Monday, August 22, 2011

Overhanging Transition? Or Just Plain 'Ol Piling On

If the spine industry were the NFL, right around this time, a zebra would run out on the field and throw a penalty flag.  It seems that Globus Medical, aka "when will they go public," must feel like they've been hit by several players after they've been tackled. Piling on has a new meaning. You know what the late Rosanna Rosanna Dana use to say, "it just goes to show you if it ain't one thing, it's another."  It's bad enough that the Cat has nine lives, but Les Paul, I mean David and his band are starting to play some dissonant notes.

On August 22, 2011, Rachiotek, LLC and the mighty Eli of Yale University have filed suit in the United States District Court in the District of Massachusetts against you guessed it, Globus Medical, for allegedly infringing upon the "675" patent by making, using, offering for sale, and or selling devices that provide spinal stabilization.  As a result of the patent infringement, Rachiotek is seeking preliminary and permanent injunctions and damages.

The case involves patent infringement, and arises under the Patent Laws of the United States, Title 35, United States Codes.  The patent in question, the "675" patent (U.S. Patent No. 7,931,675) entitled, "Dynamic Stabilization Overhanging Stabilization" was issued on April 26, 2011 to Panjabi et al.  The "675" patent is generally directed to spinal stabilization devices for use in stabilizing a spinal segment. In layman's terms a spinal segment between two vertebraes.  The "675" patent includes dependent and independent claims that define various principles of spinal fixation that are disclosed in the patent.

Example:  First and Second resilient members that cooperate to deliver a non-linear force displacement response to relative motion between the first and second attachment members or stops associated with the spinal stabilization device. One of the resilient members is an "overhanging" orientation. The Globus device in question is the Transition Dynamic Stabilization System. The Transition DSS includes first and second resilient members that deliver a non-linear force displacement response to relative motion between the first and second attachment members or stops associated with the Transition. One of the resilient members of the Transition is an "overhanging" orientation. All the usual allegations and infringements are included in the complaint.

Rachiotek LLC therefore asks for the following;

A judgement that "when will they go public" infringed upon the "675" patent
A preliminary and permanent enjoinment against Globus
Damages
A threefold increase in damages because Globus willfully infringed
Prejudgement and post judgement interest on compensatory damages
Attorney fees

And last but not least, a trial by jury. Considering that David once slew the mighty Goliath, the champion of the Philistines to show his true identity, how many more salvos can the King of Pain absorb?  Remember what David said when confronting Goliath, "This day the world will deliver you into my hands, and I will strike you down, and cut off your head."  How many more lawsuits will David have to fight?  Maybe it would have been easier to take this onto a battlefield rather than a courtroom.  You know what Louis Salinger once said,  "Some times a man meets his destiny on the road he took to avoid." David don't look back now, but it seems time is beginning to catch you, karma is a bitch!

83 comments:

  1. MSM, I heard a rumor today, (like most other days), that Globus was purchased by Stryker for 2B, and making an announcement in 4-5 weeks. Besides paying an absurd amount, do you believe any of this to be a possibility? Do you believe Stryker would run away after this news?

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  2. 6:10PM is, no doubt, the same dope who continues to post the same comment ("When will Globus go public?") on every single blog posting since the beginning of time. He's just trying to be a bit more sneaky about it this go-around.

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  3. haha I'm actually that dope and I didn't write the first post.

    Moving on, this most recent suit would not be the straw that breaks the camels back. I have heard this rumor swirling for a while and would be very curious to know if there is any truth to it. It would make sense with all the rest of the current market consolidation taking place. Stryker or Zimmer could certaintly gain a lot by purchasing Globus. I've seen what's coming down the pipeline and their are some innovative implants on the horizon.

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  4. Why would anyone buy this quicksand pool of liabilities and expensive litigation?

    It will be bought out on pennies on the dollar likely

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  5. What a waste of time. Does the Transition product even have any sales? The FDA has killed this technology. Dynamic stabilization is dead and the patents are worthless. Rachiotek is trying to get blood from a stone.

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  6. Buying Globus would be like marrying a prostitute who never retired.

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  7. "I just love it when guys peel out"

    -American Graffiti

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  8. Automate everything! I'm tired of chasing down inventory!!

