The Politics and Economics of Orthopedic Medicine

[ADR seeker]

I'm sure some of you will tell me to put on my tin hat but I'll risk dealing with the ridicule.

There is no valid reason for why the latest generations of of ADR are not available to Americans on American soil. Many of you have heard of the M6 ADR if you have not heard of this disk here's the 411. The M6 acts like the real thing. It absorbs shock and provide normal mobility of the vertebral joint. It has been used worldwide for many years and it is far better that fusions or the old ADRs.

I called Spinal Kenetics the manufacturer of the M6 and I was told that they cannot afford the costs of clinical trials. I was told that the M6 has proven to be excellent in worldwide use. The M6 is an American made disk.

As good as the M6 is the American made Neo Disk may be even better for many reasons. It is a simpler install and it has even less chance of migration and it will fuse better and even if it won't fuse it will still function normally.



The problem with these new ADRs is that they are minimally disruptive. In other words they have a faster and more complete recovery and revision surgeries are rare hence they are more cost effective.

The back pain industry is huge and there is all sorts of allopathic treatment much of which is dangerous hocus pocus such as nerve ablation and some PT and pain management.

Think of it like this. What if there were a vaccine for gum disease, crooked teeth and cavities? How big would the dental industry be? The new US made ADRs will put dent in back pain industry profits simply because they work really well for many patients and unlike fusions and old ADR the prevent the DDD cascade effect.

These disks should have been available in 2003 or earlier but because bad medicine and disease management is far more lucrative that cures Americans are allowed to suffer needless to satisfy the money lust of a corporate medical industry.

ADVOCATE!

The FDA is controlled by the US congress and the US congress is the lap dog or the medical industry. Strenuously petition your representatives.

It's YOUR body!

If you want one of these ADRs demand it. ACT UP! If you trust your doctor to be competent and honest then you should be allowed to have him implant this disk if in his and your medical judgement it is what you need to be restored to good health. Not allowing us this is a form of Nazism. Yeah, I know that word get used too much but in this case it's appropriate. Don't allow them to make us victims of medical greed!

[dshobbies]

No one will disagree with you regarding the politics behind the entire medical industry in the US. What should be and what is are worlds apart. The fault lies not only with government controlled organizations but also with private insurance companies which, in my opinion, wield much more power, even to the dismay of the entire medical profession. Basically, money talks and the rest of us walk.

However, you lost me in your summation!

Dale

[mmglobal]

ADR Seeker, welcome to the forum.

Please tell us more about yourself... are you a patient looking for solutions?

The M6 and NeoDisc are interesting designs. As with all of the devices, features and differences from one to the next.... all come with advantages and disadvantages. So much of what is said about them and what we initially understand, is marketing spin. It's difficult to separate the important issues from the spin.

I wish I could write more about these devices now. I originally wrote about the M6 from SAS-7 in Berlin. See here: Mark's SAS7 Blog.

Interestingly enough, migration is one of the problems with Neo Disc because the jacket is so flexible and what keeps the core in place is the jacket. It is a beautiful design and is so simple and somewhat smaller invasive procedure. (This may also be something of the marketing spin more than important data because the important work in a disc replacement surgery has to do with getting behind the vertebral bodies to remove osteophytes and decompress the neural structures.)

There is so much more to say... but I have to run.

Again... Welcome!

[ADR seeker]

Originally Posted by dshobbies

No one will disagree with you regarding the politics behind the entire medical industry in the US. What should be and what is are worlds apart. The fault lies not only with government controlled organizations but also with private insurance companies which, in my opinion, wield much more power, even to the dismay of the entire medical profession. Basically, money talks and the rest of us walk.

However, you lost me in your summation!

Dale

I think the medical community is divided. You have your Dr Oz style doctors and a few old timers who became doctors for altruistic reasons. Then you have the hospitalists and organ doctors who are "just following orders" and then you have snakes who say "medical school was expensive I deserve a tone of money and then we have a whole lot of apathy and mediority.

The problem is very complex and MD are certainly not a solution. In the US we pay 3 times the world average for health care and over 20% of the US GDP is health care.

The FDA is controlled by the drug companies.

There is no federal agency that oversees the actions of doctors and hospitals and as a result the third leading cause of death in the US is doctors and that is according to Professor Emeritus Dr Barbara Starfield MD of Johns Hopkins School of public health.

The leading cause if death (although there is data that contradicts it) is the US medical industry.

Today the odd of getting a health care acquired infection are 1 in 10. If hospitals used the Pronvonost protocol there would be almost no infections. Dr Peter Pronvonost is a Noble Prize winner and he also works at Johns Hopkins.

There are over 10 medication errors per day in the average US hospitals and there are three wrong site surgeries a day in the US.

All of the above is just the tip of the iceberg and what I conclude is that even if your doctor wants to have your best interest at heart and be your health care advocate he can't. It's a sleazy culture where disease is not the enemy but a cash cow to be milked.

I recently wrote to some of my state representatives asking them to legalize the M6 and the neo disk. My reasoning is that if California can legalize pot any other state can legalize something much better.

[mmglobal]

Asking them to 'legalize' the M6 and neodisc is asking them to abandon the idea of practicing evidence based medicine. If you want to bring a device to the market, you need to demonstrate the efficacy and safety of the device with CREDIBLE science.

Yes, the FDA sometimes stands in our way and keeps us from having access to life-saving technology. In other cases, it may keep us from jumping into a new technology too soon, before we understand the risks of the technology; keeping us from making a huge mistake. The system is not perfect. I don't even like it, but I do believe we would be much worse off without the much needed oversight of medical device companies. The device manufacturers are not in this for our health.

Also, the metering of access to the technologies comes not only from the FDA. Having proven and approved technologies that insurance companies still call 'experimental' 7 years after approval is of little help, except to the rich.

Yes, there is much to rant about, but not everything is as it seems.

Mark

[ADR seeker]

Originally Posted by mmglobal

ADR Seeker, welcome to the forum.

Please tell us more about yourself... are you a patient looking for solutions?

The M6 and NeoDisc are interesting designs. As with all of the devices, features and differences from one to the next.... all come with advantages and disadvantages. So much of what is said about them and what we initially understand, is marketing spin. It's difficult to separate the important issues from the spin.

I wish I could write more about these devices now. I originally wrote about the M6 from SAS-7 in Berlin. See here: Mark's SAS7 Blog.

Interestingly enough, migration is one of the problems with Neo Disc because the jacket is so flexible and what keeps the core in place is the jacket. It is a beautiful design and is so simple and somewhat smaller invasive procedure. (This may also be something of the marketing spin more than important data because the important work in a disc replacement surgery has to do with getting behind the vertebral bodies to remove osteophytes and decompress the neural structures.)

There is so much more to say... but I have to run.

Again... Welcome!

Thanks,

I can see how an old style ADR can be in many cases such as young herniations be better than a fusion but the ball and socket ADR all over rotate. For me with the problems in my neck the fusion probably would be better than an old syle ADR but it still won't be very good and even with the new ADRs we are still in the orthopedic dark ages IMO. They are not even using motion X-rays as a diagnostic tool.

It's a bit scary when you go to a surgeon and your grasp of the bio mechanics of the spine exceeds theirs. Fixing a spine is more than just stabilization and restoring motion it a combination of the two and many other factors. A motion limiting shock absorbing disk that closely mimic the real thing is probably a better choice for most people.

The best choice would be tissue regeneration and PT that is not rooted in false assumption, pseudo-science and conjecture. Again, we are in the Medical Dark Ages and the brief medical renaissance that came about in the 40's and 50's quickly died when medicine ceased being a profession and morphed into a business and then became the biggest industry in the US.

I need a new cervical spine. C 5-6 is the worst and the cascade continues do to dark ages medicine.

[teg]

Hey Mark,
I will take the opportunity to jump in here because I feel that I am a walking spokesperson for both sciences ADR and Fusion. While fusion of the intervebral bodies of the spine has been the "gold standard", my cervical spine has yet to agree with the ages of wisdom behind this science.

I live with the domino effect from my fusion of c6-c7, yet never questioned the skill of my surgeon. Here in DC, he is listed among the best. Yet, the fusion has left me in a significant amount of pain and a likely future of more surgery.

