J. Elliott
Analyst · Deutsche Bank
Great. Thanks, Jeff. Let me begin with a more qualitative review of our businesses. And then as usual, I'll share some brief thoughts on likes, dislikes and a few hot topics for the quarter overall. I'll start with our CRV Group. Our CRV business continues to lead the industry in responding to changes in the delivery of healthcare and positioning Boston Scientific as a company intensely focused on the care continuum for cardiovascular patients. Our CrossCare Program is being well received by customers and is producing significant wins including recent deals with Barnes-Jewish Christian HealthCare, Indiana University Health and Tenet to name only a few. We've doubled the number of CrossCare accounts since our November Investor Day, and we're on track to achieve our aspirational goal of 200 contracts by the end of this year. We are evolving our selling organization by advancing our unique new sales structure pilot models, which are sensitive to economic buyers, ACOs and the future potential for episodic bundled care. We expect to know the outcome of these pilot models before year end. We also continue to make significant progress on our CRV-related Priority Growth Initiatives through 4 of our recent acquisitions as well as numerous internal growth programs. Technologies from some of these initiatives are being, or will be, commercialized in 2011 and 2012. They're integral to the execution of our POWER strategy, as they play key roles in the realignment of our portfolio in setting the stage for future growth. I'll give you a brief update on a few of these growth initiatives. The WATCHMAN Left Atrial Appendage Closure Device we acquired through Atritech has CE Mark approval, and our case volume continues to grow each month. We have over 2,700 patient years of follow-up with the WATCHMAN Device, and almost 1,800 patients recruited in the WATCHMAN portfolio of clinical trials worldwide. No other LAA enclosure device can remotely compare. In the U.S., electrophysiologists have shown strong interest in the product, and we are on plan with patient enrollments in the PREVAIL confirmatory study with enrollment expected to be completed by the end of quarter 1 2012. Our Autonomic Modulation Therapy, or AMT, growth initiative is progressing well, and we anticipate having our first patient enrolled in the NECTAR-HF trial in the next month or so. AMT therapy intends to treat a large population of heart failure patients who are currently not candidates for heart failure device therapy, an example of one of the ways we intend to offer new therapies in high potential markets. Our fast-track team focused on the interventional medical device management of patients with drug refractory hypertension continues to progress well. Extensive animal studies have been initiated or completed, and we plan to commence our human trial in 2012. And last but not least, it remains our current intention to initiate REPRISE, the CE Mark trial for the Lotus Valve acquired through the acquisition of Sadra Medical during the fourth quarter of this year. We are demonstrating our commitment to realigning CRV for growth with the investments we've made so far. To reiterate, these are only a subset of the 7 CRV-related Priority Growth Initiatives originally discussed at our Investor Day last November. We continue to actively develop internal projects in nearly all of these areas while also pursuing many external opportunities. Through these activities, the execution of POWER strategy is a reality at CRV. Let's move on to CRM. As Jeff mentioned earlier, worldwide defib revenue came in slightly below the low end of our guidance. And despite the tailwind from last year's ship hold in the U.S. was flat after taking into consideration an accounting adjustment. The continued decline in the U.S. market was the primary driver behind these results. However, we believe that our U.S. share has remained essentially flat over the last few quarters. Japan continued to deliver strong CRM growth during the second quarter, driven by our 4-SITE, COGNIS and TELIGEN products. We have been very pleased with our growing relationship with Fukuda Denshi. Our partner is ramping up ahead of plan, and we have already seen twice the revenue contribution from them that we had expected through the second quarter. Our newest technologies continue to prove their importance in the marketplace. COGNIS and TELIGEN, which are still the smallest, thinnest high-energy devices in the world with excellent longevity continue to be well received. We also continue to see very positive responses through our 4-SITE DF-4 lead system in international markets. This new lead system is built on our highly dependable reliance defib lead platform and reduces the required implant area within the body, making COGNIS and TELIGEN even smaller. We remain committed to advancing our technologies and strengthening our CRM franchise. We launched our next-generation defibrillators, ENERGEN and PUNCTUA in Europe during the second quarter as planned. The full line of these products enhances BSE's position in size, shape and longevity, along with advanced algorithms to minimize right ventricular pacing, reduced inappropriate shocks and apply new heart failure diagnostics in our ICDs. They also represent