Tuesday, July 12, 2011

Summertime Blues

The last few weeks in spine have been interesting, to say the least.  Without questions surrounding INFUSE, and a bit of hoopla regarding the acquisition of Salient and PEAK by Medtronic, what would the industry really have to debate?  Another story on stem cells? Another story on POD's?  The same relentless blogger asking the ridiculous question, "when will Globus finally go public?"  Would it be safe to say that spine has hit a wall?  Or, could this be a pivotal and defining moment for the spine industry? Could the Dog Daze of Summer be lulling you the into a false sense of security? Could you be coming down with a case of the Summertime Blues? Or, has the industry continued to rear its ugly head by the way salespeople and surgeons have gone after one another, or, how The Spine Journal has now pitted surgeon against surgeon by dedicating an entire issue to INFUSE?  I guess Medtronic's new CEO Ishrak is receiving his baptism under fire.  The Korengal Valley rather than Minneapolis may be a better place to sequester oneself.  Even Larry Biegelsen of Wells Fargo fame has weighed in with his analysis of what could potentially happen to Medtronic's Kingdom if his crystal ball allows him to look into the future. Someone recently asked TSB the question, why was this blog started?  This blog was a response by a core group of people that have believed and echoed for years, the sentiment that this industry needed to develop a referendum on the way business is conducted, how scientific evidence is presented, and how unscrupulous our practices have become in a highly competitive and saturated spine marketplace.  How many of you have sat in the audience during past clinical presentations on INFUSE snickering at the underlying commercialization of a product, wondering how long will the medical community tolerate this behavior until it calls out its own colleagues? Does anyone have any questions from the audience?  How many times have you sat in the audience asking yourself is this a scientific presentation, or a sales pitch by Ron Popeil for the Ronco Rotisserie? Commercial interest from the podium, not in our industry, especially at an educational forum.  TSB knows the actors that have the leading role in this movie.  All of them are good men, but just because you have good intent, does not mean that your opinions can't be influenced by your vested or financial interest in a products success or failure.  And yes fellow bloggers its okay if the authors of this paper intended to tie in one with the other, because at the end of the day human nature does play a role in science. Does anyone really believe that the intent of this paper was to bring Medtronic down?  Absolutely not.  Does anyone really believe that the intent of the paper was to embarrass Drs. Zdeblick, Burkus and Haid?  Highly unlikely. Maybe the authors are just asking their peers and the industry for transparency.  Contrary to prevailing opinions, Medtronic and INFUSE are not going away anytime soon. Is this the wake call that Medtronic desperately needed to regroup?  Maybe they will realize that its not all about shareholder value, return on investment, and how many consultants can you have in your pocket?  Maybe the company needs to get back to basics? Regardless, Mr. Ishrak must now deal with the fact that his company's reputation has become stale because of their arrogance.  

The Spine Journal addresses the core problem of our industry, the spine community behaves like their is no systemic problem.  To paraphrase an industry platform, "the spine community is reeling, even accusing the authors of tabloid sensationalism."  Surgeons like Carragee, Weiner, Rothman, Bono and Ghanayem are questioning INTEGRITY, HONESTY, ETHICS, and CONFLICT OF INTEREST?  Today, they ask questions that should have been asked many years ago. Unfortunately, the medical profession frowns anyone that challenges a prevailing opinion even if it pertains to the so-called new savior in spine fusion. Yes INFUSE has done wonderful things for patients, but it has also been utilized in ways that it was never intended to be utilized, and that's where the problems exist.  Even Zdeblick alludes to that. Whether you like it or not, its a drug. It was developed by a pharmaceutical company, Wyeth, licensed to Medtronic and positioned as the panacea for all fusions. If surgeons are expressing their anger, they should be angry at themselves for failing to ask the necessary questions years ago when the opportunity presented itself.  TSB wants to know what our readers think, will Medtronic rebound or will they take the hit from the piranha's circling the waters.  Everyone knows that anyone with stem cells, or any other biologic are just chomping at the bit.


  1. "All of them are good men, but just because you have good intent, does not mean that your opinions can't be influenced by your vested or financial interest in a products success or failure."

    -- Amen, and perhaps the most underappreciated reason why full and complete disclosure is so important. Let the reader/audience decide that you're a good and well intended person and ethical researcher who happens to be very good and well paid for what they do. Nobody will slight that.

    Rule #1 - If you have nothing to hide, then don't hide anything.

