Caption this...

[lobelsteve]

Aspn exists because the usual douches at NANS were not douchey enough.

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[GoBeers]

impressed deer did an ironman though

 

[Orin]

this is probably true, however i generally do not consider academicians who are receiving little to no financial reimbursement from the company to be a true KOL, with the concomitant negative connotations of that moniker.

The key part is they're not being paid directly by a company, but that doesn't make them any less biased.

Most academic places have financial bonus structures that reward those things like grants, lectures, papers, etc. These are also tenure metrics which go into salary before the annual bonus.
Those podium talks at conferences are also covered by funds generated by industry support, putting them up in hotels and sometimes paying an honorarium for their time.
Even organizations that aren't directly funded by devices/pharma are supported by CME funds from supporters, which then go to cover hotels/registration fees/etc.

They are real or pretend experts getting paid to advertise a procedure/surgery/drug under the guise of legitimate medical care. BVNA/Sprint are two current examples that lack any substantive data other than industry funded and run studies. If it were not in medical care, we would call it false advertising.

Industry is the only one willing to fund this stuff. NIH/NSF/DOD/etc doesn't have the desire for those types of studies generally. At the end of the day though, those are still large studies that are done in a regulated manner and published in peer reviewed journals. Industry taint can make it more probable to have a positive result, but wouldn't generally be expected to make everything magically better just because the dollars come from your favorite vendor.

The bigger problem though is that we've got got a lot of pretend experts who sell beyond the data and other pretend experts that don't call out that BS

 

[lobelsteve]

impressed deer did an ironman though

He is the most extreme athlete in all of medicine. He has done 100mi Ultras as well. As much as I look up to him for fitness, I do not care for his practice style. And he and his 10s of millions do not care what we think.

 

[manowar rules]

Are KOLs valuable in maintaining reimbursement for our speciality? Like without Doug Beall, would cuts to vertebral augmentation be worse? If they give us some political power, I can forgive obnoxious social media posts.

 

[gaspasser127]

Are KOLs valuable in maintaining reimbursement for our speciality? Like without Doug Beall, would cuts to vertebral augmentation be worse? If they give us some political power, I can forgive obnoxious social media posts.

Many of them serve on the AMA CPT and RUC committees

Societies advocate on behalf of our speciality (yes, even ASPN and NANS) so we don’t get even bigger cuts to our reimbursement

Say what you want about the “guidelines” published but they force the hand of insurance companies to start covering certain procedures

You can hate on them for certain things… no doubt. But they are not all bad and some really do advocate for our speciality in a way most of us do not.

 

[oreosandsake]

I’ve seen industry sponsored studies that publish negative data. Viadisc study is one example. Doug or Kas or Tim don’t hide it.

no one doubts that industry dollars can cloud judgement or shift the direction of therapies. The same thing happens when cms changes in office kypho reimbursement vs asc

Most of these social media pain influencers are good people. They are wildly successful in a lot of aspects of their lives, not just medicine. Many of them don’t need the money and truly enjoy being a part of cutting edge technology. Sure Some of them are super high utilizers of healthcare dollars and you might not send your mom to them. But most are technically very good.

industry tech starts off as an idea. Then they need to find money to prove the concept. BVN wasn’t invented after the tech came. Neither was the idea of creating a spacer between the spinous processes. Peripheral n stim works but who’s going to find the studiies?

Is the cluneal neuralgia epidemic new or was it every other SIJ you thought you diagnosed?

Lot of the KOLs that get hated on aren’t the stained tie academic guys you want them to be.
That doesn’t mean they aren’t pushing the field forward.

Honest Q: if the field was like this in the 90s, would Derby, Bogduk, etc have been the KOLs ? Racz made catheters and sold needles. Who was doing talks for RF devices in the 90s and 2000s?

I heard Not a single stim conpany was at SIS this year since they were all in vegas. Like it or not, this model of trade show conference is here to stay. Sign of the times?

