Dennis Bruns

EXPLORING THE GIANT BUSINESS OF UNNECESSARY SPINAL SURGERIES Dangerous Criminals Under the Radar of Spinal Surgery Candidates BY Dennis Bruns Musculoskeletal Physiotherapy Specialist YouTube.com/@PhysioDennisBruns/ TABLE OF CONTENTS Foreword by Professor H.J. Freisleben 3-4 Foreword by Dr. John Nordt 4-5 Introduction 6 A Multifaceted Problem 7 Physician-Owned Distributorships (PODs) Dr. Death Irreversible Results and Legal Disputes Professional Cover-Up and Whistleblowers - The FBI is Out There to Get the Job Done 10 Lobbyism and Ghostwriting 11 Global Problem 11 Identifying and Appreciating the Noble Surgeons 12 Alternative Solutions 12-13 Resources/Further Reading 14-20 UNECESSARY SURGERIES Foreword by Professor H.J. Freisleben This article by Physiotherapist Dennis Bruns deals with questionable unethical practices of surgeons in the field of spinal surgery. Surgical interventions have been practiced for ages, even by Neanderthals and prehistoric ancient cultures. In middle-age Europe, surgery was not considered a part of medicine and it took centuries until surgery was integrated from barbers’ skills into the curriculum of medical schools and eventually became a discipline of modern medicine. Principles of medical ethics were first established in written form in ancient Greece, about 2500 years ago. This writing has been ascribed to Hippocrates (460–370 BC), a medical practitioner and teacher on the island of Kos and is known as Hippocratic Oath. Medical ethics have changed through centuries and what is considered “ethical” today may not have been so in former times and vice versa. However, some basic ethical principles are generally valid and timeindependent pillars of medical ethics and are – among others –important in our context, beneficence (which means doing good), non-maleficence (doing no harm), and justice(ensuring fairness). In the WHO modification, these principles are called integrity (meaning to behave in accordance with ethical principles and to act in good faith, intellectual honesty, and fairness), accountability (meaning to take responsibility for one’s actions, decisions and their consequences), and respect, which - especially in our context - means to respect the dignity, worth, equality, diversity and privacy of patients; WHO Code of Ethics and Professional Conduct demands ethical principles not only for physicians and surgeons, but also for all other medical specialists and health care workers “to conduct oneself ©PHYSIO DENNIS BRUNS | PAGE 3 UNECESSARY SURGERIES … to ensure that personal views and convictions do not compromise ethical principles and official duties”. This applies especially to medical practitioners including surgeons not to put their personal profit over the well-being of their patients. Prof. (em) Dr.rer.med.Dr.habil. Hans Joachim Freisleben, MPharm. Professor of Biomedical Pharmacology, Past Head of Medical Research Unit Faculty of Medicine University of Indonesia, Jakarta, Indonesia (from 1996) Past & Honorary President of the German-Indonesian Medical Association (DIGM e.V.) Guest Professor to Universities of Graz, Austria (1993-94); Palermo, Italy (1995); Sydney, Australia -); Priv.-Doz. (Physiol. Chem.) Faculty of Medicine & former Head, Laboratory of Microbiological Chemistry, Goethe-University Hospital Frankfurt/Main, Germany -) Foreword by Dr. John Nordt I highly welcome this article by Physical Therapist Dennis Bruns from Germany about the multifaceted problem of unneccessary spinal surgeries and related unethical systemic issues. The article contributes to raising awareness for the public about the development of unethical medical practices which are very inauspicious for patients as well as for the community of physicians. MRIs came on the scene in 1989 and sustained our clarity of diagnosis that we determined by a physical exam prior to MRIs. In the past 20 years the MRI has often replaced a careful physical exam with over-diagnosis using only an MRI image. 