Thursday, September 29, 2011

Take the Money Out of D.C. and Bring it Back to Main Street

Spine Nation,

The word on the Street is that you as a Nation are feeling the pain of an anemic economy. Based on the your input, it is becoming evidently clear that the future is not quite as sunny as some soothsayers like to predict.  Whether you are the Big Kahuna, eating that Big Kahuna Burger, or a little fish, you are being battered by your companies (lack of innovation), the surgeons (not all, but you have key detractors), the hospitals (what ever happened to free markets), its administrators and staff (let's face it they view us as the enemy), the BS companies like Vendor Rape, Status Blow, and Rep Craps, that make you jump through hoops and fire in order to earn a living.  As for eating the Big Kahuna Burger, TSB's only caveat is, be wary of what happens to those that opt to eat the BKB, you are susceptible to getting a visit from Vincent Vega and Jules Winnfield.  Oh yes, spine nation, we feel your angst, and things are not about to get easier.

As yesterday's news unfolded in the NY Times, that bastion of socialist and radical news reported that health insurance companies are charging "sharply" higher premiums this year, outstripping any growth in your wages and creating more uncertainty, as the government and corporations struggle to drive down the unrelenting increase in the cost to delivering quality, yet affordable care.  As the economy struggles, needing a desperate InFuseon of Geritol ( a dietary supplement from yesteryear before HGH become a cocktail of choice), as the real unemployment rate hovers around 15-16%, an increase in insurance premiums is as welcomed as a case of herpes, or a visit by the DOJ to Mississippi (was that Gene Hackman and Willem DaFoe).  Interestingly, both political parties are mum when it comes to attacking or criticizing their benefactors, because contrary to what some of readers believe, both Houses of Congress are bought and paid for by Big Insurance.  The BS that Aetna, United Healthcare and Oxford espouse is despicable, claiming that their rate increases are simply keeping pace with increases from physicians, hospitals, and pharmacies. What increases? What they fail to tell you is that what is billed and what is reimbursed paint a highly different scenario.  Of course, everyone will blame Obamacare, aka Romney Care, (you know the same guy that calls Obama an elitist, while he himself graduated from Harvard Law School), because as TSB has said in the past, Obama is the boogeyman in the room, but those of you that understand how the game is played know that the insurance industry has never decreased your premium regardless of whomever was in office?  As my good friend Alex Lukianov would say, nyet, nada, nein.

What is striking about this news, is that many of you have communicated that due to the poor economy, surgeries are down.  Now whether this is affecting some locally, or nationally for the long term is still playing itself out.  But one thing we do know is that people are putting off surgery and visiting their doctor in order to avoid co-payments and high deductibles, or until they meet their deductibles.  The fact remains that the longer one puts off an office visit, or a surgery, the higher the cost in taking care of that patient. Despite a decrease in numbers, insurance companies are defending their record profits, increase in premiums, payouts to shareholders and bonuses paid to these Greedy Bastards (yes Dylan Ratigan you are not alone in your observations).  As Benjamin M. Lawsky is quoted as saying, "these increases are often hitting people who just can't afford it.  But, on the other hand, we have to ensure in keeping these insurance companies healthy."  How much healthy can they get?  Spoken like the Superintendent whom oversees NY State's Insurance Department, and probably was once associated in some form or fashion with a Big Insurance company.

Let's face it, this is a game, whereby the only people that are benefitting from the rules are the people making the rules, or find new and creative ways to circumvent the rules. So this is your opportunity to stand up and be heard, its time to take all the money out of politics, whether you believe it or not, special interest are killing each and everyone of you, its killing your ability to earn an honest living, its BRUTALLY divided a country that calls itself the "United" States. We are no longer tolerant of one another, nor our we a compassionate society, especially when it comes to our own citizens.  We have been deluged with more scams, and business models that do nothing more than tear down the moral fiber of a society and industry that once was respected.  Just because Wall Street does it, doesn't mean its legal, nor is it right. The irony is that for all the people that espouse free-market principles, the only free markets that exist are the ones that specific people benefit from individually.  Take the example of the commentary on our previous post that dresses down sales people, calling you spoiled, overpaid, and sucking ass, TSB would bet that was a surgeon.  Here's a typical scenario, whereby someone is critiquing what market forces allow you to earn. But what is Dr. Famous' position when his earning power is threatened?  How does he know whether or not his earning has been over inflated, and what outcry do we hear every time the topic of decreasing Medicare reimbursements are tabled, or Big Insurance does not increase their reimbursements? Rather than coalescing and attempting to stand up and fight, but then again, it is always easier picking on, and beating up the weakest link in any chain of events.  So when you get an opportunity our good friends Dylan Ratigan and Jimmy Williams are proposing legislation to get all the money out of politics, here's your chance.  TSB wants to know what you think?


