China virus sends shiver through markets as risks mount

Global shares took a beating on Tuesday, wiping out all gains made at the start of the week as mounting concerns about a new strain of coronavirus in China sent a ripple of risk aversion through markets.

Authorities in China confirmed that a new virus could be spread through human contact, reporting 15 medical staff had been infected and a fourth person had died.

Safe-haven bonds and the yen gained as investors were reminded of the economic damage done by the SARS virus in 2002-2003, particularly given the threat of contagion as hundreds of millions travel for the Lunar New Year holidays.

“I’m not an expert in the pandemics, but you can look at previous examples like the SARS outbreak which also originated from Asia,” said Cristian Maggio, Head of Emerging Markets Strategy at TD Securities in London.

Noting that China had initially downplayed the full extent of the SARS outbreak, he said “I think the market might be fearing something similar.”

The mood swing saw MSCI’s All-Country World Index <.MIWD00000PUS> slip 0.4%, wiping out gains made at the start of the week on Monday. Asian markets were hit particularly hard.

Hong Kong, which suffered badly during the SARS outbreak, saw its index fall 2.8%.

Japan’s Nikkei <.N225> lost 0.9% and Shanghai blue chips <.CSI300> 1.7%, with airlines under pressure. The caution spread to E-Mini futures for the S&P 500 which eased 0.5%.

The chill in Asia carried over to European markets, where shares of luxury goods makers – which have large exposure to China – were among the biggest fallers. [.EU]

Germany’s 10-year government bond yield touched one-week lows.

Investors had already been guarded after the International Monetary Fund trimmed its global growth forecasts, mostly due to a surprisingly sharp slowdown in India and other emerging markets.

There had been some relief as U.S. President Donald Trump and French President Emmanuel Macron seemed to have struck a truce over a proposed digital tax.

The two agreed to hold off on a potential tariffs war until the end of the year, a French diplomatic source said.

Trump is due to deliver a speech at the World Economic Forum in Davos later on Tuesday, and trade and tariffs could be on the agenda.

In a tweet late on Monday, Trump said he would be bringing “additional Hundreds of Billions of Dollars back to the United States of America! We are now NUMBER ONE in the Universe, by FAR!!”

ALL STEADY AT BOJ

The Bank of Japan cited lessened trade risks when nudging up forecasts for economic growth after holding a policy meeting on Tuesday.

As widely expected, the BOJ maintained its short-term interest rate target at -0.1% and a pledge to guide 10-year government bond yields around 0%, by a 7-2 vote.

Japan’s yen picked up a bid on the safe-haven move and the dollar dipped to 109.93 from an early 110.17. It also gained on the euro, leaving the single currency lower to the dollar at $1.1090.

Against a basket of currencies, the dollar was steady at 97.638, just off a four-week high of 97.729.

The Australian dollar <AUD=D3> took a knock from the flu worries since it attracts large numbers of Chinese tourists, who tend to be big spenders over the Lunar New Year holidays.

Australia said it would step up screening of some flights from Wuhan.

The outbreak was particularly badly timed as the tourism industry has been mauled already by bushfires sweeping the country.

Spot gold hit a 2-week high of $1,568.35 per ounce, but traded 0.2% lower in early deals in London.

Oil prices slid nearly 1%, having earlier gained on the risk of supply disruption in Libya. [O/R]

Brent crude futures fell 1% to $64.60 a barrel, while U.S. crude fell 0.92% to $58.09 a barrel.

https://www.marketscreener.com/news/China-virus-sends-shiver-through-markets-as-risks-mount–29865190/?countview=0

Dozens of non-oncology drugs can kill cancer cells

Drugs for diabetes, inflammation, alcoholism — and even for treating arthritis in dogs — can also kill cancer cells in the lab, according to a study by scientists at the Broad Institute of MIT and Harvard and Dana-Farber Cancer Institute. The researchers systematically analyzed thousands of already developed drug compounds and found nearly 50 that have previously unrecognized anti-cancer activity. The surprising findings, which also revealed novel drug mechanisms and targets, suggest a possible way to accelerate the development of new cancer drugs or repurpose existing drugs to treat cancer.

“We thought we’d be lucky if we found even a single compound with anti-cancer properties, but we were surprised to find so many,” said Todd Golub, chief scientific officer and director of the Cancer Program at the Broad, Charles A. Dana Investigator in Human Cancer Genetics at Dana-Farber, and professor of pediatrics at Harvard Medical School.

