Sunday, August 7, 2011

Downgrading The Spine Market

To say that it has been a tumultuous and uncertain time in spine would be an understatement.  Since the beginning of the year, the industry has been making adjustments to a rapidly changing U.S. healthcare landscape.  In anticipation, downsizing began with Zimmer and Medtronic announcing layoffs, only to be followed by other key players such as Biomet and Alphatec. Granted, not all layoffs pertain to spine, but the industry has had its testosterone levels dropped a notch, and there is no need for a blood or saliva test. We are the enemy.  Outside of Nuvasive, many companies are experiencing a dose of reality playing in a market where surgical procedures are down, insurance denials are up, patients are afraid to have surgery because they are worried about losing their jobs, and declining ASP's are making many of the larger companies reassess their financial objectives and distribution models.  In addition we have POD's threatening the existence of thousands of  salespeople, blaming sales people for the high cost of delivering implants to the industry, bickering among surgeons on ethical practices, and two parallel U.S. Senate investigations.  Whether you like it or not, there have been more negatives than positives when it comes to reporting growth for many of the publicly traded companies, granted some changes in accounting rules have helped certain companies save face for another day of judgement.  Either you have something new, or you don't. And if you don't, sustaining market share may be more important than real growth to some of these organizations.  What is killing this industry and this country is that too many companies can only think short-term because of they have been hypnotized by their drug, Wall Street.  Some will argue that TSB is attacking the Street, yet even those of us that report what's been heard on the Street know that forecasts are an important metric to evaluate one's accomplishments and failure, unfortunately, we no longer think long-term. Everything is short-term.  Short-term thinking is providing the industry a rude awakening.   This week, the markets brought some companies back down to earth, taking some of that luster off their magic lamps.  You can blame the Europeans for this week's fall from grace, but the Market's performance has been on steroids to begin with.  In one fell swoop, valuations tumbled faster than you can say, "we continue to have laser like focus."

Outside of NuVasisve success, single digit growth has become the norm, unless you are one of the mid-level players in the industry.  Alex we must admit, you are one hell of a salesman.  Even though some analysts rave about some of the bigger companies, questions abound whether the industry is finally making the necessary adjustments as it moves into the second half of the year.  The most recent quarterly earning reports are not painting a pretty picture for spine.  Zimmer (3%), Biomet (10%), Orthofix (3%), Medtronic (1%), granted some of these numbers combine hardware and biologics, but spine is spine whether its hardware or software. So how does this shake out for the industry? Consolidation and annihilation continues to hover over the industry like an alien space craft.  Companies that have been surviving on a revolver line are close to being placed on a ventilator, while other companies are hoping to weather the storm.  Free markets are working their magic.  The strong may not necessarily be left standing on two feet, but the weak will definitely perish, especially if the economy continues to flounder and your company doesn't have innovation in the pipeline.  All this speculation about not investing into newer ideas and products because of the economy is short sighted.  This is a marathon not a race.

So rather than dwell on all the bad things that have happened since the New Depression occurred three years ago, TSB wants to know from our readers who are some of the up and coming companies?  Let's have a poll, you be the judge.  Does anyone have innovation that could potentially disrupt spine as we now know it?  Is there a game changer?  Who will come out of the pack in the second half of the year as someone willing to go long rather than short?  If there is one company that intrigues us, it is K2M. With all of this insanity, they seem to fly under the radar, not looking to bring public scrutiny to their attention.  Of course before your comments come to rest, our maniacal friend will ask when will Globus go public?  Get a grip on yourself, even if  that company had the ability to go public, it is so diluted that you'll probably make pennies on the dollar. So in closing, just like the U.S. Government, spine has been downgraded as an industry.  Until we fix our own house, it might get worse before it gets better.  You know what Jackson Browne once sang.

"these days I'll sit on cornerstones and count the time in quarter tones to ten, my friend don't confront me with my failures, I have not forgotten them."

154 comments:

  1. My bet is on :

    1 : LDR
    2 : K2M
    3 : Lanx

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  2. Is that 8 quarters straight of declining sales at Zimmer Spine? So after one year of Paul Graveline the only number that has increased is the $ Zimmer is paying attorneys.

    I'm placing my $ on OrthoFix Spine. New facility. Central Location. Great Management.

    Aliphatec will continue to grow in the near term, but too much revenue is dependent on sales to PODs. LDR wants too much $ for something that everyone has now. K2M ... Weak sales force and sales management (and all of their big users are financially tied to the company ... ALL OF THEM). Biomet is throwing around a lot of $ to reps with biz but their bag is really old. What would Globus's sales look like if you backed out all of the consultants and "evaluating" surgeons?

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  3. My top three for 2012:

    1. Paradigm Spine
    2. LDR
    3. Nuvasive

    K2M is marginal at best. Average implants, below average instruments. WAY to slow to come to the market with upgrades to current line. Cervical plate is VERY weak. Lateral is very nice.

    Larger companies WILL all soon be direct. Depuy Spine/Synthes WILL be an all direct company, bet the house on it. Commission's will drop. Territories will be cut. Rep's will leave for mid-level companies for sure.

    POD's still worry me, especially once the government define's the parameter's in which the CAN operate legally. This is what the are waiting for, no gray area.

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  4. I think the real up and comer will have a great new biologic that will open doors and surgeon ears. With the issues with Infuse and the crackdown/uncertainty with the stem cell products, there is a huge gap opening up. DBM can only do so much as the technology is old and tired.

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  5. 7:24

    Paradigm Spine?????

    You must work for Paradigm- To put down K2M as marginal and then place Paradigm as number 1 is a huge joke. Paradigm is not even in the same league as the others you listed

    what were Paradigm's 2010 revenue? 20 million? 30 million? What products do they have that will make them number 1?

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  6. As TSB would say, Paradigm was never intended to be a long term venture. Anyone really know what the US revenue is in comparison to the rest of the world. #1 is quite funny.

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  7. 1. Synthes/Depuy - Direct for sure in the future. Solid sales force.

    Infuse void will be filled with pharma comp.

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  8. In my territory it has been increasingly difficult for new vendors and/or products to get approved at hospitals. It will take something truely innovative to find a surgeon(s) to fight to gain approval.

    LDR is the dominate player in stand-a-lone cervical products. They are rep'ed by the Depuy distributor. Will they be forced to drop them once Synthes integration happens who knows.

    Biomet has done a nice job with their scoli set however they don't have the manpower to take cervical or TLIF and screw business from the MSD, Depuy, Nuva, and Strykers.

    Same can be said of Alphatech, K2M, Orthofix, Zimmer.

    If one of the smaller companies can flip an existing distributor then they have a shot. No matter the technology.

    Most of companies out side the top 4 or 5 will have to invest not only in technology but sales people, distribution and manufacturing. This is why we see so many consulting agreements and POD's throughout the country. Its cheaper (I didn't say better) to grow your business short term while hoping to get bought.

    Top 3 small companies that are still gaining in no particular order:

    1. Centinal
    2. LDR
    3. K2M

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  9. 10:59

    Centinal - still using ancient stalif technology that anyone can copy.
    LDR- all their eggs in c disk with no reimbursement. Plus they are French!
    K2M- desperately need new product. Stagnated since equity buyout.

    Keep trying.

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  10. Question for you gents/ladies:

    Where does Biomet fit in all this? Especially in the California market? Wil they make a serious run at being a Spine Co or will they end up like Zimemr Spine...ran by an Ortho Co and always will be an Ortho Co.

