Monday, October 26, 2009

Faith in Stupidity

Vivus Inc is a pharmaceutical company that is currently in phase 3 trial of a new weight loss drug.  The results of the studies done so far are encouraging and everybody knows that a pill for weight loss is a gold mine.  If it works as well as they are touting a few people may get very rich as the BMI of America decreases.

At the moment Vivus stock (VVUS) is up 16% in morning trading.  That's not to be unexpected and it gives me a lot of hope.  It confirms to me that there are still a lot of stupid speculative investors out there.  For one thing the new drug that Vivus is marketing is nothing more than phenteramine and topiramate.  Both of those drugs have been on the market for a while.  If this new drug does become something of a money pipeline it will be for one of the big pharma companies after the rights are purchased from Vivus.  Will Vivus make money off the deal?  Sure they will, but not enough to cover the losses they have had over the past 9 years.  The last time Vivus declared a profit for their shareholders was 2000.  In the 9 years since then Vivus has had a combined net loss just shy of $100 million.

Even if this new drug is all it says it is, it will be years before it becomes profitable, once again for another company.  If it does work we're all just going to be prescribing the equal doses of phenteramine and topiramate that will both be generic by the time this new wonder drug is approved for release by the FDA.

As long as there idiots out there throwing money at companies like Vivus there are deals to be found for long term investors.  Certainly a great boost to the efficient market theory (don't even get me started on that).

Wednesday, October 21, 2009

Recovery or Bubble?

I'm starting to get depressed about this economic recovery. Overall I'm glad to see the country emerging from last fall, but the speed of the stock market upswing is unreal. I'm up over 60% this year and I feel somewhat like I did 2 years ago when nothing looked appealing. Investing has been easy for the past year. Throwing darts would produce a sizeable return, but now the bargains are drying up. I fear we may be heading into another bubble. At this point one of my greatest hopes is that this upswing might be sustained by the massive amount of money that will continue to flood the market as employers start to reintroduce the company match on retirement contributions.

As for now, I'm still bullish on Nike, Harley Davidson and I'm starting to take a closer look at Buffalo Wild Wings (you gotta admit the commercials are catchy), though I've never eaten there so I may have to do that before I lay down any investment money.

Tuesday, September 8, 2009

Perspectives On Life - View from a Resident

How's that for a title. I actually have some serious thoughts this morning that I would like to put down.

Recently I admitted one of my clinic patients to the hospital. She was a relatively new patient to me that I had seen one time previously (a couple of weeks earlier). After arriving to the hospital floor she went into Cardiac arrest and was transferred to the ICU.

It is unknown how much damage her cardiac arrest did to her brain function as she has been on the ventilator for almost a week and a half now, but she seemed to be coming around. She was able to respond when I talked with her each morning. Overall she had been improving. This morning I came in to round on her and found her extubated and unresponsive. She had passed away at 2 AM. I had not been called because the resident on the floor had been present for the code. It would have been nice to get a call around 6, but I understand.

So now my mixture of emotions is unlike any I have felt in my life. On the one hand I feel sorry for the daughters of my patient. She was doing so well just a month ago. She went downhill quick and as I look back I'm sure there are things that could have been done differently with the knowledge we now have, but in reality no mistakes were made in her care.

There is also a portion of me that feels relief at her passing. I'd like to say that this relief comes from the knowledge that she would most likely live out the rest of her days in a nursing home struggling with her constant pain issues, but a lot of my relief comes from the fact that she is not my responsibility every morning for the next 2 months. I no longer have to get to the hospital each morning to care for this critically ill patient. That seems very selfish to me, and it probably is, but that is the direct effect of her death on my life.

I wonder if my reaction would be different had I known the patient for a year instead of a month. Am I already that jaded that a critically ill patient is just 30 minutes of extra work per day? I don't believe that is the case, but I feel somewhat deceived by my feelings this morning.