The new work appears in the journal Nature Cancer. It is the largest study yet to employ the Broad’s Drug Repurposing Hub, a collection that currently comprises more than 6,000 existing drugs and compounds that are either FDA-approved or have been proven safe in clinical trials (at the time of the study, the Hub contained 4,518 drugs). The study also marks the first time researchers screened the entire collection of mostly non-cancer drugs for their anti-cancer capabilities.

Historically, scientists have stumbled upon new uses for a few existing medicines, such as the discovery of aspirin’s cardiovascular benefits. “We created the repurposing hub to enable researchers to make these kinds of serendipitous discoveries in a more deliberate way,” said study first author Steven Corsello, an oncologist at Dana-Farber, a member of the Golub lab, and founder of the Drug Repurposing Hub.

The researchers tested all the compounds in the Drug Repurposing Hub on 578 human cancer cell lines from the Broad’s Cancer Cell Line Encyclopedia (CCLE). Using a molecular barcoding method known as PRISM, which was developed in the Golub lab, the researchers tagged each cell line with a DNA barcode, allowing them to pool several cell lines together in each dish and more quickly conduct a larger experiment. The team then exposed each pool of barcoded cells to a single compound from the repurposing library, and measured the survival rate of the cancer cells.

They found nearly 50 non-cancer drugs — including those initially developed to lower cholesterol or reduce inflammation — that killed some cancer cells while leaving others alone.

Some of the compounds killed cancer cells in unexpected ways. “Most existing cancer drugs work by blocking proteins, but we’re finding that compounds can act through other mechanisms,” said Corsello. Some of the four-dozen drugs he and his colleagues identified appear to act not by inhibiting a protein but by activating a protein or stabilizing a protein-protein interaction. For example, the team found that nearly a dozen non-oncology drugs killed cancer cells that express a protein called PDE3A by stabilizing the interaction between PDE3A and another protein called SLFN12 — a previously unknown mechanism for some of these drugs.

These unexpected drug mechanisms were easier to find using the study’s cell-based approach, which measures cell survival, than through traditional non-cell-based high-throughput screening methods, Corsello said.

Most of the non-oncology drugs that killed cancer cells in the study did so by interacting with a previously unrecognized molecular target. For example, the anti-inflammatory drug tepoxalin, originally developed for use in people but approved for treating osteoarthritis in dogs, killed cancer cells by hitting an unknown target in cells that overexpress the protein MDR1, which commonly drives resistance to chemotherapy drugs.

The researchers were also able to predict whether certain drugs could kill each cell line by looking at the cell line’s genomic features, such as mutations and methylation levels, which were included in the CCLE database. This suggests that these features could one day be used as biomarkers to identify patients who will most likely benefit from certain drugs. For example, the alcohol dependence drug disulfiram (Antabuse) killed cell lines carrying mutations that cause depletion of metallothionein proteins. Compounds containing vanadium, originally developed to treat diabetes, killed cancer cells that expressed the sulfate transporter SLC26A2.

“The genomic features gave us some initial hypotheses about how the drugs could be acting, which we can then take back to study in the lab,” said Corsello. “Our understanding of how these drugs kill cancer cells gives us a starting point for developing new therapies.”

The researchers hope to study the repurposing library compounds in more cancer cell lines and to grow the hub to include even more compounds that have been tested in humans. The team will also continue to analyze the trove of data from this study, which have been shared openly (https://depmap.org) with the scientific community, to better understand what’s driving the compounds’ selective activity.

“This is a great initial dataset, but certainly there will be a great benefit to expanding this approach in the future,” said Corsello.

###

This collaboration involved the Broad’s Center for the Development of Therapeutics, the PRISM team, the Cancer Data Sciences team, and the labs of Todd Golub and Matthew Meyerson. The work was funded in part by SIGMA (Carlos Slim Foundation, Slim Initiative in Genomic Medicine for the Americas), the National Institutes of Health, and an anonymous donor.

Paper cited: Corsello S, et al. Discovering the anti-cancer potential of non-oncology drugs by systematic viability profiling. Nature Cancer.

https://www.eurekalert.org/pub_releases/2020-01/biom-don011520.php

Australia to screen some flights from China, warns coronavirus difficult to stop

Australia will begin screening passengers arriving from a Chinese city in a bid to stop the spread of a new coronavirus, the country’s chief medical officer said on Tuesday, although authorities warned that an outbreak would be hard to prevent.

