Friday, October 26, 2012

Edition X Subtraction = Bad Press

Since the U.S. financial market nearly crashed and burned in 2008, resulting in an economy running on quaaludes with high unemployment rates, and major bailouts for criminal banksters, with the little guy being everyone's scapegoat, we have learned that as long as we capitalize on our behavior we can rationalize success without any consequence.  But can We? Yesterdays WSJ and NYT's reported that the U.S. Senate Committee on Finance reported that Medtronic edited studies by outside researchers pertaining to INFUSE (C'est Moi). This finding stems from reports alleging that physicians authors who had financial ties to Medtronic failed to report dangerous side effects associated with INFUSE. A minor omission, all for the love of the Almighty Dollar, but more on that at the end of this blog. But rather than get caught up in the Pomp and Circumstance that is always played out on Capitol Hill, let's be equitable and analyze this from a realistic perspective. There are two parties culpable in aiding and abetting these findings. Medtronic and the individual Spine Surgeons involved in the original studies.  NASS your members do have a wonderful reputation. Here are the findings;

Medtronic
  • Drafted, edited and shaped the content of the studies
  • Paid $ 210 million to physicians involved in the studies
  • and its employees recommended against publishing adverse effects
  • prepared Hal (rust never sleeps) Matthews remarks to the FDA
  • attempted to adopt weaker safety rules
As we all know INFUSE was originally approved for an ALIF surgical approach, yet the statistical analysis goes on to expose that the original issues concerning the FDA regarding INFUSE came to roost.  The fact is that 85% of all lumbar surgery was off-label use in 2009, in 2008 75% of all reported adverse events were for off-label use for cervical spine, leading up to the FDA's refusal to approve Amplify in 2011. Dosing has always been an issue, as has off-label use.  For the many good results that INFUSE has produced, by hiding the adverse events, and skewing the data, INFUSE'S long-term viability has been assaulted all for short-term gains.  But isn't this the exact business philosophy that has driven the United States economy into a grifter society?

As a by product of this report, there are many questions that need to answered if spine is to cleanse it reputation, once and for all.
  • What happens when a physician has financial ties to a company's success?
  • Does this affect their ability to make legitimate rational decisions?
  • How does this affect the market and "free-market" enterprise?
  • What happens when employees start to collaborate with physicians on the substance and content of a clinical study?
  • Does this drive up the cost of delivering healthcare?
If we believe in the "Peer Review Process," how can any company defend and accept the contributions of their employees to a clinical study?  Have any of these employees contributed first-hand surgical data to these studies? If adverse events are consciously omitted, and the physician authors agreed to this tactic, what does it say about the physicians involved?  TSB is not OTW, calling out the adversary for questioning the substance and content of these studies, but then TSB is not some wannabe financial advisor that kisses the ass of the industry all for the love of our own motives. Their is something fundamentally perverse when we game the system, extract hundreds of millions, if not billions of dollars from the healthcare system, and then we complain about the iron clad hand of government cracking down on healthcare delivery.  As TSB's mentors use to say, "there's a right way and a wrong way of doing things." How many of you recollect the many horror stories we heard in the 2002 or 2003 from some of the surgeons involved in trialing INFUSE?  

The same concerns that the FDA initially had came to fruition, off-label use.  But then, the FDA should accept some blame in this game, INFUSE is a pharmaceutical and not a biologic product in the truest sense.  The FDA should have held this product to a different standard.  As healthcare comes under assault, the potential for profiteering has escalated whereby we no longer created new technology but new ways of gaming the system.  The days of signing Dr. Famous to a consulting agreement in exchange for their business has evolved into multi-layered business models.  Today, doctors don't want to be doctors, they want to be everything but being a doctor. But who's to fault for this behavior? The company's and CEO's that have built this industry? They have advocated and encouraged this aberration, we call spine.  Today, the same people that poached other companies sales people or surgeon consultants cry foul when they have to compete against POD's and POC's. They orate that they have had "a sequential decline in revenue" due to market forces out of their control. Excuses, excuses, excuses. Can't handle the heat? Get out of the kitchen. Payback can be a bitch. If companies learned how to treat their employees respectfully, set realistic revenue expectations, and stopped kissing the ass of the milquetoast analysts, maybe spine would be an honorable industry. But then again, that would be wishful thinking, so party on.  Another bottle of Petrus please.  

