Wednesday, March 6, 2013

Talk About Circling the Bowl - Spine Frontier

Word on the Street is that Spine Frontier, a company where no man has ever gone, traveling through multiple galaxies, light years ahead of its time beyond Mars, (isn't there some millionaire that wants to fund a trip to Mars) is lying in the spine industry's intensive care unit looking for another sucker, oops, TSB means another investor that can set up a  life line and infuse some capital into a hemorrhaging and dehydrated patient. Oh Kingsley (is it Ben), as George Harrison stated, sooner or later "all good things must pass." There's birth and then there's death. How many people have taken precious time to listen to the Spine Frontier story? It's a solution to a problem that really doesn't exist at least on a major scale.  This has been more theater than anything else. Like Trans 1 and Baxano, maybe SF can cut a deal with VTI, they know how to burn through cash. Who knows, maybe it would resurrect Touchdown Tommy's career? Is he still stuck in the Heisman pose? It would be entertaining witnessing the blind leading the blind. Anyway, TSB has alerted the coroner, the body bag is ready, unfortunately, we have been informed that before they pick up the body they would like prepayment.  Hi, Ho, Hi, Ho, it's off to play we go


233 comments:

  1. What a dog shit industry!

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  2. Not too pleased with discectomy using their e-lift, qty & ease of removal. No name Virginia facility scrub tech.

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    1. I am a distributor looking at SpineFrontier. The insinuation seems to be that they are sketchy. Why? Anyone know?

      They seem to have developed some unique products, which is rare in this industry and should be applauded, not denigrated. So what's wrong with their products? Does the trans-iliac procedure not work very well? Does their extra-foraminal approach have problems? Does their instrumentation have issues like this scrub tech mentioned?

      Real answers would be helpful.

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  3. I think Bally should buy Spine Frontier.

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  4. Running out of topics quick! This blog is starting to resemble Fox news.

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    1. Love them or hate them, Fox News is the number one news network in every prime time slot except Sunday night at 6:00 PM... 60 minutes spot. If this blog starts to resemble Fox News, TSB should sell banners and retire soon!

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    2. Yes, they were number one, but they are always making stuff up based on rumors, besmirch people they don't agree with and try to scare the crap out of people. Their ratings have dropped like Nuva stock lately.

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    3. The reason fox has ratings is because people like train wrecks. TSB is popular because it's reporting on a train wreck.

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    4. 1:18 Fox still IS number one doofus. Not because they make shit up (see MSNBC or POTUS)but because they reflect most of America.
      Now try talking about spine (something you lack.)

      I hear MDT is hacking the VP ranks and middle management is on the run. Another stellar performance from the dregs of spine leftovers. How many more years can go by before they figure out the enemy resides within.

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    5. So if they reflect most of America, why did America nominate Obama for a second term? Or not call the election at the same time that other networks did? Keep living in the bubble

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    6. 5:46 The war is over, GALLUP, you know the company that Stryker can't make a move without, HAD IT WRONG, MITT's campaign team HAD IT WRONG, and YOU HAVE IT WRONG. It's about REALITY and facts, not wishful thinking. THE WORLD HAS CHANGED, this isn't America 1955. The Robber Barons do not control the world as they did in the 19th Century. Regardless, you can learn to move on and make the world a better place, or continue to fight class warfare on behalf of the politicians. As TSB likes to say: who cares about sequestration, about debt ceiling, about shutting down the government, I have to get up tomorrow morning, figure out how to survive and take care of my family. That my friend is reality.

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    7. Not sure what war you're referring to? I thought they were elections and as we all know the right guy doesn't always win. It's Bush's fault!
      I know the world has changed and I was not here in the 50's so I'll have to defer to you. But I don't see us moving in a positive direction. I am an independent and don't believe in a ruling class. Government is not the answer to every question. It is inherently inept and corrupt.
      I can't tell you if Mitt was the answer but the current POTUS is certainly not doing a good job. Can you honestly say we are better off than 4 years ago? How about 8 years ago? The bickering and divide has never been worse and you can't blame one side over the other. But he is the chief and there is a clear lack of leadership.
      Now you just want to hunker down and try and survive tells me you have either given up or have enough money you can thumb your nose at the rest. I have to try and save for retirement, pay for college, survive the ever increasing tax burden, the assault on civil liberties, the encroachment into my life and increasing welfare nanny state. All which you and I both pay for.
      They want you to stop paying attention. They count on it.
      So you can go day to day worrying only about yourself but I don't want my kids to have to shoulder the burden being left for them.
      I have a feeling you're better than that. Getting rid of BB and El meant you still give a shit.
      Go on MM! Say you're fed up and you're not going to take it anymore!
      Reality is more people give a shit about the Kardashian tramps or Honey boo boo than paying attention.
      I might be wrong but the majority of the people think the country is going in the wrong direction. (http://www.rasmussenreports.com/public_content/politics/top_stories/right_direction_or_wrong_track)

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    8. Actually Fox news numbers have been dropping damn fast post election... maybe all the insane people went backl into their bunkers?

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  5. I strongly feel the Spine industry has gone through the classic expansion and now we will begin to see the contraction cycle take place. All growth industries see this and we are at the point where: there are over 100 companies... The market simply cannot sustain.

    Unless a surgeon is part of a POD, there is no reasn to use half of these companies, including Spine Frontier.

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  6. Thanks for this post...appreciate the info.

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  7. Kingsly is a nice man, but blinded by his expectations!
    Spine Frontier will dissappear like other samll spine compnays.

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  8. In spite of our growth things got worse for the patient. Let's not kid ourselves, this a a shameful industry no matter how you look at it. Maybe that's why there is so much acrimony and back biting here.

    TSB is a bit obnoxious and snide but this industry is what it is and sadly there really are very few players that you can't honestly talk shit about. I stopped being proud of what I do long ago.

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  9. http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2012/ucm315584.htm

    Frontier needs to be gone!

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  10. So everyone complains how terrible the spine industry is for a number of reasons. What are some medical device segments that are more honorable?

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    1. There aren't any honorable device companies. Look at all the stuff Medtronic and J&J have done. I think when it comes to surgeons cardiac surgeons are the least dangerous and are actually looking for good products more than deals. They have a vested interest in keeping their patients alive whereas spine surgeons have a vested interest in keeping patients coming back and blowing smoke up their butts kinda like a DC with a scalpel.

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    2. Breast implants

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    3. 8:05pm, have you not heard about all of the shady deals given to cardiac surgeons by the big (and small?) stent companies?

