Dear OTW Reader: The philosophical ortho-musings of Dr. Gunnar Andersson …Shafique P. Pirani, M.D., wins AAOS Humanitarian Award…what a co-management model means for your future…Dr. Henry Mankin on the declining interest in science…and more…
Young Surgeons Shying Away From Spine Careers?
Time was…you’d have to get in line for spine. Now, says one patriarch of the field, Dr. Gunnar Andersson, people are thinking twice about a career in spine care. Dr. Andersson tells OTW, “Despite our many advances in the last few years, the spine field is lagging. Few products have gone to market in the last several years, the FDA is unpredictable, and there is a dearth of venture capital. The fact that it takes longer and longer to get something from the concept stage to sale is discouraging for young surgeons. They see that people are innovating, but they also see that their colleagues who have chosen spine can’t get to the next step. Part of the slowdown is related to the fact that we’re not making progress with back pain, a condition that is on the rise…and, unfortunately, we don’t know why. Surgery rates are up and we are using more products in procedures, but to what avail? Take fusion: initially, there were no implants. Then we had screws and rods—then cages—then biologics…and while our outcomes are better the problem often still remains. The crux of this, of course, is that payers are scrutinizing this. I’m very disappointed that research is not solving the back pain problem. We’ve had success with addressing rheumatoid arthritis and osteoporosis but have had virtually no impact on back pain or osteoarthritis. Why? Is it because we are genetically predisposed to these things…or is it that our tissue is supposed to break down? Or perhaps it’s something else. One thing I do know. We aren’t going to make much more progress without a better understanding of pain. And unfortunately, there are few institutions doing high level research on musculo-skeletal pain.”
New Head of Spine at Penn
Vincent M. Arlet, M.D., previously Warren. G Stamp Professor of Orthopedic Surgery and Professor of Neurosurgery at UVA, has now joined Penn Orthopaedics as the Chief of the Orthopaedic Spine Service. Dr. Arlet, who has authored more than 70 peer review papers and 50 book chapters, received his medical degree from the University of Paris. He completed an orthopedic surgical residency at various hospitals in Paris. Dr. Arlet subsequently completed an orthopedic fellowship at Montreal General Hospital in Quebec; two pediatric orthopedic fellowships at Hôpital Necker Enfants Malades in Paris; and an adult orthopedic surgery fellowship at University of St-Antoine in Paris. Prior to his time at UVA, Dr. Arlet spent 13 years at McGill University as a professor in the division of orthopedics. Dr. Arlet told OTW, “I think at Penn Orthopaedics there is a unique opportunity to build one of the top comprehensive spine centers in the nation. Being based at Pennsylvania Hospital, the first hospital in the nation where extraordinary history meets the most modern and state of the art surgical sciences, is something I could only dream of last year when Dr. Scott Levin approached me.”
Get Ready for Co-Management
Physician-hospital alignment, says Dr. Chad Mather, an attending orthopedic surgeon at Duke University, is the wave of the future. Dr. Mather, a former American Academy of Orthopaedic Surgeons (AAOS) Washington Health Policy Fellow, tells OTW, “Traditional incentives, while maybe inadvertently, promoted a volume-based health care system, but we are now moving to a value-based system. In the past, doctors and hospitals had different incentives…for example, in spinal disease, the surgeon might be reimbursed well for the professional portion of the service, but implant cost resulted in hospitals losing money. Another example…with total joints, no major physician incentive exists for early discharge, but hospitals are heavily influenced to minimize length of stay. Physician-hospital alignment rephrases the thinking to, ‘How can we safely minimize length of stay?’ The decision makers can be relatively insensitive to the total cost of care. But because physicians remain the primary decision maker on the provider side, value-based hospital care must involve alignment between physicians and hospitals. In one of these models, termed co-management, there will be more shared decision making. In this model, physicians and hospitals work together to provide valuable care—with incentives for both sides aligned in the same direction. We now have two early models at Duke, one in total joints and one in spine. The physicians involved are energized and the spirit of cooperation has benefited both sides as well as improved the overall care experience. Furthermore, as we move toward more patient centered care, hospitals and physicians must work together to provide the optimal care experience for patients. To my colleagues who doubt the viability of co-management or other alignment options, I say, ‘Take a second look…you can find ways to make it work for you…and your patients.’”
