UNF2007

I'm currently on AD in the US Army, actually just got back from a 5 month deployment to Afghanistan a few days ago, working at an FST. I would suggest not asking if he killed anyone (although the curiosity is natural, my 7 yo asked me the same question, which is kind of funny since I'm a surgeon), maybe instead as others have suggested ask about his experiences. Almost every warfighter I have met in my 17yrs in the Army, if they are involved in direct action, will have some level of PTSD from it. It's violent nasty work, in terrible environments.

Read through that article, it's interesting they say 95% of the crypto money is owned by 5% of the 13 million investors. Very top heavy. The guy talking about ICO's ( initial coin offering) was also crazy, people inventing new cryptocurrency and then selling it to the public, taking the money and cashing out. In my mind they are basically bypassing the valuation problem, by calling stuff currency. If you were trying to IPO a business, that had no assetts, cash flow etc. that would be a tough sell, but instead of shares call it xxxcoin and your golden.

http://www.businessinsider.com/buying-bitcoin-from-las-vegas-atm-2018-1 Just read this article, is this true about the transaction fee being 40-45$ now? If so it seems absurd anyone would use this as a medium of exchange for small transactions.

Looks like return on my IRA, which is indexed was 22.4% Return in my self-managed funds 51%, from a single very concentrated position in CLWY.

This is a really tough question to answer. I think part of it is there was a push in medical schools and nursing schools around the early 2000's driven by the Joint Commission, who accredits hospitals, to call pain a 5th vital sign. This was a big national push at the time. People felt pain was under treated and doctors were then somehow liable if a patient had pain and felt it wasn't being treated adequately. That opened the door in ER's with something called Press-Ganey scores, that are from patient satisfaction surveys. Part of that was a question to the patient if their pain was adequately treated. ER physicians compensation depends in part on how they score on those surveys, in many places. Also people who come in wanting narcotics and leave with nothing are probably not going to leave a good review. So in effect your incentive in the situation is to prescribe narcotics. Nurses were also indoctrinated into this pain is a 5th vital sign. They drive prescribing more then people think, on the inpatient side. They are the ones that are monitoring the patient and calling the doctor for more pain meds if they think its needed. The mindset that patients should be pain free or nearly so, drove more pain meds to be given. For a long time narcotic abuse of prescription was not in the lexicon for doctors. Anecdotally I did a surgical oncology rotation about 3 yrs ago at a major cancer research hospital. We were basically working with people in clinical trials, with end stage cancer. Many of them lived in other parts of the country, so we were instructed to prescribe them enough pain meds to last 3 months between visits. If someone is using 5mg of oxycodone every 4 hrs, that works out to 100's of pills. I refused to do it, and as a resident that is not something that is easy to do since your whole livelihood is dependent on graduation. But they just found someone else to write it. I even asked the person who was writing it, if they had any idea of the market value if the patient decided to sell it, I got very weird looks. Also of interest is that for a period about 80% of all the oxycodone prescribed in the country was being prescribed in Florida. There were many doctors, many of them foriegn medical graduates working as family practitioners who were basically running pill mills. The doctor would charge 200-300 for a physical exam, document back pain or some nonsense and prescribe a predetermined amount of narcotic. Which the person would fill and turn around and sell, and a portion of the narcotic would be given back to the doctor , to use or sell. It's interesting to me to hear how little narcotic people can actually get by with after surgery. I have altered my own practice, and after hernia repair usually only give out 10-15 percocets or equivalent. I'll give the person my contact and they can call if they need more, almost no one does. There is a big push now for us to come up with standardized amounts of narcotic for each procedure I'm working on it now,I think it will turn out to be way less then what people are now giving out, that is locally. Nationally something similar is in the works through the ACS.

I think for an individual without a team of analysts and limited resources, concentration makes absolute sense. Of the opportunities that I can look at due to time, a small percent I can understand, and a small percent of those are actually good values after I go through the analysis. To me it makes sense that if I work at it I can find 1-2 good ideas a year, but 20 or 30? no way.

For me I would put this in the to tough pile. The reason is that your REITs are dependent on the SNF for revenue. The facilities are most likely purpose build for that, and your not going to find a higher and better use for the SNF facility, or a better tenant. The SNF ability to pay is driven by the money they get from medicare and medicaid for the most part. Many SNF are low quality when it comes to delivery of care and getting good outcomes, CMS has realized this, and there is a value based push, meaning they are going to start changing the payment mix to be biased to lower cost and higher quality facilities. Quality is a very elusive thing in health care, and my feeling is that it's not quality that is so much the objective, but finding ways to push down cost. quality metrics are set by medicare and medicaid and are going to be biased to drive down payments. In another words, there will not be winners, it will be a few who keep the same rates of payment, and a bunch who fall short. So then the question becomes how much do you trust the SNF's that are part of your REIT portfolio? Are you in a position to make a judgement on the quality? The other question is how to figure out what payments look like going forward? A brief glance at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/SNF-VBP-RTC.pdf, tells me that it's not even clear to the people writing the law how they will structure payments going forward, so not sure how an individual investor would figure it out. Maybe if you have a team of people to dig through everything and model it? Anyway those are my thoughts for what it's worth.