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  11. Speaking of circling the bowl, whats the latest with LifeSpine or X-Spine? Talk about "C" Players. Their Sales Management Teams are both horrible.

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  12. This market is saturated with crap products, these small companies need to give up!

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  13. Kingsley of spinefrontier, this the same Kingsley that lost license to operate in Penn?

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    1. I was waiting for someone to raise that juicy tidbit. Correct

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  14. Talk about "circling the bowl", this blog and TSB have been doing so for months. Instead of finding something of value to post and discuss, it continues to be the same name calling & finger pointing crap week after week. Perhaps TSB should take a look in the mirror before he picks the next company who wouldn't hire him to pick on?

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    1. Actually TSB has never worked for many of the companies that he writes about, TSB is just honest enough to express what most of us would like to say but quiver in our boots to say it.

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    2. Instead of preaching to the choir maybe it's time we dig a little deeper and gather some good dirt.

      @ anonymous March 8, 2013 at 7:40 AM How about you tell us the good stuff? We'd all like to be able to hold our heads up even if it is something the competition is doing. I have no allegiance to my company and they have no allegiance to me. If I had the goods on them I'd give them up in a heartbeat and so would you. Why else do you think we are kept so far out of the loop?

      I suppose if MSM had something positive to write he'd write it. All MSM is doing is telling the whole ugly truth. His toilet analogy is spot on.

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    3. MSM knows the competition.

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  15. If you are a surgeon with an "idea", Spine Frontier would love to pay you for your "idea", as long as you use them exclusively. The more you use, the more money you make as a surgeon. Kingsley is a cocky mofo, that needs to get leveled.

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    1. Nothing like a good ole kickback! I have an idea, time for investigation.

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    2. Are there any companies who don't so this???

      I'm not being snide, seriously - Are there any companies that do not do this? Yeah, some of them are more discrete or subtle about it. But honestly, I'd be amazed to hear of a company that doesn't do it.

      And using independent distributors that pay and you give them bonuses is the same damn thing, just a clever version.

      For all you sales reps out there - we all know companies try to hire based on your 'Rolodex'. But has any company ever asked you if your Rolodex included pay-to-play surgeons?

      Yeah, me neither.

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  16. Interspinous spacers are the future.

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    1. Yes,,, they are a BIG part of my future. Keep paying your docs to use them. I love the ease they come out with when the patients symptoms come back and they switch to my surgeon and I get the lumbar fusion out of it. KEEP PAYING... I mean selling em.

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    2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2226191/

      Spacers are indeed the future. Their high failure rate assures much more business.

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    3. We revise those spacers when osteolysis occurs with an interspinous fixation device if the their spondy is still <1.

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  17. The problem with this industry is that the larger companies started providing kickbacks to surgeon in the form of consulting deals. The surgeons all got used to this income. Then once the companies like MDT, JNJ, etc were busted, the most greedy surgeons boldly started PODs to provide themselves with kickbacks. Then our government decided to take a Rip Van Winkle length nap, and failed to enforce their own laws. Now a growing number of surgeons are making their choices based upon how much money they can skim rather than the good of their patients. One of these days, medical malpractice lawyers will find out about this and sue many of these quacks.

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    1. There is such a culture of sleaze. Wrong doing gets rewarded. Long jail terms is the only answer for these pukes.

      http://orthostreams.com/2012/03/stryker-ceo-rumors-swirl-over-macmillans-departure/

      Many of us were had no clue how bad it was or how bad it would become. I hate the idea of government meddling but this industry needs an enema.

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  18. MacMillian got fired and his wife divorced him because he was diddling kids. The reason he got most of his severance package is because he has dirt on the other child sex tourist at Stryker.



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    1. Wow 5:12. You better hope that MacMillan does not take the trouble to subpoena your identity. Open and shut slander/libel.

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    2. I doubt he's a mo even mos have more integrity. It is good theory though.

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    3. yikes

      You do realize that they can find your IP and figure out who you are in a matter of seconds, right?

      NOTHING on the internet is truly anonymous

      http://www.i-am-bored.com/bored_link.cfm?link_id=82708

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    4. 8:57 How Stuff Works - http://www.howstuffworks.com/internet/basics/hide-ip-address.htm

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  19. Topical pain skin creams. The next Frontier is money makers ! All aboard '

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    1. With some BMP for good measure.

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  20. I heard RTI is looking to buy a metal company maybe this might be a good fit for them.....

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  21. Why don't we all acknowledge that plate fixation is a scam and should rarely be used. We need to educate the few honest surgeons left. I think a lot of them believe it is better. It's not.

    http://www.ncbi.nlm.nih.gov/pubmed/15541695

    A 100% and 90.3% fusion rate was obtained for one-level nonplated and plated ACDF procedures with autograft, respectively. The effects of smoking or level of fusion could not be discerned from these one-level cases. Excellent and good clinical outcome results were obtained for 91.3%. Nonplating or rigid plate fixation for ACDF in properly selected patients to treat radiculopathy with or without myelopathy has a high fusion rate and yields a satisfactory clinical outcome. Although controversy exists as to the efficacy of rigid plate fixation in one-level ACDF, solid bone fusion can be adequately obtained without plate fixation and instrumentation-related complications can be avoided. In line with the literature, plate fixation should be reserved for patients unwilling or unable to wear a hard orthosis postoperatively for an extended period of time or for those patients who seek a quicker return to normal activities. Proper patient selection, meticulous operative technique and postoperative care is essential to promote optimal graft-host incorporation.

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  22. Retrospective study. End of discussion.

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  23. One would assume that a Doc using Globus, Nuv, Atec, Lanx etc, has their hand out. The big players invented this game then indignantly point the finger at the small players for following the same path. This cannot be sustained. Every 7-10 years the industry re- absorbs the weak. Where does it end? For how long can a Rep make a living this way? If you're a $2million Rep, are you safe?

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    1. I don't think NUVA or Globus should be lumped in with that group. They actually have good stuff, and serious market share. You're telling me anyone using XLIF is looking for a handout? I don't think so.

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    2. 5:40 - Are you kidding? Do you know how many surgeons NUVA pays for BS work? They know how to play the game, and the problem is there is always someone that will pay more.

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    3. and the Depuy distributors, those that are left, still have play in the game. Contracts for everyone?

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    4. The Nuva folks have 2 of my docs using thier stuff only due to funding of a sham study going. Nuva was going to pull their funding and they stopped using them for two months. Then Nuva came back in with the wallet and game on again... NUTS...

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    5. The DOJ should investigate NUVA. Biggest crooks in the industry!