110 comments:

  1. So true brother.

    Ever since I dipped my toes into the spine industry, I have questioned the integrity of: Science, medicine, surgeons, medical device manufacturers, justice, FDA, just to name a few.

    It's depressing.

    The patients don't have a clue.

    ReplyDelete
    Replies
    1. You are SO right!!!!

      Delete
    2. patients have an option to learn about this stuff...

      http://youtu.be/OePWkaNWfVM

      Delete
  2. Money corrupts. More money corrupts more.

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  3. Great post TSB... being in this industry has brought to light the reality of our healthcare system. It has shattered my beliefs that the industry as a whole is trying to provide solid long term healthcare solutions and truly improve patients' lives. I know there are plenty of healthcare professionals and organizations doing the right thing, but the system doesn't reward people or organizations that do the right thing. The healthcare system loves that there are more and more patients with chronic health issues. Just slap a 2k band-aid on those people and wait for them to come back, so a 3k bandaid can be put on them the next time. Oh, and by the way, that bandaid really only costs 5 dollars and that patient has to cover most of that 5k bill.

    Furthermore, spine companies have to spend way too much money on things that do not directly involve helping the patient to be in business (i.e. consultant/royalty fees, legal fees, government taxes, etc). All of this stuff is great for everyone in the spine care system, except the patient.

    I am ready to wake up in the morning and know that I am a part of a real solution and not a growing problem.

    ReplyDelete
    Replies
    1. And if the solution ends up putting your ass out of business? What then?

      Oh, I don't mean to suggest corruption or anything like that on your part, but the basic sad fact of spine care is that most of the time we are treating a pathology called aging. And we're not very successful--who woulda thought it? Nature always wins.

      And frankly, my 2 cents is that state-of-the-art spine devices are no where near state-of-the-art hip or knee devices are. The fact is that the intervertebral space is not a ball and socket joint (Sorry Dr. Michelson, a billion dollars doesn't make it true); it's vastly more complicated than that, and it might just be that there NEVER will be a decent mechanical fix. We might have to wait for a biological fix.

      In my opinion you are compromised as soon as you enter the industry. We're selling a bad fix for a problem you can't fix. Simple as that. So before you get high and mighty blaming everyone but yourself (that dang government!) take a look in the mirror. (And yes, I'm just as guilty as you, that's why I drink).

      Delete
    2. Not everyone is a dirt bag like you who justifies his drinking on the industry he chose to work in (and continues to earn from).
      There are many good people, doing good work, with good doctors who care about patients.
      Show me an industry that ISN'T compromised in some fashion. Sports? Fashion? Hollywood? The Catholic church? Police? Government? Banking?
      Rise above the fray my little friend and I will by you drink.

      Delete
  4. Any word on patients who get Infuse for OMFS procedures?

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    Replies
    1. Mixed results, but the lower dose (and price) make it worthwhile if alveolar ridge graft isnt taking.....I have seen it work great (on my aunt) and seen it create some pretty significant swelling.....not life threatening, just extraordinary.

      Delete
  5. ...........and crafted Hal's technically correct but factually extremely misleading statement to the FDA panel that he had no financial interest in the whole proceedings. Sleazy greed at its very best, which went unchallenged for 10 plus year.

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    Replies
    1. Wonder why Hal left a lucrative spine practice to work for the company. Anyone? Bueller? Bueller?

      Delete
    2. And look at his career since: from Danek CMO to president of the Visco Bros MCRA, to EVP of their Paradigm, where he will be responsible for compliance while working with Gary Lowery. That's the guy who lost his license in both Florida and Arizona.... If you wrote a script like this, you wouldn't believe it.

      Delete
  6. After 18 years in the Industry, I continue to grieve the ongoing adulterous relationship between Universities & Big Pharma/Big Device. The ~+20% tax the University extracts in exchange for the Physician branding the University's logo, is no doubt a contributor to this perverse manage a trois relationship b/w the MD, the University, & Industry..and yet; REAL solutions for REAL people fighting for their health & their lives mysteriously get poor outcomes, complications, & death. It's no wonder why the Alternative Medicine, Naturopathic, Wellness, & Chiropractic communities are growing in people's trust of them over Conventional allopathic care.

    Where is REAL Leadership in the Universities, in Industry, in Medicine, in Government to protect the unsuspecting patient who has a complex back or neck problem or cancer....& all they get is funneled into some sham University study to line the pockets of the University, the Physician, & Industry?

    How appropriate that THIS week while NASS convenes bringing all the players together, that this latest finding of Medtronics abuses gets reported in the WSJ. Wouldn't you all agree that there are enough good people in our industry that we can each be part of the solution to think of the Patient & their needs 1st.....for when we do, none of us fails to care for our family & loved ones.

    ReplyDelete
  7. Hey didn't Eddie Munster say that if you play by the rules you will succeed. Eddie Who? With the size of 'em ears hopefully he won't get caught in the updraft of his bullshit.

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  8. If those doing the "research" on Infuse indeed did falsify data including not only fusion rates but cancer risks, bone resportion, etc., then these individuals involved should lose their licenses to practice medicine AND go directly to jail. If we can't trust our peers in research who can we trust? Money corrupts, no doubt.

    ReplyDelete
    Replies
    1. With examples like our lying President....you wonder why?

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    2. You talking about George W.?

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    3. You mean the guy who used to run the country? 4 years ago? Don't be a douche. Bush had his faults for sure but the CURRENT example is as bad as it gets!
      Lying, arrogant bastard.
      was hung out to dry for a lot less.

      Delete
    4. The present one may be bad, but nobody beats good old Georgy in the disaster rankings...

      Delete
    5. Let's just hope he doesn't get another four or you'll be longing for the Georgy years.
      Hell, you'll be'll longing for the last four if he gets in again!

      Delete
  9. Money doesn't corrupt, the LOVE of money corrupts. Money, like a weapon, in the right hands can yield good results. Obviously the LOVE of money has corrupted some in this industry. Would you want to have spine surgery 25 years ago when surgeons' best tools were autologous hip bone and trauma plates? The science has undoubtedly advanced, and if someone made some money, God bless 'em!

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  10. Naaaa, gov't will just extort the companies for money and finger point at reps for off-label promotion. Gov't picks and choses what they want. When have they ever truly gone after surgeons. Don't mention the guy from Oregon. He was exposed because of billing, he'll lose his license but end up somewhere.

    WE all know what went on with Infuse over the last 9-10 years. We've sat in on speakers at meetings or labs and heard the direct off-label promotion, uses and studies from surgeons manipulating surgeons.. So ridiculous. It would be great to see an example made here but it will never happen.

    Ugggg.. Someone tell me why the DoJ closed its investigation into Medtronic and Infuse in spring of this year yet the Senate committee easily uncovers this info without the same resources of the DoJ and the FBI. Really sucks.

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  11. Was there a "buzz" around anything this year at NASS?

    ReplyDelete
    Replies
    1. NuVasive's PCM cervical disc received FDA approval during NASS. I think LDR's did as well.

      NuVasive also had quite a bit of buzz surrounding it's new automatic rod bending device, Bendini. I cannot verify this, but I was told that it won an award for "best new innovation of 2012" or something along those lines.

      I remember hearing one of my colleagues talk about the recent approval for Paradigm's Co-Flex as a dynamic stabilization device, but neither one of us can see how the device might fit into our respective practices. It seems more like something that might be used in rural areas where access to good access surgeons (for ALIF) and good reps (for XLIF) is limited.

      I didn't spend much time in the exhibit hall this year, but those are the few things that I recall hearing people talk about.

      Delete
  12. Wonder if they still have that large glass memorial to the infuse researchers at the museum.

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  13. Plenty of "buzzed" douche bags at the Sheraton...

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  14. Thank you for giving information on spine surgery.It is really good and helpful for the people.Keep giving such a valuable information.I will wait for your next post.
    Regards:spine surgery in india

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  15. Medtronic Spine is run by Sith Lords.

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  16. Jesus with all the bitching and bullshit being posted, I thought I would post something positive.

    Spinal Elements, a company doing things the right way, treating people great, respect for the industry and coming out with great products in slow and controlled way with out surgoen involvement.

    I know a bunch of aholes will make negative comments about the company, but those are ones who only think they know. I'm a distributor for the company and they are the best company that I have ever worked with bar none!!!

    Nice Job Todd, Jason and Mitch.

    ReplyDelete
    Replies
    1. No surgeon involvement? I know that SE has a POD with Dr. Benavides in Kearney, NE and his rep/pal Cesar Cuevas....

      Delete
    2. Spine Element make plates, screws and PEEK cages. In other words they are another me too company buying Chinese copies of obsolete junk.

      Delete
    3. None of these companies make anything. Even the big boys are just distributors.

      Delete
  17. Nothing like a little bit of free, self-promotion for Todd and his monkies! Best Company, come on guys! BTW, the free booze was great this week but I will never sell your products since you let anyone that wants to carry your line do it ...been there, done that ... not again.

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  18. How is Globus Caliber doing? Any news at NASS?

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  19. Only real news at NASS is that Medtronic is F*CKED. Who who take over the Biologics market?

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  20. There is a simple solution. JAIL! Not Club Fed for 3 months. JAIL! Not fines JAIL! Not warning letter after warning letter from the corrupt FDA JAIL!

    There is a better solution. Have independent labs test products. It's a no brainer that the metal shedding hip and knee implants should never have gone into testing let alone gone to market. It had to have taken some major wrong doing for J&J and Stryker to get their implants approved. If someone is caught taking bribes in that scenario JAIL!

    ReplyDelete
  21. Biggest news from NASS:
    First ever 2-level FDA approval for disc arthroplasty with LDR! Poor DuhPooh-sintez, thanks for building the market. Little ole LDR will take business with a superiority to fusion study that Hansjorge was too cheap to do.

    ReplyDelete
    Replies
    1. Read the data, the control numbers were below historical, so sure made it hard to show superiority! Not fully approved, approveable!

      Delete
  22. 11:40, Word.

    6:18, yawn

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  23. Everything but paradigm is a commodity. Period

    ReplyDelete
    Replies
    1. Paradigm is doing some good stuff...outside the US.

      Delete
    2. Do any of you remember two Charles Shaw wines. Turns out some relative of the Gallos got a hold of a lot of grapes and produced a decent wine for 2 bucks a bottle. Normally that would be 10 bucks. He did it sort of as a middle finger to the industry.

      There are 5 ways to treat disk hernias for 1/15 the price of surgery.

      1. Spine Wand

      2. Stryker DeKompressor

      3. PLDD

      4. Ozone diskolysis

      5. DiskoGel

      Then there are the motion contraining shock absorbing ADRs made in the USA but not used here thanks to J&J and the other two that run the FDA.

      If this industry were ethical it would be 50% smaller.

      Delete
  24. http://www.badscience.net and in particular his new book "bad pharma". Pretty much sums it up.

    ReplyDelete
  25. LDR Superiority: any study that shows statistical superiority means that its product is superior. Is a math exercise not a discussion or argument. Either the results and math add up to superiority or they don't. The superiority was so strong in that data that they could have done it in far fewer patients.

    You're an idiot and most likely a sales rep. Watch all your two levels cases disappear as they take all your business upon full approval.

    ReplyDelete
    Replies
    1. Wake up Mary Poppins. Studies are rigged and we all know it.

      If a company want a product to get FDA approval they need to be big enough to own the FDA. We all know who we are talking about.

      Delete
    2. Sure, Ok genius!

      Delete
  26. One can only speculate that if it's superior at 2 levels, could it also be superior at 1? Also faster than prodisc because you don't have to drill out healthy bone for keel fixation. If your doc can do a discectomy, he can insert this as easily as a piece of PEEK.

