The Value of Collaboration: St. Louis Orthopedic Surgeon Straightening Scoliosis

 In light of the recent posting of physician payments from Medtronic and their online database, a brief scan of doctors revealed Dr. Lawrence Lenke, an orthopedic surgeon in St. Louis who specializes in correcting spinal deformities. His work over many years, along with many other talented doctors in collaboration with industry, has created better products for patients, which have saved millions of lives.

Lenke, who is also the co-chief of adult and pediatric spinal, scoliosis and reconstructive surgery, the Jerome J. Gliden professor of orthopedic surgery at the Washington University School of Medicine, the director of spinal surgery at Shriners Hospital for Children, and a spine consultant to the St. Louis Rams and Blues, began his collaboration over a decade ago.

He believed there were ways to do things a little better in the operating room, so he pitched his idea for an anterior spine surgery system to Medtronic Inc.  As a result of his brilliant idea, “Lenke has led Medtronic’s development of a complete spinal surgery system that can be customized according to the patient’s size,” according to a recent article in the St. Louis Business Journal. His breakthrough, known as “the Legacy Spinal System, is now one of the leading systems used by orthopedic surgeons worldwide.”

As I noted in my interview with the St. Louis Business Journal, what is even more amazing about Dr. Lenke’s work with Medtronic is that “not a lot of places in the country have orthopedic surgeons who are doing this kind of work.” And because of that, it should come as no surprise that Lenke earned $832,000 in royalties (.5%-1% of sales of the systems in royalties) from Medtronic in the first three months of 2010 to continue developing devices to cure scoliosis (curvature of the spine). 

But what is driving such high numbers are not the royalties, which are very small, it’s that sales are so large because the device has proven so effective. In fact, Lenke receives no royalties from Medtronic devices he uses in his own practice or those used by his team or at any BJC HealthCare Hospital.

Regardless, the money should make no difference to people because Dr. Lenke has found a way to help cure severe scoliosis complications as one gets older, which is an incredible accomplishment, and his patient stories and videos show overwhelming evidence that his services far outweigh any payments he receives.

Dr. Lenke’s case is also a clear example of how sometimes, the only individuals truly qualified to train physicians in the earliest stage of adoption of a new medical device, technique, or technology, are often those who developed the innovation.

In addition to his work, Dr. Matthew Gornet of the Orthopedic Center of St. Louis in Chesterfield received $209,000 in first-quarter royalties from Medtronic for his contributions to a pedicle screw and PEEK rod spinal fixation system. Dr. K. Daniel Riew, a professor of orthopedic surgery and neurological surgery and chief of cervical spine surgery at the Washington University School of Medicine, received $143,000 in royalties for his contributions to a posterior spinal fixation system distributed by Medtronic, and additional royalties from various companies he continues to collaborate with. Such breakthroughs and collaboration are essential for advancing treatments for serious orthopedic conditions.

This kind of payment information is made available because Washington University requires all faculty physicians to annually disclose all payments, whether consulting fees or royalties, received from medical companies. “Of the 1,390 physicians who filed disclosures last year, only 11 received royalty payments, according to Dr. James Crane, chief executive of Washington University Physicians and associate vice chancellor for clinical affairs at the medical school.”

The disclosures by Medtronic on the other hand “precede a disclosure requirement, the Physicians Payments Sunshine Act that will go into effect in 2012 as part of the recently passed federal health reform legislation.” Critics called for the need to make such payments public by claiming that they “create a conflict of interest, influencing which drugs doctors prescribe or which surgical devices they recommend.”

Dr. Lenke acknowledged that “transparency is very important in medicine,” and he applauded Medtronic for being the first company to make these disclosures. He also recognized however, that “there’s a potential for conflict in all that we do,” but that such potential should not hinder “collaboration between the physician in the operating room and the companies that develop the devices because such relationships are necessary for the creation of better products for the patient.”

In his own experience, Dr. Lenke noted that he began to work and collaborate with Medtronic not “to get more money or to make royalties, but to develop something that works better in his hands,” because he has to perform some of the most complex spine surgeries in the world. Frequently, doctors work with industry for this very reason: to develop the best, most effective, product that will make their job easier, and will improve the outcomes and lives of their patients.

In agreeing with Dr. Lenke, I noted that such partnerships are “dependent upon the physician to come up with an idea,” because without such collaboration, we “wouldn’t have improvement in health care.” And over a decade’s worth of work with Medtronic clearly shows this progress and continued improvement as Dr. Lenke is set to work with Medtronic on the next generation of the “Legacy system, to be known as Solera, which is set to launch in the next six months.”

His continued dedication to patients and advances in medical devices clearly show how important the relationship is between R&D, Royalty Payments, Consulting and Education. If there is no R&D going on, then no devices or drugs would be created. Royalty payments show that those devices or drugs are working and have value to patients. Consulting is important to help companies determine where to use the products and what works in what practice settings. Consulting also helps in determining if this in fact is a good idea or a not so good idea, as consultants by and large are opinionated people.

Finally, education ensures that these drugs and devices are discussed in applicability to a practice setting, because no one wants to have surgery done by a physician whose only interface is with a journal article or sales rep.  The face to face interaction is invaluable. So there is a benefit to patient care on every part of the relationship.

In the end, collaboration between physicians and companies that develop drugs and devices are necessary for the creation of better products for the patient. Accordingly, if there is ever a question about the significance these relationships have to the innovation in the medical technology industry, just ask some of Dr. Lenke’s patients or the millions of patient’s lives such partnerships have transformed.