6 ms·

Patients shocked, burned by spinal cord stimulators touted to treat pain

71 points by tareqak 8y ago

corey_moncure 8y ago
I wonder if these devices were manufactured in a certain country well known for shoddy, defective and fraudulent products, with the cheapest possible labor they could find? https://ryortho.com/breaking/made-in-china-not-u-s-medtronic-settles-false-claims-charges/ https://ryortho.com/breaking/made-in-china-not-u-s-medtronic... Yep.
- dang 8y ago
  This comment violates the HN guidelines by introducing extraneous flamebait. Nationalistic flamewar is not welcome here, especially not in new threads, which are sensitive to initial conditions. You've also violated the guidelines by snarking. If you'd please review https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and follow the rules from now on, we'd appreciate it. That article is from 2015 and concerns a single supplier that made false claims at the time.
  - corey_moncure 8y ago
    Dang, respectfully, I concede the point about the snark. In fact this was just my candid train of thought as I read the article, had a hunch, did a google search on an arbitrary choice of the makers in the article and the first result confirmed me. But it does come off as snark and I apologize for it and will do my best to respect the guideline. No nationalism was intended. I understand, as I hoped we all do, that the exploitation of Chinese workers in these deals is at least as heinous as the crime perpetrated on the end consumer, if not more so. Not days ago there was a front page thread about the conditions the Chinese endure; the poem about the screw falling from the table made a permanent impression on me. The blame lies squarely with the firms that exploit both international labor and their own countrymen to slake their greed. I don't have words in my lexicon to contain evil of these dimensions. Just which international country doesn't matter to me and is irrelevant, which is why I specifically didn't mention it by name. I hope you'll consider my clarification and judge my comment in the spirit it was intended. Mea culpa.
    - dang 8y ago
      I believe you that you didn't mean it that way. Unfortunately there has been an uptick of people getting into nationalistic flamewars on HN in the least year or so, so we have to moderate comments that point that way more rigorously, the way park rangers get more rigorous when a forest is particularly dry.
      - dangsbull 8y ago
        Here- https://news.ycombinator.com/item?id=18531288 https://news.ycombinator.com/item?id=18531288
      - ripsawridge 8y ago
        Amazing moderation, amazing response. Wow! Kudos to both of y'all.
    - dangsbull 8y ago
      Dang is a cuck who can't do anything about his gf's short clothes arousing flame wars in guys dicks. So he comes and takes it out here. Dang be a man and maybe stop the other side too? (gf and antinationals).
- ams6110 8y ago
  The reference you cite does say the manufacturer settled claims related to "certain instruments and devices used in spine surgeries," but it's not clear to me that these are the same devices referenced in TFA.
freedomben 8y ago
> Companies and doctors aggressively push them as a safe antidote to the deadly opioid crisis in the U.S. and as a treatment for an aging population in need of chronic pain relief. > Although there are roughly 4,000 types of medical devices in the FDA’s data, just six of them accounted for a quarter of device injury reports since 2008. (Francois Duckett/AP) But the stimulators — devices that use electrical currents to block pain signals before they reach the brain — are more dangerous than many patients know, an Associated Press investigation found. They account for the third-highest number of medical device injury reports to the U.S. Food and Drug Administration, with more than 80,000 incidents flagged since 2008. This is shocking (pun not intended). I understand the desire and rush to get us off of opioids, but I think this is a horrific reminder that we still need to approach things cautiously and not get swept up in excitement and the promise of a "panacea"
- mikestew 8y ago
  the promise of a "panacea" Especially considering that the “panacea” of OxyContin’s “impossible to abuse” marketing is kinda what got us into this mess in the first place.
scribu 8y ago
There’s a broader story about poor regulation in the medical implant industry as a whole. [1] Unlike drugs, implants don’t need to go through clinical trials in most cases. Furthermore, there is no central registry for aggregating problems that patients experience with particular devices. [1] https://www.theguardian.com/society/2018/nov/25/revealed-faulty-medical-implants-harm-patients-around-world https://www.theguardian.com/society/2018/nov/25/revealed-fau... Edit: Summarized main problems from The Guardian article.
- flarets 8y ago
  "Unlike drugs, implants don’t need to go through clinical trials in most cases." The artical says "surgical innovations" which probably means instruments and procedures. Also "some implants" are exempt from showing efficacy in clinical trials under HDE for cases in which the patient would have died anyway (e.g. pacemakers). All medical devices of Class 2 and 3 must go through clinical trials to prove safety and efficacy as part of the FDA IDE. Spinal implants would certainly be Class 3. Edit: clarification
  - tjoff 8y ago
    > Also "some implants" are exempt from showing efficacy in clinical trials under HDE for cases in which the patient would have died anyway (e.g. pacemakers). How about if the implant kills the patient? There was a local story today about a pacemaker where the electrode had failed and he was defibrilated 47 times during 3 hours before the battery ran out.
    - flarets 8y ago
      It depends if the implant does more good than if it wasn't implanted. All regulated devices require post market monitoring by the company and reporting to the FDA. If the data shows harm is being done to patients the FDA can issue a recall.
      - tjoff 8y ago
        That seems like a very slow process. Another story today that implants has caused 83 000 deaths. I assume/hope they have saved much more lives than that but regardless the types of failures seems to indicate that a lot more could be demanded of these products. http://www.tellerreport.com/news/---83-000-deaths-in-unsafe-medical-devices-in-10-years--.SkeMIhDd0Q.html http://www.tellerreport.com/news/---83-000-deaths-in-unsafe-...
Urinal_Pube 8y ago
Yeah, but it feels so much better when you turn it off, it's technically working.
newname2018 8y ago
If this device works in a certain percentage of users, what is the problem? Pain sufferers have further options i.e. opiates As one who's been in this exact situation it seems very good that there is a partially workable option. If it causes other issues they can fall back to the other ( opiate ) treatments
- ggggtez 8y ago
  Basic ethics? Seriously, think through the implications of allowing companies to sell medical treatment that don't mention the risks.
  - walshemj 8y ago
    I would assume that in the US as with the UK with any implanted device/surgery the doctor/surgeon goes through the risks. I have done this several times in the UK - oh and one of the most serious ones was 1/5000 chance of death :-)
eleitl 8y ago
Such a device has been life-changing for my elderly father, who is in constant pain. No malfunctions so far -- don't know the exact product, this is Germany.
slr555 8y ago
I observed a total knee replacement surgery where the surgeons were not using their preferred system due to the fact that the patient already had one knee replacement and the doctors felt the same system should be used on both sides. The representative from the implant company was in the OR for a couple of good reasons. The first was that every system uses different jigs and guides to aid in the resection of the bone and placement of the appliance, the representative helped the doctors understand how to use the system. The second reason was that the surgeons needed to have access to a range of component sizes to make sure they could place a correctly sized implant. Using the same system on both knees also helped ensure that the geometry of both knees would be consistent. At the time I was pretty stunned that the rep was talking the docs through the operation but the procedure was successful and I learned that when new devices are introduced it is very often the company that trains surgeons in its use.
- lostlogin 8y ago
  In my experience of this sort of situation, the reps are there to yell ‘stop’ when the orthopod tries to smack something fragile with a hammer. Each sub speciality has its traits and orthopaedics is no exception.
8bitsrule 8y ago
From the 1930s to the 1950s, 'fluoroscopes' used strong x-rays to let customers and employees of many shoe stores consider shoe 'fit'. Each second they were turned-on exposed customers -adults and children- to a year's worth of natural exposure. And employees? New medical technologies should be avoided during the de-bugging stages. Guinea pigs are underpaid.

71 points by tareqak 8y ago

I wonder if these devices were manufactured in a certain country well known for shoddy, defective and fraudulent products, with the cheapest possible labor they could find? https://ryortho.com/breaking/made-in-china-not-u-s-medtronic-settles-false-claims-charges/ https://ryortho.com/breaking/made-in-china-not-u-s-medtronic... Yep.

dang 8y ago
This comment violates the HN guidelines by introducing extraneous flamebait. Nationalistic flamewar is not welcome here, especially not in new threads, which are sensitive to initial conditions. You've also violated the guidelines by snarking. If you'd please review https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and follow the rules from now on, we'd appreciate it. That article is from 2015 and concerns a single supplier that made false claims at the time.
- corey_moncure 8y ago
  Dang, respectfully, I concede the point about the snark. In fact this was just my candid train of thought as I read the article, had a hunch, did a google search on an arbitrary choice of the makers in the article and the first result confirmed me. But it does come off as snark and I apologize for it and will do my best to respect the guideline. No nationalism was intended. I understand, as I hoped we all do, that the exploitation of Chinese workers in these deals is at least as heinous as the crime perpetrated on the end consumer, if not more so. Not days ago there was a front page thread about the conditions the Chinese endure; the poem about the screw falling from the table made a permanent impression on me. The blame lies squarely with the firms that exploit both international labor and their own countrymen to slake their greed. I don't have words in my lexicon to contain evil of these dimensions. Just which international country doesn't matter to me and is irrelevant, which is why I specifically didn't mention it by name. I hope you'll consider my clarification and judge my comment in the spirit it was intended. Mea culpa.
  - dang 8y ago
    I believe you that you didn't mean it that way. Unfortunately there has been an uptick of people getting into nationalistic flamewars on HN in the least year or so, so we have to moderate comments that point that way more rigorously, the way park rangers get more rigorous when a forest is particularly dry.
    - dangsbull 8y ago
      Here- https://news.ycombinator.com/item?id=18531288 https://news.ycombinator.com/item?id=18531288
    - ripsawridge 8y ago
      Amazing moderation, amazing response. Wow! Kudos to both of y'all.
  - dangsbull 8y ago
    Dang is a cuck who can't do anything about his gf's short clothes arousing flame wars in guys dicks. So he comes and takes it out here. Dang be a man and maybe stop the other side too? (gf and antinationals).
ams6110 8y ago
The reference you cite does say the manufacturer settled claims related to "certain instruments and devices used in spine surgeries," but it's not clear to me that these are the same devices referenced in TFA.

