Medtronic
Medtronic plc is a medical device company that generates the majority of its sales and profits from the U.S. healthcare system but is headquartered in the Republic of Ireland for tax purposes.[3][4] Medtronic has an operational and executive headquarters in Fridley, Minnesota in the U.S.[5][6] In 2015, Medtronic acquired Irish–tax registered Covidien (a U.S. tax inversion to Ireland from 2007), in the largest U.S. corporate tax inversion in history,[7][8] which enabled Medtronic to move its legal registration from the U.S. to Ireland.[9] Medtronic operates in 140 countries and employs over 86,000 people
Medtronic was founded in 1949 in Minneapolis by Earl Bakken and his brother-in-law, Palmer Hermundslie, as a medical equipment repair shop.[11]
Through his repair business, Bakken came to know C. Walton Lillehei, a doctor of heart surgery at the University of Minnesota Medical School. The deficiencies of the artificial pacemakers of the day were made painfully obvious following a power outage over Halloween in 1957, which affected large sections of Minnesota and western Wisconsin.[12] A pacemaker-dependent paediatric patient of Lillehei died because of the blackout. The next day, Lillehei spoke with Bakken about developing some form of battery-powered pacemaker. Bakken modified a design for a transistorized metronome and created the first battery-powered external pacemaker.
The company expanded through the 1950s, selling equipment built by other companies but also developing custom-made devices. Bakken built a small pacemaker that could be strapped to the body and powered by batteries. Work in the new field later produced an implantable pacemaker in 1960. The company built headquarters in the Minneapolis suburb of St. Anthony, Minnesota, in 1960[13] and the company moved to Fridley in the 1970s. Medtronic's main competitors in the cardiac rhythm field include Boston Scientific and St. Jude Medical. In 1998, Medtronic acquired Physio-Control for $538 million.[14]
Animal rights (2005 to 2010)
In 2005, 2008, and 2010 PETA threatened to submit a shareholder resolution to improve animal welfare standards in the company. In 2005, PETA attempted to stop five specific animal experiments that it deemed "crude and cruel". In 2008, PETA protested the outsourcing of animal testing to countries with lax animal welfare laws, such as China. In 2010, PETA attempted to stop Medtronic's reported use of live animals in testing and training. In response, Medtronic conducted a feasibility study that found that banning the use of live animals was impractical. Medtronic continues to use live animals for testing and training but has said that it will look for alternatives in the future. In each case, PETA withdrew its shareholder resolution after talks with Medtronic's leadership.[15][16]
Tax inversion to Ireland (2014)
In June 2014, Medtronic announced it would execute a tax inversion to Ireland by acquiring Irish-based Covidien plc (a previous U.S. tax inversion to Ireland in 2007), for $42.9 billion in cash and stock.[9][17] The tax inversion enabled Medtronic to move its legal headquarters to Ireland, while maintaining its operational and executive headquarters in the U.S., thus allowing it to avoid taxation on more than $14 billion held overseas, and avail of Ireland's beneficial low corporation tax regime.[7] Medtronic's tax inversion is the largest tax inversion in history,[4][7][8] and given the changes in the U.S. tax-code in 2016 to block the Pfizer-Allergan Irish tax inversion, is likely to remain the largest.[6] Medtronic CEO Omar Ishrak defended the tax inversion in a 2015 interview to the Financial Times saying, "We just followed the rules and the deal was done based on strategic merits".[10] Ireland is less than 0.1% of Medtronic (or Covidien) sales, and the majority of Medtronic's sales, and an even greater percentage of Medtronic profits (due to the higher margins on U.S. medical devices), are from the U.S. healthcare system.[4] In 2016, the Star Tribune reported that Medtronic was still winning U.S. Federal contracts and attending U.S. trade-missions as a U.S. company.[5]
In terms of scale, on 23 November 2018, Ireland's largest stockbrokers, Davy Stockbrokers reported that the total capitalization of the Irish stock market was €104 billion (this does not include Medtronic, which Davy do not consider an Irish company).[18] In contrast, on the same day Medtronic's capitalisation was listed on Bloomberg at just over $130 billion (or €115 billion).
Medtronic's acquisition of Covidien plc made Medtronic the world's largest medical device company by revenues.[3]
Post tax inversion to Ireland (2014–2020)
In February 2016, the company announced that it would acquire Bellco from private equity firm Charme Capital Partners.[19] In June, the company announced its acquisition of HeartWare International Inc. for $1.1 billion.[20] In December 2017, Medtronic acquired Crospon in €38 million ($45 million).[21] In September 2018 the company acquired Mazor Robotics for $1.64 billion ($58.50 per American Depository Share or $29.25 per ordinary share.[22] In late November, Medtronic acquired Nutrino Health Ltd boosting the companies nutrition-related data services and analytics.[23]
In May 2019, Medtronic announced it would acquire Titan Spine, a technology company focussed on titanium spine implants.[24] Chief Executive Officer Omar Ishrak will retire in April 2020 and will be succeeded by senior executive Geoff Martha.[25]
In January 2020, the company announced its intention to acquire Stimgenics, LLC and their primary therapy, differential target multiplexed spinal cord stimulation
History
1956: Vitatron founded
1962: First Implantable pacemakers
1981: Microprocessor-driven, software-based pacemaker (DPG1)
1982: Rate Responsive pacemaker (TX1)
1984: Quintech DDD with automatic upper rate behavior ("mode switch")
1988: Daily Learn algorithm (Rhythmyx)
1997: First upgradeable pacemaker system with dedicated AF diagnostics, rate and rhythm control therapy.