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    6. NUVA is just playing the game in this nefarious industry. An ethical company that plays by the rules (not that there are rules) could not survive. The game is get in get out and get rich. It's sad. :-(

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    7. DOJ should be put on 100 percent sequestration. They are incompetent in doing their job as it relates to healthcare.

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  24. Globus was built on surgeons' financial involvement from day one, equity and otherwise. They are the absolute masters of incentivising the customer base. Globus built a billion dollar company on that rotten foundation. Then they went public, shredded the dirty paper and cashed in. Evil genius!

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    1. If you look at the competition's sites most of these companies falsely advertise their products. Turn them in to the FTC.

      If we want to increase our market share and get rid of some of the crap and the crooks or at least stall them, file complaints. Eventually somebody in power is going to have a hard-on for companies like Fontier and the ones who blatantly phony up clinical trials. Keep them on the defensive and shower them in bad publicity. Make them poison for surgeons to deal with.

      OK Mr Surgeon now that you know company A has repeatedly broken the law and has a long history of unethical behavior are you still going to do business with them? We know who the worst of the worst is so let everyone know that everyone else knows.

      OK Mr Surgeon you know that Company A's product was inferior and had a high failure rate yet you used it on my client anyway. Mr Surgeon, you knew that company A had been repeatedly fined for criminal misconduct yet you still chose to do business with them. Is this true? Tell us about the kickbacks.

      We are in the biggest cutthroat business there is so somebody may as well blow the whistle on the whole thing. A big ad in some of the journals, some noise by JAMA and NEJM followed by direct mail and emails would force a lot of the cockroaches into the light of day and scare off the vultures. It all comes down to fear and greed in this business.

      Maybe it's time to stop preaching to the choir?

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    2. Huh? What false advertising are you talking about? Marketing statements are pretty closely scrutinized across the industry by FDA. You cannot make claims outside of your approval or present unsupported evidence. Actually most companies,even Spine Frontier, abide by this.

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  25. @ AnonymousMarch 10, 2013 at 4:46 PM

    http://www.ncbi.nlm.nih.gov/pubmed/19387698 Two-year results of interspinous spacer 175 patients.

    http://www.ncbi.nlm.nih.gov/pubmed/19574832

    http://www.ncbi.nlm.nih.gov/pubmed/18008014

    They should be banned and you know it.

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  26. I know that smell...Bally!

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    1. Same old stink. Same old broken logic.
      The past two blog post have been relatively devoid of FB and SB and whatever other pseudonym they go under. It's been rather civilized and productive unlike what the previous 4 or 5 months have seen.
      TSB, thanks for cleaning up this blog.

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    2. Is somebody posting facts and scientific data again with links? We can't have that!

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    3. Spacers are the biggest scam to ever come down the pike. Leggos would work just as well.

      Delete
  27. VertiFlex, Announces Sale of Certain Non-Core Spinal Implant Technologies to Stryker.

    http://www.marketwatch.com/story/vertiflexr-inc-announces-sale-of-certain-non-core-spinal-implant-technologies-to-stryker-2013-03-13

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  28. more of the same here - yawn.

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  29. Why the bad vibes towards VTI? I have not been in the industry long enough to be as jaded as some on this blog, but I picked up the line mid 2012 and have been happy with the support from the company. Not all of my customers were interested, but the ones that were are getting good results and seem to be happy with the product. I can't say the same for my experience with Trans 1.
    Who is touchdown Tommy?

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    1. Tommy Vardell - one of the many 1st rounds draft busts of the Cleveland Browns.

      I'm researching the identity of the MM. His/Her many references of the Cleveland area and Dr Steffee leads me to believe that he/she once worked for him at AcroMed.

      Does anyone have additional information to share as I have a pretty good idea who this brilliant mind belongs too???

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    2. Could be he's just been in the biz a long time. Back in late eighties, early nineties there were only a handful of companies (Danek, Stuart, Acromed, Advanced Spine...) and Steffee was a fixture on the circuit.

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    3. Somewhat close - but in proximity only....his office was right down the hall from whom I'm thinking.

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  30. Are beer farts more flammable?

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  31. Only if you have really spicy Chili first!

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  32. I cannot find a single Integra Spine customer in Southern California that is not in a POD. I thought Integra was really strict about those things?

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    1. It's Seaspine devices and $ talks.

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  33. The Integra Distributor makes the Seaspine guys look like saints. He sets up mini PODs all over the west. I would be very surprised if the FBI was not already investigating him. I have been in cases where surgeons walk in their own Actifuse and invoice.

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    1. For the millionth time, PODs aren't illegal. Perhaps the FBI should investigate your ignorance.

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    2. So it is legal to pay surgeons to use your products. There are no "safe harbors" for anti-kickback statutes genius. Whatever your crooked doctors and attorneys are telling you they are wrong. There are many differences between doctors investing in legitimate companies and PODs where they can self-refer and be assured of a return on investment.

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    3. PODs are 100% illegal and the the DOJ is slow to go after them because there is no money in it for them. The hospital will finally end PODs....not because they are illegal but it a perfect excuse to grab control from the surgeons.

      BTW, the Integra distributor in Southern California sets up PODs all over. Integra knows exactly what is going on but plays dumb because they want the business.

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    4. PODs are in a grey area. They are completely unethical and most are illegal but it's tough to prosecute.

      There are several different concerns over the legality of POD’s. One such concern is whether physician-owners are performing medically unnecessary procedures in order to profit off the sale of the medical device. There are some statistics to back up this claim. An article in the Wall Street Journal (“Senators Request Probe of Surgeons”, June 9, 2011) maintains that the spread of POD’s has coincided with an explosion in spinal fusion surgery. A 2010 study in the Journal of of the American Medical Association found that complex spinal fusions increased 15-times among Medicare patients with spinal stenosis between 2002 and 2007. According to a Wall Street Journal analysis, spinal infusion went from costing Medicare $343 million in 1997 to costing $2.4 billion in 2008.

      Another legal concern involves the ant-kickback statute. Some have argued POD’s may violate anti-kickback statutes and other federal fraud and abuse laws by creating financial incentives for physician investors to use devices that steer business back to themselves. Unfortunately, there has been no clear guidance by the OIG on this topic. While the OIG has acknowledged the risks of abuse POD’s pose, the lack of any specific rules from the government appears to be contributing to the potential for abuse and has allowed these entities to flourish.

      Only scumbag surgeons are PODs.

