Implantica AG (IMPASDB) Earnings Call Transcript & Summary

Welcome to the Implantica Q2 2024 Earnings Call. [Operator Instructions] Now I will hand the conference over to the speakers CEO, Peter Forsell; CFO, Andreas Öhrnberg; and IR, Nicole Pehrsson. Please go ahead.

Yes. Good afternoon, everybody. This is Peter Forsell speaking. And as you know, Implantica is focused on bringing advanced technology into the body and -- what is maybe important for newcomers is that this is not the first time we run the successful business. We have previously done the gastric band as well. And Implantica is a quite interesting company because we have built an eHealth platform. And eHealth will be the future of healthcare. And with this system, you can then integrate and treat patients. On this stance, you can have energizing at the patient's home and there is different aspects. So you can basically -- you center all the intelligence and the treatment from inside the body. And the doctor can then control the treatment from distance. And that's a very advanced system needed because it can't be hacked, it can't be anything happening. And this is many, many years of work. And this system will change healthcare. And we have many, many products in the pipeline. However, now when we are coming closer here to the really launching RefluxStop also in U.S., this is, of course, our main focus for the moment. So we have wireless power systems, and we have the eHealth platform designed. And we have patents, many patents for using the platform technologies to be filed for example, more than 25,000 pages, of eHealth patent filings. So we are very well protected for very advanced technology, which will come in the -- going forward. And our vision is very shy. We should become the world leader in smart medical implants. So there we set the tone of the discussion. So let's move over to RefluxStop, looks like this sitting on their instrument where you introduce it. And what I've been telling new listeners, I just want to try to explain how RefluxStop works. So all technology, you try to close the sphincter between the stomach and esophagus, because you don't want acid coming up because acid is burning esophagus, you get pain, you can get cancer, it's not pleasant. And there is one method from Dr. Nissen, he developed that you wrap around the top part of the stomach, it's like a mount and you wrap it around to support the closing. And also, you have a product from Johnson & Johnson, it's called LINX, where it's magnet who try to close and support closing. The problem is that this affects your full passage way. It gets more difficult to swallow, you can't get something up as easily. It's more difficult to get things up, belch, vomit and you swallow all the time with your saliva or food, you swallow gas or air, and this just accumulates as you get swollen, distended in your abdomen. And RefluxStop has then a completely different treatment method. We don't affect the food passage way at all. It's completely undisturbed, and that means, normally, we should not get any swallowing difficulties called dysphagia. And we simply let the body treat. We just restore a normal anatomy, the normal physiology and thereby, the body treats itself. So the previous theory that is ring muscle this sphincter here is weak. That's not correct. Nothing wrong with the sphincter. And you see a little bit 3 drawings here, how you actually then restore the functional anatomy. And the body just do it itself. And that's sort of the key to success here. And that's why we say we treat the cause of acid reflux. And that also means that the result is thereafter. Here, you see a little bit how it looks from inside the stomach and from an x-ray, see little nice device placed in position. And it's 1 billion people who suffer from acid reflux, that's an absolutely enormous amount of people. And most people take drugs. They are called PPIs, proton pump inhibitors. And the problem with these drugs is that they don't help everybody. 40% of sufferers are not helped by the drug. So we have 400 million people without discussing the complications with the drugs and side effects and the risk of taking the drugs. Just forgetting that for a moment, it's still 400 million people who is not treated today. And the problem, and you have acid coming up in your lower esophagus is that it happens over and over again, and this is how you create cancer. So if you put an endoscope or gastroscope down in a patient who is suffering from acid reflux, 10% to 20% have precancerous changes. It's called Barrett's esophagus. And then you have a certain percentage every year, we get the fulminant cancer. So in Europe and United States alone, 48,000 people die from the type of cancer you get from this disease. We can't say for 100% that all of them are caused by acid reflux, but most of them are caused by acid reflux. So it's really serious disease, and you can take these PPI drugs. When you are young, it's okay. That's because they get you more atherosclerosis so you get more cardiovascular disease. And you get older and your blood vessels simply to take it life long, that's nothing I would never do. And it's increasing, of course, then the complication. If you're young, you take this for a few years, it's probably okay, but when this disease is lifelong, you need to take this medicament all the time. So this was a little background that I'm sorry, I repeated for those who know this in and out, but it's just to have a little starting point here. Now I come to the real business update of this. So RefluxStop is currently on a way of great success, I would say. And that's carried by a multitude of published studies with excellent outcomes from leading reflux centers. And it is actually very, very important. That center after center independent, independent research their own research they come out and say, "Hey, RefluxStop is fantastic. " That is how you quickly build a new standard of care in this treatment field, and that's our goal. Our goal is to become the new standard treatment for acid reflux sufferers. And we are building it step by step, but it has started to bear fruit. And I will give you some examples later on in this presentation. So we have, again, our 3 pillars. I have showed it many times before. And I'll start a little bit with the market expansion, regulatory approvals, new centers and so on to give you a little feedback. So first of all, we have filed, as you probably know, most of you, the first module of our PMA. And we have got the feedback from FDA. It was only from the company's perspective, minor things, nothing that we can't answer or correct, which is very, very positive. For specific reason, we decided that we will file our module 2 together with the answer, and that's what we have been doing right now. And it's not so far away, of course, from filing now the module 2. It's hard to give an exact date. Many