Happy New Year! It's another Tequila Sunrise here in Blogger's or Sunnyville. As we enter 2013, aka the Year of the Snake, ahem CEO, questions abound regarding the looming medical device tax and how it will affect innovation and technology in the spine market and healthcare, leaving many in a state of uncertainty. Recently, one of the funniest things that we heard was that DPS (DePuy) had informed its sales reps that somehow, somewhere, sometime soon in the near future, the company was set to pass the medical device tax increase in the form of lower commissions to its sales force. Whether this is true or simply rumor can only be validated by our readers comments. It leaves us wondering, why haven't any of the oracles that run these companies sat down and discussed the concessions that they intend on making with regards to their compensation packages? Alex Lukianov? David Paul? Mikael Orsinger? Kevin Lobo? C'est moi? Je ne said q'uoi. How many of you have been subjected to meetings where some financial analyst or consultant is predicting the demise of the industry due to the device tax? OMG, after all these years of complicity in raping the healthcare system, making astronomical profits, cashing out their stock options and fattening their wallets, heaven forbid that anyone have to tighten their belts (wasn't that a Reagan slogan of snorts) and inform their shareholders that sacrifices will have to be made by the shareholders themselves in lieu of advancing medical innovation? But no, that's not what we are hearing. Let's lay off some poor schlepp. Let's cut commissions, hey I have a better idea let's predict that we are going to grow 20% in today's marketplace. If there is any truth to the aforementioned rumor, why is it the salespersons fault for lack of preparation and implementation by companies when it comes the medical device tax? Why is it that sales people and manufacturing pay the price for poor execution? Hey Mr. CEO, ever hear of competing in a ZERO SUM MARKET? Remember how corporations reacted to the potential of the Y2K virus? The sky was falling! Software consultants were hired in anticipation of a meltdown. Companies held meetings a year in advance in anticipation of losing their data and logistics. Today, the head AdvaMed, aka Topo Gigio, declares that it will cost the medical device industry more than $600 million (US) to implement the medical device tax and that 62% of companies are saying that they will lay off and reduce hiring to offset the cost. Mr. Gigio as TSB likes to call him, stated that Congress needs to tax action before January 1, 2013. That time has come and gone. If any of our readers haven't noticed, Congress is run like many of your companies, everything is done at the last second, and by the looks of things, Congress can't even get out of its own way. In spite of differing opinions, TSB believes that the financial onus that will be placed on some of the smaller companies within the industry will result in a cleanse. Yes Siree Bob, it's time to sing Happy Trails to some of these lingering misfits. Maybe it will rid us of some of those companies that continue to do nothing more than commoditize the market with more "me too" products. The vision of some of these companies has come and gone a long time ago. Today, most start up spine companies are glutting the market with more crap. For those that survive, they will learn how to manage their finances with discretion considering that there are companies out there that haven't introduced any new innovation or technologies and have burned through incredible amounts of investment capital with nothing to show. How ridiculous is it for anyone to want to invest $20-25 million in a company to generate $4 million in sales over a five year period? Or to have established a company nearly ten years ago and generate $ 7 million in sales, whereby most of the revenue comes from your surgeon investors. Just think of what life would be like without some of those companies?
What the industry really needs is a cleanse that will rid us of some of these companies and will effect the livelihood of some of the most unscrupulous and unethical people that any industry has ever seen. Until then...............................you're just actors in another Bogart movie. Happy New Year!
What the industry really needs is a cleanse that will rid us of some of these companies and will effect the livelihood of some of the most unscrupulous and unethical people that any industry has ever seen. Until then...............................you're just actors in another Bogart movie. Happy New Year!
The idea of the medical device tax being "paid" out of commissions shouldn't be a shock to anyone. Most companies have stated "they would not eat the cost". The hospitals stated "its not their problem". Who does that leave? The rep. I'm surprised bottom feeders such as X-Spine still offer 30+ pts, even to their PODs. These high commissions cannot be sustained and the companies that offer them must really be on the financial ropes, or their leaders just naive. Either way, the days of $500k per year incomes strictly for spine are done. Diverify now, biologics, bracing, add to your product offerrings now, before the slugs in your market catch wind of the idea first.
ReplyDeleteStryker strikes again only it's worse this time! Their latest batch of victims, the Cervicore victims, were injured even more grievously than the hip implant victims and there was even more criminality involved. CerviCore is an artificial disk implant meant for implantation into the cervical spine. Not only is it a metal shedding Frankenstein design like the Stryker hip implants, the Cervicore disk never received FDA approval for use in patients. It gets worse, the Cervicore disk never even received FDA approval to be used in clinical trials or IDE (Investigational Device Exemption). The Cervicore disk is such a piece of shit that it could not even get and IDE from the FDA but that didn't stop Stryker's doctors from implanting them in the spine of patients.