35% of the MRIs for the lumbar and cervical spine show a need for surgery on patients with no pain. The clinical substantiation of muscle weakness, reflexes and sensory changes can legitimize the diagnosis and without these clinical findings, ©PHYSIO DENNIS BRUNS | PAGE 4 UNECESSARY SURGERIES the MRI is useless and leads to failed surgeries. In most training programs good medical examinations are now substituted with the MRI. The TV show Doctor Death portrays the true story of Christopher Duntsch highlighting inappropriate surgeries which are dangerous and fraudulent, and reflect massive systemic issues. Medicare reimbursement is down 70% in the past 30 years leading to reduced reimbursement and economically unsustainable income in private practice. The independent practice of medicine depends on these reimbursements. Now physicians sign up for employment with a fixed salary and with employer pressure to produce numbers is rampant. Dr. John C. Nordt is a Spinal Surgery Specialist, former President of the Florida Orthopedic Society, and was previously a Professor at the University of Miami. “Truth has to be repeated constantly, because Error also is being preached all the time, and not just by a few, but by the multitude. In the Press and Encyclopaedias, in Schools and Universities, everywhere Error holds sway, feeling happy and comfortable in the knowledge of having Majority on its side.” ― Johann Wolfgang von Goethe ©PHYSIO DENNIS BRUNS | PAGE 5 UNECESSARY SURGERIES After reading you'll have learned about • The Dark Realities of Organized Criminal Activities in Regard to Unnecessary Spinal Surgeries • How to Avoid Becoming a Victim of Unscrupulous Surgeons and Hospitals Introduction Congress has estimated that surgeons perform 2.4 million unnecessary surgeries a year in the USA, a cost of roughly $3.9 billion--and a toll of nearly 12,000 deaths. Approximately 500,000 spinal fusions are performed in hospitals in the USA each year. These surgeries’ costs are more than $12 billion annually, according to the Agency for Healthcare Research and Quality. Opinions of experts vary about how many of them were unnecessary. Spinal surgeries belong to the category of the most profitable procedures for hospitals. Professor Dr. Richard Deyo, a scholar at the Oregon Health and Science University believes it could be as much as 50%. Senior Spinal Surgeon Dr. John Nordt from Miami, Florida, also estimates that around 50% of surgeries annually could be unnecessary. It is noteworthy that many cases go untold as many patients are simply not aware that something went wrong and count it as bad luck. Even if they notice something is not right, there is a tendency to not pursue the matter as it is usually not an easy process to file a lawsuit and have hard evidence, plus, one must usually fight for a long time to get one ́s right in court. Sadly, it is common that headlines are made only by the most egregious cases of unnecessary spinal surgeries. You should understand the magnitude of the problem to not become a victim. ©PHYSIO DENNIS BRUNS | PAGE 6 UNECESSARY SURGERIES A Multifaceted Problem The problem of immoral and unnecessary spinal surgeries is multifaceted. It is not possible to cover all aspects in appropriate depth and precision within this article, but it is possible for you to get a general overview and take away the main points. Physician-Owned Distributorships (PODs) You need to know what PODs are: PODs are groups of medical doctors, mostly surgeons, who have a legal agreement about the purchase of spinal hardware (screws and rods etc). The key point here is that the surgeons in the POD profit from their own referrals. This situation is very tempting for the surgeons in question as the financial incentive is very high, and additionally it is also very convenient to reap royalties from such practices. This creates a very dangerous situation for patients because unnecessary surgeries are far more likely to be performed under these circumstances. You must understand that aggressive surgeries on the back (with much hardware involved) are the most rewarding for the surgeon monetarily and present the greatest danger for the patient. We ́re talking about massive profits. A surgical procedure on the spine is financially far more rewarding than an operation on the brain: up to 10 times more. "While these arrangements are not always problematic, we are seeing more and more of these physician-salespeople using the very devices they sell in the surgeries and procedures they perform," Senate Finance Committee chairman Orrin Hatch (R-Utah), said at a hearing on PODs. "Many critics ©PHYSIO DENNIS BRUNS | PAGE 7 UNECESSARY SURGERIES have argued -- with significant evidence to support their case -- that this practice creates a financial incentive for these physicians to recommend and perform more and more unnecessary surgeries." The Office of Inspector General (OIG) at the Department of Health and Human Services issued a fraud alert