The capital market has never lacked myths, and medical and health themes are the makers of myths, especially in the field of cancer.
Cancer has always been known as the "king of all diseases", but according to the World Health Organization, about 1/3 of the world's cancers can be prevented, 1/3 of cancers can be cured through early detection, and 1/3 of cancers can use medical measures to prolong life and alleviate pain.
Instead of waiting for a doctor's verdict or a fully effective drug to develop, early screening and early diagnosis and treatment of cancer is the most effective way to reduce mortality.
With the capital myth of precision science, the leader of cancer screening in the United States, soared 30 times in 10 years, cancer screening has also become a "good business" chased by the domestic capital market.
Three young people from the biochemistry department of Peking University who come from the legendary four major "sinkholes" (biology, chemistry, environment and materials) saw the development space of this industry and entered such a track full of "banknote ability" early in 2015. On February 18, 2021, their Nuohui Health officially landed on the Hong Kong Stock Exchange, becoming the "first stock of early cancer screening in China". The opening day soared 185%, and the market value exceeded HK$30 billion.
However, in the past 5 months, the stock price of Nuohui Health has continued to decline. As of November 5, the company's stock price had plunged nearly 70% from its previous high, with a market capitalization of only HK$11.2 billion.
With the sharp rise and fall of the stock price, the controversy surrounding the business prospects of Nuohui Health has never stopped.
The original establishment of Nuohui Health was not a whim.
As one of the founders of Nuohui Health, Zhu Yeqing's mother was a patient with advanced stomach cancer, because stomach cancer removed the entire stomach.
Zhu Yeqing once recalled: "The 7 or 8 hours outside the operating room were the most difficult time in my life. Before that, Zhu Yeqing, like most people, felt that cancer was far away from her. But when things really fell on their heads, they found that cancer was actually very close to them.
After her mother developed cancer, Zhu Yeqing, who came from biology, had a "thought" in her mind: What can we do for our parents or family?
Coincidentally, during a business trip to the United States in 2013, Zhu Yeqing and two classmates from the Biochemistry Department of Peking University, who are also in the 88th class of Peking University, Chen Yiyou and Lu Ning, met at the San Mateo restaurant in Silicon Valley, USA.
At the dinner table, Chen Yiyou, a doctor specializing in the field of tumor pharmacology, inadvertently mentioned that he had been in contact with many patients with advanced tumors, and many people may have spent money to buy drugs, but after half a year or a year, people have also left.
Her mother's experience with cancer resonated with Zhu Yeqing, who had screened out cancer in the early stages of stomach cancer, or even before lesions, perhaps she would have been spared the pain of cutting her stomach.
At this moment, they realized that compared with similar products abroad, the domestic cancer screening market is still a blue ocean.
In 2015, when Nuohui Health was founded, the three of them had already passed the age of confusion, and all of them had a golden resume in their respective fields.
Zhu Yeqing has rich management experience, and has served as an executive in many Fortune 500 companies such as Samsung and Ge, and served as the CEO of Nuohui Health, mainly responsible for the company's strategy, management and operation.
Born in 1972, Yiyou Chen is a Ph.D. and postdoctoral fellow in experimental pathology at the University of Utah School of Medicine, where he mainly controls research directions.
Born in 1971, Lu Ning received a postdoctoral degree in microbiology from Duke University, and has extensive experience in in vitro diagnostic product development in companies such as Roche Diagnostics and Quest, and served as cto (chief technology officer) at Nouhui Health.
After that, the development path of Nuohui Health went smoothly. After two and a half years of research and development, Nuohui Health's first product "Chang Weiqing" was officially launched to the market in early 2016. In 2018, it entered the "Special Approval Channel for Innovative Medical Devices of the State Drug Administration" and won the "First Certificate of Early Screening for Cancer in China" by November 2020.