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  9. Stryker attempted to buy Globus last year......until they dug deeper into the books and realized that Globus is nothing more than a house of cards. Impossible to gauge their true value when their revenue stream is tied up in surgeon investors. This is why no one has or will buy them

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  10. 8:00...
    Impossible...the field has been too spoiled and will never conform so why the change? I have to also ask who benefits from automation...the Hospital...they could care less and will still make their collection whether they make sales effort easier or not...the surgeon benefit...NOT...so who really benefits when the cost is more expensive to get there and prices in hospitals are shrinking. Automate...not in this decade.

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  11. Patent No. 7,931,675
    Inventors: Panjabi; Manohar M. (North Haven, CT), Timm; Jens Peter (West Haven, CT), Malcolmson, II; George (New Haven, CT)

    Always a twist:
                   On December 20, 2002, in response to allegations by Biomet, Inc. of misappropriation of certain trade secrets by Interpore’s wholly-owned subsidiary Interpore Cross International, Inc. (“Interpore Cross”) and its employee, Jens Peter Timm (a former employee of Biomet), Interpore, Interpore Cross, Cross Medical Products, Inc. (“Cross”) and Mr. Timm filed a complaint for declaratory relief in the United States District Court for the Central District of California.  The complaint sought a declaration as to Interpore Cross’s rights in its GEO STRUCTURE device and all related products and technology.  On February 14, 2003, the Court dismissed the complaint without prejudice based on its findings that the declaratory relief action was unnecessary because there was no threat of imminent or inevitable litigation at the time the complaint was filed.

                   On January 16, 2003, Biomet filed an action in the United States District Court for the Northern District of Indiana, South Bend Division, against Interpore, Interpore Cross, Cross and Mr. Timm.  The complaint asserted claims alleging causes of action for declaration of patent ownership, constructive trust, patent infringement, misappropriation of trade secrets and unjust enrichment.  Biomet sought an equitable ownership interest in Cross’ U.S. Patent Number 6,206,924 (the “‘924 patent”), a constructive trust over the proceeds of any products relating to the ‘924 patent, including the GEO STRUCTURE device, an injunction against infringement of the ‘924 patent, damages (including treble damages for willful conduct) and attorneys’ fees.  Biomet claimed damages (before trebling) in excess of $1 million. 

                   In response to Biomet’s complaint Interpore filed three separate motions on March 10, 2003:  a motion to dismiss for lack of personal jurisdiction on behalf of Interpore and Cross; a motion to transfer venue to California; a motion to strike the request for monetary damages for patent infringement and a motion for a more definite statement as to the allegedly misappropriated trade secrets. 

                   On June 10, 2003, Interpore entered into a confidential settlement agreement with Biomet, which resolved the matter in its entirety.  On June 17, 2003, Biomet filed a dismissal with prejudice of the complaint.

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  12. 8:00

    This idiot has been peppering the comments on the last few posts with poorly disguised hyping for some inventory software. Piss off you wanker. Nobody here gives a crap about it.

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  13. Who would you rather

    Jwoww and 10,000

    Or

    Snooki and 50000

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  14. Funny,, ANOTHER post about Globust. At this point,, Does another lawsuit really surprise anyone? Think it will be the last? This company is a sewer pit.

    Go public? How about be in business in 2 years?

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  15. Don't be surprised if this merger happens....figure out how to take advantage of it. Consolidation IS happening, that cannot be denied. Again, I am curious what some are doing in light of this industry shift?

    I've gone to the model of sole distributor and rep for a few small accounts. Anyone think this is a bad idea? Alternative would be to join up with a large distributor for either Depuy, MSD or Globus. That option sounds less appealing. How 'bout some discussion...?

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  16. 5:55 stay solo. Why would you want to join a large company distributor and work for 6, 8, or 10 percent? There are only about 4 to 5 years left in this industry before representation is scaled back widely. Make all the money you can now at 20 percent.

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  17. Nothing beats busting your ass to build business & a viable distribution model, only to have the rug pulled out from under you by the company you've been representing.

    Regards,
    L5 Surgical

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  18. 5:55, I agree with 6:29, stay solo. As long as you have the surgeon relationships.

