The ethics of bracing (and PT) with a Scoliscore <41

[skevimc]

According to the authorship line on the validation study published in Spine, Lonner doesn't appear to have analyzed any samples, crunched any data, nor made any conclusions based on same.

ETA: Can someone with the paper check if Lonner is mentioned in the acknowledgment section and, if so, what for?

Thanks in advance.

Lonner is not mentioned anywhere in the article.

I generally like entrepreneurs and doctors as separate disciplines, but I really don't like entrepreneurial doctors. Don't we pay these guys enough of a living wage that they could forgo the ethical compromises?

I understand your concern, but this isn't all that unusual. Clinicians involved in research frequently have various stock options or honorarium or other types of payments from biotech companies. In fact, they are usually highly sought after by the companies. As well, many times, it's the clinicians that have the best ideas because they are the ones practicing everyday. So they are intimately aware of the improvements that need to be made in daily practice. As long as they present their results in a peer reviewed publication I'm fine with that. I've been skeptical of scoliscore because on their website they've been advertising their validation study with >9000 patients, etc... But this data had yet to surface, until this article came out. It's the clinicians that remain somewhat secretive and keep everything highly guarded or don't publish the data that make me concerned. Doesn't mean that they're doing anything wrong. It just makes me highly skeptical. Then again, I have little to no interest in patents and other such stuff so I'm speaking about this somewhat naively.

The scoliscore would actually take money away from surgeons because the main point of the test is to be able to identify those patients that do not need treatment. So it's really meant to shrink surgical practices so they can focus on those patients that have a higher risk. As well, there's no treatment paradigm they are promoting or repeated genetic testing. So it's a one-time cost and that's it. They've also only included patients that have a clinically diagnosable scoliosis and say specifically that it is not for the general population, i.e. it shouldn't be used as an in-school screening type of test

[Pooka1]

Lonner is not mentioned anywhere in the article.

Thank you for checking that. I am now dismissing concerns over Lonner possibly cooking any data just because he holds an interest in the test. Next.

I've been skeptical of scoliscore because on their website they've been advertising their validation study with >9000 patients, etc... But this data had yet to surface, until this article came out.

You can say that again. I was shocked that the test was being offered routinely ahead of peer review. That sort of thing doesn't not have a good track record in any field.

But I think what might be the deal is after the paper got through peer review, was accepted, and placed in the publication queue, they were free to offer the test. I don't know how long the queue is for Spine but I imagine it is quite long as that is viewed as the tippy top of the top shelf as far as I can tell. That paper may well have been accepted when the test was offered.

[hdugger]

I understand your concern, but this isn't all that unusual. Clinicians involved in research frequently have various stock options or honorarium or other types of payments from biotech companies.

A straight payment would be fine. An ongoing financial involvement with the company doesn't sit so well with me, although I understand that it's common.

I can't quite work out the economics, but I'm guessing the financial impact of decreasing treatment to the low scoliscore patients is pretty negligible. The only change they talked about was possibly doubling the time between xrays. That has to be more than offset, for Lonner, by a cut of the profits if the test is routinely given to every patient between 9 and 13 with a small curve.

There was a fascinating article (maybe in New York Magazine? I can't quite recall), where they tried to trace back the causes of skyrocketing healthcare costs. After considering and discarding most of the usual suspects--malpractice costs, equipment investments, etc--the one thing they finally settled on that explained all of the data they had in front of them was 'entrepreneurship in medicine." Hospitals and doctors with an entrepreneurial bent drove up the cost of health care, when compared to hospitals and doctors without that bent.

Edit: Oops - New Yorker magazine - here's the link - http://www.newyorker.com/reporting/2...a_fact_gawande

[Pooka1]

It is completely irrelevant if certain surgeons are making money if the product is needed and accurate.

It either is or isn't needed and it either is or isn't accurate.

That is the bottom line unless you are alleging data cooking. Are you?

It could be the world is so constructed that Scoliscore is necessary AND some folks make money. It is possible for BOTH things to be true.

[hdugger]

I suppose each of us evaluate our surgeons in our own way. I was put off by Anand's investment in the minimally invasive hardware, and I'm put off my Lonner's involvement with the Scoliscore folk.

