by Travis Johnson, Stock Gumshoe | June 17, 2014 12:20 pm
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Thanks Travis,
Very useful to have your thoughtful and timely comments when the spotlight is on LGND. Such a great example of why so many of us love your Gumshoe site.
Physicians have a way of getting very very hung up on keeping a patient “euboxic,” every box, every lab test, just where it should be. The patient can be fine, and we will literally lose sleep over a potassium of 3.8 that we want to be 4.0. And so it is with platelets. Liver doctors learn very very quickly that if they are to survive, they absolute must write on all admission orders “Do NOT contact me regarding platelet counts of less than 100K.” They have to enforce this and write up nurses that do call them. If they do not, they will be paged 50 times per day about low platelet counts and be unable to sleep, eat, function, focus on patient care, or even pee without interruption. Promacta plays to this hang-up. There is no rule or guideline anywhere that a patient has to have a platelet count of 100K or above, We evolved to have more because if you lived on the savannahs and having an arm bitten off by a cheetah was a daily threat, you needed lots of platelets. Life now is different. Unless you are facing surgery, you do not need a platelet count so high, and as I recently said to an Irregular who wrote in about his low platelet count, he is probably protected from heart attacks and so better off by walking around with a platelet count of 50K. When you deal with cirrhotic patients and see how rarely they have bleeding problems even though they walk around with 40K platelets, you get cavalier.
Anyway, I would seriously doubt there is data to say that Promacta is being used for liver patients. It shouldn’t be. Some hematologic patients may need it, but however I suspect it is overused. Frankly, you just are not at risk for a spontaneous bleed unless your platelet count is down to 15k or so. I can see using Promacta for thrombocytopenic patients facing surgical challenges, because few things are as horrible, as prone to cause stormy reactions, as platelet infusions. Platelets are bags of active chemicals and they burst with ease. I do feel insurers are going to step in and question use of Promacta because again, most doctors are giving it to treat a lab value, one they cannot admit to themselves does not matter, and not to actually treat the patient.
Kyprolis is a drug that if it proves effective can be easily imitated, as it is a peptide mimic that inhibits proteinase in the proteasome..
I feel there is less to Duavee than meets the eye. Old fashioned estrogens combined with a selective estrogen receptor modulator. I am just not convinced this will shake down to help menopause, because estrogen works by receptor binding and if you interrupt that to make the drug tamer and less carcinogenic, you also impair effectiveness on vasomotor symptoms. Paroxetine may be better and cheaper.
Probably no real case for panic-vacating the stock, but perhaps not strong reasons to be long either.
Thanks again, Dr — very useful insights.
Hi Travis and Dr KSS,
Thanks for addressing LGND so quickly. A few more links today…
https://finance.yahoo.com/news/ligand-pharmas-lgd-6972-positive-193510777.html
https://finance.yahoo.com/news/glaxos-promacta-holds-promise-194510780.html
Regards,
Cyndi
Travis, I occasionally break one of my golden rules of investing, that is, Letting the winners run, and selling the losers but in Ligland’s case I am making an exception. Sold out yesterday @ a 135% profit. Great stock, hope I can find one to replace it. Any idea’s in the Pharm. sector Buddy? Thanks for you continued enlightenment. Loyally, Raymond Somerville
I must be reading different information about what goes on with US Health care in general. These long stories about what the chemical can or cannot do is just insane as no one truly knows how each body will react. A Stock site and I must hear the Doctor stuff hear too? Well then I guess I should post the alternative.
Healthy people get sick by diagnosis from the godlike “DOCTOR”. Too many doctors do this without even being aware. (Example – the word depression immediately creates a problem that in most cases did not exist.). I believe many if not most doctors do care very much about their patients health. It is not their fault they were misled and sold a story about chasing each specific malady and do not concern yourself with the persons true energy, vibration and health because you cannot see it in a blood test or scientific journal.
There is huge evidence that sounds can do amazing healing in humans. It is no wonder no one “HEARS” about it since it does not fit the current profit model of health care we seem to be so afraid of losing (even though we have the worst healthcare of any western nation). Yet a purring cat can save a person with stress or high blood pressure as does a proper diet. Why change diet when you can take a pill. The best one has to be the pill to lower cholesterol that is really not even known what level is healthy! Then suddenly pastured butter is good for you and of course margarine is terrible.
But hey, what do I know. Lets buy stock in Monsanto so they can spray more Roundup on us and every plant they did not create chemically.