    ReplyDelete
    Replies
    1. Thanks for the training Mr. LDR Manager.

      Delete
  27. I have a surgeon that was involved in the LDR study and 90% of his patients have developed significant neck pain or have gone on to fuse....but you won't see that in their study.

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  28. LDR is a joke. I mean seriously. How many loser ex Kyphon guys can they hang their future on? Bunch of goofs who think they are tough guys too which makes it even more histerical.

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  29. 9:11 - If 90 percent of your surgeon's patients had fusions with an FDA approved artheoplasty device then he should go back to school, or maybe he just plain sucks!

    ReplyDelete
    Replies
    1. Has nothing to do with the surgeon..everything to do with the device.

      Delete
    2. Must mean that 90% was revised to ACDF

      Delete
    3. Was he an IDE site? This is the only way he could have gotten the product, so unless his patients' data was suppressed somehow in the study, you are just another trash talker.

      Delete
  30. If 90% went on to fusion, those are better than the real reported rates of ACDF fusion. Maybe it should be marketed for ACDF? Win/win - nonunion "perfect" fusion "not too bad!"

    ReplyDelete
  31. Did you see the LDR booth? Every guy had a size Sh-Medium shirt on!! I want some of the HGH they were serving at the latte stand in the middle of the booth!

    ReplyDelete
  32. There was a French company Safe Orthopedics with a screw system with 100% disposable instruments that were very robust. Very interesting concept that they claim to be able to stock at the price of whatever is on the shelf.

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  33. Had a doc stop by the VTI booth and express interest in the TLIF cage. Anyone have experience with it?

    ReplyDelete
    Replies
    1. I would rather shave a bobcat's ass in a phone booth than use a VTI expanding cage. Bad instrumentation, with even worse support from the home office. Maybe you will get the size you need and maybe not. If there are any problems, I'm sure you can take a trip out to Cali to go to a lab and learn how to properly do a TLIF as I'm sure your doc has only done 3400.

      Delete
    2. Would not have disagreed a couple of years back, but I carry the line and the instrumentation has been improved and the support from the company has been solid. Takes a patient doc with a solid disc clean out, but in the right hands it is a solid implant.

      Delete
  34. Alex Lukianov, Chairman and Chief Executive Officer of NuVasive said, "Our surgeon booth traffic was clearly the highest and most consistent versus our competitors"

    LMAO

    What an F'ing LOSER. Too bad all the people in the NUVA booth had the lanyards to give away that they work at NUVA. To have to put out a press release trying to convince people that surgeons still care about them is a sad sad thing.

    ReplyDelete
    Replies
    1. What are they going to do when Walton has to be brought to the booth in a wheelchair?

      Delete
  35. Now that's funny. He did look rough.

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  36. With that comment by Alex, NUVA is the new alphawreck. Congrats!!!

    ReplyDelete
    Replies
    1. The comment is true. NuVasive's booth did have the highest traffic out of any other booth...with or without NuVasive employees. Obviously, you were not there or maybe you just can't admit it. Either way, the comment is true. Deal with it.

      Delete
    2. No..you deal with it! Reality is tough thing.

      Delete
  37. Yeah, it is like driving by an accident, you have to stop and look!

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  38. Alex's comment screams desperation. What a moron to publicly say that. No wonder there has been such a mass exodus at their corporate office.

    ReplyDelete
  39. Alex Lukianov, Chairman and Chief Executive Officer of NuVasive said, "Our surgeon booth traffic was clearly the highest and most consistent versus our competitors"

    He clearly didn't see the flash mob at the Aurora Spine booth with their lighters held high, clamoring for Trent to pick up that guitar one more time.

    ReplyDelete
  40. Nuvasive is clearly in trouble. Alex should have sold a long long time ago...

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  41. What a joke! If you were there you should have opened your eyes, and counted (if you work for NUVA..it's ok to take off your shoes and socks to help).

