Saturday, May 28, 2011

Fiscal Austerity in Spine

"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.

78 comments:

  1. TSB: Great post and, as usual, I agree with most everything you say. You have an excellent "feel" for the industry and blend your insightful comments with a sense of humor mixed with pop culture and musical lyrics. All that being said, we need to clean up the language, vitriol and general nastiness of some of the comments. The language used by some on this blog makes all of us in the industry look bad. You cannot control this, I understand. However, your leadership is important - encourage those who comment to do so in a professional way.

    Otherwise, all of our hard work in the O.R., our professional expertise, helpful suggestions to make cases go smoothly, having three backup plans to the original surgery in the event CPD screws up again- goes to waste. A lot of what we do goes unnoticed because the surgeon never realized our "behind the scenes" activities to make sure all the trays and "special" instruments just appeared on the mayo at the right time. Let's not screw all of this up by acting like knuckleheads on this site with sophomoric language and disdain for our customers. I call it the "dumbing down" of this site. Unfortunately, without some leadership on your part, TSB, what you will have left on this site is the bottom feeders instead of the best and brightest.

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  2. TSB ! You are the weakest link ! JK. Please make everyone who posts sign in and create some type of profile. Some type of accountability must exist, even if they make up their name.... and maybe, just maybe, this can be the next match.com for the medical field. A ton of women read this site. Hey ladies!
    sincerely,
    i wear my OR mask at night

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  3. Wow - you guys had the patience and interest to get through that post?

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  4. JK. I agree that everyone should have to sign in to post, imagine what it's like to ride the range and keep the herd in line, easier said than done but I Agee with you

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  5. The posts are becoming very redundant. A lot of complaining about PODs & pricing. Why not talk about what is new out there? What is the take on SI-Bone? Whos' selling it, What do surgeons think?

    What's new in biologics? Will we ever see nucleus replacement? If so, when & who might be 1st to market?

    Seems to be a lot of other interesting topics that can be discussed & new information shared,, instead this forum seems to have turned into nothing more than a place to bithc about how unethical or unfair the marketplace has become.

    Just my thoughts,,

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  6. trans1 has a nucleus replacement in the works

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  7. MM,

    This is an excellent blog and I have enjoyed reading the posts and comments. But, a bit of civility would be nice. I first posted a few days ago, and I must say, it generated alot of anger. It appears many of your posters have defined me and my practice to what suits their anger. As you said, do not shoot the messenger.

    I chuckle to think some of the angry posts were probably made by my very own sales reps. I love you guys too.....

    And yes, the physicians have definitely seen the monetary hit. POD's make doc's and reps competitors. But, this is just an iteration of the typical business cycle. If we all step back, these things are predictable when consumers have choices, and now want value for their purchases. I tried to post about my other concepts, but I fear my responses were too long as they would not post.

    But I agree, at least make people post with a sign on so we can see who is making which comments.

    Thanks for your continued presence on the net.

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  8. Ulrich VBR's, PediGuard, AxiaLIF...anyone having success and what points are being paid?

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  9. that's deep yo

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  10. While a sign in would identify, wouldn't that take away from the free expression this blog allows? Yes, there can be common and sometimes boring, often provocative comments, and some just stupid drivel. But considering the audience (we for the first time I can remember had patient involvement), there are those that would jeopardize their business, company or professional standing by providing an opinion or fact that could be construed as over the top. Like harvesting oysters, we often have to sort through a lot to find a pearl
    . Free expression opportunities are becoming more rare. I may not fit the typical demographic of the majority of posters on this site ... I old, in the industry longer than I'm sure many have been alive, but over all these years have learned, a little crazy - often what appears to be weird to many, often comes about. Besides, crazy is often funny.

    Please do not change the format. The ability to tune out the bad noise is easy to do. We don't need vulgar, hateful expression and MM has been pretty good at culling cut it out (thanks). Let's not take life so seriously, agree to disagree sometimes, and continue this rare opportunity to speak and express freely.

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  11. hey Spineblogger - I'd bet your only calling for evidence based studies for VCF because of the NEJM articles that were very popular, very poorly designed and then very dismissed. There are many evidence based justifactions for Vplasty and Kplasty. See Kaviar or Vertos studies. How many of these randomized placebo controlled studies exist for Spinal Fusion?

