Dear OTW Reader:
Spine surgeons fleeing to the cities, worrisome retrievals, suffering patients who can’t get care, and, on one of several positive notes, the famed Dr. Izzy Lieberman’s jungle trek to deliver a Torah.
Spine Party Over?
A concerned spine surgeon tells OTW, “The bubble has burst in spine. I’m hearing a lot of concern about where we are going with innovation. Between FDA bottlenecks, product development relationships, royalty agreements, etc. innovation is in ‘stall’ mode. Take MIS, for example. We’ve done a lot, but to get it to the next level we have to build on the existing foundations—good luck in this environment. No one wants to shell out the enormous funds needed for an IDE [investigational device exemption]; and companies don’t want to work with doctors whose names are going to end up in the New York Times! I’ve recently met with industry leaders who are concerned about the increasing merger trend that could create mega companies that control 80-90% of the market. On the physician side, we are seeing a trend in small towns where spine surgeons are fleeing to big metropolises because they can’t make a living. We need to turn this around.”
Top Flight Care for Military Athletes
Brett Aldridge, director of the Andrews Institute Foundation, told OTW, “Recently, we had more than 120 people join in our golf fundraiser to support the Eagle Fund. Because of this fund, created by the Andrews Institute and Athletes Performance, military athletes now have access to a level of care that they wouldn’t otherwise have. Lots of programs get athletes back to the 80-90% performance threshold, but 10% is a big difference if you are on the battlefield. This all began when a soldier approached us and said, ‘I need help.’ We treated him pro bono and then he later made a donation and said, ‘Let this be the start of a fund that will allow others to get the kind of treatment I have received.’”
Robert J. Palmisano Now Heading Wright Medical
The Board of Directors at Wright has appointed Robert J. Palmisano as president and chief executive officer. Palmisano, who holds a B.A. degree in Political Science from Providence College, was most recently president and CEO of ev3, Inc, an endovascular device company. During his tenure, that company’s market capitalization more than tripled, from approximately $800 million in April 2008 to $2.6 billion in July 2010. Palmisano has also served as president and CEO of IntraLase Corp. and previously he was president and CEO of MacroChem Corporation. Earlier in his career, he served as president and CEO of Summit Technology Inc. until it was acquired by Alcon Inc. OTW wishes Palmisano all the best
Magic Cost Containment Wand?
A spine surgeon tells OTW, “In my state—North Carolina—we are concerned about the bar being raised even higher in order to get approval for fusions. Medicaid is figuring out that they can use the same cost containment strategies as everyone else, namely, precertification. A year from now I think more people will be showing up underinsured or uninsured, and will be straining the system. And people who really could benefit from novel spine technologies are going to have a tough time getting those. There are people who are almost bone on bone…they don’t have gross spinal stenosis, but they are miserable and by all criteria need a stabilizing procedure. But the insurance precertification system doesn’t acknowledge that group of people. The challenge is for us to provide evidence so that we can say, ‘XYZ is the best treatment for this condition.’”
Spreading Wound Coverage Techniques Worldwide
The Institute for Global Orthopaedics and Traumatology (IGOT)—an entity started by the UCSF Department of Orthopaedic Surgery—recently held its Second Annual IGOT International Flap Course and first Clinical Research Training Seminar in partnership with and preceding the SIGN Conference in Washington. Richard Coughlin, M.D., director of IGOT, told OTW, “Fifty-five orthopedic surgeons from resource-constrained countries such as Ethiopia, the Philippines, and Haiti, came to learn simple flap techniques. Orthopedists in most developing countries don’t have the luxury of a plastic surgeon so these patients go untreated—and sit in a hospital bed for months. Each participant was given a flash drive and they are already showing these procedures to their colleagues at home…instant multiplier effect.” Also involved with the course is Ted Miclau, M.D., who told OTW, “Our ultimate goal is to help build infrastructure in these countries. We also took advantage of everyone being in the same place to work on developing a global research consortium that would, in part, give doctors abroad access to ‘developed world’ research infrastructure and techniques.”
Worrisome Retrievals
OTW hears: “I am concerned about corrosion of modular prosthetic devices on or at the base of the neck (not prosthetics used for revisions but those used in primary surgeries). Most manufacturers are introducing modular necks and they could end up being a major problem. It is very desirable for orthopedic surgeons tohave the ability to use a modular neck, but given the possibility of failure, I feel we should use modularity when we really need it. There have been a number of failures and worrisome retrievals reported.”