DeleteCurrently the is a class action lawsuit being filed against Stryker Medical.
file:///C:/Users/Chris/Downloads/File%20Stamped%20Copy%20of%20Complaint.pdf
On Friday April 11, 2014 the law firm of Zoll, Kranz & Borgess, LLC filed a lawsuit behalf of a group of fourteen plaintiffs against Howmedica Osteonics Corp. (which does business as Stryker Spine) alleging Howmedica’s trial device called called CerviCore injured them.
Stryker Howmedica Facing Class Action Law Suit
Only awesome Frenchie companies will grow 20% per year, like LDR. Do you know why the Fenchies have trees on the sides of their roads? So the Germans can walk though France in the shade! Thanks Obama for putting sales reps out on the street with your Frenchi-like taxes.
ReplyDeleteDo you know what GOP stands for? It stands for grimy old pedophiles.
DeleteLet's face it, a monkey with a tin cup can sell screws, brackets and goo. The only thing that is putting you sales reps out of business is that you are competing in a whore's and your leaders don't know anything about about the spine nor do any of them have spines.
Face it sales folks, anybody can do what you do if they are a big enough suck hole and butt kisser. I have seen so many of you salesman do your pathetic little tap dance for clients that I have to snicker just thinking about it. Your company doesn't need you to sell the junk. If your crap is any good you wouldn't have to twist arms and grease palms in order to sell it. The truth is, any ethical Dr. will find out on his own what's good and what sucks. He doesn't need some flunky like you telling him hos a screw works. Who in their right mind would believe anyone who works for the top tier device companies? Answer... NOBODY!
Let's take Johnson & Johnson: Who with any personal or professional integrity would buy so much as a cotton swab from a company that has committed to is much fraud and is as rife with incompetence as Johnson & Johnson? The answer is people who have no sense of decency. When the Federal Trade Commission and the Department of Justice takes out the trash you screw and goo guys won't have a market.
I suspect that the real reason for the medical device tax is so that unscrupulous companies like, (you fill in the blanks) will be able to pay off the millions in fines and lawsuits without having to lay people off our it will be used to pay your unemployment benefits.
The average American CEO makes 475 times more in salary alone than the average American worker. Perhaps when they build one of their McMansions for one of their snout nosed kids they could keep it down to under 30 rooms. Is that really too much to ask of royalty?
I hope that these corporate gangsters end up in prison and I'm not talking about club Fed, I'm talking about a good old-fashioned state penitentiary where there are a lot dangerous and violent criminals who will be all too willing to rape these scum a regular basis the way they have raped Americans.
Say what you want about the French but they did invent something good and that was a blow job. The Greeks on the other hand invented something else and when you work for corporate gangsters eventually you're going to have to bend over and take it the Greek way but only after you have done the French method on your bosses. Bon appétit suckers.
Dude, you are way too pissed off at "the man." Not every American worker has the ability to be a CEO. If you had the drive, intelligence, and luck, you could probably be one. You are way too cantankerous to make it that close. Sounds like you were burned hard in this industry. How about you keep whining online and let the hard workers pay for your life....freeloader.
DeleteWow....thanks El. I didn't know I was such a bad person. But you have made me see the light and I am going to quit my job on Monday.
DeleteIt doesn't take a lot of brains to be a CEO. Some of those guys are the most colossal screwups on the planet and there is no way any of these creeps are worth 30 or $40 million a year in salaries alone. Nobody is worth that much.
DeleteAnyone who gets paid that much money for playing golf flying around the country and eating in the best restaurants should be held to some level of responsibility in the company they are running kills in maims people. In China a country with a huge reputation for human rights violations healthcare CEOs and their regulatory counterparts at China's version of the FDA and the being put to death when their actions kill Chinese citizens.
Here's another reality check for you peasants who work as sales reps. The average American CEO makes 475 times more than the average worker. The next closest country is Venezuela where a corporate CEO makes 50 times more than the average worker. In the rest of the world the average CEO makes about 11 times more than the average worker. I would put a Japanese CEO up against an American CEO any day of the week. Japanese CEOs are not known for running companies into the ground and screwing their workers in the process. They have something called honor which is a liability in the American corporate world. And by the way, Japan is ranked number 10 for healthcare quality and the US is ranked 38th. Japan spends one third per capita on healthcare than the United States. The Japanese are much healthier in spite of the fact that they drink as much as Americans and smoke a heckuva lot more.