My three-level ADR by Dr. Bertagnoli changed my life. WHile spine surgery is no panacea, mine was a complete success. I hope that as this forum goes forward, we lear from each other's experience. "what is good for the Government, is good for the poeple. (My two cents.) We are a financially incentived medical society in the US and innovation takes a back seat to progress.

Thelma

[james]

health care in US is all politics.
Why we import so many engineers from China and India, but we do not import many medical doctors ?

US medical system puts so many barriers in front of foreign doctors to make it hard for them to come to US.

Let them come to US and I am the one who decides whether to see them or not.

[ADR seeker]

Medicine should be run by the states and the federal government now that medicine is no longer a profession. The rate of health care inflation and extreme profiteering is beyond obscene it is criminal.

Disease is something to be eliminated and not exploited for profit. People are not commodities or cash vending machines.

[don_wagner]

James you are partly correct. If qualified foreign doc's made it into the states, they'd soon catch on and join in with the rest of the doc. crowd. Why do you think so many foreign grad students flood the top US grad institutions? They want the green card to get the green money.

[mmglobal]

I know a few leading surgeons who have transplanted themselves to the US even though they had successful practices overseas. Dr. Fabien Bitan in NY had nearly 200 ADR's under his belt in France before coming to the US and being a principal investigator for many new technologies and becoming a very heavy hitter in pediatric scoliosis. Dr. Lali Sekhon brings an amazing amount of experience to the US. He has done some amazing revisions.

Mark

[theBadCormorant]

Originally Posted by ADR seeker

Medicine should be run by the states and the federal government now that medicine is no longer a profession. The rate of health care inflation and extreme profiteering is beyond obscene it is criminal.

Disease is something to be eliminated and not exploited for profit. People are not commodities or cash vending machines.

Coming from Scotland, the USA does seem very odd in the money grabbing attitude it has to looking after their own citizens. Is it really true that if you don't have money you don't get treated (other than real basic stuff)

Our NHS is certainly not problem free, but if you get ill and that illness causes you to get poor, at least you have no worries in gaining access to some of the best medical care available. Just seems a little more civilised.

[Maria]

One needs to see if the surgeon involved does charity work if not able to afford surgery or look to a county facility for treatment which will still involve some degree of services/cost.

There may not be a "free service" but there may be quite a reduction if a person should qualify. We just underwent I believe a 2nd annual HealthCare Event in Los Angeles where all services were free. People stood in line for a great deal of time to get some kind of admittance for this event and then were allowed in on one of three days. I wish this was something that were a far more common occurrence because so many people need services. Of course something like orthopedic surgery wouldn't be performed there but at least one could get an evaluation and possibly some form of treatment that day or some kind of assistance.

Even with insurance co pays and uncovered services can really either put a serious dent into one's pocketbook or almost be a deterrent to using the insurance plus there are so many rules that one practically needs a JD to get thru all the babble about when what can be done...

[Ringo]

You speak wisdom.

The average person thinks to themselves that ADR sounds great....where do I sign up. But, the device must fit the application and not all situations will permit an ADR. A surgeon has to stick to documented evidence and statistical trials that show a device has efficacy and specific application.

Fusion VS. ADR.... both have overlapping application. But, in some instances a fusion might have greater documented efficacy for treatment.

I am certain that there are orthopedic/neurosurgeon offices that you can walk into and the doctor will say you need a posterior fusion with rods. If you ask them if there are any other options, they will say, "No" because they personally don't offer any other options. Now, I think that sucks big time. They won't tell you to go down the street and get a second opion from a guy that is younger or that is doing ADR's. Trust me, this happens all the time. They need to make payments on a new vacation home, buy into a practic and send their kids to elite collages and make sure the glamor wife stays fit or the mistress is happy or the gold leaf wallpaper in the master bath gets put in, or new hair plugs, etc. Now it's not always like that or that dramatic. But, if there is an opening in the surgery schedule, I am here to tell you that that has significant bearing on whether you will have surgery or not. This is all the human side of it. Average person can't immagine this happening but it does. I know this from the horses mouth, not making it up. Sorry for the rant. Peace.

