Other Articles

Using DNA to Predict Scoliosis
Six million people (estimate from the National Scoliosis Foundation) have scoliosis in one form or another. The primary age for onset of idiopathic scoliosis is 10-15 years old. Finally, there is a test which can reliably predict scoliosis. Fewer X-rays. Lower cost. Better outcomes.

New Capital, New Science for Cartilage Repair
$36 million invested in the last couple of months. TiGenix has more than that in the bank to fund market penetration. Then a new paper last week finds molecular cause of OA. Cartilage repair momentum is building.

Should I Become a Physician-Employee?
Large healthcare institutions are increasingly purchasing orthopedic practices. What does this mean for patient referrals? How beneficial can it be for orthopedists? The upside is more stability, among other things…and one of the downsides is loss of freedom.

Outrageous Whistleblower Lawsuit Challenged
Spine surgeons sued by whistleblowers in Boston are fighting back. Their lawyer is outraged and says the claimants are just shopping an old and settled case to another judge. Is this the proverbial lipstick on a pig? Find out.

Medical Education Under the Microscope – Is It Up to Today’s Challenges?
Where is the line drawn between what medical schools, residencies, and professors should provide to students and what doctors-in-training should reach for themselves? Here are the results of interviews with three senior surgeons, who opine on things such as attitudes, how people learn, and the possible effects on the field.

The Underlying Meaning of Zimmer’s Purchase of Abbott Spine
From the price paid to the timing, this transaction held an underlying meaning for the entire spinal implant industry. Zimmer, the $4.2 billion (revenue) diversified orthopedic company is now #5 in spine. More to come?

Resurging Lumbar and Cervical Total Disc Replacement Markets! New PearlDiver Estimates
Rumors of the TDA market’s demise were premature. Increasingly positive long term patient data is at the core of a resurging lumbar and cervical TDR market. Senior analyst Matt Menze tackles the TDA market and interviews one of the fathers of TDR, Dr. Scott Blumenthal from the Texas Back Institute. Where is this market actually heading? We think to the $2 billion range by 2015. All details here.

Six Days in June – Biomet and Zimmer Battle for Distributors in Kentucky
Documents filed recently in a Kentucky lawsuit pull the curtain back on an epic battle between Biomet and Zimmer. For six fevered days in June 2007, Biomet CEO Jeff Binder and founder Dane Miller went into the trenches to save one of their own. For all the details, read on.

Multicenter Clinical Trials: Do They Get the Respect They Deserve?
They’re not fast or sexy, but they are critical…large trials, that is. With multiple sites and principal investigators who donate their time, large trials are more complex—and normally yield more actionable data—than smaller, quicker studies. But large trials don’t always get the respect they deserve. And, says at least one physician-researcher, this could affect the future of the field.

Patent Wars: Medtronic Attacks NuVasive
MSD’s lawsuit came amid a period of declining spinal implant market share – from a peak of 60% in late 1998 (just prior to being acquired by Medtronic) to, we estimate, 36% currently – and a growing sense that MSD’s reign as the king of spine was coming to a close. What’s really behind Medtronic’s attack on its former senior exec? Read on.

Spine Gainsharing Through the Looking Glass
The feds have issued their first opinion allowing a spine gainsharing proposal. In Alice in Wonderland style, Through-the-Looking-Glass logic, they said the proposal was improper but would not impose sanctions. Who is the author of such a plan and what’s her secret? Read here.

PearlDiver Data Raises New Questions About Synovial Injections
Synovial injections for painful knees have been approved for use since 1997. If the goal is to improve the quality of life for the patient, is that being accomplished? The latest numbers from the PearlDiver Patient Records Database cast doubt.

Plantar Fascia: The Annual 3 Million Patient Market
“Plantar Fascial Fibromatosis (ICD-9-D-728.71) is right up there in frequency with pain in the shoulder joint, degeneration of lumbar intervertebral discs, pain in the lower leg joint, and carpal tunnel syndrome. As usual, PearlDiver has this market mapped out.

Orthopedic Incubators: Where Little Ideas Grow Up
Business incubation, also known as acceleration, can be a wild ride. Thus it’s best to approach it armed with the solid advice of experienced professionals. Who should take this ride? What can venture financiers bring to the table? These questions and more are answered by two seasoned VC professionals.

Just Say No to CMS Potential Coverage Decision List
Unless you want to be on the receiving end of a non-coverage letter, just say no to CMS’ proposed list of potential National Coverage Decisions. You’ve got until September 28 to make your case. Read what a leading industry consultant and analyst have to say.

Staking a BIG Claim
Alphatec, the company whose IPO collapse served as an object lesson for all medical device companies, has nearly completed its turnaround. The key? New management and new technology. Exhibit A: OsseoFix™—with it Alphatec stakes a claim to the next big spinal implant market.

“I didn’t want to be chewed on by cats.” So says Dr. Sanford Emery, Chair of Orthopaedics at West Virginia University, as to why he ended up in (human) medicine. “I grew up just below Albany, New York, in a small town. Besides me, our family consisted of my father, who was in secondary school education, my mother, a medical technologist, and my brother. My great uncle was a veterinarian who let me work with him a few summers in high school. While I enjoyed the work, the more I did it the more I could see the risk of dealing with angry cats. Oh, and my maternal grandfather was a butcher. I think the surgical bent is in my genes.”