  2. Medtronic will come through this with perhaps an appropriate slap, either small or painful, on the wrist for any influence they exerted on the docs regarding publications in the literature. But the bottom line is that BMP is a hell of an advancement in spine surgery and will remain part of the standard of care in some fashion. MDT seems to have abided by the law in that all of the complications in the studies, etc were in the FDA submission, and unless somebody has something new to report that MDT should have known about or reported, they should be fine in the long run. JMHO.

  3. Medtronic won't get even a slap. Just a little PR embarrassment. They reported everything to FDA and put it on the package inserts. Every box of Infuse ever shipped probably has a little slip of paper in it detailing the number of cases of RE, etc. found in the trial.

    If it comes out that the journal publications on their trials didn't report the complications that were reported to FDA, then the paper authors and journal editors will have some explaining to do. There may be a corporate research person helping the surgeons compile the papers...but the surgeons ultimately are the ones that submit the data as theirs. The journal editors decide whether or not they will lay the submitted data next to the publicly available data from the FDA approval.

  4. Hey TSB: did you get a free slurpee yesterday for 7/11's birthday?

  5. which spine company has the best severance package ?

  6. 11:43 Not only stopped for a slurpee but also picked up some Naan Bread and Lamb Vidaloo.

  7. I'm pretty sure that not all of them are good men. Like in every other collection of human beings, there are saints, leaders, followers and ...holes, and many other varieties. Why would that be different for spine surgeons? After 25 years I know quite a few that I would put in the ...hole category.

  8. Speaking of misrepresentation (realizing it's not directly Spine related, although wild and stupid claims say otherwise), what do you make of the shareholder lawsuit against BMTI? Sam is completely worthless IMHO.

  9. Right on TSB.
    to quote an infamous campy criminal, "this town needs an enema"

    let's get back to the advancement of science and medicine.
    I think Medtronic rebounds

  10. 11:47 that would be Biomet

  11. Vertibron was by fare the best ever. Quit paying people a month before they shut the doors. I hope they burn!!!

  12. Anyone know what that pile of dookie terry rich with Nuvasive does these days? Someone told me he finally blew, oops meant, worked his way up the company ladder to upper management?? what a joke!

  13. What's up with Zimmer Spine now a days? Are they still alive? They are part of big Z, but, in spine...probably, not many take them seriously. TSB and readers: What's your view about that company?

  14. did someone say Zimmer Spine?? The line is long gone my friends. All the old reps are gone after the dynesys mess and failure, guess they all figured that the new and exciting product Zimmer Spine just released (Trabecualr Metal Cervical Inner Body) was not going to be the game changer upper management all thought it was? Its one things to use it in a knee or hip, but come on fella's in the cervical or lumbar spine?

  15. The Spine Blogger Unmasked?-By Walter Eisner ryortho.com

    Could someone post the article (paid subscription) so I can get a good read in today.

    TSB Rules!

  16. TSB unmasked? His real name is Peter North.

    Google it.

    Stryker boy

  17. biomet has a good severance ? thanks.

  18. The Spine Blogger Unmasked?
    Walter Eisner • Tue, Jul 12th, 2011
    Print This Article

    On Saturday, February 7, 2009, a new blog, published by the anonymous Spine Blogger (TSB), appeared on the Internet (www.spineblogger.blogspot.com).

    The blogger, who calls himself Musculoskeletal Man, was first brought to this writer's attention by a former colleague at Orthopedics This Week. TSB promised to provide “a platform where the exchange of ideas, news, job opportunities and the truth can be discussed in an open forum without Big Brother standing over us and threatening our livelihoods." He requested that his followers use the platform without malicious name calling or vulgarities. "Strap yourself in, and enjoy the ride," wrote the blogger.

    And quite a ride it's been as he and his followers quickly ignored the request.

    Postings, Comments and Followers
    Since inception, TSB has logged over 500 postings, listed 281 followers, and claimed 50,000 hits and 8,200 returning readers per month by the end of the first year. While reader comments were sparse at the beginning, TSB now regularly garners between 50 and 100 anonymous comments to his postings.

    TSB's postings and his follower's comments, are generally informative and provide insight into the frustrations of anonymous spine sales reps. But over the years, as TSB dove into the changing world of spine sales and threats to spine reps’ livelihoods from PODs (physician-owned distributors), changing distribution models and commission cuts, many of the comments got ugly and personal.

    We won't list the names of the individuals and companies scorched in the postings and comments. No need to repeat what may be false and damaging attacks.