our first tiered high-voltage product platform, giving European physicians and their patients more options while aligning Boston Scientific to be more competitive in price-sensitive segments requiring tenders. Our PUNCTUA product enables us to offer advantages of size, shape and battery longevity, along with remote patient management to those customers. We plan to launch these next-generation defibrillators in the U.S. later this year -- late this year. depending upon final FDA requirements. On the low voltage side, we continue to expect to launch our next-generation INGENIO wireless pacemaker, built on the same platform as our existing high-voltage devices in Europe and the U.S. early next year, depending once again on final regulatory requirements. This new platform represents our first new major technology introduction in this category in many, many years. And it is expected to be the foundation for a series of low-voltage radio launches, including an MRI-compatible pacemaker system with both single and dual chamber devices in Europe next year, but without many of the existing competitive product patient compromises. Let's look at electric physiology. Our worldwide EP business was down versus a year ago, but this was principally due to constraints in our Chilli II catheter line. We resumed shipments in the U.S. in April, and the sales rebound has exceeded all expectations. European shipments will resume in the fall. During the quarter, we completed the limited market release of our Blazer Open-Irrigated Catheter in Europe. This product represents our entry into the rapidly growing open-irrigated catheter market and is the only system with total tip cooling design. The limited market release went very well, and the catheter proved to have exceptional tip cooling and handling characteristics. We plan to move into full market release in the fall. This launch is a significant step in the execution of our global AFib strategy and one of our 6 internally approved AFib-focused projects. We expect these products plus the expansion, development and collaboration of BSE's global EP sales force to increase market share of Blazer-based products and be drivers of growth for the future. Turning now to cardiovascular. Worldwide DES revenue was comfortably in the middle of our guidance range and reflected continued strong performance from our platinum chromium platform, particularly in the uptake of ION in the U.S. and the United States. During the second quarter, we maintained our worldwide DES market share leadership, with 9 percentage points more than the nearest competitor. In the U.S., our leading DES market share grew 4 percentage points to 50% in the second quarter, primarily from the strength of the launch of ION. However, we exited the quarter with 51% market share, including paclitaxel share of 21%, up 7 percentage points from first quarter, and making our paclitaxel/everolimus mix the highest it has been in over 18 months. The launch of ION is exceeding our expectations and proving that the combination of our platinum chromium platform, with its acute performance advantages and broad-sized matrix, and the proven performance of paclitaxel are being well received in the marketplace. We continue to extend our ION launch to additional customers. ION is our first U.S. introduction of the Element platform, setting the stage for our PROMUS Element launch in the U.S. next year. We expect the launch of PROMUS Element to be ahead of our previously announced date of June 30, 2012. I repeat, since it's an often-asked question, we expect the launch of PROMUS Element to be ahead of our previously announced date of June 30, 2012. OMEGA, our new bare metal stent of the PLATINUM -- on the platinum chromium platform, is off to a good start in Europe. And feedback from customers has been positive. We expect to start the U.S. IDE trial for OMEGA during the third quarter of this year. During the quarter, we generated additional continued strong results from our PLATINUM clinical program and the 12-month results from our PLATINUM small vessel study presented at EuroPCR. The study demonstrated very low target lesion failure rates at 12 months for the 2.25-millimeter PROMUS Element stent versus the 2.25-millimeter TAXUS express stent. These data build on the positive outcomes of the PLATINUM Workhorse and QCA studies, confirming the successful transfer of the everolimus drug through our platinum chromium platform. We are pleased to announce that the TUXEDO trial has commenced enrollment in India. This important trial compares the outcome of TAXUS Element, or ION, with XIENCE PRIME in a diabetic population. The role of paclitaxel in the treatment of diabetic patients has been appreciated by ICs for a long time, but this is the first head-to-head trial of contemporary DES technology in this challenging population. The Synergy stent continues to be in follow-up in Europe, Australia and New Zealand. We look forward to presenting the primary endpoint data from this trial at TCT in November. Our next steps will be to gain CE Mark approval for Synergy and start the U.S. pivotal trial. We're excited about Synergy's potential to reduce existing DAPT regimens, and we plan to evaluate this in a future trial. The predominant cost of DES treatment resides in the cost