Wednesday, August 19, 2009

Back to the real world Bertier

I'm doing my best to be happy about the learning I'm experiencing since coming back from vacation. I've had exactly one day without one of my patients in the hospital since returning home. The patient I currently have in the hospital started feeling sick 2 weeks ago. Interestingly enough she had an appointment scheduled with me 1 month ago and an appointment with her nephrologist 6 weeks ago. She missed both of these appointments and now she's sitting in a bed in the hospital and will be there probably through the weekend at least.

I don't mind it when people get sick. It happens, but when patients repeatedly miss appointments and then get admitted to the hospital for things that could have been easily adjusted a few weeks previously it frustrates me. Interestingly enough this only happens to my patients who don't actually pay for their medical care.

You should care about this as well because the aforementioned patient is on government insurance (you know, the one Hillary thinks works so well). The government is currently footing the bill for her hospital stay that is thousands of dollars per day. The two appointments that she missed would have been billed under $400 together. She's probably going to get better either way, but one costs us as taxpayers quite a bit more money. The patient pays the same goose egg either way, though when my patient goes to the hospital she gets a taxpayer funded ride in a taxi with lights. She has to find her own ride to her appointments.

I don't know the solution, but free universal coverage will not improve this problem.

Sunday, May 3, 2009

The Woodstock of Capitalism

As has been stated by Warren Buffett in the past the Berkshire Hathaway annual shareholders meeting is the woodstock of capitalism. Having just returned from said meeting I will now give my report.

The meeting started Saturday morning with the yearly movie. Apparently the movie has always been a very enjoyable part of the day's events and this year's movie did not disappoint. Interspersed between the numerous entertaining commercials from Geico, Coke, and a myriad of other Berkshire holdings were various snippets of a mock interview with a high ranking investment banker, who spent a good deal of time laying out the stupidity of his peers while commenting that it actually only affected everyone else as he and his peers made out very well.

Following the movie we jumped right into the question and answer session. The Berkshire Hathaway meeting is somewhat different than other shareholder meetings in that the bulk of the meeting (9 AM to 3 PM) is a q&a with Warren Buffett and Charlie Munger. As opposed to other years, the majority of questions centered around Berkshire and it's holdings, but we were also entertained by the Oracle's answers to other questions ranging from inflation, to the Chinese economy to personal investing style.

At one point a question was asked about how we can attempt to teach high finance to the upcoming generation as they are obviously financially illiterate. Warren jumped on that by stating that the current generation is financially illiterate. Charlie followed by noting that it may not be possible to teach high finance to those who cannot handle credit cards. I believe at least 30 of the 35 thousand in attendance were laughing heartily at this point.

As is custom both Warren and Charlie took their shots at American business schools. When asked how he would change the business education in this country Warren quipped that he would teach two classes and get rid of all the rest. What are his two classes? The first class would be a securities analysis course detailing how to value a business and how to stay within one's circle of confidence. Fans of Buffett are very familiar to this concept though I'm not sure many do it well. The second course would teach students how to think about market fluctuations. In thinking about the market Buffet stated that a great deal of emotional stability is required. On the same subject Charlie wondered out loud what exactly has been taught in business schools especially back in the heyday of the efficient market theory: "I mean what do you teach when you believe the markets are efficient? You arrive at class, state that the markets are efficient, then have nothing left to add for the rest of the hour let alone the rest of the semester."

When questioned about how Bershire would change now that they had suffered their biggest one-year drop in the history of the country Charlie calmly stated: "I don't get too excited about these things that come around every 50 years".

There were questions about why Berkshire does not webcast the annual meeting like so many other companies. Warren went on about the personal touch of being present at the meeting. While I agree there was definitely a personal touch being at the meeting I'm convinced that the real reason is that a webcast would encourage more shareholders to stay home and the many Berkshire businesses that benefit heavily through the weekend would suffer. Buffet likes his shareholders to spend money at their businesses.

Buffet answered a question about how to protect against inflation from an 11-year old boy by saying: "The best protection against inflation is your own earning power. The second best is a wonderful business."

