Andrew Freese, MD, is a neurosurgeon at Suburban Community Hospital in East Norriton Township, Pa. Here, Dr. Freese discusses what technology he is most excited about in spine, thoughts on how to tackle the opioid epidemic and more.
Question: What technology are you most excited about in spine now? Is there anything that you see as particularly innovative?
Dr. Andrew Freese: I find the emerging biological revolution to be the most exciting, particularly with genetic intervention. Having done many years of gene therapy research, and editing a book entitled Principles of Molecular Neurosurgery 14 years ago, it is very exciting to see how the genetic and biological revolution are driving innovation in the spine and pain realm.
Q: What do you consider when thinking about becoming an early adapter of a new device?
AF: Is it substantively better than the device/approach it claims to replace? Can it provide long term efficacy? Is it purely driven by marketing and/or profit motive or is it a real advance? Is there literature in the basic sciences supporting its efficacy? Is it cost efficient? Is it ethical? Can it last and function for a reasonable time period?
Q: Have you any thoughts on how to tackle the current opioid epidemic?
AF: I think the current opioid epidemic is multifactorial and holding physicians responsible for controlling it is naïve. There are unscrupulous doctors, just as there are unscrupulous members of any profession, who have abused their privilege to write narcotic prescriptions, but that does not mean the overwhelming plurality of doctors are guilty. Pain remains a major problem in our society, particularly as technology advances and keeps people alive longer and longer, with illnesses associated with aging that cause pain (fractures, osteopenia/porosis, osteoarthritis, spine degeneration, etc.). Appropriate pain medication remains a legitimate way of helping these patients.
Tackling the opiate crisis includes: 1) reducing the supply — just this week at a port in Philadelphia (where I now live) there was a $1 billion dollar raid of narcotics from Latin America, 2) reducing the demand — understanding why so many people in the USA turn to drugs to self-medicate for depression, hopelessness, poverty, addiction and others, 3) reducing excess use of legal narcotics by identifying where in the supply chain there is an excess, 4) stopping all advertising, 5) research into non-addictive alternatives, 6) education of all stakeholders, 7) providing family and spiritual support to reduce the desire and use of narcotics, and many others. No one group of individuals is responsible, and doctors should not be the scapegoat.
Q: How do you see bundled payments, value-based care and other new payment models affecting spine?
AF: Of course these new payment mechanisms are affecting and will affect spine. Some of them are legitimate, some are based on cutting costs with no thought about patient welfare. Outcomes are difficult to predict with spine surgery, unlike joint replacement surgery, as spine related issues are multifactorial. Legitimate decisions to proceed with surgery, properly done, should not be punished based on a suboptimal outcome. This will prevent spine surgeons from taking on difficult, elderly, or disabled patients, and make it almost impossible to consider revision surgery.
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