    ReplyDelete
    Replies
    1. You're a moron. Very few NuVasive employees were actually allowed to travel to NASS this year. Officially, this was a cost cutting measure, but un-officially, it was probably more of a conscience effort to keep key employees away from the talent stealing leaches known as Globus and Lanx. The perfection of the "hey there little boy, I have a gameboy in the back of my van...wanna play?" technique is the only thing that these two companies have ever innovated.

      Delete
    2. That would Only matter if you still had any talent left. Rats know when to jump ship but apparently Parasites cling to the bitter end.

      Delete
    3. I was wondering how long it would take before a blog about MDT being the shit company its is was turned into a Nuva, Globus, Lanx bashing affair......you guys act exactly like our current president.....nothing to claim achievement wise, so bash everyone else. Grow up little boys.

      Delete
    4. Yes, MDT is still a shit company with a horrible management team and it shows in their sales, loss of business, loss of talent and lack of innovation.
      This does not mean Nuva is a winner. The blog is fluid little man and the comments are reflective of the rapid daily information not captured by TSB. It's called news!
      So crawl back into the Cheetah's colon where you were spawned and try to make the best of what little nutrients remain after Alex et.al. digest the big stuff.
      Happy Halloween!!!

      Delete
    5. Hey 11:04..just went to the toilet to drop your bother off at the pool.

      Delete
  42. Alex has always been more about appearance & perception in lieu of actual performance. Not surprised that he'd put out a press release like the one he did. It really doesn't matter, Nuvasive had its run, the cheetah has been wounded & has slowed down for sure.

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  43. Fat man in a little coat!!!!

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  44. I saw the clowns from St. Louis asking people to borrow badges. Seems like Hans would't shell out the cash for entry. And sterile packed trauma implants? Don't get it...

    ReplyDelete
    Replies
    1. 600 for a badge, we should all share badges! Hell, most of our products are the same stuff anyway. St. Louis, what Surgeon were you paying to see at NASS?

      Delete
    2. Yes the are seasoned veterans of the spine industry..?.

      Delete
  45. Talking about Medtronic and paid surgeons: in 2010 and 11 Kevin Foley received 17.6 and 17.9 million in royalties for 13 products, in the first half of 2012 he got 8.7 million in royalties for 2 products. (source; Physicians registry Medtronic website) It just makes one wonder what these inventions and royalties really are, doesn't it? As an aside, I long ago stopped believing a word he utters or writes.

    ReplyDelete
    Replies
    1. He earned it. If you want to publicly doubt the man's integrity, provide specifics. At the very least, provide your own name and background so we can look into your own potential biases.

      Delete
  46. he invented Sextant dumbass.

    ReplyDelete
    Replies
    1. Really? You are very naive.

      Delete
    2. Let's see, between MED (now Metrx), Stealthstation, and the MERI facility, even I can recognize his contributions for them. And I've never worked for them. Foley's a good guy. Nobody "deserves" that kind of money for anything. But he's made contributions to spine surgery that apparently provide a ton of value for MDT, and by definition, their customers.

      Delete
    3. Their is a an argument to be made about his "inventing" versus the Danek engineers "inventing". I was told it was common for Danek to co-patent ideas with surgeons. Many had never patented a thing and then had dozens upon dozens. Foley had like 2 patents in 20 years and then 70 plus co-patents while working with Danek.
      I'm more concerned with your "Nobody deserves that kind of money for anything statement" though.
      Looking for a little redistribution?

      Delete
    4. I'm sure Sofamor-Danek engineers contributed a lot to making him productive, but having observed it from the competitors side, it was clear he put a lot of work into those projects (can only speak for the ones I mentioned) from what it appeared mostly for the purpose of advancing spine surgery. For example, when he and Iain Kalfas (on the Picker side) were passionately pursuing navigation as the future to largely skeptical crowds, there was no faking their enthusiasm for the projects.

      I was surprised when it became public a few years ago to learn how much money he made, as I never perceived that to be his motivation. Those projects (e.g. tubular retraction) were real advances, and he studied and pursued them as such. And when you think that he was fortunate to have the market leader as a partner, it's easy to understand how what could have been a customary royalty for the time would multiply substantially with the power of that sales force.

