Tuesday, July 20, 2010

Questions for Our Readers

How slow is business when one considers that even the Almighty Stryker reported flat sales for spine?

And,

Is there anything new and exciting in the Spine World?


79 comments:

  1. stryker reports flat sales because they are no longer the new and exciting company in spine. that distinction belongs to nuva, k2m, the disc guys and anyone who didn't get pigeon holed into me-too fusion.

    other new and exciting things? how about the apocalypse facing entire technologies in the US (dynesys)?

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  2. It never occurred to me that Stryker was an innovation leader. I truly believe that there are simply just less surgeries now than there were two years ago.

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  3. It's across the board. I hear it everywhere.
    Most of all from greedy surgeons that aren't making their big bucks as of late.

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  4. But the hospitals keep making more and if they are not then they are ran by idiots!

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  5. The numbers at JNJ and Stryker are flat because the smaller, more agile companies are taking bigger chunks of share. My feeling is that procedures overall are not down, just the proportion going to certain bigger players.

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  6. instrumented spine surgery is down as it should be.

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  7. Smaller companies taking bigger chunks of market share? I would venture that many of these smaller companies $10-$15 million are as flat as the legacy companies, if not flatter. It really depends on what segment of the market you are discussing. Biologics? Emerging Technologies? Me-Too Products? Soft Goods? Bone Stimulators? Physician Owned Distributorships? Based on our discussions, everyone is feeling this depressed/recessed economy. Yes there are companies that are receiving investment capital, but these are selective technologies that investors believe have the potential to be disruptive. Where are all the prognosticators and analysts when things are going bad? When times are great, they would crawl up our asses. Any of them willing to make predications now? This is still an attractive industry. Where is Wall Street and the investment community going to find the margins that exist in spine or medical devices? Yet, having to take less, means that we are all going to take less, with the exception of our highly esteemed CEO and senior management. Greedy Pricks and Bastards!

    The current state of the industry makes Twiggy look like she has breast. Many companies have decreased their commission plans, have a harder time getting access to their revolving line of credit, and are complaining that it is taking longer than usual to get paid. The days of 20% growth are over for at least two-four years if not longer. Like it or not, we have no one else to blame than ourselves, our elected government officials whom need to be voted out, and our friends on Wall Street. Maybe, this will snap many out of our irrational exuberance. Remember, even the greatest of great Empires collapsed, does anyone think we are immune from it?

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  8. Margin compression, lack of product differentiation, increasing patient deductibles equals stagnant industry. The ability to charge dramatic price differences compared to OUS was based on a thriving, growing US economy which is a fond memory.

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  9. What small emerging companies would you all recommend looking at? Any good niche players in spine out there?

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  10. I have a few surgeons who have noted that their case load has dropped. These surgeons are big cutters. Odd, their case loads may have decreased but their long vacations have not?????

    Peace

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  11. great question!!!!!!!
    surgeon owned companies.... they are taking down goliath companies now....

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  12. I have seen the enemy, and the enemy is within! We will be all held accountable for our own demise. That's what happens when everyone can't play in the same sandbox and gets GREEDY!

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  13. k2m got purchased- by a 30 billion dollar venture capital firm claiming they will keep buying more device companies, then will go public....
    interesting, not sure how much i buy into it...but worth mentioning.

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  14. Musco man, You said "...Smaller companies taking bigger chunks of market share? I would venture that many of these smaller companies $10-$15 million are as flat as the legacy companies..."
    These surgeon owned companies may not be blowing it out of the water but the commission is so much higher. Everybody wins!!!!!

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  15. TSB - Twiggy? Whoa. Even for an old guy like me that is a dated reference. Kate Moss?

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  16. As pricing continues to flatten the market along with fewer surgeries one doesn't believe that some of these smaller companies are going to continue paying 30-40% commissions? Enjoy the party while it still goes on because eventually Don Meredeth will be heard in the background singing, "turn on the lights the party's over!" Even the surgeon investors will get tired of subsidizing the venture and realize that the tax write will off set their investment.

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  17. first poster here - does no one care that dynesys is all but dead? i'm shocked at how little has been discussed about this

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  18. Yes dynesys is on its deathbed. Too much off-label use got the FDA to come down hard on this segment. The payors took notice and cut reimbursement. And that's that.

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  19. what's crazy is that it's still alive and kicking everywhere else in the world? does this mean the FDA is onto something about its hazards that no one else knows or that they are overreacting? either way, once dynesys goes the way of the dinosaur in the US, we'll eiher be missing out or laughing at the poor suckers every else getting ticking time bombs implanted in their backs

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  20. 30 - 40% commisions!!!-- What are they going to do ?!?! Cut them to 15- 29.5 percent!!! That's still better than anybody else out there. What do the heavy hitters pay in commisions? Trust me, it's embarassing to say the rate....So i won't.

    You can also buy in with your relationships and act as an owner. It's the future. Don't ignore it.

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  21. less than 5% is my company
    30-40% is insanity, i'd be retired in about 5 years if my company paid that

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  22. As someone who works for a spine company in the $10-15 million sales range mentioned, we have seen record sales this year and our Q2 was our best quarter ever.

