{ "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": 167, "pageCount": 239, "prevPage": 166, "nextPage": 168, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "overcrowded", "nDataPoints": 0, "notes": "Uses multiple KOL quotes to undermine the company's growth narrative.", "elementsJson": [ "headline_text", "paragraph", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/167", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-167", "components": [ { "bbox": null, "kind": "callout", "text": "Doctors more amenable to using stimulators for PDN – including Nevro loyalists - were vocal in stating that Abbott's DRG is the best waveform for PDN versus high frequency: “without question”; “it’s not even a question”; “100 times better than any other neuromodulation system.”", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3d-76db-b346-df9c5546f3ae", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.88, "x": 0.06, "y": 0.13 }, "kind": "paragraph", "text": "KOL's stated that although spinal cord stimulation has long been used for PDN, it doesn't work well given difficulties in reaching the extremities and is in fact \"notoriously very bad for the foot,\", reinforcing doctors' concern that PDN patients are already vulnerable with other comorbidities. Doctors explained why Nevro's high frequency mechanism will backfire if used for the foot. We note that doctors more amenable to using stimulators for PDN – including Nevro loyalists - were vocal in stating that Abbott's DRG is the best waveform for PDN versus high frequency: \"without question\"; \"it's not even a question\"; \"100 times better than any other neuromodulation system.\"", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "b1007f58-b39b-417b-b86d-b1e4fc691f82", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.07, "w": 0.88, "x": 0.06, "y": 0.67 }, "kind": "quote", "text": "\"The other thing is that a lot of patients with diabetic neuropathy have pain in their feet, the actual feet themselves, and I personally don't believe Nevro is the best for the feet as the Abbott DRG is better.\" – KOL and high volume implanter, who still uses Nevro moderately", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "1219c922-8277-4fa3-b9fb-6ec33efcc1e8", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.18, "w": 0.88, "x": 0.06, "y": 0.31 }, "kind": "quote", "text": "\"Doctors have been using spinal cord stimulation for PDN for a while, but notoriously it's very bad for the foot. It doesn't get to the foot. You can't get spinal stimulation into the foot without having to stimulate everything along the way, Stimulation doesn't change the plumbing. Diabetic neuropathy causes pain because there's shitty blood flow which affects the nerves, which get rewired and interpret it as pain. What's going to happen with Nevro is what happens with every other spinal cord stimulator for the foot. You can't get to the foot, so you have to jack up the current, and then you get tolerance and [any pain relief] goes away.\" – KOL and high volume implanter", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "e6f38f0e-fef6-4f68-9e8a-22d428a6a556", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.12, "w": 0.88, "x": 0.06, "y": 0.52 }, "kind": "quote", "text": "\"For diabetic neuropathy, DRG is 100 times better than any other neuromodulation system. Without question. Nevro has one size fits all. It's not even a question – DRG is the answer, at least anything neuromodulation-related for neuropathy. At least with DRG you are going to have increased blood flow because it's a real system.– KOL and former high volume Nevro implanter", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "f27f7650-6a08-4e38-9b55-f59bc5951bac", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“Doctors have been using spinal cord stimulation for PDN for a while, but notoriously it’s very bad for the foot. It doesn’t get to the foot. You can’t get spinal stimulation into the foot without having to stimulate everything along the way, Stimulation doesn’t change the plumbing. Diabetic neuropathy causes pain because there’s shitty blood flow which affects the nerves, which get rewired and interpret it as pain. What’s going to happen with Nevro is what happens with every other spinal cord stimulator for the foot. You can’t get to the foot, so you have to jack up the current, and then you get tolerance and [any pain relief] goes away.” — KOL and high volume implanter; “For diabetic neuropathy, DRG is 100 times better than any other neuromodulation system. Without question. Nevro has one size fits all. It’s not even a question – DRG is the answer, at least anything neuromodulation-related for neuropathy. At least with DRG you are going to have increased blood flow because it’s a real system.” — KOL and former high volume Nevro implanter; “The other thing is that a lot of patients with diabetic neuropathy have pain in their feet, the actual feet themselves, and I personally don’t believe Nevro is the best for the feet as the Abbott DRG is better.” — KOL and high volume implanter, who still uses Nevro moderately", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3d-76db-b346-e2a646c3c91d", "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": "497aa44b-f857-437c-a025-e007d115bd71", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.88, "x": 0.06, "y": 0.09 }, "kind": "title", "text": "11. TAM expansion and growth from painful diabetic neuropathy (PDN) and other new indications are a mirage", "attrs": null, "subkind": "action-title", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "fb35acc9-8665-4454-bd16-b5e0382eb9ad", "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": "ad936092-a1c1-4f5a-8499-b2d65f9085dd", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "antagonist-introduction", "slug": null, "matchId": "9d8b2379-4bf6-44f1-8a4a-1f5646fcfeb2", "evidence": "Frames Nevro as the 'villain' or ineffective solution compared to Abbott's DRG.", "confidence": 0.8 } ], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }