Lambert here: Shocked, shocked.
By Fred Schulte, Senior Correspondent at KHN, and Elizabeth Lucas, data-related reporter at KHN. Originally published at Kaiser Health News.
Dr. Kingsley R. Chin was little more than a decade out of Harvard Medical School when sales of his spine surgical implants took off.
Chin has patented more than 40 pieces of such hardware, including doughnut-shaped plastic cages, titanium screws and other products used to repair spines — generating $100 million for his company SpineFrontier, according to government officials.
Yet SpineFrontier’s success arose not from the quality of its goods, these officials say, but because it paid kickbacks to surgeons who agreed to implant the highly profitable devices in hundreds of patients.
In March 2020, the Department of Justice accused Chin and SpineFrontier of illegally funneling more than $8 million to nearly three dozen spine surgeons through “sham consulting fees” that paid them handsomely for doing little or no work. Chin had no comment on the civil suit, one of more than a dozen he has faced as a spine surgeon and businessman. Chin and SpineFrontier have yet to file a response in court.
Medical industry payments to orthopedists and neurosurgeons who operate on the spine have risen sharply, despite government accusations that some of these transactions may violate federal anti-kickback laws, drive up health care spending and put patients at risk of serious harm, a KHN investigation has found. These payments come in various forms, from royalties for helping to design implants to speakers’ fees for promoting devices at medical meetings to stock holdings in exchange for consulting work, according to government data.
Health policy experts and regulators have focused for decades on pharmaceutical companies’ payments to doctors — which research has shown can influence which drugs they prescribe. But far less is known about the impact of similar payments from device companies to surgeons. A drug can readily be stopped if deemed harmful, while surgical devices are permanently implanted in the body and often replace native bone that has been removed.
Every year, a torrent of cash and other compensation flows to these surgeons from manufacturers of hardware for spinal implants, artificial knees and hip joints — totaling more than $3.1 billion from August 2013 through the end of 2019, a KHN analysis of government data found. These bone specialists make up a quarter of U.S. doctors who have accepted at least $100,000 or more, and two-thirds of those who raked in $1 million or more, from the medical device and drug industries last year, the data shows.
“It is simply so much money that it is staggering,” said Dr. Eugene Carragee, a professor of orthopedic surgery at the Stanford University Medical Center and critic of the medical device industry’s influence. Much of the money is deemed to be compensation for consulting duties or medical research, or royalties for inventing, or fine-tuning, new surgical tools and techniques. In some cases, it pays for trips or splashy junkets or rewards surgeons for promoting products to their peers.
Device makers say the long-established practice leads to higher-quality, safer products. “Doctors help develop and refine medical devices, and they even create new devices themselves, sharing their intellectual property with companies to help save and improve patients’ lives,” said Scott Whitaker, president and CEO of AdvaMed, the medical technology industry’s trade group.
But industry whistleblowers and government investigators say all that money changing hands can corrupt medical judgment and tempt surgeons to perform unnecessary and wasteful operations. In ongoing lawsuits, patients say they have suffered life-altering injuries from screws or other spinal hardware that snapped apart or live with disabilities they blame on defective knee or hip implants. Patients alleging injuries range from seniors on Medicare to celebrities such as Olympic gold medalist Mary Lou Retton, who had surgery to replace both her hips. The gymnast sued device maker Biomet in January 2018, alleging the hip implants were defective. The suit has since been settled under confidential terms.
The case of Chin’s company, SpineFrontier, is among more than 100 federal fraud and whistleblower actions, filed or settled mostly in the past decade, that accuse implant surgeons of taking illegal compensation from device makers — from surgeon entrepreneurs like Chin to marquee names like Medtronic and Johnson & Johnson. In some cases, device makers have paid hundreds of millions of dollars in fines to wrangle out of trouble for their involvement, often without admitting any wrongdoing.
Court pleadings examined by KHN identified more than 700 surgeons who have taken money, including dozens who pocketed millions in royalties, fees or other compensation from 2013 through 2019.
The names of hundreds more surgeons were redacted in court filings or sealed by judges.
Court filings named 35 spine surgeons who used SpineFrontier’s surgical gear, some for years. At least six of those surgeons have admitted wrongdoing and paid a total of $3.3 million in penalties. Another has pleaded guilty to criminal charges. It’s illegal under federal law to accept anything of value from a device maker for using its wares, though most offenders don’t face criminal prosecution.
Chin, 57, who lives in Fort Lauderdale, Florida, and owns SpineFrontier through his investment company, declined comment about the DOJ lawsuit or the consulting agreements.
“There is a court date [for the DOJ case] as ordered by a judge,” Chin said via email. “If we get to that point the facts of the case will be litigated.”
Back Surgeries Under Scrutiny
The nation’s outlay for spine surgery to treat back pain, or to replace worn-out knees and hips, tops $20 billion a year, according to one industry report.
Taxpayers shoulder much of that cost through Medicare, the federal program for those 65 and older, and Medicaid, which caters to low-income people.
In one common spinal procedure, surgeons may replace damaged discs with an implant and screws and metal rods that hold it in place. The demand for surgery to replace worn-out knees and hips also has mushroomed as aging boomers and others seek relief from joint pain that restricts their movement.
Perhaps not surprisingly, the competition for sales of orthopedic devices is fierce: Some 250 companies proffer a dizzying array of products. Industry critics blame the Food and Drug Administration, which allows manufacturers to roll out new hardware that is substantially equivalent to what already is sold — though it often is marketed as more durable, or otherwise better for patients.
“The money is just phenomenal for this medical hardware,” said Dr. James Rickert, a spine surgeon and head of the Society for Patient Centered Orthopedics, an advocacy group. He said most of the products are “essentially the same,” adding: “These are not technical instruments; [it’s often] just a screw.”
Hospitals can end up charging patients $20,000 or more for the materials, though they pay much less for them. Spine surgeons — who make upward of $500,000 a year — bill separately and may charge $8,000 to $20,000 for major procedures.
Which equipment hospitals choose may fall to the preference of surgeons, who are wooed by manufacturing sales reps possibly present in the operating room.
And it doesn’t stop there. Whistleblower cases filed under the federal False Claims Act allege a startling array of schemes to influence surgeons, including compensating them for joining a medical society created and financed by a device company. In other cases, companies bought billboard space or other advertising to promote medical practitioners, hired surgeons’ relatives, paid for hunting trips — even mailed checks to their homes.
Orthopedic and neurosurgeons collected more than half a billion dollars in industry consulting fees from 2013 through 2019, federal payment records show.
These gigs are legal so long as they involve professional work done at fair market value. But they have drawn fire as far back as 2007, when four manufacturers that dominated the hip and knee implant market, including a J&J division, agreed to pay $311 million to settle charges of violating anti-kickback laws through their consulting deals.
KHN found at least 20 whistleblower suits, some settled, others pending, that have since accused device makers of camouflaging kickbacks as consulting work, including paying doctors to sit on suspect “advisory boards” or other activities that entailed little work to justify the fees.
In November 2019, device maker Life Spine and two of its executives admitted to paying consulting fees to induce dozens of surgeons to use Life Spine’s implants in the operating room. In all, 21 of the top 30 Life Spine adopters were paid and they accounted for about half its total device sales, according to the Justice Department. Life Spine and the executives paid a total of $6 million in penalties. The company did not respond to requests for comment.
Similarly, SpineFrontier received “the vast majority” of its sales, more than $100 million worth, from surgeons who were compensated, the Justice Department alleges. Often, they were paid by way of a “sham” company run by Chin’s wife, Vanessa, from a mail drop in Fort Lauderdale, according to the Justice Department. Vanessa Dudley Chin, a defendant in the DOJ civil case, had no comment.
Kingsley Chin told KHN via email that he takes no salary from SpineFrontier, based in Malden, Massachusetts. In 2013, Chin received $4.3 million in income from the company, according to court filings in a divorce case in Philadelphia from an earlier marriage. In 2018, SpineFrontier valued Chin’s interest in the company at $75 million, according to government records, though its current worth is unclear.
SpineFrontier’s management thought paying doctors was “the only reliable way to steadily increase its market share and stave off competition,” Charles Birchall, a former business associate of Chin’s, alleged in a whistleblower complaint. The case is one of two whistleblower suits filed against SpineFrontier that the DOJ has joined and consolidated. Chin has yet to file a response in court.
From March 2013 through December 2018, the company offered some surgeons $500 or more an hour for “consulting,” which could include the time they spent operating on patients — even though they already were being paid by Medicare or other health insurers. Other surgeons were paid repeatedly to “evaluate” the same products, though their feedback was “often minimal or nonexistent,” according to the DOJ complaint.
Patient Injuries Pile Up
While the payments have piled up for doctors, so have injuries for patients, according to lawsuits against device makers and whistleblower testimony.
Orthopedic surgeon-turned-whistleblower Dr. Manuel Fuentes is suing his former employer, Florida device maker Exactech, alleging it offered “phony” consulting deals to surgeons who had complained about alarming defects in one of its knee implants.
Their findings should have been forwarded to the FDA to protect the public, Fuentes and two former Exactech sales reps alleged in their suit. Instead, the company paid the surgeons “to retain their business and secure their silence” about patients needlessly undergoing a second operation to address the defects implanted in the first, according to the suit. Lawyer Thomas Beimers, who represents Exactech in the case, said the company “emphatically denies the allegations and looks forward to presenting the real facts to the court.” In a court filing, the company said the suit was “full of conclusory, vague and immaterial facts” and said it should be dismissed.
In Maryland, spine surgeon Dr. Randy F. Davis faces a lawsuit filed in early 2020 by 14 former patients who claim he implanted counterfeit hardware from a device distributor that had paid him hundreds of thousands of dollars in consulting fees and other compensation.
Davis used the hardware, which had not been FDA-approved, on about 250 patients at the University of Maryland Baltimore Washington Medical Center in Glen Burnie, Maryland, according to the suit. Several patients say screws or other implants failed and they sustained permanent injuries as a result. One woman said she was left with little feeling in her right foot and needs a cane or walker to get around. Others claim “extreme mental anguish” for fear the hardware inside them will fail, according to the suit.
The patients allege that Davis improperly disposed of defective screws and other hardware he removed rather than send the items for analysis or report the failures to authorities. Instead, the University of Maryland hospital sent “hush” letters to patients that falsely told them that no defects had been found, according to the suit. A spokesperson for the hospital, which also is a defendant in the suit, denied the allegations, noting: “We will vigorously defend this lawsuit and at its conclusion are quite confident we will prevail.” Davis and his lawyer didn’t respond to repeated requests for comment. The lawsuit is pending in Anne Arundel County state court.
Surgeons are free to implant devices they helped bring to market or promoted, though doing so can prompt criticism when injuries or defects occur.
That happened when three patients filed lawsuits in 2018 against Arthrex, a Florida device company. The patients argued they were forced to undergo repeat operations to replace defective Arthrex knee devices implanted by Pennsylvania orthopedic surgeon Dr. Thomas Meade.
Meade was not a defendant in the cases. But the patients accused him of misleading them about the product’s safety and a recall. One noted that Meade had served as a prominent consultant to Arthrex and had “participated in the design, testing, marketing, promotion and sales” of the knee implant. The patient alleged that Arthrex had paid Meade more than $250,000 for work that included “promotional speaking, travel, lodging, and consulting.”
In court filings, Arthrex admitted making payments to Meade for “consulting and royalties” but denied wrongdoing. The cases were settled in 2020. Meade did not respond to requests for comment.
Chin’s dual roles as SpineFrontier’s CEO and user of its hardware was called a “huge” conflict of interest by a judge in a pending malpractice case filed against him and the company in South Florida.
In that case, Miami resident Patrick Chapoteau alleges Chin performed back surgery in 2014 using SpineFrontier hardware even though it had little chance of success. According to the suit, a Chin-designed screw implanted to stabilize Chapoteau’s spine broke in half, causing him pain and disabling injuries.
In a legal brief, Chin’s lawyers argued that he regularly operates on people with disabling back problems, noting: “The surgery is sophisticated and challenging. On a few rare occasions, his patients have not obtained the relief they expected or experienced unanticipated complications that required additional care.”
Joseph Wooten, a former Chin patient and Florida power company employee, alleged in a 2014 lawsuit in Broward County Circuit Court that Chin had 15 previous malpractice claims that had ended in more than $8 million in settlements, an assertion Chin’s lawyers disputed.
“He never told me of his bad record injuring people,” Wooten, 64, wrote in a court filing. He and his wife, Kim, said the surgery caused “debilitating and life-altering injuries.” The case has since been settled. Chin acknowledged no wrongdoing and the terms are confidential.
KHN reviewed court pleadings in nine settled malpractice cases in Philadelphia, where Chin served on the faculty of the University of Pennsylvania Medical School from 2003 to 2007, and six in South Florida filed since 2012. Details of the settlements are confidential. Five of the six South Florida cases are pending, including one filed in December by the widow of a man who died shortly after spine surgery. In all the cases and settlements, Chin has denied negligence.
In her lawsuit pending against Chin in South Florida, Nancy Lazo of Hialeah Gardens, Florida, said she slipped and tumbled down the stairs outside her Miami office, landing on her back and arm. When the pain would not go away, she turned to Chin and had two operations, in 2014 and 2015. Her lawyers allege that a SpineFrontier screw Chin implanted in her spine in the second procedure caused nerve damage. Lazo, 51, a former billing clerk with two adult sons, said she can no longer work and remains in “constant” pain. “Based on what my doctors have told me,” she said, “I will never get back to normal.” Chin denied any negligence and the case is pending.
Government Struggles to Keep Pace
Concerns that industry payments can corrupt medical practice have been aired repeatedly at congressional hearings, in media exposés and in federal investigations. The recurring scandals led Congress to require that device makers and pharmaceutical companies report the payments, starting in August 2013, to a government-run website called Open Payments. That website shows that payments to all doctors have risen from $8.6 billion in 2014 to just over $10 billion last year. A recent study found payments by device makers exceeded those of pharmaceutical companies by a wide margin.
Both the North American Spine Society and the American Academy of Orthopaedic Surgeons told KHN that close ties with the industry, while seeming to generate huge payouts to some surgeons, lead to the design of safer and better implants. “These interactions are really essential for good outcomes in patient care and that needs to be preserved,” said Dr. Joshua J. Jacobs, who chairs the orthopedic surgery department at Rush University Medical Center in Chicago and the AAOS’ ethics committee.
Although more than 600,000 American doctors lap up industry largesse, most do so through small payments that cover the cost of food, drinks and travel to industry-sponsored events. When it comes to big money, however, orthopedists and neurosurgeons dominate, collecting 25% of the total — even though they represent only 5% of the doctors accepting payments, according to the KHN analysis of Open Payments data.
Dr. Charles Rosen, a spine surgeon and co-founder of the advocacy group Association for Medical Ethics, said he was once offered $2,000 just to show up and watch an industry-sponsored panel. “It was quite unbelievable,” he said.
Rosen said while he believes a “relatively small number” of surgeons cash whopping industry checks, many who do so are influential figures who can “help direct medical care.”
Government data confirms that even as several orthopedic and neurosurgeons received tens of millions of dollars in 2019, 81% of them got less than $5,000 from industry.
Federal officials recently signaled their displeasure with the hefty fees paid to doctors who promote their products to peers, especially at restaurants, entertainment or sports venues that feature free food and booze but little educational content. In November, the inspector general at the Department of Health and Human Services issued a special fraud alert that such gestures could violate anti-kickback laws.
Companies that ignore the reporting law can be fined up to $1 million, though no fines were levied from 2014 through spring 2020, according to a CMS report. That changed in October, when device giant Medtronic agreed to pay the government $9.2 million to settle allegations that it paid kickbacks to Sioux Falls, South Dakota, neurosurgeon Dr. Wilson Asfora to promote its goods. Officials said the company sponsored more than 100 events at a Brazilian restaurant owned by the surgeon to clinch the sales. Just over $1 million of the fine was assessed for failing to report the transactions. A Medtronic spokesperson said the company fired or took other disciplinary action against the sales employees involved and “remains committed to maintaining the highest standards of ethical conduct.”
KHN identified four spinal device makers — including SpineFrontier — that have been accused in whistleblower cases of scheming to hide consulting payments from the government.
Responding to written questions, a CMS spokesperson said the agency “has multiple formal compliance actions pending which it is unable to discuss further at this time.”
But penalties for paying, or accepting, kickbacks often are small compared with the profits they can generate.
“Some people would say if you penalize companies enough, they won’t be making these offers,” said Genevieve Kanter, an assistant professor at the University of Pennsylvania Perelman School of Medicine. She said small fines may be chalked up to the “cost of doing business.”
The Federation of State Medical Boards does not keep data on how often its members discipline doctors for civil kickback offenses, according to spokesperson Joe Knickrehm. The federation has “long advocated for stronger reporting requirements,” Knickrehm said.
Justice Department officials would not discuss whether they are seeking fines from more surgeons. But in a statement in April 2020, then-U.S. Attorney for the District of Massachusetts Andrew E. Lelling noted that the government will investigate any doctor “who accepts money from a device manufacturer simply for using that company’s products.”
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Prison time is the only thing that will work.
When will we start doing the only thing that will work?
At least the Justice Dept is interested in prosecuting this fraud. Perhaps because these companies are not big players on the federal level? As for all the growing corruption and fraud of the people and corporations who are, well…
Orthopaedic scandal is something I’ve come to learn a lot about. My former “big” boss was Professor Paul Dieppe – consultant rheumatologist who literally wrote the textbook on it. I have had dealings with a fair few rheumatologists in my time and they all go “ooooh” when they learn my employment history. He was key co-author on the paper that exposed the Cox2 scandal. Was publicly expelled from the US based global society.
Then when proven right got their medal of honour(!) He maintains to this day that the clinical criteria used to determine who would benefit from joint replacement are wrong…. It’s why he liked our quality of life instrument so much. Lovely guy. Random factoid – he was on a very unfortunate BA flight 149 that landed in Kuwait on 2nd August 1990. If you know your history of gulf war you can guess what happened. Thankfully happy ending.
The business of back surgery stinks.
The success rate is only about 50% at best. This is flip the coin surgery.
And the patients are driven to do nearly anything to find relief from pain.
I’m one of them. Two years ago, the pain was so bad, I felt like I was going crazy. The only thing that kept me going was my desire to be there for my dying mother.
Anyway, a visit to a massage therapist changed my life. While was on the table, I vented for an hour.
The massage therapist recommended Dr. John Sarno’s book, Healing Back Pain. I checked it out of the library and, let me tell you, if ever there was a book written for me, this was it. All about the psychosomatic origins of many cases of back pain.
Dr. Sarno was a big proponent of discontinuing special treatments and resuming normal activities. Over the course of the next two months, that’s what I did.
I also followed his advice on writing about the things that were provoking me. Especially the angry-makers and the anxiety-generators.
Pretty unusual sounding prescription, but it worked for me.
Today, except for the sore elbow that lingers from an early-month injury, I am pain-free. That elbow injury was the result of me doing a dumb thing. Tried to carry too much weight in a bucket. Nothing psychosomatic about that.
‘I also followed his advice on writing about the things that were provoking me.’
Wasn’t that about the same time that you said that you had dumped Facebook? Or was that Twitter?
Yes, Reverend, it was.
One of the NC commentariat recommended this book (it may have been you). I read it and it’s very informative/ According to Dr. Sarno, approximately 90% of the back surgeries are unnnecessary and don’t work. Because people get desperate they’ll pursue any “treatment”. I’ve managed back pain for a long time with yoga and other exercise and I don’t look for instant gratification.
I read and greatly benefited from Dr Sarno’s book, too. Anyone considering back surgery should read it. It’s only a book, and what have you got to lose?
The ONLY time I ever allow any of these spine surgeons anywhere near my patients is if there is permanent paralysis going on.
All I can say is the number one cause of this problem in this country is obesity. Fix that and it goes away. It is that simple for the majority of patients.
The much more difficult ones are the non-obese ones who are overusing for their work – sitting for a long time – or those having anxiety/stress. The issue is that the vast majority of the time, surgery maybe MAYBE helps a few months – – but things will often come right back – and likely worse than before.
I am of a generations of docs who in our youth never contemplated back surgery of any kind except for paralysis or cancer. That literally was it. And then the MBAs took over…………………
@Arizona Slim
June 20, 2021 at 10:27 am
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I’m glad you found relief Slim, especially without drugs.
Intractable back pain is the worst. I once had a herniated disk that caused such excruciating pain I wouldn’t wish it on my worst enemy.
It was so bad the surgeon told the nurse to schedule my surgery ASAP the moment he saw the CAT scan. Fortunately, the surgery was pretty easy and completely successful, as they only had to remove part of the disk.
I suffered from a completely debilitating “back attack” in Dec. 2004. It was holiday-time, so doctors, including my “own” doctor, were off and I spent 10 days flat on my back in bed, terrified, before I got an appointment with a chiropractor who did an “adjustment” that lasted only until I got up from the table. When I burst into tears, he explained, “You will get better. I don’t know whether it will take 8 treatments or 80, but you will get better.” At $175 a pop, I couldn’t afford to find out how long it would take.
The friend who had driven me to the appt. mentioned that after she dropped me off at home, she was going to the library, and asked if she could pick up anything for me. I asked her to check out anything she could find by Dr. John Sarno. A couple of hours later, she called to say that two books by Sarno were in my mailbox: “Mind Over Back Pain” and “Healing Back Pain.”
That evening I read the first 60 pages of “Mind Over” lying in bed, and when I got up to use the bathroom, I realized the pain was gone. This was after 10 days of unremitting pain when I was in any position but flat on my back. I read both books in short order. The pain did not return.
Now, when I experience back pain, I read a few pages of Sarno (either book), and with the reminders, the pain eases. I am not suggesting this will help everyone, but it has helped many, many people–and it sure was a godsend for me.
A virtual fellowship of grateful Sarno readers. Once again, Arizona Slim and I are on the same page!
I am another one of them. And one of the fortunate ones. In March of 2019 I had a rotator cuff repaired and had stopped taking my standard 2 and 1/2 to 3 mile walk a few days a week. I started back up a few months later And what I thought were my hamstring muscles started giving me problems. I chalked it up to being inactive for several months , my age (66 at the time) and being somewhat overweight. At first I could complete the walk after my “hamstrings” would stop bothering me after 2 or 3 blocks then 6 blocks then just stopped walking altogether. Even getting around the house was getting difficult. I had discussed this with my doctor prior to this and he suggested I go to physical therapy thinking it was my psoriatic nerve. It wasn’t quite that bad at the time so I didn’t follow through on the therapy. I know, shame on me.
Along comes Covid so I just hunkered down until September when I read some where you could get a cortisone shot in your spine to relieve the pain. So I get an appointment to get a shot. They first sent me to get an MRI of my spine which ended up showing I have congenital spinal stenosis. So no cortisone for me, and no physical therapy. My canal was so narrow in my Lumbar region you could barely fit a nickel sideways in there. So surgery it was or a wheel chair within a year. Needless to say, I went with the surgery and had 4 vertebrae fused. I spent 3 nights in the hospital, went home had a nurse come every other day and a physical therapist on the other days for 2 weeks and that was it. Within a month they wanted me to start walking a mile a day and now 5 months later I easily walk more than 2 miles. As I get back in some sort of shape I should be back to 3 miles a day within a month.
Walking has never felt better.
Some play by the rules and share the graft with the right people. Others get greedy and forget. It happens. Revolving doors require a little grease now and then.