 

[drusso]

I’ve seen industry sponsored studies that publish negative data. Viadisc study is one example. Doug or Kas or Tim don’t hide it.

no one doubts that industry dollars can cloud judgement or shift the direction of therapies. The same thing happens when cms changes in office kypho reimbursement vs asc

Most of these social media pain influencers are good people. They are wildly successful in a lot of aspects of their lives, not just medicine. Many of them don’t need the money and truly enjoy being a part of cutting edge technology. Sure Some of them are super high utilizers of healthcare dollars and you might not send your mom to them. But most are technically very good.

industry tech starts off as an idea. Then they need to find money to prove the concept. BVN wasn’t invented after the tech came. Neither was the idea of creating a spacer between the spinous processes. Peripheral n stim works but who’s going to find the studiies?

Is the cluneal neuralgia epidemic new or was it every other SIJ you thought you diagnosed?

Lot of the KOLs that get hated on aren’t the stained tie academic guys you want them to be.
That doesn’t mean they aren’t pushing the field forward.

Honest Q: if the field was like this in the 90s, would Derby, Bogduk, etc have been the KOLs ? Racz made catheters and sold needles. Who was doing talks for RF devices in the 90s and 2000s?

I heard Not a single stim conpany was at SIS this year since they were all in vegas. Like it or not, this model of trade show conference is here to stay. Sign of the times?

Great summary! I point out this: Old School OG KOLs (Derby, Bogduk, Racz, Dreyfuss, etc.) did PRIMARY research. They slogged through dissections and designed studies funded out of their own pockets and bank accounts (which, by the way, is an interesting COI...if the primary investigator is paying for the research, that should raise questions of its own).

KOLs 2.0 are more likely to take money from the industry for various investigator-initiated studies that LOOK like science but are also marketing. It's sciency, but not science.

BTW, the NIH and other Federal agencies would certainly pay for neuromodulation research, both basic and applied, but few KOLs have the institutional affiliations and R01 level track record of pulling it off. It's strange that we graduate with so many pain fellows every year, and almost NONE of them go on to develop neuromodulation laboratories in academic medical centers. Strange...

Dirk De Ridder is an example of a LEGIT neuromod KOL scientist.a

Dirk De Ridder - Publications

Neurotree: publications by Dirk De Ridder, University of Antwerpen

neurotree.org

There are many examples of LEGIT regen KOL scientists. Mishra comes to mind...

Mishra AK - Search Results - PubMed

Mishra AK - Search Results - PubMed

pubmed.ncbi.nlm.nih.gov

 

[oreosandsake]

Great summary! I point out this: Old School OG KOLs (Derby, Bogduk, Racz, Dreyfuss, etc.) did PRIMARY research. They slogged through dissections and designed studies funded out of their own pockets and bank accounts (which, by the way, is an interesting COI...if the primary investigator is paying for the research, that should raise questions of its own).

KOLs 2.0 are more likely to take money from the industry for various investigator-initiated studies that LOOK like science but are also marketing. It's sciency, but not science.

BTW, the NIH and other Federal agencies would certainly pay for neuromodulation research, both basic and applied, but few KOLs have the institutional affiliations and R01 level track record of pulling it off. It's strange that we graduate with so many pain fellows every year, and almost NONE of them go on to develop neuromodulation laboratories in academic medical centers. Strange...

Dirk De Ridder is an example of a LEGIT neuromod KOL scientist.a

Dirk De Ridder - Publications

Neurotree: publications by Dirk De Ridder, University of Antwerpen

neurotree.org

There are many examples of LEGIT regen KOL scientists. Mishra comes to mind...

Mishra AK - Search Results - PubMed

Mishra AK - Search Results - PubMed

pubmed.ncbi.nlm.nih.gov

yes, I was thinking the Dutch like De Ridder, Liem, etc

I'm not saying there isn't a strong marketing push. it's all polished in one way or the other now. the packaging has gotten sexier over time. not sure who else besides KOLs keeps track of all the new stim tech, wave forms, high/low frequency etc. in the end as some KOLs have jokingly told me "it's all the same"

how do a lot of people decide on a stim company? whichever rep answers the phone call on the first ring, shows up on a dime, and has the nicest pair of... shoes, and brings food for the office.

I for one, still think those guys in the 80's-2000s really created this field. when Derby was asked why he did those studies, he said that his motivation was to get CMS to pay for them, by proving to the world that they worked.

 

[hyperalgesia]

There are a lot of pain docs I respect and recognize as influential in the field. That's how I would define them.

I reserve the term KOL for docs who are chosen by industry to market their brand.