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  12. TSB is not advocating these studies, we are only citing them as part of the governments ongoing rationale for evidence based medicine,

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  13. MM, amen to your blog, happy memorial day, and lets try and clean this up a bit and bring more professionalism to this blog. The name calling and complaining does get old and very unprofessional. Well, going to bbq and have a cold one and dont forget lets thank all our troops across the country for allowing us our freedom.

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  14. Amen!: Especially to those that fight for our freedoms while others talk the talk but fail to walk the walk, here's a milagro anejo to all our brothers in arms.

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  15. 11:36, i had heard that Trans1 nucleus replacement had been put on hold....rumors they may have a lateral soon!!

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  16. TSB I don’t think there should be any types of singing in or accountability. You need to rememeber dude you created this roller coaster. This is one of the only blogs out there that I know of that gives US REPS a voice to bitch, complain and rip each other. In the end, it’s nothing but love. But to take away that right which you, yourself use, is wrong.

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  17. There used to be no anonymous profile you could select, and this place was a ghost town with hardly any comments. Don't bring that back. Anonymity is what makes this place good and helps encourage the sharing of information.

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  18. MM,

    We have been missing evidenced based medicine in spine for a long time. We have too many technologies looking for an indication. There have been too many "royalty" agreements paid on stuff that is cool, but just don't provide the outcomes expected.

    In a recent review of over 300 articles, abstracts and similar start in 1976, outcomes have not had a significant change in the last twenty years, and might be getting worse. If compared to other areas of medicine of about the same number of procedures, like CV and GI, studies are done with an average of over 2000 patients. Many are in the 8-10,000 range. As a result, there is opportunity to develop results oriented criteria, standardization of care and surgical outcomes exceeding 90% good to excellent. In spine, we struggle to hit 75%. All are starting with the premise of "non-specific pain".

    In the 300 plus paper review, 17 different criteria was used, and number of patients averages 136. The largest is the sports trial with over 900, and that, while reveling, and showed some trends, was poorly designed and never determined or defined what success was.

    In recent discussions with a few past NASS presidents, and especially during Rick Guyer's time, finding and defining standards of success was a hot topic. To date, none of have agreed. And while no one I talked to said it out loud, it is my belief, if standards of success, real, honest criteria to define what a success was vs. a 10 point improvement in ODI as clinically significant, a very ugly head would appear - maybe two, like CMS and BCBS, and the US would be like most other countries who just don't pay for pain.

    It's hard to not agree that the spine bubble has burst. Greed has gotten in the way of good science, and that's a shame. There are a lot of folks in need who will suffer as result for a period of time, until we get back to reality, to realize there is a patient at the end of the knife that has a life, and is not a dollar sign.

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  19. Many high guality studies with level 1 data have been done that show great advancements but they require companies and surgeons to do them collaberativly such as the BMP studies that were trashed in prio blog!
    No question that BMP increases fusion rates in the inter body lumbar space. Many other level 1studies are out there that seem to be ignored. Some of the arthroplasy studies have been done well and give level 1 data.

    Outcomes have improved off length of stay, oswestry, fusion rates and unloved quality of life.

    Paul Andersons hasvshown many spine proceedures improve quality of life equal or in excess of THR replacement.

    We still have a long way to go but things have gotten much better for patients over the last 20 years.

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  20. There are 4 different approaches to lumbar fusion and each surgeons has their own preference and some patients biology doesn't allow certain approach. With so many variables it is hard to get the numbers like GI and cardiology where there is only one way to do colonoscopy or heart cath. Again we need industry and surgeons to work together with transparency to do good studies Don't besmirch the surgeons as whores because they are working to improve our specialty. Unless of course the reps think they can do this on their own.

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  21. We can thanks the FDA for slowing the advancement that a lot of us would like to see. Keys put ome blame where it belongs!

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  22. TSB is turning into the Lord of the flies. Accountability will clean up this mess and prevent piggy from an untimely end.

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  23. The surgeons have done quite the good job of besmiching their own reputations, Hochshuler, Yuan, Wang, Polly, Kuklo, Yue, Zdeblick, Bukus, Blumenthal, in addition to mentoring a entirely new generation of entitlement spine surgeons. You reap what you sow

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  24. I would add McAffee to that list. But I don't see the reps complaining about their commissions that come from selling the implants these guys helped develop.You can't have it both ways. There have to be some surgeons you approve of.

