Mr. Big Stuff Who Do You Think You Are? MDT Sues NUVA

As Jeannie Knight once sang;

Because you wear all those fancy clothes (Cheetah's sing, "oh yeah")
And have a big fine car, oh yes you do now
Do you think I could give you my love now (Cheetah's, "oh yeah")
You think you are higher than every star above
Mr. Big Stuff, Who do you think you are?
Mr. Big Stuff ya never gonna get Medtronic's love

Yes fellow bloggers, it seems that Mr. Big Stuff is being taken to the rack one more time by his former colleagues and friends at Medtronic.  A little home cookin' is being served up to the now defunct oracle of spine Alex Lukianov (David Paul the baton has been passed) and his entourage at Nuvasive.  As has been reported in various media outlets, Medtronic has filed complaints against their former Superstar and his company claiming that CoRoent and Osteocel are infringing upon patents owned by Warsaw Orthopedics and Osteotech which were exclusively licensed to the Big Blue.

As a mere formality, Medtronic is asking for an injunction denying and preventing Mr. Big Stuff from producing its family of spinal implants and bone grafting material.  Medtronic is also requesting compensatory damages and legal fees.  TSB can see Ishrak singing to the Bear.

Dance with me, c'mon dance with me baby

Dance with me, c'mon dance pretty baby

I want you, and you want to be like me

So why can't we get together after the dance.

The Spine Industry: Guilty of Unrealistic Expectations?

TSB would like to thank all of our followers, on twitter, and those that continue to support us anonymously. Based on your feedback, those anonymous posters that do not contribute in a professional manner will be censored. No one is interested in reading baseless accusations regarding surgeon involvement with specific companies, unless that information exists in the public domain. Why?  In order to protect your anonymity, no one has the right to indict individuals by name, unless they are in the news, are under investigations, or have had legal charges levied against them.

MSM has had the privilege to travel and discuss the state of spine with many that carry competitive products.  Since the market crashed in '08, after the analysts' had downgraded growth expectations, your companies and their management teams continue to forecast revenue expectations that are unattainable. Why?  Slaves to the Street?  Most definitely, its about the stock and the shareholders  instead of the products. Adaptability? Not on your life. The reality is that these individuals are living in the past, or, they do not possess the ability to change.  How many of these individuals sold in the heyday of spine, still believing that some things have never changed?

No one ever said that man has the necessary skills to adapt to a changing environment. At the end of the day, man is a creature of habit, and old habits die hard. Your life's experiences are ingrained in your personalities. The spine market was already evolving before the Great Crash of '08.  Hardware innovation was grinding to a halt. With that in mind, everyone loves to say that they embraced change, they did it in the 2008 election, unfortunately none of us were are willing to make the sacrifice, because change is good as long as it doesn't effect you or me. Call it selfishness, call it greed, call it human nature. It's in our gestalt to deflect blame on someone else rather than look oneself in the mirror. But for those of you that compete in this "zero-sum market," contrary to what the new oracle of spine David Pavid may predict, exponential growth is not a sure thing, even if you believe that you can create 20 new products, or come up with creative ways to buy the business. MSM hears it from the distributors and their sales people who are sustaining marketshare but losing revenue, due to pricing pressures, to reimbursement issues, insurance denials, lack of innovation, in addition to having to compete in this cesspool that we call spine. Some of you will disagree. So how do you adapt and change in a hostile environment that has you pitted in a game of blink with your customers on one side, and your company on the other. The ability to sustain existing business or one's marketshare without losing a customer may actually be a testament to your character. Someone whom has built a reputation and a business on integrity, education, commitment, and a passion for one's craft. TSB can hear Doctor Famous ready to jump off the altar and attack. "What value do you bring?" "You are driving up the cost of healthcare!" Surgeons deride your skills, yet ironically, when their children do not possess the proclivity to follow their parents into medicine, where do they turn? Where else? The industry that they criticize, because by hiring their offsprings, you are going to drive down the cost of healthcare. They turn to the Medtronics, the DePuys, the Zimmers, the AlphWrecks, the Globus' to name a few. TSB calls them "children of entitlement" regardless that some will accuse TSB of envy. Walk a mile in my or your shoes and then you have the right to mouth off. Even in the adversarial climate that exists within America's hospitals your loyal customers know your true value.  Running sets around, getting up at 4:30 a.m. to cover a case, having to buy another lunch for an ungrateful office staff, even if its an outright violation of the laws. TSB does not see things getting better until we hit rock bottom, and only then will  the industry realize that the old ways of doing things just don't work anymore. Yesterdays dreams, are today's challenges.

