Sunday, May 22, 2011

Sunday Funnies

On May 18th, one of our bloggers posted a reprint from an analyst from a small cap network regarding Aphatec.  The commentary was that " when a stock climbs up in share valuation on revenues and growth, month after month, quarter after quarter, it's something that I love to see in the markets." For a stock that has yo-yo'd more than a Duncan Yo-Yo, the Yo-Yo of all Yo-Yo's, one has to wonder what this individual was talking about.  Granted the stock has had an uptick that some would interpret as a surge, but let's face facts, this stock has had a 52 weeks high of $5.82 and an all-time low of $1.85.  To give the impression that all's well that end's well is debatable.

Analysts love to promote a companies stock by emitting optimism.  Their hope is to make the public believe that a stock is on the rise, or that it will continue to increase in value.  The dissenting opinion usually comes from the short sellers, who are pessimistic because they are skeptics, knowing that management is notorious at self-promoting to extremes.  This skepticism is a natural reaction to how a company shows growth when concern is expressed in the public domain.  An example would be understanding how modified accounting rules can alter and infuse some life into revenue.  An example would be Enron, who inflated their number by using "mark to market" to inflate their valuation, or "revenue sharing," the practice of sharing operating profits with a company's employees, or of sharing the revenues resulting between companies in an alliance.

Many analysts that promote companies in the spine industry have little more than anecdotal knowledge, basing their forecasts on their trust and relationships with a company's management team.  Or, they may have heavily invested in this stock themselves.  At best these proclamations are intended to generate enthusiasms for the investor.  But what if hypothetically a publicly traded company had increased its revenue stream by going to a POD model, knowing that there are many questions left unanswered whether this is truly a legal business model.  Would an investor feel that they were being deceived by the company and their management team if they were not informed?  What if a law was enacted that declared all POD's illegal, would the stock and revenue plummet?  Would the corporation have had represented itself in good faith by being honest, sound and efficient with its investors?

So in closing, before one blogs about one's greatness, with the intent of going long, one has to wonder whether this individual has any clue to the dynamics of a specific company, the market, let alone the management team.  You know what TSB is says;

Nibblin' on sponge cake, watchin' the sun bake
All of those tourists covered with oil, strummin' by six string
On my front porch swing, smell those shrimp they're beginning to boil
Wastin' away in Margaritaville...................

59 comments:

  1. Has Globus gone public?

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  2. Great post. we are seeing in our market alphatec lead the charge with POD's and i have been wondering about their shareholders. With recent OIG announcements, the senate inquiry, hogan lovell white papers, and wall street journal (you know they are just getting started) you would think that it would be a privately held company pushing the envelope.

    I must say that i do not admire alphatec and believe that short sellers can have hay day.

    They are taking business from Globus, Spinal elements, LDR and NuVasive in my area. interesting to see surgeons chase the dollar. Well, not all othem. in fact just the usual suspects.

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  3. No kidding here. what is the future of POD's? i cannot believe that surgeons in the distribution channel will continue. I would love to hear some sage opining.

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  4. No kidding here either,,

    ENOUGH about PODs already. They're here & growing. If you've lost a good chunk of your business or find yourself dying on the vine, then perhaps you should be looking for a new profession.

    The topic has been beaten to death on these blogs and continuing to piss & moan aboout them isn't going to change the fact that they're alive & kicking in many parts of the country.

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  5. 10:44

    This goes to prove my commentary that some people fail to understand what is written, versus what they believe is being said. If you think this post is about POD's then you've missed the entire gist of our Sunday Funnies. With that said, I need to drink some more Margaritas. Peace

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  6. Sorry 10:44, can't drop PODs...I'm new to TSB and the subject is compelling. Interested in the perspectives of those that know first hand about POD trend in your region or the U.S. as a whole...I apologize if this is a tired subject for some, but 10:19 and I (and many others I suspect) could benefit by knowing more about this...
    - Are PODs growing in your area? What % of business in your area is represented by PODs today?
    - Has anybody seen PODs surge then retreat in their area?
    The collective view could be helpful to all...

