Stock in Pacira Pharmaceuticals (PCRX)

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
One word why they all go bankrupt, it's a giant Ponzi scheme. Been there done that and lost. As a resident 1998-1999 we were buying hwp and making some side money. All my pay checks went straight to tdwaterhouse. Bought, General Motors, MCI world con, pcln, stlw, with my crna friend and lost every time. Then 2001 the Nasdaq lost and my CRNA friend taught me about shorting the market, of course the markets turned in 2002 and of course I was again holding the bag. Lost all my earnings till 2003, then stopped playing that game.
Then I realized that the new game was called real estate casino. I saw nurses by 5-6 properties and was the only doctor not to own a house. Of course house prices were going up by 10 k every month. We all know how that game ended.
Now what can we look forward to? Currency failure? All that we cherish and work hard for?

Members don't see this ad.
 
  • Like
Reactions: 1 users
One word why they all go bankrupt, it's a giant Ponzi scheme. Been there done that and lost. As a resident 1998-1999 we were buying hwp and making some side money. All my pay checks went straight to tdwaterhouse. Bought, General Motors, MCI world con, pcln, stlw, with my crna friend and lost every time. Then 2001 the Nasdaq lost and my CRNA friend taught me about shorting the market, of course the markets turned in 2002 and of course I was again holding the bag. Lost all my earnings till 2003, then stopped playing that game.
Then I realized that the new game was called real estate casino. I saw nurses by 5-6 properties and was the only doctor not to own a house. Of course house prices were going up by 10 k every month. We all know how that game ended.
Now what can we look forward to? Currency failure? All that we cherish and work hard for?

the stock market is far from a Ponzi scheme. For a hundred years now, you could have thrown a dart at the S&P 500 board and if you consistently put money in you would have averaged 10% a year growth. I would never short the stock market unless I was absolutely sure. That's turning the market into the house and you into the gambler. You will lose most of the time.
 
  • Like
Reactions: 1 user
One word why they all go bankrupt, it's a giant Ponzi scheme. Been there done that and lost. As a resident 1998-1999 we were buying hwp and making some side money. All my pay checks went straight to tdwaterhouse. Bought, General Motors, MCI world con, pcln, stlw, with my crna friend and lost every time. Then 2001 the Nasdaq lost and my CRNA friend taught me about shorting the market, of course the markets turned in 2002 and of course I was again holding the bag. Lost all my earnings till 2003, then stopped playing that game.
Then I realized that the new game was called real estate casino. I saw nurses by 5-6 properties and was the only doctor not to own a house. Of course house prices were going up by 10 k every month. We all know how that game ended.
Now what can we look forward to? Currency failure? All that we cherish and work hard for?

The stock market is most certainly not a giant Ponzi scheme. It's that the name of the game is buy low, sell high. That's how you make money. In 1998-1999, you were buying when stocks were getting to their highest point ever and it's no surprise they bottomed out soon after so when you sold you sold low.

But even if you had the worst timing ever, buying a diversified group of tech stocks in 2001 at the peak of the Nasdaq, if you invested consistently in them starting in 2001 and continuing through today, you'd have earned approximately a 10-11% return per year. This is despite starting your investing at the absolute worst time ever. Why? Because it did bottom out, but the last few years you'd have more than made up for it.

Investing is a long term game. You shouldn't invest any money you will need in the next 5 years or so. Nobody knows what the market will do in the short term. In the long term, though? You always win. It's just a matter of picking smart investments (on a tax basis, cost basis, and return basis). Buying things like World Com in 1999 was what people did when they didn't examine quarterly and annual statements and merely bought a stock because everyone else was buying it and it was going up. Anybody that read the actual statements wouldn't have touched it with a 10 foot pole.
 
Members don't see this ad :)
One word why they all go bankrupt, it's a giant Ponzi scheme. Been there done that and lost. As a resident 1998-1999 we were buying hwp and making some side money. All my pay checks went straight to tdwaterhouse. Bought, General Motors, MCI world con, pcln, stlw, with my crna friend and lost every time. Then 2001 the Nasdaq lost and my CRNA friend taught me about shorting the market, of course the markets turned in 2002 and of course I was again holding the bag. Lost all my earnings till 2003, then stopped playing that game.
Then I realized that the new game was called real estate casino. I saw nurses by 5-6 properties and was the only doctor not to own a house. Of course house prices were going up by 10 k every month. We all know how that game ended.
Now what can we look forward to? Currency failure? All that we cherish and work hard for?

May I suggest that you consider personal finance and financial markets an academic discipline worthy of serious study. Watching CNBC doesn't count. Start here: http://www.bogleheads.org/wiki/Main_Page
 
  • Like
Reactions: 1 user
I'm a former Wordlcom stock holder along with Sun Microsystems and several others. Those days are behind me as now I have a well diversified portfolio consisting of Equities and Fixed Income/Bonds. Vanguard ETFs are the mainstay of my Portfolio along with a few others. My tax-deferred side is primarily 4 and 5 star Mutual Funds (as recommended by Morningstar.com) to achieve even more diversification in the Global/Foreign Real estate market, Emerging Markets especially the Asian emerging market. In addition, I use active Bond management on the tax-deferred side of my portfolio.

For a small company stock like PCRX I would never invest more than 0.5% of my portfolio and likely far less. The key to successful long term investing is good stewardess of your money which means low cost combined with diversification. I utilize ETFs for that purpose these days and am very satisfied with the cost vs performance issue not to mention the benefits of avoiding taxes on capitals gains from the ETFs.

In my tax bracket it was either ETFs, Index Funds or Individual equities for the taxable side of my portfolio and I chose the ETF route for my core holdings. I still own several large positions from the market crash of '09 in GE, Home Depot, Wells Fargo, Exxon, Chevron, Apple, American Express etc and these stocks will be held until I see a fundamental reason to sell them.

I will likely sell Apple at some point as that company hits a Trillion dollars in market cap; I will still have exposure to Apple through my ETFs.


http://www.forbes.com/sites/rickferri/2012/07/02/three-keys-to-greater-wealth/ (read)


https://www.betterment.com/
https://www.personalcapital.com/
 
Last edited:
300px-Core_Four_80_20.PNG


I'm tilted heavier to International since 11/14 as I believe there is more value in international vs our market. My ratio is more like 60% domestic vs 40% foreign/Emerging equities at this point but if we get a significant pullback I will invest more money into the USA stock market.

With markets at all time highs now is a good time to make sure your portfolio allocation is in line as a pullback (7-8%) can occur with little notice. My portfolio allocation is more conservative than the Core Four as I approach semi-retirement (50-55% Equities and 45-50% in bonds/fixed income/cash).
 
Last edited:
I'm a former Wordlcom stock holder along with Sun Microsystems and several others. Those days are behind me as now I have a well diversified portfolio consisting of Equities and Fixed Income/Bonds. Vanguard ETFs are the mainstay of my Portfolio along with a few others. My tax-deferred side is primarily 4 and 5 star Mutual Funds (as recommended by Morningstar.com).... /

Morningstar Star Ratings ain't so hot.

http://www.cbsnews.com/news/which-is-a-better-performance-predictor-star-ratings-or-expense-ratios/
 
What Are Morningstar Medalist Funds?
Medalist funds--those that receive Gold, Silver, and Bronze Analyst Ratings--are likely to outperform their category peers and benchmarks on a risk-adjusted basis over market cycles of at least five years.


To assign a Morningstar Analyst Rating, we're looking at five pillars. So we are looking at the People that run the fund, the Process that they are using, the Parent organization or the firm backing that management team. We are also looking at things like Price or expenses. We're also looking at Performance, but we're hoping to get beyond what the performance was, and really shed some light on why that performance was, and what investors could reasonably expect from future performance, given the process and the people running the fund.

For each pillar, we assign a Positive, Negative, or Neutral score, and then we roll up those scores to determine the overall rating.
 


I utilize more than Morningstar in picking a mutual fund for my portfolio. Since these funds are held primarily in my Tax-deferred accounts I have the option of selling them without incurring taxable gains. While we disagree on the role of active management ( I think it is useful for Foreign Funds, Emerging Markets and bonds) we do agree that expenses matter a great deal. I also look at long term performance of the fund manager: http://www.fundmojo.com/

The FundMojo Score, Morningstar medalist winner combined with solid performance has lead to outperformance in my portfolio.
 