      So if he was just a pitchman for ideas that the S-D guys came up with, then he was a hell of a good one. But the passion and his approach to the projects conveyed a sweat equity that suggests otherwise.

      As for the "deserving" remark, please note I'm not suggesting he didn't equitably earn the money. I'm a firm believer in the free markets, and when we as a society choose to direct such large amounts of money to a single individual, I'm happy to see it go to folks that make significant contributions to society. (e.g. Kevin Foley, Bill Gates, etc.) I was merely suggesting that as a society our rewards are often substantially disproportionate. (Don't have a better idea how to handle it, though.) But I do note that we could've bought those contributions from him for much less, so we clearly overpaid!

      Delete
  47. Hey, hey, hang on there Kemosabe. You got a lot going on there.
    For someone NOT from S-D you sure have some positive "spin".

    I almost detailed your missteps but then remembered I have a life and it's Friday.

    The most egregious I will address by saying: please reread your last paragraph. It is fraught with contradiction. He deserves, he does not deserve?

    btw...Have you ever been to the "Patent Room" at the MOMSS?


    ReplyDelete
  48. What a total scumbag industry it has become. Spine used to be the "Special Forces" of the medical implant market. Now it's a bunch of guys that wax their eyebrows and aren't even comfortable in a suit because they run around in scrubs all day long. There was a time when a surgeon would respect the representative because we stood out.

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  49. Pretend your looking at a very large hand, now focus on the middle portion of the hand.... watch the middle finger rise.... good, now this is paradigm saying keep up rookies!!!!!!


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    Replies
    1. Paradigm really??? With Dave Brown as your VP of Sales? One of my reps worked for him at Tissue Link witch became Salient Surgical where he slept with a lack luster rep and made her the national director of sales training. The stink on him from US Surgical has followed him to his next several stops, none of which have lasted more than 18 months. Great leaders produce great results, good luck to you and your hopes at longevity in the business.

      Delete
    2. An actual witch turned Tissue Link into Salient? That must have been a really strong potion. Inspiring quote too, "Great leaders produce great results." Name-dropping just proves you are a jealous, classless jerkoff.

      Delete
  50. I've always enjoyed the "discussions" on Spineblogger but as has been noted frequently over the past few months, the lack of new topics has made this a site to visit weekly instead of daily. Any suggestions on more active spine blog sites?

    ReplyDelete
  51. Replies
    1. And now with Bally weighing in with her truly unique insight it is time to call this thread closed.

      Don't forget to vote today!

      We still can't jail the inept but we can vote them out!

      Delete
  52. After Romney wins today, will our future as medical device reps change? I don't know much about the subject, but I believe Obama care was going to hurt us as reps. Thoughts?

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    Replies
    1. I can tell you that Obamacare will put a huge squeeze on reps for several reasons. First, the medical device tax of 2.3% on sales. Most spine companies make little profit because they are investing gross profits into R&D and sales expenses. The 2.3% will be shared between increased prices, a hit to the bottom line of device companies, and of course commissions paid to reps. If you enjoy a good living as a device rep, make sure you vote for Romney. Otherwise, device reps will certainly see a reduction in pay, many profitable companies will become unprofitable. This will cause layoffs at device firms, and already has at DePuy and Stryker.

      Delete
    2. Stop lying.

      Hopefully the entire industry will shrink by 50% when innovation is allowed and the crooks are jailed.

      Delete
    3. 11:53 Stop your whining, this industry is in desperate need of some consolidation to eliminate the dreck & retreads who have flourished far too long in spine. Social Darwinism at its best it what's needed to CLEANSE this industry asap.

      Delete
    4. Maybe we should being doing what the civilized world is doing which is providing better health care and 1/3 the cost. The health care industry in the US is anarchy and chaotic greed.

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    5. Tell that to the surgeons who operate on everyone. Just as many crooks that can cut, as there are dirty reps.

      Delete
  53. Did Medtronic kill Prestige LP?

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  54. http://www.jdsupra.com/legalnews/oig-issues-inquiries-to-hospital-purchas-57096/

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