on PODs, calling them "inherently suspect" under federal anti-kickback laws. By now, you should understand the fundamental and massive conflict of interest in these PODs and have a feeling for certain tactics of the spinal device companies. Dr. Death You may have heard of Dr. Death aka Christopher Duntsch who has been sentenced to life imprisonment, housed at the O.B. Ellis Unit outside USA, with no option for parole until 2045. If you do not know this horror story yet, please read up and watch the episodes on TV. This psychopath and sociopath could and should have been stopped much earlier, before he had caused tremendous and horrible harm to many people; real people like you, not actors in a movie. He is not the only surgeon sitting in prison, and he will not be the last. There are many surgeons in prison who have been sentenced for unethical practices. Some people will do almost anything immoral for the right amount of money. Irreversible Results and Legal Disputes Another key take away is to know that such surgeries are a one-way road: you cannot turn back the wheel of time and must live with the results. Such surgeries can result in your death or permanent disability (like spending the ©PHYSIO DENNIS BRUNS | PAGE 8 UNECESSARY SURGERIES rest of your life in a wheelchair and so on). You ́ll find many resources in text and video format in the bibliography chapter to see that many such cases are well documented in academia and in mainstream media. It is in your own best interest to be critical, do your due diligence, and not rely on blind faith. Spinal surgeons are also rarely held accountable if the operation fails, so do not hope to easily get properly informed or compensated if you become a victim. You might face many years of legal dispute. Those who face the terrible consequences of unnecessary back surgeries wish they had been more sharp-minded when they had been given advice by unscrupulous surgeons. Professional Cover-Up and Whistleblowers There are dramatic failures of back surgeries; this fact is downplayed on a professional scope, and there is little authoritative oversight. Listen to whistleblowers like Professor Charles Rosen from California or Dr. John Nordt from Florida who have been in the industry for decades! These spinal surgeons have spoken out about the brutal truth, even at the expense of their job security. Recent examples of horrible events in California were discovered by whistleblowers Bill Reynolds and Mark Sersansie which brought to light a Billion-Dollar Surgery Scam which ruined the lives of many patients with counterfeit hardware in their back. This healthcare fraud from a few years ago is an example of an organized crime activity which involved surgeons receiving kickbacks, with middlemen and hospital administrators working secretly together. It is one of the largest cases exposed in the history of the State of California. ©PHYSIO DENNIS BRUNS | PAGE 9 UNECESSARY SURGERIES Many surgeons are actually highly paid consultants. Don ́t let unscrupulous spine surgeons talk you into costly and dangerous surgeries by taking advantage of your naivety! It is a common practice of unethical surgeons to exercise undue influence by heightening anxiety in a disproportional way. The FBI is Out There to Get the Job Done The FBI is out there with many specialized and strongly determined units to arrest criminal individuals and gangs who operate in the fields of healthcare frauds. An example from 2021: “As alleged, Chin, Humad, and their medical device company SpineFrontier conspired to pay out millions of dollars in kickbacks in the form of sham consulting fees to surgeons across the country who sadly, prioritized these payoffs over their patients’ best interests. We believe they also cheated taxpayers who ultimately foot the bill for their medical procedures,” said Joseph R. Bonavolonta, Special Agent in Charge of the FBI Boston Division. “Today’s arrests show that the FBI will not hesitate to go after those who try to undermine the integrity of the medical decision-making process to take advantage of patients for their own personal gain.”