Saturday, October 8, 2011

Mississippi Burning

TSB can see the Wall Street Journal's John Carreyou and Tom McGinty playing the investigative role of Rupert Anderson and Alan Ward (played by Gene Hackman and Willem Dafoe) roaming the back roads of Jackson, Mississippi looking for answers to serious questions regarding a virus that has spread to epidemic proportions in the spine industry.  Carreyou and McGinty can Duke it out (No pun intended John) at the Journal's office as to who plays the leading role.  In the current climate, at times it still feels like 1964, a country divided with anger, finger pointing, and reckless abandon.  On October 8, 2011, Messieurs Carreyou and McGinty published an article regarding their ongoing investigation into surgeons taking a double cut by manufacturing and implanting their own devices.

What the industry, our readers, and the general public have found out is that there has always been a fine line between medical ethics, surgical treatment, and financial interests. Shhhhh! Let's fly under the radar, and just maybe, no one will notice us.  To use a broad stroke and categorize all spine surgeons as unethical is reckless at best.  TSB has always been a surgeon advocate, unlike those outsiders that have ingratiated themselves and continue to suck on the teat of the industry.  Our credo has always been that as long as surgeons are truly working on a product development, and not getting paid for redesigning a screwdriver in return for VOLUME, more power to them, and make as much money as you can.  If they're willing to pay for your expertise, all we ask is that you be transparent. Yet, one must raise one's eyebrows as you read the WSJ's expose.  As Carreyou and McGinty continue to lift the sheets, kick the tires, and look under the rug of our industry, they are learning and educating the American public on just how tainted this industry has become. Three Mile Island didn't radiate with as much toxicity. Surely, there will be an outcry regarding this story.  Whatever happened to the Wall Street Journal, that bastion of capitalism?  The unfortunate scenario for the surgeon in question, Dr. Lewis, is that this publicity will surely tarnish his reputation in the Jackson community, considering that those of us that have been in this industry for years, know very well that having any past affiliation with Blackstone raises everyone's eyebrows. Can you say, "VOLUME, VOLUME, VOLUME."  If the DOJ is out there reading our blog, and we know that you are, many of us in the industry are waiting for you to deliver the blow that shakes up the industry, especially when it comes to Blackstone.  If Orthofix was smart, and it is apparent that they aren't, they would put a reasonable proposal on the table and get the DOJ off their back, because the more you piss off the DOJ or the FBI, they will dig in their heels and play hardball, just ask Geoff Yielding. TSB would love to be a fly on the wall during those board meetings, but back to the story at hand.

Spinal USA would be a great case study for the Harvard Business Review, along with some of the other illustrious fly by night distributorships that masquerade as legitimate companies. The financial cost of entry into our industry is low, especially if one reverse engineers other companies products, and finds a manufacturer who is willing to get into cahoots with you.  Innovation?  Emerging Technologies? Beauty is truly in the eye of the beholder.  Yet, the reader must question the credibility and acumen of surgeons that take to their soap box and espouse their business skills, especially after reading this story.  In the spring of 2007, the FDA assessed Spinal USA with 14 violations, including failing to maintain master records for its devices, to having no system in place to track and label them.   As a spokesperson for Spinal USA stated, ahem, "rapid growth caused Spinal USA to run afoul of the FDA." You must be kidding, right? Talk about on the job training, or is this another example of the Rudy Giuliani defense, "I had no recollection or knowledge as to how that happened." Anyone running an implant company understands FDA policy and procedure, especially if they have been in this business or have ever donned a gown and gloves.  TSB hasn't met a single CEO, VP of R&D, Regulatory Director (especially the nervous regulatory guy), or Operations person that welcomes that dreaded phone call from the FDA, informing them that they will be on site on Monday, leaving you 72 hours to dot your "i's" and cross your "t's."

But here's a question for our readers, if Spinal USA was looking to contain cost by eliminating salespeople and marketing cost, why were they recruiting surgeons from other states?  Obviously to increase revenue, resulting in more profits.  You're not going to tell us that you were doing it for the love of spine surgery.  TSB can guarantee that this venture wasn't an exercise in fiscal austerity.  And how about expanding into other markets? I guess people in Mississippi must be concerned in sharing the cost savings with those in Alabama.  There is a fine line between fact and fiction, contrary to what some attorney will tell you.  But then again, isn't it the same people that take an oath to uphold the law, the same people that tell you how you can circumvent the legal system to make a profit?  As one surgeon in the article states, "I know some people in the profession don't think its ethical, but I just don't see."  Of course you wouldn't see it if you are making money off of it, neither were the people that were doctoring mortgage applications for people that couldn't afford paying for them. Though the OIG has issued regulatory guidance for complying with federal anti-kickback statutes, a thorough investigation into some of these business models could uncover some interesting ways of laundering profits.  Oh, and by the way TSB would like to know how many reps are making $26,000 per month, such as the good doctor who filed for personal bankruptcy in this story.  By the way, Dr. Famous, how does one file for personal bankruptcy making $26,000 per month on top of what one earns from the practice of medicine?

But here is the bigger question that lies in store for the people that run NASS, AANS and CNS, what's the point of subsidizing your meetings when you can't even keep your own house in order? How many more black eyes does the industry need before someone delivers the knock out punch? If you don't think its going to happen you are in for a surprise. Maybe that's what the doctor ordered, some CEO's, or former CEO's and surgeons serving time being Bubba's Bitch, dropping the soap in some Federal penitentiary. How many times do we have to hear these stories only to be reminded that our industry has run amok?  TSB wants to know what our readers think? 

118 comments:

  1. Well done MM, however, are you referring to the same NASS, AAOS, CNS.....that charges upwards of $1,000 for admission to their symposiums?

    They are getting fatter off this, why would they rock the boat?

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  2. In all fairness. Two of the surgeons mentioned were doing un-necessry surgery long before they got involved with Spinal USA.

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  3. Amen 12:42.

    If you've been in this business for any length of time you're never surprised by those MD's who've taken to the POD. A classy group.

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  4. Man, I'd love to see these guys go down. They've hit my area hard. These WSJ guys could be our saviors.

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  5. I joined the industry 12 years ago. The 1st lecture I got was about fraud and abuse laws. I've been watching a few crooked spine companies and MD's make a mockery of these laws ever since. I would like to believe that one day the rule breakers on both sides of the aisle would come under the watchful gaze of the DOJ, the OIG, whoever... So far, I am not encouraged. Good thing Obama is gonna pay my rent.

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  6. Lewis was tagged a few years ago due to his girlfriend being his distributor. No shock Lewis and his Hattiesburg buddies had to "diversify" and allow the Huntsville docs to buy in.

    I wonder if Blue Cross in MS and AL will look at the increase in spine surgery amongst their covered lives in these markets. The data reflected in this story is only Medicare patients.

    SpinalUSA has diversified to supply Ken Horton's 30 man POD. Sad to see a young surgeon in Dothan being influenced by his pathetic greedy hack father who has two other kids that act as "distributors" of various DME products. Blood is thicker than ethics I guess ... You'll find them on the front pew tomorrow morning.

    Know what's really funny? The SpinalUSA rep in Dothan pulls double duty as the Depuy Spine rep. Must be nice.

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  7. 3:41
    How do you think they like that in Raynham? I don't remember that in the credo I was forced to abide by. Unfortunately I loved spine and am now embarassed not only by the bottom feeding sales tactics but an ever increasing number of surgeons involved in this crap!

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  8. Yeah by the way, the credo only applies to people who work on the street. The DB's in Raynham aren't hobbled by that BS. Profit profit profit. All else is secondary.

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  9. WSJ could be our savior??? This article does no one in the industry any favors.

    Let me help you see the connection you apparently have missed:

    "Dr Lewis's part-ownership of a medical-device company is far from unique in the world of back surgery."

    Try this formula:
    [surgeon name here] did not disclose to his medicare patient that she/he received financial compensation from [your company name here] and uses said companies products exclusively. During this revision procedure another companies implants were removed and [your company name here]'s implants were then implanted. After surgery the patient had complications and a peer review showed the patient should not have been cleared for surgery.

    The facts and research in the article are interesting and, unfortunately, poorly relayed/ written. So the increase of spinal procedures at said hospitals is a result of one company's products- I don't think so. Look at the graph before Spinal USA arrived- the numbers still increased each year.

    whether you are 1099, direct, work for a top five or are the low man on the pole; this article has cast a big, dark, cloud over all of us.

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  10. I agree with 6:15 in saying that there are some gray areas in this article relative to the increasing # of spine surgeries the hospital. However, the existence of such relationships is something that needs to be communicated to the public in hopes of squashing them once and for all. Otherwise, we will continue to hurt the legitimate players in our industry who are continually trying to drive innovation, fund research, support national meetings, etc. This is far from a dark cloud on industry but rather on the foolish surgeons who partake in such unethical behavior.

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  11. One other angle ... Where are the leaders at Huntsville Hospital? That hospital was tagged with one of the biggest fines for fraudulent kyphoplasty billing.

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  12. Debating the spinal volume increase is missing the point. A surgeon who had a clear financial incentive to do more surgery and use more implants did a case on a patient with questionable indications for surgery. That patient died. Whether the surgeon actually changed his decisions because of financial incentives, the appearance is certainly there. His actions won't be defensible in front of a jury (who already tend to side with patients over doctors).

    However, the numbers in places like Mobile, AL and Huntsville, AL clearly show that surgical volume and use of implants go up once PODs are involved. There is also a surgeon in FL who - according to tracking by his hospital - has dramatically increased the number of implants he uses since becoming POD (he is doing A/P fusions and a spinous process fusion - ridiculous).

    Keep digging WSJ

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  13. I whole heartedly disagree with 6:15. This exposure and much more is greatly needed, like convictions and jail time. This is immoral. I have been in this industry for 22 years and the degree of dirty business that has engulfed spine in the last 12 years needs to be cleaned up. Whether it is the docs and/or co.s, large or small co.s, the playing field needs to be leveled. Free enterprise and capitalism have been compromised and the our ability to compete is destroyed.

    I applaud the WSJ article. Thank you. The surface is just being scratched and many more scandals will be exposed!

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  14. The surgeons who were principals in this endeavor were already known to operate on everyone. Indications and x-ray findings were only inconvenient facts. The blood lust in Jackson, MS was not so much about the POD, but about someone finally taking down the doctors involved. Dr. Molleston mentioned in the article has recently relocated from Hattiesburg to join...Dr. Lewis. What a dream team that is!

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  15. The leadership at at Huntsville Hospital is an absolute joke. I remember hearing a couple years ago they put out a memo that they would no longer buy implants from a company with surgeon ownership. I remember others thinking this was the end of the road of POD's down there. What a joke. A complete attempt by hospital executives to try and cover their back. The next discussion should be purchasing directors and hospital management that turns their back when these companies bring in new products.

    Couple years ago it was well this stuff is cheaper. First, great morals- its cheaper so we will buy it. Second- now its all the same price and let me add when you do a revision and could add 2 screws for $1600 or take all of the screws out and buy 12 screws for 10K your really not saving any money. Your actually losing 8K because you fail to manage a spine program.

    Numerous instances of spine surgeons threatening to leave the facility if they can't use what they want and groups breaking up.

    The Southeast has the dirtiest group of surgeons in the country- I wouldn't dare let a family member get surgery. Atleast in the West coast hospitals are standing up with 2 -3 vendor policies to protect patients. I would hope at some point referring physicians would consider who they decide to recommend to for spine care.

    Spinal is a joke and the safe harbor provision for having 40% of business from non-investors is a bigger joke. Spinal mentions they are looking for more investors from non-owners. Well goes who their "new investors" are- Phygen. Atleast Spinal makes their own hardware- Phygen the new investors that makes Spinal within government regulations. Phygen makes Spinal look like a good outfit. Hilarious. That's what you guys have to realize- these group of surgeons are never coming back- they will find some sort of way to line their pockets one way or another. So Danek- keep your lobbying with the government and OIG- it doesn't matter these guys aren't going to use your gear when their hospital tells them no.

    I'm confused why Carreylou would focus on one group and one specific patient who died. It's a sympathy story but lets face it people die in surgery. Bigger issue is patient have no idea what is being put in them as doc are disclosing nothing!! Better story is to see others that are doing this and the different business models. The scope of models that are out there would make people cringe when reading the stories.

    No leadership within hospitals or within the spine societies. Zilch.

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  16. The article might as well say, "Every spine doc has an ulterior motive to operate on a patient." And to be on the front page of the WSJ-not good

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  17. Again doctor bashing Don't the reps make their money when spine surgery is performed? Why not stop generalizing

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  18. Spinal USA and girlfriends running distributorships? Hmmmm. Sounds like Southern California for the past 5 years. Someone should look into Spinal USA's booming spine business in Fresno, Ca.

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  19. Doc Bashing, LMAOL, you're not serious 9:08. Sometimes a spade is spade no matter how you cut it, and by the way who is generalizing in this article?Again, another reader reading what they think rather than what is written.

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  20. The WSJ article is to be expected from a source that is first of all Pro Obamacare! The fact of the matter that the surgeon spotlighted, whom may not be considered the best clinician in his field, still does not prove that the implant he used from a company he has a financial tie had a thing to do with the death of a patient. So, the point of the article being that high utilization (needs to be proven and NOT assumed) of a surgeons implant choice tied to a financial incentive between the product, company and referring surgeon is whet the rub comes from. This begs the question, if the surgeon does have a financial incentive regardless of any form but yet he/she discloses this to his patient and the product is FDA approved and there are no reported failures of the product then what is wrong if this procedure is clearly acceptable as we all know that most precedes have to be cleared by insurance or Medicare before being performed. If there are dirty surgeons out there then let them be flushed out but I do believe this will be the minority.

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  21. I agree that the next focus should be on the hospitals and those individuals making the decisions in those hospitals, to turn a blind eye to the surgeons' activities that operate there.

    The hospital administration is clearly aware that they were historically unable to get the physicians to switch their implant choice to even of the Big Five Companies, in exchange for dramatic cost savings to the hospital. This was always to due the surgeons' "Clinical Preferences".

    Now, through a venture that provides indirect remuneration to the surgeons in exchange for tying up the patient referrals, they look the other way when the surgeons implant devices they would only laugh at previously, when considering switching to them for purely clinical reasons.

    Patients beware.

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  22. But did the patient really need a 360? The doc is reimbursed more for the procedure and he sold the hospital the implants and gets paid.... The company recieved a letter from the FDA regarding numerous violations
    www.fda.gov/ICECI/EnforcementActions/WarningLetters/2007/ucm076591.htm ·

    No, the implant did not cause the death of someone's loved one, but bad judgement and greed did.

    You really want to defend this?

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  23. As usual 10:10 would deflect the blame on someone else for a gross failure of surgical judgement. BTW Obama wasn't around in the early 2000's when Blackstone was buying everyones business, I guess it was his fault then, get serious in your discussion Mr. Attorney

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  24. 10:17...
    You sound like a MDT, Zimmer, Depuy, Stryker (whom else you want to include?) rep that has forgotten that Consultanting and Royalty agreements are considered remuneration and were you complaining then when your prior surgeon base was requesting your "clinical preference" products? Were your prior surgeons also disclosing their consulting agreements your company had them on...NOT! In the end, the Hospitals could care less as long as their surgeons are happy and making them $$ and cutting your prices by 10% or more because that is just extra bank for the hospital. You can cut a hospitals price in half and that is extra green for those profit hungry hospitals. Yes, this is called Business 101.

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  25. who has a link to the article?

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  26. http://groups.google.com/group/sci.med/browse_thread/thread/2569a220f368ed60/d0a8f2f681918290?show_docid=d0a8f2f681918290

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  27. Let's cut to the chase. The SPIRIT of the law was written so these kind of thing don't happen. Fair trade and competition are obliterated with a POD. Implant decisions are being based on greed alone and not based on the QUALITY of the implant, the PRICE, or the SERVICE provided. Yes ladies and gentlemen the idea that POD pricing is lower is complete HORSE $HI# and we all know it. They actually are considerably higher in some areas and doubtfully lower in most.

    And by the way, these implants are nothing but mere knock offs of products
    AMERICAN engineers came up with using RESEARCH AND DEVELOPEMENT.
    Stolen intellectual property from hard working people. It's pretty cheap to copy
    someone elses work and then accuse them of excessive profits. Wow Mr. POD.
    You have the ability to do none of the innovation but feel justified stripping the
    system to pay for your beach house or ski chalet. Competition is the cornerstone
    of the USA, and competition brings advancements. You Mr. POD are stealing our
    Childeren's medical advancements of TOMORROW for you material needs
    TODAY. HOW DARE YOU MR. POD. Or should I refer to you as MR. POS.

    And to all of you surgeons who do think it's completely immoral? I applaud you for being right and actually being in Medicine for ALL the right reasons.

    Thank You and Good Night

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  28. Who cares about PODs when we now have this awesome new Blog background? Way better view than the puke brown.

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  29. Typical POD response that tries to justify their shady business deals on the fact that large companies consulting deals is the only reason docs use large companies. I have been in 3 markets and this has never been a significant issue. Are their agreements yes, did Danek go overboard and always go after the biggest cutters for years- sure. I would say this is only the case in about 5% of surgeons with respect to the large companies.

    Next excuse from the worthless POD rep (tray runner, cheapest help doc can find) is that the doc can own an MRI and use it on patients- why can't he own implants and use them. Couple reasons Einstein- does the doc make the MRI? Did he build it- did he buy it for 100,000 and then sell it to the hospital for 800,000 and bank 700,000 for his dirty pockets? No. The issue is these dirtbags won't disclose to their patients the truth before they filet their backs, bill 15k for the operation, use extra screws and take another 4K from the implants for the case. They manipulate and mislead these patients on a daily basis.

    Hospital administrators- I hope you realize the guys you think are saving you money are buying implants for $400 and selling them to you for $3000. And oh by the way they are using 20 of these a month. Carreylou- look into this one a little deeper and you'll ask the editor for 4 pages for the next article.

    Save me the sob story jealous doc who is upset that reps make too much. There are plenty of reps that make 60k in this gig. Are some successful yes- but do you get upset at the toyota sales man that sells 35 cars a month? Sales has always been a rewarding job for some- the perception that all make great money is dead wrong. If so ask your POD rep how many other docs that have got using their gear.

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  30. Always very sad to hear about a catastrophic complication patient death regardless of what type of implants were used. My condolences and prayers to the family.

    I don't know for sure and have no facts beyond WSJ article but the facts are ugly. Patient had numerous previous abdominal operations and questionable indication for anterior fusion. That alone is very concerning. My guess is the implants were not responsible for patient injury. It does look and smell very bad especially when combined with 18 med mal lawsuits, increase in case volume, and disclosure issues.

    My opinion is this type of arrangement is bullshit and borderline unethical. If the only docs using the equipment are owners the equipment does't stand on its own merit. If the physician really has a great product that is legitimate quit medicine and become a business operator. Many physicians have done this and is completely appropriate. Alternatively, keep practicing and limit your "owned" products to 35% or less of product utilization.

    It should and probably will be a bad day at spine USA on Monday. As for companies and physicians that get in to these type of arrangements learn from this. Think about the consequences about a situation like this and is taught in every business school think about how it will look on the cover of the newspaper. That will help you make better decisions than Dr. Lewis did. Hopefully we will all (industry and clinicians) learn from this really horrible situation.

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  31. Jim Pastena is that guy really involved with Spinal USA? If he is, here is my message, its time to hang up the spurs and ride off into the sunset, you did a poor job at EBI, don't believe it look at the state of that portfolio. It sucked. Must be tough when you don't know when to bow out gracefully.

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  32. INNOVASIS was mentioned in this article, anyone know anything about this company? I have heard the name recently, just curious.

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  33. http://www.businesswire.com/news/home/20111007005727/en/Spinal-USA-Expands-Creates-U.S.-Jobs

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  34. Dont forget about Wenzel Spine ..

    In addition to Dr. Lewis's Spinal USA, spinal-implant manufacturers created and co-owned by surgeons include Titan Spine in Mequon, Wis.; X-spine in Miamisburg, Ohio; and Innovasis in Salt Lake City. Surgeon
    Peter Ullrich, chief executive of Titan Spine,
    products when he operates. X-spine and Innovasis didn't respond to requests for comment.

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  35. Does anyone find it interesting that a 360 fusion was performed and all that is discussed is the anterior hardware. Does anyone know what hardware was placed posteriorly? Does it matter? I understand Dr. Lewis has an interest in Spinal, but as it was not mentioned I am going to venture out and presume the hardware placed posteriorly was not a Spinal product. If the doc is truly that greedy why would he place another vendors product posteriorly. I'll have to presume that in this instance he was trying to do what is the best for the patient. Would I be right or wrong? The impetus of the article was the decision to operate on a patient with questionable indications, the author has used it as a forum to reflect that physicians are greedy and self serving. Well they are, but who in this industry isn't. Are all the responders here really concerned about how this affects this patient? Are they more concerned about how it affects them. You answer. All the docs are self serving to some extent, heck they have bills to pay. The question each of them should be able to ask themselves is "am I doing what is right for the patient?". Can a doc be objective about this if he owns an interest in a spinal company? if he owns interest in a surgery center? if he owns an x-ray machine? an MRI? a brace company? if he gives meds or injections out of his office? or whatever, that could potentially yield him more income or benefits? I would say that if the doc is truly doing what he feels is best for the patient he has that perogative to use whatever he feels is necessary, and this should be able to stand up in any court. That is the way I would want to be treated. To try to legislate my or your version of ethical behavior is nonsense. It will always come down to each individual physician.
    Does anyone else not find it surprising that the surgical volume in each of these facilities did not increase more substanstially with the docs ownership? Are there other surgeons at these facilities who are not owners whose volume has cut back to as to make these numbers not as impressive? Does anyone know if there been any complication related to the devices themselves, and not the procedure? or are their devices truly comparable.?
    Though I am not a great fan of the french socialist, Mr. Carreyou, I have read many of his articles. I do know he is quite thorough in his research of his topics. If this is all he can find on these guys after all his exhaustive stone turning, I am quite disappointed. There should be more, unless these guys are truly legit. Look at the characters, one in bankruptcy, and another has been sued 18 times. If Carreyou cant back it up anymore than this, I am sorry but this nothing but sensationalism, that is bad for anyone in the spine industry.

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  36. 5:22 - perhaps you should list your questions so they can be responded to appropriately. We get it you have skin in the game. The only surgical volume tracked is what is available in the public domain ... and yes, the increase in medicare patients is significant. Watch BCBS of AL and MS react now that the WSJ is doing the job while EVERY newspaper in AL and MS has looked the other way ... I guaran-f'n-tee you that spine surgery in BCBS patients has skyrocketed. Even better is when they uncover the revisions of this crap hardware. Real damn funny that these docs don't report failures of their OWN hardware.

    PDP Spine ... YOU'RE NEXT!!!

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  37. 5:22 I totally understand where you are coming from man.

    Hell I think anyone trying to legislate my or anyone else's view of ethical behavior is unethical!! We should be free to put in whatever we want.
    I don't think it influences me at all if I put in a quality 510k implant from my own company, and why should I not make a profit on it? I am the one that went through the rigorous task of finding a chinese manufacturer to copy the screws that I paid outrageous shipping costs to ship over there to use for molds. If I did the due diligence of finding someone to make it, then I ought to be able to mark it up and sell it to hospitals for whatever I can get...right??? None of this would incentivize me to use more implants or do unnecessary surgery. Fortunately for the patient and myself I copied the best implant for the patient so there I truly am putting in what I feel is best. I dare you to try to prove that I am not!

    I also think its nonsense that we as surgeons cannot be trusted to receive "grants" or consulting agreements from companies without being scrutinized up and down. I am a grown up and am fully capable of making my own decisions, if a company gives me 100k a year it has no bearing on whether I use their implants or not. If I use them its a fortunate coincidence that they happen to also be the best for my patients.

    This is a witch hunt!!

    Signed,
    Troll King

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  38. Pastena is a tool. He and his wonderful management team sank biomet. He had a hot daughter that ended up at american professional bracing

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  39. What you have to remember 5:22 is that a Jury will decide on the lawsuits that will be coming. The same attorneys that have helped physicians circumvent the laws will be the same attorneys to hit them with malpractice lawsuits. The term is "defensible act". A jury will be hard pressed to side with a surgeon whose 1,000,000.00 a year pay wasn't enough so he had to supplement it by making money off the implants. Patients and referring physicians do not look kindly on this behavior. Just ask them. Ask any person off the street if they would trust their surgeons diagnosis if they knew he made money off anything he prescribed, either it be a medication or an implant.

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  40. 7:38 brings up a good point. Referring physicians are not going to look kindly on this. I suppose a sales rep could take it upon himself if left with no other options to educate his local referring community as to what physicians are gaining additional revenue off of the implants they are putting in. If this is about protecting patients then that would be a fairly sound chess move.
    On the other hand, if this is also about protecting ones livelihood then again that is a sound chess move. I would suggest this be done somewhat anonymously though because if they find out you were the one educating their referring docs you will have just made a bad chess move.

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  41. 7:27 I also hear your point

    I am only asking "where is the line?". These guys can make $ on any aspect of the care they deliver be it x-ray, mri, bracing, casting supplies, physical therapy, ekg, labs. To see a surgeon now that only sees patients, operates and writes scripts without any of these ancillary services is a rarity!!! And yes if one received a grant or loan from manufacturer that would also be an enticement. I agree each of them can be influenced by any of these options. Just look at the numbers, the biggest scam going is their ability to refer patients to themselves for surgery. That is where they make their big bucks. This is the BIG issue. All the other crap is anxillary, and fallout from their self referrals. I dont know this for sure but would guess that what they make off a screw or implant during one operation pales in comparison to what they make from the procedure itself. The only way to make this go away, is to pay them all a straight salary, but even then, someone will find a way to capitalize from it. Here's a question for you. What do you would happen to the spine surgery volume in this country if all the docs were placed on a salaried contract? You know the answer to that!!! My point is, these guys have the opportunity to be "pursuaded" in any number of directions. They still have to have to ask themselves that question, and hopefully, most of them will do what is in the patients best interest. Even with that said, you and I may disagree on what that "best interest" is, and that is why the patient HAS to be involved and able to make an informed decision.
    I also agree if the docs are using an inferior implant they should also be held accountable, and time will tell on this. These guys whether they realize or not have a bit of double jeopardy. Just because they use their implant and their company get paid for the implant their risk is not over. They are also placing themselves personally accountable for the results, not only for their surgical expertise, but for the implant itself. Their malpractice insurance will not cover any damages related to the device, but neither will their company's corporate liabiliity insurance, it will only cover the company. And again, if failure occurs, they will have to answer to the patient and probably a jury as to why they used each specific device.

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  42. the comments on jim pastena are out of line- he's a good guy and if i remember correctly he was with biomet when they were at 100mil and left when they were at 500mil.

    the name-calling, bad-mouthing and inclusion of family is not appropriate. anonymous or not keep the inappropriate comments to yourself. It makes you look bad. and by "you" i mean all of us.

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  43. 7:38 - Dont be naieve(sp). Every time I take my son to the dermatologist and I buy some new voodoo skin cream, I know he is making something off of it. Our family MD, put my daughter in a $45 sling, for her shoulder - I know there is some profit here also. They are all trying to make $$$, and if patients cant figure that out, I've got some more bottled water to sell them as well

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  44. 8:35 don't be an idiot ok? Of course there are things physicians sell in their office that they buy for less. Please don't compare a sling or skin cream for your son's zits. These surgeons are buying things for $200 bucks and selling them for $1200- in many instances they are making more money off of their POD gig than their spine practice.

    Again you have to love when these guys try to defend themselves.

    You are missing the other issue also- they (or many) are not disclosing to their patients.

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  45. Don't forget Wenzel Spine. They are also owned by a surgeon..Dr Wenzel himself.

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  46. ..Dr "Wenzel" aka Dr. Warren Neely

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  47. My sincerest sympathies go out to Mr. Moore's family. If this surgery (360) was performed for the wrong indications or prevalent risk factors, then any implants would not have made a difference in this patient's outcome. However, I do think that serious scrutiny should be placed upon any surgeon's whose judgement is clouded by or skewed by the promise of additional income he/she receives because of their ownership in a company. I am sure that in most cases the implants would "do no harm" but doing more surgeries to satisfy a financial gain without true consideration of a patient's medical need is truly unethical. What has become of our industry? I don't think any of us are fearful of competition but the days of selling on features, benefits and price have flown out the window in consideration of which surgeon owns what percentage of what company and which relative of his/hers is carrying that product. None of us are jealous of success of others, we just would like to compete fairly. Hmmm, what happened to Pollyanna? So sorry to see that our industry has become so unsavory.

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  48. NASS and AANS, hopefully you are not only reading the comments on TSB, but also on the WSJ website. Shameful. You asked for it, now you must deal with it.

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  49. Would the WSJ please do a story on when Globus is going to go public. That is the type of Woodward and Bernstein, Pulitzer prize winning investigative journalism that we need.

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  50. Can someone cut and paste this article into the comments please, or provide a link?

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  51. Jim Pastena is a decent man. Im really surprised he hasnt resigned from this cesspool.

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  52. http://groups.google.com/group/sci.med/browse_thread/thread/2569a220f368ed60/d0a8f2f681918290?show_docid=d0a8f2f681918290&pli=1#

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  53. http://online.wsj.com/article/SB10001424053111904106704576582621677354508.html#articleTabs_comments%3D%26articleTabs%3Dcomments. The comments section page 6 has one doc's wife responding, leaving out that she has a financial interest in this scheme

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  54. Don't forget Atlas Spine started by Dr. Baynham. Amazed that it is still in business, but thats what having spine owners and investors can do to keep a company afloat

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  55. Being a distributor, we also need to focus on the other distributors that facilitate under the table deals or front for PODs. Amazing when a few smaller companies are able to get a sizable bite of business from an entire clinic. Also crazy when a physician owned company requires their non-owner partners to use their product. Great way to advance the industry when forced to use ten year old technology.

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  56. All of this stuff sort of makes one yearn for the simpiler times when it was just Stuart Medical, Danek and Acromed. As Dorothy said to ToTo we're not in Kansas anymore.

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  57. this article has taken the exception and made it the rule. sensational journalism at it's best. thanks, WSJ

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  58. Why do you consider it sensationalism? It investigative reporting at it's best, it's sensationalism when you do not agree with it

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  59. off topic...I am looking for a biologic that has the same handling characteristics as ActiFuse. Can anybody recommend something similar?

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  60. 7:38 apparently you have little understanding of the law. Physicians can only mark up the items they sell to you in their office by 10%. This law was was passed to ensure that your physician isn't over treating you. 10% just barely covers their cost to order and keep the items on hand.

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  61. 1:55

    Huh? Please provide a reference for that 10% markup "law." Never ever heard of that before.

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  62. 3:28 be assured that he will not provide the reference for said false claims...LOL

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  63. 11:10,
    Iran and Sudan are both exceptions, I guess we shouldn't report about them.

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  64. Hey John Carreyou and Tom McGinty, nice scratch of the surface. You want to blow the lid off corruption? Just study LA county for a couple months. Start with worker's comp fraud, hospital ownership by surgeons, hospital administration as distributors, Worker's comp lawyer payoffs, lean corruption, surgeon owned billing and bought referral surgeons. Just start at the Pacific HLB. Please! The POD groups, surgeon owned products, procedure abuse, and Medicare trickery are small time offenses. WSJ, why dont you really dig in? And people out in Cali are worried about earthquakes and mud slides? This is a real disaster.

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  65. 11:53
    Great Point!! For those out there living in La La Land, dirty surgeons ARE the rule now, and they all know There IS POWER in numbers! The exceptions are the clean surgeons.....and do not shoot the messenger. If you do not believe this then you are not out there cold calling on new business! Give it a try and you are in for an Eye Opening experience!

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  66. The best part of the article is when the CEO of Spinal USA says that 60% of his business comes from non-owners. What he doesn't say is that all of that remaining 60% comes from surgeon-owned PODs (the largest of which is the 30-surgeon POD out of Birmingham, AL named by someone else in these comments). So, in truth, 100% of Spinal USA's business is from surgeon owners. Great marketing, though...

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  67. After a tough day at work, it is always entertaining to read these comments. Somehow the industry reps have been left holding the" moral compass" for us all. These are the same reps who interrupt my clinic to explain how their product is the best. Only to be followed by the new rep who used to work for that company and now has a new "best product". I don't know if a rep has ever even remembered the name of a patient it which his company products were implanted. You guys are only in theses discussions because you are pissed that you may not make 300K anymore. Unfortunately, this is what happens when medicine intersects with capitalism.

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  68. between huntsville hospital and crestwood in huntsville they are doing 10 million easy. Then you have Lewis and Molleston in Miss. doing at least 3-4 million. Throw in the Mobile guys Tyler and Faircloth for 1.5 at least. Hmmm that is 15 million and they say they are a 20 million dollar outfit. Sounds like 75% to me. But not being a doctor , I am not sure i am qualified to add and divide.

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

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  70. I heard Spinal USA is merging with Globus, to form Glob USA...and then, they're going public.

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  71. I am thinking of putting together a fight league that pits know it all surgeons against cry baby reps. Both sides can duke it out in the octagon, 2 men enter, 1 man leaves. I would be willing to bet more reps would volunteer than surgeons.

    Who's in?

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  72. Hey Dr Perfect 6:03, do you have any surgeon blogs that us reps can go on and make fun of your community for the asinine comments you kids make? I was in clinic with a few surgeons around your area---they were all wondering when you will finally stop operating because they see all your revisions and they can't believe you can tie your own shoes, let alone understand spinal pathology. Your reimbursement is getting cut along with us reps. Guess what? Nobody cares about either of us. Tuck your bunny ears in and go to bed

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  73. 6:03 What happens to your compensation when medicine intersects with capatalism? I am guessing you will go from about 750,000k to 450,000k over the next few years if your lucky. Or jail. How many doctors change practices or are physicians above moving their practices or going out on their own. I honestly sleep good at night, do you? PS We interupt your practice to teach you about modern medicine, you might try using your ears mind and not your hands and wallet for a change.

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

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  75. The real sham:
    http://www.jigsaw.com/id461164/1/x_spine_systems_inc_company_directory.xhtml

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  76. The DOJ & WSJ should really dig into The Performance Group,LLC out of Birmingham,AL. Owned by docs from UAB & St.Vincents. Talk about unethical. There is a whistle blower case against them but these guys managed to get a judge to table it, so how do you stop it?

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  77. 8:30 has a great idea! One of us should set up a blog site titled outing POD's or something of the sort. Anyone could post "alleged" POD linked docs.

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  78. 8:04, of course he sleeps good at night. He probably has zero concience. Did you read the article?
    I assure you a few of the guys ithe article doing awful things to people's bodies sleep perfectly well.
    Spinal USA hasn't made these few people bad. They were bad a decade ago. This has just shined a light on their immorality.

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  79. http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/ComplianceActivities/Enforcement/UntitledLetters/ucm274938.htm

    Allosource just got a letter to stop selling (without new licenses) its Ostoecel Plus and Trinity like product because it relies on the metabolic activity of the cells. Duh. It is nice to see that these products might have to go through an appropriate review process.

    I am all for this Allostem product. It looks like a much better Osteocel or Trinity. But you got to fit those tissue guidelines. Could this spell disaster for Nuvasive and MTF?

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  80. Where is the outcry for the 100% implant markup from the hospital?

    Clearly Dr Lewis is a bit of a bad egg. (i.e. aggressive surgeon with the orthopaedic approach of "all I have is a hammer and the only nail I have is a fusion") The leading the what we all know about spine surgery - the most important part of spine sugery is matching the type of surgery with the patient's problem and conservative approaches are generall the best choice.

    The whole idea that a one year ortho "fellowship" is enough for quality patient decision making for spine surgery. But.. leave it to the likes of Adan Lewis to taint the respect of neurosurgeon spine surgeons.

    But if you really call a spade as spade, most of these comments seem to be from upset reps and former reps who want the "mark-up" income for themselves. We all know that those same reps would be beating down the door of doctors like Adam Lewis and encouraging the same behavior and implant use as present. As commented on earlier, he didn't necessarily change his implant rate b/c of financial interests - he always practiced this way - not that it is the right way to practice.

    Seriously, these types of doctors have to get referrals from somewhere. One may want to look at the practice of St Dom's in Jackson and their"suggestion" to keep those referrals "in house" The hospital will fo much better financially from this behavior than Dr Lewis ever will.

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  81. 8:05. Yes, you are probably right. Most of these comments are from disgruntled device reps who have missed vacations, birthday, weddings and much more to be at the beck and call of their surgeons who called them at all hours of the day and night to help take care of their patients. Most of these comments are from reps who EARNED their money by showing up to the OR in the middle of the night or on a holiday weekend instead of being with their family. If you have ever spent more money driving 100 miles and back to pick up a set needed for a 7:30am add on case than you made, raise your hand.

    That's right 8:05. Many (not all) of the reps on here yelling for reform are those reps who have dedicated years of their life learning every aspect of spine surgery and how they can be a resource for their surgeons.

    And now they are demanding someone look into the behavior of the same surgeons that once snubbed their noses at knock off products, swore they would NEVER use something not proven, and only wanted a certain rep in their room because they didn't trust anyone else. The guys in Huntsville are just a small example of the atrocities in territories all over the US.

    Unfortunately, as we all know, there are a lot more than just reps who have been affected because of PODs. Reps just happen to be the first ones to feel the financial effects. You as a tax payer should be outraged that surgeons involved in PODs are implanting their own devices in Medicare patients and then being paid for the surgery with your tax dollars and then making ancillary money on the implants.

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  82. 12:59 seriously? A spine rep as a resource? That makes as much sense as asking a used car salesman for advice on buying a car.

    Yes, there is the occationaly rep who tries to remain unbiased and does have a basic understanding of the operative use of instrumentation. (Not patient choice or management) The ability / depth of knowledge of most reps varies widely. Most only knowing their and only their product, some regurgitating the sales pitch from the company and others only have the qualification of immediate family relationship to a surgeon in the group.

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  83. Can we change the subject, please! If a NEW company could emerge that had some financial backing (@$5m or less) a semi-direct salesforce already in place then does everyone think a new player to step on the stage with commodity products could have a national presence in spinal implant hardware? Just trying to make a career decision here and would like to get some honest input. Thanks for your responses.

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  84. 4:09 your god complex is strong and smells funny.

    LOL @ you 6:12

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  85. 4:09. I think you missed the point. Yes. We know OUR products. You dont have to know competitions stuff to be a resource. Every company has a pedicle screws, plates, and cages. The surgeon that do see the value we bring is based on how the instrumentation is used in different approaches and cases. Rarely in ACDF or TLIF but there are some complex deformity and trauma cases the some reps have a much better understanding on the whole procedure. The docs know who those reps are. Unfortunately, even though docs know the reps that are much more knowledgable and tenured, in todays environment, it doesnt matter as much anymore. It still does, but not like it did 10 years ago with just the Legacy companies. You had a chance to prove yourself and win. Now, no way of competing with the drs son-in-law rep, Dr's PA turned rep, or straight cash. I miss the ole days.

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  86. Agreed 7:06 hard to compete with some bimbo that throws herself at every doc. Some docs kid or his wife. Cheapens the profession. At a time we knew what was out there and the benefits. Now a big rack or who your daddy is can ruin a good seasoned territory. All about the $

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  87. This has deteriorated into the same reps make too much money and burn in hell greedy docs thread that typically follows this sort of article.

    The factual piece of this that nobody can argue is that you are not seeing stories in the WSJ about reps being upset because they are being left out in the cold, you are only seeing stories about physicians looking for more ways to put their hand in the cookie jar. Get mad if you want but the focus of these articles and this controversy is pointed in the right direction, at the docs that fancy themselves businessmen and don't know where to draw the line. It will in fact bite them in the ass, as it would anyone that is abusing the system.

    Run tell that homeboy

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  88. 4:09 Sorry you have such terrible reps in your territory. That sucks for you, but from the sounds of the way you might treat them, they would probably put you in the category of "not all business is good business."

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  89. I'd keep implanting ... I don't think the heavy stuff is coming down for quite awhile -- Dr. Carl Spagler

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  90. Everyone scroll past that link on Allosource?? That could have some implications.

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  91. You know what this business needs? More cow bell damn it...more cow bell.

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  92. Eminent Spine is also physician owned. Dr. Courtney

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  93. I like fusing whiplash car crashes and making money off of industry and IMEs. I love operating on big discs. My BFFs are personal injury attorneys that have deals with the "medical mafia" and chiropractors (hey you send me three and I'll send them back). That's how we roll.

    Don't step on my shine. I am the bomb dot com. My patients get excellent results because they "never" come back, and my penis is huge. My mommy loves me...... she told me so when I had a whoobie at the age of 10.

    Does anyone have a royalty agreement I can sign up for? My daughter is looking for a job. She's really really smart.

    Wait..... I just opened a surgery center, and Dr Steinmann just saved me. I'm gonna steer your Ma toward that because we "treat them so well" and we offer sushi as the "post op meal". I promise to reduce cost!

    Hold on a sec. The insurance companies are telling me I can't do a 360. I think I'll do a spinous process fusion instead. Lanx, you are soooo sexy and your results are so impressive........ I just have to look at the CPT codes.

    Me llamo donkey. i hereby disavow the Hypocratic Oath. In lieu of "do no harm"............. it should say, "I will make money."

    The world goes round.

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  94. IFC you all hate this so much then get out. Many other young hard working people can take your place. You reps are so highly trained and so ethical!

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  95. 12:16, I think that is a little harsh and offensive. There are decent surgeons and physicians in this world that have dedicated their lives to taking care of patients.
    There are also hard working intelligent reps who don't appreciate being lumped into the same category as you and your asinine remarks.

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  96. 12:16 You just about sum up the intelligence of most of the reps. It took a while but I finally got through all of the sniveling and whining in all of the posts to realize that although it definately doesn't completely help the problem of over utilization, getting rid of you is a good beginning. Most of you can't spell orthopaedic and are very lucky to have a job in the first place because either you couldn't get into medical school, your parents got you the job or you're a has-been athlete. You are the same greedy butt suckers that were happy as hell back in the day when you could take a doc skiing, bear and beaver hunting, or deep sea fishing. You and your comrads are the ones that are in the OR every day witnessing the unessessary procedures. But, to justify it in your tiny minds you say to yourself "I'm just feeding my family". You are the ones that are part of the same self richeous group that won't say anything when you see that 16 year old kid lying on the table getting his or her healthy ACL hacked out and replaced followed by 6 months of rehab. Some of you make good points. This article went in the wrong direction and only scratched the surface.

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  97. Herman Cain for presidentOctober 12, 2011 at 5:05 PM

    Oh good, there is a doctor in the house.
    "Tiny minds, greedy, medical school, has-been athlete." Whoops, Where is the bedside manner?
    Yes, we provide no value in or field. That is why there are thousands of us.
    It's sad that these blogs continue to devolve as they go on especially when they start off with such promise. Surgeons calling us names, reps calling each other names, reps calling surgeons names?
    How pathetic.

    This is about as productive as the dopes protesting on Wall Street.

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  98. To our Surgeon readers,
    Please forgive as you can, the idiotic & disrespectful comments a few of my colleagues make towards you & your colleagues. If it weren't for you & your care for your patients, we would not have jobs or aspire to be consultative with & for you so patient care improves. Just like our profession, there are those who live & work without self-respect & integrity...Thank you from all of us & please continue blogging in to help us in this healthcare morrass.
    ~17 years in

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  99. And when the daylight dissapeared
    I took a good look inside
    Behind my pride
    I sat down and cried
    I know im not a fool
    But i dont know whats wrong
    Mabe its time to pack
    And just move on

    And i could say im trying to change
    But that would just be a lie
    Im lookin for some one to tell me why

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  100. The Spine Blogger - "The people's blog site where news, ideas, job opportunities and what's been heard on the street can be discussed in a professional manner."

    Discussed in a professional manner? What a joke. Sadly, this blog site has regressed into a dark place where former allies (reps and surgeons) hide in cloaked veils of anonymity to routinely lash out at one another.

    Why is this happening, you ask? #1, Because the one pie, which is growing smaller by the minute, has only so many ways to cut up and distribute equitably, and/or #2, Because, deep inside, this is the way reps and surgeons have really felt about each other all along.

    Traditionally, the relationship between a rep and his/her surgeon has been mutually beneficial, based on mutual respect for the important work we both perform. With decreasing reimbursements all around, however, the current landscape has placed us both in an adversarial role. This is unfortunate.

    Personally, I have always had a great relationship with my reps, and overall, have a tremendous amount of respect for the work that they do. Although, when I see all of these nasty remarks about how reps view surgeons when the lights are turned off, it makes me see all of you in a completely different light.

    Please remember that while surgeons can continue to practice our trade without reps, reps would cease to exist without the business that we provide. WE are your customers, and the first rule of thumb in business 101 is to take extraordinary care of the hand that feeds you.

    I am truly saddened by the current state of our industry, and how it has turned us against each other.

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  101. Turning on each other assures we both lose.

    In any field, you have a certain percent that push the envelope.

    The problem is medicine is not a field that is a pure business.

    To give an example, if I were selling t-shirts, I want every customer to buy a few more than they planned. I make money, my distributor makes money, and my manufacturer makes money. If I am good at it, I get better commissions, and better, higher end shirts to sell.

    But in medicine, we have an obligation to sell our customer (the patient) what they need, not necessarily what they want. IF the patient needs one operation, or a simple operation (or no operation), ethically I should be doing the single operation (or no operation), or the less complicated one. But, if I were a pure business, I would "sell" multiple operations, with all the most expensive options. It gets even more convoluted, as the "customer" often is not the primary "buyer" of the services. The insurance company or government usually directly pays for these services.

    I understand the pressures on our sales reps. Quota's, contracts, nepotism, POD's, etc. make for many sleepless nights. I know most of you work hard for your $$.

    But, the business side needs to understand the true nature of the goal of most physicians. We want to provide what makes sense for our patients. We should be offering the same opinions to the patients that we are offering ourselves. Unfortunately, secondary to remuneration, we find ourselves rationalizing other opinions at times.

    Sadly, very few spine surgeons really would have a 360 fusion for a black disc and occasional back pain, though we know some of our colleagues offer that option as "that's what the customer wants". Any BTW, the sales reps usually pursue these physicians. These physicians also tend to seek consulting arrangements, POD's, Personal injury/ LOP arrangements,and other entrepreneurial adventures.

    Instead of beating up each other, we need to collectively focus the benefits of surgery for the proper situation.

    It is not sexy, it is not innovative, but we need to demonstrate our relevance in this environment. IF we do not, the scrutiny will only expose the "dark-side of entreprenurial medicine". The government, and the public will turn against all of us, and that includes the people who are doing this for the benefit of the patient.

    In the end, we all need to make a living. But, as the adage goes, pigs get fat, hogs get slaughtered.

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  102. Well said 9:21, Wish you were in my area. Sounds like you are one of the Good Guys~

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  103. Surgeon here.....I have a simple ACDF in 30 minutes. Within 90 minutes after that I will "doing" my faithful rep for lunch. Guaranteed. Best thing I ever did was to go to medical school. Then to neuro....pinch me.

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  104. I'm amazed. Old spine doc writes another great post that brings this blog back in the right direction, and then some idiot (9:55), takes the conversation right back to the gutter.

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  105. Just when I wonder what can be done to stop TSB from becoming cafepharma, along comes Old Spine Doc again. Thanks for always providing a well thought out view of the situation. Too often we end up bashing each other and calling names to the detriment of all involved. The 80:20 rule applies to virtually everything. I think 80% of us will agree that if we could get rid of 20% of the surgeons, reps, politicians, spine companies, etc. that the world would be a better place. However, as soon as you do this another 20% takes their place. Thanks for the great posts Old Spine Doc and others who think about their posts and write in a value added manner.

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  106. "Discussed in a professional manner? What a joke. Sadly, this blog site has regressed into a dark place where former allies (reps and surgeons) hide in cloaked veils of anonymity to routinely lash out at one another. "

    Something about "entrepreneurial medicine" and for the "benefit of the patient" does not match. I cannot put my finger on it.

    I like your name Anonymous, that is a unique name. I'll have to remember that for one of my grandchildren.

    Sincerely,
    Old Spine Doc Supporter

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  107. "I like your name Anonymous, that is a unique name. I'll have to remember that for one of my grandchildren." - Anonymous

    Hey, hypocrite -- yea you 3:35 AM. Looks like you'll be naming one your unfortunate grandchildren after yourself since you are also "Anonymous". Get off of your high horse and stop pointing fingers unless you're willing to use your real name.

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  108. To the fellow who just posted - just curious what part of the country you are from...? No name needed, but please humor me and reply.

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  109. 5:00am,
    I guess you did not read the opening statement in the Thursday Op-Ed piece. No I did not think so. I am not the only one with this sentiment. Have a great day.

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  110. 1:02 PM said: "If you've been in this business for any length of time you're never surprised by those MD's who've taken to the POD. A classy group."

    And if you've been in this business any length of time, you're never surprised by the big 5 spine companies and their reps buying business with consulting and licensing agreements. A classy group. Pot calling the kettle black? Get off yer high horse big boy.

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  111. The character of the physician comes out, in my opinion, when you see how he deals with reps. There are physicians who demand subservience, free meals/trips/etc, putting physician family member on payroll, or just plain old ass kissing. Or demand an OR entourage that reminds one of a Kool and the Gang concert. Physicians who do this are just bullies. I have seen younger reps (in terms of experience) fall prey to this; fortunately, they usually figure it out. I have also seen physician bullies who tell the rep that "if you do business with Doctor X, I will not do business with you". Sometimes rookie reps just do not realize that the best surgeon is not the one who thinks everyone needs a 360 fusion.

    Some of the best reps I have had the privilege of working with NEVER bought me lunch, never gave me freebies, etc. Some of the best reps I have had the privilege of working with did buy me lunch, but I felt like I was eating with a friend (and I bought as often as they did).

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  112. Dr. POD here. Since I started my POD a year ago...I get more ass-ney from my "reps" that you can shake a dick at. Probably won't last long...but until it does end....damn I'm having fun. Hell with the money. The tail is where it's at.

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  113. If the WSJ wants to dig, they need to setup in Georgia. Medtronics has bought every doc that has come out of Emory. Now, 4-spine(Globus) is steadily taking over that role. Amendia out of Marietta is buying up surgeons and now starting pods everywhere. Funny thing is they have a merger with another surgeon owned pod. It's a short drive down I-75 to Macon. This is home of southern spine and Hugh Smisson. Lanx no thanks is there favorite friend along with Minsurg(trufuse). How do you do a tlif with Aspen and then adjacent levels with trufuse? These guys in Macon are ridiculous, the poor bone rep there has lost all his business. Southern spine has converted the hospital to it's allograft company. Another two hours south on I-16 in savannah. Globus reps who's daddies are neurosurgeons. Then there is Randy Bishop, who is now using smissons plate and does half assed surgery. Oh I almost forgot of all the fishing trips and ski trips that are offered to surgeons to use amend and southern spine. They use smissions jets and homes. Oh yeah, I almost forgot this one. All the surgeons that are in hortons pods, own percentages in his companies. Guess who the big one is? You got it Adam Lewis. If I was a betting man, that's why his pod carries Spinal USA.

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  114. Please elaborate how MSD "buys" docs - they fund fellowships but that isn't illegal, it is smart business. 4-spine doesn't "buy" docs either. You are wrong on that front. However, k. horton's companies would be an interesting can to kick over.

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  115. 10:57

    While many might speculate that what you are saying is true, it is important that if you put it into writing that it is factual. Your assertion regarding MSD and Georgia is factually incorrect. to 1:16's point, and to clarify, MSD and other big boy companies fund fellowships through OREF and NREF and do not even know where the money goes. With regard to "buying" docs that come out of Emory, you are also incorrect. Never has happened, never will.

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  116. Mattiola was the reason I lost my job. He promised my company $ millions in sales and delivered NOTHING!!! I felt he was not truthful

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