    “Me Too” Companies, Greedy Surgeons and Besieged Sales Reps
    Successful companies are frequently accused by TSB and followers of paying greedy surgeons to use their "me too" products. Companies that have failed or gone out of business are ridiculed for being run into the ground by incompetent dinosaurs that lacked the creativity to make their start-ups successful.

    TBS and his followers also took on a nasty tone towards their employers and incredibly, their customers—the surgeons. One TSB follower wrote that it was important to be able remain anonymous because if their employers knew what they really thought, they would be fired and their customers would stop buying products from them.

    The site frequently feels like a therapy session for people in fear of their livelihoods, their careers and the loss of a golden age in spine sales. TSB gives a vocal group of followers a forum to express their frustrations.

  19. Here's a TSB posting from July 2009:

    "Witness the carnage in our industry that has resulted in over 500 different pedicle screws, nearly 300 cervical plates and countless TLIF, PLIF, ALIF and Cervical PEEK devices. Have all of these products really made a difference in outcomes? …Or, have these products saturated an already existing commodity market? As investors hold on to their hard earned capital there will be fewer opportunities for 'me too' products to succeed. How will this shift affect the earning capabilities of the salesperson? There will be a shift in the commission structure resulting in less earnings for the distributor or direct salesperson. I know that many of you do not like reading this, but if the company’s bottom line suffers, so will your ability to sustain your earning capacity.

    "…What happens when companies start believing that they could exist without sales people and start to model their distribution model by selling to the hospitals directly? If you don’t think that’s possible, it has already been piloted by various small companies and tabled by larger organizations."

    Who Is TSB?
    We are frequently asked if we know the identity of TSB.

    We’ve wondered ourselves and we’ve heard other people’s speculation. But then, this past June 18th, an email came our way from, we believe, a former colleague of ours and, lo and behold, it came from the same email address that is located on TSB's blog.

    TSB only says on his website that he has a background in orthopedics and spine. In his 500 plus postings he has volunteered more information about his background.

    Our former colleague's public LinkedIn information says that he is a former VP Sales and Marketing at Custom Spine, former head of business development for Choice Spine and former Senior Director of Marketing Cervical at Surgical Dynamics. And, of course, he worked for OTW for a while.

  20. In his own words, he writes:

    “Began my career at Synthes USA as an AO/ASIF Consultant. After a successful career in sales I was hired by Stryker/Osteonics as part of the management team at Stryker Trauma. Responsible for the initial concept of the T2 Antegrade/Retrograde Femoral and Tibial Nail. Segued into Business Development and Marketing at Surgical Dynamics and Blackstone Medical launching numerous spinal deformity systems. Worked as a consultant raising capital and negotiating licensing agreements between educational institutions and early growth stage companies. Spent one and half years at Custom Spine as VP of Sales and Marketing. Currently employed at Choice Spine in Business Development.”

    Intoxicated With Entrepreneurial Fever
    Three days before the launch of TSB, our former colleague posted the following comments on www.xconomy.com in response to the demise of IST (Innovative Spine Technologies.)

    "During Wall Street’s heyday spinal implant companies sprung up because there was excess capital. Industry professionals became intoxicated with 'entrepreneurial fever' a by product of the artificial disc deals. New companies immediately aligned themselves with surgeon champions to create leverage with potential investors. Many surgeons even invested in some of these companies.

    "…at best IST was a “me too” company competing in a zero-sum market…Before ’09 is over many of these companies will either disappear, align themselves with a company that compliments the gaps in their respective portfolios or be sold in 'fire sales'."

    That got us thinking that we've read this language on TSB.

    For instance,

    On November 8, 2009, TSB posted the following:

    "Entrepreneurs have contributed to the success of spine, considering that without their interest some of the same technologies that we sell today would have never made it to the market. But, has this 'mania' led to the unethical behavior that exists in today's industry? If surgeons become 'salesmen' or public relations experts for a product that they have invested in, or are being paid by a company to use a product, is this good for medicine?

    "The total disc boom created what many in our industry still call 'Entrepreneurial Fever!' The dynamics of the economy has changed people’s expectations. It's interesting to sit around a dinner table and listen to surgeons criticize the TARP program and condemn Wall Street when their own behavior leaves much to be desired. Sometimes you feel like saying; 'look at who is calling the kettle black!'"

    There was another posting by our former colleague that made its way into the public realm.

  21. Bribery, Wall Street and DOJ
    On December 19, 2005, he responded to New York Times columnist Paul Krugman's column, "Drugs, Devices and Doctors" with a published letter titled: "The Me-First Medical Industry."