A biochemistry major at Dartmouth, Sanford Emery left behind the animal kingdom and turned his thoughts to higher-thinking bipeds. “It was a great stroke of luck that I attended Duke University School of Medicine, as that is where I met my wife, who is also a physician. Duke had a unique curriculum where you do basic science in your first year and in the second year you can do research. I was in the lab using the operating microscope, which was a great introduction to detailed work using one’s hands. It also spurred in me an interest in orthopedics-related research.”

Moving along in his career, Dr. Emery would find that he also enjoyed the group dynamic of medicine. “My wife and I left North Carolina and headed to Strong Memorial Hospital in Rochester, New York, for residency training. I worked as an internal medicine intern for six months, which made me a better doctor as I was able to learn the nuances of inpatient care. I did a surgical residency for two years, during which time I developed an interest in spine. Patients with paralysis had a real effect on me and made me want to rise to the challenge to help them. I liked the fact that in this arena I could have a big impact. I entered the orthopedic residency training program at Strong and found that I truly enjoyed the group dynamic. I love team sports and that’s what it is like being in a group, especially a residency training program. There are always new people, new ideas, and new personalities.”

Finishing up his residency in 1987, Dr. Emery then went to Case Western University for a spine fellowship with Henry Bohlman. “What a superb teacher Dr. Bohlman was. He focused on promoting young people into academics and was genuinely concerned about our careers. From a technical standpoint he taught me all he knew about the anterior approach to the spine—his forte. In a broader sense he brought to my life a sense of camaraderie and the fraternity of having been his fellow. Case had a strong orthopedics department that enabled me to work with great clinical people and utilize their terrific research division. We were doing translational research related to clinical medicine. One of the projects was with radiation and bone grafting in the spine in animal models. It gave us an idea of when one could receive irradiation after this kind of surgery and still expect the bone graft to heal. I also participated in clinical research, primarily involving the cervical spine. We looked at the results of surgery for patients with cervical radiculopathy (pinched nerves) and those with myelopathy (pinched spinal cord). Relevant outcomes for these patients include neurologic recovery, pain relief, and healing of the bone grafts. Fortunately the methods we use to measure outcomes in surgical patients are more sophisticated nowadays, but many of the clinical questions remain the same.”

Continues Dr. Emery, “For several years at Case Western I was the faculty coordinator for the residency program, which not only was enjoyable but also fulfilled some of my interest in leadership. I knew down deep that I wanted to do more, however, such as run a department some day.”

Stepping out of his medical comfort zone, an adventurous Dr. Emery set about learning corporate speak. “It nearly killed me because it was an additional 20 hours per week, but from 2001 to 2003 I undertook an executive MBA program at Case Western University. It was great fun, though, as I got to interact with a variety of bright professionals, including engineers and marketing people. There were case presentations on, for example, Southwest Airlines, Nordstrom’s and GE, which highlighted critical principles of customer service and how to think creatively. These are really organizational behavior truisms that you don’t necessarily think about in medicine. Having the degree was invaluable, but learning the language and knowledge base gives me legitimacy at administrative meetings with medical schools and hospitals. You know what they’re talking about and you may come up with ideas that are new, something that is always valued.”

Bringing his newfound knowledge into the medical realm, Dr. Emery turned his attention to detail toward the economics of academics. “Recently I began examining doctor compensation models in the academic world. This work grew out of an independent study project I began with a colleague in the last semester of business school. We sent a survey to 31 orthopedic departments around the country inquiring how they pay their faculty and how they incentivize their faculty. In medicine today, the business needs and financial climate often threaten to overwhelm academic productivity. We found that departments tended to use certain methods to determine incentive pay for academic productivity. The chair’s opinion often came into play, but some form of a point system where templates with activities are assigned a point value was also common. These point systems were used to calculate someone’s bonus.”

Soon, West Virginia University would benefit from Dr. Emery’s new skill set. “I was recruited to be the chair of the WVU orthopedics program in 2003. When I arrived it was time to rebuild the program. There were only four faculty when I arrived; now there are 13 clinical and three basic science faculty. Doing so [rebuilding the program] required not just resources from the institution, but extreme perseverance, team building and creating an environment where people are going to be happy. It was critical that we cut down turnover so we could build instead of spin our wheels. People might think that building a program is all finance and accounting and the mechanics of a small business, which is not the case. It’s actually a significant amount of organizational behavior, meaning getting the right people on the bus, creating a customer service culture, paying attention to details, getting everyone on the same page, and maintaining a sense of humor.”

Regarding leadership Dr. Emery notes, “Everyone watches what the boss watches. If you think something is important then everyone else will, too. The corollary is that if you don’t champion something, it’s not going to receive attention in and of itself. The other truism is that you have to walk the talk. You must set the example. I still take general and spine call, so I’m in the trenches with the rest of the faculty and I know that they look to me for leadership.”

As does Dr. Emery’s family. “I have three children who are all infused with a love of learning. My eldest son is getting a Ph.D. in environmental biology and is now off the coast of Chile on some volcanic islands. My daughter is a sophomore in college and my younger son is a junior in high school. They have yet to decide on career paths. My wife and children and I are enjoying the company of our exchange student from Switzerland, who is teaching us the way things are done in her part of the world.”

Dr. Sanford Emery…economic academic orthopedics in action!