Throughout the meeting I was impressed with the ability of Warren and Charlie to use simple analogies to desribe investing. Towards the end of the day a question came up of how to determine when to buy a company in this economy while stock prices are falling. Warren used the example of a burger stating that he knows he's going to be buying a lot of burgers in the future and if the price tomorrow is less than the price today he is happy, not worrying that he paid more for the same burger yesterday.

As an added bonus I sat next to an investor who had flown in from Ireland for the meeting. Before the show we got to talking about healthcare. Ireland has a combination private public healthcare system like many European countries. He stated that currently they are set up so that visits to general practicioners are a flat 50 euros and the GPs determine who should and shouldn't be admitted to the hospital, unfortunately many people have stopped going to their GP as they do not have to shell out the 50 euros if they go directly to the Emergency Department (sounds very familiar to me). I asked him about surgery wait times and he stated that it is very normal for someone without private insurance to wait for 2 years or more for a hip replacement. Somehow I don't think the average taxpayer is going to accept that here in the states.

Overall it was a wonderful day and certainly worth the trip. I hope to return many times in the future.

Tuesday, March 24, 2009

Frustration with the 401k, and 403b

History shows us that longterm investment in capital markets leads to excellent gains. With that in mind an inumerable amount of vehicles have arisen to help people to get a piece of the pie. With the increase in retirement accounts over the past quarter century there is more and more money being managed by the "professionals". The way this money gets into their grasps disgusts me.

If you have a retirement account through your work you have probably noticed that there is quite a discrepancy between the number of investment options available when you open the finance section as compared to the investment options offered by your company. In my 403b at work I have less than 2 dozen funds from which I can choose to place my retirement funds.* If it weren't for the company match I would forgo the whole thing. Contrary to popular belief I do not believe that tax savings is the do all end all for my future.

I currently have all my 403b in two funds. I have the majority of that money in the Vanguard 500 index fund (very different than an actively managed fund) and the rest is in an international fund for the sheer sake of diversification, though I may liquidate that fund in time.

At least my account offers the Vanguard fund otherwise I'd be throwing darts. I don't have the faintest idea how to evaluate a mutual fund. Mutual funds own hundreds to thousands of individual stocks. They all have their stated goals, but in the end it all boils down to maximizing profits while maintaining principle. How do I compare one to another? Each fund touts (or hides as it were) it's return over the past 1, 5, 10, and 15 years for those who have been around that long, but they all seem to be written on paper with the watermark: "Past performance does not guarantee future results". Why would I put so much money into a fund that is managed by a person or persons whose methods of investment are foreign to me. If I want to invest in a man I'll be putting my money in Berkshire (in fact I do have a significant portion of my non-tax-deferred account in Berkshire).

For the time being I will stick with my Vanguard non-managed retirement account and put the rest of my money in my Zecco account where I can buy Nike and Harley (currently trading at 5 times earnings) as I please after evaluating the balance sheet, earnings and current price. I may even read up on the CEO and majority stock owners if it fits in my schedule.

*I do have a personal choice options that apparently allows me to buy stocks and funds not offered in my plan, but as of this writing I have not been able to talk with anyone who can elaborate on the fees and procedures to do so.

Friday, March 6, 2009

The case for K-Swiss

K-Swiss is a shoe/apparel company that originally made only tennis shoes. They have recently begun to branch out to other types athletic shoes and as a result of the current market buying the stock is almost like stealing.

K-Swiss doesn't have the brand appeal of Nike for sure, but it does have a loyal costumer base. They make a good quality product and thus far have been able to maintain a good profit margin and increase earnings fairly regularly. That alone does not make the stock a good buy, but without it I would be hesitant to purchase even considering the numbers that follow.

K-Swiss has current assets of $334 million of which $209 million is in cash. Current liabilities total $53 million. They have almost no long term debt. That in itself is enough to get me somewhat excited about the company. Because of their debt to equity ratio they are well positioned to weather the storm of our current economy. Looking at last quarters numbers it is apparent that they used quite a bit of cash to do just that. Like many other companies they lost money in the last quarter.