    "I have over 20 years experience within the medical device industry and would love to share with you a first hand account of how companies obfuscate the truth between what constitutes a medical consultant and what is an outright bribe to have the surgeon’s or physician’s business...

    "…Wall Street has ramped up and sunk its teeth into the pharmaceutical and device world creating a culture of mad-money. Sometimes there is no rhyme or reason to an idea, yet with marketing and clinical backing, a potential star is born: the product. As a prominent surgeon once told me about the artificial disc, 'As long as the F.D.A. approves it, I will slap as many of them in and let the next guy worry about it after I’m retired. I have stock options and that’s all that matters...' "

    In June 2009, TSB wrote the following:

    "As most of you know, in the old days (…we actually sold for a living and the market wasn't bought by companies)... Unfortunately, until the Department of Justice steps in and makes an example of those that abuse their privilege our industry we will continue to 'shoot 'em up' and 'duke it out.' The only casualty will be the patient who doesn't know whether they really need surgery or are they being used to line someone else's pocket?"

    In July 2009, TSB wrote:

    "…there are a percentage of surgeons that no longer want to be surgeons, they want to be entrepreneurs... They want a piece of the action…They are no longer just doctors, they are now master marketeers, selling themselves to the highest bidder regardless whether they believe in the technology or not."

    Admittedly, we have picked out a very small sampling of TSB’s writings, but the themes remain the same—“me too” companies, greedy surgeons and besieged sales reps whose employers look at them as a commodity.

    By September 2010, some of TSB’s followers began to call for his unmasking. A series of comments speculated that TSB was John Nieradka, our former colleague at OTW. Another reader commented that TSB was Nieradka and that one company mentioned by TSB should pursue slander and defamation charges against him.

    “John N.” responded to followers that he was flattered, but TSB wasn’t him.

    Then, as mentioned earlier, we received a communication at the end of June from TSB’s posted email address. The name used by that email writer? “Joe” Nieradka.

    This writer doesn’t know a “Joe” Nieradka, but TSB either inadvertently unmasked himself or someone purposely tried to get the hounds off his trail.

    If TSB is John Nieradka, “Say it’s so Joe.”

    Writer’s Note: We emailed TSB a list of questions for this story. He said he’d respond. We did not receive the reply in time for this story, but will report his answers when we receive them.

    Print This Article
    Leave a comment

  22. As usual, there is a twist at the end. The name has appeared on this blog and others in the past... kind of. muwahahahahahhaha. Nice move MM, nice move.

  23. What is happening with Paul Gravelin at Zimmer?

  24. You think OTW is hurting for subscribers, could TSB be threatening their readership

  25. Kudos - Thanks for posting on a different topic. So I guess
    Walter Eisner had a deadline and couldn't wait for TSB's answers? TSB shouldn't respond now. LOL

    2:19 If you have to tell people to Google something without them asking first; you have issues.

  26. I don't want to know the identity of TSB. I hope he remains anonymous. The only way this blog can continue to offer fair and balanced reporting of our industry,
    Back off OTW.

  27. Zimmer will be the darkhorse in spine. Paul will ride him across the finish line

  28. I agree, who gives a shot who TSB is? The Spine Blogger represents all of us out there trying to make an honest living in this ever changing business. So I guess that would make us all TSB? Or maybe they are speaking of John Holmes, not John Nieradka. But didn't he die?

  29. May I have your attention please?
    May I have your attention please?
    Will the "real" Spine Blogger please stand up?
    I repeat, will the real TSB please stand up?
    We're gonna have a problem here..

    Cause I'm Spine Blogger, yes I'm the real TSB
    All you other Bloggerss are just imitating
    So won't the real TSB please stand up,
    please stand up, please stand up?

    -Courtesy of Eminem

  30. Walter another TSB follower if you submitted questions and TSB didn't respond sounds like a pending lawsuit especially publishing the guys resume, now you know why we hate OTW industry wannabes, losers ......Robin, TSB must be kicking your ass, 5 million viewed each month my ass

  31. Sounds like OTW is getting their ass kicked by TSB, all you wannabe bloggers TSB rules rules the airwaves

  32. I quit reading OTW when this website appeared. I found that OTW was "a day late and a dollar short". I also know that Robin was in the back pocket of the Lyon's brothers and helped that deal go down, he has to be thinking about the scrutiny he is under, whether he knows it or not.