    This was on pretty much bread and butter metal/PEEK product. So I wouldn't take the Stryker/Depuy/etc. numbers too seriously, there is plenty of business out there if you are willing to work hard for it.

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  23. So the question must be asked, how many of your surgeons are consultants, have equity in the company, or, are getting paid under the table. Let's get serious, unless you're selling in some podunk market place, you're not getting your me-too products that easily into major hospitals or hospital buying groups.

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  24. It's called selling. No one seems to know how to do it anymore. You can take business away from anyone who isn't being paid if you have a better product and know how to sell it. It is a lost art!

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  25. what is selling??? huh??

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  26. Is Medtronic still alive?

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  27. I just look at Globus when I want to take in a few gallons of innovation! Does somebody have a napkin? Can't get this Kool-aid stain off my mouth!

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  28. Having spent time at Xerox, pharma, and even software I have always been amazed at the lack of sales training in the device industry. Sure there is anatomy, product training, competition and all that but I have yet to see actual sales training with any company. For some of the huge dollars paid out in commissions, why is this missing within companies? Is it all about surgeon consultants and relationships and if so, why should you bother?

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  29. anonymous 622-lack of sales training because its not sales! follow the money. Actually the only people that are true sellers are the Alphatec reps.

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  30. On a related note, anyone else notice that Alphatec's stock dropped 7% today? I get the feeling that last quarter's numbers (due to be announced in a couple of weeks) will not be pretty.

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  31. i ate fried chicken for dinner

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  32. The chicken dinner comment is about as relevant and funny as the post stating that Alpatec reps are the only ones 'selling'.
    Both equally hilaroius.

    Chicken comment more truthful...

    Can't wait to see ATEC get slammed... they've been on a slippery slope for quite a while.

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  33. Are they going to find a way to turn chicken into xenograft? McFusions perhaps in the future? Or maybe they've found a way to genetically engineer some type of gene therapy, kind of like how KFC has the urban myth about beekless, legless chickens that are pumped with fluids and full grown in two weeks connected to tubes.

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  34. Anonymous 6:08PM....

    Please tell me you are being sarcastic? Globus hasn't developed anything innovative that isn't a "knock-off" from another company.

    Keep up the good work MS Man!

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  35. Mcfusions!!!!!!
    hahahahahaaaaa

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  36. There is a proven fact that even if smaller companies offer 40-50% commission, their sales will still only be flat, because they are attracting a "certain" type of distributor. I'm curious as to what exactly the big players are paying in commission, anyone have additional insight?

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  37. Give Steve Delrusso lots of credit for the great sales - they do one hell of a job getting new business for Alphatec

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  38. It's Bill not Steve. You're confusing him with Steve Lubischer, aka the Dynamic Duo of Spine.

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  39. thats why the bill lubisher or steve delrusso! your spot on keep up the great service

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  40. ya sales will be flat but they can make money-- they aren't in it to create a 100 million dollar company, just consistent fusion cases that will make them more on the side...
    all pedicle screw patents are up btw.
    it's a no brainer if you got stones.

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  41. Anon 12:00:
    Hence the Kool-Aid remark! They could have a board game at their sales training, entitled "Guess Which Company We Got This Implant From!" Does anybody mention that company without sarcasm? Even the reps are sarcastic, probably due to the limited job market and their high turnover.

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  42. that board game sounds fun. how about a board game about cages???? lets keep the metal seperate. i dont want my scrub tech getting confused. : )
    how about "is this peek, cfrp, xpekk, pekko, peeko, playdo, or expandable" game!! that would be fun. SPD would want to play for sure.

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  43. "or mystery meat"

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  44. This website is the best and really really funny. Thank you Musculoskeletal Man.

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  45. Years ago they did testing with bovine xenograft bone for structrual use. Didn't turn out so hot. I've heard rumors of using oyster biproducts to make some new BMP as well as some new ceramic bonded metal tempered by a high powered laser called croluminite. Anybody hear anything?

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  46. coLigne AG,

    www.coligne.com

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  47. I'm still not seeing the advantage besided possible cost savings (if any) using PEKK, be it carbon fiber reinforced, or whatever. How does this work for imaging properties, subsidence, modulus that tops peek? Both of these "wheels" roll the same, gimme something new!

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  48. Amplify, new bmp-2, goes to the FDA Panel next week.

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  49. So what, I heard that MSD is getting rid of all of it due to off label use and DOJ being up their ass about it.

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  50. Does BMP cause a coorelation in higher cancer rates?

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  51. Amplify is going to cost 10K per level, and it works just as good as wrapping a $4K kit of infuse around a $200 stick of mastergraft. Uninstrumented fusions with Amplify have been reported at around 65%, similar to uninstrumented fusion using Infuse with Mastergraft off-label. So why pay the extra $6K? To make your technique on-label?

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  52. MSD is not taking it off the market. That's the most unrealistic comment I've heard on this blog.

    What's more realistic is the fact that they're going to charge 10 thousand dollars a level. They're stupid enough to do it.