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  25. Ask McAffee when Globus is going public. He really wants to know!

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  26. Why don't we talk about how UPMC is screwing everyone?

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  27. Cleveland Clinic is just as bad!

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  28. The dynamics in our industry are certainly volatile. There really seems to be a perfect storm with regards to the economic pressures that all sides are facing. Throw in the current FDA, and their unwavering denials of new technologies, and their propensity to make every company jump through hoops just to file a 510K, and it is easy to understand the trepidation that we all face.

    The companies that succeed moving forward will have strong management teams, run a profitable business with no debt, and have some differentiated products in the pipeline. It is no longer about the revenues that are posted, it is all about the profitability of the organization.

    Consolidation will continue, and many more companies will run out of cash and dry up. We continue to see price erosion on a national basis. Hospitals all have a cook book that they pass around on how to leverage construct matrix pricing programs. Some are simply demanding 40% off of last year's list price in order to bring in a vendor's products. We must also factor in the POD's which are working on cutting out the middle man and selling the products to the Hospitals in order to bring about cost savings.

    The small companies that will survive in the long run, and will actually earn the 4 to 5 times revenues will be the innovators that bring differentiated products through the FDA via a PMA. The problem now is that many companies do not have the time or money to go that route and succeed. They simply do not have the cash on hand to play the waiting game with the current FDA. Companies also fear the price erosion and the POD schemes that will drive the prices down. It is much harder to see an ROI in today's environment. There are going to be potential differentiated products that will never see the light of day. This current environment is severely impacting the small start up and their ability to innovate.

    The future of spine will come from the Biologics arena. The companies that figure out how to regenerate a disc or address some other unmet need will prevail. Evidence based medicine and prospective data will determine who gets a leg up on the competition.

    Our industry has seen 80% profit margins with low barriers to entry. The result has been a lot of "me too" companies that are all fighting for the same customer. The spine industry is filled with greed and arrogance. It exists on both sides, surgeons and industry. It is a mess that needs to be cleaned up and sorted out.

    I feel fortunate to have been in this business for over 10 years. I feel like most of us are hard working individuals with integrity. Unfortunately, there are some bad apples out there that have seemed to spoil the bunch. The next couple of years will be telling. Will the DOJ and the OIG step in and shut the door on the POD's? Will we continue to experience the price erosion? Will we continue to see the consolidation that we have experienced in the last 12 months?

    I look forward to hearing what other's have to say. This blog is very entertaining to say the least. Keep up the good work TSB.

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  29. 9.33, can you list us a few of these studies? I've been working in spine for 25+ years and can't find many of them. I'm looking for "level 1" studies describing clinical research that may have been sponsored by a company, but that has been conducted and written up by surgeons who have NO vested interest in the product studied, or any other product of the same company. These are rare, aren't they?

    Here is a study that should give you pause. I now everyone will jump down my throat by saying that workers comp patients never get better because they don't want to. My answer to that is then why do surgeons operate on them in the first place? The probable answer is that the reimbursement is so good. In my opinion this study is of a higher quality than the politically motivated half finished jobs published by the NEJM.

    "Long-term Outcomes of Lumbar Fusion Among Workers’ Compensation Subjects. An Historical Cohort Study" Spine 2011

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  30. 5:50 - None of these surgeons actually develop anything. There clout is used to influence other surgeons purchasing preferences. In return, they are given equity, board positions, etc.

    Therein lies the problem with evidence based medicine. The podium is bought and sold...

    Sincerely,

    Phil MacKraken

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  31. Phil,
    Here you show your lack of knowledge about how this is really done. In most instances the company will call in surgeons who have expertise in a certain proceedures and match them with several engineers to brain storm ideas and collaborate until consensus is reach on design features. There will usually b imput tat each brings to the table
    Real IP will often come up and the design is honed until the product is finished.
    The engineers can't do this in a vacuum. The company makes incremental improvements this way.
    In a surgeon comes to the company with real IP that is eventually integrated into product his royalty is much greater. Novel ideas are harder to come upon these days so we see more small improvements to existing technology.