Occasionally docs are both respectable and are recognized by industry as a KOL. But more often than not, these are totally separate groups imo.

If you want to refer to respectable and influential docs as KOLs, then we better come up with another term for the new grad who places a stim in everyone who moves, publishes a 98.76% success rate, is a featured speaker at NANS, and has every scs rep in the country spreading the gospel about the new KOL...

 

[drusso]

There are a lot of pain docs I respect and recognize as influential in the field. That's how I would define them.

I reserve the term KOL for docs who are chosen by industry to market their brand.

Occasionally docs are both respectable and are recognized by industry as a KOL. But more often than not, these are totally separate groups imo.

If you want to refer to respectable and influential docs as KOLs, then we better come up with another term for the new grad who places a stim in everyone who moves, publishes a 98.76% success rate, is a featured speaker at NANS, and has every scs rep in the country spreading the gospel about the new KOL...

There are ranks and castes of KOLs. Then, there are Super-partners who may or may hold KOL titles. Then, there's @lobelsteve aka OG "World's Greatest Pain Doctor."

 

[lobelsteve]

There are ranks and castes of KOLs. Then, there are Super-partners who may or may hold KOL titles. Then, there's @lobelsteve aka OG "World's Greatest Pain Doctor."

I gave up the heavyweight belt to Rick Derby. He is now the current WGPD.

 

[oreosandsake]

I gave up the heavyweight belt to Rick Derby. He is now the current WGPD.

Think he just let you guard it for him 😜

 

[drusso]

If you want to refer to respectable and influential docs as KOLs, then we better come up with another term for the new grad who places a stim in everyone who moves, publishes a 98.76% success rate, is a featured speaker at NANS, and has every scs rep in the country spreading the gospel about the new KOL...

Is the term "Stim Hoe" too offensive?

 

[drusso]

yes, I was thinking the Dutch like De Ridder, Liem, etc

I'm not saying there isn't a strong marketing push. it's all polished in one way or the other now. the packaging has gotten sexier over time. not sure who else besides KOLs keeps track of all the new stim tech, wave forms, high/low frequency etc. in the end as some KOLs have jokingly told me "it's all the same"

how do a lot of people decide on a stim company? whichever rep answers the phone call on the first ring, shows up on a dime, and has the nicest pair of... shoes, and brings food for the office.

I for one, still think those guys in the 80's-2000s really created this field. when Derby was asked why he did those studies, he said that his motivation was to get CMS to pay for them, by proving to the world that they worked.

Alright, this is one of the more productive threads in recent SDN history, so I'm going to engage...

What those of us who were around and attended specialty society meetings in the late 1900s lament about the new industry-sponsored events is the lack of authenticity of the presenters and the over-scripted nature of the experience.

Pain Society meetings were bare-knuckle brawls in the early aughts, not debutant "coming out" parties. Oooh, come and see the latest Data Reveal showcasing such over-processed and manufactured data that it is the statistical equivalent of Velvetta cheese. Now, it's all Kabuki...manufactured controversy and debate designed to answer trivial questions tied to marketing talking points. It's Mister Roger's make-believe pretending for pain doctors.

Some of us remember meetings when Emeritus SDN'er (Paz RIP and others) CALLED OUT speakers in front of the whole assembly for their industry COIs. I remember seeing audience members on the fly re-calculate the speaker's data, interrupt them with the corrections, and then FINISH their talk. As my grandmother would say, "Now, THAT's Italian!"

Today, watching two KOLs, from the same company nonetheless "debate" waveforms, selection criteria, or whatever is just phony. It's like watching your sister and cousin make out in the basement. It's not that it can't be interesting, but somehow you know the whole thing is not going anywhere. So, it's the inauthenticity that frankly insults the intelligence of the observers. Why are they talking to me that way? Do they think that I'm some kind of idiot?

Like call girls who try to sell you a "total girlfriend experience," these people are up there on stage getting PAID to entertain me AND want to be treated nicely and praised for their efforts. I don't think so. I don't think it works that way. My time is valuable, and they are on the clock getting PAID for this experience. So, I should get to call the shots in terms of the kind of entertainment I want to see. In other words, I want to see KOLs mount each other. If you're getting paid to entertain me, I don't want the "total girlfriend experience." If I wanted a girlfriend, I'd go get one. I want what I can't get at home. I want the punch line to the Aristocrat's joke. I want to ride you like a pony up to a point just short of breaking the law, breaking a Holy Commandment, or committing a human rights violation.

