Wednesday, March 21, 2012

Rust Never Sleeps

Fellow Spineophiles;

Upon taking a few mental health days from blogging, it is great to get to the keyboard and share a few thoughts about the industry and some of the comments that have been posted referring to this blog dying a slow death, that TSB sold out to another TSB, that there were grammatical errors, that the creative juices are gone by asking you a simple question in our post, "where has all the innovation gone?" This is your forum, isn't it?  It has always been about the people, it has never been a PR platform for any one individual.  TSB is not Robin Young shopping his OTW around to other publications, a gadfly, an industry oracle, no we would never be that full of ourselves. TSB stopped hanging onto mommies apron a long time ago.  But before I continue to blog, let me make an observation about some of our readers.  For the most part, the majority of you contribute in a positive manner, many with surgical like precision contrary to the naysayers.  Unfortunately, there is a minority, if not a few individuals that truly believe that they are entitled to dictate what we should write about, how often should we post, and what we should say, let alone how we should say it. They continue to espouse their non-sense. With that said, let me quote Samuel Langhorne Clemens,  Mark Twain for some of gnomes that surf this site, "the reports of TSB's death are greatly exaggerated."  How ridiculous do some of you sound?  You would think that TSB was working for our readers.  Guess what?  We're not.  Not any one individual that contributes to our weekly posts works for any of you.  In all likelihood we will never work for anyone, nor will we ever pander to anyone's desires.  Our objective was and will always be to be honest and truthful about this industry and some of the cartoon characters that make up the usual suspects.

Upon attending some recent industry related meetings the one thing that truly jumps out is that this industry is as toxic as it has ever been.  Many of you and your companies have gone so far off course that the question must be posed, will you ever get back on track?  Upon visiting some of your booths, it became apparent that the delusional have never left the building. Building is a thing of the past, and maybe this is a by product of the kind of leaders some of your companies are putting in place.  As for culture, that is nothing more than a charade.  TSB and his Band of Gypsies walk around some of these meetings and do not see anything that resembles an industry that took great pride in itself. The reason this industry has reached this crossroad is because we lack an ethic and moral that once made us a proud industry.  How pathetic is it watching some of you run around kissing some KOL's ass?  They laugh at most of you, and mock you behind your backs.  As for leadership, it's a joke at best.  Leadership was about doing the right thing, today it is nothing more than a distant memory.  It's all about making money.  Yet, before anyone dare illicit a response, look at the tactics and strategies that have been implemented.  Today, leadership is not about leading, its about beating your managers and sales force over the head with unrealistic expectations.  Where do some of these people come up with their hallucinations?  Could it be that they are the people doing the drugs?  Hey, why not read another book or attend another leadership seminar only to leave those tools at the door when you leave.  Today very few dollars are directed at education for the direct and independent sales rep.  Part of the problem is that many claim to understand leadership and management, yet, few understand sales.  You actually need to be a magician to succeed in this business.  But then again, there are a few Mr. Magic's that are in sales leadership positions.

For those of you that think TSB is dead, we are just catching our second wind.  Over the next few days and weeks we will entertain you with our take on the complaint files against Phygen for IP infringement and some other oldies but goodies.  To those that think TSB is dead, remember what the great Neil Young once said, "rust never sleeps."

Hey, Hey, my, my , TSB will never die, there's more to the picture than meets the eye, hey, hey, my, my. So keep your eyes out for over the days TSB will have arisen from the dead.

Keep On Rockin' Spineophiles


58 comments:

  1. Well written Mr. Twain!

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  2. Love me some Neil Young but am partial to Unknown Legend myself. I for one am glad that TSB has not passed. While I wish there were most posts its only because this place can be one that rejuvenates the spinal spirit.

    I have been thinking about the previous innovation post. Product development in this industry has harvested all of the 'low hanging fruit.' Its simply harder to come upon ideas that haven't been done already. That writing was on the wall at least five years ago. How many times have you and your colleagues talked about finding the opportunity, the magic idea, that causes you to leave the status quo and create the experience that was ten years ago- only doing it better because we are all so much wiser now?

    There are some of us that are trying to do novel things. From experience, there are many hurdles that didn't exist ten years ago. In addition to the field maturing (if you want to call it that), risks associated with FDA and securing reimbursement have made it that much more difficult to raise money to make an idea succeed in the U.S. In a nutshell, I think that's what has stifled innovation, as opposed to PODs or other shady dealings. Unfortunately, significant innovation requires US clinical trials so its pay to play. More start-ups are choosing to make a go of it overseas. Given that it typically takes less money to enter Europe, that makes a lot of sense. Benvenue, Spinal Motion and Interventional Spine all issued Eurocentric press releases over the past few days. While its not an easy pathway, it does give the entrepreneur the chance of riding out the storm in the U.S. How long will it be until conditions turn more favorable in the U.S? I do know it won't last forever.

    How many of you would invest your hard earned money in an innovative spine technology? What would make a deal worthwhile to you? Type of market, clinical data, leadership, company strategy? There is a funding gap in medical devices, including spine, right now and I've been asking myself if its possible for the spine community to bridge that gap. Maybe there should be a spine angel network intent on breathing new life into this industry? I have to believe 'insiders' are better able to spot an opportunity than the few 'professional' investors that are left.

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  3. Globus..... public?

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  4. Be careful who you call a salesman lest you compliment him.

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  5. I often wonder if it is the chicken or the egg. Did the manufacturing side of the business start the downward slope into the mud or was it some of the dirty Surgeons that made pay to play the norm? I work in a average sized Midwest city and as far as my sales calls go, 9 out of 10 Surgeons have their hand fully extended looking for a design team/research funds/speaker deal/consulting agreement. In the last couple of years that I have been working, it only seems to be getting worse. I have called on one Surgeon in the last year that has admittedly stated he wants nothing to do with the aforementioned deals... 1 out of 10! How come the stand-up-guy/Surgeon is such a dying bread? Has the industry become all about what company pays the most and offers the best deal or has that always been the case?

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  6. Greedy surgeons, greedy reps & greedy companies, you should be ashamed of yourselves! Where have morals & ethics gone? Does anyone care about the PEOPLE under the drapes in the OR???? Innovation, what a joke! This industry is ALL about money, greed & deceit! I hope you all burn in HELL!

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    1. I don't appreciate the generalization. There are a lot of good reps, companies and surgeons and a lot not so good. Why are you so angry?

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    2. I agree, not all of us deserve to burn in HELL! but name one company that is not dirty, I work for a great group I know what is under the table, they all are greedy

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    3. Name one company...AcroMed (pre-1998)

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    4. Don't kid yourself 6:36, do you think the original surgeons used Acromed for purely altruistic reasons? No, they were enticed with stock options that eventually made them millionaires. And as the popularity of pedicle fixation spread more and more greedy surgeons went looking for their piece of the pie.

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    5. Not kidding myself. Only a few key surgeons had stock options in AcroMed and there were no consulting agreements ($) that other companies used to financially tie itself to other surgeons. Also, there was no guarantee that any of these options would ever be worth anything especially after 20/20 & 4,000 lawsuits. Finally, the surgeons with options spent a lot of time either developing products or teaching other surgeons/holding courses. AcroMed never was investigated for paying off surgeons or violating any other companies' patents (after being sold, it won a huge case against Medtronic Sofamor Danek for violating its patents). Was it perfect? No, but AcroMed was cleaner than any company it competed against.

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    6. Different time, different place. The whole industry was generating less revenue than 1 second level player now. Patents were fewer and opportunities were abundant. There wasn't a need to "pay to play". The spine doc back then was just happy to have new codes to use.

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    7. I concur with both 6:36 and 9:29. In the AcroMed days surgeons didn't have their hands out at all. Royalties were paid for actual product development project contributors, but everyone else was just happy to be involved and a part of something new. But I suspect that was the case with Synthes and Sofamor-Danek at the time as well. One very interesting point back then was that a surgeon needed to establish themselves academically, as someone of influence and respected by their peers, before companies were willing to collaborate with them as consultants. That's changed over time and the bar has really come down, which makes the credibility of both the surgeon consultants and the research they perform with the companies much more questionable.

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    8. I remember the AcroMed days fondly. Those were the good ol days, lol.

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    9. It is ALL about greed of the surgeon, rep and distributor. Too bad about the patient. It's amazing how patients fall for the BS of treating their back pain with a 10 level fusion. What level of LIES and DECEIT must a doc pass on to a patient to get a patient to sign up for that kind of surgery? The LIES would have to be on the diagnosis, the proposed BS multilevel fusion, the risks and the anticipated relief of pain. How gullible the patients must be. Too bad the patients are so trusting of these vultures. The oath to first do no harm has gone out the window.