K-Swiss has 34.86 million shares outstanding. Assets minus current liabilities equals $281 million. Cash minus current liabilities equals $156 million. Those numbers divided by shares outstanding gives you $8.06, and $4.48 per share in assets or cash alone respectively. So when you buy a share of K-Swiss you are buying between $4 and $8 of cash depending on how confident you are in the companie's ability to liquidate current inventory and collect on accounts receivable. That's nothing special until you realize that K-Swiss closed at $7.09 per share yesterday. Now the whole picture becomes a bit more clear. At the worst you are paying $2.61 per share (7.09-4.48) for a company that had increased earnings at a rate of 26% per year for the 8 years previous to 2007 (the earnings have decreased for the past two years, but the company hasn't shown a loss until this past quarter). In 2006 K-Swiss had earnings of $2.17 per share and I have no reason to believe that they won't get back there when the economy turns around. If I believe that K-Swiss could easily liquidate their inventory and collect on their accounts payable in the amount shown on the balance sheet then I actually make $0.97 per share (7.09-8.06) as soon as I purchase the stock and the actual business is just icing on the cake.

Could K-Swiss bottom out and go under? Are their numbers cooked like Enron? The answers to these questions could be yes which is why the decision to buy isn't quite as straight forward as I described in the last paragraph, but for me it's a no brainer (though the next little while could make me sick if I watch the ticker each day).

Wednesday, March 4, 2009

What to do with this recession?

Like most people I have strong emotions concerning investments. At times those emotions get in the way of sound financial decisions, but lately I have noticed that I am wired a bit differently than others I have spoken with.

Anyone who knows me or has read previous posts may have noticed that I am not exactly fearful of the current market. I have even been known to sound jubilant from time to time over the past 8 months. Much of that comes from the fact that the only significant money I have in the market has been invested in the past 8 months. I might feel differently had I owned bank stock that was worth $250,000 just 18 months ago and is now down to $25,000. I do have a little over $1,000 of that same stock that I have watched fall from $10,000. It is also true that I have a well-paying job in a very secure field. With those things in mind it isn't too hard to see why I don't get down when I see the Dow fall to record lows each day.

Many people have cut back on their purchases with the dwindling economy. I think a lot of sacrifice has been made across the board and I am no exception to that, but my thinking on the matter is different. I have not cut back because I have to (I have more income now than at any previous time in my life) but because I want to. I recently got a sizeable tax rebate (thank you Mr President) and initially I thought about using that money to buy a truck. I have always wanted a truck and they are selling for cheap now. I didn't buy a truck I put all that money in stocks (Microsoft, Berkshire, Apple, Nike and Wells Fargo). I still want a truck but when the market is as low as it is now I just can't afford to pass up these opportunities.

Eventually we will come out of this recession. When we do there will be a lot of Americans that are very scared of the stock market. I hope we get back to some basic values of thrift and saving as a nation and get rid of some of our debt. Whether or not that happens, now is the time to position yourself for the future. There has never been a time in my life that has presented more opportunities for those with some money to invest. As I've said before I don't know if the market has hit a bottom or when it will, but I do believe that enormous gains will be made by those who are investing for the long term today, however, if you can't handle watching another 50% drop in money you invest today you might want to close your eyes.

Tuesday, January 27, 2009

Invest now!

I've written about my enthusiasm in our current economy before, but never have I had such a desire to put my money in the market. There are deals all over the board. Hundreds of good solid companies are being slammed by the market and they are selling at record levels. The return on the companies is going to be through the roof 10, 20 and 30 years from now.

If you don't like dabbling in individual stock put your money in an index fund, but do it now. Unless you are trying to get out from under credit card debt you should be putting any available money you can into the market. The S&P 500 peaked out just under 1600 in 2007. It currently sits at 850. I'm not saying it won't fall further. I can't predict the bottom and if anyone says they can you need to steer clear of that person.