Then to land on the Hong Kong Stock Exchange in February 2021, Nuohui's healthy and smooth development is inseparable from the boost of capital, and its investors can be described as star-studded, including Legend Holdings' Legend Capital, SoftBank China, Qiming Venture Capital, etc., in addition to the "Hong Kong Jewelry King" Chow Tai Fook Group's eldest son Zheng Jiachun's Ding Pei Investment Group is also among them.
(Photo note: Cheng Ka-chun, Executive Director of Hong Kong New World Development)
Nuohui Health, which was picked up by capital, opened a "yin down" mode after the stock price hit a new high of HK$89.65 per share in mid-June, and as of the close of trading on November 5, the stock price had fallen by nearly 70% in the peak period, and the market value evaporated by more than HK$20 billion to HK$11.2 billion.
With the collapse of the stock price and the performance of the semi-annual report loss, the risk of the commercialization road of Nuohui Health is highlighted. On the one hand, some voices believe that the demand for cancer early screening has great potential and the market prospect is infinitely broad; on the other hand, from a professional point of view, the concept of early cancer screening is questioned, and even believes that this is a false proposition.
In the face of the problem of choosing early screening products or going to the hospital for screening, Li Jie, a doctor at a cancer hospital in Beijing, told the city: "Go to the hospital." ”
He said: "The screening on the market, some early screening products are more chicken ribs, some people are not sensitive to reagents, can not be found at all, there is a possibility of misdiagnosis and missed diagnosis." ”
Li Lei, the relevant person in charge of the early cancer screening committee of the Beijing Anti-Cancer Association, also told the city: "Since I have arrived at the hospital, it is better to choose to do an authoritative examination." ”
However, compared with the "trouble" of hospital examination, Nuohui Health adopts the original "multi-target fecal fit-dna joint detection technology", and its core product "Chang Weiqing" allows users to collect fecal samples at home and avoid invasive surgery. For high-risk groups, it can be used independently, and users who test negative do not need to have colonoscopy.
From the perspective of the sensitivity of detecting colorectal cancer, Nuohui Health has reached the best in the industry, but it still cannot achieve 100% accuracy. For a pre-screening product, the negative predictive value is its core value, and the higher the value, the lower the proportion of missed diagnoses.
Chang Weiqing announced that the negative prediction value of NPV is 99.6%, that is, if it is shown as negative, the probability of 99.6% is not sick, so there is no need for colonoscopy; the positive predictive value of ppv is 46.2%, that is, if the result is positive, the person who tested has a 46.2% probability of having colorectal cancer or adenoma.
It is worth noting that a positive test result does not equal a confirmed diagnosis, mainly urging high-risk people to go to the hospital for further examination. However, the 0.4% probability is bowel cancer, and at this time, it is still necessary to return to the "gold standard" of colonoscopy and make the biggest reassuring choice.
Since it is impossible to make a "100% guarantee", the patient still has to return to the "gold standard" test of colonoscopy.
In this regard, Amy, the head of brand marketing of Nuohui Health, told the market: "Early screening and traditional examination colonoscopy are not contradictory, and the two are not either-or relationships. In her view, the purpose of Nuohui Health's products is to urge the screening of asymptomatic, high-risk people, rather than competing with hospital colonoscopies.
Although there is no contradiction between going to the hospital and choosing early screening products, the road to commercialization of Nuohui Health is not easy.
Judging from the performance report of Nuohui Health in the first half of 2021, its revenue in the first half of the year soared by 317% year-on-year to 43.93 million yuan, and the total income of Chang Weiqing, a multi-target early screening product, was 14.2 million, and the shipment volume was 121,500 boxes, a year-on-year surge of 392%.
Colorectal cancer product Chang Weiqing has always been the product with the highest proportion of revenue of Nuohui Health, but in 2021 it was surpassed by the "poof tube" listed in 2019. Puff tube is a fecal occult blood detection product, used to detect bleeding invisible to the naked eye in the feces, can be used for colorectal cancer coarse screening, self-sampling testing, 5 minutes can produce results. (Similar to the function of the pregnancy test stick)
According to the semi-annual report, Chang Weiqing's revenue share has fallen from 54.2% in the first half of 2020 to 32.3% in the first half of 2021.