Doze,

We agree that active management doesn't add value most of the time. In fact, on the taxable side of a portfolio we are in complete agreement that the expenses plus the additional taxes generated by a Mutual Fund won't overcome the low cost, tax efficiency of a passive ETF.

On the tax deferred side of the portfolio it isn't as black and white. Careful selection of certain funds and fund managers can lead to outperformance because some of the markets are inefficient. Morningstar.com looked at Emerging Markets for example and found that active management did add to overall returns for this part of the portfolio. The same thing can be said for top rated Mutual Fund Bond managers who charge low expenses: they add value. Again,we do agree that only a select group of mutual fund managers add value even on the tax-deferred side of a portfolio so it is perfectly logical to go with an ETF or Index Fund if one doesn't want to actively monitor that portion of his/her portfolio.

http://blogs.wsj.com/experts/2015/02/12/the-shrinking-future-for-active-managers/


The bottom line is only very few Mutual Fund managers add any value to a portfolio and most will actually cost you money over the long run; but, if you have the time and energy finding the top 2% of Mutual fund managers in your 401K/tax deferred portfolio can be financially rewarding.
 
DFA has the BEST passive funds for international small caps and Emerging markets. If I had access to DFA then I would agree even my tax deferred portfolio may not need any active management. But, for most investors who don't want to pay the management fee for a DFA financial advisor active management can come close to DFA in terms of risk adjusted performance.

Here is a great video from DFA explaining Doze's philosophy in a nutshell (again, I agree that DFA and only DFA allows low cost passive investing in all equity classes especially international small plus emerging markets).

 
  • Like
Reactions: 1 user
Active versus passive. No, it’s not a debate to stir the passions of the public, but in the world of investing and deciding how to gain exposure to sectors, it is a rivalry up there with the Hatfields versus the McCoys, the North versus the South, the Yankees and the Red Sox.

Proponents of active investing tout the ability of astute fund managers to beat the managers and add “alpha,” that amount of outperformance attributable to the skill of the manager. On the flip side, advocates of passive investing point to the long-term inability of most active managers to beat the market and to the high fees charged for sub-par performance, not to mention the tax inefficiencies. And so the debate goes.

In truth, however, while the polarized positions speaks to different groups of managers battling for fund flows and for the upper hand in a market debate, most investors are best served not by an either-or approach. Instead, placing select bets on select active managers can and likely should be combined with select positions in select passive funds. That approach may not have the fireworks of “I’m right; you’re wrong,” but there you go.


Envestnet has long supported a core-satellite strategy of picking and choosing active versus passive based on where you can find more dispersion of performance and less correlation and where there a few adequate passive vehicles available. That could mean using passive funds for large-cap equity and active for small-cap and emerging markets, passive for government bonds, active for high-yield and emerging market debt, active for international equity and so on.

Another approach is to use a mix of active and passive for major asset classes, to have some of the cost and performance advantages of indexing with the possibility of outperformance by selecting skilled active managers who will either offset index volatility or add alpha.


http://online.barrons.com/articles/solving-the-active-vs-passive-investing-debate-1422304950
 
04-24-15_the_performance_of_active_management_should_be_judged_over_a_full_market_cycle.jpg


Swedroe compared DFA funds to UBS actively managed funds over a 15 year market cycle. DFA has the BEST passively managed funds in the business.
 
Members don't see this ad :)
INDEX INVESTOR CORNER
Swedroe: Another Nail In The Active Coffin
By
Larry Swedroe

April 27, 2015

Share:


[/paste:font]
I was recently asked to comment on a March 13 piece by Michael Crook, head of portfolio and planning research at UBS. In the piece, Crook notes that 2014 wasn’t a very good year for active managers. He writes: “Roughly 85% of domestic managers and 70% of international managers underperformed.



Crook went on to add that most active managers have underperformed since the end of the financial crisis, a period of about six years now, and that this isn’t completely unexpected. He then observed that “even Warren Buffett has underperformed 53% of the time on a quarterly basis over the last 20 years.” I’d note that there’s quite a difference between looking at year and quarterly data, but why be picky?



