Last night I logged yet another monthly webinar, which went well, until I had to deal with an angry medical salesperson on LinkedIn. Like many who have come before him, he didn’t like my take on amniotic fluid products, a product that his conference company was pitching. It was an interesting conversation that revealed much about how medicine works, and what we’ve tried hard to avoid at Regenexx.
The Medical Sales Industrial Complex
To most patients and physicians, the mechanics of how medical products are sold are invisible, hidden backstage like the puppet strings in a puppet show. They usually don’t understand that many medical conferences where physicians learn are scripted affairs, often heavily controlled by industry. Let me explain.
There are two kinds of medical conferences—for profit and not for profit. Generally the for-profit conferences work differently. They’re what I call “pay for play.” That means that a company advertising a product can indirectly pay fees to ensure that a representative of the company’s product can speak on the podium in front of other physicians. It’s a bit like a company purchasing a commercial on TV, but at a medical conference. In principle, as a capitalist, there’s nothing wrong with this approach, as long as the doctors in the audience know they’re hearing an unabashed commercial. The problem at “pay for play” conferences occurs when it’s not clear to the audience that they’re hearing a commercial and not a medical lecture focused on some bit of data.
At “pay for play” conferences, any medical device or product company worth its salt won’t usually put the CEO or anyone who works for the company up on the podium; they’ll generally use a proxy physician. This is all too often a university or other physician of some renown either due to his prior research or his past discoveries. This celebrity doctor on the podium may be taking actual payments from the company, or he may just get his research funded or some free product he can turn into cash in his practice. He’s supposed to disclose to the audience that he has a financial arrangement with the company. Many times this happens, and many times at many “pay for play” conferences I’ve attended, it doesn’t happen or isn’t made clear. Oftentimes these days it’s hard at these conferences to figure out which celebrity doctor is working for which company. However, having been around this block a few times, I can usually figure it out.
Messing with Medical Sales
If you follow this blog, you’ve read about my concerns about the rampant consumer fraud occurring around amniotic fluid “stem cell injections.” Basically, this is a product that we were super excited about several years ago when we were approached by sales reps claiming that each vial of the stuff had millions of stem cells. Knowing that medical sales reps are about as honest as used-car salesmen and having a stem cell research lab where we could test these claims, we set out to ensure that there were in fact stem cells in these vials. It didn’t take long to find out that it was all dead tissue (i.e., no living cells, let alone stem cells). We then turfed this over to the Interventional Orthopedics Foundation (a 501c3 non-profit) to see if they could determine the following:
- If all products we found were like this or did some have stem cells?
- If these were all dead tissue products, could some have the ability to help older stem cells?
- If not, then how did the growth factor effects of these products compare to simple and less expensive things, like a platelet rich plasma shot?
After months of testing, all of the above came back negative in that all amniotic products tested were dead, they couldn’t help older stem cells, and the effects on stimulating stem cells were generally weaker than simple PRP. While we were bummed, we weren’t surprised. In addition, we couldn’t rule out that these cells might have some other effect on patients, so that meant waiting for good clinical data to arrive that compared these shots head to head with PRP (there was none then, and there still is none today).
To make sure everyone got the message on these products, I needed a one-liner so that doctors and patients could both quickly understand our negative data, which arrived one day when an OB/GYN colleague of one of my medical partners laughed when he heard that orthopedic focused physicians were injecting amniotic fluid to help musculoskletal pain. He said something like, “Don’t they know that by the last trimester that stuff is mostly baby piss?” Hence, until we have some robust clinical data on this stuff, I have since termed these injections “baby piss shots.” Regrettably, that statement caught the ire of a conference-based sales guy last night.
My Misinformation Campaign and the Sales Guy
While I was winding down a stressful day at the office that seemed to have me pulled in 20 different directions at once that was capped off with a patient webinar, my phone began bleeping at me in rapid staccato fire mode. Huh? What could be so important at 7:30 p.m.? I quickly checked (which is likely a bad idea when you’re winding down, but after all I am a real doctor so I don’t have the luxury of avoiding my phone). Bad idea…
This was a gentleman whom I had never met. I learned from his profile that he was the owner of a company that runs “pay for play” conferences. His background is mostly in medical and software sales, and he holds no PhD or medical degree, doesn’t practice medicine, and has no publications in stem cells or regenerative medicine. What followed was a really nutty back and forth about how I was, in his opinion, misrepresenting amniotic fluid products on my webinar. At first I couldn’t figure out why this guy, whose career was in medical-device and software sales and who was now running a for-profit series of medical conferences, would care what I thought about amniotic fluid. Then it hit me: I should check his latest conference listing. What I found explained it all. There was a list of physicians, each one I could tie back to some product being sold in the regenerative medicine space and hawked at the conference. In particular, one of the companies funding the conference was an amniotic fluid vendor. OK, now it all made sense…
Agnostic About Technology…
What the conference sales guy couldn’t get (which really pisses off lots of sales guys hawking specific technologies) is that Regenexx is agnostic to what’s being sold. Our job as an elite national medical group of orthopedic regenerative medicine experts is to pick the best possible technology for our patients after vetting it all ourselves. That’s why we maintain more than a million dollars in lab equipment in Colorado and why we employ a PhD-led lab and clinical research team.
The physicians in our medical group, after being handpicked based on injection skills, use a flexible lab platform in their offices that can deploy any number of regenerative medicine technologies. While we do our own research on improving what to deploy, what patients can always count on is that we will have independently tested and vetted the best that’s out there. Here are some concrete examples of technologies that we have vetted in the last few years at our expense on the behalf of patients:
- An expensive bone marrow harvest device—wasn’t able to beat a simple device
- A liposuction device that boasted it could isolate stem cells—didn’t isolate enough of them to make a go of it…
- Amniotic fluid and membrane products—you know the story there…
Had any of these worked as advertised, they would have been deployed throughout our network. Had we taken any money from any of these manufacturers (as many physicians do), we would have been wed to that ineffective product, so again, all of these were tested at our expense.
In the end, what the conference sales guy missed and what pisses off many medical-device sales guys is that at Regenexx, we don’t care what the technology is that’s deployed, as long as it’s vetted. So even “baby piss,” if it can garner enough good clinical data showing that it’s more effective than much cheaper platelet rich plasma, we would take a second look at in a heartbeat.
The upshot? Most patients and physicians would be disturbed to know that their doctor or his educator may be on some device’s company’s dole. We at Regenexx don’t take money from industry as our goal is to stay agnostic about which technologies we use. We can invent them, or someone else can show based on clinical evidence that they need to be deployed through our medical group to better serve patients. But rest assured, we will vet them at our expense and will never be shy about letting the world know that the better mousetrap failed to catch mice!