In this episode I talk to Dr. Steven Falowski about his career as a functional neurosurgeon, his involvement in NANS (North American Neuromodulation Society), his experience in serving on advisory boards with different device companies, and his response to recent negative press from the AP levied against the medical device industry as a whole.
Justin: 01:07 Hello everyone. Welcome to the Anesthesia Success podcast. I’m your host, Justin Harvey. Our guest this week is a fellow resident of eastern Pennsylvania. Dr Steven Falowski. Steven currently serves as the director of functional neurosurgery at the St Luke’s University Health Network in Bethlehem, PA. He has a prolific research background and pain treatments by a spinal cord stim and neuromodulation techniques and he sits on half a dozen committees as well as being a member of the executive advisory boards for various treatments at both Abbott and Medtronic. Steven, thank you very much for joining us today. Thank you for having me. So I’d love to hear a little bit more about your current role at St Luke’s, but before we dive into that, I noticed a couple of things on your cv that I’d like to point out. The first is that you are a very prolific researcher and that’s clearly been a career focus for you that I’m looking forward to unpacking here shortly. And the second, which is my favorite nugget that I found buried down at the bottom, is that you graduated from Undergrad in three years with a double major while making Dean’s list, working full time and training as a bodybuilder. How on earth did you have time to do all that?
Dr. Falowski: 02:05 I think ultimately I’m just a very driven person who likes to stay very busy. I game a lot of happiness actually from, from accomplishing these things. And I ultimately, a lot of times I don’t actually view it as work. It’s the thing that actually keeps me sane and keep me going.
Justin: 02:19 Yeah. Especially with the physical activity. I’m sure it can be helpful in keeping the brain disciplined when your body’s in good shape that has a positive trickledown effect, I’m sure. Absolutely.so I’d love to hear a little bit about your current role at Bethlehem, as the director of functional neurosurgery. What does that mean exactly and what’s your role there like?
Dr. Falowski: 02:36 Yeah, absolutely. So I’m the director of functional neurosurgery. Functional neurosurgery is a specialty within neurosurgery, specifically geared around implanting a electrical stimulation devices anywhere in the brain. The spinal cord, the peripheral nerves, a functional neurosurgeons. the, the two biggest diagnosis is that we treat are, one is chronic pain with spinal cord stimulators. the second though is actually movement disorders like Parkinson’s disease or tremor that we treat with deep brain stimulators. I was brought on to St Luke’s to start the functional neurosurgery program there about eight years ago. they had never done a single one of these cases, but they were very much looking towards the future and they wanted to bring this type of surgery and therapies to St Luke’s. So I took on that role to start the program and eventually worked up now as a director of the program and brought on a partner as well to do the, the therapies.
Justin: 03:33 Excellent. And I want to talk a little bit more about what the process of starting a program looks like and a few, but before we do that, take us through your sort of, the arc of your career and love to hear about some of the key decision points along the way and what it was that inclined you to one decision or another.
Dr. Falowski: 03:47 Yeah, sure, absolutely.well my background has always been intrigued by the cutting edge therapies of neurosurgery and everyone talks about the brain machine interface and artificial intelligence and the idea of actually implanting electrical devices on the brain or the spinal cord was sort of the background. that Kinda keeps me going. Everything I was interested in as a kid all through high school and college, which led to why I knew I wanted to be a functional neurosurgeon. You know, some of the things that I realized was in the beginning of my career that the first thing you do when you get started is you want to make sure you take very good care of your patients. but quickly, you know, within a year or two into your practice, you start looking for more challenges, more avenues for you to take part in. I think probably about one to one and a half years into my practices where it had that inflection point where I realized that I want us to start doing other things besides just taking care of the patients. And I also wanted to advance my field so that the two biggest things that I realized I could do was one was was researched, but I started devoting a lot of time to research, publishing my own research, taking part in clinical trials, but then also working with industry, realizing that there’s a lot of innovation and technology that’s pushing the field forward and really wanting to actually take part in that and be a major role in seeing the space unfold.