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  32. 9:33, "length of stay and ODI have improved". Length of stay is much better than 5 years ago. ODI has not. Part of the issue is success is considered as an improvement in ODI. In the 0 - 100 scale, if a patient at 70 improves to 60, that is considered clinically significant, and for the patient, that typically means they go from really bad to just a little bit better, and they are still significantly disabled.

    For some folks, that may be the best we can get. But for the insures, who pay for it, it's just not acceptable. They paid $46K for a surgery (and that's just average hospital charges for a single level) that hasn't done much, is going to continue to cost them similar on-going and dependent on the patients age, will likely have a second procedure at over $76K.

    ODI and VAS are good indicators of improvement, but not particularly good at wellness. As it relates to GI and CV, yes there are limited procedures based on diagnosis that are effective. The problem in spine is we are not particularly good at diagnosis. Please understand, it's not because surgeons don't want to, it's just there aren't many functional tests (most everything we have is anatomical) to test the sources and cases of pain. We are still trying to better understand and define the DDD process, and it's a slippery slop at best.

    Obama and friends have been looking over seas, and north and south of our borders. Back pain is a way of life, something you just deal with. Unless your wealthy, patients learn to live with it. And, part of that is because the countries can't afford to do more, are part is most know given time, while the pain doesn't go away, most get better - and the better is similar to surgical results we report in the US.

    My point is, we have really cool technology in the US, that appropriately applied can improve patient well being, and save the economy money. We just need to get some folks together to agree on the methods and way to measure success. Easily said, but difficult to pull off as there is also high financial motive (both profit and cost) to maintain the status quo. As a result, egos and money have gotten in the way.

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  33. This blog is starting to sound like CafePharma. Medical device reps are getting squeezed like pharmaceutical reps and their complaints sound the same. The goose that laid the golden egg is drying up. The day of the $250,000 a year rep is going away forever. Capitalism is "creative destruction" which means evolve or be trampled underfoot. No one is indispensable, so get over it and be prepared for change.

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  34. 7:41, you paint a very poetic picture on how implants are developed, and I know there are situations where it actually works that way. That raises the question how much for example a slightly more ergonomic handle on your screw driver is worth. One could argue that the surgeon benefits already because his surgeries become easier, and he is publicly recognized for his acumen and smarts. 50,000, 500,000, 1,000,000 dolllar a year for 10 years? I don't know... If this is justifiable, how much should the engineer get on top of his 100k salary for actually translating the ideas in designs?

    From another perspective, in 2010 MDT paid over 25 entities royalties for pedicle screw systems, of course not including the worlds' most brilliant inventor, Michelson. Pedicle screw systems now are over 30 years old and made and sold by over 50 companies, some with IP and each with their own royalty payments. This means a few things: pedicle screw systems must have more IP attached to them than the latest hybrid cars, and royalties are paid on long expired patents.

    Draw your own conclusions...

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  35. I agree with a lot you say except, I think we do a lot better than you suggest ask each patient after one year the three questions: are you much better than before surgery. 2: would you do it again. 3: would you recommend it to a friend.

    Your patients should say yes x3 or you need to question how you r doing things or whom you are choosing to operate on. This isn't brain surgery.

    Re: workers comp. We hold out eternal hope we can pick the ones who will try to get back to work the the$ are stacked against the patients motivation.

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  36. 10:44, Now the study needs to be done that asks the question of the patients who did not get surgery, as is indirectly done in the workers comp study. The answer may be surprising!

    Given the results in WC, eternal hope is insufficient indication for a surgery that is not minor and carries real risks..... Surgery in these patients should only be done to prevent permanent neurological deficits.

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  37. 10:44. I agree. Don't operate on WC unless a simple HNP in motivated patient. Gotta agree there.

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  38. "Long-term Outcomes of Lumbar Fusion Among Workers’ Compensation Subjects. An Historical Cohort Study" Spine 2011

    May 29, 2011 7:43 PM

    Ah once again the beast rears its ugly haid.

    The trouble is, we treat mostly pain. Pain is a funny thing. I have been in this business for many years, and everything I know boils down to that: pain is a funny thing.

    Does that mean the industry is worthless? No, but it doesn't say much about its worth, either.

