Translated from "Abschied vom Messer", which first appeared on Insideparadeplatz, Sept. 28th 2020 https://insideparadeplatz.ch/2020/09/28/abschied-vom-messer-ein-boersenwirksamer-fortschritt/
As a medical student, I spent many free hours in the library of the Zurich University Hospital. In a book about the physiology of surgery, I learned that the actual procedure - such as removing the gallbladder or appendix – is not very problematic.
The danger often lies more in opening the body and creating access to the surgical area: this is an injury with the risk of blood loss and infection. There is also the risk of anesthesia.
Twenty years ago, Intuitive Surgical (ISRG) introduced the surgical robot, which performs complex operations through pencil-sized orifices. The device was very expensive. Because of the above reading I saw the potential immediately, although the experts and the stock market were reluctant. I invested as much as I could, the stock value increased slowly but a hundredfold.
In the meantime, a new technology often makes surgical access and knife completely superfluous: HIFU, the high-intensity, focused ultrasound. Kidney stone crushers have been working with ultrasound for decades. This technique has been miniaturized. Ultrasound waves are focused through the intact body surface like through a lens and thereby concentrated at a point inside the body where the local tissue is boiled away.
The technology is accurate to the millimeter and is controlled with ultrasound imaging. Because the skin is not opened, sterility, asepsis, disinfection, wound care is not needed. Often there is no need for an operating theater and even not for anesthesia, all of which saves costs.
Two French companies are leading the way: EDAP's Focal One device can eliminate localized prostate cancer. According to many prospective studies in Europe and the US the results are the same as with the operation, but largely without the dreaded complications such as impotence and urinary incontinence.US, e.g. New York and Houston. From January 1, 2021, insurance compensation will also take place in the US and sales already pick up.
The competition is behind in terms of technology and price. The company is now expanding the indications to endometriosis and liver metastases. Income is generated through the sale of the devices, through maintenance and consumables.
Due to enormous development costs, the company has so far only been marginally profitable. That is changing now, and nothing stands in the way of the share price multiplying. A buyout is unlikely because the patents were developed with the state laboratory LabTAU in Lyon.
A spin-off from EDAP is Theraclion (ALTHE.PA), which uses the same principle for the treatment of benign thyroid and breast tumors. Removing a thyroid lump with HIFU costs 65 percent less than surgery.
A new billion dollar market is the treatment of varicose veins without stripping, surgery or injection. Theraclion is currently introducing its SONOVEIN technology in twelve university hospitals worldwide and will thereafter start sales to the general medical community.
The learning curve is minimal, since the diagnosis of venous diseases is already done with ultrasound. The interest of the professional world is enormous. So far there is no competition.
The HIFU technology is a quantum leap, like the balloon catheter or computed tomography. The financial world has not yet realized this because it only looks at quarterly profitability and charts without understanding principle and potential.
As of September 27th EDAP is valued on the stock exchange at around 120 million US dollars and Theraclion at only 20 million euros. The shares cost so little - EDAP 4, Theraclion 1.2 - that they can be viewed as options on a later share value. Of course I bought as much as I can.
Patient brochure of the Kantonsspital Zürich about HIFU in prostate cancer with information about the early European studies (p.12, 13): http://www.urologie.usz.ch/fachwissen/prostatakrebs/Documents/HIFU%20Punktgenau.pdf
Website of the Mount Sinai Hospital New York about their HIFU services for prostate cancer: https://www.mountsinai.org/care/urology/services/minimally-invasive/hifu
EDAP company brochure: https://investor.edap-tms.com/static-files/a8446276-4067-447a-8c75-4c25da6cb7f2
The CEO of EDAP on the pitfalls of the US market: https://www.mddionline.com/regulatory-quality/how-survive-medtechs-death-valley
Video about HIFU treatment of thyroid tumors: https://www.lequotidiendumedecin.fr/specialites/orl/thyroide-lechotherapie-dans-le-coup
Removal of benign thyroid nodules with HIFU or surgery: comparison of safety, effectiveness, voice quality and costs: https://www.tandfonline.com/doi/full/10.1080/02656736.2017.1305127
The UK Health Service wastes £ 2-3 billion on open leg treatment: https://www.linkedin.com/pulse/nhs-wastes-2-3-billion-per-year-venous-leg-ulcers-mark-whiteley/
Varicose Veins Treatment Devices Market Size Will Reach US $ 1.7 Billion By 2025: https://www.grandviewresearch.com/press-release/global-varicose-veins-treatment-devices-market
The leading English specialist on the treatment of varicose veins with HIFU: https://www.tandfonline.com/doi/full/10.1080/03007995.2019.1699518
Video about the treatment of varicose veins with HIFU: https://www.youtube.com/embed/BJtilgxdAgA
Patient report on varicose vein treatment with HIFU: http://www.essence-magazine.co.uk/The-Whiteley-Clinic-Wellness-DecJan-2019.html