Crook then rightly states that “basing portfolio decisions off of short-term performance is destructive to long-term returns.” He concludes: “Active management relative performance must be judged over a full market cycle to be relevant.” And I agree.



No Long-Term Advantage
Unfortunately, the evidence overwhelmingly demonstrates that the longer the time frame we examine, the smaller the percentage of active managers who outperform becomes. We can see this whether we look at the performance of mutual funds or even pension plans, where plan sponsors hire high-priced consultants to help them identify those future outperformers. Put simply, active management is a loser’s game. It is possible to win, but the odds of doing so are so low that it’s not prudent to try.



Although Crook presented no evidence to support a belief in active management as the winning strategy, given that Crook works for UBS, I thought it worthwhile to turn to our trusty videotape to see how UBS’ lineup of actively managed funds have fared.



On its website, UBS describes its actively managed funds as follows: “Consistent, risk-adjusted results. Our talented, experienced investment professionals adhere to well-established and disciplined processes. Our systematic security analysis and risk management tools, help achieve consistent, explainable results.”



Figure 1 presents the performance of UBS’ eight domestic and international equity funds. The funds cover six asset classes, for which Morningstar has 15 years of returns data. That period is more than sufficient to encompass a full market cycle and, in fact, covers two bull and two bear markets.



We will compare the returns of the actively managed UBS funds to the returns of similar, but passively managed, funds from Dimensional Fund Advisors (DFA). In the interest of full disclosure, my firm, Buckingham, recommended DFA funds in constructing client portfolios over this period. Data is as of March 31, 2015.
 
I anticipate another fall in price after they report their 10-Q. And FWIW, their CEO sold 15k shares less than 2 weeks ago. I guess time will tell :D
 
Share prices have long ways to fall. QE is being phased out slowly and the 85 billion dollars that was being pumped in is being withdrawn. China had massive stock losses recently. Had to do engineer their own PPT. USA has debt till it's eyeballs. China is building ghost cities, no internal consumption or demand to speak off.
This deflation is going to end badly
 
Share prices have long ways to fall. QE is being phased out slowly and the 85 billion dollars that was being pumped in is being withdrawn. China had massive stock losses recently. Had to do engineer their own PPT. USA has debt till it's eyeballs. China is building ghost cities, no internal consumption or demand to speak off.
This deflation is going to end badly

While all of that may be true, it's mostly meaningless when discussing the PCRX stock price. They will sink or swim solely based on getting both a new indication for PNBs and turning that into a lot more profit. They currently barely scrape by with essentially no profit. Long term that's a company that will be bankrupt. They need to get their new indication and then crank up the profit. But if they do, their stock price will likely go up regardless of what happens with the macro market.
 
Down sharply after release of seemingly positive trial results on use for single nerve block. SNAFU in femoral nerve block study protocol must have hurt valuation?

Pacira Announces Topline Phase 3 Results for EXPAREL® as a Single-dose Nerve Block
I guess so. It's never great to exclude data from a study, no matter the reason. You can't just look back and see why your data didn't work and cherry pick data out. Haven't read the study, though, so who knows what the issue really was.

Also, the upper ext study is crap. 20ml of exparel Vs PLACEBO!??! Say what? Why not compare vs. bupi? Of course it's going to be better than saline!!! I guess these are "phase 3" studies, but as I've said before, I won't use exparel until there are studies comparing to the current standard of care (bupi + dex for me).
 
  • Like
Reactions: 1 users
I guess so. It's never great to exclude data from a study, no matter the reason. You can't just look back and see why your data didn't work and cherry pick data out. Haven't read the study, though, so who knows what the issue really was.

Also, the upper ext study is crap. 20ml of exparel Vs PLACEBO!??! Say what? Why not compare vs. bupi? Of course it's going to be better than saline!!! I guess these are "phase 3" studies, but as I've said before, I won't use exparel until there are studies comparing to the current standard of care (bupi + dex for me).

Right, need to see it compared to bupiv, ideally bupiv with decadron, but they won't do that study!
 
  • Like
Reactions: 1 users
What matters to me is FDA approval for nerve blocks. Then, I can offer my patients 48 hours of postop analgesia.

