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  "documentTitle": "Nevro Corp. (NVRO)",
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  "authorName": "Kir Kahlon",
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  "presentationDate": "2021-01-07 00:00:00",
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      "text": "Nevro’s PDN claims are so prima facie contradictory that we consider them fraudulent, as paresthesia mapping is mandatory to find which vertebrae stimulate the feet – “they’re lying,” to quote a KOL.",
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      "text": "Although we address Nevro’s supposed market opportunity in painful diabetic neuropathy in a later section, we note KOL comments indicating that Nevro’s one-size-fits-all lead insertion at vertebrae T9/T10 renders Omnia clinically impossible for PDN patients specifically. Getting stimulation to reach an anatomical region as far from the spine as the feet is difficult and requires a complex trial-and-error process via paresthesia mapping along various vertebrae. However, Nevro’s entire reason for pushing high frequency is that it *avoids* paresthesia mapping, which its reps don’t even know how to do properly. We caution investors to understand the preposterous contradiction at the heard of Nevro’s PDN claims: that high frequency is clinically superior for PDN patients, and high frequency is also easier to implant because its leads are always at T9/10 to avoid paresthesia-mapping. Nevro’s PDN claims are so prima facie contradictory that we consider them fraudulent, as paresthesia mapping is mandatory to find which vertebrae stimulate the feet – “they’re lying,” to quote a KOL.",
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      "text": "“Nevro has always said you have no choice with lead placement, that everyone has to place the leads at T9/T10. The beauty of paresthesia-based [low-frequency] stimulation is that if you have foot pain as a diabetic with neuropathy, I would enter with the leads at L2, and I would put the leads at L1, T12 at what’s called the cronus. I’ll turn it on and say, \"How do you feel?\" and you say \"This sucks. You’re not getting to my feet.\" Then I push a lead to L5, at the root, at T12, L1 – right in that area of T12, T11. I turn it on there, and I put the leads wide, so we can capture the nerves on the left and the right as they’re descending past the lead. And you say, \"This is much better.\" Then the next patient comes in and goes. \"What are you trying to do? Kill me? This is all ribs and butt cheek.\" Then I go back to L1 and that person is happy as a clam. So, each person has a different spinal cord. That’s why you’ve got to do your job, you’ve got to do paresthesia fishing. You’ve got to throw your line out there with bait and fish because your spine is different than mine.” – KOL and high volume implanter",
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      "text": "“I don’t know how they’re going to do both high frequency and paresthesia [low frequency] with Omnia. In fact, I think they’re lying. I think if you’re going to go for diabetic peripheral neuropathy, you can’t be in the T9/T10 spot. You’re going to have to be somewhere else, which means now you can’t do the high frequency.” – KOL and high volume implanter",
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      "text": "“Nevro has always said you have no choice with lead placement, that everyone has to place the leads at T9/T10... So, each person has a different spinal cord. That's why you've got to do your job, you've got to do paresthesia fishing.” — KOL and high volume implanter; “I don't know how they're going to do both high frequency and paresthesia [low frequency] with Omnia. In fact, I think they're lying.” — KOL and high volume implanter",
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      "text": "Source: Consultation calls with experts",
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      "kind": "title",
      "text": "10. The new Omnia stimulator, the centerpiece of Nevro’s turnaround hopes, is a Hail Mary and colossal flop",
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      "text": "Scorpion Capital | Nevro (NYSE: NVRO)",
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