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  19. The issue 709 raises is the biggest problem with the small distributor representing small to mid tier spine companies. There are plenty of innovative, small companies that offer lines that preform just as well as those of the majors. Now, before everyone gets all hot and bothered, I am not saying every company/system, just that there are specific lines from certain small manufacturers that can actually go out and win you some business. Problems happen when, as 709 points out, the small company sees green and wrecks your hard work. Lets try a new approach shall we? Any favorable stories on a small to mid size company - I think general geography should be mentioned too as alot of these companies lean heavily on their area managers' integrity. Would love to hear some upbeat feedback.

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  20. Do you consider 300 million in sales annually a small company? 7:09 is referring to Globus, I would classify them as a strong mid tier company gaining market share.

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  21. The biomechanical profile of Globus Transition Dynamic Stabilization System resembles more like: NFix II Dynamic Stabilization System(Synthes/N-Spine)

    http://www.jaaos.org/content/18/10/581/F5.expansion

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  22. while we are on Dynamic Stablization, lets NOT forget about Dynesys. Call it what you will or may, but this device has been implanted in over 50,000 patients worldwide and of those 35,000 here in the states. Yes, just like any other product out there, the indications were/are "unknown" and some surgeons placed this device in pat's were probably fusion was the course of action. But with all the negative hype out there and every pat that has had this removed, there are 10 that have had great success without fusing them or buring that bridge of treatment.
    Yes sit there and call this device a cord with a plastic spacer, but look at what was said about ACDF plates when the first internal cervical plate was developed by Dr. Bohler in the 1964..."pplacing metal on the anterior cervical spine will never prodvide fixation or heal" and look at it now, the gold standard.

    Yes, Zimmer has screwed the pooch on Dynesys. I can;t help to think what it could have become had a company like MSD or Depuy had thier hands on it first. Your feedback....?????

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  23. Wow 10:18 you are basically arguing that the Deusenberg was a great car compared to the Ford. That ship has sailed. Dynamic stabilization is DEAD! Might as well want to discuss how great Zepplin travel was.

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  24. Agreed, but I'd say the Dynamic Stabilization ship left the pier but never made it out of the harbor. Inconsistent results, and even if it had a solid IDE, insurance would deny it. Couldn't get it Medicare approved because the ideal patient population is too young. All motion preservation devices ie disc arthroplasties have been stonewalled by payors, and those have way better studies and support. This ship sunk.

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  25. http://www.patentgenius.com/patent/7931675.html#show-page3

    Patent filed 2005 for DSS

    Testing on Transition late 2006.

    This product will be the straw that broke globus' proverbial back. From inception to execution this product personifies globus. R and D a joke from the begining they damn near print out the patent and dropped it on project engineers lap, the engineer just modified it to fit the revere poly-axial head. But looking at the patent itself there going to get the idea to put it beacon screw system. The problem is why steal flawed technology? The answer is David Paul wanted to pull a fast one pass it off as your typical fusion device running the the standard MO for F1717 testing, bring it to market in typical globus fashion. And sell it under a different indication.

    Well inital submission to fda didnt go as planned, and it was a drag out fight for 3 yrs with the fda regulation board, awhich finally it was deemed a dynamic stabilization system under its approval. So once it was cleared to sell the heavens opened upon David Paul, it was wine and roses and the crowning achievement for DP. All was good for a little while.

    Well not so fast getting reps and doctors to sign off and buy into the hype of dss's came at a very steep price. Surely it will pay off in the long run right? So they spent there money like it was water building training centers, satalite offices, and other things just to pump the ego of globus.

    But the problem is yet to come, to all the little people of globus, get them resume's out and call your recruiter your in for a bumpy ride.

    With synthes vs. globus 2 , and this major debacle DP and his globus will be in the icu.

    Will this be the 2nd round of lay-offs at globus you be the judge?

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  26. What's the deal with Spine 360? Are they POD owned or just work with POD distributors?

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  27. 8:23 and 9:22,

    Obviously you two have no operations experience or are aware of the amount inventory us field reps have to manage on a daily basis. Why do I have to constantly look for inventory shipped to the wrong location or bean count a tray. We have technology out there that can do all of this.