You should listen to some Coast to Coast AM, they have people all the time on who discuss stuff like that in a pseudoscientific way, it's really entertaining, and scary at the same time. They also cover topics as diverse as cryptozoology, underground military bases, archaeological and anthropological mythology etc.

Wasn't my idea, but it's by far my largest position, and still has a way to go to fair value. CLWY

As a user of the medical literature I definitely understand the frustration some of the doctors in the article expressed about literature being untrue. As a recent example I was trying to figure out what the evidence was for sending someone on prophylactic anticoagulation after an operation for colorectal cancer, for 28 days vs stop when they leave the hospital to prevent deep vein thrombosis. There are society guidelines (colorectal, heme/onc, Chest guidelines etc), but if you use the studies they base the guidelines off of, the main one was funded by the company that makes lovenox, and all the statics were performed by a person hired by the company rather then the authors. This is mentioned in a single sentence in the methods section. The reason? Probably the study would have never been done in the first place without the funding. It's that way for lots and lots of medical research, and it makes the conclusions really hard to take as unbiased. The other problem is even if something has been studied, the studies age and the conclusions may no longer be true. For example best medical management vs CEA(carotid endarterectomy) for stroke risk reduction in asymptomatic patients. The medicines and surgical techniques/anesthesia change over time, so the answer is dynamic, the study has to be redone periodically. Many questions in medicine are similar, the answers change over time even if it has been "settled" at some point in the past. We have a weekly journal club in surgery, where we review recent literature, someone presents and we come to our own conclusions and then discuss it. At the end the question is always will this change your practice, the answer is no like 95% of the time, because many of the studies are narrow, low sample size, retrospective in nature etc. People will keep publishing them though, because there is great incentive to do so. At the same time it's the best we have, the alternative is just using your own best judgement based on experience, which more often then not is what people do. The evidence based medicine thing is really only like 10% of medicine, most stuff has not been studied enough, or there is enough grey area that many different things are acceptable. I think that if people want to question things critically that is good, because not everything done in the name of science is completely benevolent. But each question is separate with separate evidence to consider, painting a broad brush against "Research" or "GMO" or "Vaccines" is kind of simplistic thinking in my view. As an aside I read through the GMO article. #1 its an open access journal, meaning the people who published it paid the journal to print it #2 It's not designed to show if GMO is carcinogenic, and is stated as such by the authors, they only use 10 rats per arm, the standard to get statically significant data is 50, which is why incidentally they don't perform any statistical analysis on the data they present. #3 It's very hard to understand the way it's written, there is no methods section for example. They do state the analysis they performed of the GMO maize vs non GMO showed it to be chemically similar, with the exception of lower phenolic acid in the GMO group. In figure 4 they compare 11 22 and 33% GMO diet maize (the % refers to the amount of roundup used as pesticide), with the addition of roundup in the water fed to the rat, to a non-GMO diet and no roundup in the water or as a pesticide. There is a problem with that, in that it's difficult for me to conclude if its the diet or the roundup that is causing the higher incidence of tumors at 12 months in the experimental arm. The conclusion of the article is that 90 day monitor for tumor formation is insufficient as the current standard , because the majority of tumors come after this. I don't disagree, but the original article" http://wakingscience.com/2017/03/peer-reviewed-science-losing-credibility-large-amounts-research-shown-false/" citing this as something that was buried by the scientific community as evidence for carcinogensis of GMO is bogus.

Two portfolio's Active Long Only: HRI (spinoff from Hertz), MDR, PIH 80% : 20% Cash Passive: Vanguard Total Stock Market Index

See point #2 from Jack Bogle, lol https://www.yahoo.com/finance/news/retirement-crisis-actually-three-says-103024629.html First, I'm in agreement with what others have said, this is basically a problem of 1. figuring out what the average per annum after tax cash drain is going to be 2. how long will it be a problem (actuarial longevity of the retirees) 3. adjusting your valuation appropriately. Second, there are so many factors that can influence your assumptions on this,I'm not sure how you get close to any level of certainty with what the outcome will be. I may be reading what you wrote wrong, but it seemed like you said that a 10 million increase in the projected pension liabilities or 10% of the stated pension value, would wipe out the excess equity value in your model. If that is the case you basically have two choices in my view. Either you can do a very deep dive to figure out you best guess on what is going to happen with the pension issue, or look for something else. For myself I know I wouldn't have the expertise to get comfortable enough, with that small of a margin between success and failure.