Originally Posted by ADR seeker

I think the medical community is divided. You have your Dr Oz style doctors and a few old timers who became doctors for altruistic reasons. Then you have the hospitalists and organ doctors who are "just following orders" and then you have snakes who say "medical school was expensive I deserve a tone of money and then we have a whole lot of apathy and mediority.

The problem is very complex and MD are certainly not a solution. In the US we pay 3 times the world average for health care and over 20% of the US GDP is health care.

The FDA is controlled by the drug companies.

There is no federal agency that oversees the actions of doctors and hospitals and as a result the third leading cause of death in the US is doctors and that is according to Professor Emeritus Dr Barbara Starfield MD of Johns Hopkins School of public health.

The leading cause if death (although there is data that contradicts it) is the US medical industry.

Today the odd of getting a health care acquired infection are 1 in 10. If hospitals used the Pronvonost protocol there would be almost no infections. Dr Peter Pronvonost is a Noble Prize winner and he also works at Johns Hopkins.

There are over 10 medication errors per day in the average US hospitals and there are three wrong site surgeries a day in the US.

All of the above is just the tip of the iceberg and what I conclude is that even if your doctor wants to have your best interest at heart and be your health care advocate he can't. It's a sleazy culture where disease is not the enemy but a cash cow to be milked.

I recently wrote to some of my state representatives asking them to legalize the M6 and the neo disk. My reasoning is that if California can legalize pot any other state can legalize something much better.

[Maria]

I am certain that there are orthopedic/neurosurgeon offices that you can walk into and the doctor will say you need a posterior fusion with rods. If you ask them if there are any other options, they will say, "No" because they personally don't offer any other options. Now, I think that sucks big time. They won't tell you to go down the street and get a second opion from a guy that is younger or that is doing ADR's. Trust me, this happens all the time. They need to make payments on a new vacation home, buy into a practic and send their kids to elite collages and make sure the glamor wife stays fit or the mistress is happy or the gold leaf wallpaper in the master bath gets put in, or new hair plugs, etc. Now it's not always like that or that dramatic. But, if there is an opening in the surgery schedule, I am here to tell you that that has significant bearing on whether you will have surgery or not. This is all the human side of it. Average person can't immagine this happening but it does. I know this from the horses mouth, not making it up. Sorry for the rant. Peace.

Have personally been down this road myself while out surgeon shopping.. and even with having had surgery~ kkkk chinnnnnggggg $$$$$ over ethics way too often it seems

[Ringo]

I appreciate the reply.

[Maria]

My experience has also been that if one has a certain set of symptoms and findings on films then at least in the past criteria for surgery would have been satisfied. Generally a surgeon that is ethical will at least want a person with non emergent symptoms/findings to wait about 6 months at least before committing to surgery. Try the conservative route with rest, ice/heat, PT, biofeedback, injections for the spine perhaps, etc.

If things persist and findings are unchanged or worsened then pursue surgery.

Truly I think often we as the patient are all to quick to want our lives to change. To be like it was before the injury or better. My own experience is once having surgery things do change. Sometimes things are improved, sometimes something is improved and something worsened or another problem created. Sometimes there is way more pain and problems and surgery just has failed and created more problems.

IMHO people really need to take their time and check things out thoroughly before committing to spine surgery IF NOT EMERGENT IN NEED.

One spine surgery usually begets another, sadly. I would advise not to act on desperation.

Get to know your options first and make sure to get more than one opinion.

Surgeons do what they went into practice to do.. surgery. That's their livelihood. I think if someone offers a remedy without at least cautioning that it may or may not work .. then beware. Spine surgery may be precise with regard to surgical technique and all that but it's not precise with regard to how the body responds.

Good luck to anyone seeking spine surgery and any other surgery. We may not be masters of our own fate when it comes to what insurance will approve and such however we are masters of our own fate making a decision for ourselves. Ultimately if things turned out terribly it is me that signed that consent form and brought myself to the surgical front. And I did and I learned...

[Ringo]

Yes, agree.

