A few months back, I told you about how my neck had gone bad, really bad. At that time, I was in the middle of a six-month dive into pain, alleviated only by gobbling unwholesome quantities of Percoset. Three weeks ago last Friday, I had an amazing surgery that relieved my pain and gave me a neck that feels 20 years younger. And it was all because of this blog.
The experience has proven for me that there is a pressing need for a new economics in medical care, especially with regard to the technology we have access to as health care customers (as compared to being "patients"). Patients have patience, waiting for a prescription from their doctor to fix their ills. Customers can do research, issue a call for proposals so to speak, and make decisions that free them from the confines of their doctors' ability to earn fees for using certain products.
In many ways, the medical technology market today is at a stage similar to the computing technology in the late 1980s, when IT departments handled all buying decisions and people were discouraged from bringing anything into the enterprise environment that had not been approved by IT. Today, most people are their own CTO, making their decisions about what kind of computer, wireless handset and network to use, which the enterprise accomodates.
Here's what happened. After I posted about the messed up economics in healthcare, I received email from Tom Rawles at Spinal Kinetics, a developer of spinal disc replacement devices. He said the company was in early trials of its M6 Artificial Disc and that, if I qualified for the trial, they'd be happy to have me.
I'd already been turned down for a disc replacement surgery by my insurer and, despite the fact I have an excellent spine surgeon in the Northwest he did not know of any trials for what I needed, a "multi-level replacement," i.e., I needed more than one disc replaced. In comments on that posting, many of you agreed with me that the insurer was the main culprit.
But I've come to understand that it is also a matter of the sales and marketing channel for medical devices being very narrowly focused on the relationship between the doctor and device manufacturers. In many cases, a doctor can make more money by recommending one device over another. Because of that close link between doctor and manufacturer, some regions have many more options available to patients than in regions that are impractical for startup firms to reach. I should add as an aside, the medical device market is, for the most part, a build-to-be-acquired market specifically because an acquisition is the most expedient way for a startup device maker to get a sales channel. This means the products of large companies enjoy a huge advantage over new contenders.
In my case, the Spinal Kinetics M6 Artificial Disc was entering the very first stage of clinical research in the United States. The company has already sunk as much as $28 million into developing the disc replacement device—they will sell for between $5,000 and $7,000 apiece, the clinic estimated. They are putting the devices into 30 people as a first step toward Food and Drug Administration approval. After this phase, a blind trial will follow, and it will take two to four years for the FDA to approve.
I was extremely lucky to get into the trial. In some ways, my posting was a call for proposal as it the Vendor Relationship Management group has described how customers will query the market for options when buying. But it was also a matter of social connection. Tom Rawles read my blog and it carried some weight because I write for a recognized brand name in technology publishing. In short, a combination of factors came together that don't generally exist for connecting customers to new medical technology. My doctor had never heard about Spinal Kinetics until I showed him the product.
I was also taking an extreme risk. To get into the trial, I had to give my neck over for an experimental procedure. Mine was the fifth of six such surgeries to date. Fortunately, Spinal Kinetics was working with an outstanding spine specialist in Los Angeles, Dr. Carl Lauryssen. As Dr. Lauryssen told me when we met for the pre-surgical consultation, if there was a significant risk due to the surgeon, I'd have the wrong surgeon. I was impressed with the doctor and, after extensive research, I had come to the conclusion that the Spinal Kinetics disc was the most advanced solution—it offers the same range of motion, six directions, that a human disc does, and it was designed to provide increasing resistance to movement with components that make it far hardier than other options.
I took the plunge, though I wouldn't suggest anyone do so without doing extensive research about the company and device, as well as about the doctor and hospital where the surgery will take place.
A new medical device and healthcare economy will demand that customers, the people formerly known as patients, will be able to research technologies, companies and doctors. That also means that technologies, companies and doctors will have the opportunity to develop brands that command premium fees. Ultimately, this will change the way insurers compensate the insured, because it is conceivable that other factors than what your doctor says is needed will come into play. The trading of access to one's body (or information about our bodies) for access to new technology, for instance, could offset some of the cost of a procedure, a factor that should impact the payment by an insurer dramatically in many cases.
Speaking for myself, I am sold on the value of participating in a trial based on extensive disclosure of information. The surgery I had would normally cost about $75,000, according to HealthGrades.com. Since I had two discs replaced, the cost of just the devices was between $10K and $14K, and there were other features of the operating room and hospital that would have cost me $100,000 if I'd paid for this procedure on my own, which was my only option if I wanted to avoid having my neck fused.
Best of all, I woke up without the pain I'd had for years. (Check out this animation of the procedure, which doesn't show the person whose job it was to hold my esophagus out of the way for a couple hours—I felt like I should tip this guy.) The extreme pain of recent months was gone when I woke in the recovery room, and numbness in my left arm and fingers has been abating consistently since the surgery. I lost only two tablespoons of blood in a two-and-a-half hour surgery and walked out of the hospital, without any need for a cervical collar, only two days later to fly home to Seattle. It is an incredible outcome, one for which I will be eternally grateful.
Now, if we can only figure out how to make this kind of outcome more easy to discover and pay for. That's a battle for after I finish my recovery. For now, I am happy to have my life back.