Justin: 05:11 And as far as you know, starting a career in research, if there’s a physician out there who says, I’m really interested in this certain aspect of treatment or a certain device utilization, how would you recommend somebody think about taking that first step of I want to collaborate with somebody who’s been here before. How do I go about moving the ball down the field as far as helping my discipline be more advanced and more helpful for the patient?
Dr. Falowski: 05:33 The first thing you want to figure out is sort of your niche. Where do you want to fit in in the, in the research algorithm, what type of research you want to do? I think the most common for physicians is very much clinical research, research geared around the patients. If you work in a hospital setting, each hospital has its own research department in order for you to actually either get an irb approval to do a study of your own or if you want to take part in a, one of the other studies that say the hospital as part of or industry is running as part of a clinical study. So usually the easiest first step, to do that is to approach and talk to the research department of the hospital.
Justin: 06:12 What are some of the things that you’re working on right now or maybe have worked on recently that you found to be really interesting or particularly challenging?
Dr. Falowski: 06:19 Actually, the biggest research I’ve done and it was initially very challenging and something that I’m actually very proud of now is what spinal cord stimulators. Historically, they were always placed awake, which can be very uncomfortable for the patient. It could also be very uncomfortable for the surgeon and sometimes if the, if the patient’s not tolerating the procedure well awake, it could lead to inaccurate placement of the stimulator. So I spent a large amount of time, energy and my early research all the way now to my ongoing research to demonstrate ways to actually play spinal cord stimulators asleep. Thinking initially. Sounds easy, but the problem is, is that the reason you keep patients awake, with spinal cord stimulators is for two reasons. One is it’s a safety aspect to make sure that you’re not introducing any type of neurological injury or causing pain to the patient when you’re putting these stimulators in.
Dr. Falowski: 07:10 But the second reason is also to confirm that the electrode is in the right location and it’s covering the proper nurse for the patient’s pain pattern. So we had to develop protocols and ways of doing that under general anesthesia. So I had to work very closely with the anesthesiologist for general anesthesia plan that didn’t include any type of muscle relaxes. So that way we could actually monitor the nerves coming out of the spinal cord. But then I also had to work closely with the neurophysiology technicians to develop protocols that not only for the safety aspect, but also for the aspect of converting a, that the lead was in the right location. I spent many years now, actually about eight years, doing this research. It’s probably the research I’m most proud of because it’s led to a complete shift in my space, in my field, meaning historically they were always. The stigma is they’re always placed awake. but now they’re estimating about 30 to 50 percent of them are going in under anesthesia with this form of neuromonitoring. In the last eight years, this research has actually changed a space. That’s probably what I’ve been most proud of.
Justin: 08:11 Wow. That’s awesome. As you were proceeding in this research, were there any seminal moments for you where you started to see the potential of this can be a really transformative type of procedure and it sort of encouraged you to keep on pushing in that direction?
Dr. Falowski: 08:24 Absolutely. I remember after publishing the first paper, which was just a retrospective review of my own cases demonstrating that at least it was safe and accurate, that after publishing the paper I started receiving many emails and phone calls from physicians around the country who were very interested in how I did it and what the protocol was when I actually did the first publication. I just published that it was a method and that it worked and it was safe, but I actually didn’t publish the method. so I ended up spending a of phone calls asking me how to do it, which so demonstrated to me that the, the space, you know, the physicians were actually looking for this type of method and they wanted to do this. So I followed that up quickly with another mother. Say I followed up quickly with another publication on the actual methods on the protocols of how to do it.
Justin: 09:13 Yeah. Did you find that most of the interest was in your discipline or was it an interdisciplinary? You had anesthesiologists and maybe other surgeons reaching out to you?
Dr. Falowski: 09:20 Well, actually the most interesting part of that was it was the anesthesiologist being trained anesthesiologist who would be most interested in it. I think part of that is because the surgeons, they were very used to general anesthesia. They were used to using neuromonitoring, having the technicians in the room, but for anesthesiologist and the pain anesthesiologists, that’s not something they were used to, but I think that’s actually the space that it’s growing the most in and they’re seeing the most potential.
Justin: 09:47 Yeah. Makes sense. And in that context, when you’re doing research and there’s this interdisciplinary communication, can you describe a little bit like how does that work when you’re working with somebody from another specialty? How do you kind of divide and conquer? What kind of report do you have to have with a fellow researcher to be able to research effectively?
Dr. Falowski: 10:04 Absolutely. I will tell you that actually it’s that integration of specialties that makes research that much, that much better, that much more impactful when you do actually published. It’s important to actually have a relationship, especially between, I think neurosurgeons and anesthesiologist and pain anesthesiologist because there’s a lot of overlap. What we do, especially with the neuromodulation space or, or functional neurosurgery space where we’re implanting these devices because they can be implanted by surgeons, they can be implanted by anesthesiologists, they could meet in petabyte rehab physicians. So it’s important I think to actually have that integration of specialties. Think also realizing that all these specialties are involved, is why you need to work together when you do these research studies because it’s ultimately about 70 percent of stimulators in this country are usually put in by a painting trains physicians, whether anesthesia or rehab physicians, only about 30 percent are put in by the surgeons.
Dr. Falowski: 11:04 But the one thing I realized as a surgeon is that, especially with a lot of the research that I was doing, I had a collaborate, with a lot of the pain physicians and anesthesiologists because one is I needed to get the anesthesia protocols. But then I also had to work with the pain physicians to see what their needs were going to be in their settings, which are much different than the surgeons that we’ve. I’ve actually done a lot of work collaborating with guys such as Dr Pope, because he also loves to do research and is very driven. Keeps up with the studies and always looking to push the field forward. It makes it very easy to collaborate.
Justin: 11:40 Yeah. Excellent. yeah, we’re hoping to have perhaps one or both of those gentlemen on the show in the coming weeks here. So there’s the, you know, you have your colleagues obviously like for example Dr Pope who you’re collaborating with this research context. There’s also another party at times and that’s the device manufacturer or maker themselves. Describe how that dynamic (a), how it influences the work that you do and, and (b), how do you sort of get a foot in the door to those relationships to start working with some of these device companies who maybe have an idea or a product that they need to vet.
Dr. Falowski: 12:12 I think it’s important, especially in this day and era where there’s a lot of scrutiny that’s come on a medical device companies as well as relationships between medical device companies and physicians. It’s realizing that it’s very expensive to get new devices and new innovation and technology to market, and unfortunately a lot of that money can’t be funded by the government or by the NIH, so it’s very important for physicians to work with a lot of the medical device companies, the to help them know what is important, what technology do the physicians need, what patients actually need. When I first started working with medical device company, I think the one thing that was most surprising to me is the engineers who were developing products had never stepped into an operating room and I’d never spoken to a single patient to realize what the patient needs or what the physician needs to actually plant in the operating room.
Dr. Falowski: 13:04 It became important to me realizing that they need to have relationships with physicians. You know, physicians are right on the front line. Dealing with the patients were the ones who the implant goes in our hands to actually implanted in the operating room. We’re the ones that have to take care of the patients afterwards so there’s nobody more in tune with what’s needed in this space to keep it moving forward and what new technology we need than the physicians. So it’s important for them to collaborate. I think with the companies for that exact reason is that if anyone’s interested in doing that type of work, which I think is probably one of the most rewarding things I do outside of just taking care of, of, of patients is usually what you want to do is you start off with your local representative from that company and once you start using a product and you get used to it and you’re starting to realize the faults to at the good things to it, you can then reach out to your representative who will put you in charge of the district managers, with the companies and they have a lot of openings for they.