Before Christmas I squated down in my garage to clean something off the floor. I did this probably a handful of times throughout the day. I use my left leg more than my right to stand up because of a condromalasia type thing going on in my right knee. I was told I developed patalofemoral overload in my right quadracep muscle related to documented nerve damage in my right leg (my right leg is a little smaller than my left and its my dominent leg). So, my knee cap is wearing unevenly and it causes pain when I use it under load.
Well, later in the day my LEFT knee (not the right one) swelled up and I felt sharp pain inside and had limited range of motion. I went to a orthopedic group that I trusted and talked to the PA who has a slightly glorified attitude of himself. His notes read, "Patient squated down, did a twisiting manuver, felt a pop and had sudden pain." NOTHING close to what I told him. Told me I had a torn meniscus, he was willing to have the surgeon cut on me and he had me scheduled to go to surgery and I had not even seen the surgeon. I had to tell him I wanted an MRI to confirm his opinion and he agreed to that. Then he called me and said that after discussing the MRI results with the radiologist, I had "two large tears in my left medial meniscus." I ordered my report and it said I only had one small radial tear????? There were other issues with the chart as well. I am disabled but I don't like talking about the details of my disability. I have chronic pain problems that increase and decrease throughout the day and through the course of my last two surgeries, I became severely depressed and at times I get anxious (especially around doctors). But none the less, I am disabled and I don't like talking about it because I feel there is a societal stigma against people that are disabled and don't necessarily physically look disabled. I cancelled my surgery when he wrote in my notes that I had seen the surgeon and had signed a surgical permit WHEN nothing of the sort ever happened. The whole time I was wondering when I was going to see the surgeon and as I am walking to the lobby (carrying my notes) I read, "seen by the surgeon and surgical permit signed, all risks of the procedure explained." He also wrote that I was very active and muscular athletic male (they are a sports medicine clinic). I confronted him on this and he said I shouldn't be concerned because it was just "Subjective." In the last 6 years I was unable to work, been hospitalized 2 times for back surgery lumbar fusion, had three hurnias repaired (all at the same time) and been hospitalized 2 times in a psych ward for about a month for being so depressed I wanted to get out/off the planet. The ironic thing is this..... my knee healed on its own!!!!!! Sorry to get so expletive. When I start to do things just around the house, my body just starts to deteriorate and life starts to suck real bad. I have always been strong and I weigh 245 pounds and 6' 2.5". But I haven't been an athlete since high school. I get in a pool and I try to keep moving and I try real hard to watch what I eat. I have worked hard all my life and what I am is just what I am. Now I am ranting, sorry. Nobody has given me an explanation of what is going on with my back and body pain or what is causing it. I see more doctors next month but I don't trust them anymore.

Peace.

Originally Posted by Maria

My experience has also been that if one has a certain set of symptoms and findings on films then at least in the past criteria for surgery would have been satisfied. Generally a surgeon that is ethical will at least want a person with non emergent symptoms/findings to wait about 6 months at least before committing to surgery. Try the conservative route with rest, ice/heat, PT, biofeedback, injections for the spine perhaps, etc.

If things persist and findings are unchanged or worsened then pursue surgery.

Truly I think often we as the patient are all to quick to want our lives to change. To be like it was before the injury or better. My own experience is once having surgery things do change. Sometimes things are improved, sometimes something is improved and something worsened or another problem created. Sometimes there is way more pain and problems and surgery just has failed and created more problems.

IMHO people really need to take their time and check things out thoroughly before committing to spine surgery IF NOT EMERGENT IN NEED.

One spine surgery usually begets another, sadly. I would advise not to act on desperation.

Get to know your options first and make sure to get more than one opinion.

Surgeons do what they went into practice to do.. surgery. That's their livelihood. I think if someone offers a remedy without at least cautioning that it may or may not work .. then beware. Spine surgery may be precise with regard to surgical technique and all that but it's not precise with regard to how the body responds.

Good luck to anyone seeking spine surgery and any other surgery. We may not be masters of our own fate when it comes to what insurance will approve and such however we are masters of our own fate making a decision for ourselves. Ultimately if things turned out terribly it is me that signed that consent form and brought myself to the surgical front. And I did and I learned...