So, if KOLs also know that it's Kabuki and Mr. Roger's Make-Believe for pain doctors, let's take this to the next level. Our specialty should take every opportunity to Squeeze the Charmin with these folks. If they want to be treated like spectacles and commodities, let's treat them that way. Because I've got fantasies too, and I like make-believe as much as the next person. But, first, let's establish some clear ground rules and perhaps a "safe word." Rule number one: I'm not your Boyfriend...

 

[lobelsteve]

Alright, this is one of the more productive threads in recent SDN history, so I'm going to engage...

What those of us who were around and attended specialty society meetings in the late 1900s lament about the new industry-sponsored events is the lack of authenticity of the presenters and the over-scripted nature of the experience.

Pain Society meetings were bare-knuckle brawls in the early aughts, not debutant "coming out" parties. Oooh, come and see the latest Data Reveal showcasing such over-processed and manufactured data that it is the statistical equivalent of Velvetta cheese. Now, it's all Kabuki...manufactured controversy and debate designed to answer trivial questions tied to marketing talking points. It's Mister Roger's make-believe pretending for pain doctors.

Some of us remember meetings when Emeritus SDN'er (Paz RIP and others) CALLED OUT speakers in front of the whole assembly for their industry COIs. I remember seeing audience members on the fly re-calculate the speaker's data, interrupt them with the corrections, and then FINISH their talk. As my grandmother would say, "Now, THAT's Italian!"

Today, watching two KOLs, from the same company nonetheless "debate" waveforms, selection criteria, or whatever is just phony. It's like watching your sister and cousin make out in the basement. It's not that it can't be interesting, but somehow you know the whole thing is not going anywhere. So, it's the inauthenticity that frankly insults the intelligence of the observers. Why are they talking to me that way? Do they think that I'm some kind of idiot?

Like call girls who try to sell you a "total girlfriend experience," these people are up there on stage getting PAID to entertain me AND want to be treated nicely and praised for their efforts. I don't think so. I don't think it works that way. My time is valuable, and they are on the clock getting PAID for this experience. So, I should get to call the shots in terms of the kind of entertainment I want to see. In other words, I want to see KOLs mount each other. If you're getting paid to entertain me, I don't want the "total girlfriend experience." If I wanted a girlfriend, I'd go get one. I want what I can't get at home. I want the punch line to the Aristocrat's joke. I want to ride you like a pony up to a point just short of breaking the law, breaking a Holy Commandment, or committing a human rights violation.

So, if KOLs also know that it's Kabuki and Mr. Roger's Make-Believe for pain doctors, let's take this to the next level. Our specialty should take every opportunity to Squeeze the Charmin with these folks. If they want to be treated like spectacles and commodities, let's treat them that way. Because I've got fantasies too, and I like make-believe as much as the next person. But, first, let's establish some clear ground rules and perhaps a "safe word." Rule number one: I'm not your Boyfriend...

You use words good. When I was a junior KOL I would get in trouble for going off script.

 

[oreosandsake]

Alright, this is one of the more productive threads in recent SDN history, so I'm going to engage...

What those of us who were around and attended specialty society meetings in the late 1900s lament about the new industry-sponsored events is the lack of authenticity of the presenters and the over-scripted nature of the experience.

Pain Society meetings were bare-knuckle brawls in the early aughts, not debutant "coming out" parties. Oooh, come and see the latest Data Reveal showcasing such over-processed and manufactured data that it is the statistical equivalent of Velvetta cheese. Now, it's all Kabuki...manufactured controversy and debate designed to answer trivial questions tied to marketing talking points. It's Mister Roger's make-believe pretending for pain doctors.

Some of us remember meetings when Emeritus SDN'er (Paz RIP and others) CALLED OUT speakers in front of the whole assembly for their industry COIs. I remember seeing audience members on the fly re-calculate the speaker's data, interrupt them with the corrections, and then FINISH their talk. As my grandmother would say, "Now, THAT's Italian!"