  1. It is easy to sit back and blame Wall Street MM. Those guys are the same as us and if any of us could get away with it we would charge $10k per screw and not think twice about sticking the patients with tremendous bills afterwards. Wall Street is simply maximizing their profits given their environment and set of rules to work with - just like us. That said, our healthcare system is fundamentally broken.

    Once we allow the free market to dictate insurance costs across state lines reimbursements will go up. I am about as free market capitalist as they come but I am not opposed to implementing profit percentage caps over insurance companies. I think they should be forced to fulfill their end of the agreement. I also think hospitals need to rethink their costing systems. The Harvard Business Review posted an excellent article written by Robert Kaplan and Michael Porter ( which provides excellent analysis and advice for restructuring hospital costs.

    Unfortunately, we as reps are stuck floating in this mess with zero influence and ability to do anything other than react. It is a shame that many of our companies are hesitant to innovate but that is not entirely the fault of the system we are in. Medtronic and J&J are pulling in enormous profits themselves - if not for their 'greed and profit sharing with shareholders' they could be sponsoring and driving more R&D.

    In short, it is easy to look at the mess and point fingers at the weakest link like you say than it is to fight; however we must unilaterally as an industry understand and promote individuals, politicians and leaders who are willing to fight for ideas mentioned above. It isn't just our lively hood at stake, its the US healthcare system.
    -Nick Haase

  2. Maybe congress can pass legislation requiring Globus to go public.

  3. I completely agree with you on this one TSB. It should absolutely against the law for our legislators to receive any kind of gain--be it financial or otherwise--outside of a fixed salary and benefits package. Noble and selfless leaders would still run for office while the slimy money-grubbers (read: 99% of Congress today) would gravitate to other careers that are more financially spine sales. Haha...

  4. I agree that most politicians are coin operated. Why would anyone spend millions of dollars campaigning for a job that pays $175K. The bennies are nice, but the "perks" are righteous.

    TSB, couldn't you get 1 post in without a jab at Republicans? C'mon dude, its ridiculous.

    The Healthcare Reform has not a single line of legislation that cuts cost to the system as a whole. The purpose is to make it "affordable" (free) to those who currently don't have it. Regardless of your opinion of insurance companies, they have a justification to increase premiums. Nothing has changed in the way they do business or lobby politicians. The only thing that has changed is the requirment to cover children for 8 more years on their parents policy (which takes them into prime child bearing years) and a requirement to do away with pre-exisitng conditions for children. Both of these policies will increase the payouts required so their must be an equal increase in premiums. Simple.

    It is obvious that blogs play a huge roll in the divisiveness of this country. Wheter you work for Globus or Medtronic. Whether you are Democrat or Republican. Everybody picks a team and they defend their team blindly, without logic or discernment. They cowardly attack the other team under the cloak of anonymity on these blogs.

    None of you would have the guts to say the things in person that you put on these blogs. Read the comments on any internet news story and observe the tone of the conversation. This is not real life people, don't form your opinions based on the rhetoric you read on a blog, including this one.

  5. The Economist, June 8, 2011:

    One way capitalism can make health care worse and more expensive

    DAVID BROOKS had an op-ed in the New York Times yesterday that proclaimed the near impossibility of restraining costs in health care through centralised government efficiency evaluations, which is being justly ridiculed by people (Jon Chait, Jonathan Cohn, Ezra Klein) who note that every single one of the world's centralised government-regulated health-care systems is far cheaper than America's relatively decentralised private-sector one. Mr Brooks has surely had this explained to him a thousand times by now, and his failure to process the fact or incorporate it into his worldview seems to me most likely to reflect an absence of the ideological furniture on which the fact could sit. Mr Brooks doesn't seem to have an instinctive understanding of how it can be possible for unregulated free-market health-care systems to cost more and deliver inferior care than strongly regulated systems with heavy government involvement, and that's why, while he occasionally must have to acknowledge the existence of the French health-care system, he can't seem to retain it. one example among a million.