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  7. MM:

    My post at 10:44 wasn't directed at your commentary, but instead directed at the posters who continue to drone on about PODs and bring the topic into every one of your posts.

    My point was that is has become a tired subject.

    11:25 is a good example.

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  8. 11:30, MM mentioned PODs twice in his original post, no one "brought in" the topic.

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  9. 11:25....come on, it is almost embarrassing for you to comment that you are new to TSB! You are so getting your tokish beaten up by PODs that it is killing you along with your comments and others that cannot stop the runaway freight train because of your self-denial that these entities would flourish. You asked and I will answer. We were against them in the beginning as well but after doing some due-diligence at our own cost we decided to join one in my area and I am glad we did. Why? My case reps show up on time and offer me better service and quality products than I used before along with helping my hospital administration friends thanking mecand my peers for bringing down the cost of spinal implants by more than 15%. That decrease may not be too impressive but it sure put a decrease to the usual 5% or more increase my hospital experienced over the last 5 years!

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  10. Musculo. Man-

    According to Tony Viscogliosi the spine market is supposed to double by 2015.

    Maybe the upswing in Alphatec's stock is a result of betting on this increase?

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  11. 12:25 Are you sure he was referencing the BBQ market? After all, I'm sure the V Bros. had a grand showing in Memphis last week.

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  12. POD % is far less than 10% in most areas.

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  13. 12:07, I am new to TSB. I am not a distributor, rep nor with a co in the business. I am a market observer/analyst. This POD dynamic, although an old, tired subject to you, is an important consideration going forward, i.e., which way is it going from here, today? With respect, you may know what's going on in your backyard, but practices vary around the nation. Your opinion and experiences matter, but the collective view is more important in gaining an understanding on the national trend in this area.

    And from what I can see from the TSB posts in the past on this subject, I don't think anybody in this forum truly has a thorough, accurate understanding of this trend, on the national level.

    I look forward to hearing what others think about this.

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  14. 1:02 Seriously?

    Per my earlier posts, the POD topic has been covered ad nauseum on here. Do you see where it says "Search this blog" on the upper right of this page?

    Type in "POD", click the search button, you'll find 8+ pages of posts & discussions on this topic.

    Not sure there is much more to discuss re: PODs at this point.

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  15. 12:25

    You know what TSB says, " if the Tony V said it, it must be true. Is that anything like his predictions about the disc market? Even Hansen Yuan laughs at his prognostications. Tony should spend more time worrying about what some of his investors will do when he fails to deliver. Peace, Love and Understanding

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  16. 12:07 - If you're so proud of your POD, I'm sure you Include your POD affiliation on your marketing material, and tell your patients all about it, right? What's that? You don't tell anyone? Interesting.

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  17. The post is excellent.

    If ATEC is making POD's a major part of its sales initiative there will be direct impact on the market. Alphatec is a big player. Not the biggest but big. As a big player what they do and how they do it matters. It appears that the company feels POD's are a legitimate sales model. If the government declares PODs are not legal then ATEC stock price is going to reflect the loss in sales. Even greater risk than a stock sell off is the tarnishing of the brands image.

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  18. Anytime a post references Jimmy Buffett -it's gotta be da bomb!!!!!

    GO TRIBE!!!

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  19. TSB you must be a son of o son of a sailor

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  20. In light of subject of today's TSB...appropriate Buffett song title for emergence of PODS...Changes in Latitudes, Changes in Attitudes...an all time classic!

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  21. Hello fellow spine professionals. Very glad to be here with you all.
    I recently graduated from the Medical Sales College in Colorado with an emphasis in spine. Its an 8 week intensive program.

    I am currently accepting offers and hope to make a selection in the near future. If you are interested in my services, i would be glad to entertain your offer as well. Please just reply with your info.

    Good Selling!

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  22. I believe most analysts don't have a clue ... they believe Alphatec is winning and posting market share taking revenue gains by offering innovative products and service.

    A great question for Dirk and the boys would be "How much of your revenue is driven by the POD model? Specifically Phygen and PDP?"