    Zimmer Spine did an horrible job at retaining the long term reps that they had in California both Northern/Southern and left a mess in the Notthern Cal area, where they have lost ALL but a couple of surgeons business due to either no representation or poor handing off of the business to the new agents in place.

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  11. Biomet is a failure. No clue on how to maintain business and will never grow sales. Lost the bulk of bread and butter business in stimulation and failed terribly with the aquisition of Interpore Cross combining sales force failed. Not a single person in management has a clue of how to increase sales in the current marketplace, and has lost bulk of marketshare in the last 8 years. Forgot the key to growth it is all about relationships

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  12. K2M has been far from stagnant since the equity buyout. Be prepared for a wild ride if you are on that bus. So many good things are on the near horizon! Honestly, it's quite amazing that K2M has done what they have with some marginal products and mediocre sales force. The Sales force is improving every week with new strong additions both direct and distributor. The products in Alpha now are very strong. They have a very strong deformity following. The advancements that are in the pipeline with deformity are game changing. The new lateral system is better than Nuva's. K2M will continue to grow at a decent over the next several years even with all the negative industry pressure...

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  13. Not to mention, K2M is doing it all above board. Those of you think that all the users are financially tied to the company are living in the past. They most certainly are not. A small few are because that's how the company was started, but the surgeon ownership is now extremely minuscule. Also, they don't pay for play or pay surgeons to distribute their products.

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  14. I know globus is a whipping company on this board but their focus on custom instruments and product pipeline is impressive. Their expandable tlif cage is taking market share and the lateral and mis products are impressive.

    I know the comments will come but globus can not be ignored.

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  15. LDR is absolutely an innivator: faster, easier, better for the patient. However the bag's too small to be a true force. We'll see how the 2-lvl Mobi-C indication and stand-alone lateral will do in the marketplace, great stabs at something different though. Let's hope they don't get bought by Zimmer/Stryker and get the life sucked out of them.

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  16. LDR??? Am I missing something that isn't on their website? They have artifical lumbar and cervial disc, hooray. Their standalone technology isn't that great of a design, and plenty of other companies have this technology. They have a side loading pedicle screw system, not exactly earth shattering technology. And last but not least, a banana shaped TLIF cage. How on earth is this an innovator? Or am I missing something? Where do these people come from spineblogger?

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  17. one of my docs did the coflex study. he said you can almost pick the patient off the table when the coflex is in. he says its the closest device to the center spine and it is not an extension stop. he says the data is excellent. we'll see.

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  18. What ever happend to Dynesys from Zimmer Spine???? Do any of you still see this product being used in your areas? I know that ZS had much success from 2004-2007 with it but without getting the Non-Fusion indication is this product a wash?? I know it was hard for us all to think that a simple poly cord and plastic spacer could be anything exciting but I had several surgeons in my area using it with what they said "good results", then poof...I dont even see a Zimmer Spine rep nor have I seen one in my area for over a year.

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  19. dynesys as fda stated so eloquently has no understanding of which patients it works for. plus the screw and instrumentation is a decade behind where fusion screw systems have evolved.

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  20. 7:32am
    I thought we were talking innovation? Have you seen the IDE study results for the Coflex study? Statistically superior to pedicle screws. For an IDE, that is incredible. It will be a game changer. Why? you ask. Because insurance companies HATE pedicle screws . They will deny certain fusions and force physicians to use Coflex. They love this study. I put them #1 because it will grow quickly in 2012, when the FDA should approve Coflex. It has been used in over 70,000 levels for a reason. K2M will struggle until they get better managers in place, it's a joke. AVP's are NOT prepared to take them forward. Also, I work for neither company, but would like to have Paradigm in my bag with Coflex and Coflex F.

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  21. Same for 2 L mobi C IDE results - superiority to fusion. These companies are doing the right things : clinical evidence - will be happy to have both in my bag

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  22. This may be a surprise to many but I strongly believe it might just happen.

    My vote is for RTI Biologics with new biologic implants using MAPC Technology licensed from Athersys, which is scheduled for release in early 2012. With rhBMP, at best, in limbo and MSC efficacy dubious, my guess is this could be a real home run.

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  23. RTI graft breaks all the time. You can look through sizes and see the fractures before they are implanted.

    It looks like a company recruitment center in here!!

    RTI for life! Not!

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  24. The market is ripe for biologics. Many VITA reps are looking for competitive products.

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  25. 2:15 & 2:19 - that's funny stuff. Lemme guess ... You are new marketing dork at K2M? Fresh out of UVA? Ha! The only wild ride will be by those who have tied their future to K2M. Even the surgeons the bring on as consultants are scumbags. Don't kid yourself...there are almost zero surgeons using that crap who aren't on the payroll. Nothing will be "above board" at K2M until they are public (hint: NEVER!)

    3:48 the FDA shot Dynesys down ... Twice. You can now find Dynesys being ex-planted at a hospital near you. This is a classic example of Zimmer's complete ignorance of the Spine market. What an f'ng disaster that division is year after year.

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  26. What the hell are talking about with the reimbursement with LDR?? Typically stupid corporate rep garbage talk. Grow up and learn your trade you stupid goof balls, corporate johnnys. Go build a 1099 business on the side one day and stop listening to your dildo corporate managers. They have 2 separate 510ks and the plates bills as they should as external fixation which the interbody needs.

    Just ask Dirk Kuyper at ATEC why Solus is a big pie in the face. All u stupid assholes are so blind it makes me sick. Go run your own business one day and figure out life without the help of the mother ship paying all your bills.


    This industry has so many idiots they should all be in a van with Michael Keaton in The Dream Team...bunch of overpaid Pharma reps all of u are!

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

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

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  29. Interbody is indicated to be implanted with supplemental fixation...the plates with their own 510k and considered supplemental fixation and just happen to work well with the inter body LDR makes. And allows me to steal business from all u goof balls!!

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  30. My name is Rob Quinn, just always wanted to say that!

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  31. That's the answer everybody is waiting for- WHAT will Big Blue Z do? What will they do?

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  32. Who is using Coflex(fuse)??? I have heard of very few cases. By the time CoFlex gets approved, if it does, there will be more competitors. Further, the company is on it's fourth round of financing and are most likely out of money. DSS will not be paying the bills. Last, word on the street is that Centinal and Paradigm management are selling both lines to save money. Time will tell.

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  33. yes what will Big Blue ZS do???? anyone have any ideas?????

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  34. 4:31

    You are definitely an employee of Paradigm or at leat an investor or closely affiliated with the company because no one in the industry is talking about it or impressed with the technology. There are already a dozen similar technologies being developed. Interspinous implants are not game changers.

    K2M may not have many game changing products but they are generating revenue several times in excess of Paradigm. Money is worth far more than marketing hype.

    Paradigm is struggling and their managers are incompetant.

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  35. Spinal Kinetics has an innovative bearing mechanism on their ADR devices; it's constrained and not a simple poly bearing surface. I hope they get FDA clearance. Anyone know how their discs are performing overseas?

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  36. So what are all the Orthovita reps going to do now that Stryker has pulled all distributor contracts? What other product can perform with Vitoss?

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  37. A company called Providence Medical Technology recently launched the DTRAX Facet System.

    DTRAX is a titanium implant that provides indirect decompression and stabilization.

    The company received a CE mark for DTRAX in July 2012.

    There was a poster presented at IMAST in Copenhagen.

    60 patient clinical trial with 1 yr follow up. VAS, NDI, SF-12 improvements comparable to ACDF & CDA.

    Stil too early to tell, but cases starting to be done throughout Europe.

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  38. The ZS line is like a museum of old products. Zimmer needs to invest in spine or dump it. It seems that company is run totally by inertia and indifference.

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  39. Hey 4:31. Call Matt Stutter and he will hook you up.

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  40. 5:06, it's funny that you think the same issues that plague other stem cell products won't be the same for RTI. Forget it if RTI is trying to get the product on the market as an HCT/P 361. Also, RTI will just add NUVA to their payroll due to the IP infringement.

    A tissue bank, let alone RTI being an up and comer? Give me a break.

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  41. K2M has everest...this system is nicer than solera and can be brought in at affordable prices. All interbody is the same. K2m cervical plate is terrible so they will go spend a few million bucks and get another one. No big deal. And to clear the air, I'm a distributor for K2 and unlike lanx and globus there are no more surgeon investors. Zero.

    We did 120M last year and will do 175M this year.

    Unlike lanx and globus, we have also never been litigated.

    I have bet my life on this company. Only time will tell if I'm right. I hope we make money before the $390 pedicle screw comes....and if you think I'm crazy, ask yourself if your neighbor thought he would be selling his house for half what it was listed for three years ago.

    Overcapacity and pricing pressure are powerful market forces. These market forces will continue to drive our market towards less profitability.

    Sorry medtronic.

    Tb

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  42. There is much talk regarding having a surgeon use your implants in a scenario where the surgeon is somehow being paid by the implant company.

    Let me know which of the companies mentioned in this blog are not paying a single surgeon in any way.
    I suspect that they all are right ?
    That how this machine keeps going.

    I say that not to point out the hundreds of millions paid by MSD or others but to highlight the fact that some surgeons recieve remuneration for their consultative efforts. Just about every company in the spine world is involved. Now there are a Fair number of Doc's who steer clear and want nothing to do with any collaboration.
    As a whole, Implants and techniques evolve. Surgeries become safer and more efficient.

    I've been with Globus for over four years and do not give a sh@t if they go public. I am too busy running my robustly cranking multi million dollar territory to care. And I built it from 0 dollars. Zilch.

    Most importantly, I have no consultants, shareholders, evaluators, royalty deals or any other payments going to doctors. To go a step further have not ever been approached by mgmnt or in any way asked to go about getting business using the previously mentioned techniques. I am sure that there are consultants for this company that are being paid for their efforts. Many of these arrangements occur in the early stages of all companies that are developing revolutionary products.
    The company absolutely has the best products and service that I have ever seen having 18 yrs in the industry. And the innovation never ends. Well over 10 new products every year. The engineers are brilliant and reps love the fight.
    I challenge any company to present their products 'heads up' with Globus systems. NuVa really? They have one main procedure that all companies can copy and monkeys can put in. Monitoring? Can be done by any qualified monitoring outfit.

    Globus innovates.
    Globus attracts the senior professionals who can sell and train surgeons.
    Globus will continue to prevail.

    My friends, Globus is the company that is Up and Coming.
    And I do not give a rats ass of when they are going public.

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  43. Cool story, Hansel. Any innovation from Globus is a complete rip off from several other companies like Synthes and NuVasive. To illustrate my point:

    "They have one main procedure that all companies can copy and monkeys can put in."

    It's in Globus' DNA to copy. I know for a fact that one of their reps stole several products from competing companies trays at hospitals. I would imagine they are encouraged and get paid to do just that.

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  44. I believe that those making disparaging comments about Globus are mostly Medtronic and Depuy representatives who are envious of Globus representation. Consultancies for Medtronic and Depuy are still a factor, but have slowed down. Also, since the Depuy/Synthes merger will bring on a new era of Direct representation as Depuy "Must" phase out distribution, there are a lot of sales representatives who are frightened of the future, knowing territories and commissions will be scaled back significantly. It's hard to maintain compliance with Distributor run territories. So Globus becomes the "target" of frustration. As my colleague @ 6:59 states, I don't care if and when globus goes public or not.

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  45. RTI? Really? Let me say that again. RTI? Really? Must be the heat of the Florida swamp getting to you, as they have the most bloviated, under-performing, over paid top management group of any company under 200M.

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  46. 12;21 is correct. RTI will never get to market with the MAPC under a 1271 product...far too much manipulation and many passages.

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  47. 6:59 Medtronic, Depuy, Stryker, etc all copy. They all copied from each other, and also from Nuvasive. The only company that did not copy and was original was Synthes. and look what happened to them.

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  48. K2M Distributor

    Thanks for posting the yearly revenue. Its ridiculous to bash a company that is making $100+ million a year especially when your own entity is doing much worse.

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  49. watch out for Biomet.... sounds like they have quite the product pipeline and some possible game changers.... not to mention a big checkbook for m & a

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  50. My bet is on all of the new innovative technologies that will save the medical device manufacturers money in operations:

    1. WebOps
    2. SurgiTrace
    3. Solstice
    4. Awarepoint

    This is where everyone should really focus their lasers!

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  51. 6:42

    In the words of Walter Poon, "God, I admire you." Hopefully, your brilliant engineers will continue to crank out innovation when Stryker buys you.

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  52. 3:14 Stryker isn't going to touch Globus. They passed a long time ago. In other news: WE LANDED ON THE MOON!

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  53. TSB, Nuavsive's success? How about you send a message out to all the Nuvasive Cheetahs, uhhhh, I mean "shareowners", and ask this:
    How do you feel staring at $22.78? Stock options underwater? How about all the ESPP shares that you've purchased previously? For a company that prides itself on providing stock to all of its employees, I can't say that there is much benefit coming from that arrangement at this point. If you're the Bear, you can boast about growth all you want, but at the end of the day it's about cashing out & getting paid, and at this point, the prospect of that isn't looking very good for anyone.

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  54. Too many drinks have been handed to me
    I need you right now, are you down to listen to me?

    Name that tune and I will give you all the answer you are looking for with regards to Globus going private.

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  55. Biomet? Bahahahaha

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  56. 9:38
    Marvin's room - Drake

    But I already know the answer to the question! And your taste in music is as simple as your mind.

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  57. Too many Globus blow-hards talking about how great their products are and the extra benefit of them representing them...NOT! If you are so damn busy then why are you always on this post? Got to go...2 cases starting at the same time is a good problem!!!

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  58. Just two?

    Have fun with your laser pointer showing the tech which Atlantis screw to pick up.

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  59. Regarding innovative technologies to help this spine industry in the face of current challenges, please consider Computer Aided Inspection (CAI) to cut 30-40% from the new product Time To Market (TTM). Offered by Level 3 Inspection as a service or Smart Inspection Systems as turnkey solutions, these modern 3D engineering professionals have repeatably proven the ability to eliminate cycles/iterations/months/$millions from the new product precision manufacturing process optimization.
    In a constricting market, doing more faster with 10,000 times greater information and confidence can really be a strategic advantage. [Yes, I am the company CEO, and stand by these claims]
    Bill Greene 561.775.7911 bill@level3inspection.com

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  60. Downgrading The Spine Market? Here is a look at the future:

    The latest issue of the Journal of the Spinal Research Foundation is all about PT, acupuncture, botox injections, halo bracing, electomyography and workplace ergonomics. Not a single surgical subject. Good luck selling botox or computer hand rests!

    PS. The issue of TSJ on Infuse side effects yesterday was awarded the 2011 “Journalism That Matters” award, in "recognition of coverage that causes change by government or industry"

    Yes, downgrade the spine market. Like the Dow Jones, it's on the way to the bottom.

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  61. Biomet is not going to grow. Dropping dist. network and going direct again. Pull your head out if you think growth is going to happen. I am going to bet that you are working for the billing department for biomet based in india.

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  62. Change is inevitable...Growth is optional!

    So the market is changing as all things do.

    Change with it. Adapt. Grow as a sales person or find anther job.

    I think service is going to win the day. All too often there are no MSD reps in cases, reps not having the correct implants availalbe and poor follow-up.

    Their marketshare will decrease slowly as the old guard surgeons retire and the younger ones take over.

    Thats your in. Work the new surgoens and residents.

    MSD does a horrible job with young surgeons beacuse they dont have the time to service and sell to them.

    As technology flattens it will be selling and service that will take market share.

    Product features and benefits may get you in the door but selling skills and service retain it and help it grow.

    Keep your eyes on the prize! (your competitors marketshare)

    If you can't...you go the way of the dinosaurs.

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  63. Synthes Spine has not innovated since 2002; and every tenured rep there knows it. Wyss just took his $12B ball, and is going home to the hinderlands...with nothing to give to the quality folks that built his companies from 1977 on.....thats sad....thats why I left!

    David Paul has built a great company; and the innovation and speed to market are unparalleled. Still...those who have risked alongside him, have yet to see an ROI...and it remains to be seen if he diluted the stock as so many on this website have asserted.

    We shall see the legacy both men leave behind....

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  64. Well said by the last two posters.

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  65. I think the change that 7:09 is speaking of is really in the medical device manufacurer's infrastructure and he/she says it well by the way. Their current operational methods and policies (not just MSD) are simply not sustainable. They cannot keep paying the fruitless salaries of AM's and RM's with the current results. Cuts have to come from somewhere. So what will replace them? Answer: Technology...automate everything! Real-time reporting, tablet PC's for everyone, RFID tags on all products, etc. More time for rep to do their job and less time spent looking for, "Now where did that tray go?"

    How much longer will the industry turn a blind eye before they get with the times? Archaeic reporting, lost PO's because a serial number is off or accidentally put pricing from another hospital on the charge sheet which turns into reimbursement nightmare. Current industry answer: inflate pricing or charge the rep for it.
    That's not gonna fly anymore. Support the reps and give them the tools they need and stop slowing them down with field audits and AM's who have no clue what really needs to be done. Wake up!! Front end support and real-time tech is the only answer. Look at the company's highest expenditures besides AM and RM salaries...the FedEx bill! This is how you improve selling and service...Automate everything!

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  66. August 7, 5:55pm..you are correct on K2M NEVER going public. They have deep pockets since they got acquired by Welsh Carson and don't need to raise extra cash. Feel sorry for all the poor suckers sitting it out holding on to stock options. May be a long wait.

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  67. anybody have any news on the failed attempt of NUVA to merge/buy the largest neuromonitoring company in the country Biotronic?? Heard their CEO was a casualty of these negotiations. Maybe this was why they were raising the capital?

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  68. What is going on at ATEC? They had strong growth in the 2nd quarter, but cut 10% of the US employees. The leadership team there just can't figure out how to manage people....

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  69. 11:40 - easy answer. They are not profitable, simple as that, and with reduction if approved procedures, it will get worse before it gets better. Alphatec would be a very ripe target for acquistion if it could show a profit. Current stock price makes it affordable by the like of DJO, Smith and Nephew and similar, but not if it can't show the ability to be profitable for a couple of quarters. Who would benefit? Health Point Capital. They own the most of it, have had some dogs of late, and their equity partners are looking for a return or they will get out. They can't aford that, so it makes sense to get profitable fast, find a buyer and get the hell out.

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  70. Amedica with SiNi will be a game changer

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  71. Globus will grow as the opportunities arise:
    -Depuy/Synthes will phase out distribution and long standing reps will leave before going direct with a scaled down territory given to them by a new corporate AVP.
    -Medtronic distribution has already been hiring right out of college reps at lower salary as a result of decreased commissions. These kids need YEARS of development before they are mature enough to run a territory.
    -Stryker is bound to be investigated sooner or later
    Globus is positioned to seize on these opportunities.

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  72. Globus couldn't seize an engine if it ran out of oil.

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  73. In 2010 joint surgeons joined spine surgeons as the most highly compensated orthopedic subspecialty. Spine surgeons received $760,782, placing them at the top. Joint specialists came in second at $675,156.

    And that is before the consultant/royalty/
    speaker/advisor/investigator/distributor/
    trainer/reviewer deals.....

    And what does the average family physician make, who actually SEES his patients?

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  74. $115,000 - $125,000

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  75. 1:46 very very good point! Most of my busy spine surgeons dont even see their patients until they are laying asleep in the OR room. sometimes they are looking at thier MRI/CT/XRays for the first time, in the OR! Crazy shit...

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  76. "Globus will grow as the opportunities arise"...what a joke! How many times are we going to hear that??? Quit making excusses for a lame duck!

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  77. Depuy will not go direct in spine, only trauma. Possibly in the markets where Synthes dominates, they might stick with direct, but I doubt it.

    It makes no sense to bring all those sales people in house and pay for those health benefits, 401 k, car allowances, possible stock options and the other stuff currently being offered at MSD.

    I would laugh if they went direct and cut commissions. Talk about destroying the Synthes acquisition opportunity.

    Side note- I laugh now when I see the DS and Synthes rep yacking in the lobby at the hospital. I'm sure both wondering who gets who's job.

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  78. Amedica is going public soon, they will be a player in the recon/joints industry with their SiNi technology.

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  79. What is with Osteocel? NuVA selling as "stem cell technology", less expensive than Infuse(but twice as expensive as other DBM). How can you say you killed all of the cells, "except the stem cells"??

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  80. 4:20

    So you just uncovered this myth? Are you also aware that BMP has a few issues associated w/ its use? Just want to check,,

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  81. Depuy will go direct. It is not a simple matter of health benefits/401K cost analysis. There are other issues at stake. J&J plan is to have a direct force similar to their pharma reps. Lowering commissions to 6 percent allows a lot of cash for benefits, etc. Compliance is also maintained. You heard it here first- By Q1 2014 Depuy will be mostly direct with the exception of a few distribution contracts they are riding out , but will not be renewed. By using Depuys large size/marketshare to squeeze out competition they will be exclusive at many institutions. Why will they continue to pay distributor principals 20 + percent and pay distributor reps 200K-400K per year when they can pay a college grad 80K-100K ? As super-companies directly position themselves with hospitals ---representation becomes less valuable. Do you honestly think after paying 22 Billion for Synthes they plan on keeping the distributor model? Depuy reps have their better days behind them.

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  82. 4:32 I would have to agree with most of what you said. I started in this biz back in 1998 with Depuy (distributor) selling Depuy/Acromed. Then in 2001 they decided the way to go was with only direct reps. We all jumped ship. At that time a decent spine rep could easly make $200K a year so why would we go direct making half that? I have been on both sides of the fence as a direct and as a 1099. There are of course, benefits to both.

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  83. Whether Globus ever will be truly successful or not, David Pauls' lasting legacy will be that he further lowered the already shaky moral standards in this industry. HIs success, if its 's there, is built on theft and deceit. I would drive the ice cream van before I would work for that outfit.

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  84. 4:32 is right. All you DePuy distributors need to save your money because you will be done in 2014. Just look back over the last 2 years and look at how the number of distributors have decreased. Their territories keep getting bigger and the number of principles keeps getting smaller......

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  85. 8:48, Please give some facts to back up what you stated about David Paul. I read those comments on here often but have never read any facts backing these comments up. I do not know him but there sure are some people that really dislike him for som reason.

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  86. Where is Alphatec going? Whats the history and skinny here?

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  87. 8:48 Amen Brother, nuff said

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  88. Globus was founded by David Paul on theft of intellectual property from Synthes. In the lawsuit which Synthes settled for a pittance (its unclear why?), it was revealed that many Globus FDA filings contained the same spelling errors as the corresponding Synthes ones. They walked out with electronic copies of engineering drawings and 510(k)'s and used them to found the company.

    This isn't speculation it's litigated, proven fact. The very essence of the company is based on theft and deceit. It shouldn't be surprising that many in this industry don't respect David Paul/Globus "accomplishments."

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  89. Every man who has risen to accomplish Great things will have those who will choose to cast stones at them out of envy and jealousy.

    David Paul is surely one of them
    David Paul is a brilliant engineer with giant Indian balls.

    This man had the gall to leave Synthes for the dream to pursue a working environment that would provide him more freedom to serve surgeons and help patients.
    Faced with a management team at Synthes that stifled progress and independent creativity he left for a 'better world'.
    Like our forefathers who sailed to America with hopes to free themselves from the tyranny of English rulle David Paul took a major risk.
    Now before all of you run for the tissue box let me also say that David Pauls Globus is something more.

    Globus has become the world that most Senior Sales representatives in spine envy. With envy come jealousy and fear of meek who do not have the balls to take charge and create positive change in their own lives. They fear the risk in leaving the teet of companies like MSD. Sucking the the koolaid they become no ball bastards in a world of unhappy salespeople working for 6% for management that would starve if they had to sell water in the desert.

    Synthes reps repeat the same goofy mantra over and over.
    'DP is a theif' or 'DP pays all surgeons to use Globus' or 'DP stole our top management'.

    Far from the truth.

    They repeat this over and over like mindless retards. Most of the spine implant world is simply confused as to just how a man and a company could accomplish so much in so short a time frame.

    David Paul provided the vision to create a paradigm shift of thought with regard to introducing new spinal systems to surgeons and their patients.
    He purposely created teams of engineers and model maker from outside of the world of spine. He instructed these young talented engineers help create systems that would take no more than one year to move from design table then to market.
    In four short years his teams did the impossible. They innovated new systems and made vast improvement to the old ways of treating spinal pathology.

    In head to head competition I kick the living shit out of all of MSD and J&J/Synthes spinal systems across the board. I can not only match up in each product category but extend beyond theirs to treat pathology in new ways as well.

    Senior sales reps with convertible business and balls will continue to come to Globus in mass as they have since day 1.

    Now lets hear from all of the synthes tool box reps and MSD cover monkeys how Globus sucks and steals and pays surgeons. Please do not come to Globus. Stay while we continue to wreck your territories.

    Then go back to the teet and drink some more.

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  90. Market analysts also predict Depuy will adopt the Synthes Direct model. Wisely though, just as the Synthes acquisition was kept quiet, J&J is keeping the Distributor phase out quiet. What would happen if current Depuy reps realized they had a year left working for a distributor? How many would leave for Globus, Nuvasive, PODs. Times a changin' But the Synthes rep in my territory seems less worried than the Depuy rep.

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  91. 12:30, here is a little blurb from the 2007 lawsuit:

    In opening statements, Synthes said that, in September 2002 - four months before leaving - Paul convened a "secret meeting" with a detailed plan for competing with Synthes. Paul took with him employees who had confidential Synthes documents, including patent applications, safety-testing plans, and regulatory filings containing trade secrets, Synthes claimed.

    "The testimony was pretty damning for Globus," said juror Mary Ellen Krysko of Warminster. "Synthes produced copies of Globus and Synthes safety testing ratings with FDA. They were word for word, including typographical errors." Synthes also called as witnesses Globus employees "who methodically resigned on Friday and started with Globus the next Monday for eight months in a row."

    "The whole thing seemed planned at that September meeting David Paul had at his house," the juror said. "I don't know how the defense could have refuted any of it. I'm not always for the big guy, but I was in this case."

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  92. 5:23, you are probably right hat the environment at Synthes was stifling for someone as creative as you claim David Paul to be. Leaving and starting your own business is a perfect solution for that. Leaving and stealing blueprints, test reports and people to do that is immoral as well as criminal, and I guess that's what he needed those giant Indian balls for. (Read Superfreakonomics about he Indian size of the other part) No start-up company gets 510(k)s cleared within 2 weeks of opening their doors. Globus did, using test reports from Synthes, as revealed in that lawsuit in 2007.

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  93. --lawsuit settled --- Globus alive and well -------------------- Synthes is now gone bye bye.----- just another J&J affiliate. Within a year or so Synthes brand will be removed from trays and rebranded Depuy Spine ( Depuy- Pro Disc etc.)
    so please stop crying over Globus

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  94. Creeeeaaaaaakkkk.........

    The lid of the Synthes Coffin just closed shut.

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  95. 5:23: So if that 510(k) was cleared based on stolen data, should FDA revoke the clearance? Seems like ripe territory for your friendly neighborhood FDA auditor to come have a look at the Globus files.

    12:30: If these guys stole data, why was this just a civil lawsuit? Sounds like a simple case of criminal theft. Should somebody be serving jail time?

    Heard Nuva had its own smaller version of this issue to deal with a few months ago....

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  96. 7:24 Why Synthes settled is the big mystery that nobody understands. Given the statement of the one juror it looks like they had David Paul by his big balls. Bad laywers? Under the table deal with Wyss? Who knows....

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  97. Has anyone heard about the FDA's Unique Device Identification mandate for 2012?

    What kind of impact is this going to have on the market in the middle of all of this restructuring and 510(k) talk?

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  98. Couple of points to make. I don't believe Synthes settled as much as they took the maximum amount of money that was allowable under PA state law. It certainly was not a good deal for them but they really didn't have any other options.

    @6:57 to your point about the theft of the documents from Synthes - that was done by an individual who would up very high up in sales & marketing at Globus. He was forced to acknowledge he had them but had no idea how they wound up in his basement. It was laughably similar to Bill and Hillary saying "We just found this envelope laying on the table here. Who knew"?

    PS I'm not a Synthes employee, just an interested observer who happens to know the guy who swiped the documents.

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  99. 5:23, David Paul provided a paradigm shift? Now who is drinking Koolaid? No visible shift in the products he stole and not in any of the ones that followed later, but a noticeable shift for the worse in business practices. The real paradigm shifts in spine surgery were created by people with real cojones, such as Cloward, Harrington, Wiltse and many others. David Paul is an admittedly smart, but utterly slippery individual devoid of any moral compass.

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  100. Unbelievable. There is so much hating going on. Is it apparent that everyone is jealous of Globus and Nuvasive. I just came across this blog and have been in spine for a number of years. All companies have consultants. All do some shady things. All struggle to bring new technology or I should say original technology to the game. I am an independent distributor and have carried a lot of products throughout my career. It's unfortunate what's happening to MDT and the the Depuy synthesis merger is going to take a while to figure out. All of those companies reps are freaked out and they should be. In 2 years half will not have their current jobs and the other half will be paid significantly less. As for some of the smaller companies that have been listed. Paradigm, LDR,Centinel, Lynx. All have good competing technologies. The problem is they have used distributor like me with good relationships to take a chunk of your business. Although it is a small chunk, but you can't afford it. So maybe focusing on your job and your sales territory would be better suited for you. Stating these small companies have shit technology and shit studies is a waste of time. The problem I see, is your company whoever it is hasn't brought an original product to market in a long time. Xlif, Dlif, Slif is not original. New products with strong data will control the future. Insurance companies will demand it. So enough with the name calling. Go out and sell something and and quit worrying about what you can't control.

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  101. 10:02 You hit the nail on the head. But now here is a question for you: name me one new product, just one.... I don't think you can, so I will not even address your remark about strong data.

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  102. 10:20 i am not saying there is new products with strong data on the street now. what i am saying is the companies that move forward with this will win. the coflex IDE intrigues me? Not sure what will come out of it, but the word is they spent 50 million on it, and the data looks good. its the only PMA that has been submitted to the FDA in a long time. who knows what the outcome will be from the study, but i would rather take a chance on a good IDE then sell another knock off cervical plate or pedicle screw. you cant hit the ball if you don't swing. so i guess we agree there has been no new products with strong clinical data launched for a long time. MDT folks save your breath infuse doesn't count. The DOJ will take care of that. With all honesty I wasn't looking for your remarks on strong data and good products. Just continuing to sell the norm with a few new approaches seems boring. in reality 80% of spine reps have know idea how to sell new technology. a trained monkey could sell a pedicle screw. They maintain the relationship until someone brings a new device that takes business and then they change jobs. Or get on this blog and make dumb comments.

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  103. What I have read so far are sentences all based from court documents that Synthes alleged. Synthes alleged David Paul held a secret meeting. Synthes alleged he stole blueprints, patent applications, safety testing and so on. Do you have any first hand knowledge of any of these allegations? Or are you just repeating things you have heard or read in the paper? Is the person who swiped the documents still at Globus? That would or could be a moral issue. In doing some research It is my understanding that several Synthes products were designed by David Paul or under his team. I am sure somewhere his name is
    on the patents. I am sure he had some of his own IP that Synthes did not have
    or own.
    So why is it considered shaky moral standards when you do a job at one
    company, than leave and start your own company and do the same thing you did
    for the previous company but have success? If David Paul had his own IP and
    used it, how is that immoral? I know sales reps who sell
    products for one company, only to in turn leave their company and join a
    competitive company because they worked a better commission structure for
    themselves. So when a situation like that happens, and this rep had the inside
    information on his previous companies products, pricing, faults and strengths,
    business contacts and such, how is that any different? Now is that shaky moral
    standards, or is that the American Dream, to better yourself when you can?
    Companies cut territories of successful reps who have built solid territories, and
    hand it over to unqualified new sales reps all the time. This is done in the name
    of business and profitability. To me that is shaky.

    Does anyone know what the first products Globus released were? I have heard and read they were Ti VBR implants. When did Synthes last sell a Ti VBR?
    You think if products were stolen than they would have been better than Ti VBR
    spacers.
    Again I will pose the question to you, where are the facts to back up your
    claims? If you have first hand proof than you will have credibility. Don't bring some article from a paper in Philadelphia as your proof. You are obviously not in the know of true facts because you admitted you have now idea why Synthes settled for such a low amount.

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  104. First product brought to market was titanium cervial interbody called Sustain medium. Not sure if it was cleared as a VBR or an interbody device though. VBR would make sense, that route is easier to get to market faster.

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  105. I laugh when people say they don't work for a company and then spout off all kinds of facts about the products and companies that only a current employee or past employee would know. Like the Paradigm Spine guy who "doesn't work for the company" but knows how many implants have been implanted and the different models and features of Coflex and Coflex-F. I know it is on the website, which you would only read about if you worked for them or with them. Or the Synthes and Globus cats that know detailed information about the lawsuits but don't work for the companies. Gimmie a break. Really?

    I agree with some of the previous bloggers. Let's end the name-calling and focus on some real issues. I am a distributor of a few small spine companies and don't really care about the details of the Globus lawsuit or how many products a company has implanted in Europe. Globus is great company, one of the better companies in terms of developing or copying new products (how do you think MSD got big). MSD, Depuy, Synthes, Stryker and Zimmer all are great companies as well, although I think we can all agree MSD has more than their fair share of problems at this moment. Can someone say market opportunity with number one, two and three stumbling? From that perspective it is a great time to be in the business.

    Work hard, provide good service, know your product and let the chips fall where they may and you will come through the Spine downgrade just like United States will come through the credit downgrade. I think as peers we also need to come together and figure out how to minimize the negative influences in this industry such as PODs, bogus consultancy agreements and royalty agreements and the rest of the negatives (many) that have brought about this downgrade. The greedy few ruin it for the rest of us all the time, often without retribution. See the banksters as a classic example. They have brought down the worlds greatest economy and are any of them doing time? How about setting up a group/union that policies/investigates itself? Instead of Reptrax that offers no benefit at all would reps/distributors be willing to spend fifty bucks a year to belong to an organization that supports and policies their industry to protect their very livelihoods? Ok, now all you crazy right-wingers can rip the unions! Obviously the industry is not policing or protecting itself and neither is the federal government. Advamed is a fucking joke started by the most habitual offender. How can we as industry insiders make it better? Don’t like my idea, than present your own idea on how to make the spine industry better, I am listening.

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  106. J&J buying Synthes will be the greatest factor in the evolution from high earning distributor reps to greatly reduced earning direct representation. When I see all the Depuy Spine reps celebrating the Synthes deal, I want to smack them and say "wake up" Don't they realize they have just been marginalized. Commissions are payed on valuation. When a super sized orthopedic company positions themselves the way Depuy Spine, Orthopedic, and Trauma have done , Depuy reps field value has greatly diminished. I am happy to be with my small little distributor working out of surgery centers and smaller accounts. Depuys move has strenghtened them Globally, but the local reps will suffer.

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  107. 1:19 just fired a Bulls Eye into the Red Dot.

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  108. 1:19-
    Great post, from a not so crazy yet none-the-less "right winger"
    Where do I send my $50?

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  109. 119

    i also agree with. NO one in "our business" has a finger to point at Globus. They stole something?? who the F hasn't?? Aside from the sour grapes they have a pretty good portfolio and sales people. I was amazed at how fast they had a "full bag" I don't even like them, but i can't fault them for being good at what we all do.

