Sina H

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Great points David. You hit the nail on the head with consolidation. Days of the local small-time lab are numbered due to economies of scale that larger labs have. Lower shipping costs have also made it easier for docs to shop around for better deals. One of my attendings ships cases to a lab in Las Vegas that promises 4-5 day return (shorter than local labs, higher quality). The point about vertical integration meant that labs can experiment with materials to create a branded metal which they can sell to docs in block form (docs could use their machines to cut crowns out of this). Glidewell ( did this by designing their own Bruxzir line of anterior esthetic crowns.

As far as costs, I’m not sure how reimbursements will change, if it all. Sadly, it is hard to imagine dentists lowering their fees even if they’ve created efficiencies in their process. If this becomes widespread, perhaps insurance companies will reduce reimbursements in the future. In an interesting model is happening in orthodontics however. Smile Direct Club, is a new business that allows patients to take impressions on themselves, and the company mails Invisalign retainers they manufacture to fix malocclusion issues at $1500, which is $3500 less than the conventional cost of orthodontic treatment. It’s an interesting idea that actually takes the patient out of the operatory, which does introduce some ethical/legal questions regarding patient care.

Nice points Ting! There’s still a lot of potential for the labs- they will be sticking around for a while. Master dental technicians undergo years of training and are invaluable in constructing more advanced restorations (esthetic dentures, implant-retained prosthetic work, etc). An interesting revenue source would be to provide on-demand consult for designing restorations digitally, since there is a steep learning curve for using the software that still prevents docs from adopting CEREC.

Good questions Philip. CAD/CAM is well positioned in the labs currently since they can use them closer to capacity than individual offices. However, it might not matter so much since the cost ($20 k for impression scanner, $80k for milling unit) has come down enough to that docs can pay this off in 1-3 years from saved lab fees. (It’s also possible for a doc act as a ‘lab’ for nearby clinic- thereby creating an additional profit center for the clinic). Reimbursements won’t change in the short-term. Milled units are cut from high-strength zirconia which is more expensive than conventional material used for crowns. Also docs probably pay a higher price for zirconia blocks compared to the labs, so they would probably compensate by keeping fees the same.

On November 20, 2016, Sina H commented on Oilfield Services Industry: Downturn to Digital Transformation :

Nice work EK. It would be interest to see how digital capabilities improve operating efficiencies and safety in the drilling sector. I’m wondering though, how much all this technology would prompt distraction among the employees. Essentially, glass and other wearables make it easier to have computer access on site, which would enable employees to discretely check email, social media, etc. on the job. What type of protections could be put in place to allow workers to use these devices without distracting them from demanding tasks and increasing the risk of errors which the technology intended to minimize?

Wonderful post Anto! I’m curious if you know about how the University segmented add-periods for various courses. I know at my University, the class was parsed into separate groups that each had a certain queue number for various courses, meaning there was a good chance of them getting into some popular courses, but not a good chance at others. The system provided some parity by preventing classes getting unfairly filled up at a certain time, since not all 1st year students could register at the same time. It’s possible for your university to address it this way, in order to reduce the demands on the system for numerous add-drop requests.

Has there been any developments on a mobile platform? This could potentially solve the issue of access without adding extensive IT cost to the university for building more computer labs.

On November 20, 2016, Sina H commented on Garmin: Lost in an Interconnected World :

Very nice post Mike. I completely agree that Garmin needs to leverage existing tech and pivot towards new markets such as wearables and in aviation/marine equipment. Any possibility for them to remain in the auto sector? Many still find using a phone for navigation quite cumbersome. It would be interesting if they could partner with auto manufacturers to develop in-dash navi systems in manufactured cars. Another thought I had was developing discrete tracking devices for cars, bikes, or personal items, which could then be tethered to a mapping device. This is an untapped market that will see great demand in the future.

On November 20, 2016, Sina H commented on Turo: the Uber Model for Rental Cars :

Nice post AVO. I have been an avid TURO/Relay Ride user -mainly attracted by the competitive pricing and selection of cars. Thinking back on my experiences the benefits of TURO has been the convenience. Most often, the individuals who rented cars to me would give me a code to unlock the car and I would be off – no long waits at enterprise, no extensive paperwork for insurance, etc. While I see a lot of benefits, I do find find it difficult for them to break out of this niche market. I believe the vast majority of people do not feel comfortable driving someone else’s car due to liability issues, which separates this from traditional sharing services like AirBnB. Turo has a challenge to change public perception and ensure that adequate protections are placed for both the driver and renter while still staying competitive with pricing. I also believe they need to scale up their offerings in major cities (the company is still not well known) by playing around with their margins.

On November 20, 2016, Sina H commented on CVS: From Consumer Value Stores to Consumer Value App? :

Very nice post Wiss. The CVS approach to consumer health has certainly been an admirable one. It seems like they’ve taken stabs at each segment of the health care value chain in order to increase accessibility and affordability of health care for the general population. I think this is essential, especially in high friction services like primary care, which is constantly plagued by high wait times, costs, and inefficiencies. It would be interesting for CVS invest more in its primary care infrastructure and facilitate greater coordination with physician and hospital groups. Big data can be shared with consumers’ physicians in order to better understand health from a population and patient perspective. Advances in diagnostic technology can make it easier for customers to get rapid blood draws as part of every CVS visit, for instance, which can log important diagnostic information and relay this to patients. Even better – detection in vitamin deficiencies could immediately signals to the patient to purchase supplements in the store that day, leading to a more rapid, responsive health support system.

