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.

As a young girl, this St. Louis native liked taking care of animals. Dr. Kristy Weber, Chief of the Division of Orthopedic Oncology and Associate Professor of Orthopedics and Oncology at Johns Hopkins School of Medicine, would eventually find her way to higher-thinking bipeds.

“I was raised in a typical Midwestern environment, friendly and hardworking,” says Dr. Weber. “My dad’s closest friend was a veterinarian, and in high school I spent my vacations doing work at a wildlife rescue center. I had my heart set on caring for animals.”

After being accepted to the University of Missouri’s veterinary school there was a shift in Kristy Weber’s thinking. “I came into contact with people who challenged me to consider medical school. After significant consideration, I decided to apply. Although I knew I’d always love animals, I wondered if I could make a bigger difference taking care of people.”

Her eyes would be wide open as she walked into the next phase of her education. “I began medical school in 1987 at Johns Hopkins. Coming to a high-powered East Coast school from the Midwest was a bit intimidating. I was a state school kid now surrounded by consistently brilliant faculty and classmates. Hopkins was a great teaching environment, however, and I soon settled in. The diversity I found there was also a good experience. Coming from the Midwest this was new for me.”

While in medical school, Kristy Weber had visions of colored rings dancing in her head. “Orthopedics arose as a real option in my first year of medical school. I had played sports for years and could see myself being the team doctor for the Olympics. (At the time I thought there was only one.) I think I was also attracted to orthopedics because it was such a challenge to get into the field. In those days you had more time to get to know the field, to do orthopedic rotations, and to evaluate your decision. The downside was that if you decided too early, you might close your eyes to other options.”

Throughout medical school, however, Dr. Weber was convinced of her decision. “I began my residency in 1991 at the University of Iowa. I had learned of their program through one of my teachers at Hopkins, a bone pathologist named Ed McCarthy. He had studied at Iowa and had had superb mentors. While at Iowa, Dr. Jody Buckwalter, the most brilliant, compassionate man, and a tumor surgeon, became my mentor. I also took my cues from Dr. Stuart Weinstein, who I think was probably the best doctor I have ever seen. A children’s orthopedic surgeon, he had all the time in the world for anybody who needed him. He stressed the value of hard work, never gave excuses, critiqued his own surgery every time, and was always prepared for any eventuality.”

Her path set, Dr. Weber headed to the Mayo Clinic in 1996 to learn how to become a tumor surgeon. “I undertook a two-year fellowship, including one year of research, which allowed me to incorporate basic science research into my career. I learned a significant amount about research from Gobinda Sarkar, Ph.D., who taught me how to think about things in a different way. He took the information we had and instead of considering how to get from A to B, he was thinking of a whole new alphabet. Dr. Frank Sim, who helped develop the field of orthopedic tumor surgery, was also my mentor. He was a pelvic surgery expert and the best surgeon I had ever seen.”

Armed with new skills, Dr. Weber would soon learn the softer side of surgery. “I obtained my first faculty appointment, M.D. Anderson, in 1998. The five years I spent there doing big cases and basic research helped me refine my career path. The first pelvic surgery I did took 12 hours and made me realize that I wasn’t Dr. Sim yet. It turned out that my favorite part of the job was working with kids. I jumped right in and got very involved with their cases and lives. In fact, I am still in touch with some of these patients, who are now grown. For example, I regularly communicate with a young woman who beat her cancer and is now attending college.”

Word of her talent and dedication spread. Says Dr. Weber, “In 2003 I was recruited to Johns Hopkins by the Chair, Dr. Frank Frassica, in order to build a tumor program. At the time Hopkins didn’t have all of the pieces to build a sarcoma team, so we had to identify the gaps. We recruited people for medical oncology, musculoskeletal radiology, and patient database management, among others. We obtained funding for and built our research lab. Most recently we have developed a sarcoma conference where we meet once a month and present our work. Particularly exciting is that we are building a comprehensive tissue bank and database to use for clinical and basic research endeavors. Also, we have changed the biopsy system such that we now do biopsies with a needle as opposed to taking people to the OR, putting them to sleep, and removing a piece of bone.”

To address these and other issues, Dr. Weber would need dedicated funding. Dedicated to finding answers, she found the funds first. “I was very pleased to be given two research awards, one from the Orthopaedic Research and Education Foundation (OREF) and one from OREF and Zimmer. These grants, pivotal for my work, were both funding for gathering data. The initial OREF grant was directed toward my work with kids suffering from osteosarcoma that spread to the lungs. We investigated how to block tumors from moving into the lungs. In doing so we focused on the IGF (insulin-like growth factor) receptor and found that by blocking that receptor in our tumor cell lines, the cells couldn’t signal through this pathway. The next step was to test it in mice, so we developed a model and the tumor spread to their lungs. We blocked the IGF receptor in the tumor cells and they did not go to the lungs. It has just started to be tried in humans. There are a number of cooperative cancer groups around the country that will hopefully result in improved treatments for children with bone cancer.”

Continues Dr. Weber, “With the OREF/Zimmer grant I received in 2002 we shifted our focus and started looking at bone metastasis, where a tumor would start in the breast or prostate and go to the bones. This results in debilitating pain and often broken legs because cancer has eaten the bones away. That grant was to investigate how kidney cancer travels to the bone. There is no treatment available for kidney cancer once it spreads. We researched the EGF (epidermal growth factor) receptor first in a cell dish and then in mice. Then we took patients’ cancer cells from the OR, put them in a dish, grew them, and then put patients’ cancer cells into mice. This translational research (cell to mice to people) should result in some findings that will be useful in treating human patients. Also exciting is the work my colleague, Dr. Scott Kominsky, is doing using nanoparticles. Using Dr. Kominsky’s OREF grant, we are working to target drugs to areas of bone cancer in new ways so mice don’t get sick. We are working with biomedical engineers; they are the ones who get the drugs onto the nanoparticles.”

Reflecting on one of her more unusual operations, Kristy Weber says, “A rotationplasty is an operation that in the 1920s was used for children who had tuberculosis. Essentially you flip the kid’s leg around backwards. A recent case was an 8-year-old with a tumor below the tibia. We flipped his lower leg and hooked it up to the thighbone so that his ankle now functions as his knee. The toes were pointing behind him. We then put a prosthesis below the knee, making it a functional amputation below the knee.”

Commenting on the wider world of orthopedics, Dr. Weber notes, “A lot of surgeons have made commitments to try and improve the ethics of industry/physician relationships. Unfortunately, the public only sees the bad side of things, so there is a very real PR issue at hand. I think it’s important to educate patients on this issue and have conversations with them about whether or not you have any conflicts of interest. Also, orthopedics as a field needs to decide what constitutes good medicine rather than having the government do it for us. I would like our government to understand that doctors are the experts. We are the ones who should be rallying new research and distilling the current literature rather than the government coming up with something not based in evidence.”

To balance out the serious work she does, Dr. Weber takes to the skies, rivers, and canyons. “The riskiest hobby I’ve ever done is bungee jumping. It was both terrifying and exhilarating at the same time. I’ve also enjoyed the outdoors while backpacking, whitewater canoeing, and hiking the narrow canyons of Utah. I am a risk taker by nature, but ‘risk’ is a tricky word when you’re a surgeon. You must have enough confidence to do these seemingly horrible things to people, but you can’t be cocky. The field itself keeps me humble because the reality is that tumors can come back or spread and bad things can happen with cancer. It’s got to be a balance of humility and confidence.”

Dr. Kristy Weber…using her talents to open new windows of possibility for patients.