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Publication of the Connecticut Orthopedic Society President's Cor nerResearch Data vs. Marketing HypeMichael Marks,M.D.,M.B.A. - President A long held adage has been that probably only 10%of all patients with disk herniations ultimately need surgery. It is also documented that with surgery, the infection rate is roughly 1%. If we then start with a population of 1,000 patients, operate upon 100, then only one patient should be unfortunate enough to get an infection. However, if we are overzealous in our surgical indications, and operate upon 500 patients, there will be 5 infections. Still an acceptable 1 %infection rate, but now with a 500% increase in the on the bandwagon when somethingnew arrives on the scene. We do this Many of us probably remember Zomax and/or Duract because our personalities lead us to be early adapters or we – earlier anti-inflammatory medications that were feel pressured to look for a marketing advantage for our excellent pain relievers, but they were taken off the practices. Without a crystal ball, there is no way to know market because they caused severe end stage liver what the longitudinal studies will demonstrate – until failure. Like Toradol, they were designed for short- sometimes it is too late. There is very little in medicine or term use, but physicians kept on writing prescriptions society where the terms always or never apply. We must that lasted weeks and months. We must be vigilant in remember to keep in mind what the true indications are for checking laboratory work in patients we keep on anti- a particular drug or prosthetic device.
inflammatory medications for long durations.
The most sage statement on this subject I heard was at an It is apparent that COX-2 inhibitors are not the AAOS meeting in the 1980’s, when a paper on the panacea that was marketed to us. They however do Kennedy LAD ligament was preceded by the statement, provide a choice in cases where there is truly no drug “Why is it that when we get a new hammer, everything alternative – patients unable to tolerate the gas- looks like a nail?” The Kennedy LAD ligament was trointestinal side effects of NSAIDs, those on developed as salvage for the multiple-operated ACL coumadin and in the perioperative period. I applaud deficient knee. Many complications arose when it was used the FDA for using common sense on this issue and leaving these drugs in the armamentarium of physi-cians. It is now time for physicians to likewise use Spine surgery seems to be at the forefront of new innova- similar common sense and judgment in their prescrib- tions. In the 1990’s the Ray and BAK cages were marketed as easy devices to achieve spine fusions. They literallywere being thrown in both front and back. As a result, too COX-2 inhibitors were marketed to both physicians many cases were being done with many complications and and the public. We have also been barraged by marketing on minimally invasive techniques for joint ( c o n t . o n p a g e 3 )
The 2005 Legislative Session is well underway and itwill be a long session especially for medicine as the battle continues in the liability reform arena. The Con-necticut Orthopedic Society and its members are work- ing diligently this legislative session to protect physicianmembers and to augment the political activities of otherspecialty societies and the Connecticut State MedicalSociety.
Liability reform will be a major focus once again this
session. There are numerous bills currently being replacements and just around the corner – total disk considered that focus on various aspects of liability replacements. One currently is FDA approved, with more reform and a public hearing on all the bills is scheduled to come. All of these pharmaceutical and device implant for Wednesday, April 6th at the Legislative Office
companies are designed to improve the quality of our Building. For more information and/or to sign up to patients’ lives but they also produce profits for their provide testimony, please contact the CT State Medical publicly traded companies and that we should never forget. DePuy Spine paid $325 million for the ChariteDisk, Stryker paid $360 million for the Flexicore Disk, Other major focus areas that are important to physicians Synthes paid $350 million for the ProDisc and Medtronic and the practice of medicine include the following bills: paid $270 million for the Bryan Disk. The average Expand Podiatry Scope of Practice to include the
lifespan for a spinal implant is 3 years. I’m sure that these ankle (SB 544 – introduced by Senators Duff & companies expect a good return on their investment, which Gunther). A public hearing was held earlier this month means that many cases will have to be done for a return on and thanks to your colleagues, Drs. Aronow, Cimino and their investment. The mentality of these companies is no Berson for taking the time to testify on behalf of all different from the automotive industry – products must orthopedic surgeons. We anticipate legislators request- constantly be changed and innovations added to maintain ing the Society and podiatrists mediate this issue outside of the political landscape and the Society will work to However, we must still applaud these companies for ensure that patient safety is held to the highest standard.
spending large sums on research to bring us new products.
Establishing Standards in Contracting for Physicians
We should and must keep our offices open to the company which would prohibit insurer’s from unilaterally chang- sales representatives – we have a symbiotic relationship, ing a contract and require full fee schedules to physi- but remember “Buyer Beware.” The relationships would cians considering the contract (SB 929 – introduced by work better if there wasn’t direct to consumer advertising Sen. Crisco). This bill continues to work through the of pharmaceuticals and device products. As physicians we Committee with many legislators favoring relief for are getting hit by both sides (patients and manufacturers) to adopt new products and prescribe new drugs.
Patient Access to Physical Therapy to revise the
Part of the Hippocratic Oath stresses that the physician definition of physical therapy to permit physical thera- should do no harm. I have always found that by asking pists to treat patients without a referral for up to 30 days one simple question I can sleep comfortably at night.
and would establish minimum continuing education Would I recommend to a favorite family member to take a requirements for therapists (HB 6767-referred to Public drug or have a particular surgical procedure performed? Health Committee). The Society will be fighting this bill These are difficult times for the practice of medicine.
and provide testimony once a public hearing is sched- It gets somewhat easier when we remember the scien-
tific basis of our profession. Mark your calendar to
Cooperative Healthcare Arrangements to allow
attend our Annual Meeting, April 29,2005 at the
physicians to jointly negotiate with insurers ( HB 6759 – Farmington Marriott for a collegial time with scientific
referred to Committee on Labor & Public Employees) enrichment. I hope to see you there.
( c o n t . o n p a g e 5 )
EDITOR'S NOTE: The Society appreciates the assistance of Dr. Ron Ripps, Immediate Past-President, as the contributing
editor for this column.

