The First Guy Through the Wall Always Gets Bloody…

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This morning I’d like to share a quote from the movie “Moneyball”. The context is to contemplate my journey since 2005 and to provide inspiration for innovators dealing with the weight of being first. It’s been a hell of a ride and while I might tweak a few things, I wouldn’t trade it for a more traditional career. Let’s dig in.


My 58th birthday was on Labor Day this year. I spent it with my youngest son trying to get back home from a college football game which itself was like a scene from the movie “Trains, Planes, and Automobiles”. So instead of getting back to Denver at 11 am, after a few Delta Airlines SNAFUs and a 5-hour unplanned drive from Florida to Atlanta, we walked in at 7 pm. However, despite the trouble getting there and home, it was such a special time with my son who leaves for college at the end of this school year, that I wouldn’t have traded it for anything. Hence, that experience got me in a contemplative place, which is something we “hair on fire”, 24-7 workaholic types rarely do. So I thought I would take advantage of that and write.

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In the sports world, one guy that took a completely different path, who was destroyed for daring to change the game of baseball, and then had great success was Billy Beane – the former general manager of the Oakland A’s. The A’s had a problem. They had far less money to spend on star athletes than someone like the Yankees, so Billy went a different direction. The research had shown that analytics like getting on base were better predictors of scoring runs than star power, so they began to recruit that way. This really pissed off scouts and traditionalists who were looking for future stars. Ultimately, after being excoriated for making this change, Billy and his team were rewarded with a record 20 game winning streak.

All of this is captured in the movie Moneyball, with Brad Pitt. At the end of the movie, Billy is invited out to Fenway Park for a job interview and is met by the billionaire who owns the Red Sox and this is what he tells him:

“I know you’re taking it in the teeth out there. But the first guy through the wall, he always gets bloody, always. This is threatening not just a way of doing business but in their minds, it’s threatening the game. But really what it’s threatening is their livelihoods, it’s threatening their jobs, the way that they do things. And every time that happens, whether it’s a government or a way of doing business or whatever it is, the people who are holding the reins, who have their hands on the switch, they go batshit crazy…”

Founding Modern Interventional Orthobiologics

Way back in 2004, when I began this journey, only one person on earth had treated orthopedic problems with a same-day stem cell procedure (bone marrow concentrate), and based on his publications, he was focused on treating bone disease. Nobody had published that either bone marrow concentrate or culture-expanded mesenchymal stem cells could be used to treat more common orthopedic diseases like knee arthritis, shoulder rotator cuff tears, low back pain, or ligament injuries. There were no machines to produce these products made from the patient’s own stem cells and certainly no kits. There were no textbooks or papers written to show how to perform these procedures. Even PRP was only generally used by a handful of dentists.

So I spent about a year researching the safety of doing something like this and then I convened an Institutional Review Board (IRB) to bounce my ideas off of other physicians. Then we began treating patients with that supervision. A few years in we learned that the FDA didn’t like us culturing cells and we painfully challenged that decision. Ultimately that led to the current FDA regulatory paradigm.

Along the way, this was very much like pushing a HUGE rock uphill. Many of my colleagues thought I and my partner John Schultz were insane. Many of those same colleagues who called us witch doctors back then have long since added the same orthobiologic injections to their practices. So we had the last LOL.

Eventually, after we began seeing amazing results, that pole position of being first led us to a billionaire investor and the attention of other physicians who wanted to do the same thing. Regenexx was born, which led to all sorts of great things like developing a new field called Interventional Orthobiologics, a fellowship program where we could teach this to young doctors, a hugely successful practice, coverage by self-insured companies, dozens of peer-reviewed publications, etc…

It’s been bloody at times as the first through the wall, so when I watched Moneyball again, that quote and scene spoke to me. Maybe it was the confidence with which the billionaire investor said those words, having worked with countless start-ups. He said it like he had used that speech with many innovators who were feeling the enormous weight of being the first person to try something new.

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Looking Back and Forward to the Finish Line

Now, as I relayed above, the funny thing is that we have a huge percentage of modern orthopedic practices that have adopted interventional orthobiologics. Hence, it’s much easier to have been the first guy through the wall, looking back with the scars to prove it.

The goal now for the next decade and the twilight of my career is to tie up the loose ends. Get as much of the seminal research done as possible so that the picture is left as complete as it can be. Also to encourage all the people in this space to get that research done as well. To leave this crazy idea as the standard of care rather than experimental. In addition, to help train and educate young physicians so that they too can innovate well beyond where we are today.

The upshot? The first guy through the wall always gets bloody. However, I wouldn’t change being that guy for anything. Sure it’s no fun when you’re punching through the wall, but when you’re looking back and what you did is now almost self-evident, it gets a lot more fun. So if you’re innovating and feeling the pressure from daring to change the game, ignore the naysayers and noise and push forward; it gets more fun later on.

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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