As for the studies, once the FDA grants formal approval I believe the data will be published comparing Bupivacaine with exparel.

All we have now is just a few off label studies but FDA approval will change that

https://file.scirp.org/pdf/OJAnes_2015072215494532.pdf

Addition of Liposome Bupivacaine to Bupivacaine HCl Versus... : Regional Anesthesia and Pain Medicine

Blade, are you long on PCRX?
 
Let me think about this....
Bupivacaine 30 ml $1.84 (with PF dexamethasone for additional $5) vs. Exparel ($330-360 per bottle) and nebulous results... Keep drinking the Kool-Aid....the choice is simple.
 
  • Like
Reactions: 1 users
Let me think about this....
Bupivacaine 30 ml $1.84 (with PF dexamethasone for additional $5) vs. Exparel ($330-360 per bottle) and nebulous results... Keep drinking the Kool-Aid....the choice is simple.

I've got no problem with the FACTS once they come out. That means the FACTS may not agree with your premise that Exparel is an over-priced drug vs Bup with decadron. My anecdotal experience says otherwise but I'm open to more data based on peer reviewed evidence. Are You? The safety profile of Exparel is excellent and I think the published data will eventually show superiority in duration of analgesia vs Bup with dexamethasone.

FYI, there are thousands of other Anesthesiologists in the world who are also seeing excellent results with Exparel. But, for some their minds are made up in advance about this medication.

Again, even though my anecdotal experiences with Exparel are excellent I'll wait for the published data (which will only occur once FDA approval is granted for nerve blocks) to make my final decision.
 
So when is this golden FDA approval coming!?!?
 
Down sharply after release of seemingly positive trial results on use for single nerve block. SNAFU in femoral nerve block study protocol must have hurt valuation?

Pacira Announces Topline Phase 3 Results for EXPAREL® as a Single-dose Nerve Block

Problem is - it wasn't really positive. It looks to me like it didn't do much better than straight bupivicaine. It helped - sure...but not comparatively. I was hugely disappointed in the results of this well done study.

I'll still use it for nerve blocks when I don't want to do a catheter - but I wish it worked better.

I've been using dexmetatomidine as an adjunct. Anyone else? The published data on that is pretty good. I don't like using dexamethasone. I'd prefer that drug be given systemically (which also prolongs a block).

Interestingly enough, alpha-2 agonists, buprenorphine, ketamine, and dexamethasone work by also blocking the sodium channel. I just read that...pretty cool.
 
Have any of you looked at HRTX at all?
Looks like they are targeting 2018 for the FDA approval application for HTX-011 (biochronomer bupivacaine-meloxicam combo). The "biochronomer" bupivacaine seems to be a direct competitor to liposomal bupivacaine. Exparel's window might not be open for very long.

HTX-011 | Heron Therapeutics
 
Hope no one is holding on to pcrx cuz it’s down 18% today!
 
The trials they conducted were vs placebo only, so there's no real proof that it's better than regular bupi (other than anecdote), but suprised it didn't get approved sides they showed it was safe and better then placebo. Does anyone have the actual FDA explanation?
 
Isn't the evidence pretty clear that this exparel is no better than straight bupi?
 
Anyone out there actually testing for blocks 24-48 hours out and finding efficacy?
 
Isn't the evidence pretty clear that this exparel is no better than straight bupi?
Depends on what study you read. A lot of the data is coming out that it's marginally better, if at all. Lots of Ortho guys are jumping ship, though.

I know @BLADEMDA had used it a ton and thinks it's far more effective than standard bupi.
 
at a time when the FDA is under enormous political pressure to approve anything for pain that isnt an opioid this is a damning decision.

(from IBD)

"It should be noted that the five anesthesiologists on the panel voted 4-1 against approval," Needham analyst Serge Belanger wrote in a note. "It now seems unlikely that FDA will approve the label expansion, even for a narrow indication, without additional studies."


Belanger downgraded Pacira stock to a hold rating from buy.

Exparel was tested as a regional anesthetic in patients following shoulder and knee surgeries. Panelists discussed the risk of falls in patients after knee surgery and whether Exparel could be approved for blocking specific nerves, Piper Jaffray analyst David Amsellem said.