D x : St r e s s
couldn’t wait till our next outing. I was actually having a R x : B e c o m e a M e n t o r
blast! Going places and doing things that my wife wouldcertainly never do, and which my teenage boys wouldn’t Special thanks to contributing writer, Steven Schutzer, do with me anymore proved to be incredible FUN. My M.D., Orthopedic Associates of Hartford, Hartford, CT, “LB” and I enjoy going to the movies… although none have been Oscar winners, I think I laughed harder watch- OK…who is feeling a little stressed out with the ing “Johnson's Family Vacation” than any other film in increasing day to day pressures of our busy practices, many, many years. We have a natural “Big/Little” rivalry hectic family schedules and mega baud pace and expec- that has led to some fierce competition at the bowling tations of our high tech society? Count me in. Finding alley, on the basketball court, at the batting cage, at laser and maintaining optimal balance has become quite a tag, and on the go-cart track. Last year, he finally caught a challenge these days but is, perhaps, more important now than ever before. Fortunately, I’ve discovered severaloutlets that have helped me, enormously, to remain Teaching the value and importance of hard work, success and achievement has been one of my goals. Consequently,we spend some afternoons working on school projects or My martial art training has, for many years, provided reports, reviewing books that we’ve both read or discuss- a roadmap for self-discovery and personal growth. A ing local, national or international current events. I’ve ride on my Harley Davidson Road King down some been somewhat surprised to find that my “LB” actually windy country road can surely do it for me. Yet, for soaks up the life lessons that I’ve tried to impart to him, some reason I felt compelled to inquire about becoming even across our cultural barriers. Most importantly, it has a mentor with the Nutmeg Big Brother/Big Sister become quite clear to me that this isn’t work at all, but a program. My interest in becoming involved was based rather remarkable way to improve and positively influence on a variety of personal factors (but certainly NOT to fill a young person’s life…and have a lot of fun doing it.
a void in my time or daily schedule). After a compre- From a self-serving perspective, I receive more than I give,
hensive screening and training process, I was finally and I often wonder who’s helping who? As our friendship “matched” with a “Little Brother” just over 3 years ago.
has grown, my “LB” has become part of our family and me Colleagues,…it has paid off in so many ways that I a part of his. Having shared many interesting, personal experiences, we’ve both grown tremendously from thisfriendship.
Volunteering to become a “Big Brother” was at first abit nerve wracking. Did I really need the added respon- Hey, you got stress? Want to see it evaporate every sibility? Did I have the time? Did I have the fortitude to week ? Rx: become a mentor now! For information on the make it work and not let my “Little Brother” down? Big Brother/Big Sister program, contact Ms. Laura Green, Could I deal with his family? Am I supposed to be his Executive Director, at