    We are living in the stone age. Filling out a charge sheet and faxing it? Are you serious? So I'm off a number or wrong price and then what happens? I don't get paid for months and why because someone doesn't want to automate our process. Or how about another audit? How much time is wasted there? No, you're right lets just buy 200 more sets to make up for the laziness, dock my commissions, fine me for late loaners so I can go home after being in the OR ALL DAY and count out disposables and trays for tomorrows full day of cases. You two obviously do NO business so you have NO idea what hard working rep goes through. Keep your pens handy and have fun on the phone with customer service with your laundry list ready to go. Yeah, you're right no advantage here...hate to be cliche' but I have to...MORONS! Automation is the key to fixing all of this crap, wake up! How many more inventory guys or couriers or shipping fees do we have to pay before we stop the bleeding. TSB, how about a blog on the the fact that medical device manufacturers do not report lost product to their investors or exactly how much shipping companies are leaching off of our industry? Let's get to the bottom of all of it and be real. Fix this hole in our boat before it sinks and we all end up in the soup line making 5% commissions.

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  28. 12:21

    What automation system can possibly address all of these inventory and tracking problems? It just doesn't exist!

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  29. Built for the medical device manufacturer/distribution model?

    It is going to require a combination of several technologies all available in today's tech market. Besides the obvious ERP on the backend there are several targeting the front end portion that brings it all full circle and completely transparent.

    www.SurgiTrace.com
    Webopsmobile.com
    Solstice medical
    Itraycer

    Some have both software and hardware. Having the hardware is the key to creating true transparency and taking the pressure off of the rep.

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  30. I hope you realize only bored reps who are only interested in the latest gossip read this blog. you need to advertise where CEO's and CFO's will have a chance to see what you are pitching. Senior executive people don't have the time to waste in here. But do let us know if you hear the latest scoop on old so and so

    Thanks

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  31. next time, instead of doing question and answer session with yourself and wasting so much screen space just leave us with a hyperlink to your totally stellar website

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  32. Globus will be fine. By the time anyone has to pay anyone anything, even if it comes to that, Globus will have continued to grow and gain market share like it always has. History has shown this company is not phased by lawsuits and it does not slow them down. Lawsuits certainly have not hurt their growth because they are one of the fastest growing orthopedic companies around.
    If Stryker buys them they get a pretty complete and upgraded spine line, and Globus will get the money and systems upgrades it needs. With big money behind lawsuits might even be fewer and far between.
    I bet Globus has more growth than any other spine company this year.

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  33. 3:32,

    So you're just cattle I suppose?

    If that's the case why do you post? Run out of hay?

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  34. Mr. Automation:
    Can you name ONE successful account or implant company that has come anywhere close to what you are passionate about and if not why are you still operating in the stone age of filling out charge sheets and counting set inventory and not marketing the next thing to make your fortune? Oh, maybe you are marketing via this website...Good Luck Automate Man...hate to call your baby Ugly.

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  35. 3:32 if no one except of low reps read this blog then why in the hell are you on here, first, and secondly, you even took the time to post. Sounds like its you my friend that is bored. And I like this quote from you----
    "But do let us know if you hear the latest scoop on old so and so".
    Sounds like a guy that has never carried a bag to me! What are you pissed cause you havent seen that thing you call a di*k in over 5 years cause that belly of your gets in the way from too many conference calls and sitting at the desk punching out emails to the field all day "lets go team". Man I can smell you sweating each time you hit a key/enter button.
    And what I am smeeling is fear buddy, fear that one day, very soon you won't have that job and will be punching keys at the local unemployment office filing out the paper work on-line.

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  36. 5:02 or should I say inventory guy?

    MDT came close with Verifyi.

    Zimmer too.

    Problem is both systems still require rep interaction with some sort of handheld reader. Reps should be selling not managing inventory with the exception of making sure product is functioning properly before going in a case.

    Is 5:24 right? Are you afraid of losing your job?

    - Automate everything!

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  37. P.S.

    I fill out charge sheets, bean count, and chase misplaced inventory because cattle like you won't call your CEO and CFO to invest in something better. Maybe if we stand together we can make a difference or not and settle for hay and 5 points...your call.

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  38. We need a "thumbs up" or "thumbs down" feature on this site. How bout it Musco Man?