[Pooka1]

Lonner isn't involved in the prove out and he didn't manufacture the need for Scoliscore.

He is no different than someone who is a friend of someone starting a venture capital business that addresses a need in society in an accurate way. Had you or I known about it maybe we could have gotten in on the ground floor.

The future belongs to the clever and the lucky.

[jrnyc]

having met Anand for a consult one year ago, and seeing Lonner for follow up with my scoli, disc, etc. condition(s) for 6 years, i can tell you privately about both surgeons...my opinion as a patient, that is...

i don't pay much attention to predictive research, and personally, my small curves got large when my spine deteriorated as an adult...

jess

[hdugger]

I'd be really interested in hearing your impressions, Jess. I don't have any sense that they're an ethical lapse here - I just wish doctors didn't have barely conscious reasons for wanting to see things in a certain way. It's hard enough to handle the complex variables they have to handle, without adding this kind of kink to the system.

[jrnyc]

hey hdugger
am sending you a pm...

jess

[Ballet Mom]

The scoliscore would actually take money away from surgeons because the main point of the test is to be able to identify those patients that do not need treatment. So it's really meant to shrink surgical practices so they can focus on those patients that have a higher risk. As well, there's no treatment paradigm they are promoting or repeated genetic testing. So it's a one-time cost and that's it. They've also only included patients that have a clinically diagnosable scoliosis and say specifically that it is not for the general population, i.e. it shouldn't be used as an in-school screening type of test

It is my opinion that this test may take a little money away from pediatric surgeons, but the real effect of this test (if used as proposed) will be to transfer the revenue from the large bracing market that helps children who would like not to have an increased deformity, to Scoliscore, its insiders and its venture capital backers plus enormous additional profits when Axial Biotech is taken public.

I predict the adult orthopedic surgeons will get increased business due to the increased progression rates of the larger resulting curves, leading to many more adult surgeries and much greater additional cost.

Once again, this is my opinion.

[Ballet Mom]

Lonner isn't involved in the prove out and he didn't manufacture the need for Scoliscore.

He is no different than someone who is a friend of someone starting a venture capital business that addresses a need in society in an accurate way. Had you or I known about it maybe we could have gotten in on the ground floor.

The future belongs to the clever and the lucky.

I'm not sure why you keep implying that Scoliscore is accurate and needed. It doesn't appear to be either from the data we've been talking about. And I certainly don't know any kid or their parents that are going to be thrilled that their kid progressed to a very large deformity with high odds of progression as adults due to this test.

Scoliscore is interesting research and it should still be just that.

[Pooka1]

I'm not sure why you keep implying that Scoliscore is accurate and needed. It doesn't appear to be either from the data we've been talking about. And I certainly don't know any kid or their parents that are going to be thrilled that their kid progressed to a very large deformity with high odds of progression as adults due to this test.

Scoliscore is interesting research and it should still be just that.

Tell that to all the kids sprung from their braces including that girl in the Lonner video.

Good luck.

[Ballet Mom]

Tell that to all the kids sprung from their braces including that girl in the Lonner video.

Good luck.

How many kids do you think score between 1 and 10? And how many of these cases would have been in braces? Not many. Even between 1 and 10 the doc in the LA Times article stated that "most" of those who score between 1 and 10 don't become progressive. How accurate a test is that? And how needed?

If the kids aren't progressive, they wouldn't have been put in a brace in the first place....remember?

[Pooka1]

How many kids do you think score between 1 and 10?

I'd have to see the calibration data. BTW, the girl in the video scored a 16 I think.

[hdugger]

I'm still puzzled about the story in the video. She scored 16 on the test, but had a 25 degree curve to begin with and then had a big curve increase during her growth spurt (again, according to the video). I'm not sure what that adds up to, but I'm guessing she has to be at least over 30 degrees (25 + "unnamed big increase")

If that's a low-risk case, I'm a little puzzled about what a medium-risk case would look like.

I'm also not sure why she was put in the brace *after* the growth spurt. Aren't kids at 25 degrees-but-still-growing mostly already in brace?