2003: Vitatron goes digital: 1st Vitatron C-Series, the world's first fully digital pacemaker.[60]
2004: 2nd Vitatron C-Series, digital, fast pacemaker.
2004: Vitatron T-Series: The full picture, digital pacemaker system.
2005: Vitatron C-Series, A3 models, a new top line range of digital pacemakers for bradycardic patients.
Business units
Medtronic has four main business units: the Minimally Invasive Therapies Group, the Diabetes Group, the Restorative Therapies Group, and the Cardiac and Vascular Group. Medtronic develops and manufactures devices and therapies to treat more than 30 chronic diseases, including heart failure, Parkinson disease, urinary incontinence, Down syndrome, obesity, chronic pain, spinal disorders and diabetes.
CRDM
Cardiac rhythm disease management (CRDM) is the oldest and largest of Medtronic's business units. Its work in heart rhythm therapies dates back to 1957, when Bakken developed the first wearable heart pacemaker to treat abnormally-slow heart rates. Since then, it has expanded its expertise in electrical stimulation to treat other cardiac rhythm diseases. It has also made an effort to address overall disease management by adding diagnostic and monitoring capabilities to many of its devices. An independently-operating Dutch pacemaker manufacturer, Vitatron, acquired by Medtronic in 1986, is now a European subsidiary of the unit.[61] Medtronic and Vitatron pacemakers are interrogated and programmed by Medtronic Carelink Model 2090 Programmer for Medtronic and Vitatron Devices; they use separate interfaces.[62]
In 2007, Medtronic recalled its Sprint Fidelis product, the flexible wires, or leads, which connect a defibrillator to the interior of the heart. The leads were found to be failing at an unacceptable rate, resulting in unnecessary shocks or no shocks when needed; either can be lethal. The scope of the problem continues to be a matter of research. Studies since the recall, disputed by Medtronic, suggest that the failure rate of already-implanted Sprint Fidelis leads is increasing exponentially. Medtronic's liability is limited by various court decisions.[63]
Spinal and biologics
Spinal and biologics is Medtronic's second-largest business. Medtronic is the world leader in spinal and musculoskeletal therapies. In 2007, Medtronic purchased Kyphon, a manufacturer and seller of spinal implants that are necessary for procedures like kyphoplasty.[64]
In May 2008, Medtronic Spine agreed to pay the US government $75 million to settle a qui tam lawsuit after a whistleblower alleged that Medtronic committed Medicare fraud. The company was charged with illegally convincing healthcare providers to offer kyphoplasty, a spinal fracture repair surgery, as an inpatient, not an outpatient, procedure to make thousands of dollars more in profits per surgery.[65]
A "special report" by writer Steven Brill in Time showed that according to Medtronic's quarterly SEC filing of October 2012, the company had, on average, a 75.1% profit margin on its spine products and therapies.[66]
Cardiovascular
Medtronic's cardiovascular therapies span the major specialities of interventional cardiology, cardiac surgery and vascular surgery. The products are used to reduce the potentially debilitating effects of coronary, aortic and structural heart disease.
Neuromodulation
Neuromodulation is the second-oldest and third-largest department of Medtronic. Its products include neurostimulation systems and implantable drug delivery systems for chronic pain, common movement disorders and urologic and gastrointestinal disorders. The department's revenues in 2014 amounted to $1.9 billion, or 11% of Medtronic's total revenues.[67]
Diabetes
The diabetes management manufacturing and sales division of Medtronic is based in Northridge, California.[68] The original company, Minimed Technologies, was founded in the early 1980s by Alfred E. Mann and spun off from Pacesetter Systems to design a practical insulin pump for lifelong wear.[69] Most devices then were either too large or impossible to program and were extremely unreliable. The release of the lightweight, menu-driven MiniMed 500 series changed the landscape, and it was a major factor in bringing insulin pump usage to the mainstream.
In 1996, the MiniMed was redesigned by the innovation consulting RKS Design to look both more flashy and more elegant and to resemble a beeper. The friendliness of the device boosted adoption rate, and sales increased by 357%.[70] In the early 2000s, Medtronic purchased Minimed, to form Medtronic Minimed.[71]
On 11 May 2009, Medtronic announced it had chosen San Antonio, Texas, for the location of its new Diabetes Therapy Management and Education Center. The company announced that it expected 1400 new jobs would be created to staff the 150,000-square-foot (14,000 m2) facility.[72]
In September 2016, the FDA approved a device, MiniMed 670G, which automatically pumps insulin to a diabetic patient's body on sensing its absence or reduction
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