Regarding new devices, including ADR

[MDE]

DO NOT BE THE FIRST. Or the second... Or even the 49th person to have a specific procedure done.

I hate to put it like that, but there is a lot of clinical data (and common sense) that shows the following:

1) Surgeons get better with a procedures/approaches over time: (clinical outcomes are worse earlier in a study as compared to later)
Rule of Thumb: Unless a surgeon has done a procedure at least 50 times in the past year, don't have them do it to you. (this works for ortho, spine, neuro, etc) Let them learn and get comfortable on someone else.

2) When comparing two devices in a clinical trial, often times the data will show that the device the surgeon is more familiar with proves better, even if it is a worse design. (Studies are specifically designed with this factor in mind, typically trying to avoid using surgeons that are very comfortable with the control device) This has to do with surgeon familiarity being more of a factor in patient outcomes than implant design. And even if two devices look similar, that doesn't mean the procedure/instrumentation etc is the same. DO NOT accept the number of times they've done the procedure off the top of their head. Almost every surgeon I've talked to grossly exaggerates the number of *insert device here* they've put in in the past year.

3) Just as not all people are equal, not all surgeons are equal. This doesn't mean you should try and get the surgeon with the "biggest name" either though. I know of several surgeons who are "bad" surgeons (I wouldn't want them operating on me) but have published a lot of good work and are well known.

I'm entirely devoted to defeating the fallacy of "If it could be done, someone would have already done it" but at the same time, I wouldn't try to play the odds when the risks usually include chronic pain, paralysis, and death.

[Justin]

Greg, very good points above.