Chinese authorities have confirmed more than 200 people have caught the new virus, which causes a type of pneumonia that has killed four people in the central city of Wuhan.

The virus – which can pass from person-to-person – broke out in Wuhan but four cases have been reported in Thailand, Japan and South Korea, raising concerns about its spread through international air travel.

Brendan Murphy, the chief medical officer for the Australian government, said biosecurity officials would begin screening passengers arriving on the three weekly flights to Sydney from Wuhan starting on Thursday.

Passengers would be given an information pamphlet and asked to present themselves if they had a fever or suspected they might have the disease.

Murphy said the measures only offered limited protection.

“You cannot absolutely prevent the spread of disease into the country. The incubation period is probably a week,” Murphy told reporters in Canberra.

“It’s about identifying those with a high risk and making sure those who have a high risk know about it and know how to get medical attention.”

China is the largest source of tourists to Australia, with more than 1 million people arriving last year.

Around 160 flights arrive in Australia from China each week, and Murphy acknowledged Chinese tourists could arrive via other locations. There are only three flights from Wuhan each week, arriving in Sydney.

Australia’s additional screenings come as hundreds of millions of Chinese prepare to travel domestically and abroad during the Lunar New Year holiday that starts this week.

Despite the elevated risk, Murphy said Australia would not begin scanning passengers for higher body temperatures, a precaution previously used during the Severe Acute Respiratory Syndrome (SARS) outbreak.

SARS killed nearly 800 people globally during the 2002/03 outbreak that also started in China, but Murphy said recent evidence indicated body-temperature screening was ineffective and created a false sense of security.

https://www.reuters.com/article/us-china-health-pneumonia-australia/australia-to-screen-some-flights-from-china-warns-coronavirus-difficult-to-stop-idUSKBN1ZK007

Biotech week ahead, Jan. 21

Biotech news flow remained light last week, although there were some notable developments such as FDA panel reviews of opioid pain drugs, a few clinical data readouts, presentations and updates at the JPMorgan Healthcare conference.

Here are the key catalysts that could prove market moving in the unfolding week.

Conferences

American Society of Clinical Oncology, or ASCO, Gastrointestinal Cancers Symposium: Jan. 23-25 in San Francisco, California

PDUFA Dates

The FDA is scheduled to rule on Epizyme Inc’s EPZM 4.62% tazemetostat, an experimental drug to treat metastatic or locally advanced, unresectable epithelioid sarcoma. FDA’s Oncologic Drugs Advisory Committee, which met Dec. 18 to discuss the NDA for tazemetostat, unanimously recommended approval of the drug. The PDUFA date is set for Thursday.

The regulatory agency will announce Thursday its verdict on Merck & Co., Inc.’s MRK 0.22% NDA and sNDA for DIFICID (fidaxomicin) to treat Clostridium difficile infections. The NDA pertains to an oral suspension formulation and the sNDA is for the label expansion of the indication to treat children, ages six and older. Dificid, in tablet formulation, has already been approved to treat Clostridium difficile infections in adults 18 years and older.

Clinical Readouts

ASCO Gastrointestinal Cancers Symposium Presentations

Bellicum Pharmaceuticals Inc BLCM 9.05%: Phase 1 Cohort 5B new translational data for its pancreatic cancer experimental drug BPX-601 (Friday)

Forty Seven Inc FTSV 11.15%: Phase 1b data for magrolimab in combination with cetuximab in colorectal cancer

Earnings

Wednesday

Abbott Laboratories ABT 0.86% (before the market open)
Johnson & Johnson JNJ 0.53% (before the market open)

Thursday

Intuitive Surgical, Inc. ISRG 0.29% (after the market close)

https://www.benzinga.com/general/biotech/20/01/15136889/the-week-ahead-in-biotech-focus-on-epizyme-merck-ahead-of-pdufa-dates-j-j-to-kickstart-big-pharma

Long Island’s Northwell Health Deploying ‘Black Boxes’ In Operating Rooms

Surgery is now being recorded in some Long Island operating rooms.

It’s a high-tech effort to improve safety, similar to black box technology used in airplanes, and it’s not only being reviewed in the event of an accident.

They have them for trains, planes and automobiles, and now black box technology is coming to a hospital near you: Overhead while you are under the knife.

Long Island Jewish Medical Center is the first in the United States to install the OR black box in two operating rooms.

“There is no question that this is going to improve the quality for patients,” said Dr. Louis Kavoussi, a urologist with Northwell Health.