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    5. Equating the rise in spine surgery between 2002 to 2007 to PODs is absurd. PODs were still uncommon in 07. There were so many other factors at work - demographics, technology (that was the height of BMP, for example), and growth in the number of spine surgeons.

      If anything, that time period coincided with massive payouts via illegal consulting agreements by the big companies. There were several high profile settlements to that fact.

      People can always twist the facts to fit their point of view.

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    6. As far as I am concerned PODs and illegal payouts are one in the same. Both are illegal and immoral and I find it odd you continue to defend PODs. If a POD surgeon recommended that you loved one have surgery would you be at all suspicious? I assure you I would seek a second opinion.

      Do PODs have to disclose their payments per the sunshine act like REAL spine companies? If so I see a lot of fines on he horizon as the government will pursue this easy source of revenue.

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    7. Actually, distributors are exempt from disclosing under the Sunshine Act.

      The surgeon getting payment for doing surgery? The more he does the more he makes? How unethical! It is much more ethical for device companies, reps, insurance companies and hospitals to keep the dollars. The surgeon is far too corruptible to tempt in that manner.

      Perhaps you should go to the free clinic when you need spine surgery.

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    8. You are an idiot. If the companies have to disclose the distributors should have to disclose.

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    9. How are the dollars kept by reps? If a POD surgeon increases volume to make money on the implants he is making more. A depuy rep working with a surgeon receiving consulting fees makes no additional money. The fees do not incentivize the surgeon to operate more because fees have zero to do with individual surgeries.

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    10. You forgot that the surgeon wouldn't be working with Depuy in the first place if it wasn't for the consulting. The reps livelihood depends on that consulting, don't forget it.

      Although it might not be directly pay for play, consulting agreements always somehow seem to go to the busiest surgeons.

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    11. 12:34 You're the idiot. Read the Sunshine Act. Distributors are specifically EXCLUDED from reporting requirements. Have a nice day.

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    12. The right wingers here seem to think that making some unethical like PODS legal some how makes them OK.

      PODs are bad for the patient and ultimately bad for the industry.

      There is no point in calling on POD surgeons if you are a competitor. These guys will never go with what's best for the patients. When most of us started in this we thought we'd be selling solutions but now it's all about the deal.

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    13. Oh give it a rest. If PODs weren't taking dollars out of your pocket, you wouldn't give a crap about them. Doctors have been selling products to patients since the time of Hippocrates.

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    14. 3:05 many busy depuy consultants in Philly

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    15. Better they consult than get paid on every implant they put in.

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    16. Zimmer has to "acquire" something to be considered a spine company.
      Otherwise The Song Remains The Same.

      Hear my song. People won't you listen now? Sing along.
      You don't know what you're missing now.
      Any little song that you know
      Everything that's small has to grow.
      And it has to grow!

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    17. 9:11 But when its so suspicious that the remaining few Depuy distributors seem to get the consultancy deals its just as bad as a POD. need to make quota, get a customer signed on for something!! They need to be audited

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  34. I would imagine that virtually every distributor of X-Spine has at least one POD going. That's the only way they can sell their products...Anyone know how they're doing? Speaking of circling the toilet.

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    1. Rumor is>>>> Products are sold to a large stocking distributor in CA/AZ extremely cheap and resells to the PODS at a huge markup. Program was started by a former executive of the company in hopes that a buffer would exist between company and PODS…..

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    2. Baxano, Smaxano! Who gives a crap about the merger between these two worthless, dying companies? Really?
      Here's a better question. What decent spine companies will be acquired in 2013 and why?
      Think on it, chew on it a little and converse amongst yourselves.

      Delete
    3. Don't know who they are going to buy, but Globus is sitting on a hoard of cash they have to do something with. An acquisition is definitely on the horizon.

      It might sound crazy, but a smaller joint company would be a good idea. Or a spine company with a good international presence.

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    4. So, they'll buy Zimmer or Lanx??

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    5. Zimmer won't sell. They are too arrogant to give up and will let spine flounder forever.

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    6. Lanx wants way too much. So much money invested they will never get back. They should have sold when they had the monopoly on interspinous. Now everyone has one. They could sell if they were willing to cut their losses, but they have doubled down with lateral.

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    7. X-Spine is doing quite well. Business is growing briskly and they are launching new products. Like all X-Spine products, they are well-engineered and the instruments are good.

      I don't know what anyone has against X-Spine. I wouldn't say I know everyone there extremely well, but I will say this: The people I have met at X-Spine have been among the least sleazy and most trustworthy people I've met in this industry. I have seen them go out of their way, and even lose business, to AVOID screwing someone over.

      If you're looking for sleaze, you need to be looking at Amendia. To quote a surgeon who met with their execs "Geez, you gotta take a shower after talking to those guys." And no, to his credit, he did not end up working with them.

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  35. All spine companies with independent distributors are working with PODs. It's part of the industry, like it or not. Companies like Integra are either lying or clueless when they say they don't work with them.

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  36. Zimmer Spine may be in the toilet, but the ortho side is still the largest pure play ortho company in the US. Globus does not have the money to purchase Zimmer the total joint side does more revenue in one year than Globus would in 5 years. Let's look at things from a realistic stand point.

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    1. It's just Zimmer's spine division in play. It's been a neglected stepchild of the Zimmer organization, and their have been rumors that they may divest it. Globus may be a buyer at the right price. The Zimmer joint side is not in play.

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    2. Paulson was axed last week.

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    3. Hold the phone! Jeff Paulsen was axed last week? Why didn't they didn't announce it? That's a big deal if true- any proof?

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    4. Never mind, just found it:

      Form 8-K for ZIMMER HOLDINGS INC

      15-Mar-2013

      Change in Directors or Principal Officers


      (b) Departure of Named Executive Officer

      On March 11, 2013, Zimmer Holdings, Inc. (the "Company") announced the separation of Jeffrey B. Paulsen, Group President, Global Businesses, effective March 20, 2013. The separation is not the result of any misconduct.

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  37. Zimmer Spine is an easy 250-300 million dollar division. Zimmer would want minimum 3-4 multiplier on sales (most companies want 6), so your looking at 750 - 1.2 billion minimum to buy them. Ask yourself does Zimmer want to divest themselves of spine with bundling upon us. Any hospitals in your area gone to one vendor for Ortho, Spine and Trauma?

    Globus on the other hand is tracking around 400 million in sales and probably banking close to 30 million in profits. Maybe in 30 years they will have saved up enough. Conversely Zimmer has close to 2 billion in the bank and almost infinite borrowing power, which makes Globus, Nuvasive, Lanx, K2M, LDR, etc. all likely acquisition targets for them any time they want to get serious in Spine.