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  39. WC is a different thing than motivated soccer mom with single level DDD. A fusion or arthroplasty should be don in 1 1/2 hours, home in 24-36 hours with excellent results. Many surgeons can and do get those results. We are truly doing better than you describe. Pain in clearly described patients that match most IDE inclusion and exclusion criteria can expect to do well. There many good level 1 studies that back this up

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  40. Most reps should choose one surgeon they think does a really good job and then follow him in the office for a few days. Patient outcomes are much better than are represented on this very negative blog site.
    Most surgeons should be getting very satisfied patients. Put the WC thing aside,that is well understood, but look at the PPO pt and how they improve. I believe we are doing much better than 20 years ago!

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  41. 6:08: ".... home on 24 to 36 hours with excellent results." LOL! These patients do well for about 12 months, than in many the results start to fall apart. (One skilled spine surgeon in the south calls this the 'black widow syndrome"). Many surgeons never even see this because they a) don't follow they patients that long, and b) the patient seeks another clinician. That's why so many surgeons say they rarely see bad results, but in the same breath mention all the problem cases from their colleagues they have to fix. By the way, does anyone on this blog know what exactly generates pain in DDD? And why so many radiologically diagnosed DDD's have no complaints at all? And again, I respectfully ask whether you could provide a list of 10 level 1 studies with authors who have no financial interest in the device studied

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  42. I think we all agree that evidence based medicine is (or should be) a good thing. What is frightening, however, is how it will be defined and utilized and by who? Keep in mind that the majority of the foundational beliefs in spinal care are NOT supported by statistically robust level I studies.

    Just as the major insurance companies are cherry-picking evidence utilized as criteria so as to minimize payouts, everyone needs to get used to the idea of CMS/Medicare doing the same. In the future, they will be paying for a greatly increased number of patients from a fixed bucket of money. EBM will be one of their weapons to ration care whether one likes or believes this or not.

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  43. 10 Level 1 studies? There have only been something like 30 in cardiovascular in the last decade... Everyone holds devices to the same standards as drugs, but they are not the same. It is easy to use a sugar pill as a placebo control. It is very difficult to structure competent control groups in the device world due to the inherent surgical procedure bias.

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  44. Offering surgeons product royalties, but not offering that same opportunity to engineers shows there is obviously something else involved beyond bringing ideas to the table. Surgeon input is actually relatively minor when you consider the entire scope of what it takes for engineers to bring a product to market.

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  45. I have to laugh at many of the bloggers on here ripping surgeons for trying different techniques and/or products on their patients. Remember, it is Practicing medicine.

    I was a chiropractor in a previous life and you want to talk about a bunch of craaaaaazy BS and techniques for treating patients!! I had a research scholarship at the largest (at that time) Chiro. school in the world. The research coming out of there was complete crap. In my opinion, the Chiropractic researchers would make up these outlandish claims of the results they would get using their own "tried and true" techniques. There was no research possible that anyone would pay for nor even be able to do to disprove some of these theories.

    While in school I asked one of the professors, "how do we know which technique works?" His answer to that question was, "They all work, just find the one you like the best". And that ladies and gentlemen is the reason I do not practice Chiropractic. Simple logic would lead one to the conclusion that if you can "crack" someones neck/back and make them better, then it must also be possible to make them worse! I was thinking I should patent my own technique for Bopping patients on the top of the head and making the claim that I reduced every subluxation in the spine.

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  46. Amen 7:12... And I must be working at the wrong company, cause I have never met an engineer making 100K. Maybe I should get my resume together

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  47. To 8:05am Shame on you for pursuing a field you did not even believe in. When you applied to chiro school you should have had a reason for wanting to go. A local chiropractor had an influence on you, or , someone in your family benefitted from chiro, or....
    what did you say during you interview process? Why did you apply and attend chiro school? If it took one professors answer to shatter your whole belief system in a profession, you are a person who cannot be trusted upon in any field.
    sounds like a cowardly exit if you ask me..

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  48. Chiropractors are unprofessional and lack integrity.

    Sincerely,

    Jim Tressel

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  49. 10:39am is obviously a chiro who was offended by 8:05am's negative comments toward his profession.

    8:05am, I think that it takes great courage to do what you did. There aren't very many people out there that are gutsy enough to quit a good paying job just because they know that the services they provide are bunk. Add to this the fact that it takes 3-4 years of extra schooling after undergrad to be a chiro and you're looking at quite a sacrifice. The cowardly decision would be to stick with chiro even though you truly believe that it's just a bunch of BS.

