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December 2004 Archives
End of Year Wrap It was a good year for our site, Angioplasty.Org as well. We've doubled our monthly readership from a year ago. We currently are getting a quarter-of-a-million page views monthly and we continue to be a source of information to patients, media, investors, doctors and nurses worldwide. And, of course, I started this blog.... I'd personally like to thank all the people out there who've taken the time to share their experiences with us. We're basically a not-for-profit enterprise and a lot of what keeps us going is the knowledge that we're providing some help and comfort. A Healthy and Happy New Year to All.
Birthday Present Anyway, Guidant turned ten -- and a day later became one -- with Johnson & Johnson. They plan to keep the Guidant name, a new division under which they'll merge the Cordis and Guidant companies. Once finalized, and they indicate they want this to happen quickly, J&J will become a major player in the ICD market, as well as having a large new stent design portfolio on which to develop future products (like second and third generation drug-eluting stents). I think they will also get a good boost of PR among the interventional cardiologists who might have been miffed by initial supply problems with the Cypher stent. Before drug-eluting stents, Guidant had the top-selling bare metal stent, and the Guidant reps were the interventionalists' best friends, so some of that "currency" is bound to rub off. As for the antitrust worries that have been wafting through the various articles, I said a week ago that I didn't think it would be a problem. Evidently J&J agrees:
So does Jim Tobin, Boston Scientific's CEO, as per yesterday's WSJ article, which noted:
J&J to Buy Guidant
Addendum to Last Entry
On To More Serious Subjects In my letter to him, I noted that Germany figures importantly into the history and development of angioplasty. Just as the Vietnam conflict was starting, Portland, Oregon-based radiologist Charles Dotter came up with the idea of using a catheter-based system to treat atherosclerosis from the inside-out. He was ridiculed by the vascular surgeons in the U.S. and it took a visionary compatriot like Eberhardt Zeitler from Nuremburg, Germany to see the brilliance of Dotter's concept. Zeitler taught Andreas Gruentzig, a fellow German, the technique. Gruentzig, now considered the father of coronary angioplasty, refined it for use in the heart in 1977. Gruentzig, by the way, was born in Dresden, Germany, only five years before it was totally incinerated by our Air Force in the final months of WWII. His mother got her family out in time. And now our soldiers go to Germany for medical treatment.... Then yesterday, an article in the Boston Globe was published, discussing the casualty/death rate in the Iraq War. It was titled, "Amputation rate for US troops twice that of past wars". But the point was that the death rate of American soldiers in the Iraq War has been far less than that in previous conflicts. Why? Kevlar! Actually it's a material that has been used in coronary guide catheters. The Kevlar vests have saved many lives. I already knew about this phenomenon -- Bill Blaisdell, one of the pioneers of vascular surgery, discussed this with me during an interview I did with him a couple of years ago. He was talking about the Afghanistan war and how he had been asked to consult for the U.S. military and how deaths were down, but amputations were up. The vests protected the vital organs, but extremities were unfortunately still vulnerable to bombs. While over 1,000 soldiers have been killed in Iraq, almost 10,000 have been injured, half seriously enough to be sent back home. Hippocrates said, "If you want to be a surgeon, follow an army." You can see a "brief history" of vascular surgery and how it literally was advanced during the various wars the U.S. fought in Chapter 1 of my documentary "Vascular Pioneers: Evolution of a Specialty". The odd thing is that amputations were significantly reduced from WWI through Vietnam because of the development of vascular repair in the field (thank you, M.A.S.H., Frank Spencer, Norm Rich, etc.). But the advent of Kevlar vests, while saving lives, has increased the amputation rate to the extent that Brown University and M.I.T. have launched a research project to develop better prosthetic limbs for a new generation of returning soldiers. There is also a very comprehensive report in this week's New England Journal of Medicine about the role of the courageous surgeons who have been working under tremendous pressure and dangerous situations in the Iraq and Afghanistan wars.
Epilogue on My Merger Commentary
Media Merger Swirl My thought on the anti-trust area, not being a lawyer (or a doctor -- guess I should have listened to my mom) is this: why would it not be an anti-trust issue for another device company, let's say...Medtronic, buying Guidant's stent business? After all, Boston Scientific greatly expanded when it was able to purchase SciMed in 1995 and then Schneider in 1998, both major players in the angioplasty field (Schneider actually manufactured the first PTCA balloons for Andreas Gruentzig in a garage). I'm not sure the acquisition of the sales force is that big a deal anyway, although I'm sure there will be a "consolidation" of the force. Getting a better platform design, however, may be very important to J&J. With Boston Scientific readying their Liberte' second-generation stent, J&J/Cordis are going to need to update their Cypher product -- and Guidant's Multi-Link, etc. designs were the market leaders before the advent of coated stents. Of course, such a new generation stent would not beat the Liberte' to market which is already in trials. But what I've mentioned before, about J&J obtaining Guidant's patent portfolio in the deal, might be one of the most important aspects -- these could be used to defend new products, as well as litigate against others. Just a few thoughts.... Word is that a Board meeting has been scheduled for Sunday, so we should hear news very soon.
More on Merger Talks Moreover, eyes are on the upcoming REALITY trial data. J&J-sponsored this trial which puts their CYPHER stent head-to-head with Boston Scientific's TAXUS. Results to be announced in three months at the ACC in Orlando. What does the winner get (besides a trip across the street to Disney World)? If the data shows one stent to have significantly better restenosis results than the other, the winner will get lots. Of course, there will be big debates about what the results will mean. There are many measures; no doubt terms like late lumen loss, TVR, TLR, edge effect, etc. will be spun by both sides. While cardiologists will decide what they'll use based on a number of criteria, including something called "deliverability", ease of use and available sizes, the retail press is sure to amplify the announced results, not necessarily accurately -- remember the panic headlines of this past year -- and that will affect patients' preferences. Heart patients research their disease and procedures, using our site, Angioplasty.Org, and others; they're hip to the devices and, if they read a news article that says Stent A prevents restenosis better than Stent B, they're going to ask their cardiologist why he's using stent B. This already happens with pharmaceuticals -- and device companies have discovered DTC (Direct To Consumer). So with a possible acquisition of Guidant and the upcoming REALITY trial, J&J should have an interesting quarter.
Merger Talks Heat Up I first coined the term "Stent Wars" almost three years ago (sorry, Motley Fool) -- and it's an apt metaphor, although we're not sure who are the Rebels and who is the Evil Empire. Guidant was one of the first to create a drug-eluting stent, a co-project with Cook -- only problem was it didn't work so well and they dropped development. That, plus legal issues brought against them by Boston Scientific, scrapped their anticipated merger with Cook. Then J&J got their approval, but stumbled when they couldn't supply enough product in enough sizes and subsequently experienced a media panic over the issue of stent thrombosis. Within months, Boston Scientific came in with their newly-approved Taxus and grabbed 70% of the market. Great going until they found a serious problem in a very small number of catheters this summer and, as a precaution, recalled virtually their entire inventory. Ouch! More media panic. But four months later, they report that their major market share is back. Stay tuned. |