“Kickback arrangements pollute federal health care programs and take advantage of patient needs for financial gains,” said Acting United States Attorney Nathaniel R. Mendell. “Medical device manufacturers must play by the rules and we will keep pursuing those who fail to do so, regardless of how their corruption is disguised.” ©PHYSIO DENNIS BRUNS | PAGE 10 UNECESSARY SURGERIES Lobbyism and Ghostwriting It is also noteworthy that much research literature published in top academic journals as well as in mainstream magazines is funded by the industry, not by independent researchers. Their marketing budget is extremely high to activate surgeons and their affiliates as lobbyists. And ghostwriting is a connected problem in this whole mess: it is well known fact that certain medical device companies pay famous researchers and medical practitioners enormous sums to have them put their name under the articles which have been written by the company itself, of course in favor of the devices needed for surgery. Global Problem It is also not a problem solely existent in the US, but it is problem prevalent also in other countries on a vast scale. The topic is investigated by many governments and foundations and the evidence is overwhelming. As an example: Germany ́s Bertelsmann Foundation has also recently published an extensive report about the great prevalence of overuse of diagnostic procedures and unnecessary surgeries. So, your takeaway here is that you need to keep your eyes open wherever you are in the world when it comes to surgeries. ©PHYSIO DENNIS BRUNS | PAGE 11 UNECESSARY SURGERIES Identifying and Appreciating the Noble Surgeons On the other hand, there are important and urgent surgeries, and there are excellent surgeons with bright brains, noble hearts, and gifted hands. It is important to identify them and acknowledge their great qualities and service to society. Surgeons study hard for a very long time to be proficient in their discipline, and go through many hardships to master their craft. Even after being fully graduated they continue to educate themselves on a regular basis. A good surgeon will try their best to prevent surgeries, using conservative treatment as much as appropriate, will inform you patiently with compassion about the upsides and downsides of surgery, will not feel irritated when you express your wish to have a second or even third opinion, and will talk in a relaxed and transparent way about their financial involvements with surgical device companies if you ask. It is important that your surgeon is not keen on immediately suggesting a surgery, and helps you to thoroughly consider alternatives. Alternative Solutions Passive and active Physical Therapy is cost effective and helps in the vast majority of cases. Conventional (non-surgical) therapies have far more upsides and far less dangers such as paralysis and life-threatening complications. The smartest approach is focusing on preventing surgeries in the first place: being disciplined in exercising on a regular basis, using movement as medicine, is a relatively easy and inexpensive prevention method. The exercise doesn't have to be a complex endeavor. For instance, swimming, climbing, cycling, or yoga 2-4 times a weekly with only moderate intensity can be utterly enough to avoid back pain. Importantly, do not neglect to take care of back pain via a model which incorporates the ©PHYSIO DENNIS BRUNS | PAGE 12 UNECESSARY SURGERIES entire person (bio-psycho-social model). In short: in prevention and rehab, mechanical factors are rarely the main or single factor when it comes to back pain. Recent research suggests psychological, and social-economic influences play a large role in many cases. Developing these positive selfcare habits will have a great return on investment for your spinal health. Acknowledgements I thank Professor HJ Freisleben for his valuable review and comments for corrections, and his foreword. I also extend my gratitude to Dr. John Nordt for sharing his great knowledge on the subject matter, and for writing a helpful foreword. Finally, to Rahula Shakya-Friedensohn for helping with editing, proofreading and formatting this document. ©PHYSIO DENNIS BRUNS | PAGE 13 UNECESSARY SURGERIES Resources/Further Reading Unnecessary Surgeries/Medical Malpractice Medress ZA, Jin MC, Feng A, Varshneya K, Veeravagu A. Medical malpractice in spine surgery: a review. Neurosurg Focus. 2020 Nov;49(5):E16. doi: 10.3171/2020.8.FOCUS20602. PMID:-. Tayade MC, Dalvi SD. Fundamental Ethical Issues in Unnecessary Surgical Procedures. J Clin Diagn Res. 2016;10(4):JE01-JE4. doi:10.7860/JCDR/2016/- DuBois, J.M., Chibnall, J.T., Anderson, E.E. et al. Exploring unnecessary invasive procedures in the United States: a retrospective mixed-methods analysis of cases from-. 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