  33. When's the FBI crawl up his ass Mr Dealmaker

  34. Paul Graveline in front of a surgeon? You'd be better off introducing your surgeon to a brick wall or other "wall like" objects such as Paulsen and Dvorak.

    Graveline is stuffing his resume so he can move into a CEO/Pres. role of some middle of the road med device company looking for that sort of "polish".

    Zimmer Spine has been dead for a long time. Dvorak sucked them dry and on top of questionable acquisitions he watched over HORRIBLE integrations of both Endius and Abbott Spine. The leadership has been ineffective and inept.

    Fact is nobody wants this boat anchor which is why there are no exclusive Zimmer Spine distributors. You know who really has it tough? Zimmer Spine's genius decision to employ DIRECT REPS!!! With that crap bag? Good grief.

    Zero innovation, zero presence in the market, zippo pipeline and quarter after quarter of declining sales and lost marketshare.

  35. Hello fellow Spine Bloggers can anyone help me out here...I am looking for the name and possible number for the Area VP/Sales Manager ofr Stryker Spine on the West Coast. Any help would be appreciated.

  36. 7:01 - why don't you just call Stryker Spine and ask them? freakin' moron!

  37. 7:13 - Chill. Know-it-all. How infantile!

  38. 6:47 what line do you carry? haha you're a sheep

  39. 7:13- Dude chill. Why would you even respond if you could offer nothing other than an insult? Lets talk about freakin' moron. Your the reason why this site is getting a bad rap! Great professionalism man!!!

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

  41. 7:13 obviosly took 7:01's comment as sarcasm because of the whole bioinititives departure.

    Which in all reality was probably the case.

  42. Recently I received an email from OTW previewing articles. One sparked my interest, but since I no longer am a subscriber I couldn't read it. I called at least 12 of my fellow spine professionals to see if any of them could retrieve the article. Not one had maintained their subscription to OTW. I think Robin inflating his numbers since he is shopping is little rag and and no one is interested in it. Robin, none of us care who TSB is, why do you?

  43. IMHO because the man with the fake mustache is losing the numbers race to a blogger and he wants to sell OTW and PD.

  44. Spinal USA?

    Anyone, anyone...

  45. Torpedo TSB? Sounds like Robin comes from the Rupert Murdoch school of journalism.

  46. What's a Spinal USA? Is that anything like a Spine Art?

  47. Does anybody have any thoughts on who NuVasive is going to buy? They have alot of money in the bank, so they must be positioning themselves to buy something!

  48. Last thing that was posted on SB was that someone heard that they had looked at ATEC. Company probably could be bought on the cheap

  49. I like the picture of Robin on his stinked in.....er, linked in page. He looks like the bastard love child of Captain Stubing and Dr. Bricker from the Love Boat series.

  50. Robin likes to think he's he pilot fish, yet he's more like a remora.

    "The relationship between remoras and their perfect hosts is most often taken to be one of commensalism, specifically phoresy. The host they attach to for transport gains nothing from the relationship, but also loses little. The remora benefits by using the host as transport and protection and also feeds on materials dropped by the host. There is controversy whether a remora's diet is primarily leftover fragments, or the feces of the host. In some species (Echeneis naucrates and E. neucratoides) consumption of host feces is strongly indicated in gut dissections."

  51. 6:42

    Don't hold your breath for anything big. Here are Nuvasive's acquisitions in the last 5 years:

    Osteocell (from Osiris)
    Formagraft (from Radius Medical)
    NeoDisc (from Pearsall's)
    Dynamic Stabilization IP (RiverBend LLC - 2005)

    What company out there has a technology that makes sense or adds anything to Nuvasive's portfolio of products?

  52. 7:36
    Please don't EVER....ever, ever, ever, ever, ever post stupid shit like that again! Why not just say the dudes a parasite?! Painful to read.

  53. OK the dude is a parasite

  54. NUVA buys ATEC for peanuts, shuts them down and uses their european distribution to gain worldwide market share. They will toss GLIF out in the trash with all the management and executives. PODs will have to search for another supplier.

  55. 4:08- It's not '5 million viewed each month'. Get your facts straight before you run your mouth.

    You want to call this 'fair and balanced reporting of our industry'? Some of these comments are nothing but berating and insulting to a person's demeanor. I get it, "Opinions are like assholes. Everybody's got one and everyone thinks everyone else's stinks.", but how about we debate the issue at hand as professionals, as I thought most of us were suppose to be...

  56. I know Aesculap Spine hires PODs.Only way they can get business in my area.
    Now that is an excecutive team to follow...not!!