Getting Professional About Professionalism
Ken Egol, M.D., is vice chair for education in orthopaedic surgery at the NYU Langone Medical Center. He tells OTW about their interesting new program: “We are using the Objective Structured Clinical Exam to assess and improve the professionalism and communication skills of our residents. Actors pretend to have clinical issues, and also present various ethical/professional situations. It may be dealing with an impaired colleague, a hostile staff member, disclosing medical errors to families, etc. We videotape each situation and review the tapes with the residents. Each actor has a checklist and evaluates whether the trainee explained things well, was respectful, etc. It’s a great learning tool, and I think we are pioneering it in orthopedic surgery.”
Preliminary Bone Graft Device
Brett Crist, M.D., co-chief of Orthopaedic Trauma at the University of Missouri, is making strides in fracture care. “Many people are trying to maximize fracture healing rates and minimize fracture healing time through biological adjuncts. Part of the problem is that our bodies do it with a vast number of chemical pathways and investigators are trying to identify single compounds to augment or block. Unfortunately clinical trials are currently lacking that convincingly shows a magic bullet to address all of the bone healing problems. Due to the potential risks of bone graft harvesting, including pain, people are looking for alternatives that are commercially available on the shelf. However, the gold standard for treating fractures that don’t heal, is still autograft bone. A newer technique for harvesting large amounts of bone graft from primarily the intramedullary canal of the femur is commercially available that may or may have fewer complications than taking bone graft from the patient’s iliac crest. Clinical studies are ongoing that are comparing the clinical effectiveness of this device and several basic science studies show that active bone healing compounds are present in the graft as would be expected. We have compared the viability of cells harvested using this technique versus standard iliac crest harvesting and the data shows that the graft is equally viable and able to produce bone.”
Calling Talented Adventurers
Peter Trafton, M.D., professor of orthopaedics at the Alpert Medical School of Brown University, is the director of the Ghana site for Orthopaedics Overseas—and they are recruiting volunteer orthopedic surgeons—especially those strong in trauma. Dr. Trafton tells OTW, “Orthopedics Overseas is seeking orthopedists to go to Ghana for at least two weeks. We are looking for people who are strong on trauma care, those who have some interest in pediatric orthopedics, those interested in general orthopedics, and people with a minimum of the basics of fracture care. There are good things happening in Ghana…including a new residency program that has the full support of the hospital. Come help your orthopedic colleagues in Ghana develop their skills…you will change a country for generations.” Please visit www.hvousa.org, or contact Andrea Moody for more information: a.moody@hvousa.org.
The 80-Hour “Card”: A Resident Speaks
A resident taking the pulse of his peers tells OTW, “There is no scientific basis for the 80 hour work week…and there are lots of studies showing the negative effect of this edict. Example: A junior resident was on duty one night when a patient with a certain type of fracture came in. He worked it up, read up on it, but then had to go on to another rotation…so he wasn’t around when the attendings taught about the case. None of the residents present knew the patient and none could speak in an informed, educated manner about it. The people coming in on the day shift come in and they are the ones operating on the patient—and they don’t know how to manage the disease. It’s really aggravating the attendings because more and more the burden of taking care of things is falling to them. They are also not thrilled about this: there are times when residents leave in the middle of a case because they have reached their limit…they are pulling the 80-hour card.”
Izzy Lieberman, M.D. Delivers Torah to Uganda
As part of a recent medical mission to Uganda, Dr. Isador Lieberman of the Texas Back Institute braved the mud roads to deliver a Sefer Torah to an excited, small village in remote Uganda. Dr. Lieberman tells OTW: “I learned of an orthodox Jewish village with about 300 people…I met their leader, Rabbi Enosh, last year. He showed me their small Sefer Torah, which was made of paper and is essentially what you give as a souvenir at a bar mitzvah. In a lapse of reasoned thinking I promised him a real Sefer Torah. When I—along with a team of volunteers including my mother—delivered it a couple of weeks ago there was a procession where the rabbi and others carried, paraded and danced the Torah into the synagogue. I have run marathons, but their enthusiasm which lasted well over two hours, completely exhausted me…there was a real excitement in the air while they welcomed the new Sefer Torah into their village.”
