"As I lay dying, the woman with the dog's eyes would not close my eyes as I descended into Hades."
One of the many uncertainties in writing or blogging is that one never knows what the publics reaction will be to your post. That is evident when people attack the messenger rather than read the message. But that is to be expected. If one believed otherwise, one should not attempt this exercise. The fact remains that most of us formulate our own impressions based on our life's experiences and interests. Just look at any other blogger, journalist, or writer. Whether you are attacking Goldman Sachs, questioning the clinical efficacy of a surgical procedure or business model, defending or accusing Lance Armstrong of using performance enhancing drugs, there are those that will side with you, and those who believe that you have some hidden ulterior motive. None of that could be further from the truth. It's the story that counts. It's about getting the information into the public domain so that you the reader and or blogger can make your own decision on what is right, what is wrong, what is fact, and what is fiction. And let's face facts, most of these topics are out there in the public domain. All TSB does is provide you with a forum.
An economic upheaval is unpredictable, its riddled with anxiety, distrust, anger, and plenty of rationalization. TSB has been through a few of these experiences. As unwelcome and uncertain as they may be, one learns to survive and move on, hopefully, never looking back. Hopefully, making you a smarter individual. Whether it has been the economy readjusting itself, a company being acquired, integration and downsizing, or even personal challenges, hopefully life imparts some wisdom, maturity and dignity. Reality has a way of leaving a bitter taste in everyones palate, witnessed by the many comments that have been directed at people in the last two posts, or even TSB. Its human nature to defend oneself, but its also human nature to stretch the rules. Whether its performing a study, attempting to manipulate stock, justify a POD, run a company, or defend one's ability to earn a livelihood, it's human nature to stretch the rules. No need to reason since history has a way of substantiating our point. As this industry adjusts to an unwelcome harshness, things must change. Not because we want it, they have to, if we are to survive.
20% growth is a thing of the past. Those days will truly be remembered as the golden years. Yes, there are companies out there that report 30-40% growth in their press releases, but look at the size and scope of those ventures. Perspective has its own honesty. Turmoil usually brings division, and chaos ensues. This division couldn't be any greater than what currently plays out each day on this blog and in our industry. As the the industry has matured, we evolved from true innovation, to duplication, to saturation, to commoditization, and are heading to extermination. The companies that have an inability to innovate, let alone adapt, will die a slow death. If you don't believe it, look around. Modern technology has given man the ability to shape and move markets with incredible speed. The unfortunate aspect of this gift is that balance is an art that our industry finds difficult. We are an industry of extremes, but then, maybe we are nothing more than a by product of a large phenomenon. Think of an innovative product, not necessarily unique, but different. By the time that product has picked up momentum and is generating new revenue, there are 5-7 products like it within months or maybe a year. Market data and analysts create unrealistic expectations, because numbers may not lie, they just don't have a human element to them. If you don't believe, go back and read the original JP Morgan report on the future of artificial disc market, or think about other so-called market makers in our industry and their predictions. Just like reconstructive orthopedics had its day of atonement with pricing, spine is still in the initial phase or readjustment. As insurance companies squeeze the life out of procedures, as surgeons perform less surgeries, as our business distribution model evolves we are squeezing the life out of the industry. Don't be too upset with the surgeons because, their day will also arrive. Fiscal austerity has become everyone's tag line. There are those few that proselytize in hope of attracting more investment capital using demographics. Unfortunately, the government, the economy and the realities of the market place have an entirely different plan.
Everyone is going to have to tighten their belts. Judgement day is coming, the uncertainty will be where do we stand when it finally arrives. No TSB is not talking about the end of the world, the religious right gave us a reprieve by reloading the date in their virtual calendar for sometime in August. Even Nostradamus wasn't given this many passes. As Prince once sang, this gives us all a little more time to party like its 1999. What we are finding out is that if one looks at evidence based medicine, change is not merely a thought, it is a reality. A recent study found that Medicare spends a fortune each year on procedures that have no proven benefit. Included in this study was two recent randomized trials finding that patients receiving kyphoplasty and vertebroplasty experienced no more relief than those receiving a sham procedure. Granted, if the studies in question were those sponsored by the government, one must wonder whether those studies were skewed. This would be no different than questioning the outcomes of a study when a group of surgeons are on a company's payroll. Nevertheless, if it costs Medicare an estimated $1 billion dollars a year to manage vertebral compression fractures and the outcomes are not that much better, are we heading in the direction of evidence based medicine? If dynamic stabilization was proven to be "as effective" as fusion, did we expect the insurance industry to welcome it with open arms? The extent to which Medicare pays for a procedure like kyphoplasty or vertebroplasty with questionable benefits must be quantified. Maybe evidence based medicine will provide us with better information as to how we manage an America where everyone wants to prolong their youth, and its unacceptable to have arthritic pain, or pain in general. No one likes pain, but the cold hard facts are that some will have to learn to live with it whether they like it or not.
So as you prepare for this Memorial Day weekend, break open a cold one, go to the beach, drink some good wine, go play a round of golf, throw some shrimp on the bar-be, and spend some quality time with your family, 'cause no matter what you may believe you work to live, and not live to work.