  57. 8:41 Why don't you practice what you preach,
    do you think what you wrote is professional?

  58. man 'ol man this site is getting weaker and weaker every day. All you guys/gals do is bitch and try to one up each other! Sad...

  59. Hey my 6 year old son told me that Zimmer Spine would be aquiring Aesculap Spine and making a run at the #12 spot in the spine market (I think he said 12 as he could'nt put that many fingers up). Now thats good news...

  60. Zimmer Spine will be moving up the charts over the next 6-12 months. Word is they are about steal a big cheese from Medtronic to head up the field. Anyone know anything?

  61. If you have received the "drug" Infuse, call 1-800-ASK-GARY
    You may be entitled to compensation.

    Enough said!!

  62. how about a blog about consultants that hospitals/health care systems are hiring to drive our prices into the ground. Anyone dealing with Aspen? Here in the Northeast, these clowns are a tornado leaving a path of destruction that has taken a substantial amount of money out of my pocket and made all of us wonder if this job is really worth it anymore. Anyone else out there seeing this?

  63. What makes this industry so pathetic is the extremely large number of people that consider themselves "sales professionals", who can't, couldn't, or haven't sold a thing in years,, or perhaps EVER.

    They are good at moving sets, using laser pointers and filling out charge sheets, but they have no clue how to sell new technology or how to teach a surgeon a new procedure.

    I am looking forward to this industry's continued consolidation so that much of the drek is purged from the profession.

    Enough of hiring a surgeon's college buddy, girlfriend, neice, nephew, etc. who brings NOTHING to the table other than a relationship.

    I continue to interview people for open positions routinely and am AMAZED at how 85% of them actually of jobs in this industry as they don't know much and have no idea how to grow the business. Most have simply been hired and told "Ok, don't lose any business, just cover these cases. If a competitive rep starts snooping around, let your manager know ASAP."


  64. TSB, Great post.

    So seriously,, When WILL Globus go public?

  65. Interesting about the OTW post. I think Robin, Walter and the gang there actually often have pretty good stories. Their interviews and industry specific (rather than general) perspective on the news stories gives some good insight into the industry that we wouldn't get elsewhere. However, I still won't pay for it, but I enjoy the free stuff they provide.

    The story about TSB seems way beneath them, and I agree, it's probably because they feel threatened. If they really wanted to support their contention that they are a journal of record for the industry, they would have published a fair piece outlining the seemingly increasingly popular blog.

    Think the way NBC nightly news might cover a story about the popularity of Facebook. That's a win-win story for both. The way they did it, the only winner is TSB.

  66. 12:00 how about writing to us at our spineblogger e-mail address and providiing us with some information on the challenges that you and/or your colleagues are dealing with when it comes to these consultants. TSB would love to post a blog so that you can out their practices and techniques, PS we will even credit you with the post.

  67. If Robin writes an article about the MM man and no one reads it (or cares to read it) is that the same as if a tree falls in the forest and no one hears it - does it still make a sound????

    The picture on stinked in is awesome - Robin, have you seriously looked at it - without laughing????

    The thinker you are NOT!!!!

  68. 12:48 Is that Rodin's the thinker, LOL, hey robin talk about tabloid sensationalism, look at who is calling the kettle black, the backlash is beautiful OTW has stooped to an all time lo

  69. Definition of irony will be OTW dedicating an entire issue to Robin's many advertisers, I mean conflicts of interest, I mean advertisers, I mean conflicts of interest...

  70. 12:00pm and MM - in regards to Aspen, and all the others out there, this, like many trends in the spinal business (ie: POD's) started on the West Coast and slowly picked up momentum and moved east. Many facilities in California were affected by Aspen and their ability to take control away from the surgeon and place the control in the hands of the hospital administartor to lower price, price, price. The same case you made $500 on in Hospital "A", the next week, you made $250. Then the hospital up the street Hospital "B" catches wind of this and the same thing happens there, but the price is 5-10% LESS than the prior hospital. Pretty soon, Hospital "A" is crying foul because Hospital "F" has pricing 30% LESS than theirs and they resubmit an RFP and your $250 is now $175 for the same case you did 6 months ago that paid $500.

    And next year...your quota goes up based on the pricing PRIOR to all the RFP's and price errosion...

    When is it time to get out?

  71. Zimmer Spine and moving ahead doesn't seem to go together. If they are looking at someone from Medtronic as a savior than I am sure they will get will be sorely dissapointed.