It would take a lot more money than what the spine companies pay you guys to sell your screws for me or anyone I know to ever work in this industry. Everybody has a price and some people come real cheap. Bally and I have both said it, Home Depot is hiring.
Is pretty pathetic that some goofball selling screws what do something special to surgeons who think they are something special and getting paid crap money for doing it are defending their corporate masters. At least the slaveowners Their slaves or sold them to another plantation owner who had worked for them. When they let you guys go and that they is coming soon you'll hit the unemployment line and then you'll be blaming everyone and everybody but yourselves for getting screwed, pun intended.
Nothing funnier than the juvenile comments stating what people are "worth" or not "worth". When you graduate from 5th grade, let us know. I'm embarrassed for you.
DeleteThat poor Obama, it's all his fault. The poor guy can't get a break.
ReplyDeleteStop this blog forever. Since it started, nothing has changed: Reps still complain, companies and surgeons are still corrupt and devoid of ideas, and patients are still milked for their money and undergo unnecessary, and often debilitating, procedures by the tens of thousands.
ReplyDeleteI believe there has been a conspiracy among all of them concerning revision surgery. I can not find any history on number of revisions due to faulty hardware on spinal usa . why are these article not published for the patient to make a decision which device to be implanted in them.
DeleteThe funny thing about the medical device tax is it only applies to the US. Companies like Johnson & Johnson sell and manufacture their Tinker toys and poisons all over the globe. These greedy CEOs and boards of directors are using this to get their slaves, the hapless sales reps work even harder for crap money.
ReplyDeleteWhat I see here is an age-old trick. Upper management sees the writing on the wall. They know the Federal Trade Commission and the Justice Department is about to come down on the medical device industry with both feet in response to all the fraud and corruption that is resulted in death and injury to patients. They want to get rid of as many employees as possible so they don't have to go through the process of rating their pensions. They will get rid of their salesforce and then they will tell the other slaves that since sales are down they are next on the list to go. They will probably get involved in some sleazy venture capital deals that artificially inflate company profits so they can take out loans that are federally insured and when they default the taxpayers will pick up the bill and they will walk away with billions.
That's how it is folks it's called corporate welfare. Bally and I have both been telling you to punch up their resume and apply to Home Depot and Ace Hardware. You see how works is the contractors who work on the mansions that are owned by your bosses get their building supplies and places like Home Depot and Lowe's. After these guys get paid off in their vulture capital deals and screw over stockholders and then make a cool billion or 2 on insider-trading they are going to need bigger and better houses.
Alright EL you and Fat Bastard have beaten me. I will never read this blog again. It is bad enough with the negativity from the occasional point of view, but the two of you are relentless. I hope there is some happiness in your lives because it is hard to believe from reading your posts.
DeleteIt's not where the product is made, it's where it's sold genius.
Delete"Rating" their pensions?? Really?
DeleteDo you actually look at yourself in the mirror each morning and not feel a bit of embarrassment?
DePuy isn't cutting commissions because of the device tax. They are cutting them with their "team" approach to keep all of the higher-ups in the company fat and lazy. Way too top heavy at DePuy Synthes.
ReplyDeleteName me one worthwhile AVP or above at Depuy, Medtronic, Nuvasive, Stryker, or Zimmer. Anyone?
ReplyDeleteMatt Link - VP of Sales at Nuvasive. STUD.
DeleteRobert Sargent..Depuy MIS Special Action SEAL team Squad Leader.
DeleteSargent......Sure about that. Sargent after a year as the distributor in SOCAL for DS failed miserably and had the distributorship revoked. BioInitiatives came and within months began to meet DS sales goals. So, after Sargents epic failure he's awarded VP position with DS.... All too familiar.
DeleteSargent is sharp and in a great position for his talents. He'll do just fine. The SoCal market is rough and even bioinititatives didn't have the muscle to hold on during the merger. DS board members have quickly become a bonus focused leadership team. And it's spread down to bottom management. A decent number of territories grew business and the reps won't see any bonus even though jnj was down 7% give or take and the industry was flat for the most part. But hey, they got iPads!
DeleteMany received IPads before they had to give them back.
DeleteAll liars. AVPs are the biggest waste of corporate money. RSMs are almost as bad.
DeleteHappy New Year
ReplyDeleteStryker Poland division Under Investigation For Bribery Allegations
The worm has turned against Stryker and many other EU countries will follow. The US Justice Department will have to review the DPA deal with Stryker (2007) - obviously Stryker lied to the investigators.
Go to www.MedtronicMurders.com and check out Don Alexander's new book: Medtronic Murders
Today Poland, Tomorrow the World!!!
DeleteAnd nobody goes to jail. If they were in China they would be executed.
DeleteHope all is well with you Philomena. Don't let those bastards breathe!!!
http://ryortho.com/breaking/stryker-under-bribery-investigation-in-poland/
ReplyDeleteFYI
Meanwhile the surgeon owned Spinal USA/Precision Medical/Precision Spine LLC sure seems to be having MAJOR issues with their overpriced screws. 6 our of 8? Search the FDA's MAUDE database on Spinal USA and Precision. Caveat emptor/Patients beware.
ReplyDelete"It was reported that the patient underwent an acdf c4-7 procedure on (b)(6) 2012. Subsequent radiographs showed six (6) of the eight (8) screw pulling out of the vertebral bodies. Revision was performed on (b)(6) 2012, during which the plate and screws were removed and replaced"
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.CFM
This comment has been removed by the author.
DeleteI showed my brother-in-law, a mechanical engineer some pictures of pedicle screws and in his opinion there are NOT enough threads on the screws. He believes that the threads should be finer and deeper but I guess it surgeons are too lazy to turn them screwdriver that many times or smart enough to use a torque gauge.
DeleteHe also believes that these pedicle screws need some sort of washer arrangement that's commonly used another fasteners to keep them from backing out particularly in an area is dynamic as a human spine. He also allowed to say, that he can read any book a doctor can read the most doctors can't read his books nor do they possess the gray matter to become a top-flight engineer. That must be why the surgeons are too stupid to see just by looking at the Tinker toys they put into humans the potential for catastrophic failure. Anyone with a bit a mechanical aptitude and experience tinkering with mechanical devices can see with just one look that the hardware surgeons use to remediate spinal conditions would not pass most standards for other engineering and mechanical applications. That's probably why the spine companies hire reps who aren't the smartest cheddar but are good at parroting their sale spiel.
I have seen MRIs and x-rays from many failed back surgeries and it boggles my mind to see the sloppy work that so many spine surgeons perform. The precision required just is not there and that may account for so many hardware failures. What we have are sloppy surgeons working with terrible tools. It's a testimony to the healing power of the human body that we don't have even higher failure rates.
It may interest you to know that the federal agency that has the most freedom of information requests is the FDA. We all know that when it comes to governmental agencies that the American FDA is by far and away the most corrupt. We also know that what comes to corruption in American medical industry is a most heavily fined and corrupt industry in the history of mankind
When will Globus go private?
ReplyDeleteWhen will TSB step up?
ReplyDeleteEl Douchebag and Fat Bastard? Really?
Step up TSB and grow a set!
This post has become S**t! Block El Douchebag & Fat Bastard. They have nothing to offer. In the last four topics, I see 127 posts of crap. We know what they spout. How about we have a real conversation about the industry. You suck SpineBlogger!!!!!
DeleteWe know TSB has a set, do you? Of Mice and Men
ReplyDeleteI used to visit the spine blogger for useful information on new companies, products and people on the move. All I see now is the same rehash of the same whining by the same people.
ReplyDeleteCompanies on the move? People on the move? What is this RY Ortho? Hey maybe TSB should hire Billy Bush or Mario Lopez? Aurora? LMAO. Medicrea? Can we all laugh louder. Eminent Spine? Do I have a deal for you? X-Spine? Where have you gone Joe DiMaggio, Ryan? Life Spine or should we call them Life Line? Hey while we are on it, let's talk about Alphatec's rise, please, can we all laugh louder. Hey maybe Robin Young can pump their image up a little bit more. Boy that stock has really skyrocketed, and while we are on it what ever happened to Closet Spine, or VTI whose acronym probably stands for Very Tough to Implant. You are right 4:19 maybe the reason you don't find useful information, is because the truth is that there aren't many useful things or innovation that is making a difference, that's creating a buzz in the industry, and you know what happens when there isn't anything exciting, people whine. You can't make beef wellington out of bullshit, can you? The truth hurts, but then many would rather have you lie to them than accept the truth. Because as Colonel Jessup said, "you can't handle the truth." The fact of the matter is that spine is under the microscope and has been for a long time, so old wise one tell us where all the innovation is? Explain how it will better the outcomes, cut cost, and make the art of spine surgery better than it is? Until then, you don't need to convince our readers you need to convince yourself.
ReplyDelete4:19 here.
DeleteSorry you're not viewing it as constructive criticism.
What about a Cleanse of the horrific reps? The girlfriend, The Brother in law, etc.
ReplyDeletelike who? the depuy reps in the mid atlantic? sons, daughters? can you spell "payola"
DeleteThere are interesting things still happening:
ReplyDeletehttp://www.thespinemarketgroup.com/
Great site for resourceful information. Nice post.
