The Spine Blogger Unmasked?

On Saturday, February 7, 2009, a new blog, published by the anonymous Spine Blogger (TSB), appeared on the Internet (www.spineblogger.blogspot.com).

The blogger, who calls himself Musculoskeletal Man, was first brought to this writer's attention by a former colleague at Orthopedics This Week. TSB promised to provide “a platform where the exchange of ideas, news, job opportunities and the truth can be discussed in an open forum without Big Brother standing over us and threatening our livelihoods." He requested that his followers use the platform without malicious name calling or vulgarities. "Strap yourself in, and enjoy the ride, " wrote the blogger.

And quite a ride it's been as he and his followers quickly ignored the request.

Postings, Comments and Followers

Since inception, TSB has logged over 500 postings, listed 281 followers, and claimed 50, 000 hits and 8, 200 returning readers per month by the end of the first year. While reader comments were sparse at the beginning, TSB now regularly garners between 50 and 100 anonymous comments to his postings.

TSB's postings and his follower's comments, are generally informative and provide insight into the frustrations of anonymous spine sales reps. But over the years, as TSB dove into the changing world of spine sales and threats to spine reps’ livelihoods from PODs (physician-owned distributors), changing distribution models and commission cuts, many of the comments got ugly and personal.

We won't list the names of the individuals and companies scorched in the postings and comments.  No need to repeat what may be false and damaging attacks.

“Me Too” Companies, Greedy Surgeons and Besieged Sales Reps

Successful companies are frequently accused by TSB and followers of paying greedy surgeons to use their "me too" products. Companies that have failed or gone out of business are ridiculed for being run into the ground by incompetent dinosaurs that lacked the creativity to make their start-ups successful.

TBS and his followers also took on a nasty tone towards their employers and incredibly, their customers—the surgeons. One TSB follower wrote that it was important to be able remain anonymous because if their employers knew what they really thought, they would be fired and their customers would stop buying products from them.

The site frequently feels like a therapy session for people in fear of their livelihoods, their careers and the loss of a golden age in spine sales. TSB gives a vocal group of followers a forum to express their frustrations.

Here's a TSB posting from July 2009:

"Witness the carnage in our industry that has resulted in over 500 different pedicle screws, nearly 300 cervical plates and countless TLIF, PLIF, ALIF and Cervical PEEK devices. Have all of these products really made a difference in outcomes? …Or, have these products saturated an already existing commodity market? As investors hold on to their hard earned capital there will be fewer opportunities for 'me too' products to succeed. How will this shift affect the earning capabilities of the salesperson? There will be a shift in the commission structure resulting in less earnings for the distributor or direct salesperson. I know that many of you do not like reading this, but if the company’s bottom line suffers, so will your ability to sustain your earning capacity.

"…What happens when companies start believing that they could exist without sales people and start to model their distribution model by selling to the hospitals directly? If you don’t think that’s possible, it has already been piloted by various small companies and tabled by larger organizations."

Who Is TSB?

We are frequently asked if we know the identity of TSB.

We’ve wondered ourselves and we’ve heard other people’s speculation.  But then, this past June 18th, an email came our way from, we believe, a former colleague of ours and, lo and behold, it came from the same email address that is located on TSB's blog.

TSB only says on his website that he has a background in orthopedics and spine. In his 500 plus postings he has volunteered more information about his background.

Our former colleague's public LinkedIn information says that he is a former VP Sales and Marketing at Custom Spine, former head of business development for Choice Spine and former Senior Director of Marketing Cervical at Surgical Dynamics.  And, of course, he worked for OTW for a while.

In his own words, he writes:

“Began my career at Synthes USA as an AO/ASIF Consultant. After a successful career in sales I was hired by Stryker/Osteonics as part of the management team at Stryker Trauma. Responsible for the initial concept of the T2 Antegrade/Retrograde Femoral and Tibial Nail. Segued into Business Development and Marketing at Surgical Dynamics and Blackstone Medical launching numerous spinal deformity systems. Worked as a consultant raising capital and negotiating licensing agreements between educational institutions and early growth stage companies. Spent one and half years at Custom Spine as VP of Sales and Marketing. Currently employed at Choice Spine in Business Development.”

