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William Haynes

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  • It Can Happen Here: The Confiscation Scheme Planned For U.S. And U.K. Depositors [View article]
    Worst article ever. You seem to have missed multiple instances where the paper makes it clear that 'insured depositors' are different from 'unsecured debtors'. For example:

    'In order to achieve this, the authorities recognize the need for effective communication to depositors, making it clear that their deposits will be protected.'
    Mar 28 12:38 PM | 27 Likes Like |Link to Comment
  • How Apple Keeps Screwing It Up [View article]
    The reasons for switching all seem to be techy ones, with the possible exception of ATT (though I have excellent ATT service - far faster than I used to get with Verizon - and I can get data at the same time as voice). As a consumer, I don't really care about 'intermediate software layers' or app store approval times (there are 185k apps despite supposedly draconian approval steps). What i care about is user experience, user experience, user experience. I am a physician, not a techy. I want a phone that I never never ever need to look at a manual for. That I turn on and use. That does email, web, epocrates, stock tracking, a few games without me even thinking about it. That is fast, and doesn't crash. Multitasking would be nice (and I think that's coming in a couple of weeks). I tried using a palm pre phone and gave up - I couldn't figure out how to navigate. I tried the Nexus One and an app froze the first day!!!! Unbelievable. I don't believe that google will be able to maintain a pristine user experience on Android with an open source OS PLUS no curation of apps PLUS multiple handset manufacturers. And what's wrong with a 'Walled Garden' if it maintains quality. Everyone goes on and on about this 'walled garden' without realizing that while it may have it disadvantages (to tech types who want to switch out their 'dialer'), for me it only has advantages (seamless consistent interface, trustworthy apps, fast, no crashes, can easily transfer music, vids, photos etc). I have no doubt that Android will take a significant market share, but I never thought Apple would get 100%. However, I suspect that the Android market share may not continue to rise quite as fast when Verizon stop giving away free smartphones.
    May 26 07:08 PM | 6 Likes Like |Link to Comment
  • Why Can't Microsoft Innovate Like Apple? [View article]
    The BIG worry for MSFT must be that their established monopolies become non-monopolies. It is possible that this happens.

    1. On the desk or laptop - Mac OS is gradually increasing market share (I think from 3-6% in past 5 years, and accelerating). Chrome OS is coming too and will target cheap computers.

    2. Mobile - MSFT is down and out. Be very tough for them to come back against Android and iphone (and maybe Symbian). The mobile space illustrates their complacency - Balmer was completely clueless when the iphone launched. He actually LAUGHED at it! I cannot understand why he is still CEO. 3 years on and MSFT still has NO credible multitouch mobile OS shipping. Mobile 7 looks as though it will NOT be competitive against Android 2.0 and Iphone 3.0 let alone the iterations that are coming in the next few months.

    3. Tablets? FAIL. Windows is not mutitouch friendly. Stylus does not equal touch. ipad will take a lot of the market. Chrome and Linux most of the rest.

    4. Internet search- NOPE. Google owns it.

    5. Cloud - Google too. And Apple might make an effort here in music, video, books.

    6. Office suite - this is the surprising one. 5 years ago Jobs would have been laughed at if he launched a tablet without MSFT Office. Now MSFT may have to BEG Apple to get Office on to the ipad App Store. And they won't be able to charge $200 versus $30 for iwork. Also, I have noticed a LOT of small business using Google docs and especially OpenOffice. Scary for MSFT.

    Why does it happen this way? MSFT had a monopoly; they did not want to disrupt it by reducing prices or selling new devices that undercut their existing ones. That may be why Apple has been so careful in pricing. They kept macbook prices very high (and boy did the analysts bitch). Now they make a cheap ipad that is clearly good at some things (content consumption) but not at others (content creation). So people will not downgrade from macbook to to an ipad. BUT now Apple has something to offer in its stores and Best Buy to those customers who want a netbook equivalent for browsing, email, music, video, ebooks, games (and a neat photo frame) for $500-700. Also, Apple almost went bust 13 years ago, so they have a survivor's psyche that may help innovation. MSFT was given its monopoly on a platter by IBM, Apple has had to work to give itself one.
    Feb 6 06:50 PM | 4 Likes Like |Link to Comment
  • SIGA: Thursday's Drop Was Nothing but a Tree Shake [View article]
    I agree. There is minimal money in smallpox. I'm a physician scientist, with NIH funding. I've reviewed SIGA's publicly available data and it is VERY early stage. Personally I doubt the underlying science will be applicable to humans. They may get some research grants to keep them alive, but any commercialization is a long time coming. There is a HUGE risk in investing in SIGA. Pump and dump...
    Dec 5 03:51 PM | 4 Likes Like |Link to Comment
  • Good News for Generex: Positive Data on Oral Insulin Coming in September [View article]
    This could be good. But another reason for an absence of antibodies and insulin resistance, no weight gain, and less hypoglycemia could simply be that the oral insulin is less bioavailable (i.e. less ibulin is getting into the body). That would not be good. So the critical question is what are the changes in HBA1c with oral insulin and how do they compare with the control group?
    Aug 16 06:50 PM | 3 Likes Like |Link to Comment
  • Why I Would Not Bet on iPhone over Android [View article]
    I'm long AAPL but try not to be blind :)