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  53. Infuse contains an average of 12mg's of protein @ $5000. Amplify contains 40mg's of protein! Do the math - MDT is screwed. My heart goes out to them...

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  54. Anon 3:11, sounds crazy but word on the street from different sources say it's true. It's out of the hands of the metal reps now, too. There are current studies observing cancer as well. Varied opinions about using it with allograft creating resorbtion and subsidence. Too many other issues from reimbursement, off label use, limited indications with limited implants to use it with, etopic bone growth, etc. Maybe more research should have gone into this besides does it grow bone. Always make sure your prom date doesn't have an Adam's Apple before you get her back to the hotel room after the dance! Some things assumed due to initial observations may end in a big surprise.

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  55. This comment has been removed by a blog administrator.

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  56. We'd all better hope that the Amplify panel meeting goes well next week. PMA approvals in spine industry are rare. If a company spends millions of dollars on the IDE study and then can't get the product approved by the FDA, let alone reimbursed, how long do you think the VC money will keep being invested in spine startups? Lumbar discs..clinical/reimbursment failure. Cervical discs...reimbursment failure. OP-1....FDA approval failure. There's a lot riding on the panel meeting next week for the future direction of the whole spine industry.

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  57. Medtronic is attempting to release new tissue dilators that allow for dynamic EMG neuromonitoring. Sound familiar? NuVasive patent lawyers are ALL over this one.

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  58. I sure that MSD will do its best to sway the FDA. As for VC money? There is plenty of it around, just look at the companies that have raised capital over the last year. Though these companies may not be hardware companies per se, they still have products that are spine-centric. Investors love to gamble, it's their nature. Even when they are wrong, many still tend to believe the situation will right itself. Look at the idiots that continue to invest in Small Bone Innovations. That market does not have anywhere near the legs that Tony V claims, yet people still believe him, even if he has to go to Malaysia to raise capital. An infamous character once said; "the difference between truth and fiction is that fiction only has to make sense."

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  59. Minsurg has filed a lawsuit against Nuvasive and others? This should be interesting.

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  60. I heard the guys over at xspine are in deep shit- running out of money!!

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  61. Yeah I hear xspine is on the verge of bankruptcy, technology investments, new hires and zero new sales, sad they had a good cervical plate too. Everthing else mediocre

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  62. Whoever is talking BS about X-spine is obviously a competitor who lost business to them. (I would bet that 8:37 and 6:36 are the same person).

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  63. TSB has not heard any word about X-Spine losing market share or in financial distress, and we have some of the best sources within the industry. I couldn't agree with Anonymous 5:51 that whomever is throwing around this horse manure doesn't have their facts, otherwise, prove it.

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  64. 'Amplify' is a nice name: It does seem to amplify the problems that already were hinted at in the ALIF and ACDF applications, and that for a long time were ignored. Soft tissue reactions necessitating steroids, which by the way are very effective in preventing bone healing, or surgical decompression. Impressive seromas necessitating drainage to prevent permanent disability, ectopic formation of what a pathologist once described as 'weird' bone inside and outside the canal, sometimes ways distant from the original site of application. Again necessitating further surgeries. It does seem that a lot more than just bone is Amplified.......

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  65. What is the future with ATEC? Seemed to bring on a bunch of distribuitors, but people say they are ran by corporate people way in over their heads? Thoughts?

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  66. who knows about ATEC. That entire ship is run by Foster who lives on the opposite side of the continent. Kuyper is only in there to be a fresher face to investors but really it's Foster calling all the shots. The "acquisition" of scientx was one of the funniest things I've ever seen orchestrated in my life. "Hey guys! What if my medicore spine company in california pretended to buy my other mediocre spine company in france? Would investors think we made a super uber duper company? Let's give it a try!"

    In all seriousness, I think ATEC will be fine. However, the histrionics involved in the management and investor relations departments are overly contrived sometimes make me want to puke.

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  67. It seems to me that something is cooking about third generation elastomeric discs
    When you see how fast Spinal Kinetics pushed up its M6 sales in Germany taking market leadership over Synthes in just a year you think that this might just be the next thing
    MDT, Biomet, ZMH have been looking into it very recently

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  68. Disk technology will only play outside the US fo the indefinite future. With the current state of the FDA, getting elastomerics approved will be difficult if not impossible. And by the time they are approved, maybe in 7-10 years, the US payors will continue to reject them.

    Unless the MDT, ZMH etc. can make a business case to support development for EU-only, these technologies will languish.

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  69. Some still show equivalent when not better results than fusion ; with long patient series (up to 10 years) and a rising demand
    A few european private clinic still live on american patients flying over to get their neck or their back fixed
    What does it take to make the Payor believe ?

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  70. The VP level people at ATEC are worthless!

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  71. Leave Billy Lubisher alone!

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  72. Xpenis has become very me too- capless failed and product recalled- so what do they have that is unique?

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  73. Anyone ever hear of a company called Verticor run by Todd Stanaford in Midland, Texas?

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    Replies
    1. yes, he is a swindler...wont pay you, is over leveraged...do not do business with him....

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  74. This comment has been removed by a blog administrator.

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