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  50. 7:12, you are correct. There is something more involved beyond bringing ideas to the table, clinical knowledge and revenue. Many engineers have great ideas but most lack the clinical knowledge to make their ivention effective in the O.R. As valuble as engineers are, they are not implanting these inventions therefore generating no revenue. Proctoring surgeons are received much better by other surgeons when talking about real clinical situations and techniques.

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  51. Without engineers, there would be no implants, and therefore no revenue. Surgeons are undoubtedly a great source of knowledge and inspiration. They are an essential part of the product development process. But in any realm, not just spine or even medical device, anyone can spew out ideas for new technologies; the trick is making them possible.

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  52. 8:05 here-

    You know I actually had been helped by a chiropractor as a child, he basically re-located a dis-located shoulder. I loved the fact that I had the opportunity to be a professional with my own practice.

    Obviously I did not have full knowledge of every facet of the field, but I went into it with the mind-set that I would be helping people, like I had been helped.

    How was I to know that the chiropractic profession would be based on such little true science (this is my opinion). I kept going quarter after quarter waiting for the educational process to enlighten me as to the verification of the reduction of the subluxation. There was never any proof that the adjustments ever did this!

    Now I am not saying that people are not helped by chiropractors every day, I am just saying I did not believe we actually were doing what they were teaching us. All of the reps out there that have watched a surgeon reduce a subluxation know what I am speaking of.

    How many times have you heard the patients of chiros say "yeah, I really felt pretty good after the adjustment, but then I was feeling bad again."

    To 10:39..... all I can say to you is shame on you for judging me without all of the facts. You call me a coward for not wanting to feel like I was lying to patients for the rest of my career? Sorry, maybe you can do a job that you don't really believe in, but I cannot.

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  53. No 8:05 Shame on you,, I judged you by your posting. You mocked the whole profession with your comment about patenting a bop on the head technique.
    And for the record, I am not a chiroprator, I am a sales representative that realizes that even the medical doctors we work with will tell you sometimes they cannot explain exactly why something works; however their patients feel better after. Attacking a whole profession is cowardly. There are good and bad in all professions. If you are a salesman I guess you only promote "proven" technologies.

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  54. and as a follow up to 8:05 / 2:59 we are waiting for your post on what is true science. Please enlighten us with your new found wisdom on what exactly is the cause of back pain and what is the true scientific method to treat it. Please provide the link to your "miracle" treatment in a box. The wonder-fix that cures all and prevents future pain and future degeneration. --because only chiros have patients that only get short term relief. I stand by the Coward verdict

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  55. 10:39 sounds like a broken hearted chiro to me! Cant you find some other blog to stalk patients or research for your next billing chance? Give me a break!

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  56. 7:12/2:58- you guys crack me up....the belief that it takes one person to get a product to market is not only egotistical but truly shows your ignorance and will probably be the reason you either stay in your cubicle for 30 years or always get beat out for a promotion by that kiss up Hanrahan...no engineer can run a company by themselves, they need surgeons, sales people, marketing people, finance people etc. It's like the sales rep who says "without me, you wouldn't have a job" which is also equally obnoxious....the faster you lay down that grudge or jealousy you are carrying around, the faster your career will improve...

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  57. 10:39,

    First of all, I clearly stated that these are my opinions only and I am entitled to them. I am not mocking the profession when I say that some patients do get better. Until you have actually been through a chiro program maybe you should not comment as if you are the only blogger that can call bullshit.

    I had a 78 year old patient that came to my research lab one day claiming that chiropractic had helped him his entire life, and he wanted to "give back" for all he had received. I personally took his x-rays to find he had a double S curve that would put a 14 year old scoliosis patient to shame. Funny thing about that though was that he had ZERO neurological deficits! So a profession that claims to "align the spine and reduce subluxations in order to optimize neurological efficiency" probably caused such a laxness in his ALL and PLL that resulted in a severe scoliosis.

    Now 4:16 to answer your question on true science. There are electrodiagnostic procedures called dermatomal evoked potentials that actually allow me to measure the time it takes for an electrical impulse delivered to a peripheral nerve to travel through the brainstem and end up on the somatosensory cortex of the brain. So in other words I can measure the time it takes pre and post adjustment for the response to travel through the root level segment diagnosed as subluxed down to the millisecond.

