{ "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": 63, "pageCount": 239, "prevPage": 62, "nextPage": 64, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "overcrowded", "nDataPoints": 0, "notes": "The slide uses yellow highlighting to emphasize key accusations of trial manipulation.", "elementsJson": [ "headline_text", "paragraph", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/63", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-63", "components": [ { "bbox": null, "kind": "callout", "text": "That the study's results were a sham appears to be an open secret in the SCS field.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3d-76db-b33a-95ebb455112b", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.4, "x": 0.06, "y": 0.31 }, "kind": "list", "text": "Comments by 5 different KOL's and high volume implanters", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "e451f73c-5d30-4373-a3a9-5bb1c8c2900b", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.88, "x": 0.06, "y": 0.13 }, "kind": "paragraph", "text": "Our research indicates that disbelief and mistrust of Nevro's SENZA-RCT study is widespread among high volume implanters and leading KOL's - including recipients of payments from Nevro - as well as among the company's former executives and employees. That the study's results were a sham appears to be an open secret in the SCS field. One of the most well-known KOL's stated that \"there were so many problems that we just shook our heads....\" Others conveyed the view that Nevro has \"always played a lot of games\" with their trials.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "3c737402-7c53-4088-bd16-c06bb1672309", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.07, "w": 0.88, "x": 0.06, "y": 0.43 }, "kind": "quote", "text": "I initially had high hopes for Nevro's high frequency. From the very beginning though, the trial wasn't a fair fight. They were comparing brand new technology with a 3 year old one. That study was flawed.", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "09b7de33-b70e-4030-b373-0223112d55d2", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.07, "w": 0.88, "x": 0.06, "y": 0.52 }, "kind": "quote", "text": "I've read every study from every company. Nevro says it's better but there's no superiority data for HF10 to Burst, or HF10 to 1200 hz or whatever. Interestingly, there's nothing comparing these devices to placebo or sham.", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "5506ce7d-b2ee-42a8-8c28-ca6fbd367170", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.11, "w": 0.88, "x": 0.06, "y": 0.74 }, "kind": "quote", "text": "The Hawthorne effect is well documented in science. If a person knows they're getting the experimental product or treatment they tend to have more of a placebo effect. Every patient in Nevro's study knew which device they got. Doctors believe the Hawthorne effect completely skewed Nevro's results. It happens in all their studies. Everybody knows which device they're getting. Nevro's always played a lot of games.", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "c415f301-d315-4b18-9cf5-42c2e8fe1472", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.05, "w": 0.88, "x": 0.06, "y": 0.36 }, "kind": "quote", "text": "Nevro definitely designed their HF10 trial to make their product look better. There's no question about it.", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "cb8335f9-15ed-4c27-b22e-88a8325a45d1", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.11, "w": 0.88, "x": 0.06, "y": 0.61 }, "kind": "quote", "text": "When Nevro first launched, we looked at this and said, \"There could be something to a high rate of stimulation. You're basically flooding the zone. What a great idea.\" And then you start going through the study design, and you start looking at real outcomes, and there were so many problems. Huge problems with their study, the Kapural study. There were so many problems that we just shook our heads in some of our doctor groups.", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "d77980eb-d8a6-4d63-b502-cf9f26a1ed57", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "\"there were so many problems that we just shook our heads....\" — KOL; \"Nevro definitely designed their HF10 trial to make their product look better. There's no question about it.\" — KOL; \"Nevro's always played a lot of games\" — KOL", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3d-76db-b33a-9a2ac44f45f2", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.2, "x": 0.06, "y": 0.91 }, "kind": "source-note", "text": "Source: Consultation calls with experts", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "b63da243-4859-442f-8a21-cb701f92b04d", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.8, "x": 0.06, "y": 0.09 }, "kind": "title", "text": "3. Trial investigators, KOL's, and ex-employees painted the SENZA pivotal study as a fraud", "attrs": null, "subkind": "action-title", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "e0c8b74c-e65a-448a-926b-ed728467f10c", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.4, "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": "5e5d1893-5571-4a5a-9156-a37063732e78", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "fraud-exposure", "slug": null, "matchId": "2610f999-6655-4102-a60e-e7c3fe5317ba", "evidence": "The slide systematically presents expert testimony to allege fraudulent trial design.", "confidence": 0.9 } ], "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 }