    Im going to throw out a thumbs down to the automation jock who is basically spamming this site.

    Another nice feature would be to number the comments. That way, they can be easily referenced.......oh god, did I just give the automation dudes a plug?

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  39. 6:34,

    How about we take away your computer, phone or tablet PC that you're posting from and de-automate your ability to send your message to this blog. Maybe you can write it with a pen and paper and we can read it next week sometime when the new thumbs up or thumbs down system is in place.

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  40. @7:09am
    Both sides were lead by unethical and morally void individuals. It was bound to happen at some point. The result... GM lost 2/3 of their business in affected area, DP and BA were exposed and their true colors shined brightly. The reps have regained most, if not all of their business. Rug pulled out? Not the case. The aforementioned individuals were the largest contributors to their own demise.

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  41. Automate Man...6:00 and 6:07 (same poster)
    You are correct in that if a company finds a way to automate what you get paid a good commission to do then you will be eating hay and lucky if you get 5 points...go make some extra charge sheet copies for your case tomorrow.

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  42. Loosing my job? Lol Ive been a distributor for the last 17 years. Carried a bag my whole career and loved it. I wasn't really making a dig at reps I was poking fun at the guy trying to hock inventory software. So get your pantys out of you crack and chill. 34 waistline by the way. Reps that work for me have lots of cases to cover and families hang with after work. Seriously doubt they have the free time on their hands that you obviously do. I'm sure you sleep in most days too

    Take care

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  43. 7:29,

    You will NEVER take the rep out of the OR! Nor will you diminish their value by automating inventory management and PO processing? What hay are you smoking?

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  44. Get over automation dude people. Let's get back to the earlier comments about starting your OWN distributor vs working for a large dist/direct?

    Who out there has gone down that route? what do you miss? wish you had done differently? how is it working?

    With all these companies merging, laying off, and our industry changing I think it's best to be as a dynamic as one to two man show can be.

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  45. Dynamic stabilization is dead, but when you look at all these hospital RFP,s, the DSS systems are the most expensive and the hospital will pay for it. So, $700 screws or $1200 canulated DSS screws?

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  46. I've got an observation on the market that seems to be positive with respect to technology and FDA. Nobody on these boards has seemed to have noticed so I'll throw it out there. This blogger is very interested in the collective opinions of these developments.

    Case 1. Spinal Restoration completed their pilot study and moved into a pivotal study. Their product is a based on an intradiscal injection of fibrin into the disc. Its intended to help back pain. From press releases it seems that they successfully negotiated a 6 month endpoint and placebo control. A more recent press release claims the benefits of their initial pilot study were maintained to two years.

    Case 2. Relievant Medsystems announced earlier this month that they received FDA approval to begin a pivotal study of their minimally invasive treatment of back pain. This is based on ablation of the basovertebral nerve and is indicated as a treatment for back pain. Again a six month endpoint and placebo controlled.

    Case 3. Mesoblast recently announced that it has stared a Phase II trial of their stem cell technology as a treatment for back pain.

    Coincidentally, I just received the daily spine-market email as I was writing this. Both Spinal Restoration and Relievant are making announcements today.

    I think this is big because if FDA is entertaining 6 month endpoints, the amount of capital and subsequent risk is reduced. Scientifically, these blinded placebo controls make for strong studies. In addition to shorter follow-up, you can bet they will enroll quickly. Capital should be attracted to these technologies. If any of them work, hardware sales are going to get a big haircut. I don't know anyone that wouldn't prefer an injection to spine surgery. I think these technologies will reshape this industry and are genuinely exciting.

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  47. 10:07, FDA may accept 6 months for a pilot, not for a pivotal. Fibrin injection in the disc? Where is the rationale? Same for stem cells. Unless someone can prove what the exact pathophysiological mechanism is that causes back pain, these 'therapies' are shots in the dark, and chances are better than 50/50 that the results of a well designed prospective double blind randomized controlled study will be disappointing. Same for ablating one single nerve. By the way, anatomy books don't mention a basovertebral nerve, it does not exist. There exist an ascending and descending branch of the sinuvertebral nerve, but that's only part of the afferent system.

