{ "docId": "019dd923-622c-750b-8b9a-2a2468219173", "docSlug": "ce565b841c40", "documentTitle": "Nevro Corp. (NVRO)", "authorId": "58_Scorpion_Capital", "authorName": "Kir Kahlon", "documentKindSlug": "activist-deck", "documentKindLabel": "Activist deck", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2021-01-07 00:00:00", "orientation": "landscape", "aspectRatio": 1.3333334, "pageNumber": 119, "pageCount": 239, "prevPage": 118, "nextPage": 120, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "overcrowded", "nDataPoints": 0, "notes": "The slide uses direct quotes from a KOL to support the claim of unethical sales practices and patient manipulation.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/119", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-119", "components": [ { "bbox": null, "kind": "callout", "text": "Nevro's response to its explants crisis appears to be marked by denial, cover-up, retaliation, and patient/doc manipulation", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3d-76db-b340-1909f94f1e64", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.18, "w": 0.88, "x": 0.06, "y": 0.15 }, "kind": "paragraph", "text": "A sixth KOL elaborated on the “tremendous potential for abuse in the role the rep plays with the patient,” describing reps who were “full of crap,” “acted unethically, and were “just very sleazy.” He described a toxic dynamic of quid pro’s quo’s between stimulator reps and doctors. Another KOL illustrated how the paresthesia-free nature of high frequency is tailor made for patient manipulation. Because patients feel no tingling – and therefore can’t even feel whether the device is on or off – they are particularly susceptible to the rep convincing them it’s working. He added that Nevro was “very sneaky” at launch in hiring reps who were good at handling patients.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "556b4c37-1d57-4506-b1fe-e08a16e796f1", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.3, "w": 0.88, "x": 0.06, "y": 0.61 }, "kind": "quote", "text": "“You bring a patient in for a trial implant and then you turn it on. The patient is like, when are you going to turn it on? Especially if they're used to the feeling of paresthesia. And I'd say, no, the device is already on. Patients never felt the device being on. It was always just a leap of faith that the thing was working. So when it stopped working, Nevro's reps could use that tactic against the patient. You're not doing this, you're not doing that. How do you even know when the battery is dead? The whole time, the patient just has to believe that the device is on and that it's working. You could probably get a placebo effect. Whether it's on or off, they just always think it's on. Nevro did another thing which was very sneaky. When they first launched, they hired all the best reps in the country. The ones that did the best because they are very good with the patients. A patient who likes their rep will be happy and report a successful stimulator. Even if the device is turned off. I'm telling you, it is all about the reps.” – KOL and high volume implanter", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "b6b252f9-3171-4569-bc33-bee2ed18784c", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.2, "w": 0.88, "x": 0.06, "y": 0.4 }, "kind": "quote", "text": "“There's tremendous potential for abuse in the role the rep plays with the patient. I have refused to work with reps who have acted unethically and that I knew were full of crap. There's no question that they influence the patient during the trial. There's no question about it, that there's the ability to influence. It just depends on your judgment. It's more common with younger implanters and people who work in private practice, who are trying to get a business out there. The reps are saying I'll do this for you, I'll do that for you, I'll introduce you to doctors. It's natural. No question, I've seen over the years reps that are just very sleazy. I have told companies straight out: I will not work with these people.” – KOL and high volume implanter", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "dad48abf-bef9-47f8-a5f7-591c149946c1", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "There's tremendous potential for abuse in the role the rep plays with the patient. I have refused to work with reps who have acted unethically and that I knew were full of crap. There's no question that they influence the patient during the trial. There's no question about it, that there's the ability to influence. It just depends on your judgment. It's more common with younger implanters and people who work in private practice, who are trying to get a business out there. The reps are saying I'll do this for you, I'll do that for you, I'll introduce you to doctors. It's natural. No question, I've seen over the years reps that are just very sleazy. I have told companies straight out: I will not work with these people. — KOL and high volume implanter", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3d-76db-b340-1ecd0e4c61b6", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.2, "x": 0.06, "y": 0.96 }, "kind": "source-note", "text": "Source: Consultation calls with experts", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "f86007be-8a20-4261-b875-a2fd22beb162", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.05, "w": 0.88, "x": 0.06, "y": 0.09 }, "kind": "title", "text": "8. Nevro’s response to its explants crisis appears to be marked by denial, cover-up, retaliation, and patient/doc manipulation", "attrs": null, "subkind": "action-title", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "8db5adde-7a32-402d-9410-d7023b87c40e", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.35, "x": 0.06, "y": 0.04 }, "kind": "title", "text": "Scorpion Capital | Nevro (NYSE: NVRO)", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "a891e4ca-4e8b-431b-8620-9bb50bfb4e07", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "antagonist-introduction", "slug": null, "matchId": "2b40eee4-20b1-4a3f-b26b-ffcc42106161", "evidence": "The slide frames the sales representatives as the antagonist manipulating patients.", "confidence": 0.8 } ], "arcBeats": [ { "to": 150, "from": 51, "beatId": "903c076a-f368-4ca1-844c-277874c1afb2", "arcName": "Overcoming the Monster", "arcSlug": "overcoming-monster", "beatName": "The Victory", "beatSlug": "overcoming-monster-the-victory", "evidence": "The deck presents a conclusion that Nevro's problems are insurmountable", "position": 2, "confidence": 0.8, "parentBeatName": "Turn", "parentBeatSlug": "turn" } ], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }