Monday, September 5, 2011

Are We Ready to Self-Implode? Yet?

As Mark Twain once said, "the reports of my death have been greatly exaggerated." As an author and humorist who grew up in Hannibal, Missouri, TSB can relate to Twain. As the summer comes to an end, and we enter the autumnal season there's only one question to ask our fellow readers, "are you ready for football?" Contrary to some observations, TSB does have a second, third, fourth, and fifth in line to succeed in the event of an attempt to subvert our organization, and contrary to a few industry platforms that would like to see our demise, the party goes on.

The past week's comments by our readers have exhibited the insanity that has come to rule the Spine World, your lives, and let alone the U.S. healthcare delivery system.  In addition to our readers comments, NBC Nightly News reported that the U.S. ranks 41st globally in infant mortality, and that we spend more per capita for healthcare in the US, than any other country in the world.  We would like to think that the majority of our readers are rational, we hope, and that this in itself is disconcerting, considering that five years ago we were ranked 29th, based on those facts TSB believes that we are moving in the right direction. NOT. Maybe it is time for a real Spine Summit, and not the BS Spine Technology Summit that has become a self-serving commercial venue for individual special interests, especially the person that runs it.  The definition of a Summit is a meeting or conference of heads of state, conducting diplomatic negotiations or an easing of tensions.  If there ever was tension in our industry, all one has to do is scroll down and read the comments on our blog site.  The only easing of tension at the Spine Summit is the hand massage each one of these individuals give one another.  You have a choice, patronize or boycott, and boycott seems to be more apropos.

How is it that we initiate a blog on a specific company, technology, a rare happening, or an individual observation, and it becomes a cry for help?  Don't believe it, just read the comments posted in the DTRAX blog. A.D.D., hopefully not, but then again, maybe so. The hilarious comments about the guy with $2,000 cowboy boots, Versace glasses, and canary sports jacket, we didn't know cowboys wore Versace, made us wonder what would the Duke would think if he was alive? Now there's a new definition for the rhinestone cowboy.  If anyone delivered a fitting reality check for the industry, TSB can only thank Mr. August 31, 2:37 p.m.. Yet, contrary to a minority of executives and surgeons opinions, this is our industry and many of you have made it what it is with your passion, commitment, and dedication to a job well done.  But getting back to our point, if our illustrious leaders happen to log on to our website, and we know you do, has it dawned upon you that you lack the leadership, the respect, verve and vision that it takes to make a difference. You have become greedy and useless as well, our readers can fill that in. You have become lackeys to your shareholders and the suck on the teat of The Street. Your arrogance belies most of our imaginations.  You lack the guts to do the right thing. As one of our eyes and ears on the street reported this week, where are the IDE's, where is the investment capital, what are the CEO's doing to drive progress and innovations? Blame the R&D departments, blame marketing, blame sales.  If y'all spent as much time focusing on innovation as you do on suing one another the world may be a better place.  

Well the fact is that if there ever was a time to have our so-called spine "heads of state" conduct a meeting and face the music, the time is now.  Our industry is a microcosm of a greater disease that afflicts the American Healthcare System.  GREED.   TSB wants to know are you willing to fight, or are you going to lie down?  Stay tuned for our report on the NuVasive and Medtronic as they go toe to toe battling one another in the courts.  Now that everyone has had their batteries recharged with a great vacation, it's time to get back to the spine world.


  1. thank you tsb for lumping us together and calling us all greedy.

  2. MM, sorry to disagree with you (a rare event), but if it was on NBC Nightly News then it must be true! Do you believe that Cuba's system is better than ours because of some trumped up numbers from their state-controlled media? Don't buy the lie, it's just another attempt by OUR state-controlled media to run me and you out of business with gov't-run healthcare, because we all make too much money according to Obama and Hillary. I expect better from you sir.

  3. Balance in life is a novel concept

  4. 5:49, pull your head out of the sand. As someone who has worked with health care systems in Europe, Asia and here, I can tell you that those statistics are pretty accurate. For the common man, and of course that does not mean you, the health care system in many countries works a lot better and cheaper. These numbers are not Castro or Hillary generated. Whether we all make too much money depends on your perspective. However, as our economy collectively makes less and less real tangible products, less new real money gets into the system, and less will be available to pay you. So instead of making more, in future you will make less. In case you have forgotten the concept, for real tangible products you take clay, water, steel, wood and make things that people all over the world are willing to pay more for than the raw materials and your labor have cost.

  5. Does anyone here know of any good companies that design lighting solutions for these minimally invasive spine surgeries?

  6. 5:49 is wrong.

    Not only do we have substandard care (according to NBC who got the numbers from WHO, the World Health Organization), we pay almost twice what the rest of the world pays for health care per capita.

    Last I looked US spending on health care was 14 percent of GDP. In the rest of the "civilized" world it was less than 10. No wonder we're not competitive.

    These are facts, and blaming Hillary or Obama or Cuba doesn't change them.

    But by all means, lets spend the rest of the thread arguing about facts.

  7. Hilarious, you spend the first half arguing that we pay too much for healthcare, and the second half demanding innovation! Do you understand the way business works at all?! Why would anyone risk capital for development of a new medicine or device when the reward is shrinking and under pressure to get infinitely smaller? Don't forget the added perk of this administration pushing for patents to be essentially useless.

    The good news is that your healthcare cost is likely to go down. Unfortunately your taxes will go up, your paycheck will go down, and if you have an incurable disease you can count on that to remain the case.

  8. Anyone seeing a huge decline in the amount of spine surgeries in their accounts?I work at a hospital with a few orthos and a good deal of neurosurgeons and there is a very limited spine surgery going on, and almost nothing instrumented.

  9. Everybody has skin in the game on the problems that TSB has highlighted above. Everybody also has the GREED to hide and disclaim his malfeasance. Surgeons in various locales know this well. The list is long. Many players at levels of responsibility are arduously investigating this list and gathering a laundry list of evidence (painful to gather for some of you at your esteemed levels). Well you brought the back room deals to the front and now it wears many faces. Beware who you know and what they want. "And the Beat goes on...."

  10. Hey 7:51, last I checked, innovation can be faster, better, easier, and yes, also cheaper! Southwest innovated in the airline industry by making air travel less expensive, not more, and became one of the leading players.

    One of the problems in many aspects of healthcare is that the marketplace is often not very price sensitive, so there has been little interest by anyone already in the market to come out with a cheaper alternative to their product. (If you don't get additional share, why reduce your revenues.) But now times are changing and incentives by decision makers to lower costs will hopefully result in some innovations in the form of less expensive alternatives.

    And yes, I second what others have said about the European and US systems. We have the most luxurious healthcare system in the world (for those who can afford to buy it), but not necessarily the best.

    And infant mortality is one of those statistics where we fall short, probably because we have a higher number of uninsured than most other countries, so a higher percentage here don't get the care that can prevent infant mortality. It's a tiny number in this and other civilized countries, so just having a few more folks outside of the safety net swings you from first to last pretty quickly.

  11. Give me a break with the infant mortality rates. I would say that has little to nothing to do with the quality of healthcare or access. You can lead a horse to water but you can't make him drink. We have a huge cultural problem of unqualified "parents" who don't give 2 sh*ts about prenatal care even if the surgeon general made free house calls. Abortion rates on unwanted and malformed fetuses is MUCH higher in those civilized nations you mention. That stat does not make or break a healthcare system, nor does it tell the whole story. Anytime a liberal (TSB) mentions babies or children, just know they are trying toanipulate policy via emotions.

  12. 5:49 here, 7:19 is wrong and must unscrew his lefty Eurotrash view of free markets! Americans also spend a heck of a lot more than the rest of the world on iPads, but Obama doesn't seem to see this as evil. It's our birthright as Americans to pay for platinum healthcare, we can afford it because we invented most of it.
    Ask your Canadian and Eurotrash buddies what happens near the end of their gov't fiscal years: healthcare simply stops. Nothing is free and I'm proud as hell to help my surgeons provide their patients with THE BEST, and I don't give a squeeze about how the rest of the world screws over their own populace's healthcare!

  13. 5:49- you seem to be missing the point. Our healthcare may be the most expensive, but it is clearly not the best- or even very good compared to most. If we spent twice as much on it next year, it would still not be the best. In fact, it may not even improve. I have probably been in 100 hospitals in 20 countries in the last 10 years; I can assure you that they were as nice as U.S. facilities, and the patients were receiving care at least as good as U.S. care.