    Until somebody comes with a real good story, backed up by data, these therapies are likely to go the way of the nucleotome, chymopapain, IDET, dynamic stabilization, laser etc. That is to say, you can have it done for 60,000 dollar at the Bonati Institute or some other airline magazine advertiser.

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  48. Zimmer didn't screw the pooch with Dynesys, the FDA shot it down.


    Just call me a day late and a dollar short

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  49. South Carolina Spine Society has voted to start a statewide POD.........

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  50. If that's true...the industry has just entered the pit of fog and conflicted interests.

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  51. 11:22, mark my words: if Perry becomes president all these unproven treatments will make a triumphant return. As somebody who believes in intelligent design, and who allows FSCs to be pumped in his disc and his veins, he surely will try the IDET next.

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  52. Perry had spine surgery himself in Houston. Can't hurt our chances.

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  53. SCSS had a closed door meeting before the Society Meeting and POD's were presented and voted on. Was never discussed in open forum.

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  54. Zimmer did screw the pooch as I was with them for over 9 years and saw first hand the problems internal. Lack of clear cut indications, data that was just thrown together by surgeons "on the take" and 2 year follow up that was a joke. Lets not even mention the instruments that dated back to the stone age.

    Had Spine Tech done their due dilagence and clearly defined the indications here in the States and had internal people that knew how to deal with the FDA, this product would have been a home run. But hey, I can't complain, I had my run with this product for 4 years and made $$$. Loved walking into a hospital and selling it as "new tech" and get top dollar while the MSD was in the next room billing out 1/4th of what I was for implanting Legacy screws...

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  55. Whats the deal with the SCSS? A single POD for the whole state or just the sanctioning of PODS as an acceptable business model?

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  56. 7:10

    1. Lack of clear-cut indications
    2. data that was just thrown together
    3. by surgeons "on the take"
    4. 2 year followup that was a joke

    Last one first--you know what is the joke? The Zimmer Spine sales force, you included. What a joke you guys are, and always were.

    As for the rest, I'm sure you offered your brilliant insights BEFORE the FDA shot the thing down, right? Or are you engaging in 20/20 hindsight? I'm sure you are.

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  57. 10:26, while I am not the person who posted that(7:10), I take offense to your post. Not only was it rude but unprofessional but showed what true character some of you reps have. Really! I wish you had posted your name instead of hiding behind the vail of "anonymous". Sounds like the joke is one you!
    If you could please post your name so that I can make sure your not one of the reps calling on this office. But that will be a cold day in hell as you are probably one of the reps that talk crap behind the surgeons/staff back and then kiss ass while your infront of us. Sounds jsut like the Executive staff around most hospitals.

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  58. Hey 10;26 you sould like the pissed off MSD rep that this poster was speaking about?? Why call this person a joke? You say all the ZS reps were/are jokes? It sounds like someone was getting their ASS handed to them by a ZS rep?? too funny!!!!!!!!!!!!!!!!!!!!!!

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  59. No way 7:10 was a Zimmer rep. He is just stirring the pot. Trying to make Zimmer reps look bad.

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  60. If Zimmer automated their process and streamed that data in real-time reporting they could have avoided most of those issues.

    -Automate everything!

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  61. 11:24 I was a Spine Tech/ZS rep for 9 years if you would like to test me...make my day.
    Tim Lanier/Bob Molinie/Bill Pfost were the AVP's when I was there. Terry Slaughterback (old Zimmer Trauma VP) was our first Spine Pres. I went through both the cage rage along with BAK Vista and Dyensys rage (used the 1st gen instrument set that the IDE surgeons had to use). So Mr. 11:24 Big Shot know it all...should I continue to make you look the fool or what??????????????????????

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  62. 7:10's 4 points are dead on.

    Dynesis

    1. Lack of clear-cut indications
    2. data that was just thrown together
    3. by surgeons "on the take"
    4. 2 year followup that was a joke

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  63. 11:22 - suggest you Google Dr. Michael Heggenness and look at his work related to the oblation therapy. This isn't something thought of in the past few days. He and team have been working on it for years. There's certainly better than average science behind it, and the research has received considerable acclaim. I think you will find Dr. Heggenness doesn't see this as the panacia, but certainly an alternative considering the outcomes related to fusion for pain. Just love it when folks shoot from the hip. (and no, I have no interest in the company, but like most good professionals, I read and invest knowledge before taking an oral dump)

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  64. 12:45, am aware that Heggeness has been working on this concept for ages, or at least 15 years, and others at for example Dartmouth and in New York have followed suit. That makes it more than a little suspicious that there has not been a single presentation or abstract on what the effect is when you ablate or anesthetize that particular nerve. That would not be that hard to do. Lets hope it works, because we know that fusion for back pain is singularly unsuccessful!