people involved. We have around 10 people working on this PMA. So -- but it will be in the near term, we will file, of course, the module 2. And Module 2 includes the clinical data, all the clinical results from our now 5-year study. And I will give you some insight into that as well. In parallel, U.K., NHS, the National Health Service, who stands for the public healthcare in U.K., they have started to investigate RefluxStop to see if it should give it full payment in their healthcare system. And we are starting to operate in more and more NHS hospitals as a public healthcare hospitals. And NHS, they have an organization called NICE, National Institute for Health and Care Excellence, and they are defining who should be treated, what should they be treated with and which product should we approve in our healthcare system and they give guidelines. And this is what we are actively working on right now. We have a meeting with them in September. We have supplied a big dossier to them. And that's, of course, quite interesting because this affects not only U.K., it's -- they are very influential, this NICE. We have now have more than 35 hospitals and more than, it says, 850 is more than 900 patients. It will soon reach 1,000, I guess. So it's going step by step. We are still focusing on the countries you have seen before. We have been quite successful in Italy and Spain, as you know. And I can give you some centers that have started is quite important. One is University of South Hampton. And this is a very interesting hospital because in many treatment areas, they supply healthcare for 4 million people down there in South Hampton. So it's a huge, huge hospital. And here, we did the surgery, you see the grumpy man there, that's me, together with Dr. Fergus Noble there. And it was robotic surgery. So what you see to the left of Dr. Noble there is, is actually a robotic system. So it was completely done with robotic surgery, which is quite interesting. Also in Germany, we have a very important hospital, it's Herzogin Elisabeth Hospital in Braunschweig, and this is nice because it's an INEK reporting hospital. That means they report all their cost for the procedure, which is quite valuable for us when we shall have increased reimbursement in Germany, we can refer to these centers who operate. So we are collecting these type of centers for the moment to get more and more surgery done, which is directly reported to the healthcare society. And in Spain, we have Dr. Sanchez started to operate. We have another center in Spain in Valencia also started. And this, of course, not all the centers. I just wanted to give you some feeling. It's nice to see some nice pictures with happy healthcare people. Although in Spain, they have decided that they should use these very orange color so people should not steal the dresses, the clothing because they are so ugly that no one wants them, but it looks very ugly when you see them also. So yes, that this also we have made some really nice marketing campaigns. So we have really start now. And especially in U.K., we wanted really to -- it's come from the patients up to the surgeons, and we need really to create more hospitals and more interest in RefluxStop. So we had a patient story featured on BBC South Today, Breakfast News and also on ITV, and it was around then started with 8 million viewers, but this ended up in 67 different publication pieces. People took this up from everywhere, everything from TV to press to an incredible reaction and people who understand this have calculated that the potential reach was 1.17 billion people from this campaign. And Dr. Fergus Noble at South Hampton, he described the incredible number of patients inquiring as just inundated, he called it. So it's so many people calling the hospital after this campaign, so it was just incredible because we have 1 out of 5 have this disease. And that's why you get so many patients. We have done a similar in Italy, where we had the TV channel RAI2 to have a 15-minute long patient story, of course, a success story. And this was picked up by 5 television agencies, 6 news agencies and 13 online channels. And they calculated the total reach of this compare to 9 million people. So the hospital involved here who started this process, they had to set up a new call center just to handle all the phone calls from patients as a complete separate person, just doing nothing else than answer requests from patients. That's how huge this treatment field is. This is just to give you a feeling of the potential of this product. Problem still we have is that we need to get paid for the product. It's nice to sell a product. But if you don't get paid, it's more difficult. And what we need is the public healthcare system to pay for the product. And that's what we are working on step by step by step. So let's go to the next pillar in our 3 key pillar, market access profile here. And that's, of course, we need to create superior clinical evidence. And that, I would say, we have been very successful. So here, I wanted just to show you, we have a complete team to support surgeons, help them with different things, to get things, presentations, articles, everything done. And we have so far this year, 36 conference abstracts submitted. We have 28 oral and posters, we have 20 submitted manuscripts, 12 are published and 7 additional manuscripts completed and ready for submission. This is a heavy work. And this means that it's more and more of these centers now who have started with RefluxStop some years back, now we start to bear fruit. They come out with their own results, everybody says, "Oh, RefluxStop, that's fantastic." That's selling surgeons to surgeons that is 100x more effective than salespeople selling any product. We're, of course, doing our RCTs, I think I have a special little slide on that, so I will come back until our studies, which, of course, also very important. And yes, here is the slide, sorry. So we have got Ethics Committee approval in Vienna, Austria, because it's Professor Schoppmann, at AKH, it's the largest university hospital in Europe actually in Vienna here. They are the leading hospital in this randomized trial comparing standard of care in Nissen Fundoplication. And they got the approval. In Austria, though, it's some kind of a competent authority that also need to say it give us, so to say, the okay. So it's another application filed and that is said that you should be maximum 1 month. And I think some weeks has already passed on that. So we are very close now to finally get started with this RCT. And we have more in Frankfurt, it's also in Germany, there be also a visit by Dr. Moustafa Elshafei to the Ethics Committee. And they basically have said that they will approve also in Germany. Switzerland is already filed. It's quicker handling. I think it also very soon will be ready to start. So we can really get going with this first very important