The loss of Nuohui Health is still continuing. Losses from 2019 to the first half of 2021 were $106 million, $534 million and $2.89 billion, respectively. For the expansion of losses in the first half of the year, Nuohui Health attributed the main reason to the fair value loss of preferred stocks, and the net loss after elimination was 99.934 million yuan.
In the face of the commercialization risk of early screening of cancer, Wang Chikun, a partner of Jianggen Capital, told the market: "If cancer is regarded as a blind box, cancer screening is to open the blind box, which is itself a very niche market, because the frequency of use of C-end users is extremely low, the user stickiness is very poor, it is impossible to use more effectively through further development, and therefore it is impossible to share the new cost." ”
As a pioneer, achieving from 0 to 1, cultivating and expanding this market is a huge challenge facing Nuohui Health.
Nuohui Health not only needs to reach a "consensus" with the hospital, but also needs to gain more consumer recognition.
First of all, as far as many clinicians are concerned, they are still skeptical about early screening products, because the early screening products on the market cannot be compared with traditional examinations.
Public awareness of early screening for colorectal cancer is extremely low. According to the survey, 85% of patients do not know about early screening for colorectal cancer; 97% of patients have never had colonoscopic screening before diagnosis.
If diagnosed early and detected before cancer, colorectal cancer can be both cured and prevented. It can be said that Nuohui Health's early screening products shorten the distance between screening and disease.
However, due to the fact that it is not a 100% screening rate, doctors recommend early screening products to patients, there may be "false positive" situations, if the patient after further "gold standard" testing such as colonoscopy, biopsy and other means found that it is not cancer, false alarm also wasted a lot of money. For doctors, there is an extra layer of risk that leads to tension in the doctor-patient relationship.
This "game" occurs not only between Nuohui Health and doctors, but also between patients. In addition to the inability to achieve 100% accuracy, as a screening project, Chang Weiqing of Nuohui Health does not have a price advantage. The terminal price of Chang Weiqing is 1996 yuan, while the traditional colonoscopic test is only about 300 yuan-500 yuan, and the painless colon microscope is about 1000 yuan, and the price of the stool occult blood test is less than 100 yuan.
Compared with the traditional examination, the single price of Nuohui health products is a big burden for the vast majority of income groups, an ordinary family, even if only to the parents of both parents to do screening, the annual cost is close to 8,000 yuan, and this is only the screening price of bowel cancer, plus some other screening, the cost is above the level of 10,000 yuan. Even if you do it once every 3 years, it is not a small expense.
This price difference is the opposite of abroad. According to the Guoyuan Securities Research Report, cologuard, a colorectal cancer early screening product of the American precision science, was priced at $649 after listing, far below the "gold standard" colonoscopy that cost thousands of dollars. Moreover, under the "pay" of medical insurance, 94% of patients do not need to pay out of pocket, which greatly improves the accessibility of screening.
For the expensive price of cancer screening, Tian Geng, chairman of Yuanma Gene, told the market: "Cancer early screening is currently on the eve of dawn, and the price will definitely be lower and lower in the future." In Tian Geng's view, the future decline of early screening products to less than 1,000 yuan may be the time when this market is really opened.
In the face of the "game dilemma" of many parties, Zhu Yeqing, founder of Nuohui Health, also clearly saw that it is an anti-human thing to let asymptomatic people do cancer screening, "When no one is lying on the sofa after eating, they will think whether I want to do a cancer screening, he needs to be triggered, whether it is someone, or something." ”
Nowadays, the significance of cancer screening does not need to be emphasized, but the niche market of early cancer screening is completely "triggered" and a long game is needed.
Cancer early screening companies have drawn a "big cake" for the market, but they don't know when they can fully eat it in their mouths.
(Li Lei and Li Jie are pseudonyms in the text)
(Except for the separately marked source, the above picture is from Visual China)
(Author 丨 Zeng Jiayi, Editor 丨 Liao Ying)