On November 6, 2016, Sina H commented on Allianz: Insuring Both Sustainability and Resilience :

Very nice post Ben. I also wrote about an insurance company and was surprised to see how little the industry is doing to address this state of increased risk. The consensus seems to be that these extreme events are rare, and weather models are not predictive beyond the very short term. Thus, pricing the risk is very hard. That being said I don’t see this being a huge problem, as they can always respond with higher premiums and higher capital adequacy ratios as you mentioned. Warren Buffett himself told investors not to lose sleep over the effects of climate change on his own insurance business. Rather than passing the risk on the consumers, I imagine insurance companies can strengthen their image by providing premium incentives for households that invest in clean energy while underwriting insurance for clean energy technologies. Climate change, at least for now, is good business for the insurance industry.

On November 6, 2016, Sina H commented on Paper for the Planet :

Very nice post! WestRock clearly has a good handle on sustainability despite being such a huge producer of paper products. I’m curious if there are any innovations that we will see in the future related to paper production. Does it HAVE to come from trees? Is there a production process like particle board that uses a higher % of the logs cut down?

A common trend I’m seeing here with companies that truly tackle sustainability is that they address sustainability at all levels of the supply chain. From their own manufacturing, to ensuring compliance from wood procurement, to recycling over half of their own production, WestRock has clearly made a strong commitment to reducing it’s minimizing it’s ecological impact and I wholeheartedly believe that this is related to its continued success. Good work!

On November 6, 2016, Sina H commented on ITC: Leading India Inc.’s sustainability charge :

Very nice post! I think India often gets ignored on the topic of climate change. I watched climate change documentary recently that highlighted a particular challenge India will bring to the climate change front: their rising middle class. As it stands now, hundreds of millions of Indians will start to come “onto the grid” in a few years as socioeconomic conditions improve, which has huge implications for fossil fuel usage. If India is committed to renewable energy, there is a huge market potential to provide renewables, maybe in the form of solar panels/batteries to ensure that this growing population does not have a negative impact on GHG emissions.

Agriculture is a key industry that needs to respond and it looks like ITC is moving in the right direction. One thing that needs to be addressed is the risk of farms/crops being destroyed by extreme weather events related to climate change. Despite negative popular opinion, I think we need to move towards genetically modified crops (or perhaps microbial-enhanced??) to ensure that our crops are resistant to dramatic weather changes.

On November 6, 2016, Sina H commented on Health Care without Harm :

Very nice post Ting! As a clinician, it’s extremely hard to be cognizant of your carbon footprint. Between managing patients, rendering care, leading teams, and managing the business aspects of a practice, reducing waste in your practice can become an afterthought. In practice, hundred of pairs of plastic gloves, patient bibs, and disposable materials go straight to the trash. The hard part about managing this waste is that virtually none of it can be recycled because it potentially has contaminants from patient contact. There could be ways to recycle these materials while getting rid of potential microbes and pathogens –we just need the technology! Beyond this there’s definitely low-hanging fruit that can be addressed by both hospitals/clinics and supply companies. Better coordination in terms of demand and storage information can allow manufacturers to send materials in bulk, thereby reducing transportation costs. Simple, resource-efficient packaging would also reduce the wasted associated with medical products. On the medical side -I would argue that further investment in biomedical research is necessary, as advancements in medical and surgical technology has the potential to reduce hospital admissions and their associated carbon footprint.

Very nice post summarizing Tesla’s strong position in renewable energy and zero-emission vehicles! Tesla recognized early on that simple making electric vehicles will not curb the world’s dependence on fossil fuels and it’s consequential emission of GHGs. Because Tesla batteries need to be charged with electricity, Teslas will still have a carbon footprint associated with burning of natural gas and coal to generate that power.

The Gigafactory is an IMMENSE undertaking (figuratively and literally -10 million sq. feet!) by Tesla and a huge step in the right direction. The promise of batteries used to supply energy brings a lot of hope, especially in the developing world, where is a lack of infrastructure in generating power. One fact that struck out to me from a recent climate change documentary I saw was that India’s rising middle class (~300-700 million people) will start to consume more natural energy resources which will have untold impacts on GHGs. I’m curious if Tesla has a strategy to work with developing countries in order to distribute/sell these batteries to areas in which the fuel alternative will be much worse for the environment.

Apparently, it will only take 100 operational Gigafactories to make the ENTIRE WORLD 100% renewable. Clearly, this seems within reach -but no one is stepping up to the plate. I’m curious to know what Tesla’s role, if any, will be to partner with states, international organizations, and NGOs to influence policymakers to take direct action to discourage further consumption of fossil fuels and develop renewable capabilities before it’s too late.