So as we turn the corner and head into the last quarter of the fiscal calendar, who will be the market leader when we enter 2013?  Who will back up their promises with innovative products that will improve patient outcomes?  Where do we go from here?  Has spine's heyday come and gone or do we have some more life left in the old girl?  TSB wants to know?  

Sunday Editorial

The last few weeks have reared the ugliness and immaturity that exists in our country and in spine, this has become indicative by the vulgarity and sophomoric humor (to some) that has surfaced on TSB's blog. So let TSB share some wisdom, the definition of freedom means exemption from "control, interference, or regulation." If you notice TSB put those words in quotations. The time has come to implement regulation. Contrary to what some think, this is not your blog, neither is this a forum to spew vulgarities and non-sense..  You don't control the blog, neither do you have a "right" to spew the non-sense that comes out of some of your foul mouths. The purpose of this blog has been to provide everyone with a forum that no other platform has or ever will provide for the industry. You don't see it on OrthoWorld, Orthopedics This Week, or Orthospine News.  If the intent of the few is to destroy the blog or drive readers away, the necessary measures will be taken to incarcerating your thoughts or opinions. Censorship is a beautiful thing.  If you want to spew your non-sense develop your own blog, or better yet log on to Medical Holocaust, but then again no one follows or reads that second rate blog because no one likes crazy people. Yes that's right, CRAZY PEOPLE. Your rights and freedoms are nothing more than a fleeting moment.  So in closing, like the Times, the Wall Street Journal, The New Republic, or any other publication, it you want censorship remember what TSB says, "So I say to you, ask and it will be given to you; seek and you will find, knock too hard and the door will be slammed in your face."  TSB will not tolerate the disgusting and vile non-sense that the few of you write, neither do our readers welcome this aberration. Patients, Physicians, Public Officials, Attorneys and the General Public read this blog. If this vile and disgusting language does not cease TSB will block your IP address so you never have access again.  TSB wants to know what our readers think about these few individuals from North Carolina, Alabama and California that exemplify the unprofessional people that have infiltrated this industry.  This is your blog and TSB wants to know what you think,  It's time to let these people know what you think!

Profits Over Patients

Spine Nation:

As another season comes to a close, as the melancholy sets in for the many that love summer, it has become apparent that everyone is anxious to get closure on the upcoming election. Politics like the spine industry is not for the faint of heart. Confusion reigns when it comes to Medicare, and many ask why does the government continually attempt to stick its fork in an industry that has resembled the wild wild west. In many respects this weeks national and local news exemplifies the environment that we all will be challenged with in the years to come, regardless of whomever wins the upcoming election.  Whether you concur or dissent, the current healthcare environment is not sustainable even if the smartest guy in the room believes otherwise.  This weeks news was that there were more distributor cuts on the general orthopedic side at Biomet/EBI and the fallout from the DePuy/ Synthes merger says it all. "Legacy" reps, what a joke. After years of loyal dedication and commitment, a swift boot in the butt speaks volumes about the mercenary attitude that corporations continue to exhibit to those that gave their blood, sweat, and tears. Loyalty is a word that doesn't exist in the corporate lexicon.  Yet, for all the hoopla surrounding those companies, the investigation by the DOJ into HCA Hospitals speaks volumes about why healthcare continues to place profits over patient care, and why the government is compelled to intervene.

