The Ten Most Disruptive Trends in Orthopedics | Orthopedics This Week
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The Ten Most Disruptive Trends in Orthopedics

Source: Wikimedia Commons and Alejandro zorrilal Cruz

Ten potentially disruptive trends are gathering momentum and some or all of these, we think, will change orthopedics forever. From least to most, here are our picks for the coming disruptive trends in products, services, hospitals and employment in orthopedics. What do you think? We’d like to know.

Everyday 10, 000 baby boomers turn 65 in the United States.

Simultaneously more active and more obese, the group of Americans born in the two decades after World War II is entering their infirm years almost begging for increased rates of orthopedic treatment. This generation wants their nachos and their tennis games—well into their 70s and 80s. But the human body isn’t cooperating. Both soft and hard tissues begin to degenerate at around age 40. This deterioration manifests itself in several forms, the most relevant of which for orthopedics, is arthritis.

According to both PearlDiver Technologies, Inc. statistics and data from the American Academy of Orthopaedic Surgeons, the prevalence of arthritis and other rheumatic conditions among U.S. adults aged 18 or older is about 21.6%. But, among U.S. adults aged 65 and older, the prevalence rates rise to more than 50%. What is arthritis? It is pain and limited motion. What do orthopedic surgeons do? They stop pain and restore motion.

Bottom line: Start programming Led Zeppelin, Neil Young and the Beatles in the waiting room Muzak.

125 million Americans suffer from a chronic medical condition.

Only half of these patients actually follow treatment recommendations. One in three adults is obese (BMI ≥ 95th percentile of the CDC growth chart). Diabetes is exploding.

People with chronic conditions are the heaviest (pun intended) consumers of medical care. They use 96% of all home health care services. They buy 88% of all prescriptions. They represent 72% of all physician visits. They occupy 76% of all inpatient hospital beds. And, no surprise, 85% of people aged 65 years and older have one or more chronic conditions.

Bottom line: like zombies, these patients will keep coming and coming and coming.

3.6 billion prescriptions were filled last year in the U.S.—not counting medical marijuana.

That’s equal to about 12 per person.

The American dream is now two kids, two cars, and a dozen drugs in the medicine cabinet. Society has absolutely adopted the attitude that drugs are the answer for aches, blocked arteries and sleep-deprived adults.

Where does this trend go?

It grows and finds new channels of expression like nutriceuticals and medical marijuana (i.e., self-medication). Back pain and joint pain are two of the most common reasons given for obtaining a medical marijuana prescription in the 16 states that have legalized the use of medical marijuana. United Kingdom-based GW Pharmaceuticals is testing cannabis-based, Sativex. Its Phase II and Phase III trials show positive results for the relief of neurological pain related to several causes including spinal cord injury, rheumatoid arthritis and brachial plexus injury.

Bottom line: in a fight between drugs and devices, drugs win.

Pace of technology change is accelerating at an exponential rate.

For example, the cost of sequencing the first human genome was $3 billion. The cost of sequencing the entire human genome today is $10, 000. By 2015, experts are estimating that the cost of sequencing the whole human genome will be $100. In short, do more—much more—with less.

These are irreversible changes. Last month researchers from the University of Missouri and Boston University reported in The Lancet that they had successfully grown a replacement shoulder in rabbits using an implanted biologic scaffold.

Bottom line: mind stretching and inconceivable changes are only a matter of time.

The smart phone is becoming a medical device.

More than 15, 000 medical apps are now available.

Eighty percent of all U.S. physicians will be using smart phones by next year and will be accessing checklists, demos, formularies, diagnostic calculators and 3D medical images. On the horizon, real-time wireless vital function monitoring, networking to central databases with links to outcome analyzers which bake in the specific patient’s genetic information, behavior and demographics. FDA regulation is coming on almost as fast—but not quite.

Bottom line: portability will rule and hospital administrators will drool.

The number of robotic-assisted surgeries performed worldwide has increased three-fold over the past two years.