DeleteYes, tonnes of good info! UNLIKE this blog. One site getting added, one site getting deleted...
DeleteWhat's Depuy's current commission plan anyway? Anyone know?
ReplyDeleteiPad, a gas card, and a quarterly bonus of 2%...maybe.
Delete"What the industry really needs is a cleanse that will rid us of some of these companies and will effect the livelihood of some of the most unscrupulous and unethical people that any industry has ever seen"
ReplyDeleteLooks like Poland is leading the "global cleanse" of unscrupulous companies operating like vultures in their country, namely the Almighty Stryker. I wonder how this probe is going to square with the Deferred Prosecution Agreement Pact of 2007. I noticed the dates for the alleged bribery probe were between the year 2003 AND 2006. This could turn out to be very tricky for Stryker.
"Zimmer, Depuy, Biomet, Smith & Nephew and Stryker Settle DOJ Investigation for $311 million BY LAUREN UZDIENSKI, SEPTEMBER 27, 2007
Federal prosecutors announced today the terms of a settlement with Zimmer, Depuy, Biomet, Smith & Nephew and Stryker following an investigation into physician kickbacks.
Zimmer, Depuy, Biomet and Smith & Nephew entered into deferred prosecution agreements (where a company can avoid indictment if they consent to reforms and monitoring) and will agree to industry reforms in addition to paying a combined total of $311 million. Zimmer announced that they will pay $169.5 million of that sum; additionally, J&J will pay $84.7 million, Smith & Nephew $28.9 million and Biomet $26.9 million.
Only Stryker avoided monetary penalties. SYK will enter a non-prosecution pact and, like the other four companies, agree to industry reforms and undergo corporate monitoring for 18 months.
Even as this investigation winds down, physician compensation worries may be far from over for the industry. Just this morning, the New York Times reported that Sen. Charles Grassley (R-Iowa) sent Medtronic, who settled an investigation into alleged kickbacks in 2006, a letter inquiring about consulting payments to surgeons in the time since that investigation."
http://www.healthpointcapital.com/research/2007/09/27/zimmer_depuy_biomet_smith_nephew_and_stryker_settle_doj_investigation_for_311_million/
Could be a very interesting New Year - 2013. Could this be the first shot heard around the world that wakes up other countries to the fact that companies like Stryker have been sucking money out of their State Health Care systems to the tune of billions? All the while acting like "good little corporate global citizens" for the US DoJ.
If the DoJ doesn't responsed to this wake up call and starts digging a little deeper at the Michigan headquarters accounting offices and puts the squeeze on their bean counters to cough up the second set of "black books" where the slush funds are kept, I will write to Obama and request he call Holder to the shed for answers.
Here these device companies are screamimg bloody murder over a 2% device tax when in fact they are bribing physicians and hospitals globally to buy their crap and double the costs for revisions surgeries et all when the devices fail, resulting in permanent injuries. Put a few CEOs and Board members in jail under the Park Act and we will see some serious corporate internal cleansing taking place in no time.
2013 - the year of the Great Corporate Break Up. The only way to get a handle on these companies is to break them up and sell them off. No more fines, jail time and dissolving companies caught red handed corrupting the market.
its amazing how Stryker reps seem to spend money on things "under the radar" -- all circumstantial albeit. but the tickets and freebies?? how does the stryker rep manage the slight of hand for the DOJ... Distribution shenanigans?? its time the DOJ checked into the "incentives" offerred and locked some people up.. Its funny how Stryker avoided the deferred prosecution... just in my honest opinion
DeleteReally, only the Stryker reps?
DeleteWe used to call bribes premiums. The company spent a certain amount of money with us they were entitled to premiums so we would provide them with a catalog. We would give the managers and purchasing agents and other procurement people catalog with a lot of goodies in it. They could fill out an order form and send it in and it would be shipped to whatever address they want to put on it. If they were honest and ethical they would order something for their company like a microwave oven for the cafeteria or refrigerator, clear screens for their computers, office furniture or they could order other items and have them shipped to a private address. We didn't know what they did, we didn't care and we didn't ask.
DeleteI guess in the spine industry merchandise from a catalog is chicken feed to a greedy surgeon. They want cash cash transfers to their offshore accounts and that can get kind of sticky for the person offering the bribes.
Today the surgeons are offered all expense paid trips and payment for phony consulting fees and honoraria for lectures. I would love to be able to go on vacation and have somebody else pay for it and then pay me to go on a vacation.