of DAPT, not in the cost of the stent. Therefore, confirming the safety and efficacy of a short DAPT regimen with Synergy offers the potential benefit to both patients clinically and the healthcare providers from an economic perspective. Turning to other CV product lines, our worldwide non-stent IC core business was down in the second quarter. Consistent with prior period, the decline was largely attributable to share declines in IVUS and continued price erosion in PTCA balloons. We maintain our U.S. and worldwide PTCA balloon leadership positions in the second quarter, with 54% and 32% share respectively, and expect to see a modest improvement in IVUS results due to technical improvements in the near future. In our peripheral interventions business, we generated good growth, driven by performance outside the U.S. Our worldwide TI stent franchise grew 5% constant currency, and was driven by outstanding international growth of 14%. U.S. stents were down 9%, driven by share loss in balloon expandable and carotid stents. We continue to take share with our Epic vascular self-expanding stent system in international markets and our Carotid WALLSTENT launch in Japan. In our core PI franchise, which includes PTA and vascular access, we grew sales 4% in the second quarter, with 10% growth in vascular access and 1% growth in PTA. We produced excellent international growth of 10%, but the U.S. declined 3%. Our interventional oncology franchise produced very strong 15% worldwide growth in the second quarter, driven by 18% growth in the U.S. and 11% growth internationally. Our success with the Renegade/Fathom System launch and the Interlock .035 launch provided great momentum in the second quarter. We are pleased to see the strength and growth trends in all 3 PI franchises in the second quarter and expect to see continued progress throughout 2011. Our performance was clearly boosted by the new product launches in multiple geographies mentioned earlier. These are the first PI new product launches in many years. We've also made very good progress with our continuing PI pipeline over the last quarter. In our core franchise, our Mustang workhorse .035 PTA platform successfully completed tentative market evaluation during the quarter and moved to full launch in late June. We're also confident that our COYOTE .014 below-the-knee PTA platform, formerly codenamed Panther, will launch in the second half. We fully launched Interlock. 035 in the U.S. and Europe at the end of the second quarter. This novel coil implant for obstructing and reducing blood flow in the peripheral vasculature during embolization procedures received very positive feedback from our radiology customers. Interlock. 035 extends on our best-in-class PI coiling technology, and is expected to provide continued strong growth in our interventional oncology franchise. We continue to make progress with our 2 acquisitions focused on chronic total occlusions. Our TRUEPATH intraluminal CTO device is expected to begin a limited market release later this year. Our off-road re-entry CTO device is on track for an o U.S. launch by year end. We're in the planning phase for our U.S. clinical trial and expect to begin enrollment in the first half of 2012. With the accelerated growth from new products achieved in the second quarter, we are continuing to see results of our PI pipeline rejuvenation strategy. Now moving to our endoscopy business. The endo business continued to have solid growth in the second quarter. The metal stent franchise again had strong results, recording an 8% increase internationally. This performance was led by our WallFlex Biliary RX fully covered stent, which recently received CE Mark Approval for the treatment of benign biliary strictures as well as the continued strong adoption of our WallFlex duodenal stent in Japan. Worldwide growth of 5% was also recorded in our biliary device franchise, supported by growth in our product portfolio driven by our recent launches of both the Advantix biliary plastic stent and the Expect Endoscopic Ultrasound Aspiration Needle. The hemostasis franchise delivered strong double-digit growth of 14% on the continued adoption and utilization of our Resolution Clip technology. We continue to make great progress on the integration and commercial efforts of Asthmatx. During the quarter, we were pleased to receive 2 important decisions impacting the reimbursement of the Alair Bronchial Thermoplasty System. In June, CMS issued 2 new healthcare-common procedure coding systems, or HCPCS level II codes, which are effective July 1, 2011, specific to bronchial thermoplasty when provided to Medicare beneficiaries. In addition, on July 1, the AMA announced that effective January 1, 2012, bronchial thermoplasty can be billed using 2 new current procedural terminology or CPT codes. We view these 2 important announcements as very positive steps in our effort to secure reimbursement for the Alair Bronchial Thermoplasty System. Let's now move on to urology and women's health business. Our international business continued to gain momentum, with strong double-digit growth in 3 out of 4 regions. Our urology business continued to expand its leadership position and delivered worldwide growth of 6%. Elective procedures continued to pressure our women's health