Dr. Falowski: 14:04 They put together advisory boards, whether it’s once a year or twice a year where they want to talk with physicians and get input from the physicians. In addition, they always run a lot of educational courses, so if you’re interested in learning some of the new techniques or new technology out there,they can help you with that and the education courses and then eventually what happens is you can become the first in teaching those courses. So it’s usually an easy way a entry into working with, with medical device companies
Justin: 14:31 And at the outset that seems like a potentially big decision if you’re going to kind of like, you know, plant your flag with a certain company or a certain device. How do you, you know, as you come in, you probably don’t know. I mean you’ve, you’ve done some procedures with a certain device probably, and maybe you’ve seen good effects from that device. How do you determine that this is in fact the company and the device with which I want to really invest time or why would you not maybe see what else is out there with a certain type of device to see which one’s the best? How do you, how do you kind of make that decision as a young physician?
Dr. Falowski: 15:02 Yeah, absolutely. I think especially the young physician, I can tell you what I did in the beginning was I implant the whole companies. I still actually to this day make sure that I implant all the companies because I want to have experience with what I implant so I can make a very educated decision on what I’m doing and why I’m doing it. I didn’t initially for the first year to year and a half into my practice, I spent more time learning how to take care of patients. Doing that properly, learning the different companies, learning the different devices that go in so that you can start formulating an opinion. What do you don’t want to do is run away, start off and just try to pick somebody to work with. And one of the things actually I pride myself on is that I work with all the companies.
Dr. Falowski: 15:44 I do have ones that I work with more than others. but for the most part, some of my favorite things to do is have advisory boards and teaching educational courses. And those two things I will actually do with with all the companies because I feel that that’s it. That is not products necessarily. Specific advisory boards are meant to help all the companies, the improve all technology and educational courses that these companies run are meant to actually teach physicians how to put these in safely. So those are things that you can do with regardless of which company you choose to do that with, when you start choosing a specific companies, when you start molding with them and joining forces for doing research together and also pushing their technology forward, a village of the things where you want and then start getting into more company specific which requires. I always say it takes the time to learn all the different devices that you can make an educated decision.
Justin: 16:40 Makes sense. So you described this kind of dual prong role of being on an advisory board as well as being an educator. Maybe you could take us into each of those briefly and talk about what does it. What does it mean to be an advisory board member? Who are you collaborating with? What are your meetings look like? What types of Intel are you trying to offer the device maker in order to be able to modify their product in some way?
Dr. Falowski: 17:00 Sure, absolutely. The advisory boards are usually put together by the companies. They’re usually a full day event, anywhere from eight to 10 hours and it’s going to be. They usually put several physicians in a room together. Multiple specialties will be pain anesthesia, the neurosurgeons even sometimes neurologists and essentially what they do is what did they ask you, your opinions on certain aspects of the field where you think the field is going and what a lot of times companies will do then is they’ll start presenting to ideas of where they think this field is going to go and what new devices that they’re working on. Also new research projects that they’re deciding where to put the money into and then they have the physicians all chime in and talk about what they think. The most important aspects are aware of what the field actually need. If the research studies that they’re working on are valuable, how do they go down that road?
Dr. Falowski: 17:51 How do they design the research study if they’re working on new products and the physicians can get involved that yes, that’s actually a product that we do need in our space and this is what that product should do and this is where you should allocate your resources because ultimately the, these companies have a set amount of money that’s going to get returned back into vice device innovation, as well as into research. So they’re, they’re really trying to decide also where to allocate those funds. And you really can be impactful in the space as a physician on these advisory boards because you’re actually guiding these companies on where to put their money to make the field better. And then ultimately as being part of those, those advisory boards, you actually can then become part of the research. Let’s say now you learn that there’s a research study that you wanted them to push forward.
Dr. Falowski: 18:39 They’ve now agreed, you can be one of the centers that takes part in it. That I think is actually probably the one of the, I think most rewarding parts of working with industry and especially those advisory boards. But I also do truly enjoy the educational offerings and I do a lot of work through societies like the North American Neuromodulation Society, as well as, even as we’re a large amount of pain society for educational purposes. I run a lot of the courses as course director. I truly believe that one is our space is going to grow through education. The more physicians, you educate the more actually going to go out and do the therapy, but more importantly they’re going to go out and do the therapy of the right way, and the safe way to do it, which is what you want because that’s what protects the, our field and our space.
Dr. Falowski: 19:26 And if we’re going to grow, we have to grow the right way so we can run a lot of educational offerings through society, which is a great way to get to get involved. But also,the device manufacturer companies also run educational courses. So I get invited by a lot of these companies to help direct their courses so that they can pick topics and how they’re going to train the physicians. One of the big ones now that the companies are moving towards an, especially in societies as well as fellowship education is educating fellows early on so that if you learned this early on in your career, you have a whole career ahead of you where you can be part of this innovative space.
Justin: 20:03 Yeah, that makes sense. And so I noticed that you’re, you’re on a number of committees with Nan’s and I’d love to unpack a little bit more your work there because it seems like you’re putting a lot of time and effort into developing in some cases that the next generation with mentorship and the resident fellows committee, et Cetera. So what kind of work is being done in NANS specifically to be able to bring these pretty advanced technologies downstream to physicians earlier and earlier?
Dr. Falowski: 20:28 Absolutely. I would say NANS says devoted, it’s attention to education in this space. And I was one of the people who were tasked with that very early on. About eight years ago we started a what was considered the cadaver course for fellows at Nan’s specifically geared either anesthesia trained or even a surgical train fellows who were going to be going into neuromodulation. When we first started this course at NANS a, the first year, I think we had about 12 people to put this into perspective. Now eight years later, we are the largest international course of its kind where we train over 250 physicians in one thing. It’s one of the most sought after courses and we actually have it fully funded and we haven’t funded by all the different companies equally and then what we do is we give an unbiased equitable exposure to every all the fellows to all the different companies, all the different technology, and they spend an equal amount of time on each cadaver station with all the different technology.
Dr. Falowski: 21:28 And the reason we like doing that is because very early on now it not only will they get repetitive for implanting these devices, but they’re going to get an equitable exposure to see all the different companies and the technology so that they can go out and make their own decisions about what they want to use later. So that has been a large focus to keep developing education. We’ve now developed a resident fellow committee at Nan’s that has grown tremendously. I think it has now about 300 members. It has its own internal board as well. That’s how much it’s grown. And they do things like we put together career fairs for residents and fellows so that they can learn about jobs that are out there. They also help with contracts and teaching about contracts and, and the different types of positions that are out there.
Dr. Falowski: 22:14 So the last thing that we’ve actually moved onto at NANS which is something I’ve been the head of as well and really trying to push this forward, is we’ve now started a certification process. we eventually want to get to what we consider credentialing, just like you have in the cardiology space for, for pacemakers, all, you have to be credentialed to put in a pacemaker. We eventually want to get to the point where we credential people for putting in a stimulators to make sure that they’re put in safely and effectively. The first start to that now is to do a certification process. So what we, I’ve helped do with, with others in NANS is we’ve created an entire educational curriculum and platform that goes over a one year period starting with entry level, a examination, taking the fellows course, going through a series of webinars and reading publications throughout the year and it ends with a final test at the end of the year. at which point then Nan’s will certify people, for putting in the stimulator. So it’s an initial step.
Justin: 23:12 Is that something that would be open to any a practitioner in any point in their career or is it more geared towards sort of the new residents and fellows?
Dr. Falowski: 23:19 So we have two tracks, one for residents and fellows, and then we have a second track for those who are already in practice, that second track for those who are already in practice, if they’re already doing these types of therapies and they feel comfortable doing it, we have a different track where they can be signed off on different milestones.but we also have attract where if, if you’re, if you’re out and attending in practice. But still I’ve never done these therapies. We have a track for them as so we have different tracks.