    Guess what, no chiropractors in the entire college even knew we could actually prove the effectiveness of an adjustment. Guess what else, after tireless research trying to actually PROVE I as a Chiropractor was making a difference.....the data did not bear this out


    You keep on judging!

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  58. 4:39 nice of you to defend your significant other, we are still waiting for his miracle treatment posting

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  59. Dude, this chiro guy going after 8:05am sounds bitter and scared. Scared of what? I don't know. Maybe he'll tell us. 8:05am?

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  60. 8:27 Dude.... not going after anyone, just blogging a counter opinion on a prior post. Too bad you don't see it that way through your censor-vision. Take off the commie red sunglasses you are wearing and enjoy the freedom of speech

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  61. I heard of a chiro who is opening a POD right after Globus goes public.

    If so, that is unethical and disgusts me.

    Sincerely,
    Jim Tressel

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  62. Has anyone ever heard of chiro students trading adjustments for tattoos?

    If so, send me their 40-times and rap sheets.

    Sincerely,
    Jim Tressel

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  63. Who is Jim Tressel?

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  64. Jim Tressel is a the surgeon that helped Alphatec create their cervical system. Tressel....duh!

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  65. Jim Tressel is the inventor of the POD:

    Players Payable
    On
    Demand

    Sincerely,
    Terrell Pryor

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  66. how much does a small, medium, and large infuse go for in your area?

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  67. a nickel a pair , a dollar a box

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  68. Among other topics in spine, attorneys are seeking patients that have undergone facet fusion procedures with bone dowels. Here is the link:

    http://www.spineuniverse.com/community/back-pain/39128/problems-or-pain-associated-trufuse

    "My name is Jonathan Wilson. I am an attorney with the Minneapolis, Minnesota law firm of Dorsey & Whitney LLP. We would like to speak with anyone who has received a procedure involving the TruFUSE technology from minSURG. Specifically, we are seeking information about whether you or anyone you know has had this product implanted and has experienced problems because it did not perform as intended. Interested parties can contact us at 612.492.6651 or wilson.jonathan@dorsey.com."

    I would say this is the beginning of the end of the facet fusion allograft bone dowel market space.............it's about time.

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  69. MM ...blog spot or a place to sell a service? It's like you have allowed an attorneys office to have a commercial on here.

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  70. I agree with 9:17.....all attorneys are unethical and not trustworthy - especially the ones with tattoos.

    Sincerely,
    Jim Tressel

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  71. 9:17 and 9:30

    It's not a commercial from an attorney, rather it's a posting from spineuniverse.com.

    The way you both are taking it so personal, you're probably the bottom-feeders out here selling this crap bone dowel technology. Maybe the attorney will include distributors in on the potential litigation.

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  72. 10:23

    It sure sounds like you are pimping Spine Universe - I thought you were against commercials here???

    Do you have something something against infomercials???

    Sincerely,
    Ron Popiel

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  73. How boring & mundane is this press release?:

    "The Proliant Polyaxial Pedicle Screw System is designed to provide secure fixation of the thoracolumbar spine while offering surgeons improved speed and ease-of-use. The pedicle screw has a dual lead thread for faster insertion and a patented Tightlok™ thread pattern that is designed to reduce screw pull out and facilitate fusion. The low-profile screw is designed to reduce the risk of tissue impingement, and the EZ Set tulip head allows the surgeon to easily position and set the tulip head in any position for rod insertion, creating a simple, easy-to-use posterior lumbar fixation system."

    Really? Thank god there's ANOTHER screw system on the market,, I'm sure it's incredibly unique.

    As they say,, Same shit, different day.

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  74. Won't the proliant system be the 5th or 6th screw line they carry?

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  75. 4:35 YES, exactly my point.

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  76. Judgement day is coming??? Seriously?

    Perhaps "the end is nigh" would be more appropriate.

    John, you are a buffoon, everyone laughs at you.

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  77. Facet Bone Dowels in conjunction with an Aspen plate is an excellent operation. You can knock out 5 in a day.

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  78. Stryker to buy Orthofix? Any chance or they way to dirty for the "mr. Clean" of the medical industry

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