    I can't blame Zimmer for not acquiring any companies with declining reimbursements, fusion denials, PODs, and all the scumbags and idiots in Spine. However, they are going to have to make up their mind soon if they want to divest the division or get serious. They really have one choice as the only potential suitors that could buy them, Medtronic, Depuy, Stryker, Biomet and Smith and Nephew all seem like long shots. I don't see Medtronic or Depuy buying them, what would they want. I don't see them selling to their rival Stryker and a merger for two Ortho giants seems unlikely to go through. I am not sure Biomet or Smith and Nephew have the cash or any greater commitment to the Spine space. Of them all Biomet is a possibility as the people that own them could probably come up with the funds. But why, Biomet Ortho is a cash cow and Zimmer Spine probably loses money? Unlike Biomet the VC's couldn't siphon the money out of Zimmer Spine and it would take a relatively big investment.

    ReplyDelete
    Replies
    1. Zimmer spine is at 200m and falling fast with an ancient product line and distributors heading for the door. If it wasn't for the Zimmer name and hospital connections it would be much less than that. A billion for that would be criminal.

      Delete
    2. Zimmer has a spine line?

      Delete
    3. Zimmer spine did less than 150 million in sales last year, the 200 million is overstated by quite a bit. They may choose not to get out of the spine game, but this division will never have success. Winning is contagious and unfortunately for them, so is losing.

      Delete
    4. Zimmer has to "acquire" something to be considered a spine company.
      Otherwise The Song Remains The Same.

      Hear my song. People won't you listen now? Sing along.
      You don't know what you're missing now.
      Any little song that you know
      Everything that's small has to grow.
      And it has to grow!

      Delete
    5. Many of you have overlooked the fact that sales growth and revenues are not the only value associated or placed on companies when evaluating their worth for a potential acquisition. Everybody on here loves to slam Zimmer and no doubt they are an easy target. However, what makes them as valuable or more than the Globus, Nuvasive, Alphatec and Lanx's of the world it two fold, one they have a large patent portfolio and two most of their business is not bought. Those factors are still worth something and have diminished the value of many of the other companies mentioned. Alphatec and Lanx reps taking shots at anyone seems rather ironic.

      Delete
  38. I have read this thread with great interest. Since most of you are posting anonymously you can speak freely and honestly. Let's say that it actually matters what we do in life because there really is a hell and a judgement day. That being the premise I would like to hear some honest comments touting the virtues of the spine industry and why a just and loving God would be pleased to see how it serves his suffering children. Remember, don't lie.

    I have also never read anything positive from any of you about the companies you discuss. You guys trash the leadership of every company as though they are a bunch of stumble bums. The truth is, these stumble bums don't work nearly as hard as most of you yet they make more money in an hour that most of you will see in a year. That said, is your Monday morning quaterbacking and trashing of these captains of industry really just sour grapes?

    Can any of you name a spine company that you actually believe has integrity?

    How would you rate this industry:

    A) Highly ethical?

    B) More ethical than most?

    C) About Average when it comes to ethics?

    D) Less than average when it comes to ethics?

    E) Very unethical?

    F) Down right shameful?

    Last question:

    If you were offered the same pay to wait tables or shovel equine feces would you quit spine?

    ReplyDelete
    Replies
    1. I think you are missing the point of this blog. It's a forum for a lot of people to blow off steam in this very high pressure industry.

      When people are anonymous, they will act their worst. The attitudes here do not represent the broad industry. There are plenty of hard working and ethical people in the industry, they just aren't represented in this forum. I have worked in a number of industries and I can honestly say that spine is no more or less ethical than any other.

      As an outsider looking at this blog, it would be easy to conclude the worst about spine, but that just isn't the case.

      Delete
  39. Tp answer your question: The truth hurts. We have become downright shameful. We are a mirror image of ourselves, an amoral and unethical society. Stealing, lying, padding the bills (attorneys do you hear me) inside trading, raping the healthcare system, the end justifies the means, doesn't it? Hopefully, when you are caught, since most of these crimes are white collar, you get a monetary fine and a slap on the wrist. Then when things go bad, its in our nature to deflect the blame onto others. Interestingly, those who lecture to the anonymous to look in the mirror should spend some time examining their own behavior, but then that would be a slap in the face or a cold dose of reality and they really don't want to face that, do they?

    ReplyDelete
    Replies
    1. This is getting done right philosophical. Are there no good people? Are people neither good nor bad and simply choose to do good or bad things?

      This is what I think. This industry is an example of incrementalism. There has always been a certain amount of greed and snake oil and medicine but when the industry was run primarily by doctors that greed and snake oil was kept in check by a moral code called Hippocratic oath. Greedy capitalists look at healthcare and they saw dollar signs and incrementally doctors became greedy capitalists and in the process they chucked their moral code and put profit above ethics.

      It's obvious that in the mind of the surgeon what's best for the patient has taken a backseat to what's best for the bottom line. This is not unique to spine because the entire healthcare industry has become a reflection of the very worst of capitalism.

      I love capitalism but when discussing the healthcare system even that maniac Glenn Beck was smart enough and honest enough at the time to say that what is missing in healthcare is care.

      There probably people here who are big fans of Paul Lyin Ryan and his Ayn Randian devotion. Call me old-fashioned but I don't see honor and compassion as a moral failing or as a weakness. Personally, I cannot think of any other industry more despicable than spine.

      It's a scientific fact that people who behave in new moral manner unless they are sociopaths die sooner. People can ignore their consciences forever. Eventually it catches up with them.

      I reject the idea that this blog is an example of people at their worst. The truth is there isn't anything good to say about this industry. Can any of you think of another industry that is nothing good to say about it?

      Delete
    2. Just heard another inkpen hit paper in Pennsylvania , could it be another Depuythes consulting agreement?

      Delete
  40. Hi everyone! I know this is off subject but I wanted to contact the expert reps in the spinal industry. I'm a neuro rep and 90% of my time is spent in brain surgery, 10% in spine.

    Unfortunately my mom is getting an ACDF in the next month and the surgeon is requesting Synthes w. K2M bone graft. Does anyone have any opinions on the Vectra and Zero-P VA compared to others?? Pls let me know. Thanks in advance!

    ReplyDelete
    Replies
    1. Id use MTF bone over K2M all day. Zero P or Zero P va are great options for 1 levels.

      Delete
    2. That's because you get paid on the MTF bone. K2M bone is from LifeNet and is perfectly fine to use.