I am guessing that the reps/order takers are not aware of the kickbacks that go on at the close of the sale. They get their paltry commission/finders fee and they waddle away thinking that they made a big deal. God knows that they don't want any of these guys becoming whistleblowers.
These companies keep you reps around so their bosses will have somebody to throw under the bus. Blaming the hapless salesman is an age-old guise and a favorite of corporate criminals everywhere.
I would urge the reps who come here to seriously consider becoming whistleblowers. You can make a hell of a lot more money taking out the trash than you can trying to sell it.
Deletehttp://lib.law.virginia.edu/Garrett/prosecution_agreements/pdf/strykerorthopedics.pdf
ReplyDeleteStryker's NPA with DoJ 2007
This blog is bipolar. Plenty of hating on the big players that have too much pork, can't innovate and buy doctors. Plenty of hating on the small players that have physician investors, physicians that happen to use those products. Some of you will say these investors are 'bought' too but I would hope docs use their own products. So who gets cleansed and how? Spinal hardware does have a place and helps a good number of patients. New companies won't happen if doctors can't invest in them. So if you want them cleansed, it would sound like you are willing to accept a market run by the four dominant players.
ReplyDeleteThis has turned into a spine industry criticism blog. If you hate spine, think spine surgeons are quacks, the companies are crooked, and the government isnt doing enough to clean it up, this is the place for you.
DeleteFor those working hard and trying to make a living in spine, go away you are not wanted here! You are part of the problem and are evil. You probably torture puppies and club seals!
I saw a t-shirt that had a pic of a baby seal on it with a caption above: "I'd hit that"
DeleteNo relevance, I just thought I'd share !
The bottom line is, patients are not much better off today than they were 30 years ago.
DeleteThere is no medical or scientific reason for why the motion constraining shock absorbing ADR are not available in the US.
The medical industry is crooked and what it more pathetic is that we now call medical care and industry. When the profit is in the cure health care will improve. We need outcome based medicine not profit based.
MSM might want to start a blog with his reviews of the various goos and screws and them monetize the blog. Had he done that maybe there would be less Infuse deaths.
AnonymousJanuary 7, 2013 5:15 PM said:
DeleteThis blog is bipolar. Plenty of hating on the big players that have too much pork, can't innovate and buy doctors. Plenty of hating on the small players that have physician investors, physicians that happen to use those products. Some of you will say these investors are 'bought' too but I would hope docs use their own products. So who gets cleansed and how? Spinal hardware does have a place and helps a good number of patients. New companies won't happen if doctors can't invest in them. So if you want them cleansed, it would sound like you are willing to accept a market run by the four dominant players.
***********************************************************
It is a major conflict of interest to have doctors investing in medical device companies. It's like athletes gambling on sports. It's just wrong.
The market in run by a few top tier companies. They run the FDA.
5:15 here again.
DeleteBB. Patients are better off than they were 30 years ago but perhaps not much better than they were 10 years ago. You keep blabbering on about the shock absorbing disc/s not being available in the US. First, where are the large randomized studies to show that these devices actually work like *you think* it does? Why haven't the studies been been conducted against the lowly fusion control? Surely people would be saved from the injustices of degenerative disc disease.
One truth is that the problem isn't so much this device or that. The problem is that spine pain is multifactorial (disc, facet, ligament, muscle, mechanical, chemical) and involves a myriad of concomitant physical and mental issues. Some of you act like these devices do no good. That's just BS and I've seen many patient's data over my career.
Yes, it may be a conflict of interest to have doctors invest in medical device companies. Yet, who better to evaluate the potential of a (new) medical product? I'm sure you don't care for venture capital either. So how do you propose to get these new (eg. the shock absorbing discs) ideas funded, brought through the FDA, and made available to patients. The world needs doctors to invest in novel technologies.
I say let the docs invest in whatever they want. If its a new product, they can't participate in the clinical trial or disclose their investment. But, they should be able to take the gain or loss from their investment. Their angel capital is a lifeblood of early technologies.
If its a commodity product, let the docs invest in their companies and compete like everyone else. The more of these 'me-too' companies that are out there, the more pressure on the big players, prices come down and the industry finds a new baseline. I don't see how else you reduce the incentive for corruption. The cost of hardware has to come down such that its no longer attractive.
Give it a rest Bally. Motion constraining, shock absorbing TDRs dont work. The biomechanics are wrong and the failure rate is too high. Look up the Acroflex disc. For someone who is so fiercely critical of our industry, it is weird that you would be advocating any TDR - these are the most ethically questionable devices being used. Tainted data, researchers on the payroll, marginal outcomes, the technology stinks.
Delete@11:14
DeleteGood post. Unfortunately, as you know Surgeon investment in these private companies often is a carrot used by companies to deliver sales numbers. Also, a majority of these deals are initiated by Surgeons in a pay to play scenario. While I agree, the end user has a big role in evaluating the product. How many evaluations do you need for the me too garbage? I have not seen a novel technology for some time. Re-invention of the pedicle screw is pretty much it. While I don't fully disagree with Surgeon investment, I think it opens a can of worms in regard to ethics.
@5:08 agreed
@Bally I agree that a more result driven system, would make sense. Problem is, what end result would be the winner? Fusion, VAS etc.... If you have a pain free patient, but no visible fusion is that patient a success?
-stl
AnonymousJanuary 8, 2013 11:14 PM SAID.....
Delete5:15 here again.
BB. Patients are better off than they were 30 years ago but perhaps not much better than they were 10 years ago. You keep blabbering on about the shock absorbing disc/s not being available in the US. First, where are the large randomized studies to show that these devices actually work like *you think* it does? Why haven't the studies been been conducted against the lowly fusion control? Surely people would be saved from the injustices of degenerative disc disease.
One truth is that the problem isn't so much this device or that. The problem is that spine pain is multifactorial (disc, facet, ligament, muscle, mechanical, chemical) and involves a myriad of concomitant physical and mental issues. Some of you act like these devices do no good. That's just BS and I've seen many patient's data over my career.
Yes, it may be a conflict of interest to have doctors invest in medical device companies. Yet, who better to evaluate the potential of a (new) medical product? I'm sure you don't care for venture capital either. So how do you propose to get these new (eg. the shock absorbing discs) ideas funded, brought through the FDA, and made available to patients. The world needs doctors to invest in novel technologies.
I say let the docs invest in whatever they want. If its a new product, they can't participate in the clinical trial or disclose their investment. But, they should be able to take the gain or loss from their investment. Their angel capital is a lifeblood of early technologies.
If its a commodity product, let the docs invest in their companies and compete like everyone else. The more of these 'me-too' companies that are out there, the more pressure on the big players, prices come down and the industry finds a new baseline. I don't see how else you reduce the incentive for corruption. The cost of hardware has to come down such that its no longer attractive
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Obviously you been reading too many industry sponsored American studies. Commission E doesn't see it that way. Spine pain in some cases may be multifactorial but nerve conduction tests as well as a simple facet block can usually isolate the offending disk. If the outcomes were not better using the new ADRs then the countries with single-payer healthcare who actually care about keeping costs down would not be using them.
There's an old saying," don't piss on my leg and tell me it's raining". If the physician looks at an MRI, or a CT scan or a myelogram, does a nerve conduction test and performs a facet block they've a pretty good idea what the source the pain is and whether decompression will alleviate that pain. The evidence I have read regarding discogenic pain is conjecture at best.
You are very naïve to think there could actually be competition in the screw and glue market. Three simple, there is no competition in medicine in the United States. If it were outcome based than it would be competition to get better but in the United States bad medicine is more lucrative than good medicine.
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DeleteA conflict of interest is a conflict of interest and physicians owning a company that makes product and then installing that product into a human being is probably a violation of antitrust laws but we don't enforce antitrust laws anymore. A physician wearing the hats of so many other industries is just reckless and beyond greedy. Of physicians job is to help sick people and it is a clear violation of the spirit of the Hippocratic oath to do anything other than that when it comes to disease. Doctors are not qualified in most cases to design hardware. Most of them don't have the education or the basic intelligence to create a mechanical device. A grease monkey may know how to fix your car and he may have a basic knowledge of the mechanical principles of an engine and a transmission but the chances of him ever designing one that actually worked are slim and none. It doesn't take a genius to do a back surgery. Removing a diseased or damaged disc is not much more difficult than filling a tooth. Selecting the right instrumentation isn't very tough either but a lot of surgeons screw that part of it up.
Artificial disc implants are superior to fusion. Even though crappy ones available in the US are better than fusion if you were to believe the studies. All one has to do is go on to patient spine forms and read the ones who were thrilled about going to England India Germany and Brazil and getting fixed right the first time and then read the stories of people saying that fusion was worse than I ever did. Perhaps if they had fusion done outside US they would be in better shape.
http://www.spine-health.com/backtalk...pinefus01.html
http://www.medscape.com/viewarticle/588851
"The ProDisc is a safe and effective alternative to fusion, and showed statistically significant improvements over fusion in our study in Oswestry Disability Index (ODI), SF-36 scores, reoperation rates, narcotic usage, and patient satisfaction," said Jack Zigler, MD, fellowship codirector at the Texas Back Institute, in Plano, and lead investigator of a study of ProDisc vs fusion for treatment of disc pain at 2 vertebral levels between L3 and S1.