  72. 11:45
    Zimmer's big cheese from MDT is the new VP Chris Ryan. Don't get your hopes up as he is not going to be presenting at a Mensa meeting near you anytime soon. Good luck trying to run the sales organization when you live in Florida.

  73. 3:59
    Wholeheartedly disagree. CR has a potent combination of true passion, integrity, and humility - not to mention a highly decorated history of success. All qualities that many in this industry are thirsting for in a leader. I've never been much impressed with Zimmer Spine, but wouldn't underestimate the impact this guy could have on that sales organization.

    -Not Chris Ryan

  74. 3:59 (aka Chris Ryan)
    Nice try. You were a district manager who had a few good years (and more than a few I know you would Like to forget and/or may not remember) but vp? should have taken the DePuy distributorship you signed on for first.

  75. Chris Ryan, seriously???

    All I have to say is put on a rain coat when he is talking to you and try not to stare at the white froth on his lip. Oh and he cries a lot.

  76. Paul G of Zimmer Spine...gosh...I don't have any words! For the COO, whose english vocab over the years consists of only 3 words/phrases..."Alright?" or "You know?" or "You know what I mean?"...(that too in that "typical" accent) you don't have to be fortune teller to predict that Paul G will indeed ride Zimmer Spine's horse...but, not to the finish line, but to the graveyard!

    Simply amazed by the incompetency of ZS management. No wonder they are laughing stock of the industry.

  77. First off as an ex Zimmer Spine rep for over 8 years. Let me tell you one thing...Chris Ryan won’t be running a dam thing for ZS...Zimmer Corp RUNS EVERYTHING! There has been what, 6 "acting" Presidents in over 5 years, and everyone thought the same before they were "asked" to step down. Hell one guy last all of about 3 months. Until Zimmer stops running Zimmer Spine (which will never happen) they will be doomed to fail just like all the others.

    TSB lets blog about the REP fees that we have to pay for shit like RepTrac, VCS, VendorMate. Let’s talk about how were has sales professionals now have to pay each one of these "babysitters" cause that what the hell they are, in excess of $150 each year. This doesn’t include all the cost we have to absorb like getting vaccinations, background check fees, drug test, DOJ clearance. While some of you may have these cost absorbed by your company if you are direct, the majority of us don’t. It has cost me over $1200.00 a year just to get recertified, and I have had to do it every year for the past 3 years.
    Anyone care to comment on their experiences or feedback?

  78. 12:03 if you are in need of someone let me know. Looking to relocate to San Diego. Plz email at onespineguy@hotmail.com Thank you. And its not a joke. Dont want to waste my time with dumb ass sales recruiters that think they know more about the business then we do. Or if there is anyone out there looking for a seasoned spine rep plz email me back. Thank you.

  79. Zimmer Spine is going nowhere.

    As for college buddies, friends, girlfriends, boyfriends, nieces or nephews, sales is about relationships. If the 'me too' companies can produce similar products (hence, the name 'me-too'), then relationships will drive the business.

    What could possibly be more important than your delusions of self worth as a rep? How about a relationship that has been forged on trust and friendship and other commonly preferred attributes instead of ass kissing, false friendships and the overall dependence that drives it all?

    How many doctors still respect the reps or even attempt to extend courtesy if there's nothing in it for them? How many reps would continue to foster a relationship if they knew they would never benefit on the business side? These 'relationships' are very transparent, contrary to popular belief.

    This is business, and if quality is not compromised, relationships prevail. This is a simple concept and is consistent in every industry. That fact is that many companies, including small companies, have a good line of products. Smaller companies may not have a full basket of goods, but, there are ways around that.

    Where did that large companies acquire the broad portfolios? Certainly not from their own IP. They bought it! Therefore, no need to disrespect the small companies for being small. Their time has just not arrived yet. Furthemore, the industry is making it difficult to consider acquiring smaller companies. Without PODS, they may become extinct and some may be bought on the cheap. However, the mere existence of PODS will weaken the 600 pound gorilla and allow smaller companies with good products to prosper without requiring extensive financial backing on their part.

    Company loyalty is a good thing, but we must look beyond and evaluate our reasoning behind our decisions. Are we using the best products for our patients? Which companies do have better products? Does any one company really have the best of everything? Come on. Really? Are there many options for accomplishing the same goals? Who is responsible for cost savings? Who decides what is ethical?

    As long as patient care is not being compromised, do whatever you want. If that means using your friend as a rep, go ahead. If you would like to use what you were trained with, go ahead. Just know why you do what you do, and do the right thing.