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  110. I would say send it to me but that would be unethical and immoral as it probably wouldn't get spent on policing the industry. TSB, how about a post on how we can improve the industry we work in and form an organization that protects and serves the very institution that provides our livelihood? How about a Oprah moment where instead or regurgitating the same old tired clichés about all the companies and people in this industry we set about making meaningful positive change? Let's come together and cast out the crooks and shed light on the underbelly. Let’s watch the cockroaches scurry for cover. Much like the doctors have done to their peers regarding Infuse. Let's make a covenant, sign it guiding the principals of spine sales and put resources into battling the pay for play reps, physicians and companies. Let's take away the support for those people, companies and physicians and see how well they do without it. How many of you’re POD doctors call you for the revisions and cases they can’t do without you. Let’s start telling them; sorry I don’t work with POD doctors. I am not talking about calling an 800 number to report a lunch I am talking about legal action against the people who pay doctors to use their products. We all know the culprits, Spinal USA, Nutech, Choice Spine, Alphatec, Aesculap, Spine 360, X-Spine, Amedica. Let's also go after the companies that have more than 20% of their sales from surgeon investors, consultants and inventors. Let's not sell these companies products. Let's get organized. Let's draw the lines and see what happens. If it doesn't work out we can all sell something else, it is better than watching your industry implode and being forced to do something else. Right? I don’t know all the answers and numbers and I am not asking to be the leader but let’s do something besides watching the Titanic sink

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  111. Fight the power brother!

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  112. 10:30am MDT has great new product called SOlera. It is selling like gang busters

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  113. I thought it was called SO Longa.

    My Bad.

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  114. 3:23 that's brilliant stuff. Stealing is OK because everyone is doing it. You are an embarrassment .

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  115. 3:23...
    Can you provide any truth to your comments that ANY of the companies you mentioned pay surgeons to use their products? Before you make public statements involving legitimate companies not doing business in a legitimate and legal manner then you better have your facts together before you find yourself in a worse legal nightmare you probably cannot afford. Put your $$ where your mouth is and prove with public facts before you post your bitter comments. Maybe you need to find another industry to work in that is not so stressful to your health and self denial that you were not cut out to be a salesperson in a medical device market.

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  116. Hey 5:23 am all that talk of balls has me thinking you have some in your mouth! Globus is a horrible company.

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  117. ok enough talk about this stupid spine market...lets place some odds on who will win the Super Bowl? All this NuVu, Globus talk has me all hot and botherd and worked up...man you guys are a bunch of blow hards!!

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  118. Hahaha.
    Funny Guy.

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  119. 7:26 Ahh, the threat of lawsuit. If the aforementioned companies sell products to PODs and PODs pay physicians to use their products than I would say there is a legal question to be answered if the companies mentioned pay their surgeons to use their products. Along with that question there is the threat of counter suit for illegal competition, torturous interference, anti-kickback laws and medicare fraud just to name a few that could cut the other way. So put your moeny where your mouth is. Or is your company afraid to open their books? We will see who has a better chance of winning a lawsuit in a couple of weeks won't we? The great thing is because I can't sell, have no business and should admit I am not cut out for medical sales I must have very little to lose. On the otherhand if I am right you and your company have a great deal to lose including possibly your freedom. I believe TSB likes to invoke lyrics, "When you've given into your fears, when you've lost your will to fight, Let me know what I can do, let me try and make it right, and I will shine the light, I will shine the light."

    6:58 Not sure where I said stealing was alright because everyone is doing it. Maybe copying with suttle changes and improvements to get around patents. That is what Synthes did to Aesculap with their first cervical plate. Copied and improved it, has anyone accused them of stealing? This is the copycat league and I am not talking about the NFL.

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  120. Regardless of it being a pipe dream, I cannot imagine why any legit person in this industry wouldn't want better oversight of his peers. If you aren't providing sham consultancies or otherwise doing shady work, then there shouldn't be any reason for concern. That said, Advamed perpetuates the fraud and I am just not convinced that we could ever have proper oversight without some sort of 1984 type environment.
    What bothers me is the lack of understanding shown by an earlier poster (Aug 19 12:27). People like this have no idea how IP is created..."So why is it considered shaky moral standards when you do a job at one
    company, than leave and start your own company and do the same thing you did
    for the previous company but have success?" and goes on to talk about DP's "personal" IP. What? When you work for a company, what you develop is OWNED by that company, dumbass. You may have some experience in spine sales but you are obviously clueless about how product development works. Go speak with some of the design team at whatever company you work for and pose this question.
    People with this degree of understanding drag all around them to a lowest denominator.

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  121. 8:17...
    Keep fooling yourself that you have all the answers and go get an audition for the next American Idol try outs coming to a city near you! You are so full of yourself that I would bet you have not covered a case in your area that has billed out over $7k in a month. PODS and those companies you mentioned are more than likely eating your lunch and allowing you more time to load your song lyrics on your out dated Ipod! So long Mr. Not Know It All wanna be spine guru. I have to get prepared for my cases the rest of the week and get my charge sheets sent in from last couple of days cases.

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  122. 8:21 That is a very logical post and argument and I agree with most of it (except the dumbass part, kidding I wasn’t the poster). However, depending upon how the employment contract is written the inventor can also "own" part, some or all of the IP and the inventor is probably best suited for knowing how to get around the IP. Unfortunately these legal issues attempt to get in the way of the world, which is cannibalization. The young, strong and hungry eat the old and weak. It doesn't matter if it is a chef, football player, engineer or rep you are training your replacement. You may think you can prevent it with a contract but you really just make it more difficult. Is it right, no. Legal, that is for lawyers to decide. Is it as bad as some of the common behavior in this industry? I would argue not. Surely a man of your sophistication can delineate the differences.

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  123. What percentages do Globus reps get paid on their business? Dist/Direct?
    I have over 2 million in convertible business and am weighing my options.

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  124. 8:17 As usual dead on. Man if you were anymore right. Let me know if your still covering all those cases in a couple weeks. Let me know if the doctors still use those products if they are not getting paid. Let me know if there still using you. I will take the answers to my Idol tryout and sing you a song, "since I have been missing you."

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  125. TSB you have outdone yourself with this one.

    I enjoy the passionate responses.
    We are getting somewhere.

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  126. TSB has been silent on this. The person who has brought this blog to a great debate is the person that questioned the idiot who slammed David Paul with no facts. I was finally glad to see someone stand up and say enough of the slander. Unless you have facts shut your mouth and take your medicine like a man. Where are the facts? He has yet to respond since he copied an article from a newspaper and tried to claim that as the truth.

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  127. 11:07, nice to meet you, I'm your idiot. I did not respond until now since I actually work, as I have been doing in spine since the 80s. I will not return your compliment, but the facts mentioned can be found by anyone with a modicum of brains and skills in court documents and newspaper articles from 2007. No slander involved here. If one would repeat the rumors about the interesting reasons as to why no CFO seems to last very long at Globus, that might be slander.

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  128. I know a game changer...

    Real-time inventory tracking and sales reporting. The first company that launches this successfully wins!

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  129. TSB you should call this Blogsite "hello I am a Globus rep and I am worried that my 1000 shares will be worth nothing in 2012, anyone hiring??"

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  130. Biomet has the best Deformity system on the market!! I just looked at this system and it has everything I need to derotate and provides me with optimal corrections!! The best.