Justin: 23:47 Great. I want to pivot here and discuss some of the press that has come up in the last few months with regards to the collaboration between physicians and these drug companies and required disclosures and things.shortly after you and I began speaking there was that the AP article about pain and neuromodulation specifically where it was highlighting some of the financial relationships that physicians had with drug companies.and then there’s, there’s been a handful of others in the last couple of weeks with the New York Times and the Ama journal that has evaluated this. So I’d love to hear your thoughts. Describe the way that compensation arrangements work in this context. If you’re doing consulting for a company, if you’re on an executive advisory board, if you’re running a study, how does that function for the physician and what checks and balances and measures are in place to be able to navigate the moral hazard of working for a company, being in a position to potentially advocate that hardware and but maybe it’s not best for the patient in some cases.
Dr. Falowski: 24:47 I think this is a very hot topic now and I think that unfortunately the news tends to sensationalize things and they don’t always present everything in the brightest of lights. I think the important thing to realize is that when physicians work with medical device companies, especially with consulting arrangements, there’s rules and policies that are in place by a company. And what they do is they determined what’s called fair market value, which essentially means that physicians have to be paid an hourly rate within what’s considered a fair market value, which basically means that, you know, as a physician, you just cannot be paid an exorbitant amount of money compared to anybody else. All the physicians are kept within a certain range. So when consulting agreements are put into place, your hourly rate is determined on that fair market value. So ultimately it usually means that the more money that they would make with a medical device company need some more hours that you have put in because usually little rules in place that you can only charge for eight hours a day.
Dr. Falowski: 25:43 So even though if you spend an entire Saturday of 14 hours with the company, you still can only charge for eight hours for that day. So there are these policies and regulations in place. Now there, I always say there are bad seeds out there who are trying to push the envelope. And, but when you’re working with the large companies, companies like Medtronic, companies like St Jude or Abbott, Boston Scientific, these larger companies, they are very much held by the ABA guidelines and strictly follow them. So it’s important to realize that when you see these financial relationships that exist between the physicians and the companies, that they are heavily regulated and it’s considered a fair market value and you’re just being paid for your time for working with them and not, and not necessarily anything more outside of that is right now there. There’s public websites, there’s the Sunshine Act Website.
Dr. Falowski: 26:33 There’s also a propublica.com which allows you to just put physician’s names and and then it will come up. What they made, with, with companies. I do think that disclosure is extremely important.it is very hard when you’re, you’re seeing multiple patients in a day though, in every office visit to say to each single patient, well, it’s important that you know, that I work for this company and this company and this company usually. And there is no rules or laws in place that say a physician have to necessarily disclose to every single patient. I do think it’s important to try to disclose to the patients when you can and when you remember, when you have time. I would hope that a lot of patients also want to educate themselves. So if they’re going to see a new physician, they can look at anyone of these public websites and they can bring that up to the physician as well.
Dr. Falowski: 27:20 Um, but I think as patients that it’s important for them to realize that this is not enticement. If a physician wants to help push the field forward and work on an advisory board or a physician wants to train other physicians through an education course that is being put together by the medical device company, that they’re just being paid full time under a fair market value. So all the physicians make about the same amount of money per hour. So I think it’s important to patients. And also the general public just realizes that this is not like an enticement to physicians. This is a, this is paying a physician for their time to do this outside their normal business hours that they would take care of their patients. That I think that’s something that that’s a good point that actually drive home.
Justin: 28:05 And with regards to the fair market value level, does that vary based on experience and expertise and research or is it, is it kind of uniform? And, and can you give us a little bit of detail on what, like how much is that number?