father, brother, or just a friend? How could I get out of itif it proved to be a disaster? Why should I think that Ihave anything to offer some less fortunate kid? These D o Yo u H a v e A St o r y ?
were just a few of my many concerns.
The Connecticut Orthopedic Society would like to hear Truth be told, the first few months were not always from any member who has an interesting hobby, pastime or easy. It was reassuring to know, however, that a Nutmeg anything of human interest to your fellow colleagues. If Big Brother/Big Sister match advocate was always you would like to share your story, please email your 500 available for counsel and advice. As with any new words (or less) article to the BACKBONE Editor, Ron relationship, it also took time, patience, perseverance, Ripps, M.D. at If your story is selected and a healthy dose of experiential/parental child psychol- for the next issue, you will be notified. All submissions ogy. As surgeons, we’re accustomed to and expect should be in Microsoft Word format and sent to Dr. Ripps immediate results. This very special bonding process, prior to June 15th for the SUMMER issue of BACK- however, takes time. I soon found that in sharp contrast BONE. We look forward to hearing from many of our to my worrying about making the relationship WORK, I Connecticut Orthopedic Society Annual Meeting Friday, April 29, 2005
Registration 7:45 a.m. Program 8:00 a.m. - 3:00 p.m.
Farmington Marriott Hotel, 15 Farm Springs Road, Farmington, Connecticut The Connecticut Orthopedic Society, under the direction All Society members (who have paid 2005 membership of Michael Kaplan, M.D., Program Director, has as- dues), medical interns and residents are invited to attend sembled an impressive educational program for its 2005 this event free of charge. Emeritus Members can attend Annual Meeting. Join your colleagues at this centrally at the reduced fee of $40.00. Physician assistants, located meeting and learn from the best speakers and physical and occupational therapists will be charged educators in their respective fields. You won't want to $100.00 for the meeting and luncheon. (See page 5 for
miss this event which will provide you with important Registration Details.)
clinical information, updates and an opportunity to earn4 hours of AMA Category 1 CME Credits.
The Society gratefully acknowledges the generous MEETING SPONSOR
M a x i m i z i n g M o t i o n A f t e r To t a l
K n e e R e p l a c e m e n t
M e n i s c a l T i s s u e Tr a n s p l a n t
F a c i l i t a t i n g Wo r k e r s '
C o m p e n s a t i o n C l a i m s
P r e s e n t a t i o n o f O r t h o p e d i s t o f t h e
Ye a r Aw a r d
P r e s e n t e d t o J o s e p h Z e p p i e r i , M . D .
Tr e a t m e n t o f U n i c o n d y l a r
O s t e o a r t h r i t i s
O r t h o p e d i c Tr a u m a
A A O S U p d a t e
A s s e t We a l t h P r o t e c t i o n
* T h i s a c t i v i t y h a s b e e n p l a n n e d a n d i m p l e m e n t e d i n a c c o r d a n c e w i t h t h e
E s s e n t i a l A r e a s a n d p o l i c i e s o f t h e A c c r e d i t a t i o n C o u n c i l f o r C o n t i n u i n g M e d i c a l
E d u c a t i o n t h r o u g h t h e j o i n t s p o n s o r s h i p o f t h e A m e r i c a n A c a d e m y o f

