Monday, October 24, 2011

Crossfire

Day by day, night after night
Blinded by the Neon light
Hurry here, hustlin' there
No one's got the time to spare
Money's tight and nothin's free
Won't somebody come and rescue me
I'm stranded, caught in the crossfire

Well fellow bloggers, it seems like the Spinal USA debacle won't come to rest.  No it's not Carville and Buchanan, neither is it Begala or Kingsley, some individuals have taken it upon themselves to question the credibility of the Wall Street Journal, calling the article, well...... tabloid sensationalism. A sophomoric attack on the bastion of capitalist publications, you know what Tommy DeVito would say, WTF?  Spinal USA's CEO, compares SUSA (no offense Synthes) to K2M and Kyphon. C'mon Jim, you can't be serious? As Clara Peller use to say, "Where's the Beef?" Granted, we all know that K2M and Kyphon had surgeon investors, but those surgeons were, well....actually designers of systems that have either set a precedent for managing VCFx's, paving the way for investment capital into other companies with VCFx technologies, or arguably, the MESA can be called the best deformity system in the industry. What is it that SUSA has in its IP pipeline that will actually make it a legitimate player in the industry?  Another pedicle screw? Another cervical plate? Here is your chance to set the record straight.  Prior to the this story making headline news, one must ask, where was the transparency? Today, SUSA attempts to perform damage control. After talking to various people in the industry, there were some  people that didn't know this company even existed. Hmmmmm?  It gets even funnier when a surgeon's wife defends the organization in the WSJ, going to the extent of defending the surgeons decision making without identifying herself as the surgeons wife, deflecting the impetus of the story on some disgruntled rep. As usual, its the reps fault, but isn't this class warfare at its best?  Carreyou and McGinty must be shaking in their boots, when their credibility is questioned by the Jimmy Olsen's of the world.  But let's be frank with one another, does anyone believe that the WSJ would run a story for the sake of tabloid sensationalism, unlike some other platforms that sensationalize anything and everything in the industry?  Somewhere between those words a bigger story prevails as to what's been going on for years in this industry, as some people jump from one venture to another in hopes of hitting a financial windfall without any consideration as to how it effects the industry, the investors, the employees, the patients, and one's own decision making prowess.  As for emerging technology or innovation, maybe SUSA will be a new entrant for the Spine Technology Awards to solicit, they could even have a new category called "best me too products."  Considering that Pastena brought up K2M, TSB must ask the six million dollar question, is that company on the move?

Over the last few weeks, there has been much activity down in Leesburg,Virginia. Considering that K2M launched two new products at CNS, which were line extensions for their cervical portfolio, the Pyrennes, translational cervical plate and the Chesapeake zero-profile device now provides K2M distributors with a complimentary armamentarium.  This past weekend at the Society for Minimally Invasive Spine Surgery in Viva Las Wages, K2M debuted the RAVINE lateral access system along with the ALEUTIAN lateral inter body system.  The dual flat blade system should be a less invasive system for splitting the trasnspsoas. Some people will wonder why TSB is writing about K2M?  Well....... considering that Spinal USA attempted to compare themselves to a company that continues to increase its product portfolio and market share on a national level attaining critical mass, let's see what new and innovative technology will come out of Jackson, MS?  TSB wants to know is Spinal USA a nationally based company, or are they nothing more than a physician owned company?  TSB wants to know what the court of public opinion believes?

54 comments:

  1. Kind of a dumb question TSB. SUSA is a giant POD. K2M is a legitimate company trying to compete for legitimate business. What about discussing how the 2013 med device tax is going to kill half of the spine companies out there?

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  2. 1:19 there is a difference between a POD and POC. As for killing half of the spine companies out there, that would not be a bad idea especially the small ones that do nothing but re-engineer other companies products, JMO, are they really contributing anything new and innovative?

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  3. Spinal USA is a PFP and not a POD or POC. Pay-For-Play. You can call it whatever you like but I call it a inducement or kickback. That is what people would say about me if I paid surgeons to use my product.

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  4. To find out if SUSA is a legit company or a PFP POD, lets ask the TSB readership if anyone out there knows of ANY surgeon out there using SUSA products that does NOT have a financial interest in the company OR is NOT a member of a POD implanting SUSA and other products.