Another example of grooming and Rape Culture.
Humans are vulnerable when it comes to health, and the psychology of protecting the mortal imperfect vassal that is our body— or even worse- the body of a loved one.
The immorality of our ‘health care’ system, the deeper socio-economic implications… well, it just gets me the most riled of any topic.
Typical libertarian ideology at work everywhere. Get extra cash buying and installing these items, so what? It’s all part of the ‘free market’ system where government is not involved. “So sue me, sucker” Is the libertarian diarrhea.
6 months ago I had a partial knee replacement, which absolutely took away my pain and the limp I had been walking with for two years. But it pops and creaks every time I bend the joint. People can hear it across the room! My surgeon tells me it its normal. I just can’t wrap my head around how this device could have this issue. The device had smooth operation before the surgery, and a post-op x-ray shows perfect installation. I thought about seeking a second opinion, but who needs all the drama associated? Not me…
I was supposed to have the same procedure performed on the other knee, and the ortho tells me a hip replacement will be due sooner than later. I decided, instead, to lose 80 pounds this year, then re-assess the situation in a year or so. Forty five pounds down, so far, and the pain in my bad knee has been reduced tremendously. Fortunately, the hip hasn’t worsened.
(sarcasm font) If I didn’t know better, I might be inclined to think the surgeon has his wallet in mind more than my mobility!
I have used chiropractic, massage and acupuncture for an old back injury and it’s worked quite well. Taking a micro dose of CBD everyday has also helped as it’s good for inflammation.
After the horrible mess an Otho surgeon made of my Fathers knee replacement. Three operations after a defective knee replacement apparatus was replaced by another defective device.
I think in a lot cases people need to think about aging as the fact that our bodies wearing out is a normal process. This is the normal process and most of us can deal with it better and in more natural ways than taking pills and having steel implanted in our bodies. Our entire medical system is corrupted by money. I stay away from them as much as possible.
I was having, not for the first time, terrific lower back pain (I am again). A friend had given me her pain pills from an operation–no longer needed by her. I had tried hot tub–made it worse. Scotch worked fine, except for the “side effects.” I took the pills with me to Costa Rica, where they helped. When they ran out, I couldn’t climb into a van. But a pharmacy could–and did–sell me 25 of the same pills. And guess what: by that afternoon, the pain had disappeared. Not permanently, needless to say. But for then. Go figure. No operations for me. Oxy, however corrupt, works.
Paul, I don’t have back pain. I wouldn’t let anyone fool with my back if I did. I’ve seen too many people with failed surgeries, arachnoiditis from multiple cortisone blocks, one in a wheelchair from repeated injections. Unfortunately, if one is doomed to intractable pain, one is doomed to these devices, if one allows it. (Medtronic, imho, is one of the worst.) The schtick is if you need pain relief, you are weak or you are, per se, an addict. Therefore, it’s either these devices and steroid blocks, or you’re on your own now. I’m an older, odd, complicated autoimmune afflicted person with plenty besides multiple sclerosis. I can’t tolerate anything but 5 element acupuncture (good luck finding it) and I’m far too brittle for chiropractics. I have been meditating for almost 30 years. I don’t apologize for needing pain relief. The cards you’re dealt you handle with grace and aplomb! Feel better!
Literally a couple of minutes before clicking on this post, I had been looking at this article on Yahoo about the record large numbers of people in the US who are leaving their jobs and/or looking for other ones. So that has nothing to do with this, and I have seen other stories about that phenomenon, but the connection is the guy whose situation was the lead graf and photo for the story:
At some point early this year, Justin Hoffman concluded that he was being underpaid.
The marketing director at an orthopedic practice in Findlay, Ohio, Hoffman was making $42,000 a year — about $13,000 less, by his count, than people were making in similar jobs elsewhere.
“Marketing director at an orthopedic practice” struck me as odd. Doctor’s offices have marketing directors? And “director” kind of suggests that there may be additional marketing staff working under the person. It shouldn’t have surprised me, and it made sense when I looked at this post.