Today, watching two KOLs, from the same company nonetheless "debate" waveforms, selection criteria, or whatever is just phony. It's like watching your sister and cousin make out in the basement. It's not that it can't be interesting, but somehow you know the whole thing is not going anywhere. So, it's the inauthenticity that frankly insults the intelligence of the observers. Why are they talking to me that way? Do they think that I'm some kind of idiot?

Like call girls who try to sell you a "total girlfriend experience," these people are up there on stage getting PAID to entertain me AND want to be treated nicely and praised for their efforts. I don't think so. I don't think it works that way. My time is valuable, and they are on the clock getting PAID for this experience. So, I should get to call the shots in terms of the kind of entertainment I want to see. In other words, I want to see KOLs mount each other. If you're getting paid to entertain me, I don't want the "total girlfriend experience." If I wanted a girlfriend, I'd go get one. I want what I can't get at home. I want the punch line to the Aristocrat's joke. I want to ride you like a pony up to a point just short of breaking the law, breaking a Holy Commandment, or committing a human rights violation.

So, if KOLs also know that it's Kabuki and Mr. Roger's Make-Believe for pain doctors, let's take this to the next level. Our specialty should take every opportunity to Squeeze the Charmin with these folks. If they want to be treated like spectacles and commodities, let's treat them that way. Because I've got fantasies too, and I like make-believe as much as the next person. But, first, let's establish some clear ground rules and perhaps a "safe word." Rule number one: I'm not your Boyfriend...

I like it when you engage

You could be a pulp fiction writer

 

[callmeanesthesia]

I like it when you engage

You could be a pulp fiction writer

Fan fiction maybe.
KOL fan fiction; now there’s a (horrifying) thought.

 

[Ducttape]

Alright, this is one of the more productive threads in recent SDN history, so I'm going to engage...

What those of us who were around and attended specialty society meetings in the late 1900s lament about the new industry-sponsored events is the lack of authenticity of the presenters and the over-scripted nature of the experience.

Pain Society meetings were bare-knuckle brawls in the early aughts, not debutant "coming out" parties. Oooh, come and see the latest Data Reveal showcasing such over-processed and manufactured data that it is the statistical equivalent of Velvetta cheese. Now, it's all Kabuki...manufactured controversy and debate designed to answer trivial questions tied to marketing talking points. It's Mister Roger's make-believe pretending for pain doctors.

Some of us remember meetings when Emeritus SDN'er (Paz RIP and others) CALLED OUT speakers in front of the whole assembly for their industry COIs. I remember seeing audience members on the fly re-calculate the speaker's data, interrupt them with the corrections, and then FINISH their talk. As my grandmother would say, "Now, THAT's Italian!"

Today, watching two KOLs, from the same company nonetheless "debate" waveforms, selection criteria, or whatever is just phony. It's like watching your sister and cousin make out in the basement. It's not that it can't be interesting, but somehow you know the whole thing is not going anywhere. So, it's the inauthenticity that frankly insults the intelligence of the observers. Why are they talking to me that way? Do they think that I'm some kind of idiot?

Like call girls who try to sell you a "total girlfriend experience," these people are up there on stage getting PAID to entertain me AND want to be treated nicely and praised for their efforts. I don't think so. I don't think it works that way. My time is valuable, and they are on the clock getting PAID for this experience. So, I should get to call the shots in terms of the kind of entertainment I want to see. In other words, I want to see KOLs mount each other. If you're getting paid to entertain me, I don't want the "total girlfriend experience." If I wanted a girlfriend, I'd go get one. I want what I can't get at home. I want the punch line to the Aristocrat's joke. I want to ride you like a pony up to a point just short of breaking the law, breaking a Holy Commandment, or committing a human rights violation.

So, if KOLs also know that it's Kabuki and Mr. Roger's Make-Believe for pain doctors, let's take this to the next level. Our specialty should take every opportunity to Squeeze the Charmin with these folks. If they want to be treated like spectacles and commodities, let's treat them that way. Because I've got fantasies too, and I like make-believe as much as the next person. But, first, let's establish some clear ground rules and perhaps a "safe word." Rule number one: I'm not your Boyfriend...

here is the drusso that i had the sneaky feeling was there all along.


as a side note, it is important to note that academician KOLs are compelled and willing to report COI. not so with the salesmen/marketer KOLs.

"Therefore, render to Caesar Industry the things that are Caesars Industry's, and to God Science the things that are God's Science's"