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  131. 8:38 (and no I am not 8:17) You are the one who is fooling yourself into believing you are not going to end up in handcuffs someday. History teaches us it is NEVER the surgeons who end up doing time....the docs high priced lawyer will cut you to shreds and prove he was just simply trying to take care of his poor and sick patients until YOU came along and tricked him into taking YOUR DIRTY MONEY!!
    And for all of those idiots out there saying you better have proof before you start spouting off about this and that company paying surgeons, why do you think these suits have not already been filed??? BINGO, because they know they cannot have the OIG peeking at their books and finding out they have been paying these docs illegally!!!
    Do any of you morons who say "my docs are not getting paid!" actually think you really know the truth? Guaranteed...50% surgeons will admit to being paid because they are just plain stupid, 40% will lie about being paid, because they know the legal system prohibits it, 5% are just too ethical to accept any money, and 5% have legitimate IP they are being paid royalties on.
    Now bend over in the shower and take whats coming to you!

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  132. Need to change the name of this blog to:
    Gossip Spine Girls

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  133. TSB - next topic?

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  134. How about that Robin Young is going back to the trough for a 3rd spine awards at NASS. The fact that PEEK won in the first show gave me enough reason to say this was a f-in joke

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  135. Globus reps get paid anywhere from 10-14% on all business. Expense account is a joke though.

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  136. 3:23

    This is the best post I've ever read on this blog. I would work for/with you any day and I couldn't agree more about banding together to create a solution to the current problems in the industry. If you can sell it doesn't matter if you are selling pedicle screws or toothpicks. Sales is such a relative term for what actually takes place in our industry today. Walking into a book of business that is being paid for does not constitute "sales".

    I mean look at 8:38 when he says, "I have to get prepared for my cases the rest of the week and get my charge sheets sent in from last couple of days cases." The people on this blog that have any clue in life can picture this guy in their minds and just laugh to themselves. Good luck in life buddy. Keep masking those insecurities with anger and humor.

    There are plenty of solid reps out there that would love something that would govern this industry. I think you are on to something and this could and should be implemented sooner than later. Thanks for the sanity

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  137. I can't believe that no one has mentioned ISTO Technologies as an innovative company with game changing technologies. They have the only juvenile cell based platform in the world. They have a cartilage regeneration platform in the final phase of clinical trials.

    They are about to start the final phase of a disc regeneration human clinical trial, which has shown outstanding early results. This is the future of spine and orthopedics.

    They also have a unique synthetic bone graft that is the fastest growing synthetic in the country. It is FDA approved anywhere in the spine when mixed with autograft. It is an angiogenic biosynthetic. We have been selling it for over two years and we represent one of the larger spine companies.

    Our surgeons have seen excellent results with the product. All of my friends that just lost Vitoss are picking up the line. They have a new putty coming out soon, as well as a unique MIS delivery system. The company will sell well over $12 million this year, and they have only been out there for 3 years. Excellent management team, not some BS marketing story with these guys. This is real science driven company.

    I also think K2M is poised to do some great things. They are really growing fast out of the U.S. They have a private equity firm behind them now that has $4 billion in cash and can fund them to become one of the market leaders over the next few years. Sentinel is another to keep an eye on. They have an interesting product.

    The metal market is going to continue to experience consolidation and price erosion. We focus on Biologics and we are making a healthy living selling them as an area of focus. There is an $800 million Infuse pie to go after now, and into the future. We continue to take away business from Medtronic. The news will continue to get worse before it gets better for our friends at MDT. The FDA is going to inflict some pain before too long.

    We will see more consolidation and only the strong will survive. It will come to great leadership, vision, and execution. Only the small companies with differentiating technologies will survive this market. The weak will run out of money or will sell to the bigger companies for pennies on the dollar.

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  138. That's Centinel not Sentinel.

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  139. TSB...tomorrow is a big day in the world of spine.....in fact it feels like christmas eve.....to know we will have a "guideline" as to the POD situation.....right?

    btw fuck vitoss and the horse they rode in on.....them dudes....or peeps at stryker.....a bunch of ^%%$# can go suck a Tronic toe...or slong

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  140. Vitoss at 12 million is killing it? HA!, LOL, ROFLOL ! That's NOTHiNG!
    Can you say "Snake Oil"?
    Do you really want to look in the mirror every morning and see a Snake Oil Salesman?
    Oh god, I'm having side pains from laughing so hard... Please stop....

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  141. lets just nickname the Stryhhim guys as snake oil boyz

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  142. 10:04

    Dont be mad Orthovita and now Stryker sells a biologic with level 1 clinical evidence. Looks like Stryker recognizes the value in this. Its ok, go sell your LDR and unrevisable, unstudied Vertebridge technology or continue to convince your surgeon that Spinous Process device, can provide the same reimbursement as your Alphatec screws in half the time. Continue to do a disservice to any and all Spine patients who walk into your hospital. If I were you I would join one of the big 4 as before long, you will be trying to find a job with one of us.

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  143. So many "frauds" & "posers" on this blog. What were many of you doing before you were hired into some distributorship or company simply because you know a surgeon or you're a relative of someone? Were you working at Home Depot? Perhaps a wine salesman for Cavit? Maybe even a caddy at the local country club? Yes, ALL are actual backgrounds of reps who now find themselves in the O.R. these days, the common denominator is that all were hired not because of the experience they bring or what they know about soine,, but INSTEAD because of who they know.

    How many actual reps on here have found themselves in cases w/ there was another rep who knew NOTHING about their product & the tenured/ expereinced rep had to help the surgeon out w/ the unqualified rep's product? Yep, many I suspect,,

    The take away is that this industry is saturated w/ over-paid, under qualified people who feel entitled to something without the qualifications or expereince to be worth anywhere close to the income they are paid.

    Net/ net is that this industry will purge itself of some of this w/ these mergers & acquisitions, but will take some time until we see a true cleansing of the spine industry.

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  144. LOL@"Net/net".......such a bullshit pharma term!.....Monkey.

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  145. How do you free reps up to spend more time on education and increasing sales?

    Answer: Automate everything!

    How do medical device manufacturers spend less on shipping and more on innovative products?

    Answer: Automate everything!

    Automation fosters speed, reliability and true transparency.

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  146. 10:35 You must have been the caddy that I referred to in my earlier post; sorry to have offended you. Please, continue to sit & watch the PGA Championship dreaming of "what might have been" while continuing to grow more frustrated at the continued prospect of being nothing more than a case coverage person for the DP that you work for while your consist of nothing more than setting up cases & shiping sets in & out of your hospital.

    Need another zip tie?

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  147. 1:06
    No offense taken. I just had a hunch by ur "net/net" conclusion that you are some egomaniac middle manager(possibly pharma at one point) that has ALL the answers..... Sounds like the only one offended was you, b/c I called out ur pharma "net/net" bullshit. Good luck, Mr. corporate monkey. -Stevie Williams

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  148. K2M may have a bunch of money behind them bur they need to have people who know how to run a company in order to succeed. They really do have shitty product and even worse instruments. Ravine and Range are good but aside from that everything else sucks. Eric Major is a good person, but aside from him the rest of the management team really does suck. If they succeed, it will only be because they have so much money to throw around from Welsh Carson, but they still have to execute.

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  149. I was under the impression that a marathon was a race.

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  150. Globus and Stryker... Not happening.. Also a little food for thought for all you hoping for a buy out. Let's review: Spine market = low single growth, procedures down, pricing way down, reimbursement down and Obama care on the way. What is attractive about this market that the big company's are going to invest in it? please educate me. Ship has sailed on this market my friends. I think I saw an RIP blog last month. The list is going to grow.

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  151. What's with dude that's all obsessed with OPERATIONS? Weird....

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