CRH Medical is updated and rated Speculative (higher) Buy. This is a small company with a market cap of U.S. $250 million. It is very much in a niche industry as it mainly provides anesthesia services for colonoscopies. Demographics are certainly favorable to it. It is a growth by acquisition company. It funds that growth through debt and cashflows and has not issued shares since 2014 when it first entered the anesthesia business through a large acquisition. In addition to a steady pace of small acquisitions it has been buying back shares for the past two years which is an indication of its strong cash flows. A possible major risk is that new technology could emerge that would make colonoscopies largely obsolete. To date the company does seem to fear that will happen. Absent a major change in technology, I expect this company to continue to grow by acquisition. It appears to be trading at a low price to its cash flows or adjusted earnings. Since it is a smaller company, interested investors should probably not make it more than a small part of their portfolio. I added to my holding in this company today.