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  65. No, I'm not a rep. I'm just a guy who works inside the borg for many years, and listened to the incessant whining, day after day, year after year, by reps who made 4x what I made, and never hit their number two quarters in a row, ever. Ever.

    And when you called them on it, which never happened, so I suppose I should say, if you DID call them on it, you got the same sad old whine over and over: "You never give me any new product" wah wah wah all the way home. Well, guess what? Spine-tech started with one, count it, one product and now the child, Zimmer Spine has how many lines? 20? 30? Doesn't stop the whining though.

    I'd have Glengarry Glen Ross'd the lot of you, with a few exceptions long ago, and you wanna know what? So would most of the people in-house.

    We got wise to your whine a long time ago.

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  66. 1:46 - there have been presentations and there is a paper by Heggeness. I have it in my files somewhere and will post the information if I can find it. It may take a few days as I will not be home for several days. Or, you can contact him at his office in Houston. Past requests for information came willingly and surprisingly fast (he did pretty interesting work on occipital-cervical fixation) 12:45

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  67. You'd have Glengarry Glen Ross'd them? Keep in mind WHO delivers the message: The top salesman, played by Alec Baldwin, because he had the clout and success to do so. Not some engineer.

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  68. Mr. Spine Blogger,

    I have an idea. Ask David Paul for a tour of the facility! Come feel the Globus “engine” run! Touch the products. See the pipeline. Learn from the people. Experience why everyone is afraid! I guarantee after you will never write such bullshit again!

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  69. Thanks 3:03. Excellent allusion to an excellent film. Never forget who makes the $ for the company. There's a reason some people are behind a desk and some aren't. If you're not happy with what you make, put on a coat and tie and start asking surgeons the hard questions - but be prepared to get your teeth kicked in repeatedly. My guess is that your engineers skin is about 1 micron thick and you'd be crying for your CAD program in about an hour.

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  70. Who's the guy who says fusions don't work for back pain. That is total rubbish. I've done several thousand fusions over 27 years and they have been extremely helpful for most patients. ALIF is especially successful stand alone with BMP 1ortwo levels. Several level one studies bear this out. If the surgery is done skillfully the results should be very good and only break down with natural progression of generalized DDD.
    Also, don't discount the mesoblast MSC study. The protocol is sound and may very well add slot to our understanding of what is possible. Unless you have studied the preliminary data and lab work why are you so eager to bad mouth what people are at least trying to do. These are areas that need to be objectively explored no matter what the results show. This is the direction that will someday allow for better treatments, especially if you don't like mechanical fusions.

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  71. ISTO has the most promising technology for disc regeneration. Their cells actually regenerate the disc, not just fill it up with fibrin like spinal restorations. Their Phase I clinical data is the most compelling out of all the company's working in this area.

    This is the future of spine. I continue to sell hardware, but have seen our fusions going down over the last year. We are also experiencing price erosion on top of all of these insurance denials. We are focusing on selling Biologics and some smaller ancillary lines. The future of metal implants does not look good. I think we have a few good years left, than we will all be turned into pharma reps.

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  72. Yah the market wil turn into pharma as soon as patients decide to go to the doctor when the pain first occurs not when they absolutely have to. You know what that means? Never!

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  73. 6:16, that would be me, someone with about he same length of experience as you. And no, that is not total rubbish, but a simple fact which you can easily unearth if you take the trouble to critically review all the data that's out there and that has been generated over the same 27 years you did your thousands of fusions. Fusions done for pure back pain with no clear anatomical abnormality other than a black disc on MRI and/or some loss of height have no better results than physical therapy, psychological counseling or a nice vacation. There are so many articles and arguments that speak to this fact that the space available on this blog is not enough. Instead, let's do a poll right here and now: who among all you experts in the field would undergo a spinal fusion, or a TDR for that matter, for pure back pain without any neurological involvement. First vote is mine: not ever.