Dr. Falowski: 28:16 There is a range. It’s considered like a bell shaped curve. It’s not a massive range though. We’re not talking a difference of hundreds of dollars an hour. Basically, there’s a range that’s determined and these policies that are in place that if the fair market value is considered within a certain range, and then basically based on your experience or research level, the, how well you do things, if you’re really highly sought after, you may fall more towards the top of a range, as opposed to this is your first time consulting and you’re just starting to work with the companies and all, you may fall on the bottom portion of the range. The important thing though too, is that when companies decide if they want, like, say the more experienced person, if they’re going to try to pay you on the higher part of that range, it actually has to be signed off by policies that you have to fit certain criteria to have an experience level research background to get that.
Dr. Falowski: 29:12 Um, it, it all depends on your specialty too, on how much you make. So, you know, say, like as a neurosurgeon, you may make a slightly more than an anesthesiologist who will make more than say, an internal medicine physician. It’s also based on the idea of the fair market value is also based on replacing the money you would’ve made if you were working. So if I’m going to cancel a full day of clinic with patients, it’s based on the fact that what you were full day of work would have been at your normal career spot.and it’s meant to just replace that so it can range anywhere from basically, I would imagine like $200 an hour up to about 500 or $550 an hour depending on specialty.but within a specialty that range is only gonna vary from anywhere from like 50 to $75 I’m filled with the most experience would maybe make $50 more an hour than the person who’s less experienced.
Justin: 30:09 So when you’re doing things like the executive advisory board or you’re running the education for these companies, that’s, that’s your rate for that, you know, that engagement.
Dr. Falowski: 30:17 Correct. It’s important, rose, I think that I think people in the public has become very tainted by this idea that pharmaceutical companies are parading physicians around in Hawaii. And we’re just, you know, we’re just giving these talks at these elaborate dinners and you know, and I can tell you for me especially, I love working with the medical device companies and I hardly ever give a talk or a presentation to advertise accompany and they’re single product. Usually everything I do revolves around advisory boards, educational courses, or even as you saw it as we’re getting to present my own research. So mechanisms of action with spinal cord stimulation. And also there’s a lot more things you can do with these companies that actually helped push the field forward, that are not that old mentality of just, you know, you’re advertising for our company or are you just giving a big dinner presentation?
Dr. Falowski: 31:12 Uh, that’s all revolved around fancy stuff. Like a lot of that is really a thing of the past. so it’s important that people realize that and you need to have these relationships with the physicians and the company so that the space can push forward in innovation and technology can happen. And unfortunately, there’s a great statistic out there. There’s a book called Pharmaphobia and they talk about 90 percent of the money for innovation and technology in this space as in healthcare has come from medical device companies. It hasn’t come from the NIH or the government, so it’s our job as physicians to make sure that, that that money that these companies are putting back into the space or put back into the right locations and this is how we do it. We have to take part of them big part and working with them and you’re paid at a fair market about you’re paid for your time to be there, so work with them.
Justin: 32:02 What kind of advice would you give to a young physician who is considering this kind of collaboration but maybe has seen these headlines in the last month and in is a little bit gun shy?
Dr. Falowski: 32:11 Yeah, and I, I tell you that with these articles that have come out, the biggest fear I have is that the scariest patients there is the public and then is also scared of physicians and it scared them from doing the right thing. You know, spinal cord stimulation, what was highlighted in the Associated Press article as one of the medical devices, but it actually attacked a large portion of the medical device industry. Everything from cardiac pacemakers, the birth implants, in reality, all really doing is it’s hurting patients from getting the proper therapies because now they’re nervous or scared. and the same thing with physicians. Physicians now are going to be gun shy of working with companies out of the fear of all this public attention. What I can say is, and this is just something I believe in my heart, is you should do what you think is right.
