Wednesday, February 08, 2006

JnJ Cordis as I see it

First of let me say I have no vested interests in JnJ Cordis.

JnJ has been solid in their pioneering work in the field of balloon angioplasty. Plain old balloon angioplasty began in 1977 after which came the trying out of a plethora of devices. I'm sure we all remember the days of the atherectomy device, the laser balloons, the rotablators, the rotac device, and many others.

They all suffered failure with unacceptably high restenosis rates or just plain danger with some of these devices. All others fell away with some fortunate enough to be used occasionally as niche devices.

JnJ invented the first stainless steel stent that was shown to be safe and prevented angioplasty restenosis (a restenosis rate of about 40-50%) that we saw so often in plain old balloon angioplasty, and the other devices (some with restenosis rates of 50-70%). Large sums of R&D money were spent to prove this fact by way of two large scale international trials, one each on each side of the Atlantic.

When the Interventional people started to use bare metal stents widely, they very quickly realised that bare metal stents still has unacceptably high rates of restenosis, about 15%. They again took the lead by studying a new class of drug-eluting stents. Their Cypher stent again proved to be the best in this new class of drug-eluting stents. It clearly outshone the nearest rival, the taxus stent, in a head to head comparison, and later again in a second head to head against the other rival, endevour stent.

This all led to JnJ stock soaring. The JnJ "Guidant fiasco" in some way reflects the conservative nature of JnJ culture, as opposed to the aggressive management style of Boston Scientific. We are all rather worried for Boston Scientific as their war chest must be very low by now and with their liberte balloon still causing them niggling problems of balloon stickiness, and the FDA observing them closely.

Can they continue to play their role in the field of Interventional Cardiology, or will they go belly up, from trying to swallow more then they can chew? And as for Guidant, I feel sorry for her. A good company, now almost certainly will be subdivided, dissected and plundered piecemeal. Well, this is called business.

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