Shafique P. Pirani, M.D. Wins AAOS Humanitarian Award
In recognition of his having trained 4, 000 health care professionals and students in the Ponseti Method in Uganda—not to mention the more than 3, 000 children who have been successfully treated as a result of his efforts, Dr. Shafique Pirani of British Columbia has been honored with the AAOS Humanitarian Award. Dr. Pirani has done this work through the organization he created—the Uganda Sustainable Clubfoot Care Project (USCCP). In 1972, when Dr. Pirani was just 15-years-old, he and his family were forced to leave Uganda by the country’s dictator, Idi Amin. Years later he became a physician, and joined the Department of Orthopaedics at the University of British Columbia. In 1998 Dr. Pirani learned that an estimated 10, 000 children were living with neglected clubfoot in Uganda, and another 1, 500 were born each year with the condition. Dr. Pirani brought the Ponseti Method to the country with great success. The USCCP has been instrumental in teaching and institutionalizing the nonsurgical Ponseti Method of treatment throughout Uganda’s health and higher educational systems. He also presents the “Ugandan Model” of Ponseti clubfoot care in other under resourced countries and jurisdictions. Recently the World Health Organization recognized the success of USCCP and recommended its model as a way of helping the disabled worldwide.
Who Cares About the Science of Orthopedics?
Dr. Henry Mankin, Edith M. Ashley Professor Emeritus of Orthopaedics at Harvard Medical, is shaking his head these days…who will take care of the science of orthopedics? Continuously funded by the NIH from 1962 until 2003 for orthopedic biologic research, Dr. Mankin says that for the most part, young orthopedists nowadays are ambivalent regarding the science behind the field. He tells OTW, “When I trained residents things were different…now I see that people are more interested in making a living and staying out of others’ way. Overall, they just don’t care enough about the science. But I keep plugging away and working with those who are interested. One of my current projects involves looking for factors that modify tumor cells. We are introducing different agents into tumors in order to make the cells less active. I am also excited about the two pathophysiology collections in my possession: one is my collection of tumors that I have treated in my lifetime—approximately 20, 000. The other was willed to me by the late Dr. Henry Jaffe, a pathologist formerly at the Hospital for Joint Diseases. It contains diagnoses, histology, X-rays, photos, and letters that he sent to people…I am in the process of digitizing it. This will be very helpful for anyone who, for example, needs to look for 86 cases of giant cell tumor and find out what happened.”
Kevin Carroll of Hanger Wins International Award
Hanger’s Vice President of Prosthetics, Kevin Carroll, MS, CP, FAAOP, was honored with the Roscrea People of the Year International Award. The award, given by Roscrea People, a community publication of Roscrea Co., Tipperary, Ireland, was given in part his work on the patented Hanger ComfortFlex Socket System, and overall for Carroll’s work with amputees, his more than 30 years as a prosthetist, visionary researcher, and skilled educator. Carroll, who grew up in Roscrea, is also the co-developer of the first prosthetic tail for a dolphin, the story of which debuted September 23, 2011 in a 3D feature film titled, Dolphin Tale. Carroll has also appeared on news broadcasts such as Dateline, 20/20, CBS Early Show, NBC Nightly News, ABC’s Good Morning America, and the Discovery Channel.
Gil Beyen of TiGenix Changes Direction
TiGenix has announced changes to executive responsibilities within the company. Gil Beyen, co-founder and Chief Business Officer of TiGenix will hand over part of his responsibilities to take on a mandate outside TiGenix. Beyen remains a member of the Board of Directors and the company’s Chief Business Officer. Leading his senior business development team, he will focus on corporate and business development for TiGenix, and transfer his investor relations activities to Claudia D’Augusta, Chief Financial Officer.