RCT, randomized trial where you basically have lottery, which you should operate, RefluxStop standard of care. And we also have then many superior articles coming out, and I will guide you a little bit through that. So first of all, we have our excellent 4-year results. And this is the results, but 5 years that we are using for our FDA. We have not told you yet about the 5-year results, I can't say so much. They are also excellent, but we have presented a 4-year results. And you have a link in our press releases, I think we didn't put it here. We have in our press release, we have given you a link if you want to read yourself. This is published in Surgical Endoscopy, which is a very interesting journal because it's the official journal of SAGES, the American GI and Endoscopic Surgeon Society. And it's also the European Association for Endoscopic Surgery. So this is a very influential magazine. They are involved in the guidelines to the payers, to society to tell what should be used and not used. It's a very important magazine here. And the results, of course, is -- I mean I should be objective and say fantastic that you can say nothing less than fantastic to be objective here. It's incredible results basically. It's -- so there is -- here you see regurgitation that how many -- how much is coming up. Acid reflux is basically often called by regurgitation is coming up stomach fluid in esophagus. And here you can see how it has developed over the years. And you see that it's stable. It's nothing -- all this we have 4 years. It's -- the outcome is stable. And if you look at swallowing problems, which is 1 serious difficulties with standard of care. You have between 30% and 50% of the patients with 5-year results have swallowing difficulties with standard of care. And here, you can see we have 1 patient -- 1 single patient with swallowing problems. This is what you call night and day to have half of the patients or 1 patient that's really different. And basically, no patient takes any drug PPI due to acid reflux. It's actually 2 patients who took drugs, but not for acid reflux. They have something called gastritis or some magkatarr in Swedish. And then there is other reasons that patients cannot be happy. But the key is, is it because of acid reflux because that's what we treat. We don't treat other problems. We have also another very interesting magazine. This is also a very, very highly respected magazine, it's called Swiss Medical Weekly. And this is the magazine where Dr. Nissen, the one who invented Nissen Fundoplication, the current standard of care has been used all the way since 1956. He published his results in this magazine back in 1956. So this is really top of the line press here. And then we have Dr. Zehetner, who published his first results. And that's very interesting because he has operated patients who doesn't have any good treatment today. So we had operated patients. We call them ineffective esophageal motility. And that means that your nerves and muscles in lower esophagus that doesn't work like they should. You don't transport food as you should. You are very weak at transporting the food down. So this patient often has swallowing difficulties. And you can imagine, if you then put in circle something around esophagus and try to press to close, they have really get difficulties to swallow. So these patients according to the NICE guidelines, I talked about before, they are not recommended for surgery. These patients have no go treatment today. And also the large hernia patients with existing treatment, they have like 50% recurrence rate in 5 years. So 50% of the patients need to be reoperated. So neither of these 2 groups has really had a good treatment today. And I will say the IEM patients, that's 1/3 of the sufferers, and large hernia is another 1/3 of the sufferers. So we talk about here, 2/3 of the sufferers who really doesn't have any good treatment, at least not the IEM patients, the other 1 you get to reoperate over and over gap. So we had a little statement from Dr. Zehetner, who is Professor USC, "Based on 150 RefluxStop cases I've performed over the past 4 years, it's clear RefluxStop has the potential to reform how we treat severe GERD patients, especially with ineffective esophageal motility where RefluxStop is turning out to be the best available treatment option." So we have been, from this perspective, very successful. Here you see its results. You can see that after surgery, all patients were satisfied except maybe a couple of patients of these 40 who was neutral. No one was dissatisfied after surgery here. You see the swallowing problems, they are fading out also after the surgery that the patient had before surgery. And you can see you have a questionnaire here when you ask questions before and after surgery, the very long ones, or when you asked the questions before surgery, the nonexisting or very low ones, they are after surgery. And in this case, we have separated questions for heartburn also. And you see they go down to 0. You see regurgitation goes down to 0. And the total score is improving dramatically from 35 to 2 in median IQR scale here. So it's just absolutely astonishing results, not matched by any other technology, anything I'm aware of in the literature can match this. We have also Professor Schoppmann, which is leading the RCT study. He has done another study of just IEM patients, as these will affect motility. And his conclusion is this is excellent result in this group of patients with IEM, who have no optimal treatment available until now. And this is published in Nature Scientific Reports. This is 1 of the most highest respected and rated magazines in the world here, we talk about. So he got it immediately published because this is such a great news. Here you see a little bit his results. The score goes down and a little bit also the different things. So I would say we are carried on a way of success in terms of publications and convincing the healthcare society. We -- extremely well, nothing less, you can say. Then we have the cost effectiveness. And that we have, again, published more articles. So we go through country after country to conclude that RefluxStop is the most cost-effective antireflux treatment. That's very important for the payers. And this we have been doing now in many more countries. So we have Sweden, Norway, Switzerland, Italy. So we have a couple of articles published also here. So we have Swiss Cost Effective is published in Journal of Medical Economics, also very respected journal. We have in Italy, published in PharmacoEconomics, also very influential magazine. So it's all about building blocks. It's like you're building a house. We are building it from the ground and up, and we do it professionally. We do it methodically step by step. Yes. That's time then for Andreas to say something about the capital market and finance. Andreas, the world is yours.