Dr. Kavoussi welcomes the technology in his OR. Cameras and microphones record, and the data is transmitted to a Canadian company that analyzes everything from sterile technique to distractions.

“Who should or should not be coming in or out of the operating room, should telephone calls come in, should there be music played,” Dr. Kavoussi said.

Through algorithms, it can predict a mistake and alert a surgeon.

“We all think as surgeons we are perfect, but we aren’t. And this is an opportunity to use artificial intelligence to analyze what’s going on in the operating room,” Dr. Kavoussi said.

The founder – a surgeon himself – says it’s like professional coaching.

“The reality is as long as there are humans, there will be errors,” said Dr. Teodor Grantcharov, the founder of Surgical Safety Solutions. “We want to create a system that makes it very difficult to make an error.”

Unlike the black boxes in transportation, it will not be used to assign blame. Northwell Health’s chief quality officer says it is used to improve systems, not punish individuals. It’s protected from subpoena in New York state as a quality control project. Patients are not identified.

“It’s not going to be used punitively, and most importantly, the data is de-identified. They blur out the picture of the physicians and nurses and even garble the voices a little if we ever look so no one ever knows whose case was whose,” Dr. Mark Jarrett said.

The plan is to install more of these black boxes in hospitals throughout the Northwell Health system. The more cases, the more data, the more quality control and improvement, officials said.

The technology is already in use in ten hospitals in Canada and western Europe.

Northwell Health Deploying ‘Black Boxes’ In Operating Rooms

Industry Voices—3 ways payers, PBMs can team up to save on specialty drugs

Today’s advances in medicine enable the successful management of diseases for which there were once few effective treatment options.

However, innovative specialty medications come at a cost upward of thousands of dollars per dose.

In fact, specialty drugs are so expensive that they drive 40% of today’s prescription spending while treating less than 1% of the patient population. National strategies for managing the cost of these drugs include promoting biosimilar development and increased competition, but there are steps plan sponsors can take now with pharmacy benefit managers (PBMs) to address spending on specialty drugs.

Improved care coordination and communication

Controlling specialty spend is about supporting patients and working with their healthcare team to ensure that treatment is safe and effective. Medications that don’t work as they should translate to poor health outcomes, which drive up overall costs.

PBMs are perfectly positioned to work with all members of a patient’s healthcare team to improve communication. PBM pharmacists have access to all data gathered from prescription claims and, potentially, integrated medical claims data. This allows them to see a comprehensive picture of the patient’s medication history, diagnoses, lab results, indicators of adherence and other applicable medical data. As a result, PBM pharmacists can alert prescribers and retail pharmacists of any issues and facilitate the identification of safer, more effective treatment options.

Specialty pharmacists and nurses should speak directly with their patients as well about the medications they’re taking and how they’re feeling. This dialogue develops a rapport, trust, empathy and understanding. It also allows these clinicians to work with the patient’s healthcare team to address any challenges that may arise—such as poor medication adherence due to intolerable side effects or complicated dosing schedules.

Through this outreach, the PBM becomes a patient advocate, bringing all members of a patient’s healthcare team together to find treatments that deliver the best value and outcomes.

Advanced clinical programs

To be able to provide effective care coordination, PBMs must also offer comprehensive, advanced clinical programs. Prior authorization provides an example of how clinical programs are not created equal. The intention of prior authorization is to make certain medications are used appropriately. But does the analysis review whether the medication is appropriate for a specific individual’s needs? Not all prior authorization programs do. A comprehensive program considers whether there are warnings and contraindications related to factors such as the patient’s age, health conditions, metabolism, lifestyle or other medications they may be taking.

Advanced clinical programs are proactive, delivering vital information before a medication is dispensed so adjustments can be made without putting patients at unnecessary risk. This can reduce spending by preventing serious adverse drug reactions or wasteful drug utilization.

In addition, quantity limits can be used to eliminate excessive spending by cross-referencing the amount of medication being dispensed with the actual amount of medication being billed. For example, if the quantity in a prefilled syringe is rounded up for billing, the plan sponsor is overcharged. For specialty medications costing thousands of dollars, the financial impact is significant.

Creative contracting and partnerships

Finally, plan sponsors need a PBM that works with them, putting the plan’s and patients’ best interests first while delivering ethical, transparent benefit management. They should consider PBMs that tie performance guarantees directly to their clinical programs. A pay-for-performance arrangement holds the PBM accountable for how well it facilitates responsible, effective drug utilization that reduces the plan’s spending.