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    10. Who are you and why are you so angry. Spine surgery helps people all over the world everyday. There are bad surgeons but it's up to the patient to get a 2nd, 3rd, 4th opinion. If you are told you need a 10 level fusion and do not get another opinion you have no one to blame but yourself.

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    11. ... and the surgeon that offered the ten-level fusion. Sorry, the term buyer-beware should never be an acceptable component of healthcare.

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  7. Wow. Take a chill pill, dude.

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  8. Has greed sent this industry in a downward spiral? Probably. But when? I was not around for the good ol' days when hospitals payed without asking, there were no monthly committee meetings to deny most new product into OR, etc. Through war stories of the sages, it seems no one thought of it as greed back in the day. Is it only greed when people are fighting to maintain pricing while institutions cap it? Is it only greed when POD's reap financial benefit of their implant volume? People justify their decisions in all kinds of ways whether you're referring to POD rep/surgeon reaping the rewards, a hospital value analysis committee member cutting cost and denying a new device into the hospital with zero clinical knowledge of what said product does, insurance reimbursement specialist denying request for coverage of patient in dire need of surgery from a grade II spondy, etc.

    The good ol days for med device sales reps is changing, some say it is over. But you can still make great coin compared to most professions. However, if you are hedging your future and your children's college education by selling only in spine, well...

    Every day is a good one. Get up earlier than the next guy or gal, be positive, work hard, study and get smart, be genuine and honest and you will get yours in good time. And there will always be a job for you. The scamsters, shady entities (you all absolutely know who you are) and such may get the quick dollars, but they will be short lived. Lazy reps and the stupid will be filtered out quickly-ish (not quick enough!). Companies will be called to the carpet for their false promises quickly enough and surgeons will move on.

    This stuff is a lot of fun, isn't it?!?

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    1. I would disagree. Remember the good old days when the Depuy reps in California were putting implants in the ceiling so they could make even more money, I think they were getting good pricing back then. They ended up in jail as I understand.

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  9. your an imposter! tsb has gone down the tubes since you have taken over! was formerly a great blog--sad

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  10. Hey 9:14 - Check yourself, you just wriggity wrecked yourself...just made the most annoying mistake of the cell phone generation (usually done by 15 year old girls.) Big difference between your and you're.

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  11. I would have gotten away with it if it had not been for those meddling kids!

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  12. MM is not dead..!

    He's metamorphosised into 03.41 pm...!

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    1. You may be right... (I may be crazy... ) Sorry, it was Billy Joel night on Idol last night.

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  13. I heard Phygen lost a bunch of employees again. Maybe they should rename the company Allez/Phygen 3.0 and collect another 50k from surgeons. Any surgeon that put a nickel into that company must feel like a dope.

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    1. Phygen is short for Physician Generated. They had to change their name since reports in the Register Newspaper in Orange County had articles about over use of implants. It amazes me how the hospital administrators have no idea what a POD is or how they work. All administrators are only concerned on how much a particular implant will cost. They somehow don't think that the dishonest spine surgeon will do 300% more surgery on those cases where he gets paid via the POD model. How long can this BS model go on? When will the OIG FINALLY stand up to the abuses of patients? Getting rid of the PODs would save Medicare and others a ton of money that could then, perhaps, be used where needed. New Hampshire is in the middle of considering outlawing all PODs. The rest of the states should get it together. Will this have to be judged at each individual state or can the feds make a decision about PODs?

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    2. Several of my best surgeons are Phygen members. They told me that Phygen does not pay anything to surgeons and hasn't for like five years. One of them told me that Phygen is trying to build value through product development like K2M. I blew coffee out my nose when he said that. What a joke. Whatever they're doing or not doing, I hope they keep it up. I won the business the old fashioned way, with hard work.

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  14. zimmer and lanx have some new technology coming out.

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    1. and.........what is the techmology? Your comment adds nothing to this Blog.

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    2. just a shot in the dark, but i bet you carry zimmer and lanx.

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  15. new for those 2: cervical plate. 4 screws, titanium plate, indistinguishable from anyone else's. Maybe a PEEK cervical cage, too. List will be $3,000 on the plate and $2,000 for the cage and they'll wonder why only their surgeon advisors seem to use them. Inserters will jam on every tenth case. You'll tell marketing, but marketing won't tell development about the problem. Three years from now, there we'll be...trying to explain why our me-too 1 level ACDF should go for $5,000 while there are 10 competitors at $2,000 with products no one but the company reps and engineers can tell apart...then comes the "discussion" of why we missed quota again...

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  16. Zimmer taking the USA by storm... more to come, or cum

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  17. 11:24

    That Alphatec u are referring too?

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  18. overheard --new local SynPuy manager claims not all of reps to be on board after full transition. who will survive? the Synthes rep or the Depuy rep? pink slips a-cummin

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

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

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  20. What were the commission rates of Depuy Distributor Reps and what are the commission rates now that they are direct? I have noticed many leave and a few were solid reps. They have a one year non compete clause in their contract. Thanks.

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    1. At 5:26, in my area, I'm told it your commission rate is depend and on how closely you're related to the Distributor.

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    2. the solid Depuy Reps did leave, the remaining ones are weak and are just holding on to the Legacy, they aren't salesmen, but their days are numbered

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  21. distributer reps 8 percent direct 23 percent

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    1. Are you sure about that?? So why don't we all go direct? Ha

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  22. Distributor reps get less than direct? are you sure?

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  23. yes when you add in all the perks...car benefits etc...

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    1. I assure you that is incorrect.

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    2. Once again, inaccurate. Please describe the 15% in perks you reference.

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    3. Twice the commission rate far exceeds the 15% in perks a direct rep gets.

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  24. Wow! A crappy hybrid coke can to drive around in and a cool JNJ nametag! That's worth the pay cut for sure.

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  25. Your guess of 8% distributor and 23% direct is not correct. More like 8% distributor and 4% direct with benefits. That said, like 6:44 stated the commission rate exceeds the perks of a direct rep. I am aware of a handful of Depuy reps who left and wanted no part of the direct model. They were very good reps with tight relationships. I work for a small distributor and I have witness the back stabbing my principle gets from the companies we represent or have represented. In the end the knife is sharp on both sides, direct or distributor, in time you will get sliced. Peace.

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    1. Is Robert Sargent still around?

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    2. 9:44A.M. ---you wanna see a sharp knife? IF and WHEN the audits start -retroACTIVELY- of the Distributor-Managers Credit cards and activities.
      One must wonder if they are AdvaMed compliant, Will they put JNJ in a place where the JNJ compliance team has to take action? Why were some distributors so much more successful than others? Could be just geography and demographics, could be creative distributor managers going above and beyond! What is the Secret To Their Success?? Just some random thoughts!! Very possibly there was just GOOD SELLING. Only the JNJ Compliance team Knows.... But if there was some sideline antics... the Docs who played will certainly sink along with the ship. We are all waiting for the answer/outcome ...HOW have the largest Distributors been so successful??? Let the Investigation begin!!

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    3. Any DePuy reps who took the most recent HCC module know how serious JnJ is about compliance and Advamed. Reps are duty bound to report any possible illicit activities without fear of reprisal.

      As a former DePuke rep I was subjected to a new manager who informed me that all of the most succesful distributors never played by the Advamed rules. He went on to tell me how he had spent thousands of $$ out of pocket the previous year on HCC prohibited shenanagans. Under his comand I was encouraged/compelled to do everything from rewarding surgeon offices with Panera after cases to being compelled to spend $300. to play golf in a foursome with one of my customers in a Charity golf event (I had no choice in the matter and I have the receipt to boot). There were many other little things such as some hockey games with customers, happy hours etc. On an individual basis not anything too bad, but taken together it is clearly a pattern of behavior and I was only one of several reps under his control. Certainly JnJ would not find any of this amusing.

      Yes its all a "he said - he said" situation, but I would sign a an affidavit and do a polygraph if necessary. Can't sue somebody for defamation if its all true. I have no imediate plans to ring the compliance line at DePuy, but that will be vases on how I am treated in the future.

      As an 8 year rep for DePuy I never broke the rules a single time. I despise those who do and yes many of those at DePuy who achieved their success through shortcuts will have to face the music at some point.

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  26. Alphatec is undergoing big changes. New CEO, new VP Operations. How long before they change out the VP of sales and the AVPs? Betcha by the end of April the musical chairs will be filled with new bodies.

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    1. The are too far gone. The new team should package it up to sell and cash out. They have never been able to get it together and never will.

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  27. The Koreans. GS Medical would probably buy for at least $100.00. Maybe Integra would pick up at that bargain basement price. Gotta love those California companies. Too close to Hollywood and they are all glitz and no substance.

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