    PODs are here to stay. The boys in Huntsville, AL, Jackson, MS, and Hattiesburg, MS have been at it long enough to build a substantial warchest at the expense of patient outcomes. No idea how the morons that run the hospitals haven't figured out how bad they are getting worked over by these docs. The "fever" has spread to Mobile, AL where, again, PDP and SpinalUSA rule the day.

    Someone please let me know when you spot a SpinalUSA rep in your area trying to "grow" business. Until then the SpinalUSA model is a great big Ponzi scheme.

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  23. 1:25 needs to grow up. the POD conversation is not old but is revealing on a daily basis. we have to keep the dialogue open and robust. there is no greater threat to patient outcomes than POD's. The study cited in the Hogal Lovells article from 2009 showed revision rates at over 300% post surgeon interjection into the distribution channel. i for one would not touch one. the potential qui tam implications make ones head spin.

    it is illegal, unethical, and shameful

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  24. I think it is absolutely hilarious to hear a surgeon get on this blog and espouse a faux concern about the prices of implants they are putting in their patients. In fact, the total opposite is true, how many of you out there have heard, "that freakin hospital can suck it!!! I make them them so much money bringing my patients in here that they should get down on their knees and pray to God that I never ever leave their piece of shit hospital!" Then to make matters worse, They want us to put in the most expensive implant/BMP/DBM/cross-links etc and then COMPLAIN about the commissions we make. Then they go open up their own private surgical hospital that won't take medicare, and all of sudden they ARE interested in the prices of their implants! We are all just pawns in this business. You could be the best servicing sales rep on the planet and it won't make much difference. When the surgeon has a choice of whose pocket that dollar is going into.....it will be his 99% of the time.

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  25. Let's take an informal pole here and find out how many reps out there have actually had a surgeon say "you know what I love your hardware, but its just too expensive"

    I will start by saying ZERO!

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  26. I'm not going to take any "pole", formal or informal, other than the "pole" I'm getting from my local POD.

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  27. 6:42
    I had a surgeon say that.
    Now he had just opened his own hospital, but he said it!

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  28. PODS is like AIDS; insidious, growing out of control, and people are uncomfortable talking about it. Have faith in the marketplace- it will all sort itself out.

    Hang in there guys!

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  29. SpinalUSA and Ken Horton of NuTech have joined forces in creating a "private" label implant for Ken to sell to his surgeon investors group.

    Can anyone elaborate on how Mr. Horton is presenting his "ponzi scheme" to his surgeons? It has to be some POD knock off.

    Both groups are crooked.

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  30. Alliance..... anyone know what spinal companies sell to their POD models?

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  31. look at the wall street journal article. the letter contained on the web version had the companies listed.

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  32. Is it too late to change the name of the Spine Blogger to POD Blogger?

    GO TRIBE!!!

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  33. I'd like more insight on the NuTech/SpinalUSA partnership! I hope SU has locked down any IP they may have. The NuCrook cronies are famous for the snatch and grab. It might even be in their their Mission Statement!

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  34. Bahahahaha!!! 8:20am thinks Spinal USA has IP. Good one!!

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  35. 1:25
    it's 1:02...you're right, not only a ton of info on PODs both here on TSB (opinions at least), but also elsewhere on-line, I should have done my homework before I asked.

    But it's interesting, I'm clearly not alone, it's not a tired topic for a lot of people out there...it appears to remain a very hot topic.

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  36. For those of you who think PODs are new, think again. This isn't a new model, in fact it is old as the hills. Too many moons ago, in the days before cell phones and pagers unlimited distance, particularly in rural areas, surgeons bought trauma products like femoral rods, compression hip screws, standard hip and knee sets and sold them to the hospital for a mark up. True, it was more out of neccessity than the greed model we see today, but the system worked pretty well. It went away because as systems grew larger and more complicated, more expensive and communications improved, there was no need.

    Part of the reason it worked is surgeons had what they needed to provide for their patients, or knew what they needed and didn't buy every freaking size of everything X 2. They managed inventory quite well. So, before everyone goes ape shit, the dust of time has not clouded my vision, yes times have changed. But inventory management hasn't. It doesn't take a rocket scientist to figure out what you want and need, and inventory systems that are very simple and accurate are readily available on line. With the parity in products and services, it's understandable why surgeons believe they can do just as well as the local distributor, particluarly since for the most common maladies use a very finite set of tools.