  80. 8:06

    I share your frustration with the numerous vendor credentialing scams. My best accounts no longer pester me about checking in with a badge since they consider me family and that I'm so helpful as a rep "that I should be paid by the hospital for being so helpful in surgery". That's a recent quote from a circulating nurse.

    Here's a great example of the nuisance factor of these vendor credentialing frauds. I think it is VendorMate who requires an annual credential for the varicella vaccine, which you may know is chicken pox. I provided documentation that I had chicken pox as a child and therefore didn't need the varicella vaccine and they rejected it. I had to have my GP write a letter explaining that I did not need the vaccine since I had chicken pox and they finally accepted it. But here's the kicker; I have to send that letter in every year to reestablish that annual requirement. Ugh!

    These clowns need to get a medical director to wise them up before they implode due to their own incompetence.

  81. Chris Ryan may spit when he talks, he may have had a year or two that he would like to forget, but every time he got knocked down the guy got up and became the best at what he did. Chris is a talnted leader that calls it like it is. If you have something bad to say about him, chances are you were the one that was not living up to your responsibilities and he told you so. If Chris does not succeed at ZS it won't be because of Chris and his efforts or talent to lead.

  82. Congrats to Chris Ryan for taking the job that no one wanted. Rumor is that they pursued a Stryker guy and a DePuy guy - both were too smart to take the job. We all know Paul G. will be making the calls with Big Z.

  83. Bash Zimmer Spine you want. But watch out, they may buy something really, really big.

  84. There's no business like show business.
    That's what a top spine consultant said recently during a talk.
    What could he have meant.

  85. 4:13 AM
    Completely agree with you. This lousy business is loaded with selfish losers trying to ride a wave...and precious few passionate leaders. CR is one of the few and will force his will on a stale organization.

  86. 7:22 are you kidding me? No, you are kidding yourself if you think any one person, even if its this Chris guy (can tell there are a bunch of MSD kiss asses on here), that can go into a dissfunct organization like ZS and make a difference. Did you not here the prior post my man...NOT one President at ZS has lasted more than 16 months, all with the "same" pedigree. ZS is NOT ran by a ZS President that wannabe machine is ran by BIG BLUE. Wake up you kiss ass MSD reps.

  87. Has anyone heard of Spinal USSR?

  88. no such company exisit.

  89. I think he meant Spinal USA...

  90. Chris is a passionate guy and has been very successful. But his passion was always for Medtronic. Company man thru and thru. I'll be interested to see if his fire can stay lit with the Zimmer product line and the demoralized sales force.

    Did CR just feel like a VP job was something he couldn't pass up or did he lose some of his fire for Medtronic? Probably some of both. Anyone know if he had a falling out with MDT?

  91. Spinal USA...as in soon to be DOJ's new Bitch!

  92. Future Former MDT ZombieJuly 14, 2011 at 7:46 PM

    MDT left Chris first. The douche bags in charge here have no idea what they're doing and are in fact the reason the division has been wallowing in the crapper. Yes men surround King Dug and he stabs the rest in the back. Yes, Chris got out but not sure he landed in a better place.

  93. who is the new acting President for Zimmer Spine now and what role will Chris Ryan take on with ZS??

  94. Pres: Steve Healy (formerly Dis Dynamics)
    VP Sales: Chris Ryan

    Chris is a good guy. He got fed up with MDT years ago but needed some time to get his life organized (went thru a divorce). He is sharp, but anyone would struggle at Zimmer Spine.

    However, I'm betting big blue is looking at buying the stumbling giant - Medtronic. Any bets?

  95. what role does Paul Gravelin have with Zimmer Spine>

  96. So what is all this talk about Spinal USA? Are practicing doctors really involved with this company or is it just a rumor?

    Will the DOJ actually turn up the HEAT on PODs?

  97. Along the lines of surgeons getting paid to use products, or saving money at their own surgery centers with lower cost items - who makes a decent pedicle screw system/cervical plating system that comes in at a 'savings' and isn't an largely inferior system?


    * DOJ is investigating Infuse

    * Dr Eugene Caragee is a paid consultant of DOJ

    How us that not a CONFLICT OF INTEREST!?!?!?!

  99. Larry Biegelsen of Wells Fargo Securities in his July 5 report on Medtronic stated that the entire Biologics Sales Force had been laid off
    NOT TRUE! But his article had people saying Medtronic would have to spin off its Spine Division.
    He has no credability!!!!!!!!!!!!!

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