{ "docId": "019dd923-622c-750b-8b98-be9011f05a27", "docSlug": "1cbf7684bf7d", "documentTitle": "Penumbra, Inc. (PEN)", "authorId": "54_Spruce_Point_Capital", "authorName": "Spruce Point Capital Management", "documentKindSlug": "activist-deck", "documentKindLabel": "Activist deck", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2019-07-31 00:00:00", "orientation": "landscape", "aspectRatio": 1.3333334, "pageNumber": 52, "pageCount": 61, "prevPage": 51, "nextPage": 53, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "dense", "nDataPoints": 2, "notes": "The slide uses testimonials from medical professionals to frame the company's regulatory actions as anti-competitive 'bully tactics'.", "elementsJson": [ "headline_text", "paragraph", "callout_box", "quote_block" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b98-be9011f05a27/52", "deckHref": "/decks/019dd923-622c-750b-8b98-be9011f05a27", "deckJsonHref": "/decks/019dd923-622c-750b-8b98-be9011f05a27.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b98-be9011f05a27#slide-52", "components": [ { "bbox": null, "kind": "callout", "text": "Is management resorting to policing its doctors to protect its commodity products from competition?", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd952-ee3a-7528-92b9-9ec773bb90d3", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.9, "x": 0.05, "y": 0.17 }, "kind": "paragraph", "text": "In 2017, as the practice of using intermediate catheters for aspiration thrombectomy was becoming increasingly widespread, the FDA received a complaint about, and subsequently issued a warning against, the use of off-label catheters as aspirators in the treatment of acute ischemic stroke. Several doctors and industry experts with whom we spoke saw this as an aggressive attempt by Penumbra to preserve market share. They acknowledge that, for the time being, it likely succeeded in scaring many purchase officers into buying only on-label aspiration catheters for neurovascular thrombus removal. However, they also note that most doctors saw through this tactic, and that it rubbed many the wrong way: neurologists apparently do not like being told how to treat their patients. Penumbra has since communicated warnings to doctors that their aspiration catheters are cleared by the FDA for use only with Penumbra accessories and vacuum pumps, even though, according to doctors, these items are entirely interchangeable. Is management resorting to policing its doctors to protect its commodity products from competition?", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "a70d820f-a83d-40bd-a3cd-788b290874d7", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.09, "w": 0.42, "x": 0.53, "y": 0.75 }, "kind": "quote", "text": "The FDA label matters more to less-sophisticated doctors, like radiologists. People like me do whatever I think is best. - Neurosurgeon", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "10ea13ac-8c94-4ee9-9bce-5667e9c58bc0", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.35, "w": 0.47, "x": 0.05, "y": 0.49 }, "kind": "quote", "text": "Part of the commodity here is that...it's hard to have IP around a plastic tube... I could hook these things up to a wall suction and they would work just the same way. And everyone knows that. So, it is things like - some things they've been trying to do by essentially putting fear of human destruction into the hands of people who are not clinical, and they don't know how to respond to that. - Neurosurgeon", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "3a3cdbbb-8af1-40ae-8c49-c476ff227082", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.42, "x": 0.53, "y": 0.49 }, "kind": "quote", "text": "Penumbra went around to, and made a very big deal about, physicians using Medtronic, Terumo and Stryker aspiration catheters that previously did not have the stroke label indication. They freaked out a lot of doctors. This annoyed the doctors a lot because [the Penumbra salesman] should not be telling the doctors how they should be treating their patients. This also swayed some doctors to use Penumbra. - Neurovascular Products Sales Director", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "94980211-d7ad-42c6-9d0c-cc16699b313b", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "Part of the commodity here is that...it's hard to have IP around a plastic tube. Especially if you argue that you can put any suction on it. Just to give you a bit of context, there have been some companies engaging in a somewhat nefarious game of trying to sell supply chain departments that their aspiration catheters can only be used with their aspiration pump or their aspiration tubing, because that's the way that it is approved by the FDA. I mean - that's great, right? But obviously that is also a hollow argument because I could hook these things up to a wall suction and they would work just the same way. And everyone knows that. So, it is things like - some things they've been trying to do by essentially putting fear of human destruction into the hands of people who are not clinical, and they don't know how to respond to that. — Neurosurgeon; Penumbra went around to, and made a very big deal about, physicians using Medtronic, Terumo and Stryker aspiration catheters that previously did not have the stroke label indication. They freaked out a lot of doctors. This annoyed the doctors a lot because [the Penumbra salesman] should not be telling the doctors how they should be treating their patients. This also swayed some doctors to use Penumbra. — Neurovascular Products Sales Director; The FDA label matters more to less-sophisticated doctors, like radiologists. People like me do whatever I think is best. — Neurosurgeon", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd952-ee3a-7528-92b9-a2a4ff76774c", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.08, "w": 0.65, "x": 0.31, "y": 0.04 }, "kind": "title", "text": "Management Resorting To Bully Tactics To Protect Market Share?", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "c2860b10-fc4c-4f43-9adb-0056b615231a", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "fraud-exposure", "slug": null, "matchId": "d5699c6f-e3d7-4c0a-8041-8e8aaa26b5f5", "evidence": "The slide frames corporate actions as deceptive and anti-competitive to support an activist thesis.", "confidence": 0.8 } ], "arcBeats": [ { "to": 61, "from": 31, "beatId": "12d3c67f-b91e-48ff-a8d3-c9685144b586", "arcName": "Overcoming the Monster", "arcSlug": "overcoming-monster", "beatName": "The Victory", "beatSlug": "overcoming-monster-the-victory", "evidence": "The document presents Spruce Point's conclusion of 40-55% downside risk in PEN shares.", "position": 2, "confidence": 0.8, "parentBeatName": "Turn", "parentBeatSlug": "turn" } ], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }