Sunday, May 13, 2012

Sunday Editorial

Before MM goes any further, today is Mother's Day, and those of us at TSB want to wish every mother a happy and healthy MD, and no that acronym does not mean a Doctorate in Medicine. On April 26th, TSB posted a blog entitled, "Is There Anything That Money Can't Buy in Spine."  In addition, to that post, many of you have read our opinion on the commercialization of the spine industry. A few years ago we even suggested that rather than publish spine surgeons commercial interest in the back of the annual NASS booklet, by law NASS should have them wear golf shirts with company logos and baseball hats as they walk around the show. But back to the editorial. Upon finishing Professor Michael Sandel's book, "What Money Can't Buy, The Moral Limits of Markets," ironically our mailbox had received another e-mail from ISASS, aka The International Society for the Advancement of Spine Surgery. The e-mail was an invitation from Heather Howard on behalf of Chairman Larry Khoo and James Yue the Co-Chairs of this ISASS program. The faculty is the Who's Who that have been as responsible for the commercialization of medicine as have their mentors, and many of you know who they are.  But today's editorial is not about any of these individuals.  It really is about the concerns that are raised when you receive an invitation at the cost of participating at $30,000 per station. Obviously the going rate in today's market.

Now before anyone goes on a rant, TSB knows that no one gets to play in ISASS' (love that acronym) sandbox without paying an admission fee, but $30,000?  Obviously this course is being held in the City of Lost Wages, Nevada on July 21-22, 2012 (I'll give ISASS a plug for free, unlike their good friends at OTW).  It's all about critical mass Drs. Khoo and Yue, and based on our number we're definitely giving you visibility.  But TSB must wonder, if surgeons haven't gone too far in the commercializing medicine? Don't believe TSB, why is ISASS offering to promote the participating companies on their website and generating e-blasts as part of the admission fee? Does anyone believe that the advertisement of your participation as a company is going to attract some fledgling spine surgeon to attend the "OCCTTLSTL" Hip Hop Surgeon Training in the middle of the summer no less, in the adult playground capital of the world? Do any of these surgeons really care as long as you're dropping your 30 grand on the table?  So here's what you get for your fee;

1 Lab Station:
1 Cadaver: All you need is a torso with head 
1 Set of General Instrument: Most companies can supply these tools that will attend
Battle Gear:  Scrubs, Masks, Caps, Shoe Covers, Gloves (How expensive is that?) 

But here's the kicker, a disclaimer states that the $30,000 does not include the honoraria or the consulting payments to the lab faculty, and that participating companies may choose to provide consulting payments to chosen faculty according to "their" normal policy. Does that mean the surgeons normal policy, or the company's? You have to love medicine, especially if you think that we haven't commercialized it to the extent that an organization like ISASS promotes the education of their members or peers, you as a company get to pay an admission fee to promote some screws, wires, and that some of the surgeon participants may even have a vested interest in a company and potentially they are using this forum to further commercialize a venture that they may have a capital investment in.  Can you hear disclaimer?

Ironically, at the bottom of ISASS e-mails is a famous quote from Albert Einstein, it states, "a person who never made a mistake, never tried anything new."  What it really should have said is, "a person who never made a mistake, never tried anything new, but it's much easier when you use someone else's money."  Maybe what TSB should do is end his blog posts with our favorite Einsteinism: "the definition of insanity is doing the same thing over and over and expecting different results." So in closing TSB will leave you with the legal definition of insanity;

"mental illness of such severe nature that a person cannot distinguish fantasy from reality, cannot control one's behavior due to a psychosis, is subject to uncontrolled behavior." Market Economy? No Way! Market Society!  Everything is for sale. TSB must ask one question: how much is ISASS laying out for this meeting, and don't come back crying talking about the cost of promotional marketing.

TSB would like to wish all of our readers a Happy Mother's Day.  PS: I'll see you at the turn in Pauite, we're outta here!!!!!!!!!!!!!!!!!!!

47 comments:

  1. MM
    I am all for education and training, but it seems to me, the primary purpose of these types of meetings is more for lining the pockets of those who put these meetings on, than it is for training the surgeons.

    having been in spine sales for 2 1/2 decades now, it is sad to see the level at which this industry has stooped.

    At the risk of sounding like an old fogey, I can recall when educational courses were modestly priced and companies were invited (sometimes begged) to attend free of charge.

    At that time surgeons and the educators were appreciative of the companies and sales reps there as we helped in setting up the work stations, assisting the educators and cleaning up afterwards. It wasnt all about the money at the time, but truly as an educational experience for the surgeons and also provided us the sales reps with a great training experience as well as the opportunity to work shoulder to shoulder with our docs. Then at nite we would all go to dinner etc and were viewed as part of the "team".

    Fast forward to today, now manufacturers are seen as little more than a revenue source for these types of programs. I couldnt agree more that $30,000 is a ridiculous amount of money for any cadaever training program and as most of these training course have become, nothing more than a means in which the hosts stand to make a fortune on the course.

    It seems nearly every week, we recieve some invitation or announcement regarding a training course at a location somewhere, it is my belief that the "business" of training courses has become a very profitable vehicle for those who host them.

    Of course this is the way it is today and there is little that any of us can do to change this current environment; save for avoiding and refusing to participate in these types of programs.

    It will be very interesting to see where this industry is in another 5 years.

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    1. Great post, and I share your perspective. Well stated.

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  2. MM,
    The free market rules, if you don't like it, don't participate.

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    1. 7:45am, I would have to agree with you on this. While we all can sit and complain about this, we created this monster. Being in this biz myself for 15 years, I too remember the good old days these groups used to beg us manufacture reps to particapte in these meetings and we do so without hesatation. My major UC teaching hospital has a spine meeting every year and it is required that we give or "dontate" $5K each to particapte.

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  3. This is no different than what is happening all over. There is a prominent religious based hospital near Beverly Hills, CA (name omitted to protect the guilty) that has told key vendors that if you want to be included as a primary vendor YOU MUST PONY UP $100,000 to support their spine conference in Las Vegas (how ironic). It is money well spent for those companies that don't do any business at this morally ethical teaching institution. The sad part is that the fellows/residence graduate from this dump turn into the same corrupt individuals as their mentors. Like father like son...the cycle won't end...

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  4. 6:38, you're dead on right. That's why after 23 plus years in spine I, with a sigh of relief, have turned to other areas of medicine. My initial interactions there, even with plastics, show a refreshingly patient-centric world view. The majority of high visibility spine surgeons only look at the dollars, and couldn't care less how the patient fares. We all know their names. Maybe it all is due to the fact that they have desensitized themselves to the on average very mediocre outcomes....

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  5. Obamacare will fix it, just like he fixed the exonomy.

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  6. 7:45 I respectfully disagree with your opinion. On the contrary "Free Markets" do not rule, and that is the exact point of Professors Sandler's book. There is a price tag on everything, therefore, nothing is free. You know it from first hand experience. What Doctor Famous' business, there's a price tag for their business. As for 12:21, is there anything more ridiculous than state that Obamacare will fix it like he fixed the economy. Being the staunch Republican of Tea Partier, I'm sure Henry Paulson did a great job feeding the beast. You probably aspire to be just like Jamie Dimon.

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  7. MSM whatever happened to having a simple, happy and honorable life? Money dilutes peoples senses, they become invincible until the walls come crashing down.

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  8. M&M,
    Professor Barack Obama has a grand total of ZERO businesspeople in his cabinet, just Professors. The last people qualified to talk about free markets are Professors! Never had to make a payroll, pay for employees' health benefits mandated by a leviathan government, never had to compete in an arena where cold hard facts like making a number mattered, just Professorial bloviations. M&M, I respect your blog and love to keep abreast of our business here. However, you're off the reservation when you say that everything's for sale, when that's the point of Capitalism isn't it? If that doesn't square with your happy/shiny view of what a lefty world should be, well, just sing "Imagine" while reality passes you by.

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

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    2. 5:18 You're obviously correct, the government is ALWAYS the reason that free markets are hindered. You're right, its the governments fault that healthcare costs are out of control, it's the governments fault that JP Morgan lost $2 billion dollars last week on a hedge in the credit derivatives market because banking, I mean gambling is over regulated, you're spot on that the government is hindering product innovation in spine. Why don't we just have a lawless and unregulated society, no taxes, no public services, no police protection, no fire department, hey we could let our bridges collapse like in Minnesota, who cares if you or your loved ones perish in such a calamity, I mean its just life, right? Let the roads go to shit. And on top of that we could make sure that grandma and grandpa are collateral damage ruled by the government death panels. Obviously you understand Capitalism so well that you really don't care whether your children become amoral or unethical because life is all about making money, isn't it?

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    3. Amen brother

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    4. MM,
      Did 5:18 mention any of those things, or did you just feel the need for a hysterical rant? If anybody understands that nothing is free, it is conservatives. Regulatory compliance costs businesses money, which costs people money. And rarely, if ever, do the benefits outweigh the costs. Nobody is espousing a world completely free of regulation as you liberals like to chant while defecating on police cars. Nobody blamed government for JP Morgans loss last week. Government is absolutely the primary reason for the lack of innovation. When an IDE costs $25M, only the big boys can play and even then they only play with big ideas. Ones, by the way, that do not lower costs, but typically add costs and volume, otherwise, it wouldn't be worth their while.

      There is a reality between the scenario you so sarcastically paint with no police and falling bridges and a society where the government provides for your every need by taking from those they feel can afford to help you. But eventually in your utopia, you run out of other peoples money (to quote Margaret Thatcher) and the jig is up. Then there's no money to fix your roads and bridges and you have to choose between those projects and the myriad social programs that have never been effective at doing anything other than KEEPING people poor and voting for the hand that feeds them just enough to get by because they have now forgotten how to provide for themselves. Let me ask you a question MM, how much money are you willing to spend on a bridge to save a life? There is a point where you can spend enough to guarantee that bridge will never fall, but if we spend that on every bridge the entire country goes down the tubes. It's a crass scenario, but it is also reality. The same question can be asked about government provided healthcare, section 8 housing, green energy projects, education and everything else the government is involved in. As a nation, we simply cannot pay for all of those things and expect to survive.

      And how arrogant of you to say that someone who doesn't think like a you or any other socialist is raising their kids to be unethical or amoral. Is MM exhibiting that great tolerance that all liberals demand from evil and mean conservatives? I personally don't see how anyone in this cut throat, competitive, testosterone overloaded business can fight all day to take money out of a competitors pocket and then come home and write a blog decrying people who want to keep their own money instead of giving it to the government to waste. Why don't you just go find the worst rep in your area and help him convert some of your business so he can survive. That would help him a lot more than the government ever could.

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    5. To spend the money to save a life is really not worth it. Just wait until your child or loved one dies in a tragedy that could be averted, then you'll sing a different tune, until then you're invincible.

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    6. Is that Ayn Rand speaking to TSB from the dead, or is Paul Ryan following this site. I agree with 6:14 but then the bible thumpers and free market people all bitch until something effects their lives.

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    7. My life is being effected already by the endless spending. The question is not "how much is a life worth?", but how much can we spend protecting people on the fringe and their lifestyle and their "dignity" before we wreck the country? And how many entitlement programs have we ever been able to get rid of? Nobody has the balls to "take" a benefit away from individuals for the sake of the country. Is it better for the country to fail so that some indivuals don't have to do without? We certainly should take care of those who can't provide for themselves, but our social programs go way beyond that and they are abused badly. Our "poor" are considered rich by most of the world. We are ALL going to have to pay to right this ship. But that includes fewer entitlements for the bottom 50%, more taxes for everyone who makes a full time paycheck and massive reductions in spending. The top 2% can't touch this problem, even at 100% tax rate

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  10. Business People? Just look at some of the business people running start up companies, 5:18 they are real gems at what they do. You must be one of those people that pice in a bubble

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  11. The real question is what's the ROI on your 30k? If you can get a surgeon customer or two then it's worth it. Last year at NASS, the only companies ponying up for big booths were the Tier 2 ones, the ones with the most to gain.

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    1. My question is what kind of return is this so-called "non-profit" making? I'd like to know what Heather Howard makes in terms of salary and perks. Just look at the BOD of ISASS-- a who's who of surgeon/profiteers.

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  12. Business people are generally clueless trust-fund entitlement cases and predominantly the cause of America's percipitous decline. But of course you're not buying it, because your simple brain cannot grasp that it's not the black guy from Kenya who did this to your con of an industry, since the bible doesn't say so...

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    1. You are an idiot. Thanks for making that clear to all of us.

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    2. Truth hurts, doesn't it?

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  13. People would respect 5:18 if he admitted that he is a racist and hates black people, but then that would take balls and considering 5:18 accuses everyone of being a coward hiding behind our own anonymity, he hides behind his. Love religious zealots, go to church on sunday to ask forgiveness for Monday -Saturday.

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    1. nonsense nonsense nonsense No indication of racism here. this poster is trying to inflame everyone with no basis what a nonsense post

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    2. Its the liberals way of trying to end an argument they are losing. Go ahead libtards, call every conservative a racist and see where that gets you in November. Personally, I think its racist to call Obama black. He's 50/50. So he's both and neither. Only a racist would apply the "single drop" rule to call a person black because they have ANY black lineage. Would you call him a liar if he claimed to be white? He has just as much claim to his whiteness as his blackness.

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  14. IMO african americans seem to be the most racist of all. Just from my personal experiences. So angry and not a care in the world who is around them or who they may be inconveniencing.

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    1. black jokes are 99% safe in a forum full of spine reps

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  15. You're a good boy who loves his mama, loves Jesus and America too, you're a good ole boy crazy 'bout Elvis, loves spine and his girlfriend too, you must be free fallin'

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  16. How much money will be available for all of the boondoggle courses we do? The last RFP I received was ridiculous low. Love those consultants.

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  17. Just what I want to do, spend $30K and then have to pay an honoraria to the lab instructor, gotta love America, and Jesus too.....MM

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  18. Actually, I think the free market will soon bring this "extortion" to an end. Costs are an issue for our industry, and with product pricing coming down, big and small companies alike are keeping the budgets in check.

    Big players don't see these courses as ways to boost share, and they're likely reaching their limit knowing their business isn't going anywhere if they pick and choose their courses to support.

    So how good is the course going to be when only second tier players show up, thinking they have something to gain?

    And what happens when they don't gain much, as ultimately it will be the familiarity, product, rep and now cost that determines which systems actually get used. Suddenly no ROI for Tier 2 folks either.

    These courses are like professional boxing in the late 80's, extracting the bucks because they can, and profiting in the short term big time as a result. But patterns change when the free market has incentives to do so, and change they will. Half the country might have been willing to pay 20 bucks to watch Leonard or Tyson fight, but that ended fast and who are they watching now? MMA, because you could watch them for free.

    Like a cruise ship, it's a slow turn, but a turn nonetheless.

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  19. What is happening to the ATEC stock? What is the Eclipse deal all about?

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  20. MM,

    Why don't you just come out of the closet and say it, "I am a Socialist!" Ahhhhh, now does'nt that make you feel better? Yes, money is the root of all evil, and our glorious government will take such great care of us. I cannot wait until we are all little Lemmings suckling on the teet until we die a pathetic unfulfilled life of mediocrity..........

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  21. 12:51 - What do you mean whats happening to ATEC stock??? It's been flatter than Twiggy for over 2-years. From May 14, 2010 to today -66%.

    Look at the products (or lack of) that they offer as well as the management team (revolving door) and you'll understand why.

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  22. 1:53 Mediocrity is the norm, just look at our industry you fool

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    1. Mediocrity is the "American values" of today.

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    2. Mediocrity is the norm, by definition. The difference is that in socialism, everyone is forced into mediocrity. In capitalism, you can aspire to, and achieve, excellence and be rewarded for it.

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  23. Corporate America loves mediocrity except for the CEO's that run the industry, they are the smartest guys in the room without them nothing gets done

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  24. MM,
    I must havehit a nerve at 5:18, I promise you that without an overzealous govt we would have BETTER:
    Roads
    Bridges
    Public security
    Trains because of the EXCELLENCE that competition always produces. The obese govt bureacrats are only a hair better that those blobs of chewing gum that we have to deal with on a daily basis known as "Hospital Adminsistrators" destroying more than they create (BTW does Obama create anything?)

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    1. He's created more bureaucracy!

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    2. What did Bush create except for ruins?

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    3. What about Woodrow Wilson? Bush is not president. We aren't talking about Bush. Nobody is claiming that Bush is a golden boy. The election is this year, time to own up to the fact that Obama is at the helm, things are no better and the country is more divided than I can remember in my lifetime.

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  25. Let's face facts we are divided because no one is willing to make any concessions, and that includes the politicians from both parties and special interest groups. It's the corporations, the surgeons, the patients, the salespeople, its grandma and grandpa, we don't have to worry about terrorists infiltrating this country we do a pretty good job dividing ourselves as a nation. How ridiculous do we sound, the POTUS is from Kenya, he isn't an American citizen? We applaud this behavior when we should be embarrassed. No individual POTUS creates the problems that exist today, its thirty years of deregulation and everyone in office for the past thirty years is responsible. Then when we attempt to reign in this type of behavior those that have benefitted most cry foul. United we Stand, Divided we Fall. It's all about what benefits me most, its greed, its selfishness, we have become a shamelessness society. Have we learned anything from our mistakes? No, just look at the way JP Morgan has responded to their faux pas, does anyone actually believe that the CEO did not know that people were hedging on derivatives of this magnitude? We've become soft. We need to reward our children for finishing sixth in a swim meet because we don't want to traumatize l'il Joey's psyche, we have become soft and you know it. You don't sell anymore, you broker and when you can't find the right deal you move on to the next company, why? Because there's no loyalty from anyone anymore. Why do you think this industry has such high attrition rates? A company hires you and doesn't expect results, they expect immediate results. Sales cycle? That's a thing of the past, it's all about what have you done for me lately. We have become a prefabricated society. The problem is that no one wants to change, because change calls for concessions and we are incapable of doing that. So the next time you look at your children start thinking about what their world will be like, because unless you're a doctors son or daughter they will probably not be working in this industry.

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  26. I don't disagree with anything in your last post MM. Although I'm not sure who celebrated the "Kenyan" debate. POTUS unwillingness to produce a birth certificate just fueled the fringe lunies.

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  27. Depuy time... Just weeks before they fire the Synthes counterpart and have the whole SynPuy bag to themselves. Depuy reps will make more than most spine surgeons.

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