In 2006 three private equity firms bought HCA for $33 billion, proceeding the $1.7 billion fraud settlement between HCA and the U.S. Government.  With new ownership came a new strategy. Under the auspices of these firms and their representation on the board of HCA, the alleged strategic plan was how can HCA get more money out of private insurance companies, patients, and the U.S. government?  Did TSB say the U.S. government?  It seems that many common folk would like the government to stay out of healthcare, yet, maybe the powers to be love the government more than they are willing to allude to? Could new ownership at HCA have been looking for creative ways to aggressively increase their billing? Like any new owner, HCA immediately looked to reduce its emergency room services to those that were not qualified as emergent, in addition to cutting to its overall expenses, along with a reduction in staff.  The result of these policies was a compromise in patient care. The public can fully support profiling non-emergent patients and directing them to another provider, but inadequate staffing in critical areas and placing profits over patient safety is unacceptable.  As more and more hospitals are gobbled up by for profit organizations the question must be asked, are these entities even qualified to make the necessary decisions to influence the delivery of healthcare? What tactics will these for profit hospitals employ as lower reimbursements become a reality. If companies like Kravis, Kohlberg and Roberts have a 40% stake in HCA, as Cerebus Capital and the Blackstone Group acquire other healthcare systems, what is the future of medicine?  

At the heart of HCA's problems was the introduction of a new coding system for its emergency room care. Overnight the billing coming out of HCA emergency rooms was alleged coding for sicker patients. Doctors complained of quotas and financial objectives mandated by the powers to be at HCA. In addition, patients in HCA facilities were getting more bedsores, wounds, infections and complications.  In an independent survey, HCA owned eight of the top fifteen hospitals in patients developing bedsores. There were complaints regarding a shortage of nurses.  So the question must be asked of our readers, is this the future of modern medicine?  Who needs the government to take away your healthcare, you can go to a HCA hospital for a first hand experience. So TSB wants to know what our readers think?  Is this a healthy antidote?  For Profit Hospitals by For Profit Private Equity Groups?

Another long summer's come and gone,
I don't know why it always ends this way
The boardwalks quiet and the carnival rides
Are as empty as my broken heart tonight
But I close my eyes and one more time
We're spinning round and you're holdin' on tightly

Sunday Op Ed

The last couple of weeks in spine have been nothing less than sensational.  Dirk Kuyper is no longer running the good ship AlphaWreck, Spinal Elements has come up with a potentially "game-changing" vertebral inter body device (just kidding, isn't every product that comes out in spine game-changing), and David Paul can stand on the Aircraft Carrier Globus Medical declaring, "Mission Accomplished." With twenty, ahem, new products in the pipeline will he have the time to spend all of that money? Who knows, maybe he can enter the Presidential race. He is a CEO isn't he? And if running a company qualifies you for the highest office in the land, there is hope. Can anyone say, "birth certificate?" Who knows maybe he can legislate some policies that would take us right back in time when the industry didn't have to worry about pricing, or whether there would be any scrutiny by the insurance industry when it came to rubber stamping back surgery, when reps didn't have to worry about a reduction in commissions. But austerity has become our mantra. Pass the blame on everyone else except those that are running the companies themselves. It's time for those CEO's to personally tighten their belts and commit the necessary resources toward new technologies. Unfortunately many still would like to live in the past. You know what period TSB is talking about. Investors showered every insane idea or company with capital in hopes of the Holy Grail. How we long for them old 5-7X days. Those were the days my friends, we thought they'd never end. Not only were private investors throwing their millions at you, surgeons stopped being surgeons and became investors, subsidizing companies and protecting their investment by finding enough of patients to keep their investment and the company solvent. How many of those still exist?  Can someone say Mississippi? Maryland? South Dakota? California? Outside of Globus, where have any these other ventures gone? Nowhere. TSB is sure that some pompous small growth company CEO will rationalize that his intent was to never sell the company, unfortunately those individuals rarely stop to look in the mirror. When it comes to change, spine is an obstinate industry. Many of our readers blame the FDA, some even blame the current Administration, some are even willing to blame those that provide access to capital resources, but the truth is that the party is coming to an end regardless of whichever party takes office in January of 2013.  Our only saving grace lies with David Paul and Alex Lukianov so that they can finally put their difference aside and run for office. It's never too late. They are CEO's, aren't they? That automatically qualifies them to get the country out of the doldrums. Hey we could move all manufacturing to India and the Soviet Union. On second thought, that just isn't going to happen since their egos are larger than the Capitol's rotunda.

