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  "documentTitle": "Nevro Corp. (NVRO)",
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  "authorName": "Kir Kahlon",
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  "notes": "Uses expert testimony (KOLs) to undermine the company's growth thesis.",
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      "text": "A PDN label won't help Nevro's market share with me.",
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      "text": "While many KOL's indicate that they already use stimulators for PDN today, others stated that diabetics who have deteriorated to the point of neuropathy are too risky as stimulator patients and suffer far higher complications when implanted. Our research suggests that the PDN opportunity is already played out with doctors firmly entrenched in two camps: those who already code it and it implant it today, and those who are wary because of higher complication rates and are unlikely to be swayed by label and reimbursement tweaking. A KOL who occasionally uses stimulators for PDN explained the conundrum: “the ones with the worst pain are the ones with worst diabetes” and therefore the riskiest, adding that “a PDN label won’t help Nevro’s market share” and that most doctors he knows “feel similarly.” A second KOL, a moderate Nevro user, expressed skepticism of Nevro’s PDN study and corroborated why a PDN label won’t be “a gamechanger”: a small, suspect market of high-risk patients whose comorbidities make it less likely they’ll even be referred.",
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      "text": "“I wasn't so impressed with the PDN study. I'm a little bit leery because it's a market of primarily elderly sick people with a lot of comorbidities, and I am not sure that it is such a big market for them, number one. The patient population is a suspect category for referral to a pain doctor or surgeon. A lot of them are more elderly, sick with other comorbidities, risks of infection, so it's less common that they'll be referred. I think the patient population is suspect in terms of surgical candidates. I don't think it's going to be a gamechanger.” – KOL, high volume implanter with moderate use of Nevro",
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      "text": "“PDN would give Nevro an opportunity to have an extra condition on their label but it doesn't move the needle. I'm already using stimulators for PDN but in general diabetic patients are very sick and I don't like to use a stimulator. They're much more likely to get a side effect. They have four times the infection rate with an implant. When one of these devices gets infected it ruins my month and makes me miserable. I really try to avoid diabetic patients. If their diabetes is under decent control I'll do them. But the ones with the worst pain are the ones with the worst diabetes. A PDN label won't help Nevro's market share with me. When I talk to other implanters at my hospital, most feel similarly to me.” – KOL and high volume implanter",
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      "text": "\"the ones with the worst pain are the ones with the worst diabetes\" and therefore the riskiest, adding that \"a PDN label won't help Nevro's market share\" and that most doctors he knows \"feel similarly.\" — KOL",
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      "kind": "title",
      "text": "11. TAM expansion and growth from painful diabetic neuropathy (PDN) and other new indications are a mirage",
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      "text": "Scorpion Capital | Nevro (NYSE: NVRO)",
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