Thank you very much, Peter. Good afternoon or good morning. We reported net sales of EUR 554,000 for the quarter, an increase of 59% compared to the same period last year. This driven by a combination of new centers and higher activity levels at existing centers. As a reminder, in Europe, we are only selectively engaging with key opinion leaders to build a strong reimbursement platform. In the U.S., we are not commercial as we are currently in the FDA approval process as outlined earlier. Let us turn to gross margin. We continue to deliver industry-leading gross margins. Adjusted gross margin for the quarter amounted to 91% compared to 94% in the same period last year. We expect to continue to see quarter-on-quarter volatility in the gross margin levels. This provided the subscale nature of the current operation. The combination of superior gross margins and no limitations to scaling reflux of production, underpins the operating leverage we can expect as the business scales and matures. Let us look at earnings before interest and tax, EBIT. The operating loss expanded to EUR 5.9 million, up from EUR 4.3 million in the same period last year. Looking at the quarter-on-quarter development, we saw OpEx decreasing by EUR 1.3 million from the elevated cost levels we experienced in the connection with the FDA filing preparations over Q1 this year. The quarterly GA costs remained roughly flat year-on-year. We experienced an increase in R&D spending, where R&D expense for the quarter came in at EUR 3 million versus EUR 1.2 million in the same period last year. A key difference compared to the same period last year was the EUR 1.1 million capitalization of development expenses in Q2 2023. For Q2 2024, this number was close to 0 as all R&D was expensed in the P&L. As communicated earlier, we are continuing to reduce investments in eHealth and pipeline product as we redeploy resources to the commercialization of RefluxStop including the randomized clinical trials that were discussed. These trials are reflected as R&D expense in our financial statements. Let us turn to Slide 52. We are fortunate to have a robust financial position. Over the quarter, the total net cash outflow amounted to EUR 6.3 million. End of June, we held EUR 74 million of cash, and we do not carry any interest-bearing debt on our books. And with that, let us turn to Slide 53. In addition to our CEO and main shareholder, Dr. Peter Forsell and other senior leaders in the organization, our investor base is dominated by Swedish and Swiss high-quality institutions, and we are grateful for the trust and support we are receiving to build the commercial organization to address a massive unmet patient need. Back to you, Peter.

