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Thread: Money Driven Medicine

  1. #16
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    Quote Originally Posted by Pooka1 View Post
    CD, way back before my kids developed scoliosis, I had heard that surgery, presumably including fusion, is NOT the answer for back pain. The figure I recall is that ~60% of people operated on for back pain have MORE pain afterward long-term. In other words, the state of the art of surgery to address back pain is not there apparently. This is a legitimate area for alternative treatment in my opinion if only because we have evidence surgery fails to relieve pain often.

    I think many accept that too mush surgery for back pain is going on and too much of that is not helping.

    All of that given, it is IRRELEVANT to surgery (fusion) for scoliosis and by extension back pain associated with conditions associated with scoliosis where pain is only one indicator.
    At an SRS meeting quite awhile ago, there was a paper on who was doing scoliosis surgeries. The vast majority of scoliosis surgeries, at that time, were being done by non-SRS doctors. (Hopefully the internet has changed that at least a little!) I suspect the same thing is true for all spine surgeries. That is, general orthopaedists are doing most of the spine surgeries. If that's the case, it explains why 1) too many spine surgeries are being done and 2) why so many people who have back surgery end up with residual pain.

    --Linda

  2. #17
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    Quote Originally Posted by LindaRacine View Post
    At an SRS meeting quite awhile ago, there was a paper on who was doing scoliosis surgeries. The vast majority of scoliosis surgeries, at that time, were being done by non-SRS doctors. (Hopefully the internet has changed that at least a little!) I suspect the same thing is true for all spine surgeries. That is, general orthopaedists are doing most of the spine surgeries. If that's the case, it explains why 1) too many spine surgeries are being done and 2) why so many people who have back surgery end up with residual pain.

    --Linda
    That might explain it.

    But I question the general question about non-SRS folks doing scoli fusions.

    Our SRS surgeon referred us to a non-SRS surgeon for my daughter's surgery. So at least some SRS guys seem to think some non-SRS guys are up to the task.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  3. #18
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    Quote Originally Posted by Pooka1 View Post
    That might explain it.

    But I question the general question about non-SRS folks doing scoli fusions.

    Our SRS surgeon referred us to a non-SRS surgeon for my daughter's surgery. So at least some SRS guys seem to think some non-SRS guys are up to the task.
    Maybe, but I think non-SRS surgeons with adequate training in scoliosis surgeries are exception rather than the rule.

    --Linda

  4. #19
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    Quote Originally Posted by LindaRacine View Post
    Maybe, but I think non-SRS surgeons with adequate training in scoliosis surgeries are exception rather than the rule.

    --Linda
    Well if that were true, you are in the best position to know it. I certainly have no idea how true the comment is in general.

    If you look at the requirements for SRS membership, I think you have to devote at least 20% of your practice to scoliosis cases. Apparently that might be easy enough to do while maintaining a specialty elsewhere. I asked the nurses how many scoli fusions our non-SRS surgeon does a year and it is comparable to some SRS surgeons based on what I have read.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  5. #20
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    Quote Originally Posted by Pooka1 View Post
    Well if that were true, you are in the best position to know it. I certainly have no idea how true the comment is in general.

    If you look at the requirements for SRS membership, I think you have to devote at least 20% of your practice to scoliosis cases. Apparently that might be easy enough to do while maintaining a specialty elsewhere. I asked the nurses how many scoli fusions our non-SRS surgeon does a year and it is comparable to some SRS surgeons based on what I have read.
    Actually, they have to devote 20% of their practice to spinal deformity (which includes scoliosis, kyphosis, and spondylolisthesis).

    --Linda

  6. #21
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    Quote Originally Posted by LindaRacine View Post
    Actually, they have to devote 20% of their practice to spinal deformity (which includes scoliosis, kyphosis, and spondylolisthesis).

    --Linda
    Yikes. Okay that even makes my point further!

    That would definitely explain how a non-SRS guy can be doing similar numbers of scoli fusions as the SRS.

    When I realized he was doing so many, I asked someone who would know why he didn't get the SRS certification and the answer was he had no reason to do so. There is no advantage to him I guess. He certainly seems to get enough scoli cases from SRS surgeons without it through word of mouth seemingly.

    I guess this is similar to whether I join a particular scientific research society or not. Now that I can get any journal article I want free through work, there is no need to join. I may rejoin a few when I think I'm close to a promotion though, which may or may not be in this lifetime while I'm part time.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  7. #22
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    There are plenty of reasons to join the SRS, including supporting the organization that funds a lot of scoliosis research, and participating in multi-center studies on the discipline that pays one's bills.

    With that said, I don't think being an SRS member is an absolutely necessity when one is trying to find a specialist, but I personally think it counts for a lot. The most important factor, in my mind, is whether the doctor has done a fellowship at one of the better spine centers.

    --Linda

    Quote Originally Posted by Pooka1 View Post
    Yikes. Okay that even makes my point further!

    When I realized he was doing so many, I asked someone who would know why he didn't get the SRS certification and the answer was he had no reason to do so. There is no advantage to him I guess. He certainly seems to get enough scoli cases from SRS surgeons without it through word of mouth seemingly.

