driving is considered. carried this article.

In the financial sector there are many high-profile women especially in money management. Women make excellent money managers maybe because they take more calculated risk/rewards; risk/reward is an important fundamental in driving returns. A UC Davis study of 1991-1997 showed that in households, men trade 45% more than women; trading instead of buy and hold subsequently lowered men's returns are lowered by 2.65 percentage points a year as opposed to 1.72 percentage points for women.

One thing is clear. There are no scandals involving a woman CEO that brought a company to the brink of financial ruin; certainly none that pushed a company over the edge. The list of male-run companies with boiler-room deal-driven cultures is significant (most of Wall Street; Enron, MCI-Worldcom, Tyco...)

I wonder how gender plays out in shareholder returns in running public companies and venture-backed startups? Is there is a correlation ? Is such a study even possible ?

NVCA Predictions 2009

NVCA Predictions 2009

Plastic Surgery: Started in 600 BC

Sushruta, the Father of Surgery, wrote a famous book "Sushruta Samhita" in 600 BC. This detailed collection of manuscripts was the first and very impressive manual of surgery. It contained descriptions of 120 surgical instruments, as well as several surgeries for the first time including repair of cleft lips, disssection of cadvers, removing the prostrate, cataract lenses and abscess drains. The most detailed descriptions are of rhinoplasty (nose repair), which developed into a science.

Natural Orifice Surgery: A new development

Natural orifice transluminal endoscopic surgery (NOTES) is a new method of surgery where a natural orifice (mouth, urethra, anus, etc.) is used as a point of entry for insertion of surgical instruments, thereby avoiding external incisions or scars. The incision is made in the wall of the orifice to enter the site of the surgery.

This surgery was performed in 2004 for the first time anywhere in the world in India on humans; it was an appendectomy through the mouth. Its still experimental, but it was named one of the Top 10 medical innovations of 2009. CIMIT received several millions in grants to study this field in greater detail. Credit for inventing the surgery goes to Anthony Kalloo of Johns Hopkins University in Baltimore and Venkat Rao and Nageshwar Reddy of the Asian Institute of Gastroenterology in Hyderabad, India..

NOTES is attracting some criticism. Its not surprising. Every new development has people who takes sides. I remember when airbags first came out, Lee Iacocca argued against the technology in his book, saying airbags would go off without warning, creating more dangers than if we had them. Medical developments tend to attract greater sceptics.

Time will tell if NOTES goes mainstream or if it finds selected killer applications:

Robert Oliver

A US News article talked about a patient who had pain after the procedure in her mouth. See here

Cleveland Clinic: Top 10 Innovations of 2009`

Top 10 Medical Innovations for 2009 (reproduced from Cleveland Clinic)

1. Use of Circulating Tumor Cell Technology:
Use of new technology to measure circulating tumor cells as a predictor of success of chemotherapy.

2. Warm Organ Perfusion Device:
Warm organ perfusion device to preserve organs for transplantation during transplant.

3. Diaphragm Pacing System:
Use of a diaphragm (phrenic nerve) stimulator to enable paralyzed patients to breath without the assistance of a mechanical ventilator.

4. Multi-Spectral Imaging Systems:
Improvements in multi-spectral image analysis to assess multiple protein pathway configuration in a single sample/cell.

5. Percutaneous Mitral Valve Regurgitation Repair:
Use of a special clip to percutaneously repair mitral valve regurgitation (MVR).

6. New Strategies for Creating Vaccines for Avian Flu:
Use of new strategies for creating vaccines for avian flu, including genetically-engineered virus-like particles (VLPs) as the basis for vaccines.

7. LESS and NOTES Applications:
Laparoendoscopic single-site surgery (LESS) and Natural Orifice Transluminal Endoscopy (NOTES) for nephrectomy, cystectomy, prostatectomy, colon resection, and other applications.

8. Integration of Diffusion Tensor Imaging (Tractography):
Integration of diffusion tensor imaging (tractography) with surgical navigation of the brain to minimize damage to fiber tracts during brain surgery.

9. Doppler-Guided Uterine Artery Occlusion:
Doppler-guided non-invasive transvaginal uterine artery occlusion for treatment of symptomatic uterine fibroids.

10. Private Sector National Health Information Exchange:
Use of a common exchange standard among participants to enable access through the Internet regardless of provider source.

Wednesday, January 14, 2009

PWC and the Satyam Scandal

I'm still scratching my head about the Satyamin cash in the bank and were reporting $1.1 billion. The easiest thing to find out in auditing is cash on hand. In fact it is the first thing one is taught in auditing.

All one has to do is get all the original bank statements, look at the end-of-year balance, add it up and that's what you have. There is no excuse to miss this number, least of all misreport it by $950 million.

India rightfully came down harshly on banks who were involved in the securities scandal in India many years ago. Credit Suisse lost its license. Its important to do a full investigation into PWCs role.