    However, I think one area I disagree is the assumption in most of the articles that it is all or nothing in terms of market share. Just as BMW, Mercedes, Lexus have 10-20% of the car market there is no reason to think that 10-20% of phone (note 'phone' not smartphone) owners will choose an elegant, integrated software/ecosystem experience using premium hardware. If the phone market is 1.5 billion units, and AAPL gets 15%, and their ASP falls 33% to $400, that still equals over $80B in sales (plus their itunes/appstore/access... cut). The whole company has sales of under $40B currently. One could argue that AAPL will do better because they make it easier for developers (few models, standardized input, screen, specs), and because they will get a halo effect on mac sales. But I'm still betting they can achieve 30% pa growth in revenue and earnings for at least another 5 years.
    Dec 16 12:28 PM | 3 Likes Like |Link to Comment
  • The Unsustainable Lie of Inflation [View article]
    1. Yes - inflation will eventually happen if we keep zero interest rates and expand the money supply. But can anyone make the case that we will have zero interest rate and money printing in 2 year's time?

    2. Why on earth would ANYONE believe that the fed or government would not increase interest rates at the appropriate time? Interest rates were increased after the recessions of the 70's, 80's, 90's 2000's. To say that this will not happen now is ridiculous.

    3. One can debate about WHEN interest rates should increase. I would make the case that it is certainly not now, with unemployment at a 25 year high, the output gap huge, consumer prices falling (year over year), and NO wage pressure at all (most workers are taking pay or benefit cuts).

    4. Oil and gold may go higher (maybe even 30% higher). But I would not like to be holding either as the fed increases interest rates in 2011, 2012, 2013. One thing they will do this time is keep increasing rates if they detect any sign of an asset bubble WHEN the economy is growing (i.e. not what Greenspan did in 2002-4). If you hold oil at $100 a barrel or gold at $1500 an ounce be prepared to lose half your money. Too much risk for me. I hold 50% international stocks, 20% DBV (carry trade play), and 30% JNK (17% yield when I bought it - still 12% now)
    Nov 10 05:34 PM | 3 Likes Like |Link to Comment
  • Arena Pharmaceutical's Lorqess: A Briefing Document Analysis [View article]
    Given the Meridia vote a few minutes ago was split 8 to 8 on whether to withdraw the drug (for an agent that has been PROVEN to increase CV events), I think the panel on 9/16 is likely to vote in a majority for lorcaserin. I agree completely that the FDA can require further animal toxicology studies and also post marketing surveillance for cancer. They did that for liraglutide (Victoza; NVO) where there was thyroid cancer in BOTH mice and rats at low doses. Interestingly, for that drug the FDA wrote an editorial in the NEJM that said the approval was given despite the possible cancer signal because of the need for a new treatment option and the weight loss associated with liraglutide. The same argument could apply to lorcaserin.

