Sunday, January 31, 2010

Sunday Morning Op-Ed Piece

Recently, TSB was traveling with a principal of an early-growth stage company when this person exclaimed; "its amazing what we have done to ourselves as an industry." I would have loved to use the word "principle" but in all honesty, there are very few people in spine that possess the guiding sense of the requirements and obligations of right conduct. Years ago, spine was a well respected industry, one that focused on delivering innovative technologies that really made a difference in the clinical outcomes and the quality of life for those that needed it the most, the patient. With over one hundred companies, the industry is beginning to exhibit massive gridlock, where executive management teams resemble the United States Congress lacking in true leadership by bringing old values and strategies of self-preservation. The truth is that the industry is as dysfunctional as we have ever seen it. Somewhere along the way, the industry lost its moral compass by throwing aside the clinical and ethical obligations "of doing the right thing" by wanting to play in a game that few are qualified yet many long for. Based on conversations that TSB has had with colleagues held in high esteem because of their integrity and love of the industry, the belief is that the defining moments were the development and sale of Charite to DePuy and Spine Solutions, aka ProDisc, to Synthes. True innovation does not last very long.

Up until then, many companies were developing products incrementally enhancing their respective portfolios willing to build a business based on common sense and realistic financial forecasts. Suddenly, in one fell swoop, the game was on. Charite was brokered by former U.S. Surgical employees and Spine Solutions, gave us an introduction to a former Wall Street analyst turned merchant banker. With the sale of those technologies came entrepreneurial fever. The common theme heard was "if they can do it, why can't we?" Not only did this change the mind set of industry professionals and surgeons, it open the door to every private equity and venture capitalist around the world. With innovation came the craze to patent any and every idea that one could come up with. This was reinforced by the Michelson victory over Medtronic Sofamor Danek. With innovation, we were introduced to deal making. Today, our market is glutted and will be gutted because of our ability to imitate, rather than to innovate. The only true innovation comes from those companies that have the ability to come up with a better marketing spin. How does one develop another pedicle screw, another cervical plate, another zero-profile device, another cage, or biologic when it doesn't truly change the clinical outcomes? Simply, by the art of the deal.

Suddenly, everyone had to be in on the deal. Everyone had an idea. Products were churned out regardless of innovation or not. We heard the words; first generation, second generation, third generation, fourth generation. All this with no retrospective data. It was pure marketing at its best. The more capital that was taken in, the more we had to learn that nothing on Wall Street or by investors was done long-term, life became a short-term race. Today we pride ourselves as an industry that is constantly under scrutiny by the Department of Justice, an industry where we applaud a CEO who started a company by stealing his former employers IP and employees, conspiring against it. And, we applaud its success. Shameful. Many of you call it genius, I call it criminal. An industry where the leading question in an interview is, "how much revenue can you bring within a certain period of time, meaning how many surgeons do you own." Where distributors buy surgeons business by either hiring their brother-in-law, or kicking money back to the surgeons under the table. Where surgeons no longer want to be surgeons, but want to be distributors, where hospital CEO's are in bed with companies. Where an employee is no longer an asset but a commodity, treated disrespectfully because those that lead have no idea of what their doing.

It's become quite evident that we are in a race. The question is, "are we in a race with ourselves or is it a race with time, before someone has the wherewithal to put on the brakes?" Where are the Howard Beale's of the spine world that have the intestinal fortitude to stand up and yell, "we're mad as hell and we're not going to take it anymore." The fact is that we have become a see nothing, do nothing, hear nothing industry. TSB wants to know what our readers think?


  1. An excellent piece TSB !

  2. With all due respect, TSB, it’s easy to sit on the sidelines and criticize companies for engaging in practices you don’t approve of. If you ever had the opportunity to run one of these companies in this hypercompetitive market, I think your morally superior attitude would evaporate as you struggled to meet payroll and build a viable business.

    The fact of the matter is that without aggressive marketing it would be difficult if not impossible to wrestle market share from what you call the spine cartel. Mind you there is a distinct line between aggressive and illegal. Smart growth companies have consulted with experts and know exactly where the line is and don’t cross it. As much as you would like to think shiny happy companies with innovative products will win the race, history says otherwise. The gutter is lined with companies which have tried to make it on nice technology and an earnest approach. The winners are the ones who kicked everyone else in the face on the way to the top. How do you think Medtronic and Depuy got to the top of the heap? The CEOs and managers that you rail against are acutely aware of this – they are paid to deliver results and have an obligation to do anything legal it takes to build their business.

    If we were to do as you suggest and “not take it anymore” then we might as well all go to work being an assistant to the assistant sales manager at Medtronic and wait out our days for the company pension. No thanks.

  3. Having been in this business for many years, I probably have forgotten more about it than you'll ever know. There was a time that we all played by a distinct set of rules, being respectful of one another. Unfortunately, somewhere along the way. the lines got blurry and everyone started to believe that its okay to act in a corrupt manner. It's the "those rules don't apply to me generation." Just for your information, I don't sit on the sidelines, like anyone else I am in the trenches everyday. As usual, thanks for your commentary and don't believe for one second that all those wonderful CEO's play by the books, because I have sat next to them in many a meetings.