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  5. 1:22 my hunch tells me you work for one of the legacy companies (mdt,synthes/depuy) and would love to see the pod model and ankle biters go away. Unfortunately for you 1:22 they will be around in some form going forward. The system is not going to support a rep making $300k a year no matter how handy you are with that laser pointer while wearing your lead apron. On top of that the system is not going to support your distributor who makes $3 million a year, never steps foot in the accounts and brings no value other than a nebulous dinner, payola, and golf/ski trip with your A-dog surgeon. The surgeons have had enough and are sick of their implant rep making more per case than he is. All surgeons know how filthy rich your distributor is and they are sick of him to. Finally, the surgeons collectively are far more organized from a lobbying stand point than a bunch of 32 year old repressed jocks that actually think they add value to the care of their patients spine. The surgeons,government and doj, will figure out a way to make this work because it will ultimately drive costs down when you back the cut that you and your distributor enjoy. Sorry 1:22 save your money because the gravy train is coming to an end.

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  6. Choice Spine? Seriously? Looks very POD-ish. Is the pot calling the kettle black here?

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  7. @ 2:08... here, here.

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  8. Kyphon? Does Anyone know their annual sales within MDT now? I know they lost a ton of people recently.

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  9. 2:08
    No surgeon, nor the DOJ will ever determine how much a rep will make. When you use a product, some sales rep is going to get paid as long as you have a say so in what products get implanted in your patients. The amount they get paid is not, and will never be, controlled by you. The market will determine how much he is paid (as a percentage of the sale). You do have control over whether or not a particular rep gets paid by choosing his product or not. But the guy who you do pick, he will get paid. Why do you care how much he makes if he earned your business.
    And you can keep telling yourself a rep makes more than you on a case if it makes you feel better about being judgemental or if it gives you a sense of power and control to feel like you control something that you don't. It is absurd to think a rep makes more on an ACDF than the surgeon. It might happen on a scoli or multilevel fusion, but that doesn't mean the rep makes more than you on his W2. Even if he does make more than you, are you so petty as to use that as a reason not to use that rep? How does that correlate with product quality or the value that rep brings to the OR?
    Likewise, if a distributor makes $3M, the value by which he is being paid is not based on his acumen in the OR or his ability to set up trays, knucklehead. He is a businessman who is turning a bunch of product and that is what he is paid to do. You can't do it, therefore no one should be paid that well to do? What kind of narcissistic opinion is that?
    Do what you do, do it well, compete with other surgeons and quit worrying about how much other people make in other jobs. It is very easy for us to say that spine surgeons make too much and we could all jump on that bandwagon if we choose. We just arent control freaks who are always right.

    Stick to the Spine Journal and leave the Wall Street Journal to people who live in the real world!

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  10. @208 Surgeons that make millions are considered innovators and researchers with only a few bad apples- CROOKS.
    Distributors and reps that make a million or a couple hundred thousand (respectively) are useless jocks that don't give any added value and if they sell a small companies products, they are CROOKS!
    Quite frankly, Doctor, stick to doing surgery, reps stick to providing great service to the doctors that demean you and at the same time demand expensive dinners, consulting contracts (because we all know you are the only MD that can add value) and hospitals that keep driving down implants. Ditto to 2:58

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  11. SUSA may well be a viable model going forward. Get over it and compete! I compete against them in FL and it's not fair but life aint fair. Or join them as a POD bitch, either way you will feed your family.

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  12. Gentlemen, you're all right. No surgeon should be concerned with what a distributor or rep makes. Their interest should solely be what the service level and the quality of products are that they are providing, in relation to their cost.

    And it is in the latter point that 2:08 is correct in saying that the system likely won't support our heretofor luxurious distribution chain in the future. Whether it's because their hospitals are forcing them to take an interest in cost, or simply limiting their options, or they're choosing to capitalize on the lucrative margin of the distribution chain themselves (POD), either way, it's less in the pot for the traditional distributors and reps to divvy.

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  13. ... sorry for the presumptiousness, as I should have said "Ladies and/or Gentlemen..."

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  14. K2M's lateral system is a joke. FYI they launched it over a year ago. This "launch" was their international launch of the same enormous retractor that everyone else uses in posterior spine cases. Not many use K2M without getting paid. That's why nobody will buy that dog and it's NOT going public.

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  15. 2:08- Why all the anger and resentment toward those that have attained a degree of success in their professions? I have been around the medical device business for 25+ years and certainly have seen significant money made by those that brought minimal "value" and in many cases demonstrated consistently unethical behavior. However, more often I have seen high integrity people rewarded for bringing great talent and effort to their jobs. Your gross generalizations directed at the honest and hard working members of the medical device industry are simply ignorant and piss me off.
    I hear your vitriol spewed regularly, typically by individuals that for whatever reason seem to have a great sense of entitlement. I’ve worked my ass off, made many sacrifices (as did my wife and kids), took some risks and made some wise/lucky career decisions to attain a degree of professional and financial success. Most of the people I work with have followed similar paths and we apologize for nothing. We are the ones working, paying taxes, buying medical insurance and educating our kids. How many of the folks camping out on Wall Street can say the same?
    I do hope you are correct in your assessment that “the gravy train is coming to an end”. It can go over a cliff for all I care and I hope all the seats are filled with the sleaze and greed that are so often the topic of this blog.

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  16. K2M was bought last year.

    http://www.medicaldevicestoday.com/2010/11/welsh-carson-taps-into-spinal-market-with-k2m-buy.html

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  17. Anyone else see this?? Are companies running press releases when they sign up distributors? Stryker must be loving that

    10:45 a.m. Bacterin was awarded approved vendor status by American Medical Concepts, an orthopaedic, spine and neuro product distribution company that serves hospitals and freestanding surgery centers in the northwestern U.S. (Source: Bacterin International Holdings, Inc.)

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  18. @5:25. Just read that press release. WTF. They are just a distributor. Large yes...but a distributor still. It infers they American Medical Concepts owns the hospitals and surgery centers. They do not. That is the most ridiculous PR I have ever seen.

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  19. 2:08

    POD prices are equal or more expensive in my market. So surgeons are using products that offer no savings to hospital, patient or insurance. If the POD saves the system money maybe its legit model. Surgeons use the cost savings as a justification to use the implants. If they were concerned w/ saving the patient money than why not mark up implants 20% above their purchase price. A surgeon could still make 100K a year extra. Instead prices are the same or higher than the comp. So instead of making a 100k on implants they are pocketing 400k. Saving the hospital zero $0 000

    You maybe right that POD's will be around for awhile.

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  20. The patients are not seeing any reduction in the cost of healthcare. The hospitals still bill off of our list price plus their markup. The patients and payers are not seeing any cost reduction. The hospitals are however seeing, increased profits. The surgeons, especially 2:08, are ignorant pawns, or have a financial interest in the profit of his/her/it's hospital.

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  21. 3:59...guess you lost business to K2M

    Happens to everyone, get over it.

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  22. Can we please get back to bashing Nuvasive & Globus?

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  23. No one cares about Globus or Bacterin. They are irrelevant.

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  24. K2M? Give me a break TSB! A bunch of me too products at best! What actually did they launch at CNS that you are so proud of? This is your second mention in as many posts. Get off the bandwagon.

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  25. TSB = K2M paid advertiser?

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  26. 6:17, looks like you can find out at NASS...

    http://www.k2m.com/en_us/press_releases/press_releases/view/42/k2m-continues-its-momentum-with-nine-new-products-at-2011-north-american-spine-society-annual-meeting

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  27. 2:58, the rep making $300k and the distributor making $3 million are both going to get a haircut. There are plenty of qualified people to "turn a bunch of product" as you say. You are correct that a surgeon nor the DOJ will determine a reps income, but the market will.

    4:10, Congratulations on working,paying taxes, buying medical insurance and educating your kids. That's what you are supposed to do especially since you are not camping out on wall street. Sorry that you are pissed off, and yes you will get a
    haircut to. Glad you worked your ass off all of these years and again that is what you are supposed to do.

    All the best, 2:08

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  28. @6:16: It's merely indicative of the desperation at Bacterin to show any kind of activity suggesting growth. What is missing from the PR is anything substantive, such as what, if any, increase in sales or market share has occurred. The other non-exclusive distributors in the area are surely excited to read the announcement. It is especially curious in light of the CFO's statements on the Q1 2011 Financial Results Conference Call when he said (6:05), "...as part of the company's continued conversion to a direct sales model from a distributor-based model." and (6:42), "we believe an increasing portion of our sales will come from our direct sales force, as we look forward..."

    http://web.servicebureau.net/conf/meta?i=1113294135&c=2343&m=was&u=/w_ccbn.xsl&date_ticker=BONE

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  29. WOW!!!!!!! Just out today. Give up Medtronic!

    Bacterin International study shows OsteoSponge equivalence to rhBMP-2 in spinal fusion (BONE) 2.80 +0.01 : Used in conjunction with the patients' own bone marrow aspirate, OsteoSponge is a highly effective osteoinductive and osteoconductive bone scaffold that aids in spinal fusion. The study was conducted in collaboration with researchers at the Salt Lake Orthopaedic Clinic, Spine Surgery of Salt Lake City. The two-year post-operative, clinical data showed OsteoSponge to be equivalent to rhBMP-2 in achieving an interbody fusion based upon radiographic assessment, CT scans, and quality of life outcomes. Additionally, patients receiving the OsteoSponge graft reported statistically significant less leg pain at one year relative to the rhBMP-2 group

    http://finance.yahoo.com/news/Bacterin-Study-Shows-prnews-618746924.html?x=0&.v=1

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  30. Unless I am missing something, Osteosponge is just a DBM, 100% donor tissue. They have some proprietary processing, but I don't see how that would generate osteoinduction/conduction above other similar DBM products. The better study would be if it could outperform generic DBM and aspirate in the same indications.

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  31. K2M is extremely aggressive on recruiting talent and on price. I am a new K2M distributor who worked for Danek for 7 years and finally discovered that MDT is no longer competitive.

    K2M's MIS system for degen spine is better than Longitude or Sextant. Ravine is a very nice lateral system when coupled with appropriate monitoring. We also just launched Solera....I mean Everest..

    tb

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  32. Yep. Agreed, 307. I am familiar with the bmp paper. The criteria for fusion is very broad. And after two years bone grew... I would hope so. Was there any sign of arthrodesis at 6 months? How much radiation did you zap the patient with during this post-market study?

    Demineralization leaves a pure collagen scaffold. We know cells, be it the patient's or allograft, like sticking to collagen but can we call that osteoinductive?

    I have seen other DBMs grow bone in two years. I've also seen autograft grow bone. While I applaud the efforts of the study, unfortunately, it falls short.

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  33. 2:08
    If there were a plenty of people in a market that could turn a bunch of product, the market wouldn't pay a distributor $3M (your example) because one of the many would do it for less. The fact is that there aren't plenty of people who can do this job well. And just so you are clear on it, the job is not to be handy with a laser pointer. The job is to sell product. The laser pointer skill is a by product of skill and knowledge about the products, the OR, your technique or whatever else is required to sell product.

    As far as the market determining what we make, I stated that clearly in my earlier post. The best way to take the earning potential away from sales reps is to take the decision making away from the surgeon. That is happening in some places, but I'm sure you are against that type of strategy to save somebody else's dollar. Another way to drive down healthcare costs would be to pay surgeons a flat salary. Even a salary that is hire than what they already make. You would see surgical volumes plummet if the cases didn't need to be done in order to make an obscene income (I thought I would throw that in there so you can see what it's like for a third party to judge your income based on their non-qualified opinion). If you don't disagree with that, then you, by default, agree that surgeons perform cases for financial reasons as much as clinical reasons. So who is worse? The distributor who makes $3M because he beat his competition or the surgeon who makes $3M because he doesn't have to beat the competition, he just has to have a low threshold to cut.

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  34. 3:27
    WTF? If a rep sells products for a small company, they are crooks? You must be smoking entitlement crack.

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  35. Whatever Einstein at bacterin thought up a press release for signing up a distributor should be turfed. I would hope that their investors would see through that type of crap

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  36. well done,629! and said with no insults- love it

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  37. Times are changing. You can adapt to them or you can just back and complain about the good ole days. The expenditures in our healthcare system cannot be sustained and the cuts have to start somewhere. The first people that are going to go are the 6-figure sales folks. The people keeping their jobs will be the less expensive ex-scrub tech coverage reps. I meet with execs for large and small spine companies and I hear this echoed repeatedly. They MUST find ways to disassemble the beast they have built in order to cut costs- its just the facts. The whole rep in every room holding a surgeons hand is no longer going to be the standard in spine surgery. At the end of the day, when Medicare or private payer tells a surgeon they are going to pay them $x for a lumbar fusion and they can spend it where they want throughout the episode of care- they aren't going to pick the most expensive pedicle screw because that company has the best sales rep. If the money goes in your pocket or theirs,well we all know who will win out on that one. This is the direction things are going. Read the new Bundled Rate initiative announced from CMS. These changes are very real. My advice would be to either hop on or hop off but the train is leaving the station with or without you.

    You all have some decisions to make. I used to be a sales rep and understand the value they bring, unfortunately it just can't and will not continue. The one's that will continue to be successful post "golden era" will be the one's who realize these changes the earliest and adapt. You decide.

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  38. I suspect the 11:03 post came from Tommy Mitchell of OrthoDirect. http://www.orthodirectusa.com/globalConnection/home.html.
    As a sales exec with a major spine company, such drivel is not "echoed repeatedly" by anyone in our organization. We are always looking to increase the talent level on our team and anyone who has recruited and managed in our industry knows that hiring inexperienced scrub techs is not a successful strategy.
    Things are always changing, in our business as in all others. However, selling in the current competitive environment while managing relationships at all levels of the supply chain, managing pricing, mastering ever more technically demanding products, etc., is not a job for inexperienced personnel with minimal business acumen. I have the greatest respect for scrub techs and their clinical peers, but just as sales reps are not qualified to step into this clinical role, the opposite is usually true as well.
    Everyone that plays a role in delivering the best possible outcome to our patient customers has a difficult job. This includes surgeons, hospital personnel (clinical and business side) and industry people. It pains me to see everyone involved in the patient care continuum badger and disrespect each other’s role on this blog. Whether we like it or not, we are all on the same team with common goals. I don’t hear too many defensive linemen in the NFL bitching about the quarterback or receivers on their team. Why? Because they understand that everyone has a role.

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  39. 12:09- this is not Tommy Mitchell though I am familiar with what he is doing. My intention was not at all to "badger" or disrespect anyone or their role. All I can go by is what I have heard from CEOs and VPs for many big players in the space. The only point I was trying to make is that the late adapters or the ones in denial about what is going on around them will not make it through these changes. Whether PODs stay or go- the fundamental way healthcare is delivered is changing. Like I said, I too was a sales rep and have much respect for what they do and any smart rep or distributor who's head isn't in the sand will have a place and thrive in the new world. It may be a few years away but mark my words it IS happening.

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  40. Well said 12:19, I agree things are changing and will continue down that road.

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  41. The richest one percent of this country owns half our country's wealth, five trillion dollars. One third of that comes from hard work, two thirds comes from inheritance, interest on interest accumulating to widows and idiot sons and what I do, spine and real estate speculation. It's bullshit. You got ninety percent of the American public out there with little or no net worth. I create nothing. I own. We make the rules, pal. The news, war, peace, famine, upheaval, the price of a pedicle screw. We pick that rabbit out of the hat while everybody sits out there wondering how the hell we did it. Now you're not naive enough to think we're living in a democracy, are you buddy? It's the free market. And you're a part of it. You've got that killer instinct. Stick around pal, I've still got a lot to teach you

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  42. You are all a bunch of Mo Mo's. You know why? You don't have the guts to be what you wanna be? You need people like TSB. You need people like TSB so you can point your fingers and say, "That's the bad guy." So... what that makes you? Good? You're not good. You just know how to hide, how to lie. Me, I don't have that problem. Me, I always tell the truth. Even when I lie. So say good night to the bad guy! Come on. The last time you gonna see a bad guy blogging like this again, let me tell you. Come on. Make way for the bad guy. There's a bad guy comin' through! Better get outta his way!

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  43. Both 11:03 and 12:19 are right. Cuts to the gross margins of industry are coming as they continue to give decision making power to those who care about costs, or make those already with decision making power care about costs.

    They will succeed at this, and what's left will be for us to succeed based on providing the best overall value in the product / service combination. And value will no-longer be based on purely benefit to the surgeon, but rather overall benefit to the surgeon, hospital and patient. Any excesses in the distribution chain will be squeezed out, as a good marketplace should do, and truly qualified folks doing a good job will be left and rewarded for their efforts. And as a tax payer and health insurance premium payer, I'll be happy to see the lower tab, even if it means my income will be harder to come by as a result.

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  44. boy oh boy how things have changed and the ride all of us are in for in the next 5 years will be the ride of our lifetime.

    In many of our areas, pricing has over-corrected and soon the days of $350-$400 pedicle screws will be here folks. For those of us working for a legacy company, we wonder what the business model is that we will even make pharma money anymore. Sure the days of $300K+ are over, but doing one level fusions for 1700 bucks and making the standard 7-8% is going to be tough to make a living.

    All we can do is sit and watch surgeons literally texting other surgeons while in our cases selling their POD implants. What makes things even more interesting is pricing. Known POD account have the lowest pricing in the state. One would think that if the surgeon has monetary interest in the implants, the price would hold....just the opposite...

    Not crying about it, just really worried about the future of the spine business. We keep hearing how this time is similar to what the knee and hip market went through years ago. in my opinion, this is a way different animal of a marketplace than any I have ever heard of.

    as I started, hold on to your hats, its going to be an interesting ride...

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  45. @ 2:17: So the stock-holding paid consultant Chairman of Bacterin's "Scientific Advisory Committee" and a Bacterin employee PhD got together and wrote a paper. Not that there may be a bias or conflict of interest or anything. Heck, that's what Medtronic did with their studies, too...

    And this study will receive peer-reviewed status when?

    Congrats to the docs on the poster presentations!

    Wow!!! Check out this news release also centered around red herrings and communication through flatulence!
    http://news.nationalgeographic.com/news/2003/11/1110_031110_herringfarts.html

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  46. anyone watching this olympus story?

    http://www.reuters.com/article/2011/10/26/olympus-stryker-idUSN1E79P1UI20111026

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  47. Bacterin may have some "proprietary processing"??? That is a joke, right? Any tissue bank that can dunk cancellous bone in a bucket of acid can make osteosponge. They weren't the first to do it, nor will they be the last. Alphawreck has one, allosource has one, rti has one, integra has one, lanx has one, and so on and so on. These are commodity products, pure and simple

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  48. Stryker + Olympus = V Brothers. This one should be interesting to watch!

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  49. looks like someone needs their legs broken, its inevitable, as Ralph Waldo Emerson said, follow the money

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  50. Sure are a lot of Nostradamus wanna-be mofo's up in this place!

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  51. Shock and Awe said...
    WOW!!!!!!! Just out today. Give up Medtronic!

    Bacterin International study shows OsteoSponge equivalence to rhBMP-2 in spinal fusion (BONE) 2.80 +0.01 : Used in conjunction with the patients' own bone marrow aspirate, OsteoSponge is a highly effective osteoinductive and osteoconductive bone scaffold that aids in spinal fusion. The study was conducted in collaboration with researchers at the Salt Lake Orthopaedic Clinic, Spine Surgery of Salt Lake City. The two-year post-operative, clinical data showed OsteoSponge to be equivalent to rhBMP-2 in achieving an interbody fusion based upon radiographic assessment, CT scans, and quality of life outcomes. Additionally, patients receiving the OsteoSponge graft reported statistically significant less leg pain at one year relative to the rhBMP-2 group

    http://finance.yahoo.com/news/Bacterin-Study-Shows-prnews-618746924.html?x=0&.v=1
    October 25, 2011 2:17 PM


    Shock & Awe, You are clearly and Idiot if you expect us all to believe the efficacy of your paid for conclusions by a surgeon who is as disgusted as the rest of us by this meaningless diatribe you call a paper..

    10 to 1 I bet Shock and Awe is Molly the mouth Mason

    Still stuck

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  52. What I recall of the 2-Year follow-up to the study was that the CT scans contradicted the written assertions.

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  53. Wait till you see their Charlie Sheen "Winning" marketing material at NASS. A real classy bunch. Wonder what the donor families would think ?

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