Intoxicated With Entrepreneurial Fever

Three days before the launch of TSB, our former colleague posted the following comments on www.xconomy.com in response to the demise of IST (Innovative Spine Technologies.)

"During Wall Street’s heyday spinal implant companies sprung up because there was excess capital. Industry professionals became intoxicated with 'entrepreneurial fever' a by product of the artificial disc deals. New companies immediately aligned themselves with surgeon champions to create leverage with potential investors. Many surgeons even invested in some of these companies.

"…at best IST was a “me too” company competing in a zero-sum market…Before ’09 is over many of these companies will either disappear, align themselves with a company that compliments the gaps in their respective portfolios or be sold in 'fire sales'."

That got us thinking that we've read this language on TSB.

For instance,

On November 8, 2009, TSB posted the following:

"Entrepreneurs have contributed to the success of spine, considering that without their interest some of the same technologies that we sell today would have never made it to the market. But, has this 'mania' led to the unethical behavior that exists in today's industry? If surgeons become 'salesmen' or public relations experts for a product that they have invested in, or are being paid by a company to use a product, is this good for medicine?

"The total disc boom created what many in our industry still call 'Entrepreneurial Fever!' The dynamics of the economy has changed people’s expectations. It's interesting to sit around a dinner table and listen to surgeons criticize the TARP program and condemn Wall Street when their own behavior leaves much to be desired. Sometimes you feel like saying; 'look at who is calling the kettle black!'"

There was another posting by our former colleague that made its way into the public realm.

Bribery, Wall Street and DOJ

On December 19, 2005, he responded to New York Times columnist Paul Krugman's column, "Drugs, Devices and Doctors" with a published letter titled: "The Me-First Medical Industry."

"I have over 20 years experience within the medical device industry and would love to share with you a first hand account of how companies obfuscate the truth between what constitutes a medical consultant and what is an outright bribe to have the surgeon’s or physician’s business...

"…Wall Street has ramped up and sunk its teeth into the pharmaceutical and device world creating a culture of mad-money. Sometimes there is no rhyme or reason to an idea, yet with marketing and clinical backing, a potential star is born: the product. As a prominent surgeon once told me about the artificial disc, 'As long as the F.D.A. approves it, I will slap as many of them in and let the next guy worry about it after I’m retired. I have stock options and that’s all that matters...' "

In June 2009, TSB wrote the following:

"As most of you know, in the old days (…we actually sold for a living and the market wasn't bought by companies)... Unfortunately, until the Department of Justice steps in and makes an example of those that abuse their privilege our industry we will continue to 'shoot 'em up' and 'duke it out.' The only casualty will be the patient who doesn't know whether they really need surgery or are they being used to line someone else's pocket?"

In July 2009, TSB wrote:

"…there are a percentage of surgeons that no longer want to be surgeons, they want to be entrepreneurs... They want a piece of the action…They are no longer just doctors, they are now master marketeers, selling themselves to the highest bidder regardless whether they believe in the technology or not."

Admittedly, we have picked out a very small sampling of TSB’s writings, but the themes remain the same—“me too” companies, greedy surgeons and besieged sales reps whose employers look at them as a commodity.

Unmasked?

By September 2010, some of TSB’s followers began to call for his unmasking. A series of comments speculated that TSB was John Nieradka, our former colleague at OTW. Another reader commented that TSB was Nieradka and that one company mentioned by TSB should pursue slander and defamation charges against him.

“John N.” responded to followers that he was flattered, but TSB wasn’t him.

Then, as mentioned earlier, we received a communication at the end of June from TSB’s posted email address. The name used by that email writer? “Joe” Nieradka.

This writer doesn’t know a “Joe” Nieradka, but TSB either inadvertently unmasked himself or someone purposely tried to get the hounds off his trail.

If TSB is John Nieradka, “Say it’s so Joe.”

Writer’s Note: We emailed TSB a list of questions for this story. He said he’d respond. We did not receive the reply in time for this story, but will report his answers when we receive them.