Surgeons and engineers have been collaborating on surgical robotics for more than a generation. In 1985, a robot, the PUMA 560 performed a brain biopsy. In 1999, the first robotic assisted heart bypass was performed at Ohio State University. In the last two years the use of robotic assisted orthopedic surgeries has skyrocketed—particularly in knee and spine surgery.

Robotic assisted surgery more precisely translates the surgeon’s movements into minimally invasive cuts and tissue removal. “Robots” are really computers with micro motors which allow the surgeon to overcome the limitations of the human eye and manual dexterity.

Bottom line: robots will make every orthopedic surgeons technique near perfect and minimally disruptive.

Adult stem cells have been used in more than 190, 000 patients in the U.S. since 2004 with no reported adverse events.

A conservative presidential candidate asked to have his back pain treated with stem cells derived and cultured from his own fat tissues. He then wrote to his state’s medical board saying that he hopes his state will “become the world’s leader in the research and use of adult stem cells.”

That politician is Texas Governor and likely presidential candidate Rick Perry. He is now the U.S.’s best known recipient of a non-FDA approved stem cell treatment.

How is he doing? Great!

Every week, a dozen or more stories emerge from local papers regarding patients who’ve been treated with their own concentrated or cultured stem cells or with allograft stem cells. In Vermont, a company just announced that they are building a $100 million stem cell center. Funding is already in place. The investors? Koreans.

Bottom line: adult stem cell therapies are fast becoming part of every orthopedists armamentarium.

Artificial intelligence systems are now beating humans in quiz shows.

Watson, IBM’s artificial intelligence system, won the Jeopardy quiz show. Imagine what it can do in medicine—outcome analyzers, agent-oriented diagnostic techniques, medical image processing improvements, machine learning based systems and neural networks among physicians, surgeons and other healthcare providers.

The key lesson learned from Watson is that more open ended artificial intelligence systems have progressed so far that, in the case of an English language, culturally bounded quiz show, an artificial intelligence system considered all of the possible solutions and came up with the right answer more quickly, more often than humans.

Bottom line: fewer diagnostic and procedural screw ups.

50% of doctors are now employed by large healthcare corporations.

Six years ago, more than two-thirds of U.S. doctors owned a medical practice. By next year, two-thirds of all doctors will be salaried employees of larger institutions.

Over the next few years physicians can be expected to:

  1. work as employees of increasingly larger medical groups or hospital systems

  2. establish cash-only practices that eliminate third party payers

  3. reduce their clinical roles by working part-time

  4. opt out of medicine altogether by accepting non-clinical positions or by retiring

The reality is that the current regulatory and market changes are pushing most physicians to join larger organizations to be able to afford the expertise and systems necessary to remain viable in today’s practice environment.

Bottom line: entrepreneurial surgeons are becoming an endangered species.

The U.S. Government will pay less than it is paying now for healthcare in the United States.

De-leveraging its balance sheet, stimulating a sluggish economy and paying for Social Security puts this writing on the wall.

Analysts at the Congressional Budget Office (CBO) wrote earlier this year: "Future growth in spending per beneficiary for Medicare and Medicaid—the federal government’s major healthcare programs—will be the most important determinant of long-term trends in federal spending. Changing those programs in ways that reduce the growth of costs—which will be difficult, in part because of the complexity of health policy choices—is ultimately the nation’s central long-term challenge in setting federal fiscal policy."

The CBO also projects that "total federal Medicare and Medicaid outlays will rise from 4% of GDP in 2007 to 12% in 2050 and 19% in 2082—which, as a share of the economy, is roughly equivalent to the total amount that the federal government spends today.”

Bottom line: direct and indirect per capita U.S. Government spending on health care will decline.

 


 

So, these are OTW’s best guesses as to the ten most disruptive trends likely to affect orthopedic surgeons, suppliers and patients. We want to know what you think. Leave a comment on the web site (www.ryortho.com) at the bottom of this article.

 

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