Dec. 1--Looking back now, July seems like such a simpler time.

The Dow was around 11,000. "Bailout" wasn't yet a buzzword.

So, with that in mind, consider the following stock pitch made by CNBC's "Mad Money" host James Cramer during his July 17 TV show.

Shares of Symmetry Medical -- a Warsaw-based orthopedics-instruments supplier -- were poised for a rally, Cramer said.

"Nobody stops getting hip replacements because the economy is bad," he said, according to a recap of the July 17 show on financial Web site thestreet.com. Cramer said the stock, which that day closed at $16.08, could reach $21 a share.

Shares of Symmetry closed Friday at $8.96.

Cramer's pitch was based on the idea that health-care stocks could prosper even amid a possible recession, according to thestreet.com's writeup.

This is not an attempt to criticize Cramer. Instead, this episode illustrates the complex challenges facing companies in today's hyper-competitive and struggling global economy.

Competitive pressures and strategic missteps are exacerbated during tough times.

On Nov. 12, Symmetry's stock took a hit after the company lowered its earnings forecast for the year amid ongoing losses at its unit in Sheffield, England. Symmetry previously had disclosed accounting problems at its Sheffield unit.

Symmetry Chief Executive Officer Brian Moore, on the earnings conference call with investors last month, talked about "sustained momentum in demand" from the company's major customers.

Yet he also appeared cautious heading into 2009.

"If we didn't read the newspapers and the media, we would not be aware of any issues economically from what our customers are telling us, what our plants are saying and what the facilities are actually producing," said Moore, according to a transcript of the call.

"Obviously, we do read the media and the newspaper and we do realize that the economy, everybody is forecasting that at some point it would recover clearly, but it's likely to get worse before it gets better."

Zimmer Holdings, a Warsaw-based artificial joint maker, also is feeling the pressure. Shares of Zimmer closed at $37.32 Friday, down from a 52-week high of $80.92 in April.

Last week Morgan Stanley analyst David Roman downgraded shares of Zimmer and rival Smith and Nephew, citing a host of challenges -- economic and otherwise.

Roman, in a Nov. 25 research note, called them "headwinds."

More patients would delay elective orthopedic procedures amid the tough economy, he predicted. He also saw a coming shift from traditional surgeries to newer treatments such as cartilage preservation and tissue regeneration -- a trend requiring companies to boost research and development spending.

Indeed, the downturn is hitting even dynamic health-care companies.

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