  4. TSB. I would be interested in knowing if the company or companies you work for abide by the guidelines you have espoused in your blogs including the one above. While it's easy to pontificate from afar, it's harder to implement the changes you outline from within a company. Would be interested in knowing what success you have had making this happen where you earn your living.

  5. Anonymous: I have never bought a surgeons business, nor do I intend on buying someone's business. Surgeon's make enough of money. I am an advocate of consulting agreements as long as they are legitimate projects not the fictitious kind that are utilized to buy business. Ironically, there are a few of us in the industry that marvel at the machinations that some companies, distributors and surgeons will go to just to make a buck. Thanks for your commentary and keep on reading.

  6. It was easier for the industry to "do the right thing" when there was little money in spine...the past several decades have seen a gold rush mentality with the discovery of and profitablility of spinal implants. The industry will return to its "principles" when the money dries up.

  7. applaud a CEO who started a company by stealing his former employers IP......

    You mean DP? Surely you jest.

  8. TSB, if I knew who you are, I'd kiss you! Rarely were truer words written.....

  9. Interesting comment on how the turning point was with the Charite acquisition.

    Once upon a time I was a rep for multiple ortho lines including Waldemar Link's instruments. One year at AAOS they had a 4-5 level Charite construct and wondered how the hell that would work as I'm an engineer by training and had another spine line at the time. Talked to one of the German engineers and he said that "Charite will never be sold in the United States."

    How times have changed.

  10. How many ways can you jack open the posterior foraminal space? Good Question. The question we have been asking: How much money can we make jacking open the posterior foraminal space? The question we should be asking - What's the most cost effective way to jack open the foraminal space?

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  12. I feel everyone thinks this pain doesn't exist. Like a lightning bolt from left ass cheek to my ankle. Sitting is torture.therapy makes it worse battle thru and have never called off work, but how can I get this to stop? Don't want meds or money or time off, just want to be able to sit, and tie my work boots myself

  13. part too
    I was taken to a small city hospital ,I was mmassively hurt but survived
    I healed mostly bt two breaks of spine wouldn't in the lower L 3-4-5 AND S -1 AND THW IMAGINARY S 2 ,ITS REALLY THERE

    I had bones legs they wanted to amputate at first looking at me ,both 1st wife and 40 y r r n nurse my mom wouldn't think of amputation he' d kill us was what they told the docs .
    they tried to heal the breaks ,I was first patient for young very very good dr muagna cum l uade he was from uni of Maryland and he was Rhodes scholar ,and he went to mayo clinic for 2 y r special training with Medtronic drs on spinal surgery .
    I was 1st patient when he came to town and joined the spinal {ortho group }
    we did the dance ith fluoroscope direct into the spinal column injections for about 1 yr ,hurt ungodly ,but I tried them ,we decided th e inner --outer spinal fusion would alleviate my suffering ,I would also have a laminectomy and a compression which would open up nerve which had been pinched when she ran over me with her car .
    he would put the hardware into the spine and remove broken bone .
    it went ok at 430 am june 1 2004 I arrived in or under partial sedation ,I was origanaly scedaled in march 2004 for surgery at st peters in allbany ny but was rescheduled for june 1 2004 at st marys hospital in troy ny I really didn't like st marys hospital .
    I walked with help on june 1 and june 2 2004
    on june 3 I walked in morning by 5 pm I was ill I told y nurse she started checking me and agreed I asked for aircon and wet cold towel sshe got me some ,7 pm I was 105 f 8pm 107f by middle of the night my eyes wer ebleeding I had a massive gut-bowel illeous ,kidney failure output was 0% ,heart ,lungs collapsed two tubes were inserted ng tubes in nose ,I became incontenent both bladder and rectally ,very liquid green feces {lasted for up to 2 yrs
    when I awoke from coma I didn't know my wife of 30 yrs I didn't like her either ,I didn't know my adopted son either or two of my sisters I lost 10 to 15 yrs of memories ,I had toxic wncephalopathy causing brain damage and the brain swelleing they cut off top of my head and put in nitrogen rods to reduce the swelling .
    I have illness still I have needed 35 other surgeries to stay ahead of the grim reaper side effects of medtronics devices used on me in a simple back surgery
    we ar ein agroup one og my devices was recalled in 2007 by medtronics ,I cannot hav eit removed to much bone growth ovwer it .
    so we await to see if they will offe rus anything to compensate or help the lawyers don't ever want to help it doesn't fit the types of cases they want .

  14. sorry but guess make beleive is all good not real live sorry to bother all the little guys I will come back when the adults come on
    bye children

  15. I was going to have the surgery. But now I'm not. Thank you for saving my life people. Sorry you all had to find out the wrong way.

  16. I went in for a consultation and was pressured by Peter Dapont to give them a 1000 dollar deposit...I decided prior to seeing the doctor to cancel my exam and was charged 1000 dollars for their soon as I questioned their protocol I was treated like a leper and had to fight for my non authorized while you still can