So where do we go from here?  If you believe Spinal Elements and Dr. Kitchell, they may have created the "ideal" environment for bone healing.  Don't believe it?  Imagine the novelty of an implant that has been sprayed with a titanium porous coating. Why didn't Globus, Nuvasive, or DePuy Synthes ever think of that?  Isn't it absurd and embarrassing that educated men tout this "new" product offering as "an exciting new technology?" How desperate can they be?  Taking a step forward?  Come on fellas, if this is all you have to offer, it's a wonder that SE has gotten this far. In all likelihood, this is another company that is on a bridge to nowhere. Is there anything innovative?  Have we had bad results with the current line up of interbody products?  Thank goodness for amateur marketing.  It was reported in another industry rag that the company's first two product were called Lucent and Crystal.  Maybe therein lies the problem, someone was doing too much crystal.  But you know what Tug McGraw use to say, "you gotta believe!"  By the way, for you young uns, Tug McGraw was Tim McGraw's   daddy.  So in closing, as the dog daze of summer are upon us, and everyone is gearing up for the silly season when we embrace the Spine Technology Awards and NASS, TSB wants to know, where's the beef?  Who has the keys to the Emerald City?

You sit in you big fancy house baby and you drive your fancy car

You treat us like we're not there, but I guess that's who you are

I'm on the the bridge to better days, better days are coming now

Globus: Did David Slay Goliath? Or Did He Get Something He Never Wished For?

The sky lit up in Audubon, PA this weekend.  One could smell the thrill of victory and not the agony of defeat.  Yes fellow bloggers, Glo-bus finally went public. Maybe just maybe, once and for all, we have heard the last of our obnoxious blogger, whom we have taken an affinity too, asking our readers the proverbial question, "when will Glo-bus go public?" In retrospect it will be interesting to assess how many shares were really sold, and whether or not the Dr. Famous' of this world who invested in this company will keep on giving the gift of giving by using Glo-bus products? Whoever said there wasn't any monetary incentive in using a specific companies product if there wasn't a potential payout in the end?

It has been a long and arduous journey for David Paul. A trek that spans many continents, the travails of leaving the company that you thought once loved you under the harshest of all circumstances, a rift amongst family members, being sued, and sued, and sued, and sued, and finally arriving at that magical moment when the stars all do align themselves for that one bright shining moment. So everybody have fun tonight, everybody Wang Chung tonight. With all that capital, who knows, maybe Globus will settle with the many plaintiffs that have filed suit against the Glo-bus for allegedly violating their patents, and move on. That would be wishful thinking. Maybe David Paul will now acquire another assistant to assist his trust worthy aide, Tatoo, or maybe he will really shock us at this years NASS meeting and arrive with pomp and circumstance, that would be pretty funny. Could a Jenna Jameson spokes model be in the picture? TSB could see the new Glo-bus booth, make no mistake.  A shining new sign will be up declaring that GMED is now a member of the NYSE. Maybe those that did not believe that this day would happen will be invited into the booth for some Naan, Roti, Tandoori Lamb Chops and Palak Chaat, one of TSB's all time favorites.  Who knows maybe David will hire TSB to cook for him? What a better way to get to know the man, the legend, the genius as his caddie McAfee calls him. Maybe McAfee will finally become his concubine? For one thing, TSB is relieved that everyone will no longer have to listen to McAfee embarrass himself at the podium declaring that "David Paul is a genius."

In closing, it was a fun weekend for those of us who had any stock or acquired some stock in the new kid on the block. But the mystery question is, will the Glo-bus be able to sustain success or will they just become another me too company? With 12-20 new products on the horizon, depending on whose propaganda you believe, poor David must not have any time to enjoy the fruit of his success. Who knows? Was he burning the midnight oil? Probably not.  In the end, after all the pomp and circumstance dies down and David takes the time to reflect on his success there will be that moment of clarity when he realizes that after all is said and done, he has become everything that he once detested about his former employer Synthes. Don't believe it?  Just ask Lukianov. Congratulations to all our friends at Globus, we'll be looking to stop by the booth at NASS to interview you.  As Bogie once said, "Here's looking at you kid!"