      Delete
  41. Or better yet, she is getting C4-5/C5-6/C6-7 fused so what would you want your Mom to have?

    ReplyDelete
    Replies
    1. The Zero P is the way to go. It sits completely within the disk space, so it is less likely to irritate the esophagus and cause swallowing problems. It is also easier to extend the fusion in the future, if needed (hopefully not).

      The Vectra is not as advanced, but it's tried and true technology, with a good track record. In the end, either choice is acceptable. Good luck with your mom.

      Delete
    2. The truth is instrumented fusions using cages, screws and plates are not as good as the tried and true fusions using the patient's own harvested bone aka auto-graft or cadavar bone aka auto-graft.

      Our industry will tell you that the substitutes are as good as the real thing. That's a lie.

      Before she gets all those levels fused she should see if a minimally such as a percutaneous diskectomy may be a better option at least at some of the levels. Multi level fusions rarely work well.

      If it were my mother I'd send her to the UK for a disk replacement or a hybrid procedure. I work with US surgeons and based on what I've seen I would not let them operate on a dog.

      Delete
    3. LDR is horrible. Its spiked plates that split the vertebral body. Hard to revise. Zero P has no graft area, the hole is small and blocked by screws. Plastic doesnt fuse. The nurse is correct. Bone is best. However if you must go with PEEK stand alone, the Stalif device has a larger graft hole to pack with bone. Bone on bone fuses.

      Delete
    4. Don't listen to Surgical Nurse. She is not a nurse but a troll who hates the industry.
      Sending your mother to the UK to get a 3 level disk replacement is not the answer. There are many great options here in the states.
      I would suggest you get a second opinion however if you have not already.

      Delete
    5. 10:06 -- The Zero P 4 and 2 screws now have a regular and large footprints. The large has a huge lumen.

      Delete
    6. Listen to surgical nurse. People don't come to the US for spine surgery. Americans go outside the US because we are 30 years behind the times. Outside the US it's about fixing backs. In the US it's about exploiting spine problems. I'm sure you've seen a lot of the scams. Guys with MD after their name are just as slippery as chiropractors.

      If a surgeon has financial ties to a device company avoid them.

      Delete
    7. http://www.wral.com/news/local/story/116672/

      Here's a doctor who uses cages and this guy should be in a cage. Total scumbag!

      Delete
    8. 9:28 has obviously not read the dozens or peer reviewed papers that have shown improvements in fusion rates and quicker return to activities than without a plate.
      By the way, nobody uses autologous bone graft anymore unless the patient has comorbidities where it makes since. A year after an ACDF and the patient still complains about the pain in their hip where the graft was taken - but their neck is doing great.

      Delete
  42. Thank you so much for your input. I really appreciate it!

    ReplyDelete
    Replies
    1. you might want to check out:
      http://spineblogger.blogspot.com/2010/01/zero-profile-cervical-devices-boom-or.html
      for added perspective on Zero-P

      Delete
    2. I would use the LDR Roi c .it is the number one cervical stand alone on the market.

      Delete
    3. who's market? next to ZERO sales in our 5 state area,, not even a rep in our state

      Delete
    4. ROI-C number one. That's funny. I bet Synthes sells more Zero P than LDRs entire US revenue. That fin is great – you get to bill for a vertebrectomy every time you remove one.

      Delete
    5. I had a relative get C4-7 Zero P. Good as new, seriously!

      Delete
    6. That is great to hear! So when your relative had a c4-7 fusion ( i guess that's considered level 3?) did the surgeon use 3 Zero P's? Ie: zero P has either 2 or 4 sites of fixation using 1 plate so did your relative have 3 zero p's implanted?

      Anyone's input is helpful..I was in a long case today and was able to talk with my surgeon about my mom's severe arthritis and stenosis..and he explained to me that an ACDF would 'cure'my moms tingling in her arm (which she rarely has, but an ACDF wouldn't necessarily 'cure' her neck pain which is 99% of her discomfort)., he said he would take a more conservative approach before an ACDF even though he does do ACDF's often. I'd like to know is this the 'last resort' type of surgery? What will her post op recovery be like and will she have to go back for a revision every 7 years?

      Delete
  43. 3 level ACDF is very rarely appropriately indicated and post op function carries some significant disability. Seek another opinion or two and definitely get a mixture or ortho and neuro spine guys. Don't worry about the implant...

    ReplyDelete
  44. NUVA warning letter!

    ReplyDelete
    Replies
    1. Who's to blame:
      a.) Marketing
      b.) Sales
      c.) Engineering
      d.) All of the above

      http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2013/ucm343749.htm

      Delete
    2. That was a trick question it's e.) Regulatory!

      In order to mitigate any further embarrassment to an organization, all marketing/sales advertising should get Regulatory approval. Just sayin…

      Delete
  45. This story is circling the Drain!!

    ReplyDelete
  46. Who has the most consultants:
    a.) Medtronic
    b.) Nuvasive
    c.) Depuy/Synthes Direct
    d.) Depuy/Synthes Distributors

    ReplyDelete
  47. a.) I bet more than all the others combined. All the Ortho companies have shed a ton of consultants and royalty surgeons due to their DPA.

    ReplyDelete
  48. Look in LDR's tech guide, ROI-C is not stand alone. Indicated with plate or post fusion

    ReplyDelete
    Replies
    1. You retard. The tech guild states this:

      Indications (United States)
      When used as an intervertebral body fusion device, the ROI-C Implant System is indicated for use in skeletally mature patients with degenerative disc disease (DDD) of the cervical spine with accompanying radicular symptoms. The ROI-C system is to be used with autologous bone graft and is implanted via an anterior approach at one disc level from C2-T1.The device should be used with supplemental fixation.

      If you were not so stupid you would realize that LDR was very smart as they got two 510K approvals. One is for the peek cage (ROI-C) and one is for the "supplemental fixation plates" that can be used with the cage. The device is absolutly indicated for stand alone use and the biomechanics rock!

      I also think it is so funny when peopel talk about it being hard to revise. I was a sythes rep for 8 years. ROI-C is a peice of cake to pull out and anyboy one has done it knows I speak the truth. zero-P on the other hand is a horrible as all you synthes or now ex-sythes boys and girls know how easy driver/screw integration strips and plate is a bitch to get off due to bone growth.

      LDR is the real deal!!!

      Delete
    2. Also taken from the tech quild:

      VerteBRIDGE™ Plating is the supplemental fixation designed specifically for the ROI-C cage and can be
      used in applications where a stand-alone anterior construct is appropriate. Additional supplemental
      fixation options that can be used with the ROI-C cage (with or without VerteBRIDGE Plating) include
      posterior screw/rod systems and/or additional vertebral plating.