    Healthcare is not a normally functioning economy in the U.S. The consumer is disconnected from the buying decision, and the relative value of the products available. Insurance policies eliminate local competition, and drive patients to in-plan providers rather than the best they can afford. Diminishing returns also play a role; a modern hip replacement costs 300% more than one designed 10 years ago, yet only improves survivorship by 2%. You get the idea.

    I agree that greed is present in our industry. Just like every other industry. Unfortunately our false healthcare economy has allowed this greed to become a market-deforming force, where schemes and tricks abound in place of true value creation. In that regard we resemble the financial industry, I'm ashamed to say.

    I think your criticism of business leadership in orthopedics is unfounded. They are simply playing on the field that's been presented to them. More IDE's you say? Tell that to the venture investors who are about to get burned on BMTI, who spent $100M on a company that followed FDA's procedures, had a study that met the endpoints, and got a panel recommendation- and STILL may not get FDA approval. Nobody is going to invest a dime in IDE's until FDA gets their heads out of their arses.

  14. First, kill all the lawyers.

    Ask any ( on call) Neurosurgeon how many false leads they receive from hospitalists. Everybody wants to pass off the problem patients as quickly as possible. For the high trained specialist there is no where to pass the buck too.

    Medicare and Medicaid create a buffet style healthcare system where patients get MRI's and every other high dollar test at the drop of a hat. You can't control
    costs in this system.

  15. Completely off subject but I need a little insight. Has anyone or is anyone in or been in a situation/circumstance where certain navigation companies who also sell hardware are holding the navigation fees over the hospital/surgeons head unless they use their hardware?

    I.E. Hospital owns the system but will train no one to run it and unless the surgeons use the parent companies hardware (navigation is free if their hardware is used), they will charge them quite a hefty case coverage fee.


  16. 7:16 have you looked into Lumitex? They claim they make all the light sources for Medtronic, Nuvasive etc, but sell at a fraction of the cost.

  17. Whose greed is in play here MM? Am I the greedy one for getting up early every day and busting my arse to put my God-given talents to use earning a nice living for myself and my family, or is it the schmuck that wants to spend his days at the beach surfing and smoking pot - and have healthcare and funemployment handed to him for nothing?

    In our system, are we upset that a surgeon is making some extra income by investing in a distributorship? That a hospital is marking up a $1,000 screw to $8,000? That an insurer is denying a perfectly justified procedure to save a $50,000 payment, despite a patients' premium having been fully paid for the last decade? That a patient wants more care than he is willing to pay for out of his pocket or has the insurance to cover? That a politician sees a chance to frame an issue in his favor to earn re-election?

    Stop with the lefty greed rhetoric already, MM. You know very well it's just a pile of Marxist dung to appease the masses. All you're seeing is a market economy at play, where every player is doing what he should---trying to get the best deal for himself, given the playing field available.

    The heads of the ortho companies will do just fine without some BS "summit". There's no music to face. Just a market economy, slightly restrained by government interventions (FDA, Medicare, Medicaid, etc) at work. Get used to it.

  18. Yeah, it seems that Lumitex seems to have a custom lighting accessory for nearly all of the "big players" retractor systems. The light they just started making for Pioneer seems to be most impressive.

  19. To MM, TSB and the four horseman that will takeover if the blog man retires,

    First I would like to say I hope that doesn't happen. This blog provides, at times, valuable insight. Make no mistake we are undergoing a correction on many levels but what is concerning is the lack of perspective when it comes to the operational changes. This is where the true attrition occurs and impacts a company's bottom line. Here is where the decision is made if sustainability can or cannot be achieved. Why the acquisitions? Lack of innovation or sustainability? I say sustainability. You cannot keep spending millions of dollars for Fedex and courier fees, product still getting lost and think this model is sustainable. Buying more sets/trays is NOT the answer. Until this is corrected all of the innovation in the world will not save us. Someone has to stop the bleeding before there is no reason for a blog, fair, profane, unprofessional, perfect or otherwise.

  20. TeDan Surgical has a great lighted MIS retractor set.

  21. I personally know a brilliant engineer and manager who last year went to work for someone else as a VP of R & D, which was NOT what he wanted to do, because he was afraid he wouldn't be able to pay for his family's health care if he worked for himself, and INNOVATED, which is what he wanted to do. The health care expense, which he would shoulder himself, unlike any European or Canadian, was very much the deciding factor.