In addition, plan sponsors can seek out direct savings by partnering with a PBM that provides actual acquisition cost pricing on specialty medications. This means that the plan sponsor pays exactly what the pharmacy pays for the medication, without any markup or spread generating hidden revenue.

Specialty medications are an increasingly important part of the drug spending equation. Rather than wait for external factors to drive savings, such as competition and biosimilar development, plan sponsors should challenge the status quo, ensuring their PBM partners are transparent and proactive. Specialty spending can be controlled by making strategic choices in PBM relationships that support better patient care and drive transparent, accountable programs and results.

Michael A. Perry is the president of BeneCard PBF, an innovative PBM that engineered a purely transparent pharmacy benefit management model along with a pure pass-through program. BeneCard PBF’s approach centers on clinical programs that drive costs down while helping improve member health outcomes

https://www.fiercehealthcare.com/payer/industry-voices-3-ways-payers-pbms-can-team-up-to-save-specialty-drugs

Intuitive Surgical CEO Cracks The Da Vinci Code Of Success

What do a dedicated math teacher, an honest college prof and a lousy jump shot have in common? The Intuitive Surgical CEO followed each to find success.

How? Gary Guthart, Intuitive Surgical (ISRG) CEO since January 2010, pulls together seemingly random events from his past, lessons from mentors and disappointments to extract the best outcome from opportunities he gets.

Much of Guthart’s experience traces back to growing up in Sunnyvale, Calif. It’s the heart of Silicon Valley. It was also, he told Investor’s Business Daily, a great place to grow up in the 1960s and ’70s “if you were a math and science kid.”

“Both my parents worked, which was unusual at the time,” Guthart, 54, said. Some kids might have seen busy parents as a negative. But opportunity arose. Guthart’s calculus teacher saw a student with potential and both parents at work. He signed Guthart up for an internship at NASA.

“(My teacher) told me, ‘I want you to go check this out,'” Guthart said. “So I got on my bike (and) went to the research center.” There, he met a second professional mentor, Sandra Hart, “then the only female director of a NASA lab,” he said. She put him to work writing software code that examined how pilots learn.

The job sparked Guthart’s interest in science. He saw the intersection “of how people and technology interact. Not technology for its own sake, but how the two go together,” he said.

The mindset of a future Intuitive Surgical CEO was born.

Bringing A Winning Mindset To Intuitive Surgical

This link between man and machine is the core of Intuitive Surgical. The company is a game changer in the field of robotic surgery. Its da Vinci surgical systems help surgeons perform successful and delicate procedures.

The company also enjoyed enviable success with Guthart at the helm. In the roughly ten years Guthart has been Intuitive Surgical CEO, the stock jumped nearly 500%. That easily outpaces the S&P 500’s 195% rise during that time. And the company’s revenue is on pace to hit $5.1 billion this year, up 380% from when his CEO tenure began. The company is seen earning $1.4 billion in 2020, says S&P Global Market Intelligence. That’s up more than 350% from 2010.

Guthart, who joined Intuitive Surgical in 1996, also served as its president from July 2007 through 2019.

Intuitive Surgical CEO: Focus On Your True Strengths

Guthart earned a Ph.D. in engineering from the California Institute of Technology. His plan? To teach. His thesis advisor urged him to contact a Massachusetts Institute Technology professor about opportunities. He did not get the help he thought.

Guthart recalls the MIT professor telling him: “Gary, I’m not going to (help) because I don’t think you’re going to be a good enough professor. You like to talk to people. That’s not what professors do. You have to write. It’s really a solitary profession.”

Guthart didn’t like what the honest professor told him. “I told myself, I’ll show him, and I kept looking for (teaching opportunities). I got a couple of offers, but finally realized that he was right,” Guthart said. “He did a hard thing (by being honest), and he did me a huge favor.”

Jump At Opportunity No Matter Where They Come From

Guthart, instead, got a job at SRI (formerly the Stanford Research Institute). His jump shot languished, though. Good thing. He and a group of fellow researchers met regularly at lunch for a pickup basketball game. And Guthart sat on the sidelines — again — when Ajit Shah approached him. Shah ran SRI’s robotics lab. He wanted to add to his staff.

Shah took Guthart back to his lab. He asked Guthart to sew a dead rat’s blood vessel using a microscope.

“I was a model builder as a kid, so I was pretty good with my hands, but it was really hard,” Guthart recalled. “Then he sat me down with the SRI prototype. It was substantially easier.” Shah told Guthart his team’s research aimed to put robots in the hands of surgeons. And he asked if Guthart would help.