Thank you very much. Yes, I guess it should then be time. First of all, I want to thank everybody for listening. And then I think it's time for questions. If anyone has any questions, see if I have received any...

We will ask the questions first. We go to the -- anyone who has to ask any questions.

[Operator Instructions] The next question comes from Chien-Hsun Lee from Pareto Securities.

So, first question regarding the randomized clinical trial. Since you are enrolling the first patient in Q3, how many patients do you plan to enroll in total for the Nissen Fundoplication trial? And is there any cost estimate for both of the trials?

Yes. So in the Nissen trial, it will be 100 patients in each group. And we have then a second trial with University of Oxford, where we have been waiting for all the regulatory approval in that hospital, we are coming close to start as well. And that is 75 patients per group in a trial, and that will then compare PPI use. And in IEM patients, the 1 with the swallowing difficulty I talked about. And of course, it's not for free to do studies. It will cost a few million extra to do this. That's clear. We, of course, are trying to negotiate hard with the hospitals to don't ask for too much money. But it's clear that some millions extra, but we intend to save those millions by reducing a bit our other outlay. And as you know, we have had extremely high outlay for our FDA approval because it's so many tests and validations and it's a few consultants needed for that project as well. So quite heavy extra costs we have had. So we don't expect that we should increase any cost because of the trial.

Okay. And the second question is about the NICE IPAC decision, which is expected in first half '25. So let's say if the result is if it trends positive, to which extent do you think it will help the U.K. reimbursement? Do you think you will automatically cover -- the government will be able to cover the cost?

So the NICE, they have different groupings, so to say. So you can get in a group where you are fully reimbursed or they can say, "Okay, we pay for you, but only in the study mode" for example. So when you do patients in the study, like we have our big register study, for example, the ongoing all over Europe. So if you are doing that is already in the study, you can get paid, for example. And this is different levels, and we don't know if they -- it's a balance. We have fantastic results. But of course, we don't have -- so we don't have hundreds of articles. We have -- the really good ones is maybe 10 articles or so. And the question is just if NICE thinks this is good enough with this amount, but the results, they are outstanding. So if we are lucky, you can compensate amount with quality. But it's impossible to say simply. And...

Okay. And yes, the final question from me. So regarding the commercial strategy in the U.S., do you plan to market the product by yourself? Or do you -- are you also looking for some sort of commercial partnership or you plan to adopt the similar strategy in Europe as you are targeting the top KOLs and top medical centers?

Yes. So we have basically already identified the starting centers in U.S. So as you know, we had a big study -- training study on cadavers where we educated. So we have the surgeons in U.S. has been trained on the procedure, and we had 4 European surgeons over there and we had 45 surgeries done. So we already have like 20 hospitals lined up to start already and people are very enthusiastic. We have been very successful also with the marketing in the U.S. So we can probably easily start with double that amount quite easily in U.S. So we don't think we need any big sales organization. We just need salespeople who can be trained and go there and visit them and so on, but to identify the centers they come to us, basically.

Okay. And congrats on the progress.

[Operator Instructions].