    Also, the human cancer data actually showed only 4 cases of breast cancer versus 7 with lorcaserin in the placebo group. Tiny numbers, but not of a concern at all. And weight loss should reduce cancer rates in the long term, which would likely outweigh a remote risk from the drug itself. Hopefully, the panelists or FDA will mention that.
    Sep 15 04:26 PM | 2 Likes Like |Link to Comment
  • The Importance of Arena's BLOOM-DM Study [View instapost]
    I think lorcaserin will get approved for obesity. Diabetes may be a more difficult indication. The FDA has tighter criteria for diabetes drugs, including proof that the effect on glucose in INDEPENDENT from that on weight (this is both weird and tough). This requirement tripped up orlistat (Xenical), which showed improved HBA1c and prevention of diabetes but was unable to get a suppl NDA approved for either indication. SInce then, the FDA has tightened up on diabetes drugs and now demands CV safety data. I think the best lorcaserin will be able to achieve is an indication for WEIGHT LOSS in type 2 diabetes, with coincidental improvement in HBA1c. This is subtly but importantly different from a full diabetes indication and may limit its uptake somewhat in this population.
    Sep 6 12:53 PM | 2 Likes Like |Link to Comment
  • Arena Pharma: Understanding the Market for Anti-Obesity Drugs [View article]
    Wow - I think this is the best article I have read on seekingalpha. Carefully argued, impeccably researched, novel concepts, meticulously referenced. I'm a physician treating and researching obesity and I really appreciate your teasing out the relationship between treatment persistence and efficacy.

    I'll add a couple of caveats. First, lorcaserin used with orlistat and metformin and/or topiramate could cause 15-20% weight loss. That won't happen quickly but will help in the long run. Second, the thing that really helped statin sales was the demonstration of cardiovascular protection from MI and stroke. Meridia has failed that test but orlistat may pass it (in the LOOK AHEAD trial). Lorcaserin will likely have to do such a study. So it seems possible that $1B in sales could be achieved in the first 3 years that them take another bump upwards in years 4-8 from combination use and proof of CV protection - perhaps to $3B.

    Some minor points:
    1. Reimbursement is critical - no insurance company I deal with covers obesity treatments now.
    2. I think there is a strong possibility that the FDA will put stronger warnings on or even withdraw phentermine after the Meridia discussions on 9/15. Sorry if I disappoint those commenters who think phen/lor will be prescribed to tens of millions of patients.
    3. On current trends there is no way lorcaserin will be competitive in a stand alone diabetes indication. Orlistat was unable to get that indication and had a larger effect on fasting glucose in non-diabetics than lorcaserin does. Also, almost every obesity drug tested has a smaller weight loss effect in diabetes than in non-diabetes.
    Sep 4 12:53 AM | 2 Likes Like |Link to Comment
  • Dendreon and Provenge: What if We Lived in England? [View article]
    I'm not going to even get into the QALY issue. But I am disturbed by the umber of people touting 'median' as being a reason why this analysis is incorrect. Sure, we all know that 'median' is different from 'mean'. But if using mean versus median survival has minimal impact on on QALY. It does not matter if some patients life years longer - median of 4 months means half of them live less than that, and half more! If one is to do a QALY calculation you have to assume that everyone gets the medicine, INCLUDING those who lives less than the median! Now for a medicine that is given in cycles over many months, one can adjust the cost down as non-responders die or drop out. But my understanding is that this would not apply to Provenge. I thought this was a very reasoned analysis. After all, WE pay for Medicare. I'm a cardiologist and am very concerned about what happens when we have a safe and effective implantable artificial heart that costs $1M that could save the life of the 30% plus people who ultimately die of heart disease. The company that makes it will get FDA approval. The company (and it's investors) will insist Medicare pays for it. How can medicare afford to implant millions of such devices a year - just 1 million artiicial hearts per year would 1 trillion dollars per year. Someone needs to think about how we make this work. Control prices? Ration care? Exclude from Medicare?
    Jul 7 04:06 PM | 2 Likes Like |Link to Comment
  • Amarin Will Receive A Positive Vote By The Advisory Committee [View article]
    I am an MD and direct a lipid clinic. There is no evidence that treating TG levels under 500 either reduces CV events or prevents pancreatitis. If TGs are above 500, then it appears that treatment prevents pancreatitis.

    The reason the FDA and AdCom went they way they did is likely due to a combination of the trials they referenced plus the torcetrapib fiasco (when Pfizer almost managed to railroad the FDA into approving an unsafe lipid drug), PLUS the Zetia controversy. In fact Zetia is closest to the situation with Vascepa. A drug that is not unsafe, but which gets a lot of prescriptions and marketing, but then is found to not protect from CV events. The FDA did not want another Zetia controversy, simple as that.