    I guess this is similar to whether I join a particular scientific research society or not. Now that I can get any journal article I want free through work, there is no need to join. I may rejoin a few when I think I'm close to a promotion though, which may or may not be in this lifetime while I'm part time.

  8. #23
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    better spine centers

    Hi Linda,

    I agree with your comments above. I'm wondering though, in evaluating a doc's credentials, how is one to know if a fellowship site is one of the "better spine centers?" I am sure others have wondered this also.

    Thanks,
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

  9. #24
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    Quote Originally Posted by leahdragonfly View Post
    Hi Linda,

    I agree with your comments above. I'm wondering though, in evaluating a doc's credentials, how is one to know if a fellowship site is one of the "better spine centers?" I am sure others have wondered this also.

    Thanks,
    Scottish Rite I think is one of the "better" spine centers AFAIK.

    That's where the SRS guy went who handed us off to the non-SRS guy for the surgery.

    At 20% of ALL spinal deformities not just scoliosis to be in SRS, I am thinking many, if not most non-SRS guys might be doing as many scoli fusions as many SRS guys. At least I wouldn't be surprised at this point if it were true.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  10. #25
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    Quote Originally Posted by leahdragonfly View Post
    Hi Linda,

    I agree with your comments above. I'm wondering though, in evaluating a doc's credentials, how is one to know if a fellowship site is one of the "better spine centers?" I am sure others have wondered this also.

    Thanks,
    Hi Leah...

    That's a good question. I don't think there's any easy way to know this, with the exception of checking out the amount of research done by at the center. I think it's best to at least check to see if the surgeon has done a spine fellowship.

    My top picks would be UCSF, Washington University (St. Louis), Hospital for Special Surgery (New York), and Leatherman (Kentucky). With that said, there are a handful of surgeons that I've heard really great things about, who did not perform a fellowship in one of those places.

    Although this list is dated, I try to track scoliosis specialists and list where they did their fellowship (if at all). You can find the list here:

    http://www.scoliosislinks.com/ScoliosisSpecialists.htm

    I'm sure that my short list will piss a few people off. So, I suspect we'll hear about other quality centers as well.

    Regards,
    Linda

  11. #26
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    Quote Originally Posted by aterry View Post
    PNUTTRO I agree with the jist of your comment but lots of people don't have money for choosing which doctor or treatment to use. In NY (and maybe everywhere) the most highly thought of spine doctors don't take insurance (or only a couple of fancy plans)--you have to pay out of pocket. This has lead to a disagreement between my husband and me. I want to go to the highly recommended Boacie, at least for a consult, but my husband says why get started with someone we can't afford, even if he is the best?
    Why go to this doc? If he has alot of valuable info to offer that others dont, its worth it. On the other hand if he has alot of valuable info. but doesn't want to share it unless you are financially commited to continuing with him, than it's a bust. How do find out the answer to that before your first visit???

  12. #27
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    Quote Originally Posted by LindaRacine View Post
    There are plenty of reasons to join the SRS, including supporting the organization that funds a lot of scoliosis research, and participating in multi-center studies on the discipline that pays one's bills.

    With that said, I don't think being an SRS member is an absolutely necessity when one is trying to find a specialist, but I personally think it counts for a lot. The most important factor, in my mind, is whether the doctor has done a fellowship at one of the better spine centers.

    --Linda
    The most important factor, in my mind, is whether the doctor has done a fellowship at one of the better spine centers.

    --Linda
    with all due respect. coming from the perspective of a chronic sufferer and patient the most important factor, is if the highly experienced and educated physician actually cares about his patients. I've had much better patient care from my regular MD, (no specialty) than from somone on that referral list. I actually left a certain specialist office completely distraught from being told within 2 minutes of the doctor entering the treatment room there was nothing that could be done for me.period. It was both the"lack" of attention given my condition and the way it was verbalized to me. Unbelievably bad.

  13. #28
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    Quote Originally Posted by dianew View Post
    The most important factor, in my mind, is whether the doctor has done a fellowship at one of the better spine centers.

    --Linda
    with all due respect. coming from the perspective of a chronic sufferer and patient the most important factor, is if the highly experienced and educated physician actually cares about his patients. I've had much better patient care from my regular MD, (no specialty) than from somone on that referral list. I actually left a certain specialist office completely distraught from being told within 2 minutes of the doctor entering the treatment room there was nothing that could be done for me.period. It was both the"lack" of attention given my condition and the way it was verbalized to me. Unbelievably bad.
    Bedside manner matters for sure.

    Other important considerations for me include the number of relevant procedures they do and their outcome. I take it as a given that someone doing a bunch of procedures is up on the relevant literature even if they aren't a member of a specialty society. I have yet to stump our non-SRS guy with any scoliosis question. I expect if he is doing scoliosis fusions that he knows the literature up and down, front and back, sideways, etc.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  14. #29
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    Doctor makes big money faking research

    $788,000 Paid to Doctor Accused of Faking Study

    Medtronic said on Wednesday that it had paid nearly $800,000 over an eight-year period to a former military surgeon who has been accused by the Army of falsifying a medical journal study involving one of the company’s products.
    Bio with photo of Dr. Timothy Kuklo

    Clinical Specialties
    Cervical Spine (all pathologies); Spinal Deformity (both pediatric and adult); Spinal Tumors; Spine Trauma

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