If you were in the market for a 50 inch LCD that was $1600 and got slashed to $850 would you wait to see if it goes lower? I wouldn't. I would buy the thing and enjoy the Super Bowl on Sunday (speaking of which the best time to buy a TV is the week following the Super Bowl because of all the discounts).

If you believe that American business is out of luck and we are going to falter as a country and as an economy then by all means buy some land, build a cabin, dig a well and go be happy, but if you are like me and feel that the economy will rebound sometime and things will be business as usual in the next 10 years then get some money in the market.

Personally I think Microsoft is a great buy right now. The announced layoffs hammered the price of the stock, but that just shows me that the company is in the business of making money. Harsh as it may sound I'm not looking for a feel-good company to put my money in. I want a company that can make the right decisions when it needs to. Microsoft is suffering because the public isn't buying new computers or new software, but do you think that will last? The economy will rebound and I'm betting that when it does a lot of people will be upgrading their computers. When that time comes Microsoft will shoot up again. That's a boat I want to be on.

I also think there are some good banks out there that are going to come out of this recession like champs. The banking industry is getting hammered and because of it some very good businesses are selling for cheap. Check out Wells Fargo.

Sunday, January 18, 2009

Inauguration: A sign of things to come?

As we are now in the midst of the worst economic downtrun of my lifetime many are looking to the highest office in the land to make the policy changes to bring us out of this recession. Yet as we begin this historic term we are asked to swallow an inauguration party with a bill of $140 million.

I'm not about to say this isn't a moment that should be celebrated. Barack Obama being sworn in is a wonderful moment for all Americans not just African Americans. Maybe we need this party as Americans. Maybe we need to splurge for a weekend during these hard times. Maybe it's important to let your hair down every once in a while. Or maybe our president elect should have said "hey we've got to tighten our belts as a country" and start with his own party.

I, for one, hope this is just a splurge for a momentous occasion and not a sign of fiscal irresponsibility for this administration, an administration for which I voted and fully support. Washington resembles Hollywood more and more each day and I believe this blatant disregard for taxpayer funds is just another example of the disconnect between the powers that be and the powers that make them be.

Not even president yet and the man has already disappointed me.

Tuesday, January 13, 2009

Electronic Medical Records

President elect Obama wants to computerize all the nation's health care records in 5 years. I'm not going to go into how much this will cost or whether or not it is feasible, but I will put my support behind it. I work in a hospital and clinic that are both almost entirely paperless. We still have some paper floating around for things such as MRI because the MRI is owned by two hospitals and the radiology group and not all are on the same EMR (electronic medical record).

I love electronic medical records. The transition from paper records to computer records is going to be very difficult for many physicians, but for those of us who are now being trained, computers are second nature. The errors that are avoided by not having physicians write their notes or orders are just the beginning. In addition you also have the accessibility to patients records whenever you need them. When I'm on call I can review labs, read consultant notes, and put in orders all from the comfort of my own home at 2 AM. When a patient of one of my collegues calls with a request for a prescription that was written but never called into the pharmacy I can quickly bring up the chart and read the note from the visit earlier in the day.

IHC in Utah has one of the best EMRs I have seen. In addition to being a very competent program it is also used by all the IHC facilities in Utah and thus it is possible for a physician in Southern Utah to see the results of a test done at Primary Children's Hospital in Salt Lake minutes after the test is reported. Physicians can share common drug formularies across the state to increase the speed of the paperwork required by the healthcare industry.

My hospital went paperless less than one year ago and it has not been easy. Many of the older docs complain (loudly and rather unprofessionally) every day about the system, but I love it. I enjoy being able to read what my consultants have to say rather than spending my time translating the chicken scratch of the cardiologist.

When I was in medical school I was very worried about the regulations that were coming down the line to prohibit cursive writing in prescriptions and to eventually requiring all prescriptions to be printed or phoned. Since graduating from medical school I have not written one prescription by hand and in that time I have only received one call from a pharmacy requesting clarification on an order.

I think Obama has a good idea here and we would be smart to get behind it.