    Sorry for the run-on sentence. Just a data point of one, I know.

  22. 1:28 Michelle Bachmann is looking for a campaign manager I think you qualify. If TSB is smoking pot and surfing, I'm in, its a lot better than sitting around in the operating room, JATSB admirer.

  23. Hi, I'm not in your industry but stumbled upon this blog while doing some investment research.
    Can anyone tell me a timeframe for the company named Globus go ing public?

  24. Getting close to sparking up and skiing. Come on snow!

  25. Check out a company called Invuity for lighting. They have lighted retractor blades, lighted suction, taylor retractors, etc. Some cool technology.

  26. 5:12 - hahahha.

    IMO we use technology, no, rely heavily on technology, more than we should. I read an article several months back about a surgeon from NY who was training his residents. After CT's, MRI's, a slew of tests along with everyone sharing ideas they couldn't figure out what was wrong with a patient.

    A dr from a less developed country came in, held a stethoscope to the pts chest and said there was fluid in his lungs. ding ding ding! we have a winner.

    technology and innovation is not always the answer. If a treatment or modality costs millions to bring to market and 10 times more than an existing treatment how much are the improved results worth? especially when we (as a world) could reallocate those funds in to preventative care for many many more people.

  27. What do you want to bet all the " residents" were clueless, weak, Affirmative Action types, schooled only in textbooks and litigation inspired content.

    And the " Dr from a less developed country" was probably sent here, on his families dime, or from a fund from the village, with pressure to succeed, but based on his past success and proven aptitude serving said village's clinics health needs or veterinary needs?

    We try and force a square peg in a round hole, ignoring reality, towards furthering irrational political ends, for votes. Foreign countries aren't rich enough or spoiled enough to be able to afford this folly.
    Some of our residents faint at the sight of blood, and others who never get how to use a ratchet handle.

  28. 1:28, given the nature of your writings you must be really struggling, as there is no talent detectable, God-given or otherwise. In a Eurotrash country you might have received state-funded institutional care.

  29. For anyone looking for some perspective on the U.S. infant mortality CLAIM:

    Gotta get the facts straight folks...

  30. 6:14, even when the facts are straight, 14th after eliminating San Marino and Martinique (really, Martinique is even better??) is not something to be too proud off given the money invested.

  31. Go to the this web site:

    The infant mortality rate is skewed higher in the African-American community.

    Infant mortality:

    Non-Hispanic Black 13.3

    Non-Hispanic White 5.6

    All Races 6.8

    The African American community by itself would rank about 80th. Take out the African American stats, and the US would be in the top 10.

    70% of African-American babies are born to single mothers, the majority of whom did not graduate high school and are on welfare. Almost half do not participate in any kind of prenatal care. Until we can change the welfare system in this country that is gutting the African American family unit, this will continue to be a horrific problem.

  32. 11:04 with a cross sectional breakdown. get-it. interesting point. and how ironic that it leads us to another problem with our country. get pregnant and live off welfare - yahoo!!! bogus.

  33. 2:11

    I know no one is listening, but just a note for the fact free among us, such as yourself: AFDC, which was the big Federal welfare program for mothers and children, was ended during the Clinton administration. About 12 years ago.

    In short, your dreams about mothers and children living high off the hog (God forbid) on your dime? Doesn't happen now for sure.

  34. 3:37

    My compliments on your thinking about this. It is true that Aid to Families with Dependent Children (AFDC)was eliminated under pressure from the Gingrich congress. However, it was replaced with TANF, Temporary Assistance for Needy Families. When taken together with food stamps, child day care, and post natal care programs, TANF now pumps more money into single-mother African American homes than AFDC did.

    In the name of Social Justice, our government is destroying the African American community by incentivizing them NOT to be families. I'm done, I'm off the soap box.

  35. 3:37

    You didn't actually think that welfare was dead, did you?

    Why don't we make the welfare recipients work the jobs that the illegal mexicans are currently working, and pay the mexicans to stay in Mexico and do nothing? We wouldn't spend ourselves into oblivion any faster, but at least everyone's lives would be improved (except the quality of labor would go way down)