      7:30pm = RETARD

      Delete
    3. thanks for clearing things up for 7:30 in the way only you could TE.

      Delete
  49. Bacterin is circling the drain...stock at 88 cents.

    ReplyDelete
    Replies
    1. Here's a good one....why would any surgeon use MDT's Prevail over the other options in the market. That thing stinks, no graft containment, peek bar in the middle of the lumen and screw angles that make it more difficult than others to place on adjacent levels...

      Delete
  50. hey 950...
    maybe the rep is just better than you?

    ReplyDelete
  51. maybe medtronic paid the doc to teach a course and its payback time

    ReplyDelete
  52. Hey TSB are you okay?

    ReplyDelete
  53. Any thoughts as to what's in store for Zyga or SI Bone with a tracking code looking to hit them both this year?

    ReplyDelete
  54. why dont you ask the LDR guy hes smarter than all of us

    ReplyDelete
  55. Did TSB finally find a full time gig?

    ReplyDelete
    Replies

    1. Nah, TSB just met his "Soulmate" online and the two ran off to "get busy".

      That's why you are seeing no posts from TSB and ... Bally.

      Delete
    2. This Fox has a longing for grapes:
      He jumps, but the bunch still escapes.
      So he goes away sour;
      And, 'tis said, to this hour
      Declares that he's no taste for grapes

      Truth hurts huh? This is just another case of kill the messenger.

      I think his toilet analogy was spot on.

      Delete
    3. The marketing strategy for this company should be, "all the stuff we sell is crap and all the companies are crap but my company sells the best crap. Care for another shit sandwich?"

      Delete
    4. TSB should get a Nobel prize for shining the light of day on this loathsome industry. Since he has a flair for writing maybe he will write a book. Keeping track of the slime in this industry is a full time job.

      Delete
  56. The people on this site hilarious. First you bitch about the truth, then you bitch about the content, then you bitch about yourselves, then you attempt to take down a forum that the industry has never had, and you don't even have to pay for your voice to be heard. You think Robin Young, aka caterpillar mustache, or John Dinglehardt have the balls to write anything critical of the industry? They are pharisees, do you know what that means? Laying at the feet of the Lukianov's, the Paul's, the Dvorak's, the Lobo's singing their praise of hosanna's on the highest. Oh Alex you are so smart, Oh David you were absolutely correct in doing what you did, oh Double D let me sing your praise so you can subscribe to my publications. Let's be frank with one another why should someone take the time out to provide us with a forum only to be criticized by those who are the guiltiest of them all? TSB it's your thing, do what you wanna do, keep on rockin' the free world.

    ReplyDelete
    Replies
    1. Are you saying : "Fat Bottomed Girls you make the Rockin' world go 'Round ! " ?

      Delete
  57. When someone has a c4-7 fusion and considering using Zero P...( i guess that's considered level 3?) does the surgeon use 3 Zero P's? Ie: zero P has either 2 or 4 sites of fixation using 1 plate so does that mean 3 zero p's were implanted?

    Anyone's input is helpful..I was in a long case today and was able to talk with my surgeon about my mom's severe arthritis and stenosis..and he explained to me that an ACDF would 'cure'my moms tingling in her arm (which she rarely has, but an ACDF wouldn't necessarily 'cure' her neck pain which is 99% of her discomfort)., he said he would take a more conservative approach before an ACDF even though he does do ACDF's often. I'd like to know is this the 'last resort' type of surgery? What will her post op recovery be like and will she have to go back for a revision every 7 years?

    ReplyDelete
  58. It sounds like this guy is being straight with her.

    http://www.indiamart.com/shri-krishna-surgical/spine.html

    Keep in mind that zero P is a made by Synthes so there may be some quality control and contaminations issues.

    The chances of your mom being pain free are slim. I would suggest that she try an etanercept paraspinal injection. https://www.youtube.com/results?hl=en&safe=off&client=firefox-a&rls=org.mozilla:en-US:official&q=perispinal+etanercept&bav=on.2,or.r_cp.r_qf.&bvm=bv.44158598,d.eWU&biw=1366&bih=587&um=1&ie=UTF-8&sa=N&tab=w1

    Paraspinal injections are far safer than epidural or facet blocks but it's hard to find a doctor who will do them because it is an off label use for etanercept/Enbrel. She may need only one injection to me pain free for years. There is a doc in Boca Raton Florida who does them.

    In rare occasions osteophytes reabsorb when bone is used for the fusions especially if the surgery is precise.

    ReplyDelete
    Replies
    1. Could you please tell us all where you recieved your medical degree, and what is your license number to practice medicine?
      Bally... Really. Please shut up.

      Delete
    2. One does not need a medical degree to state the obvious. Over the years I have seen patients made far worse by surgery, partucularly ones with hardware.

      Multilevel fusion has a high risk of major complications with re-operation rates up to 40%. Back pain from implant fatigue and/or adjacent segment disease (ASD) is one major reason for poor clinical outcomes after surgery. Patients with radiographic ASD had significantly worse ODI scores than the patients without.

      Don't get me wrong, I an not one of the anti surgery DCs but I am very selective to which surgeons I refer patients. Based on the unbiased medical literature intrumentation is rarely superior to standard fusion.



      Delete
    3. Of course DCs don't like surgery. Why fix the problem when you can do the hocus pocus manipulation for 200 bucks a pop forever. Sorry, but your credibility and that of your profession is nil.

      Delete
  59. With all the shake-ups in the spine industry some clever reps and mamagers have found a way to thrive when their companies hit the skids.

    http://www.thespinemarketgroup.com/2012/05/corporate-whistle-blower-center.html

    This may be right for you.

    ReplyDelete
    Replies
    1. It's obvious you need a "mamager" , as you put it.

      Ya just can't fix STUPID.

      Delete
  60. 8:49 do not listen to 11:07.

    ReplyDelete
    Replies
    1. Listen to everything and make up your own minds. Anyone who tells you to ignore advice or opinion wants you remain ignorant. This industry and its surgeons do not like informed patients. You walk in as a patient and they do their well rehearsed tap dance and they want you to leave thinking that you talk to somebody who's quite erudite when in fact your surgeon is just parroting the industry party line.

      Spine surgeons in medical device companies are not in business to fix spines, they are in business to make money. Patients are not their first priority in most cases.