Only by threatening the survival of an auditing firm can we ensure they will comply by the law and do what they are paid for.

PWC needs to either show that it was not negligent or like the banks, it should get its India license revoked. This is the only way to send a message that the nation is serious, to improve transparency and ensure that auditors do their jobs properly and protect the interests of shareholders above the interests of the company at all times.
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Sunday, January 11, 2009

The price of cigarettes and the cost of saving a smokers life

New England Journal of Medicine published a study after following 30,000 smokers for 12 years.

484 suspected cancers were found.

375 patients opted for surgery.

92 percent lived 10 years or more.

Lung cancer is generally aggressive with extremely low survival rates because it moves so quickly.

The question is - what would it cost to save a smoker ? If a CT scan costs $500, in this study it would have cost $500K for each life saved. We realize that every life is priceless and precious. But let's suspend that theory for a second and talk about pure economics. The economic value of an American is approx. $40K per year (per capita GDP). Over 15-16 years this cost would be paid back so its beneficial to the US to do this.

However since lung cancer is mostly "self-inflicted" with 90 percent deaths to smokers, let's presume we have to recover this cost through a "scan tax". For an annual scan of $500, and assuming an individual consumes 20 cigarettes a day, that works out to 6 cents per cigarette in tax, or an additional $1.36.

This analysis doesn't take into account the complications of radiation.

There are some other interesting lung cancer tests coming that could stratify who should be scanned.

But price-wise, I don't see why smokers won't be willing to pay less than a buck fifty to smoke while vastly improving their chances of survival.
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The Future of Cancer: Detection or Cure ?

On the flight over th JPMorgan I read a Wired Magazine article titled the Truth about Cancer.

If you can find cancer early, 90 percent of the time it can be cured through a combination of surgery, radiation and chemotherapy. Detect it late and the chances of survival are 10 percent. These statistics are somewhat of a generalization for all cancers but its generally true.

One in three people will get cancer in their lifetime. If we could find it early we would fix it for most people. Yet the money isn't going in this direction yet. Only 8 percent of NIH funding ($300MM) is going towards detection.
A cure for cancer is so much more exciting than complex tests for detection. The venture industry is geared up, and has lost a lot of money funding these cures.

Siemens has invested in diagnostics. SVC has invested in three diagnostics companies, and every week we come across interesting biomarkers for cancer that are being converted into tests. Its early days of some fascinating developments that should really start to make an impact on survival in the next decade.
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Saturday, January 10, 2009

A Kiva Fellow's Journey

A Fistful Of Dollars: The Story of a Loan from Kieran Ball on Vimeo.

Kiva: Loosening my Social Entrepreneurship Credit Today

I read a week of Wall Street Journals today. Lots of articles about worsening credit. The only lending I do is through so I've doubled the money I've channeled into the system.

Kiva is creating an impact. This week alone Kiva lent out nearly $800,000, and 7000 more people started lending. The default rate is 2.85 percent and the delinquency rate is 2.21 percent. Incredible.

Mohammed Yunus said that credit should be everyone's birthright. Not the kind of credit that got Wall Street and Main Street in trouble but enough to feed, clothe and shelter one's family. Its a powerful thought. Kiva is empowering those who are lending, to give these people a chance to do exactly that.

I looked at some interesting benchmarks. The average Kiva lender has lent $134 to date and received $75 back through 3.6 loans. This isn't the total amount lent out. It includes all the loans through money that was recycled. $59 is still in the system and in June there are 400,000 lenders, which means Kiva has $24MM in the system right now.

One billionnaire could increase that amount 50 times. Even at a 2-3 percent delinquency rate, that is a 25 percent better return than the Nasdaq. The personal social return is priceless.
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Monday, January 5, 2009

Jefferies: Medtech comparisons from 2007 to 2008

This just in from Jefferies:

1) The Medical Device Public Company Universe traded at 3.0 times LTM Revenue, 27.5 times LTM Earnings and 21.6 times one year forward Earnings, versus trading at 1.6 times LTM Revenue, 17.0 times LTM Earnings and 14.5 times one year forward Earnings today.

2) Thirteen companies were in registration to go public (three ultimately were successful), versus three in registration today.

3) The IPO Class of 2007 was trading in positive territory (up 1.8%), versus the IPO Class of 2008 trading off 33.2% as of today.

4) Thirteen industry sub-sectors were trading in positive territory, versus none today.

5) Five industry sub-sectors (Hearing, Analytical Equip, Orthopedics, Diagnostics and Diversified) out-performed the broader index for the year, versus four (Components, Safety/Sterilization, Diversified, Home Care/Respiratory) today.

6) The average M&A multiple for the prior twelve months was 2.9 times (LTM Revenue), versus 2.8 times (LTM Revenue) today!

Sunday, January 4, 2009

Gary the Snowman Christmas Card

This first hit in 2006. It made me laugh. Happy new year and thanks to Blueprint Ventures for keeping us smiling !