business, particularly in the U.S. The persistently high U.S. unemployment rate and increasing employee insurance deductibles and cost sharing continue to put pressure on elective procedures. Competitive new product launches in both slings and pelvic floor repair also impacted our growth, as hospitals initiated new product evaluations, as did the recent FDA update that came shortly after the end of the quarter, which I'll discuss a little later. The U.S. rollout of our next-generation Genesys HTA System for the treatment of abnormal uterine bleeding had another strong quarter, delivering double-digit growth and expanding our market share. We continue to believe that the significantly enhanced user interface and ease of operation will enable the business to grow its share of the $400 million worldwide endometrial ablation market. In neuromodulation, we achieved an outstanding 16% growth, taking substantial share in both the U.S. and internationally. We believe this strong growth was driven by physicians and patients recognizing the clinical outcomes afforded by our products and services. We launched the Clik Anchor system internationally in May and are excited to share the benefits of our novel anchoring technology with international physician community. We expect continued strength in the back half of the year as we approach a full year of sales with our expanded product portfolio. We'll also expect further market share gains as we focus on improving our sales execution strategies. Let me finish with some overall perspective on the quarter. What we liked, what we didn't like and some hot topics for takeaways. As usual, I'll start with what we liked. Number one and most importantly, we like the progress we've made in pursuit of our POWER strategy. I'll review this for you now, starting with the P, which represents prepare our people. In recent months, we've taken significant steps to prepare our future leaders, including graduating the 78th member in honorable class at our Boston Scientific Top Gun leadership academy and selecting a new group of emerging executives for the class of 2011. Almost 2/3 of the graduates have received promotions just in the last year. We have aggressively and purposely improved our diversity inclusion through actions such as the creation of an executive diversity and inclusion council, the development of divisional diversity action plans and the expansion of our close the gap coalition effort to address disparities in cardiovascular care for the underserved patient populations of women, African-Americans and Hispanic Latino Americans. We're extremely aggressive in hiring and developing plans to support our emerging market strategy. In CRV, we've also made important changes to our organizational and leadership structure, appointing new divisional presidents in each of our major CRV business units. These changes are part of a planned evolution for CRV in creating a more dedicated business focus and preparing the next generation of senior executives. The O in POWER stands for optimize the company. At our Investor Day last November, we laid out several significant near-term cost reduction opportunities, many of which related to optimization. The integration of CRM and CB into a unified CRV is largely complete. The remaining tasks are on track, and the related savings are ahead of plan. Through project transformation, our efforts have derived $200 million in productivity and efficiency within R&D. We now have a consistent global approach to product development, target standard costing and an annual cost improvement process based on our very successful Boston Scientific VIP program. Our Plant Network Optimization program continues to make good progress. We have doubled the size of our operations in Costa Rica, and product transitions are on track and clearly [ph] reductions at only 12 manufacturing sites. We're now implementing Kiva robots to automate our 550,000 square foot main distribution center in Quincy, Massachusetts. As we announced early today, we've also included the initial planning phase of our zero-based budgeting initiative. And components of our emerging market initiative allow us to move into the execution phase through our 2011 restructuring program. I'll provide more details on this in our hot topic section. The W of the POWER strategy stands for win global market share. Toward that goal, we've been investing $30 million to $40 million this year in emerging markets, primarily India, China and Brazil. Our investments in people and infrastructure are proceeding rapidly, and we're on target to meet our hiring goals for the year, with more than 100 employees already hired in the first half of 2011 and strong double-digit revenue growth in both India and China. This quarter, we plan to open an R&D facility in Shanghai and move into our new India country headquarters in Delhi. In all of our emerging markets, we're actively building our brand and maintaining a strong cadence of new product approvals and launches, such as the recent and important registration and anticipated quarter 4 launch of PROMUS Element in China. Yesterday, we announced our intention to invest an additional $150 million in China over the next 5 years. This investment will be used to develop a local hold your own foreign entity