I have been following this story with interest for some time. I think the lesson I have drawn from it is that you really have to do your own work on an idea. At some point the argument was made that if venture firms are putting money into this idea then by extension they have sufficiently vetted it with the appropriate due diligence (they obviously didn't). That having a board of big name people must mean ipso facto that they have spent the time to evaluate the company, it's research and product and found that it was valid (they didn't). This is in retrospect one of Munger's 25 causes of human misjudgment , #10 Bias by influence by authority, probably some others as well.

http://www.wsj.com/articles/pensions-play-with-puts-for-protection-1471777202 Read this article in the Journal yesterday. In brief it seems that some pension funds have been writing large volumes of index put's as a means to increase yield. They go so far as to say 2008 taught them they didn't understand the risk they were taking and they are now de-risking their portfolios by doing this (Hawaii put 1.6B out of a 15B fund towards this). My gut reactions to this were 1. it seems like they are achieving the opposite of what they want 2. this is being done after a long running bull market 3. how do they have any idea what is going to happen with market levels in general. It seems like a terrible risk to take with OPM. My other thought was who are the counter-parties to this? , it doesn't talk about it in the article and I wonder if these funds have thought about who is taking the other side of this trade. Thoughts?

Agree with what other people have said, I think the answer is explained best with game theory. To illuminate further there is actually an example in the CFA course materials that covers this exact topic. The answer as to why the cartel doesn't work well is that based on game theory it winds up being in everyone's best interest to cheat, which winds up creating an overall non-optimal result. Here is a link that explains it better http://www.investopedia.com/exam-guide/cfa-level-1/microeconomics/oligopolies.asp

http://www.wsj.com/articles/at-theranos-many-strategies-and-snags-1451259629 http://www.businessinsider.com/theranos-wsj-report-on-allegedly-doctored-tests-2015-12 http://www.businesswire.com/news/home/20151229005120/en/Hagens-Berman-Announces-Investigation-Theranos-Relating-Representations http://www.nytimes.com/2015/12/20/business/theranos-founder-faces-a-test-of-technology-and-reputation.html Diamandis, E. (2015). Theranos phenomenon: promises and fallacies. Clinical Chemistry and Laboratory Medicine (CCLM), 53(7), pp. 989-993. Retrieved 30 Dec. 2015, from doi:10.1515/cclm-2015-0356 Articles I have read recently about it. I think the whole thing is a fraud.As a doctor I was hoping that it would not be (mainly due to the cost implications), but have been skeptical from the beginning. As I understand from the articles her family was well connected, Timothy Draper was a family friend, obviously having a startup with someone like that in your court is big. Also they had connections to political figures through her family, hence the board. Once you get enough forward momentum behind an idea, people jump on the bandwagon. If you go back people in the scientific community were raising questions about this way before all the negative press came about. The other thing that irks me is her push to have people go and test themselves without a physician or equivalent order. This is absurdity in my opinion, but I can see the appeal to the public. Here is the thing people don't know, most of the lab tests have error ranges that make it desirable to not test unless there is a strong clinical suspicion for something, which increases the pretest probability. Most doctors I know will not run massive lab panels just to check, because the chances are you will detect some minor abnormality which then obligates further testing, money and risk.

MDR- Turn around play on an international EPCI company, has been ongoing for some time 2yr, but old unprofitable contracts written by previous management are finally running off, they have been building a good book of business over the past 8-10 months and have long standing relationship working with the Saudi's (among others), despite oil prices. Over 75% of FY 2016 revenue are already booked in the current backlog. They did a refinancing last year, and have a stable balance sheet, with over half the market cap in cash, trading about 1/2 book currently. They are being very careful and have been doing a good job managing their cash since the new CEO took over. People are worried about further capex cuts hurting the backlog, but my thesis is there will be continued need for brownfield work no matter what happens to oil. Catalyst potentials in 2016, continued improvement in EBITDA as the legacy contracts fall off and maybe the market revalues the risk of further capex cuts, if oil stabilizes.