O r t h o p a e d i c S u r g e o n s a n d t h e C o n n e c t i c u t O r t h o p e d i c S o c i e t y . T h e A m e r i c a n
A c a d e m y o f O r t h o p a e d i c S u r g e o n s i s a c c r e d i t e d b y t h e A C C M E t o p r o v i d e
c o n t i n u i n g m e d i c a l e d u c a t i o n f o r p h y s i c i a n s .

T h e A m e r i c a n A c a d e m y o f O r t h o p a e d i c S u r g e o n s d e s i g n a t e s t h i s e d u c a t i o n a l
a c t i v i t y f o r a m a x i m u m o f 4 c a t e g o r y 1 c r e d i t s t o w a r d t h e A M A P h y s i c i a n ’ s

R e c o g n i t i o n Aw a r d . E a c h p h y s i c i a n s h o u l d c l a i m o n l y t h o s e c r e d i t s t h a t h e / s h e
a c t u a l l y s p e n t i n t h e a c t i v i t y.
President Michael Marks, M.D.
Phone: (203) 845-2200, E-mail
Vice President (President-Elect) Robert Green, M.D.
The Society is urging all of its members to take part in 2 Phone: (860) 728-6740, E-mail the Connecticut State Medical Society sponsored "Doc-
Secretary/Treasurer and Councilor Edward Collins, M.D.
tors' Day at the Capitol." This event provides an
Phone: (860) 456-3997, E-mail opportunity for physicians from throughout the state to Councilor Frank J. Gerratana, M.D.
meet and talk with legislators deciding on key legislative Phone: (860) 832-4666, E-mail issues impacting physicians and their patients.
5 Immediate Past President Ronald A. Ripps, M.D.
Phone: (203) 792-5558, E-mail B BOARD MEMBERS
Wednesday, April 13, 2005
10:00 a.m.
State Capitol, Old Judiciary Room 3rd Floor
11:00 a.m. - 1:00 p.m.
Legislative Office Building
browner@nso.uchc.eduChris Cassels, M.D.
Contact your County Medical Association to register for Doctors' Day at the Capitol or call the CT State Medical Society at 800-635-7740. Don't forget to wear your teamkaplan@aol.comT. Jay Kleeman, M.D.
Adminstrative Office
26 Riggs Avenue West
Hartford, CT 06107

○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ Coding Workshop On March 10th, over 100 physicians and their officestaff took part in a coding workshop at St. FrancisHospital and Medical Center. Thanks to the Society'sunderwriting of the program, Society members and theirstaff were able to learn important coding updates and Annual Meeting
reimbursement tips for orthopedic practices at a fractionof the normal program cost.
Registration Form
___Yes, please register me (us) for the Annual Meeting
This workshop covered updates and changes in coding on April 29, 2005, at the Farmington Marriott Hotel for 2005 and featured speaker, Ms. Mary LeGrand from Karen Zupko & Associates. She presented practical tipsand useful hints for the attendees. This is the Society's4th year hosting this successful workshop.
○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ Practice________________________________
Art Gelber, HealthCareIQ, Mary LeGrand, KarenZupko & Associates, Address________________________________
MBA, and FrankGerratana, M.D., AAOSCouncilor, discuss coding Telephone_________________ Fax___________
The Society would like to extend special thanks to
Registration Status (check one)
___Connecticut Orthopedic Society Member • Robert Green, M.D., President-elect and Ms. Carol
Hornish for organizing the event;
•St. Francis Hospital & Medical Center for hosting the

___Connecticut Orthopedic Society Emeritus event and;
•Sanofi-Aventis, Healthcare IQ and Med-Aid for their
financial support.

___Medical Student, Resident or Intern (NO FEE) ___Physician Assistant, Physical or Occupational Therapist ($100.00 per registrant) Return form and payment (if applicable) to: The Society is pleased to provide members, through our Connecticut Orthopedic Society
lobbying firm, Halloran & Sage, a user-friendly bill tracking report that even provides quick email access to your legislators. To access the current report, log onto and when prompted for username enter hs-ortho and password ortho6871. Thereports are updated every Friday.
We need all our members to get involved. If you are The Backbone is a publication of the Connecticut
Orthopedic Society.
Comments and suggestions should be
interested in testifying (either written testimony or public) at public hearings or contacting and visiting key Susan Schaffman, Executive Director
legislative members, please contact Susan Schaffman, 26 Riggs Avenue, West Hartford, CT 06107
860. 561.5205 phone, 860-561-5205. It is important that email:



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