freedomben 8y ago

> Companies and doctors aggressively push them as a safe antidote to the deadly opioid crisis in the U.S. and as a treatment for an aging population in need of chronic pain relief. > Although there are roughly 4,000 types of medical devices in the FDA’s data, just six of them accounted for a quarter of device injury reports since 2008. (Francois Duckett/AP) But the stimulators — devices that use electrical currents to block pain signals before they reach the brain — are more dangerous than many patients know, an Associated Press investigation found. They account for the third-highest number of medical device injury reports to the U.S. Food and Drug Administration, with more than 80,000 incidents flagged since 2008. This is shocking (pun not intended). I understand the desire and rush to get us off of opioids, but I think this is a horrific reminder that we still need to approach things cautiously and not get swept up in excitement and the promise of a "panacea"

mikestew 8y ago
the promise of a "panacea" Especially considering that the “panacea” of OxyContin’s “impossible to abuse” marketing is kinda what got us into this mess in the first place.

scribu 8y ago

There’s a broader story about poor regulation in the medical implant industry as a whole. [1] Unlike drugs, implants don’t need to go through clinical trials in most cases. Furthermore, there is no central registry for aggregating problems that patients experience with particular devices. [1] https://www.theguardian.com/society/2018/nov/25/revealed-faulty-medical-implants-harm-patients-around-world https://www.theguardian.com/society/2018/nov/25/revealed-fau... Edit: Summarized main problems from The Guardian article.

flarets 8y ago
"Unlike drugs, implants don’t need to go through clinical trials in most cases." The artical says "surgical innovations" which probably means instruments and procedures. Also "some implants" are exempt from showing efficacy in clinical trials under HDE for cases in which the patient would have died anyway (e.g. pacemakers). All medical devices of Class 2 and 3 must go through clinical trials to prove safety and efficacy as part of the FDA IDE. Spinal implants would certainly be Class 3. Edit: clarification
- tjoff 8y ago
  > Also "some implants" are exempt from showing efficacy in clinical trials under HDE for cases in which the patient would have died anyway (e.g. pacemakers). How about if the implant kills the patient? There was a local story today about a pacemaker where the electrode had failed and he was defibrilated 47 times during 3 hours before the battery ran out.
  - flarets 8y ago
    It depends if the implant does more good than if it wasn't implanted. All regulated devices require post market monitoring by the company and reporting to the FDA. If the data shows harm is being done to patients the FDA can issue a recall.
    - tjoff 8y ago
      That seems like a very slow process. Another story today that implants has caused 83 000 deaths. I assume/hope they have saved much more lives than that but regardless the types of failures seems to indicate that a lot more could be demanded of these products. http://www.tellerreport.com/news/---83-000-deaths-in-unsafe-medical-devices-in-10-years--.SkeMIhDd0Q.html http://www.tellerreport.com/news/---83-000-deaths-in-unsafe-...

Urinal_Pube 8y ago

Yeah, but it feels so much better when you turn it off, it's technically working.

newname2018 8y ago

If this device works in a certain percentage of users, what is the problem? Pain sufferers have further options i.e. opiates As one who's been in this exact situation it seems very good that there is a partially workable option. If it causes other issues they can fall back to the other ( opiate ) treatments

ggggtez 8y ago
Basic ethics? Seriously, think through the implications of allowing companies to sell medical treatment that don't mention the risks.
- walshemj 8y ago
  I would assume that in the US as with the UK with any implanted device/surgery the doctor/surgeon goes through the risks. I have done this several times in the UK - oh and one of the most serious ones was 1/5000 chance of death :-)

eleitl 8y ago

Such a device has been life-changing for my elderly father, who is in constant pain. No malfunctions so far -- don't know the exact product, this is Germany.

slr555 8y ago

I observed a total knee replacement surgery where the surgeons were not using their preferred system due to the fact that the patient already had one knee replacement and the doctors felt the same system should be used on both sides. The representative from the implant company was in the OR for a couple of good reasons. The first was that every system uses different jigs and guides to aid in the resection of the bone and placement of the appliance, the representative helped the doctors understand how to use the system. The second reason was that the surgeons needed to have access to a range of component sizes to make sure they could place a correctly sized implant. Using the same system on both knees also helped ensure that the geometry of both knees would be consistent. At the time I was pretty stunned that the rep was talking the docs through the operation but the procedure was successful and I learned that when new devices are introduced it is very often the company that trains surgeons in its use.

lostlogin 8y ago
In my experience of this sort of situation, the reps are there to yell ‘stop’ when the orthopod tries to smack something fragile with a hammer. Each sub speciality has its traits and orthopaedics is no exception.

8bitsrule 8y ago

From the 1930s to the 1950s, 'fluoroscopes' used strong x-rays to let customers and employees of many shoe stores consider shoe 'fit'. Each second they were turned-on exposed customers -adults and children- to a year's worth of natural exposure. And employees? New medical technologies should be avoided during the de-bugging stages. Guinea pigs are underpaid.