Dr. Falowski: 32:57 I firmly believe that when I work with these companies on advisory boards and educational offerings and research studies and all that, I’m actually doing something that’s actually shaping the field and that makes me feel very good. The only thing you can really do on your side of the decision is try your best to have full disclosure when you can. Whenever I write a research publication, I always try to make sure my disclosures are as up to date as possible for that publication. Whenever I give a talk at a society meeting,I always load up my slide with as many things as possible in my disclosure slides to put it out there. the main thing is, is that there should be nothing to hide. There should be able to have full disclosure and that’s the only thing you can do is continue doing what you think is right.
Justin: 33:41 And I think that Steven, that’s a great segue to what I want to ask as our last question here to wrap things up.and, and you alluded to this earlier and I’m curious to maybe you can give a specific instance of, you know, you’ve put in a lot of time looking at your cv and all of the research and collaboration with peers and drug companies, device manufacturers, etc. You’ve given so much of yourself to your profession in advancing your field. Tell me a brief storY reflecting on one of your proudest moments.
Dr. Falowski: 34:07 Maybe I have to have a big influx, like proud moments that I had in my career. the first one was, I was able to work with, the company Medtronic to do the first ever live video stream of a deep brain stimulator going in for Parkinson’s and we live streamed that out of my hospital all over the entire country to, to other physicians, to fellows, to engineers who worked for the company. And it was aired some multiple spots all over the United States. So that’s the first ever time you could actually see a live case in the operating room where people could actually talk back to me as well while it’s operating and ask questions. And I think that was such a big step in, in our space for actually not just that medical device company collaboration with the physicians, but you know, giving access to even engineers to see what it’s like in real life in an operating room with a patient.
Dr. Falowski: 35:02 When a physician, a surgeon, is taking care of a patient to see the, where their devices fall short, to see where they actually work well, to see what the patient’s actually going through. But it also gave the opportunity to educate other physicians. So they can see live in the operating room who someone is considered experience then with the surgery to see how they do it, to do that. And it was a, it’s a one year in the making actually I make that occur. And it was something I was very proud of that actually have that. The other one I’ll, I’ll tell you, there’s always a patient I have a dog out with for me with spinal cord stim and one patient that always sticks out to me, but she’s, she’s actually a statement for what really happens in our space. And she was an older lady who had a severe scoliosis and many years prior went through a very massive spinal fusion and the spinal fusion actually did help her and helped her for many years.
Dr. Falowski: 35:54 But then she eventually developed excruciating back pain. She was in her mid fifties at the time. She had to stop working. She became nearly nearly bedridden. She had gone through multiple physicians and multiple surgeons, multiple pain physicians for years. We all pulled out. There was nothing else that could be done for her. Finally, somehow some way she made iT onto my doorstep in my practice and I said to her, it’s going to be unorthodox, but I can find a way to drill through your fusion and get a spinal cord stimulator in for you, and she trusted me and we did it and it was still actually, believe it or not, a same day procedure where she went home the same day. I will tell you at 55 years old when she was bedridden for probably over five to seven years, she’s now out of bed and she’s working.
Dr. Falowski: 36:38 She went back to work and she sends me a Christmas card every year for thanking me for actually giving it a shot for her and when she went through numerous physicians over years, he told us there was nothing left that can be done. Her card, when I get it every year just sticks out to me because it’s something that happens in our space all the time where the physicians aren’t trained. Say like in spinal cord stimulation or neuromodulation. They just don’t even offer it to their patients. And the big thing is I think in anything in healthcare and in medicine, if you know something’s out there, even if you don’t know how to do it, find a way to offer it to that patient, to send them to somebody who does that. That’s where collaboration really comes in and this patient, she feel always sits with me. So she just. She nailed that a to a t.
Justin: 37:26 Yeah. Excellent. Cool. Well Dr. Falowski It’s been a pleasure chatting with you today. Thank you very much for joining us on the Anesthesia Success podcast.
Dr. Falowski: 37:34 All right, thanks a lot. Appreciate it.
Show produced By: Dan Gummel & Justin Harvey
Show Music: Great Scott: Don’t Hold Back