manufacturing operation, which will enables us to access more of the Chinese market and to build a world-class physician training center. We also plan to increase our headcount in China to more than 1,200 employees, including an increase in our sales force to approximately 700 people in an effort to accelerate the expansion of our commercial footprint there. By leveraging our emerging market opportunities, we expect to fuel growth, win global market share, gain access to global talent and bring our less-invasive therapies to more patients worldwide. Longer term, the products we design and develop in China may in fact reach other Boston Scientific global markets. Now let's move on to the E in POWER, which stands for expand our sales and marketing focus. We're investing in re-shifting resources to businesses and geographies with higher opportunities for growth. As well as from more traditional marketing channels to areas such as digital media. We have deployed 2,500 iPads to increase the productivity of our sales reps and proprietary Boston Scientific apps, such as patient medical records to remotely access implant information, CRM device spot check to compare product specifications, iTrial dashboard to view clinical trial metrics and demo apps for products including the ION stent, the WallFlex stent and the Journey guidewire, as they're already available or in the works. We're also evolving our cardiovascular service line to maximize the value of our combined CRV groups to patients, clinicians and economic customers. This means developing new sales approaches, structures and tools that leverage our full line of products to make this uniquely competitive. In addition to programs like CrossCare, we're expanding our value proposition in other ways, such as sharing our supply chain expertise with customers and helping to provide expanded patient advocacy, education and awareness to optimize patient care. We are also evaluating opportunities to partner or cross-sell to third parties to further expand the breadth of our capabilities and product offerings. The R in POWER calls for us to realign our business portfolio. The core element of this plan is our 12 priority growth initiatives designed to enable long-term sustainable revenue growth. We continue to make excellent progress, with 6 acquisitions made in the past 9 months, as well as a number of internal projects with these targeted areas, including in endoscopic pulmonary intervention, we're progressing well with the integration of commercial efforts of Asthmatx and recently received, as already noted, 2 positive reimbursement decisions in the U.S. for the Alair Bronchial Thermoplasty System. The structural heart, we expect to begin enrollment of the REPRISE trial to gain CE Mark for Sadra's Lotus Valve in the fourth quarter of this year. In our atrial fibrillation business, the WATCHMAN Left Atrial Appendage Closure Device continues to grow its case volume outside the U.S., remains on plan for U.S. patient enrollments in the PREVAIL study, which we'll use together with the PROTECT-AF trial data to support future FDA approval. We also have completed the limited launch of our Blazer Open Irrigated Catheter in Europe and have 5 other internally approved AFib-focused projects underway. In peripheral vascular disease, our TRUEPATH intraluminal CTO device should begin a limited market release a little later this year. And our off-road re-entry CTO device is on track for an o U.S. launch by year end, with U.S. trial enrollment expected to begin in the first half of 2012. In AMT, we are very close to enrolling the first patient in the NECTAR-AF trial in Europe, which will evaluate our unique approach to vagal nerve stimulation to improve heart function in patients who are currently not candidates for heart failure device therapy. In hypertension, we're focusing on proprietary technology for the interventional medical device management of patients with drug refractory hypertension, and plan to commence the first of many trials in 2012. And in deep brain stimulation, the integration of Intellect's operations is complete. Our efforts to integrate their DBS technologies are progressing on track, including progress on our Parkinson's disease program in Germany. Innovation is alive and well at Boston Scientific. In fact, Forbes Magazine just recognized that by naming us as one of the world's 100 most innovative companies. Of major medical device companies, only Stryker joined us on the list. Moving on to like number two, we like the continued improvement in our balance sheet strength and capital structure. In the quarter, we pre paid the remaining $750 million of our term loan, which brought our gross debt to a targeted level of $4.2 billion, with our next payment not due until 2014. We feel a little like the family that made that final mortgage payment. Our relentless focus on aggressively prepaying debt has been largely facilitated by our consistently strong free cash flow. Our efforts have not gone unnoticed by the credit rating agencies. In the quarter, Moody's moved us to positive outlook, bringing us to just one action step from investment grade. More importantly, last week, Fitch upgraded us to BBB-, which means that we now have investment grade status with 2 of the 3 major credit agencies. Going