Some new spine technologies are initially met with skepticism and the argument that they can be “solutions in search of a problem.”
Spine surgeons discuss that idea and ideal metrics to determine if new tech is valuable.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
Next question: What’s something in your practice that has surprised you the most in the last five years?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, Sept. 2.
Editor’s note: Responses were lightly edited for clarity.
Question: How do you respond to the argument that some new spine technologies are “solutions in search of a problem” — and what metrics should we use to justify adoption?
Tan Chen, MD. Geisinger Musculoskeletal Institute (Danville, Pa.): The field of spine surgery is undergoing a renaissance of evolving technologies and implants, and having a healthy degree of skepticism to the unfamiliar is only natural. Not all innovations will demonstrate immediate clinical advantages over the gold standard alternative. Each surgeon should apply their own critical thinking, recognize their own biases, and thoroughly study the objective data and patient outcomes prior to mass adoption of new technologies. As well, cost data and healthcare expenditures should play a role in this decision-making process. Our field can ultimately only progress by innovation, and experimentation is a key aspect of innovation.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: There is no question we do things sometimes for the sake of doing them, or to post on social media about something we are doing before everyone else. The slow adoption of new technologies and techniques is a good tactic as we have all seen certain arthroplasty techniques, and disc closure devices all fall by the wayside. The best metrics are ones we already have: amount of pain relief, resumption of work and physical activity, and how they feel since having surgery.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): This centerpiece discussion is potentially awkward for most, especially those of us with strong relationships with biotechnology companies and direct patient care. ‘Selling a solution by creating a problem,’ or ‘a means to an end,’ and ‘a (product) solution in search of a problem,’ is both implausible in medicine and science, and counterintuitive to our training and ethical oaths. The aforementioned definition of Utilitarianism, and seemingly the historical and current metaphysical context of mistrust that belabors every facet of consumerism. In my observations, the winding path of discarded failures is littered with so many shiny, miraculous and ‘life-changing’ spinal devices that numb the senses upon recall. Being entrepreneurial does not lessen nor excuse one’s foundation or training.
To criticize one’s problem-solving approach, by saying that proposing a solution in search of a problem is basically in reverse or bias driven, and yet, it remains wrong. The majority of human trials on pharma or biomedical devices are performed in developing countries for a whole host of reasons. Conclusions and reasonability are obvious and legacy-based. This accepted metric and the forlornness’ in predictability may be the first rock to look under.