Hmmm, let’s see, vibrations, sounds for liver disease?? Sure. i am certain, just certain, Douglas Cohn, that a tuning fork at the right frequency will cure HCV! How about a little aromatherapy for your brain tumor? Fix you right up! Unfortunately, as your post proves, there is nothing we doctors can do about stupidity. Purr kitty purr.
There is much evidence that a cat’s purr is healthy for a human but you have every right not to agree for any reason. Here are two sites that discuss how sound/music therapies are used including the tuning fork you mentioned.
http://en.wikipedia.org/wiki/Music_therapy
http://www.faim.org/complementaryalternative/therapeutic-use-sound-alternative-conventional-medicine.html
I wish you all the best Dr. If I gave the impression I wanted to humiliate you then I sincerely apologize as it was not my intention.
Doug
Good job Doc.
Just what I expected. Bend those words to suit you.
Want to buy some magic beans, Douglas? Green coffee enema for your colon cancer? The doctors are not the enemy. The enemy is the unilluminable darkness of ignorance, and those who traffick in it. Magic spells, ghosts, demons, vitamins, herbs and the Mayan calendar. Yeah. You remind me of the Prefect Poe writes of in one of his Monsieur Dupin stories, “in the habit of calling “odd” everything that was beyond his comprehension and so lived among an absolute legion of “oddities.”” Reading broadens the mind, but I think a broad mind scares the heck out of you. Dr Oz is the opiate you need. I can just feel you jamming pins into the voodoo doll of me you have! Purr kitty purr.
WOW.
I have nothing but good feelings toward you and hope some day you can see I do not believe it is Doctors at all that created the current situation our US patients are in.
An MD cared for my wife of 30 years for 6 of the 9 years until she passed from a severe case of Myotonic Dystrophy last year. She would sing in Bed and taught me what is really important. I cared for her as best I could and hired people to help while I worked as she required 24 hour care. His boss sold his practice of 35 years and bought a 300 acre farm to promote natural diet and healthy living as an alternative to the current health care system. His goals were to keep her singing and out of the hospital. When a second low sodium level came in a blood test taken at home to avoid going to the hospital I asked him how much salt can we give her to raise the level. I do not recall exact amount but every 4 hours she would drink Gatorade with natural salt dissolved. The next day she was feeling better. Two days later they took another blood test and she was normal. For the next 6 years she drank 1/4 teaspoon of natural salt in water twice a day. She never had to go to a hospital again.
I hope you do understand that no matter what you say I have nothing against you and again apologize if it appeared like my goal was to humiliate you as I know how hurtful that can be.
Regards,
Doug
I would be glad to get you the Doc’s contact info if you would like to hear it from him directly. He came to her funeral bless him. He is a great doctor and does treat people with Allopathic medicine as his position requires but favors a more natural approach when suitable.
http://www.thenewmedicine.org/timeline/allopathy
Doug
Lemelson released an appendix about Ligand today, reiterating their short argument but supplying some details. The worrisome aspect for me is Promacta, which is really the one thing to look at with Ligand for now because it so dominates their results — if Promacta sales are in decline and will decline more precipitously, as argued by Lemelson, then you can’t really build a reasonable argument that Ligand should be valued at $60 right now, but I haven’t seen evidence of that yet. There was a several percent decline in Promacta sales in the fourth quarter, which hit Ligand royalties in the first quarter, and it’s quite likely that this was related at least partly to decreasing interferon treatment because of the new treatment available from Gilead. If that continues in this next quarter, and if Kyprolis is not likely to get a first or second line indication from ongoing trials, then I’d have to reconsider my position — absent other news, I’m likely to wait and see what Ligand’s results are next quarter, which ought to be in about three weeks. Kyprolis has some trial results coming in the second half of this y ear, and if Kyprolis doesn’t ramp up then Amgen made a big mistake in buying it — not impossible, of course, pharma companies make mistakes all the time. Absent a blockbuster launch from Duavee, which seems unlikely, Promacta is the core story and Kyprolis the growth story, so if either is weak or faltering there’s abundant reason for concern. I’ll let you know if my opinion changes.
The other negative stuff from Lemelson’s report, indications that Captisol is their only real asset and it is risky because it is single-sourced, and that their effective spinoff of Viking Pharmaceuticals was a financial engineering event designed to raise funds for research without Ligand having to do the secondary offering, are accurate but not particularly worrisome to me at the moment. I’d call them distractions — the big issue is Promacta sales: if they keep growing gradually as GSK and later Novartis expand indications, then Ligand will do well; if Promacta peaked last year, Ligand is very overvalued.