forward, we expect our continued strong $100 million per month free cash flow to provide us with the flexibility and capacity to strike a balance between bolt-on acquisitions within our 12 priority growth initiatives and other internal investments and returning cash to shareholders. To that point, we were very pleased to announce this morning that our board of directors has approved a new to plan to buy back as much as $1 billion in our common stock over the next 5 years. This is in addition to approximately 37 million shares remaining under a previous share repurchase program. At yesterday's closing stock price, these combined programs would allow us to buy back more than 10% of our company. Number three, we like the recent positive developments in our DES franchise. You might consider the most obvious piece of good news to be J&J's decision to exit the DES market. I'll address that shortly as a hot topic. But I would argue an important event in the quarter was our U.S. launch of the platinum chromium ION stent and the resulting share implications. The increase in our U.S. DES market share from 46% in quarter one to 51% exiting quarter 2 is a significantly -- is primarily attributable to the successful start of the ION launch. We picked up 4 percentage points in our paclitaxel share. And our paclitaxel/everolimus mix is now the most favorable that we have experienced in more than 18 months. You might assume the share gain came as a complete surprise. But this is something we have baked into our plan well before the launch. It has played out much as we expected, and the shift alignment has nicely contributed to improve gross margins and operating income, albeit somewhat offset by ASP pressure. In addition if the previously mentioned, TUXEDO study delivers the desired result, TAXUS Element and ION may well become the desired stent of choice in a very large and growing diabetic population. Physician feedback during the launch has been exceptionally positive so far. It closely mirrors the response from international physicians during the launch of our Element series outside the domestic market. The positive market reaction bodes well for anticipated U.S. launch of PROMUS Element next year. We truly believe the platinum chromium platform sets a new standard for DES performance. We expect that our 2-drug strategy, delivered on this advanced third-generation platform, will allow us to maintain our global DES leadership into the foreseeable future and bridge us to our bioerodable synergy platform, which is in currently in clinical trials. Number four, we like the fact that we continue to reduce the litigation risks facing the company. We have significantly decreased the volume of litigation disputes with Johnson & Johnson over the past 2 years. We've had some recent favorable developments in some of the matters that remain. In May, a jury awarded us $19.5 million in damages for Johnson & Johnson's willful infringement of our Jang patent by the sale of the CYPHER 2.25 millimeter stent. We're seeking additional damages in our first trial motions. In June, the U.S. Court of Appeals for the Federal Circuit affirmed a finding that the right patents that Johnson & Johnson asserted against our PROMUS coronary stent franchise were invalid. We also received good news concerning 2 government investigations involving our CRM group. The first relates to a previously disclosed criminal investigation by the U.S. Attorney's office here in Boston into the events surrounding our March 2010 iCDN CRT-D device ship hold and product removal actions. The U.S. Attorney's office informed us that it is discontinuing that investigation. A second bit of good news relates to an investigation that was initiated in 2008 by the U.S. Attorney's office in Maryland concerning payments made to physicians who performed valuable training services for our CRM sales representatives. The U.S. Attorney's office for the district of Maryland advised that it is also discontinuing that investigation. Though we still have litigation challenges. We believe our exposure is far less problematic now than it has been at some time, and things are moving in the right direction. We will continue to run our business and manage the litigation in an effort to further minimize future risks. But in the meantime, litigation risk has improved dramatically. Dislikes. Turning to dislikes, the first in our continued decline -- the first is the continued decline of the U.S. defib market. During the second quarter, we saw some further softening in implant volumes in the U.S. market. There are a number of factors in play here, including physician reaction to the JAMA article and other negative study results and media articles, the DOJ investigation and local inquiries into the ICD implant appropriateness of use. However, this is only part of the story. Based on our discussions with physicians and hospitals, we see that internal audits mandated by their senior leadership are significantly influencing the volumes at many accounts. With the increase in hospital consolidations and the growing focus on procurement and inventory efficiencies, many facilities are refusing to hold pay for the large device inventories. Additionally, the alignment of electrophysiologists with hospitals and hospital systems