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  74. I agree with 7:16. The outcomes on patients with mechanical axial back pain solely, without neurological involvement are not good with surgery. You are better off losing 10 pounds and building your core.

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  75. Duhh ???

    So let's do more XLIF's right ?

    Makes no sense....

    Indirect decompression is a JOKE !

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  76. I second 7:16 and 7:23. No fusion for me unless there's obvious instability or neurologic symptoms.

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  77. I am not only a rep but a patient. Had an 360 performed on me and the ALIF alone provided indirect decompression for a grade 2 spondy. Have never felt better. So its NO JOKE! When and after you ahve surgery on your back after years of pain...come let me know how it went, until then shut up!

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  78. 12:22, so you are a patient who had a clear anatomical abnormality. That is not what we are discussing here regarding unnecessary fusions. Get with the program!

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  79. 1:11, my comments are directed to 9:32 comments that indirect decompressions are a joke.
    But since you want to go there...as I indicated, until you have had a fusion yourself and see that outcomes first hand you have no idea what your talking about. I think one of the requirements for each rep is to have had a fusion prior to joining a company. You will have a much different look at this business and appreciate what you do much more than sitting around worring about things you can not control. Success form fusion has too many variables on who and why one fuses over another. Get with the program...PLEASE

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  80. 2:54
    No one cares that u had a 360 and happen to be/have been a rep?!....Big effin' deal! I have seen ur story about this atleast 2 or 3 times! Join a support group! Surely u don't share ur personal experience w ur docs?....That's so LAME.

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  81. Wow such big egos on here. I can say without a doubt you reps have more time on your hands than I thought. I have been in pratice for over 16 years and would have to agree with what 2:54pm is saying. 4:48pm, I am a little confused as to the point you are trying to make about this person sharing this with his/her doc's? I find it somewhat refreshing to hear.

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  82. 6:16, 27 years of fusions for back pain. PUBLISH YOUR DATA. If it's better than 75% good to excellent results, and can withstand the scrutiny of your peers, your are on to something others need to know about, but that's the best data out there. In direct decompression works, that's a fact, but the results are no better than direct. Each avoid complications, but also introduce others.

    For the Grade 2 spondy 360, you had an instability. EVERY study for instability show good results, and considerably better than the results for pure back pain without radicular symptoms. Fusion for pure back pain, no instability, no neuro complications ... I wouldn't have that surgery, most surgeons I know wouldn't have that surgery or allow their family and friends have that surgery unless it was a very last resort, last ditch effort.

    And BMP, not much chance of that either. Fusion happens faster, but complications almost double of allograph and the same fusion rate.

    Carragge not withstanding, there are complications other than swimmers heading the wrong direction, like total bone resorbed, overgrowth, tissue irritations ... I don't want any of those either.

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  83. For as many good posts found here, I marvel at how some others truly meander with people taking shots at each other...Globus will succeed, but only at the expense of having lost many solid peep due to poor executive management. The model was based on a calculated risk of knowing the conservative Synthes culture and they 'won' despite losing the IP case...$20M? When they were already doing $100M at the time? I remain impressed with how this field has progressed in the level of arrogance and ignorance both in the field and at the executive levels in most of the companies today. It is an exception to the rule that there remains a 'good' management team with an appropriate 'sensitivity' to both internal and external customers...it's always about the dollars it seems--I get that all are in this gig as a for profit--nonetheless many remain short sided at how they manage expectations. Having worked for Zimmer Spine shortly after the Centerpulse acquisition, I can attest to the huge opportunity cost which occured when they tried to apply the Warsaw culture overnight to what could have been treated as a true start up again...they had the capital and a decent management team in place...TS was a decent guy, but ultimately a puppet and the rest of the team slowly migrated away because Z wasn't going to do anything more than maximize the ROI through cash-flow management. The ROI occurred in 18mos...and did so as a result of revenue tied more to Centerpulse than that of the spine revenue. Dynesis didn't really take off for another year. Still, they came out accomplishing what they wanted financially. All the brew-ha today with people coming in from Stryker will be interesting long-term since Zimmer will always be Zimmer--with the same stripes...

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