"There was concern that usage via a femoral nerve block (after knee surgery) could prolong quadriceps weakness, thereby inhibiting the extent to which a patient can ambulate, and to the extent that a patient is ambulating, increasing the risk of a fall," he said in a note.
 
at a time when the FDA is under enormous political pressure to approve anything for pain that isnt an opioid this is a damning decision.

(from IBD)

"It should be noted that the five anesthesiologists on the panel voted 4-1 against approval," Needham analyst Serge Belanger wrote in a note. "It now seems unlikely that FDA will approve the label expansion, even for a narrow indication, without additional studies."


Belanger downgraded Pacira stock to a hold rating from buy.

Exparel was tested as a regional anesthetic in patients following shoulder and knee surgeries. Panelists discussed the risk of falls in patients after knee surgery and whether Exparel could be approved for blocking specific nerves, Piper Jaffray analyst David Amsellem said.

"There was concern that usage via a femoral nerve block (after knee surgery) could prolong quadriceps weakness, thereby inhibiting the extent to which a patient can ambulate, and to the extent that a patient is ambulating, increasing the risk of a fall," he said in a note.

They made an error in this decision. Exparel is safe and should have been granted FDA approval based on its safety not just efficacy. Let the clinicians decide the drugs efficacy and utility for patients.

For example, I like using Exparel to block the nerves for a patient getting an AKA/BKA. The drug provides reliable 48 hours of analgesia without a catheter. Or, an adductor canal block with Exparel lasting for 48 hours.

The reason I wanted FDA approval (for nerve blocks) was to spur research in this area by a larger number of clinicians. I was hoping for peer reviewed double blinded studies to get published. But, without FDA approval I'm skeptical this research will now get done.
 
  • Like
Reactions: 1 user
Mizuho analyst Irina Koffler suggested Dow's Johnson & Johnson (JNJ) could acquire Pacira for its base business and potential cost synergies. But, following the FDA panel on Exparel, "the likelihood of takeout is now somewhat lower," she said in a note to clients.

Pacira said it will work with the FDA to address outstanding panel concerns ahead of the full FDA meeting in April.

The ultimate goal, Chief Executive Dave Stack said in a written statement, is to offer "additional flexibility in the way Exparel can be administered so that clinicians and patients alike have increased opportunity to realize the benefits of long-lasting non-opioid pain con
 
Anyone out there actually testing for blocks 24-48 hours out and finding efficacy?

It works quite well. I recommend you give it a try. That said, a cocktail of adjuvants added to Bupivacaine will provide analgesia for approximately 30 hours vs straight Exparel at 0.66% concentration which provides analgesia in the 40-48 hour range. The former costs under $40 vs Exparel which now costs over $315 per vial.
 
We present 5 cases of women requiring bilateral
mastectomy for breast cancer; all included immediate
reconstruction involving bilateral tissue expander
placement. Our course for postsurgical pain control
included ultrasound guided single shot tPVBs performed
at the T4 level using liposomal bupivacaine. We found
that this technique provided extended post-operative
pain control, lowered narcotic use, improved pain
scores and resulted in no incidence of postoperative
nausea or vomiting. Additionally, two cases were able
to be discharged home on POD 1. These cases
demonstrate a new approach to an old technique that
can help breast cancer patients with their recovery by
effectively managing their postoperative pain



contact info:

Yitzhak Belsh, MD
North American Partners in Anesthesia of NJ, LLC
Monmouth Medical Center
300 2nd Ave
Long Branch, NJ 07740
[email protected]
 
The reason why you need to do a Subcostal approach plus the typical TAP block is the Linea Semilunaris. The local simply doesn't flow past this anatomical landmark.

image-full;size$500,294.ImageHandler
 
If you wanted to play the whole opioid crisis, Nektar nktr would have been it. Their PEGylation polymerization tech reengineers drugs to change their kinetics. movatnik is their technology

In March announced positive p3 data on nktr-181. Essentially polymerized morphine with much slower brain absorption and reduced euphoria/addictive properties. Stock was $18 in April 2017 to $88 in December based on likely expedited approval. if approved they will at least in the short term have a 12 billion dollar market for themselves. Good bye OxyContin.
 
Last edited:
Top