    I certainly don't agree with the current POD model because it has nothing to do with taking better care of patients. It has nothing to do with improving the dismal outcomes spine has been experiencing for 20 years. It's all about the money. And I guess that's ok to a point, but it would be hard to argue that if spine surgeons and the companies who serve them, no matter in what capacity, paid more attention to making patients better, doing things to stop the insanity that has been caused with 3rd party payers and their understandable reluctance to pay for crap results, then those who pay the bills who get off our ass and many of the issue plaguing our industry would go away.

    Yes, prices will still go down. The entry to the commodity market is too low to stop low cost players from entering, but innovation could be restored. 3rd party payers might finally pay for it, but they won't until we do a better job of caring for those who need vs. our current greed mentality.

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  37. In reference to the topic originally suggested, I can't imagine if any stock analyst spent a week in any spine company and had the opportunity to smell what was going on behind the curtain for the past couple of years, most would puke.

    After college, while working towards my CPA, I worked for a very sage gentleman who made it very clear, when the CEO asks "how are we doing?", your answer should always be, "how do you want it to look?". Though you can't (or at least it's naughty) lie about financials, there is a way to spin just about anything financial to make it look the way you want. As mention in earlier posts, those charged with selling paper find a way to make it pretty.

    We have to remember, a large majority of investors of spine stocks are not familiar with the on goings of the industry. They look at risk/return. Why is Zimmer's price continuing to move back towards $70? It sure isn't because they are setting the world on fire. They are very good and making sure shareholders are happy, it's a part of their damn mission statement. If ATEC is savy, they are and will continue to do the same irrespective of what us spine folks think of them, for in the end, that's what matters to them, not what we think of their stance on PODs.

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  38. There are two types of spine companies, those that work with PODs and those that want to work with PODS but can't because of exclusive territories and distributors already in place.

    In this cutthroat industry, there is no company with an inactive territory who gets called by a POD in that territory that won't take the business.

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  39. Eye surgeons bring their own IOC implants. Plastics bring their own breast implants and no one says anything. It just works that way. They know what that need and supply it. PODS are similar and not really any different. I know this is a paradigm shift in spine but it will likely grow. Sorry guys.

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  40. http://beckersorthopedicandspine.com/spine/3447-5-points-on-lowering-the-cost-of-spinal-fusion-care

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  41. MM you said it best yourself! Although you seem to display your malice towards PODs, the fact that you stated in your piece that "What if a law was enacted that declared all POD's illegal", PODS are legal and are a part of this industry.

    For 99% of you uninformed readers, the Hogan Lovell white paper was paid for by Medtronic, Depuy, Stryker. Do some homework, the big five went out and hired Hogan Lovell to defend there turf. The big five, now big four cant play in this arena, and if you can find any where in the Hogan Lovell piece that says that a POD is illegal then you win the argument, but you will not, they are legal......for now!

    You all claim that you know that utilization will increase or reops will increase, you have no phucking idea if that is true or not. You guys all bitch about a surgeon being greedy and doing it for the money, well what the hell are you all doing this job for, why did you all get into this industry in the first place, what was it that drew you to medical sales??????? All you greedy bastards did it because it paid well, you did it for the money!

    You think you know, and MM you are as uninformed as any, but instead of reading the bitching and cryinig from all the reps that were so use to making 300K a year for filling out a sales invoice, spend 10-15k to really find out if this is legal or not and talk with an attorney. I mean this is the job that you are so entitled to correct? I would think that it would be appropriate and prudent to spend a little money and educate yourselves! Most of you are so lazy or stupid, you have no idea how to go about it or will just wait for your company to do it for you, and Medtronic or Deput is really going to give you the truth about a POD.

    No wonder surgeons look at you all with such disdain, you guys make it easy to use you as a punching bag because of how pathetic you present yourselves on this blog.

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  42. 3:20

    Uninformed I'm not because old wise one, you quoted me yourself, "what if a law was enacted that made PODS illegal." There's a difference between being an advocate, and having an adversarial opinion. Yet, I do not spend my day, interpreting the law, as some "wannabe lawyers do." You're probably the guy that writes on this blog and doesn't know the difference between slander and libel.