So you are arguing that the market becomes more efficient as the market cap moves up? It seems like it could be the case especially since I have read it from other investors so frequently, but to play devils advocate if you look at the price swings of large caps over a 52 week period, it seems hard to justify business values changing so drastically. Ill just pick one at random, MO, 52 week range 44.79 to 56.70 about 27%. I would submit that even if the large caps are more efficient the variability leaves plenty of room for mispricing. With the water and car example, the primary issue is not absolute price of things it's the efficiency of the market. In a club or movie theater the market is controlled, there is a monopoly at that moment and place. In the car example you are using a free market that is much more efficient, people can google prices, or craigslist etc and the market is not one sided. Also there is the whole information thing, I would argue that when it comes to pricing consumer items, people are much more familiar on where to look for information, they can ask their friends how much they paid, they may have bought something similar before etc... For the general public this is not the case when we are talking about companies, it really is a specialized knowledge set and temperament. I have met some very educated people who dabble, but when you talk to them they honestly have no idea what they are doing. I have a friend who I have talked to for many years about investing and believed he was totally rational, but recently when the market corrected 10% he panicked and sold everything and he was only invested in the VTSMX and some ETF's. Obviously if enough people like him do the same thing, it could affect large cap prices even though they are the most efficient, at least temporarily.

I have learned from example he has set by living his life in a humble way and deciding to return his wealth to society.

It's really tough to admit mistakes, but I appreciate when people share because it always provides some food for thought on how to do better. Big Ones From 2014-2015: -taking a spec risk in an small cap E+P company with significant "asset value" , about 8 months before the bottom fell out of oil, took a 30% loss. My lesson from this one is that estimating commodity prices needs to be in the too hard pile for me, anything where the asset value rests on commodity prices belongs there as well. -overestimating the moat around WTW, took a 20% loss before selling. Seemed compelling from a valuation perspective. But after thinking it through some more, and trying out some of the competing software which is quite good, realized that I made a big mistake about the viability of the business model.

"He relishes the opportunity" , a double entendre?

Agree with her brilliance, however the concept behind this company deserves some scrutiny, extraordinary claims require extraordinary proof in my view. The most important is obviously if the tests they have developed match up well with current ones. Point of care testing has existed for a while in the ICU environment, with extremely small blood volumes, specifically for ABG assessment. However the problem is that it only gives a rough approximation of the true values, and is not as accurate as a regular ABG. I actually hope it works out, but the thought that she is worth 4.5 bil based on a valuation assigned by PE is funny. There was an article a while back that talked about valuations being chosen not based on value, but based on the ability to attract more investment. Here is a good article with some of the questions that have been raised about the company. http://www.businessinsider.com/science-of-elizabeth-holmes-theranos-2015-4

Has anyone bought shares off a foreign exchange? I was watching a speech by Eric Prince talking about the Blackwater operations, at the end he mentions a public company he is CEO of now that is setting up logistics operations in Africa, for transport. Basically if you want to have the peace of mind that you can be anywhere in country and have access to transport for medivac etc. They are also going to be involved in the logistics of getting natural resources out of hostile areas, and creating the infrastructure for that. I have just started the due diligence on it, but before I even commit to that I was wondering if anyone has bought stock of the HK exchange. There aren't any ADR's available, so I'm guessing this will involve converting USD to HK dollars, with the resulting currency risk, in addition I'm guessing there are going to be some weird tax implication with owning a foreign company. Any infor will help, thx.

I have been thinking about social media a lot lately, after reading what some of the youtube channels are generating in ad revenue for the people running them. It seems to me the current model is to reimburse based on the number of people watching/time watched, but my question is does that translate into increased sales for the companies that are advertising? I wonder if anyone has studied the increase of sales per ad dollar spent on the various mediums, or if it's possible. My guess is that the sites/channels that drive the most traffic (pewpewdie) are also going to correspond to a demographic that has the least disposable income, with the most time to spend on social media and turn out to be the least profitable. I think at some point companies are going to start paying more attention to what value is created, when advertising on social media. There is a finite amount of ad dollars and shifting away from the more traditional forms of ad spending to social media may not turn out to be as profitable as everyone is thinking. If that's the case the ad dollars are going to shift back and the valuations/salaries of the social media content generators are going to reflect that. The corollary to that is some social media sites may become subscription based in the future, if the ad revenue falls off.

Did similar stuff as Scott when in undergrad, although I did have a roommate. I liked hanging out with people but it was limited mostly because I was focused on a goal, getting into med school, so basically anything that didn't have a direct impact towards that I almost completely ignored. I noticed similar behavior in other people in my med school class, one person who had an aerospace engineering degree from MIT, worked at SpaceX etc, lived in an apartment with no furniture, white walls, no A/C. Another guy, slept on cots in the med school path lab, studied constantly, rarely went home, he became an orthopedic surgeon. I think for some people, when you have a very specific goal in mind and you are determined to get it pretty much everything else becomes secondary. That said, once I got my acceptance I started dating, got married, have kids now which make me very happy. I just couldn't even entertain any of that until I had met a very important goal, I think some people are like that, my 2 cents.