continues to grow stronger as independent practices turn increasingly to hospital-owned practices where the EP is an employed and not an operating partner. These long-term trends go beyond the short-term impact of a couple of unfavorable stories or media stories. Adding these factors to the mix would lead us to believe the recovery will take a little longer than originally foreseen. We expect the worldwide CRM market to show slightly negative growth in the near term and then return to modest growth in the low single digits within the next couple of years. The good news is that our U.S. defib share remained stable sequentially. We are also planning for FDA approval of our next-generation ENERGEN, PUNCTUA and INCEPTA models late this year, which will support our growth into 2012. Number two in our dislikes is the continued weakness in elective procedures. We've seen this across nearly all businesses, and it's a trend that has now persistent for more than a year. Earlier this year, we updated findings from a major internal study of procedure volume changes in our served markets with a focus on elective versus nonelective procedures. The research confirmed the decline in procedural volume growth rates would generally reflect the current economic environment. We continue to monitor the recovery of procedural volumes with internal data and external market surveys. Our operating plan assumes low to mid-single digit procedure growth, but we are optimistic that a modest recovery will emerge in the near term as built-up demand for procedures begins to unwind. However, any recovery will be moderated by lingering high unemployment rates; higher out-of-pocket expenses for insured patients, which may encourage them to delay care; an ongoing trend towards physician subspecialty employment by hospitals, which is expected to approach 60% by 2012; and a shift in procedures from inpatient to outpatient settings. We've carefully assessed how these findings may impact our priority growth initiatives, and are confident that we're focusing on new products, therapies and patient populations that are not only less impacted by these trends, but in fact may mitigate their effect. Number three is the ongoing pricing pressure we're seeing in many of our key markets. As part of our research on procedure volumes, we collected data that validates these pricing challenges. Evidence points to the increasing influence of economic bars in the U.S. and European hospitals, who have a sharper focus on vendor management and cost containment. Long-term trends toward physician employment with hospitals and greater emphasis on health technology assessments have also impacted current pricing as well as our ability to secure premium prices for new products. Price pressure has been a problem for some time now, and we expect it to continue to impact our margins in the next year and continue to be one of our biggest challenges. What will set us apart in this area is our ability to offer highly differentiated products that demonstrate clear advantages through clinical data that bring value to physicians, patients and payers. Dislike number 4 relates to the recent FDA update on the use of urogynecological surgical mesh for pelvic organ prolapse. On July 15, the FDA issued a communication that included a revision to the 2008 public health notice, updating clinicians and patients on the complications related to surgical mesh for pelvic organ prolapse and stress urinary incontinence. Based on their review of the available literature and adverse events reported to the FDA, they believe there is not sufficient clinical evidence versus traditional surgeries that do not use mesh. Furthermore, the FDA believes that the use of mesh introduces additional complications. The communication also states that in September, they will hold an FDA advisory meeting in order to discuss their findings with outside experts. In this meeting, they will seek opinions on the type of clinical data that may be required to better assess the risk and benefits and possible regulatory changes for these products. The FDA continues to evaluate the effects of using surgical mesh for the treatment of stress urinary incontinence and will report those findings at a later date. Since 2008, Boston Scientific Urology and Women's Health has been aware that FDA has had these concerns. Beginning in December 2010, we have had several discussions with the FDA on this matter. In April of this year, we had a face-to-face meeting with the FDA, in which 2 of our key opinion leaders educated the FDA on our products, treatment options and the risk/benefit profile. We have also been working with our mesh manufacturers throughout the med to prepare for the upcoming advisory meeting in September. We and the physicians who use mesh strongly believe that these products are a valuable tool to treat patients with pelvic floor disorders and stress urinary incontinence. Let me turn now to hot topics. The first hot topic I'd like to address, the 2011 restructuring program that we announced today. Like most companies in our industry, Boston Scientific is facing a number of challenges and evolving market dynamics, many of which have been addressed today. In response to these challenges and to further position the company for long-term growth, we