    PODS are about a changing landscape, where everything and anything goes. It will eventually come back to haunt the industry, whether you agree or not, and that includes those that utilize the POD model as a means to an end. You said it yourself, its about greed, and many of our bloggers opinion is that it is about job preservation. TSB doesn't believe that most "surgeons" look at sales people with disdain, maybe the surgeons that are involved in POD's, especially the ones that believe that they are "Entitled" to use any method they want, to make as much money as they can. You know the tough guys that aren't willing to challenge the hospital administrator or fight the insurance industry. As an example, those are the same insecure individuals that bitch about podiatrists operating above the ankle, or interventional radiologists performing VCFx procedures. Its okay for me to rain on your parade, but please don't rain on mine. It's no different than the people that complain that we pay too much in taxes when taxes are at there lowest since 1948 and that my friend is a fact.

    Your diatribe says much about your personality, as it does about your greed. You believe that you are smarter because you spent $10-$15 thousand to get an opinion from an attorney. You believe that those that have worked extremely hard, probably for years, are lazy and stupid. Most of the people that complain are not waiting for their companies to do something, their getting up this morning and going to work. But "old wise one" your smugness and arrogance speaks words about whom you are. Ever hear of a couple of guy named Ken Lay and Jeff Skilling, they too believed that they were the smartest guys in the room, today, one is dead and the other sits behind bars.

    So in closing thanks for the lecture and the next time any of our bloggers run into you, we will make sure that we genuflect and praise you with hosannas for being the smartest guy in the room. Peace, now go out and sign another POD and have a great day.

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  43. 4:01 - Very well done but where are these facts???? I'd say SHOW ME - I'm from Missouri, however at this time that seems a bit out of place.

    People in Joplin and the Midwest - GODSPEED

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  44. 3:20

    You think that your $15K spent on a lawyer makes it legal? I'm sure Medtronic paid a lot more for their opinion. I would also bet that Hogan Lovell is much more respected and experienced than your local lawyer. The fact is that until clear guidance is given, or the laws are rewritten to be more specific, there is uncertainty about the legality of the model. However, if you look at the available opinions online, you will find that MOST opinions find the model on the wrong side of the law and ethics. The only opinions to the contrary are the $15K opinions from POD groups who paid an attorney to write up their model to fit within the law and the safe harbors. But just because it was written to fit within the law doesn't mean the surgeon owners are acting within the law or even within the bylaws of their own POD.

    Your comments about service and quality and pricing sensitivity are laughable. If your coverage rep is providing better service than the rep you were using prior to the POD, you didn't choose reps wisely. If the quality of the products you are using now is better than prior to the POD, you didn't choose products wisely (my guess is those same products were available outside the POD model) and if you are concerned about pricing, you could have partnered with the hospital and made product decisions that had a much larger impact than 15% prior to your POD. To suggest that these 3 issues are all better than before reveals that you are willing to lie to justify your new revenue stream which denies your patients your best efforts at helping them.

    If you really believe what you are saying, I challenge you to identify yourself and lets have a chat about: 1) what specific product you now use vs. your prior product choices, 2) the reasons you chose the reps you used prior to the POD and what your POD rep is offering that is superior, 3) and what kind of pricing issues the hospital has had and will have with your POD.

    I don't think you will accept this challenge because I don't really think you actually believe anything you wrote above (no one else does either).

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  45. Back to the original topic. Is Alphatec open with investors about their sales to POD's? I haven't seen anything specific from them in public comments but that doesn't mean the investor community doesn't know. Has anyone seen a mention of this in any reports?

    If POD's go away, it should only effect stock price relative to the percent of their overall business that POD sales represent. Anybody have an idea what that percent is? You have to think that those sales are at wholesale prices and do not add up as quickly as sales through distributors.