    Finally, it seems that a lot of the longs here swallowed the Amarin management line (LDL effects are substantial and important), rather than look at the data independently. In truth, the LDL effect of Vascepa is minor. And the drug is less effective at reducing TG than Lovaza.
    Oct 18 09:21 AM | 1 Like Like |Link to Comment
  • Amarin - Still Not Worried By A Generic Lovaza And An Update On Vascepa [View article]
    My only problem with talking about 'efficacy' is that Vascepa is LESS effective than Lovaza at the job it is hired to do. What is that job? Reduce triglycerides. Lovaza reduces TG by about 50%. Vascepa by 35%. LDL is a secondary target in such patients, has other drugs that can control it better, and is inaccurately measured and less prognostically important when TG is above 400. Non-HDL cholesterol is more accurate and important in such patients, and the differences here between Vascepa and Lovaza are less.

    So, when I see a patient in my lipid clinic (that I have run for 18 years), with triglycerides of 1000, and at risk of acute pancreatitis from that, what drug do I recommend? The one that lowers TG the most (Lovaza). If the non-HDL cholesterol is above target after I give that patient Lovaza, then I may add a statin or ezetimibe. But my primary target is triglycerides and I will use the drug that lowers that best. If the insurance won't cover Lovaza then I recommend over the counter fish oil (i.e. Super-EPA or similar).

    I have no position in Amarin or GSK or any other pharma company.
    Sep 17 09:22 AM | 1 Like Like |Link to Comment
  • The Future Of Omega-3 Based Lipid Management: All Eyes On Amarin [View article]
    I am an MD and Lipidologist. The Science Daily story cited quotes one (1) scientist from Oregon State University who is way more enthusiastic about fish oils than warranted by high quality studies. Also, be aware of this below that story:

    'Story Source: The above story is reprinted from materials provided by Oregon State University.'

    High dose EPA and/or DHA are good for triglycerides. However, I and most physicians now have doubts that fish oil reduces cardiovascular events. The recent trials shoing no benefit of fish oil were exceedingly well performed, lasted several years, and had 1000's of patients. See this story in theheart.org:

    http://bit.ly/10QfQLJ

    Quote of the story:

    'Dr Eric Topol (Scripps Clinic, La Jolla, CA), editor in chief of theheart.org, posted a video blog on the site, noting that the dose of n-3 fatty acids used in the study was the same dose used in the GISSI and GISSI-HF trials, two studies that showed a benefit with regard to reducing sudden cardiac death, presumably through the ability to suppress ventricular arrhythmias. "I have an awful lot of patients that come to me on fish oil, and I implore them to stop taking it," said Topol.'

    The ANCHOR and MARINE studies were well conducted but do not prove that Vascepa has any CV benefit other than on triglycerides and non-HDL cholesterol. While the changes in LDL are in the right direction, they are small compared to what can be achieved with a dose increase of a statin. And the price of using Vascepa is that triglyceride control is worse (look at the the TG changes in the labels of Vascepa versus Lovaza). If I am prescribing a drug for triglycerides, I choose the one that works best on TG (currently Lovaza or OTC equivalents; Costco has a great deal on high potency fish oil)

    I am 100% sure that I will be flamed for this post. But be aware that I have been running a lipid clinic for 17 years and using fish oil to treat triglycerides for much longer than Lovaza let alone Vascepa existed.
    Jun 1 06:46 PM | 1 Like Like |Link to Comment
  • Aegerion's Lomitapide - FDA Approval, Strong Launch, Stock Price Increase Anticipated [View article]
    Lipidologist here - working in an academic medical center. I reviewed the data extensively. My view is that loimitapide is more effective and can be given orally, but has more GI side effects and causes far more hepatic fat accumulation than mipomersen. The oral option is usually far preferable to patients so I will try lomitapide first but monitor carefully for liver fat accumulation. And if there are abnormal LFTs at baseline then I will go straight to mipo. I think about a 60:40 split between lomitapide and mipomersen is reasonable as a short term estimate. Longer term it may end up being 50:50. The market size estimates are overblown. There are 300 patients with homozygous FH in the US. There are many more with heterozygous FH and/or severe hypercholesterolemia, but these are not the indication voted on. And remember that insurance companies will be exceedingly tough on prior approvals, probably more so than for LDL apheresis which is cheaper (~$150k) and has other obstacles to widespread adoption. And neither treatment is likely going to be able to lower LDL as much as LDL apheresis so the insurance companies may well restrict it further. So I would redo your math based on a smaller market size.
    Oct 24 05:21 PM | 1 Like Like |Link to Comment
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