So waiting for, if anyone want to ask a question directly, I can maybe answer some of the written question here. So someone here is asking, Robert. I suppose your second module will include year 4 and 5 CE study data. So yes, FDA has said that they are happy with our CE study. That's the information we have got so far. And yes, it's the 5-year data we are filing for FDA. So this is the big package of stuff. And for your information, we talk about 600 pages of tables and graphs and figures approximately for such filings for your understanding how huge this is. How is your RCT going? I think I basically answered that a little bit during the presentation. So we are very, very soon now starting up. When file for Japan and France? So in Japan, we are targeting to use United States to avoid any clinical trial. So we are in the preparation work. We have brought surgeon from Japan to Europe, train them. They are involved to help us to support. So we are setting up meetings to discuss, and the goal is that they should be happy with the U.S. approval process in Japan. In France, it's needed another study. And our goal is that we should try to incorporate our existing randomized trial in the France process. Strategic acquisition. For the moment, I don't think we are targeting any acquisition, yes. And then we have -- see here, if I can scroll. Okay, sounds something -- another question on Japan. I think I basically answered that. It's ongoing, but by taking it a bit calm and using the U.S. data, we probably will save time in the long run. Module 1. Why would you get transformed in summer since it has to be? Yes. So yes, the question here with the FDA need someone is asking if you only have 3 months between the modules and so on, why it will take to the summer 2025, he asks. And the answer is that the most key part of this is FDA's visit to our production site. So FDA will come to us, they will visit our office. They will visit all the people who's involved doing the packaging, the production of the tool, the device itself. And what really decides the time line in the end is how quickly these audits, these visits could happen. So the filings of the modules that will be done somewhere in the spring, then we have sort of -- and it's all about how positive FDA is to us. That's why we try to have a good relation to FDA and try to -- that's more important than anything that try to do things in a professional good way. And someone is then asking when Module 2 is coming and they are asking, is it 1 to 3 months, 3 to 6 months or 6 to 12 months. It's, of course, the 1 to 3 months we are targeting as soon as possible now. And here we have another question -- this is... Yes, the answer is, of course, that these -- as someone is asking about if these results help us to get reimbursement. And the answer is, of course, yes. That's extremely valuable and it could not have gone better. And this is independent university hospitals who published. This is not Implantica anymore. And that's, of course, holds a really high value and independent surgeons come and say the same thing that, oh, your fantastic study you made, the CE-Marked study, we can see -- we have the same results or even better results. I mean that's what really counts here. Another question about Japan. Surgical instrument question, that's repeated, okay, what are we hear, FDA time line, France. Yes. So -- yes, I have the first surgery be done in Sweden and Norway, they have. So in Sweden, we've done the first 3 surgeries and successful surgeries. It's just the healthcare economics in Sweden, who -- a little bit is the problem that the sort of just saving mode rather than sort of it seems like the patient's best is not longer what drives the healthcare in Sweden. It's just costs who drives. So we don't really know how that will go out. And maybe we need -- someone need to start to operate on Sofia and that if the healthcare system is not able to support. But we have to see. And in the approval in U.S., we -- because it's not in our hands. I can tell you a month or a date when I believe it will be ready, but it still depends on FDA. It's not in our hands. And it's just stupid for me to say something because you just feel I'm not trustable person, and it's not correct, but I can't affect the FDA. It's a very strong organization, and we just have to adapt and do the best. But of course, it could not take forever most hopefully. So maybe sometimes in 2025, so to say, we very much hope that we will be approved. But exactly what time of year I can't dare to tell you. Yes, both question, do I have them here, how can we... Yes, someone is asking about the other products. And of course, we -- when we come so close now to really getting a breakthrough with RefluxStop and when we hopefully in a not too long future, we'll be able to launch in U.S., we feel that we need to reduce a little bit on other products. So we have a team continuously working. But it's not -- it will not be a big, huge team until we either get going now with the RefluxStop -- so it's a little bit -- we have moved some resources over from the continuous development over to RefluxStop now. That's I must honestly say then. Yes, I think more or less, this is change capitalization. Yes, Andreas, someone is asking here, could you elaborate on why you changed capitalization rules?

Right. I mean thanks for the question. And this goes back to what I just mentioned about us doing less R&D work on the new products. And most of the R&D attention is going in the direction of RefluxStop and RefluxStop adjacent products that are not being capitalized.

Okay. I see here someone asking where do you see RefluxStop in 3 to 5 years? And I see RefluxStop conquer the world basically. That's what we are doing, but this doesn't go in the coffee break. It takes some time, but we have an enormous treatment field. We have a treatment field where too many people die from cancer. And we have side effects from drugs that is really nasty long term. I see the only way this can go long term is that people need to be operated for the RefluxStop in a higher level than a much higher, higher level. We can't accept any more that let people die. I mean, take breast cancer. They don't let people die with breast cancer. They have huge programs to find every breast cancer they can. And here, they just let 48,000 people die every year. That's U.S. and Europe only, only U.S. and Europe, I talk about. And for me, this is totally unacceptable. It's so ridiculous. This need to change. And I think that RefluxStop has all the attributes to really become a really hit product. That's my opinion. I mean that's why I invested all my money in this because, I mean I'm a surgeon in this treatment area. So -- and the surgeons agree with me now. It's coming -- it's not only me. You can read all these different articles from these university clinics. It's not only Implantica who says this is the best anymore. So yes, in 3 to 5 years, you will be happy if you are an investor of RefluxStop -- in Implantica and that's my opinion. No private opinion. Don't sue me. So yes, I think that's more or less it. And I thank you very much if you still are listening so long here. But it's always a pleasure, and maybe we see each other soon again. And if anyone wants some kind of more information, just write to us and we can organize some kind of teams of some meeting or yes. Whatever, thank you very much. Have a really good day.