    ATEC takes a lot of heat on this blog, and maybe its justified, but my understanding is they only sell to stocking distributors and have no financial ties to the POD. Does anyone have evidence to the contrary? If this is the case, can a wholesaler be held liable for the actions of the retailer? Some on here suggest they can, but is that just wishful thinking? Somebody to blame for the POD taking their business? Personally, I don't feel strongly either way. They are clearly taking a risk if POD's implode legally, just from a reputation standpoint and maybe from a legal one also. They certainly have a lot of sales guys out there slamming them to their customers for their participation in "enabling" POD's with a full line.

    My tendancy is to put more of the guilt on the surgeon owners than the manufacturer, but I understand that others disagree. If the rumors on here are accurate that the big boys are bidding on POD business at TBI, then I think there will be a monumental shift of opinion about ATEC, or at least the focus would be shifted squarely to the big boys since that would be a much bigger threat to a lot more people.

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  46. 5:57 all you are doing is demonstrating that you are unifomred on the issues like so many. Gee Medtronic paid more for the "White Paper", not a legal opinion, so that is the first thing you are completely wrong about.

    Lets see Medtronic paying someone a bunch of money to write something to fit Medtronics agenda....Big Blue would never do that, they are clean as clean is....

    Over utilization is a myth, good clinical surgery overcomes all and POD's are here to stay. They save the hospital money, the surgeons use good clinical product and performs the same quality surgery. The surgeon no longer has to deal with a bunch of reps begging him with consulting agreements to please put in my metal so I the rep can make a living that I am use to, and the surgeon benefits for all the hard work that he does all day every day.

    No your facts 5:57 you FAIL!

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  47. So, Is PHYGEN a POD or NOT?

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  48. Know how to spell and maybe you'll get a little further in life.

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  49. Yes Ken Horton started a POD and he, allegedly, purchased his supply of implants from SpinalUSA.

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  50. Hey doc your greed will ruin you! It's about the patient, not your pocketbook!

    bonz

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  51. Plenty of surgeons in the midwest are involved with POD's and/or own their own spine company or hospital. The smart surgeons will sprinkle in a few of the Big 5 guys for a few fusions a year.

    It's not rocket science why they do it this way

    Tougher to build a case against a surgeon who uses his own company and a few of the Big players in the industry

    Also, what better way to develop his rinky dink surgeon owned instruments/implants than using Danek/Stryker/Depuy every now/then (we all copy each other anyway)

    The fact that the surgeon community is even trying to justify this being ethically right/wrong is puzzling. I want to vomit when I hear a surgeon say, "other medical profession's have a form of PODS (plastics) SPINE is no different"

    Wouldn't it be great if upon entering into your local spine surgeon's clinic, they would have to disclose if he/she was involved with a POD, surgeon owned hospital, owned their own spine company?

    Which surgeon in your town would still be in practice if this happened...and how busy would they be (or not be)

    I'll take the surgeon with bad bedside manner who's only focus is doing great surgery versus the schmoozer that's double dipping and complains about his re-imbursement being cut.

    It's about time that the patient's knew the truth about these guys...you are just a bag of cash to them.

    Yawn

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  52. Since this blog started about the Alphatec post lets get back to it. It seems very curious that MM trys to always place this company in a bad light. He has, I believe started three blogs hell bent on why Alphatec is such a bad company. Why? Inquiring minds really would like to know. Do you have an axe to grind? Whats your beef with the management team? Is it that you a no longer a professional in the field cast out for lack of performance so you need to cast aspersions and try and get people to call attorneys to try and hurt this company? Do tell your fans why Mr. Integrity....

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  53. Has your stock consistently performed as your mouthpiece stated in a press release? No What's the post about? Dpn't be so thin skinned. What are the 52 week highs and lows. No need to go on.......

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  54. Please answer the question. Why all the attacks and start up blogs on this company all the time?

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  55. I am not MM but i can answer in my market. Atec is ONLY using POD's and bashing to gain any business. They do not focus on technology or patient benefit.

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  56. Some Atec guy post bs from a guy named Dennis Askew and you attack TSB for talking about the 52 week performance of the stock talk about underperformance. Look at who is calling the kettle black

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  57. I second the request. Let MM defend the question. Why the attacks on Alphatec all the time? There must be a reason.

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  58. Not all of the time TSB, only when it warrants an attack. If the shoe fits wear it Alphatec

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