    The other day I went to the IPO announcement of a company that does some fairly state-of-the-art medical stuff. The company was spun off from a public institute a few years back to exploit this technology, but it's been unable to establish significant revenue or market share, or to get within shouting distance of breaking even. Meanwhile, competitors with similar technologies have gobbled up most of the market share, and one is already quite profitable. The company said it planned to raise some tens of millions of dollars with the share issue, many times its current annual expenditures and about a third of its overall market cap. And what would it do with this money? It was going to use half of it to finance a marketing drive, targeting key decisionmakers at American health-care providers and health insurers, and doctors.

    Why hadn't this company been able to generate significant revenues? Were its technologies inferior? No, said an independent molecular biologist I talked to. Its product was certainly as good as the competition's. Moreover, it had actually gone to the trouble of getting its technology approved by the FDA, which the competition hadn't. (In this sub-sector FDA approval isn't yet mandatory.) But it hadn't marketed itself well. It hadn't established the relationships with providers and insurers that would ensure that its product was the one they selected. Doing so would require a marketing budget of tens of millions of dollars, in a sub-sector where the entire annual market is a few hundred million dollars.

  6. Just think about this for a minute. A medical technology company is going public to generate the money it needs to advertise its products to hospital directors and insurance-company reimbursement officers. This entails significant extra expenditures for marketing, the new stocks issued to fund the marketing will ultimately have to pay dividends, banks will have to be paid to supervise the IPO that was needed to generate the funds to finance the marketing campaign (presumably charging the industry-cartel standard 7%)...and all this will have to be paid for by driving up the price the company charges to deliver its technologies. But beyond the added expense, why would anyone think that a system in which marketing plays such a large role is likely to be more effective, to lead to better treatment, than the kind of process of expert review that governs grant awards at NIH or publishing decisions at peer-reviewed journals? Why do we think that a system in which ads for Claritin are all over the subways will generate better overall health results than one where a national review board determines whether Claritin delivers treatment outcomes for some populations sufficiently superior to justify its added expense over similar generics? What do we expect from a system in which, as ProPublica reports today, body imaging companies hire telemarketers to sell random people CT scans over the phone?

    Matthew Yglesias takes the right tack by comparing the medical industry to the shoe industry, where we all agree that the private sector produces far better shoes at far lower cost than could be produced by a state-owned manufacturer. I think the analogy is also helpful when we add in the dimension of marketing. Beyond a certain point, you can't explain the value of a great pair of shoes in any rational fashion. The reason a pair of Air Jordans was vastly superior to a pair of nondescript Soviet sneakers in 1989 was only partly that they were more durable, or had better support and traction. Most of the added value wasn't there. It was in the interplay of marketing and fashion. The satisfaction customers derive from marketing and fashion is absolutely real; in the case of shoes, it's practically the whole point. But in the case of medicine, it usually shouldn't have any place in decisionmaking. We shouldn't be aiming to make Americans happy by marketing medically useless knee surgery to them and then letting them walk down the street feeling all fine and dandy with snazzy new knees that aren't actually any better than the old ones. Not in the publically insured sector, anyway. Medically unnecessary cosmetic surgery is fine, but not on the taxpayer's dime.

    The other key thing to pay attention to is who this marketing campaign was targeted at: key decisionmakers at providers and insurance companies. Those are the people who decide whether medical procedures get ordered. It's not patients. Patients aren't going to experience a loss of freedom or satisfaction because an expert reviewer at the Independant Payment Advisory Board makes the call as to whether a procedure is medically beneficial, rather than the corresponding bureaucrat at their insurance provider or at the for-profit clinic they're attending. Health care is different from buying shoes. Which is why it wouldn't be at all surprising if a board of 15 experts could play a major role in reducing expenses and improving care outcomes in the American medical industry. That's what corresponding boards of experts in France, Germany, Britain, Canada, the Netherlands and so on do, which is why their health-care systems cost half what ours does, cover everyone in their countries, and generally provide better care.

  7. While I am in complete agreement that the countries mentioned spend less on health care, I would tend to disagree with the notn that it is generally better than in the US. By what standard are you basing that statement.

    The problem we face is that we are accustomed to a high level of access to diagnostics and treatments that patients in those countries are not provided. For the government to step in and actually save money, they will have to limit access. Even if the limitations don't degrade health outcomes, politicians are not going to ration even unnecessary care. It will cost them votes and they don't have the spines to make the choices that are right for the country if they go against the publics wishes. That is why the health care reform won't work, it doesnt limit unnecessary expenses, it only provides access to care, necessary and otherwise, to the people who don't have the access now. The politicians aren't even willing to provide limited access to the indigent, they will have the same access as everyone else.

    Likewise, we have a system of providers and suppliers that are fed from the excess care delivered. To ration access to that unneeded care would require politicians to go against the physician's lobby and the device mfg lobby. Again, they won't do it. So where is thee efficiency going to come from. I would submit to you all that there will be no reduction in the amount of GDP spent on healthcare. It will simply be shifted around, or redistributed.


  9. "It will simply be shifted around, or redistributed."

    When is Globus going to be redistributed?

  10. 2:30, I am a citizen of the Netherlands and have spent over 15 years in the US. I can assure you that the so-called higher level of access to diagnostics and treatments in the US is a myth, that is kept alive because so few Americans have any in-depth experience with health care in the countries mentioned. Here on the east coast I had to wait on average 7 weeks before I can see my family doctor for a non-urgent matter, I had to wait at least 15 weeks before the dermatologist had any time, and waiting times for orthopedics and spine were and are not much better, unless you have the connections. In the Netherlands you may have to wait a few days before seeing your GP, and anywhere from 2 to 10 weeks for a specialist. Diagnostic and therapeutic tools are 99.9% the same as in the US. The big difference is that their use is completely dictated by clinical necessity and not influenced by any motives of legal coverage or financial gain, so hey are used a lot less. And the whole shebang is 90% paid for by PRIVATE insurance companies, which are regulated by the government as utilities. This means that they have to abide by some basic rules. One of them is that their CEOs cannot earn 30MM a year, which of course is the one socialist sin that the US will never tolerate...

  11. 3:05, I too have lived in the US for just under 5 years and have also lived in England and Canada. Your comments are rock solid and echo my experiences 100%. GPs are utilized as gate keepers so a person with a sore back, sore throat, or itchy scalp isn't popping into the local neuro, ENT, or Derm and their increased fees and services. The vast majority of Americans have no clue what healthcare is like outside of the USA, outside of op-eds, magazine articles and politicians espousing their various points of view. As a number of people have stated on the healthcare debate, you can have your own point of view, but you can't have your own facts. Data and statistics don't lie and unfortunately this commonly states that the US finds itself no where near the top ten in healthcare. If money is no object, I truly believe that the USA is the place for your healthcare, but for the rest of us, falling through the cracks can have dire consequences.

  12. Democrats are bad, mmmmkay. Obama is bad, mmmmkay. Hey 1:47, shut yo face.

  13. Are insurance companies being "too greedy"? Hmm...

    Aetna for FY 2010:
    Revenues: $34,246m
    Income after tax: $1,766.8m
    Margin = 5.2%.

    Apple, FY 2010:
    Revenues: $65,225m
    Income after tax: 14,013m
    Margin: 21.5%

    Starbucks, FY 2010:
    Revenue: $10,707.40
    Income after tax: 948.30
    Margin: 8.9%

    Maybe they need to raise premiums to keep the business profitable....

  14. Great comparison.....

    Arguably 2 of the most successful businesses in the world against a
    health insurer. Fail.

  15. 3:05

    I would be interested to know the number of docs per capita. My understanding is that we have more docs per capita in the US. Yet we still have waiting periods? Is the reason because we don't have enough doctors? I don't think so. Is it because a gatekeeper or insurance company controls who gets seen. Again, I dont think so. I think it is because American seek medical attention for more minor issues. And as you said, they all get a full work up with diagnostics and the doctors are incentivized to provide many of the services because they have skin in the game. There are more imaging centers than there are Subway restaurants, and doctors own most of them now.

    By access, I am not simply referring to the wait time. If you can't get into a dermatologist, there are dozens of others you could go to. By access, I am referring more to the tests and treatments that cost us so much money. I am not saying your healthcare quality is poor, just that you don't use as much of it and I agree with that philosophy. But how can it be taken away now that all Americans are used to that level of access? Americans are notoriously selfish when it comes to taking away something that they have gotten accustomed to. "Reform healthcare, but don't make me pay for my own CPAP machine and power scooter, that's just not fair".

  16. 6:01

    Do you think a 5.2% margin is in the range of "evil" and "greedy". I can tell you this, I make a lot more margin than that in my business.

  17. 4:14
    Tell me that to my face, cowardly punk.

    Yours truly,

  18. Profit margin comparisons across separate industries are meaningless. Companies under public scrutiny such as those in insurance and energy sectors are much less likely to post high profit margins for a couple of reasons:

    Firstly, they are easy political targets every time any of those companies show profits in a down economy, it angers the public.

    Secondly, as a result of my previous point, many would-be profits are often disguised through higher costs or deferred revenue.

    Those flash numbers sure do make a nice quick impression though as you have shown

  19. 6:35,

    What's with the name calling?

  20. I love hearing bankrupt Europeans, who've had their national defense funded by the U.S. for the past 60+ years, pat themselves on the back for their healthcare systems.  

    I spent a month as a patient in an EU member hospital.  The care I received was acceptable but I found it humorous that I had to provision my own spoon, fork and knife while I was there and wash it each time I was done with my meal.  I guess that's one way to cut down on healthcare costs.  Silly Americans and their need for flatware!  Another family member of mine (a European) in different EU country, regularly has to offer bribes in order to see her oncologist in a timely manner--and isn't time of the essence when we're talking about cancer care?    Sounds like a de facto copayment doesn't it?

    Each country in Europe offers individual variation but the bottom line is that European socialized healthcare is no better or worse--fundamentally--than the American system.  Both systems are train wrecks and unless, and until, people start accepting individual responsibility for their health, vs. assuming the State can, should, and will take care of them cradle to grave, both systems, and potentially the countries that fund them, are headed for collapse.

    It's time to reap the whirlwind ye entitlement minded pansies who think you should live to 100 without so much as a sniffle or an owie.

  21. 7:46, as you rightly point out there is no single system in the EU, especially as the EU now includes countries such as Romania and Bulgaria (which sends us their donor bone, by the way, courtesy of you know who). Therefore, you should focus on countries such as Germany, France, The Netherlands, Sweden, and non-EU countries such as Norway and Switzerland. You're also right in that no system is perfect, but the imperfections in these countries fade in the face of the imperfections here, and on average they cost less than half as much. And just as a fun fact, in the US, where ~17% is uninsured, about 30% of costs are born by various government agencies, in The Netherlands, where ~1% is uninsured, that number is 5.5%. So, which system is more socialized?

  22. Meanwhile the insider transactions at ATEC are getting slammed.

  23. What is the reason for the low uninsured number? Is unemployment low or avg income high. Does the government mandate that it is purchased? I am unfamiliar with their system, but <1% uninsured is a remarkable number.

    I don't think anyone disputes the fact that Medicare/Medicaid is socialized medicine. It is also grossly abused with overutilization and rampant fraud which the government can't effectively control. Private carriers are far better at catching the cheats.

  24. 12:55
    What are you talking about?

  25. 12:55, only if you keep the private insurers under control. No CEO is worth 30MM per year, unless he or she invented something. Insurance CEOs obviously have invented nothing. The 1% exists because premiums are relatively affordable, unemployment benefits are better than here, and in general there is a recognition that having health insurance is worthwhile. The non-insured tend to be the ones that refuse on religious grounds.

  26. 2:13
    Are the premiums subsidized? How are unemployment benefits paid for? What are the effective tax rates in the countries with Cadillac healthcare for all? What is the overall standard of living like? What kind of houses do people live in? How much does a liter of petrol cost? Etc etc etc.

    There are opportunity costs here that must be taken in to consideration unless healthcare for all, regardless of one's ability to pay, is considered the first and last most important thing in society.

  27. Dear 2:13,
    Who, may I ask, are you to say that no insurance company CEO is worth 30 million? Is his contribution to society less than Peyton Manning's? Heaven forbid that CEO should say "no Rutgers English major shlepping spinal instrument trays and pointing at pedicle screws with a laser pen is worth 300K per year."

    CEO pay is an example of truly market driven remuneration. Talent migrates to $s. If the position doesn't pay a company gets a commensurate quality leader. It may be me but some of your comments, while well informed in the area of healthcare, seem a tad Pollyanna-ish.

  28. A lot of European countries also mandate that if you draw unemployment benefits for a certain period of time (usually 6 months), you are required to start a program that teaches you a needed skill. This helps move people off unemployment and helps countries adapt to their industry needs. We could learn from Europe.

  29. zzzzzzzzzzzzzzzzzzzzz........


    Hey Wake up !!!!!!

    Dry discussion so far but dis anyone see that NuVa stock is at an all time LOW !

    The street must not Likey the great news of their exciting new acquisition.


  30. anybody following what propaganda Orthodirect is pushing? Nasty, nasty stuff. Article below written by a surgeon with his own company. Certified techs? Lord help us.

  31. A couple of lawsuits against hospitals will cure that. Having reps help the OR staff is really most important during the fifteen minutes each case the relief tech comes in, who usually does only eyes or general surgery, and who never works with complicated instruments for a reason... they hate it...and their stumbling leads to loss of critical time, wrong instruments and implants being handed to the surgeon, and a good case suddenly gone terribly wrong.

  32. How many of his patients care about the profit margin of his surgery center enough to receive "generic" implants? I'm sure most would rather pay a little higher copay

  33. I'd like to see us go to a European-like single payer patient reimbursement model (much more efficient and fair), and also go to a European-style device approval system; i.e. no FDA, no IDEs or PMA's, just ISO approval of devices (just as efficient and CHEAPER).

    Talk about innovation. Spurring creativity! Yeah baby!

    You say that I'm a dreamer
    But I'm not the only one
    Someday you will join us
    and the world will live as one

  34. Dear god,
    Please look kindly upon us Mighty Cheetas.
    This stock price thingy is really concerning to us Felines.
    Under 17 now ?
    WTF God ?

  35. In the meantime the purple stock is seeing red at 15.50. Any bets as to how low it will go? Opening bid: 10

  36. Maybe Globus can buy them?

  37. Pretty soon you'll be able to buy Nuvasive for a share in a peanut butter sandwhich.

    Big Blue'll cost you an additional glass of Kool-Aid.

  38. What about fraudulent billing on stand-alone cages, interspinous spacers, and other devices ? Its disgusting that surgeons do it even though they know they are committing fraud on their codes. Many companies are just as guilty by misleading surgeons that they can get away with it, even though they know its fraud, The victims are patients and taxpayers. A guy that sticks up liquor stores and hasn't been arrested yet is still an armed robber! Our healthcare industry is revolting and hopefully one day the government will make those rapists pay for their crimes.

    I'd like to see their faces if medicare ever collects back the money that has been stolen from tax payers.

  39. Damn I'm bored. What else is going on out there? What's the latest with Globas?

  40. What about Zimmer Spine?

    One reader on this blog claimed to have an inside knowledge of a huge deal that Zimmer was supposed to making soon...this was couple of months ago.

    What's the news now, buddy?

  41. 4:55,

    Can you share a few more details on the fraudulent billing with ISPs? What are companies telling Docs to code? What are some of the coding schemes being used? How should it be coded?


  42. Always though NUVA stock shouldn't be much more than 6 or 7 bucks. Holy ATEC stock tank!!

  43. A few bad headlines in a bad market. Typical overreaction. Could be wrong, but I see NUVA stock back in the 20s as early as this week possibly next. Will finish 2011 low-mid 30's.

  44. 6:47 can I get some of what you're smoking? That must be some good stuff! I to am sick of dealing with this pesky reality.

  45. Didn't Zimmer get most of the IP that MDT got when the Michelson lawsuit settled? Maybe they'll step in and buy Nuva or Globus. I hear there has been alot of activity at that little Warsaw airport.

  46. Dear NUVA Board of Directors:

    We would please like a new management team leading the company. The current group seems to have been more hype than substance.

    Someone with a track record of actual earnings, not just revenue, growth would be appreciated.

    Oh, and can we please get our money back from that gaudy sail you bought for the chief patent counsel's boat? Turns out, perhaps his work wasn't worth such a nice reward. Hope you remembered to file that as a fringe benefit with IRS!

    With warmest regards,

    Your investors.

  47. Spine-tech licensed Michelson technology. Zimmer bought Spine-tech. The license is still valid even though Michelson sold out to MDT. Far as I know, that's the only connection between Michelson's IP and Zimmer.

    Zimmer bought Endius and found that 1 + 1 = 1.1
    Zimmer bought Abbott and discovered that 1 + 1 = 1.2, approximately.

    The trouble with growth through acquisition is that have to buy low, or at least buy something you can grow. I dunno what they can buy low, but even if they find something their record in terms of growing it is not good.

    Dave D is a muscle builder. There's a good book on that culture, but basically they are people who feel weak inside and want to shield themselves from the world. That's not a trait of a good leader. And he isn't.

  48. 8:43-Activity is probably at Biomet--word out of Europe is the S&N deal to be finalized