Thank you!! I scroll through your rants much faster since you post every other line in every single topic. We know your stance. How about you go find a girlfriend you 400lb piece of nothing in Spine. Do you really know anything about spine surgery or do you just post rhetoric and URLs. How bout you debate procedural differences or get the fuck out!! Call me when your ready.
DeleteWah, wah, wah, wah, you think this industry is clean, should we laugh at you now or eternally?
ReplyDeleteMore of the same, YAWN.
ReplyDeleteBRYAN disc has as much shock absorption and visco-elastic characteristics as any other "shock absorbing" disc outside the United States. 7 year follow-up from the FDA ramdomized trial forthcoming.
ReplyDeleteThe plate that attaches the BRYAN disc doesn't look adequate and the company who sells it is quickly on its way to breaking Guinness Book of World Records for most fined companies.
DeleteI would think that this disc has had major issues with migration. There is a simple way to prevent migration and a very slight modification of the Bryan disc could make a possible. By simply adding a small square post that could be inserted into the for vertebral and plates along with the plate on the disc migration would be impossible.
This disc like anything else there is put into the human body should be made from an inert nonferrous and nonmetallic material such as carbon fiber.
The good thing about the Bryan disc is that if a revision is necessary is much easier to perform. I suppose that the reason that this disc and all other tasks don't have a square post is because the unqualified people who design them don't know how to drill a square hole. They might learn something by watching Norm Abrams on Yankee workshop. The surgeon would also have to know a little bit about what a machinist does something get the whole in the right place. That would involve using a jig that can be adjustable for the placement of the hole along with some preplanning before going in willy-nilly in doing it wrong. If they didn't want to drill a square hole then two holes in a for vertebral and plates would keep the disc from migrating and assure its proper placement.
I would think that some company could create a disk like the Bryan disk, change the shape of it slightly and add posts and have it approved under section 507.
Here are all the disks compared. http://www.neckpainexplained.com/insets/NPE.jpg
7 year follow-up???!! It just came out!! Nice job MSD F**ktard!
DeleteWhat spine companies pay the highest commission and still have great products? What is the average for a mid size spine company?
ReplyDeleteEl obviously has no idea what BRYAN actually looks like or how it's implanted based upon his ignorant rant. I assume the opinion stated is that of his engineer brother-in-law who also sounds like a pompous, ignorant ass.
ReplyDelete10:50 PM is a dumb ass and possible a F**ktard, whatever that is. BRYAN does have 7+ years F/U. Look it up.
I am familiar with the Bryan disk and El is correct. Just look at a picture of it.
DeleteWhat the clinical trials and surgeon data report are most likely BS based on their track record.
There is only one screw per vertebrae. It doesn't take an engineer to know that it has a history of migration.
Here the 411 on the Bryan, http://www.ncbi.nlm.nih.gov/pubmed/22009921
Here is an image. http://www.londonspineclinic.com/Bryan%20disc.jpg
It's a crappy design.
I thought something happened to you TSB
ReplyDeleteI've been hearing about "universal payment" coming in 2014 with Obama care. I guess the hospital gets the payment from Medicare or the insurance company. Then they pay the surgeon and the device company of course keeping a nice chunk for themselves. Is this true? If so, it sounds like the end of the road for the reps.
ReplyDeleteI've been telling you salesmen all along that you will all be obsolete soon. When surgeon start buying hardware and goo based on quality and cost will be no need for you guys to offer them kickbacks since surgeons will be rewarded based on outcomes. Surgeons will be motivated monetarily by what is best for the patient and not their pocket book.
DeleteWhile you sales reps are about 1/100 of one percent of the cost of a screw plate elimination of your costs might mean a new BMW for one of the CEOs Mistresses.
Billy, what is the plan? Just remember that the quality of titanium is not the same in India and the low cost products will not perform as compared to US/German metal grade screws. Surgeons will be motivated by what is best for the patient and their pocket book. I do know that Direct Tv has another call center hiring right now.
ReplyDeleteThe juvenility of this blog post is mind-boggling.
ReplyDeleteEl is just awesome. I hope he continues posting. You guys must not recognize the comedy he's shared with us.
ReplyDeleteimho: I believe El and Bally are the same dude. I just can't imagine anyone else with the capacity to say something like "El is correct". Regardless of the text before of after.
ReplyDeleteI've taken the stance that if it's offensive, annoying, or just plain ignorant it was probably written by one of them.
Repeal efforts continue, but there's no immediate sign we'll move beyond the MDT. If not, we'll all pay more in the long run.
ReplyDelete