introduced the POWER strategy during our Investor Day last November. POWER is the foundation around which all of our goals and objectives are based, and is designed to position us for continued innovation, future growth and increased shareholder value. In support of the POWER strategy and specific to the O for optimize company, we have identified opportunities to become more efficient, productive and competitive. Today, we announced details of our 2011 restructuring program designed to help achieve these goals while further supporting new investments and increasing shareholder value. Key activities on the program include the company's zero-based budgeting initiative and components of the emerging markets initiative. The program as a whole is intended to drive long-term competitive advantage and enable us to accelerate innovation of technologies that save and enhance lives. Under the restructuring program, we plan to expand our ability to deliver best-in-class global shared services, particularly in emerging markets. This will enable us to grow our global commercial presence and take advantage of many cost-reducing and productivity-enhancing opportunities. In addition, we are undertaking efforts to streamline various corporate functions in international regions to increase productivity and align corporate resources to key business strategies. It's clear that we are facing an evolving industry landscape being reshaped by a number of external factors. To remain competitive and maintain the right level of resources, we're taking the necessary steps to reduce our cost, optimize our processes and enhance productivity. Through the 2011 restructuring program, we are practically managing this change to ensure we have the proper infrastructure to support our size and anticipated growth. This program will also better prepare us to grow in a rapidly expanding international markets by increasing our footprint and leveraging global talent. There are those who believe our expense ratios are already low or lowest relative to our competitors. On the contrary, we believe that in the world we're heading into, their expenses will prove to be too high, and we are correctly at the leading edge of the sort, but not that at the fabled bleeding edge. As the last hot topic, I'd like to address J&J's decision to exit the DES market at the end of 2011. For several years now, we have all followed J&J's difficult times in the DES market, quality issues declining market share, layoff setbacks with its needle program and the general lack of a pipeline. Given all that, their decision on CYPHER in total still took us by surprise. Obviously, we're excited about the potential upside, but frankly, we don't anticipate much benefit this year since the remaining businesses with a loyal base of customers who likely won't transition products until forced to. Current estimates of the global CYPHER stent business are in the $200 million range for 2012, and some have predicted Boston Scientific could capture as much as 2/3 of that business. I'm not willing to validate such a prediction, but I do know the following facts: We have the leading Olimus stent in PROMUS; we have launched our third-generation paclitaxel platform in ION, which has enjoyed good early success; and we expect to launch our third-generation everolimus element platform, PROMUS Element, earlier than mid 2012. We believe these products will serve us very well in attempting to capture the lion's share of the DES business left on the table by J&J in addition to having striking delivery and performance benefits to those combatants remaining. A more difficult factor to assess in the J&J story is their $400 million segment of non-DES interventional cardiology products, which includes bare metal stents, guidewires, balloons and diagnostics. This segment suddenly becomes more vulnerable to competition once we remove DES from their Cath Lab portfolio. However, we expect it to be much tougher to take share here since J&J has some strong products and will continue to have a sales force focused on that area. Overall for Boston Scientific, it's a rare opportunity and frankly a rare gift. We assure you that we are taking steps needed to maximize the share of this business that will come our way. In closing, we believe that we've shown great progress in continuing the execution of our POWER business strategy. Among other things, we have aggressively reduced our debt to target capital structure levels and regained our investment grade profile. We've already announced 6 new acquisitions, and our improved balance sheet will allow us to continue to pursue appropriate acquisitions in our priority growth areas. We will without question return value to shareholders through share repurchases. We have announced a restructuring program designed to strengthen operational effectiveness, achieve substantial cost savings and make Boston Scientific a stronger global competitor. We have and will aggressively reinvest in double-digit growth emerging markets. We have talked about Boston Scientific being powered for growth, now we are proving it. That's it for my comments. With the amount of information provided today, I'm sure there will be no lack of questions. So with that, I'll turn it back over to Sean, who will moderate the Q&A.