      I clicked the link to spine marketing group but unfortunately I don't have a lot of evidence so far regarding wrongdoing in my company but I'm quite sure my manager does. Hopefully there will be another group of turds circling the bowl. Right now whistleblower lawsuits are about all we have but unfortunately it's not nearly enough to and the culture of sleaze that is the spine device industry.

      Delete
  61. Well psycho Bally is back, lying and trying to mislead!
    That last post is all a lie, trying to get folks to click link, under it Bally even posts about the " unscrupulous industry " "needing an enema" bla bla bal get this- under a fake moniker "The Spine Blogger"

    What a total fool- Bally go away- you embarrass yourself.

    ReplyDelete
    Replies
    1. Bally has been banned numb nuts.

      Given the well earned dreadful reputation of this industry it is good advice to tell patients to seek second opinions. We know that a lot of PODs use junk and we know whose junk they sell. Do you want a POD surgeon putting junk in your back? Why do you want these POD gangsters putting junk in some stranger's back?

      Delete
    2. Bally rides again ! Yeah you were banned No-Nuts but like a smelly gaseous turd swirling in the bowl you keep popping up.

      You need to be flushed once and for all.

      Delete
    3. The explanation for all the mental posts are clear:

      "Wally" is guilty of abusing "The Beavor"

      Delete
    4. That's "Beaver" dumbshit !

      Wally is guilty of abusing the Beaver!

      Now that's funny cuz it's true

      Delete
    5. Q: Whata another name for a tampon?


      A: Beaver dam

      Delete
    6. Are you saying Bally is demented because they diddle themself to excess?

      Hey don't abuse the messenger-

      Delete
    7. I figured it out. The sophomoric comments come from the reps whose jobs are on the line and the downright retarded comments come from the surgeons/PODS who are on their way to prison.

      The reps don't/can't see this as an opportunity and that is why they will never be anything but a rep. They don't hire you guys for your critical thinking skills. If you reps could keep you ears open and your mouths shut you could cash in by nailing some of the PODS.

      What do you call a spine surgeon with a POD after the Sunshine Act? Answer... an inmate!



      Delete
    8. Rome burns... And Bally diddles...

      Delete
  62. Please don't make fun of my Mom "Bally" like that.
    Sure she is sick, criticizing the spine industry like she does, but if you knew her like her family and her shrinks you'd be more likely to be more tolerant. Before the medical industry, she spent her time mercilessly criticizing fat people. And maybe the Big Gulp and donut industry,
    I can't recall for sure. And the sticky- glue rat trap manufacturers, and oh yeah the BeDazzle rhinestone people. But hey Mom is harmless as long as you ignore her.
    She is already murmuring under her breath at the dinner table about going after manufacturers of toy trains next.
    You gotta hand it to Mom, she's really devoted to whatever whack cause she is on at the moment. Well bye now.

    ReplyDelete
    Replies
    1. Hey "TB" Turkeybaster- good hearing from you again- do you think you can steer your psychotic Mom "Bally" to rant on some seriously bad dudes like the war munitions mongers and real agents of death and misery, and leave alone the makers of therapies designed to fix the victims?

      Delete
    2. Ha! Fat chance, and by that I mean not only Mom's obsession with criticizing fat people
      (Like herself,) but also her relentless close minded intolerance of normal people whom she hates because of her jealousy an all that.
      Bye now,
      School day tomorrow.

      Delete
  63. Big Story on RY ortho, Safewire! Things are looking up!

    ReplyDelete
    Replies
    1. Oh where can one invest !!

      Guide wires = Buggy Whips.

      Delete
  64. You mean salesman try to convince hospitals that training isn't needed to use their products so sales will be higher?

    http://www.nytimes.com/2013/03/26/health/salesmen-in-the-surgical-suite.html?src=rechp&_r=0

    ReplyDelete
  65. https://oig.hhs.gov/fraud/docs/alertsandbulletins/2013/POD_Special_Fraud_Alert.pdf

    POD

    ReplyDelete
  66. RIP POD DRs and Hospitals... POD Surgeons are going to jail, and in most states loose their medical license. OIG POD Advisory Released Today - https://oig.hhs.gov/fraud/docs/alertsandbulletins/2013/POD_Special_Fraud_Alert.pdf

    By its terms, the statute ascribes criminal liability to parties on both sides of an impermissible “kickback” transaction. Violation of the statute constitutes a felony punishable by a maximum fine of $25,000, imprisonment up to 5 years, or both. Conviction will also lead to exclusion from Federal health care programs, including Medicare and Medicaid.

    Both Sides = Surgeon and Hospital

    ReplyDelete
  67. This Special Fraud Alert could not be clearer in stating that most, if not all, PODs are illegal. As noted above, they make it clear that the hospital/ASC pruchasing from a POD is just as guilty as the POD. They also make it clear in multiple places that it's an illegal kickback if only "one" purpose is to remunerate the physician for using the product. This Alert addresses almost every comment posted on TSB over the past few years stating why PODs are legal. It was also interesting how they called out "some PODs purport to design or manufacture their own devices." and then states that the "risk of fraud and abuse is partucularly high in" these situations.

    ReplyDelete
  68. Call the OIG with any information about the fraudulent surgeons, supplier, and hospital affiliation: Make a difference!!!!

    ReplyDelete
  69. To report suspected fraud involving physician-owned entities, contact the OIG Hotline at http://oig.hhs.gov/fraud/report-fraud/index.asp or by phone at 1-800-447-8477 (1-800-HHSTIPS).

    ReplyDelete
  70. Yeah. Be a rat. People love snitches. I swear.

    ReplyDelete
  71. You POD haters are jumping up and down that you may get your business back from your surgeons you have been dog-cussing and spreading rumors about ever since you got your butts handed to you! Keep on dreaming for your business will continue to be gone and PODS will continue to survive and keep prices down from the Big 5 trying to raise them every chance they can! Long live PODS!!!!!!

    ReplyDelete
  72. If you are a POD in Southern California you should be really worried. A novel just went out the OIG with some really good tips. Hahahahahaha. I have never been happier to work as a direct sales rep.

    ReplyDelete
  73. PODs are already on the way out. Gainsharing is on the way in. Direct to hospital, no rep, hospital and doc split the savings. OIG approved and Obamacare endorsed. Bye bye reps. Peace out.

    ReplyDelete
  74. What is that ticking sound?

    All those PODs about to blow up. When history looks back on PODs they will be like stated income mortgages...in retrospect, it is obvious that didn't make any sense. The only ones willing to say it did make sense were those who directly benefited from it.

    I guess docs will have to focus on the practice of medicine.

    ReplyDelete