Pinned straw:
A Time for Some Extra Perspective
As a young schoolboy in Australia’s bicentennial year of 1988 I have some hazy recollections of being introduced to a narrative. It was the bicentennial of the arrival of the First Fleet, but I also remember ‘learning’ that Captain Cook ‘discovered’ Australia and had a vague notion that this had occurred a few years before. He did of course, but in the same way that I ‘discovered’ compound interest, cloud storage, or Krispy Kreme donuts — I have found such experiences have enriched my life, but they were personal discoveries from which I can make no pretence of having been the first person to do so.
So too was Australia very much a personal discovery for the Yorkshireman — in that First Nations people had beaten him to the punch by some 65,000 years. Later of course there were others including Melanesian peoples, Austronesian peoples, and the Dutch, who had also beaten Cook variously by many millennia to centuries.
Truthfully, what I really liked about it all was a catchy tune featuring Botany Bay that you sung loudly in the same accent you’d use if you were auditioning for the lead role in My Fair Lady. I really loved that song.
These are silly and slightly cringey recollections. Thankfully Australia and the world moved on and the concept of our identity is now more evolved and inclusive. In finding the above picture on eBay I see that my Dad’s prophecy that the medallion every single Australian student got given “might be worth a lot of money one day” has not yet come to pass. If you missed out but have $14 plus p&h, then miss out no more.
However, looking back, it is a reminder that:
- Narrative is only ever one side of a story; and
- Being too concise can foster inaccurate shorthand that is too easily mistaken for truth.
Before my interest in Anteris I know one strong bias or intellectual shorthand I was using was equating the United States FDA’s approval with the words “proven” or “safe”. Conversely, anything without out FDA approval was “experimental” or “unproven” and, “unsafe” or, at least, of “unknown safety”.
It’s a bit beside the point that I’d like to make here that the definitions of these words, and their cultural contexts, can differ. I remember seeing an interview on TV with a person suggesting that if aspirin was invented today, rather than in 1853, it probably wouldn’t get FDA approval for doctors to dispense — let alone be sold in supermarkets. It’s an interesting thought experiment to ask the same of ethanol. Or refined sugar. What would the outcome be if such things were inventions or discoveries of 2023 looking to get FDA approval? It is also true that not everyone trusts governments in the first place.
However, I’m very middle-of-the-road on these things. I genuinely believe that the food and drug regulatory bodies of wealthy, stable, modern democracies value both the scientific process and the safety of their citizens. They just don’t have a monopoly on these values.
At present, at least 27 human beings have had their lives and health significantly improved by Anteris’ DurAVR. For many it has been a functional cure for their aortic stenosis, and for some it has saved them from fairly imminent death. All outcomes which have been achieved without the FDA’s approval for commercial sale.
The breakdowns and dates for these 27 individuals is as follows:
- 5 — First-in-Human (FIH), 1st cohort, Georgia [ASX announcement 24/01/2022];
- 8 — FIH, 2nd cohort, Georgia [ASX announcement 31/05/2022];
- 8 — FIH, 3rd cohort (including 1 x compassionate use case), Georgia [ASX announcement 31/05/2023];
- 2 — Valve-in-Valve, Special Access Program, Canada, [ASX announcement 14/08/2023];
- 2 (or 3, open to interpretation) — EFS, USA, New York [tweet by Montefiore 25/08/2023]; and
- 2 — EFS, USA, Arizona [tweet by Dr Thomas Waggoner, affiliated with PIMA 08/09/2023].
If there is a spectrum of experimentation — where Elon is blowing up every second rocket in the early days of SpaceX on one end — then Anteris is much more at the other end. The one which involves ticking boxes and cutting red tape. This isn’t some reckless or fanciful fishing expedition.
Captain James Cook was a significant figure whose achievements included being the first to document and map a voyage on the eastern coast of Australia. He has historical importance for Australia and the world, but he is not alone in having that status.
Cook also had a fairly good idea of what he was looking for. He was exploring a finite space and had something of a sense of the parameters. He knew he was going to be threading the needle at some point east of New Holland and west of New Zealand. There was a very limited range of outcomes. So too with Anteris. Most of the discoveries have already occurred now. This is much more about getting it all down on paper.
Hollandia Nova detecta, 1644 — by French cartographer Melchisédech Thévenot
Metis
I’m sorry to say @Strawman my highlight of the expo was having an ice cream for the first time as a 2 year old. Unfortunately i don’t remember the experience but my mum reminds me of the criticism she got from a stranger for feeding a 2 y.o processed sugar@PabloEskyBruhnot sure if it was FDA approved then.
I first invested back in the day in admedus (now anteris) for about 4 years in 2012. It was the start of my investing career and I finally didn’t have the stomach for the continued capital raises and sold for quite some loss. (Fortunately i didn’t make much money back then so it was minimal, apart from the opportunity cost).
This is a huge market. My interest peaked during my time as a trainee in St Vincent’s hospital Sydney where I anaesthetised quite a few. So I bought more. Sadly I had no understanding of where a company was in its lifecycle during this time. Recently Wollongong hospital where I now work has started doing TAVI’s in the private hospital. My mate and colleague has come back from training in the UK for them where he did 8 a day. Yes you heard right… that is at least 4 times the efficiency of a standard aortic valve repair, where we would get 1 done a day paired with a smaller case. (I am not a cardiac anaesthetist now for the record and these are my training days). Note that there is different patient populations suitable for each procedure TAVI (which is a minimally invasive procedure) vs Open heart surgery. My understanding is that there is limited initial difference with stroke and immediate mortality depending on the study however there is a much greater rate of re-operation within 5 years. So if you are super old you get a TAVI if you are younger you get open heart surgery. Correct me if I’m wrong @PabloEskyBruh but this is what Anteris is trying to change with its technology, the length of time for re-operation.
Recently I asked the procurement nursing unit manager at wollongong private hospital what was the driving process of which TAVI device they used. I think they use Medtronic and one other I have forgotten sorry. But the main reason is they will use a heap of stents/pacemakers and the company will give them an amount of money to spend on whatever they want due to their loyalty. They often use this for TAVI’s. So the companies become entrenched in a hospital.
I was trying to find out the number of competitors and it is pretty large.
My question to you? Is the bull case that this will increase the number of years for re-operation and therefore become the dominant use case? If that hypothesis comes true this is a massive company. With the in human uses currently (2022) does that mean we will be waiting until at least 2027 to really understand this?
Cheers and thanks for reviving an old flame/nightmare ;)
Strawman
I still have my bicentennial coin somewhere @PabloEskyBruh, and was.likewise told it would be "worth a lot one day". Haha
Then again, it was the people issuing the coin that were saying that..so, yeah.
(The highlight of expo88 for me was getting to sit in and talk to KIT from Knight rider. My 13 year old self was in heaven)