Guthart transferred to Guthart’s group. Intuitive Surgical’s founders noticed the SRI group’s work. And they licensed the technology when they formed the company. Guthart joined as employee number 11. It seems like a no-brainer now, but, at the time, it was a risk.

“My first response was no. I’d just gotten a promotion. And John Freund (one of three Intuitive Surgical founders) … convinced me to come over. He said, ‘If you want to be a researcher, come and you’ll be a better researcher.’ I sat down with my wife — we had our first child — and she said do it now.”

Ask For Help So You Can Focus

Guthart started writing machine code that allows the elements of the robot to connect smoothly. But he hit the wall. “I just couldn’t work fast enough. There weren’t enough hours in the day,” he said. “I’d come in early, work all day, drive home to have dinner with my wife and drive back to the office.”

Guthart saw opportunity, again. He asked to hire help. The founders agreed, but added, “we have no revenue so hire someone good,” Guthart said. He asked around and colleagues pointed him to Gunter Niemeyer from MIT. Niemeyer was the right choice.

“He could do in a few hours what took me a full day. He was just that much faster and a humbling choice,” Guthart said. “It taught me that being a manager started with hiring really great people and letting them push you out of the way.”

Aim Higher Than You Think Possible

In the late 1960s, surgeons developed minimally invasive surgery (MIS) techniques. Instead of making large holes in the body, MIS required only small ports. The ports allowed surgeons to put in a long lens. They could use tools like scissors to snip and retrieve unwanted tissue.

Guthart and Intuitive Surgical saw an even better way. But they knew slight improvements wouldn’t sell. Advances needed to be radical.

“We made a few key decisions early on. If (a surgeon or hospital) was going to adopt something new, it had to be something much better,” he said.

The company went through a series of breakthrough robotic surgery prototypes. The first was Mona (as in Lisa). And the final was da Vinci. After much testing and success in Europe, the FDA approved da Vinci for laparoscopic surgery in the U.S.

Sign Up Allies

Sales took off when a Swiss urologist working in Frankfurt, Jochen Binder, saw da Vinci could help with prostate surgery. He showed it to peers. Mani Menon, a surgeon at Detroit’s Henry Ford Health System, became an enthusiastic user. Support grew.

Menon watched Guthart build the company. “(Guthart is) used a scientific method to collect data and took notes,” Menon said. These notes prompted Intuitive Surgical to modify instruments to help urologists.

The company still faced a big hurdle. High-ego surgeons resisted change. This was relatively easy to correct, though, because of the ease of robotic surgery and the better outcomes.

Intuitive showed its equipment at surgical gatherings. At one, a young resident exclaimed: “I’ve just spent seven years of my life learning to do (surgery) laparoscopically with sticks and now” — he points to a security guard — “he can do it.”

Be A Salesperson With Facts

Convincing hospitals to buy the equipment proved more difficult. Simply, da Vinci was expensive: $1.5 million at the time. Hospitals have a number of financing options now. But those choices didn’t exist early on.

So Guthart relied on stats. “Hospitals were fixated on the cost of capital equipment. But there are all kinds of costs beyond the equipment: the surgeon, the anesthesiologist and scrub nurse, the overhead of running the hospital,” he said. “What really matters is the total cost of treating the patient.”

Community hospitals signed on first. Smaller facilities were “looking for the efficiencies.” The robotics surgery also provided a marketing tool.

See A Bigger Opportunity

Alan Mendelson, who worked with Intuitive Surgical as legal counsel, credits Guthart for the company’s growth.

“Gary’s ability to transform (Intuitive Surgical) … from a small, single-product company to a large 7,000-plus person organization without losing the culture, soul, and focus on what enabled the company to initially succeed,” he said.

So it seems, in the end, Guthart’s choices were a slam dunk.

Intuitive Surgical CEO Guthart’s Keys

• Rose from a programmer at fledgling Intuitive Surgical to president and then CEO in 2010. Helped the company manage explosive growth the past decade.
• Overcame: Resistance by doctors and hospitals to trust, and pay for, robotic-aided surgery equipment.
• Lesson: Spot and take advantage of opportunity wherever it comes from. Your path to success may not be what you expected.
• “When I came out of school my thought process was to find a great technology.”

https://www.investors.com/news/management/leaders-and-success/intuitive-surgical-ceo-cracks-the-da-vinci-code-of-success/?src=A00220&yptr=yahoo