In January, 2011, I wrote a controversial four part expose’ about bone marrow biopsy technology.
The controversy involved two issues. One was how the cost of a BMB system influenced which system was used in a hospital or clinic. The other involved some resistance in the medical community to use a new BMB innovation: the OnControl power driver.
Instead of rehashing all of this, here are links to each of the four posts:
Bone Marrow Biopsy Technology: Not Ready For Prime Time?
More About Bone Marrow Biopsy Technology From A Patient’s Perspective
Bone Marrow Biopsies From A Patient’s Perspective- Continued
Profit Before Patients: The Conclusion To An Alarming Story About How & Why Doctors, Clinics & Hospitals Purchase Bone Marrow Biospy Systems
So why revisit all of this now? Because there have been several twists and turns to this story.
More and more patients are starting to ask for the OnControl driver. It was used in my last BMB, and it worked as promised. Very little post-procedure pain or bruising. And Medicare has now approved funding for the new device, so now more hospitals and cancer clinics are starting to use the OnControl driver.
But there are still hurdles to jump for Vidacare, the fledgling medical technology company that developed OnControl.
For example, I sat next to a surgical pathologist–the ones that look at biopsies while you are still on the table to see if the surgeon needs to remove more tissue–on my flight back from Boston last weekend.
Her name was Nicole. You can guess that I was like a kid in a candy store, asking her lots of questions about pathology and what she does. Nicole was glad to oblige, answering my questions and interjecting stories about her medical education and experiences.
Half way through our conversation, Nicole mentioned a fabulous new invention that she had used during her surgical rotation. It was a hand-held drill for bone marrow biopsies. She went on and on about how the core samples were cleaner and more complete. Think about it. From a pathologist’s point of view, that would be important, right?
But Nicole concluded her story reminiscing about how the head of the department had refused to allow the OnControl driver to be used in his department. We speculated why, but apparently he never gave a reason. He didn’t have to–he was the head of the department!
Was it that the driver was too new? (a lot of docs don’t like change) Or that it was too expensive to use? We’ll never know.
I just found it fascinating that she would bring up the OnControl driver –unprompted by me–the same week that Vidacare would issue this press release:
Wall Street Journal Recognizes Vidacare Corporation for Second Time:
OnControl® Bone Marrow System Receives
2012 Overall Bronze Technology Innovation Award and
Top Award in the Medical Devices Category
(SAN ANTONIO) – The Wall Street Journal announced the winners of its 2012 Technology Innovation Awards today, and for the second time, Vidacare Corporation has been recognized for its ground-breaking technology. Vidacare’s OnControl® Bone Marrow System is the overall Bronze winner in this year’s Technology Innovation Awards and the winner of the Medical Devices category. Vidacare’s EZ-IO® Intraosseous Infusion System won the overall Gold Technology Innovation of the Year award from the same program in 2008.
In its twelfth annual competition, the Wall Street Journal received over 500 nominations from around the world, with only seven percent receiving recognition from the program. Complete coverage of the 2012 awards can be found in The Wall Street Journal’s three global editions today, as well as online at: www.WSJ.com/Reports.
The OnControl® Bone Marrow System combines a specially-designed needle and powered driver to provide the first significant advance in bone marrow biopsy technology in over 40 years. OnControl is proven to offer high quality, safe, reliable and less painful bone marrow procedures, with consistently better samples, benefitting both patients and clinicians.
“The entire team at Vidacare is thrilled to be recognized for a second time by the Wall Street Journal,” said Mark Mellin, President and Chief Executive Officer of Vidacare Corporation. “Our passion is to help patients in need, and this honor is further acknowledgement that we are succeeding in that endeavor.”
Established in 2001, Vidacare Corporation is the pioneer of a broad technology platform for accessing the intraosseous (inside the bone) space. Current products include the EZ-IO® Intraosseous Infusion System, the OnControl® Bone Marrow System and the OnControl® Bone Access System. Applications include vascular access, emergency and disaster medicine, oncology and spinal surgery. Vidacare’s focus on enhancing clinical efficacy, patient safety and comfort, and reducing complications and their associated costs, has resulted in its devices becoming the recognized technology standard. Privately held, the company is based in San Antonio, Texas, and its products are marketed in over 50 countries worldwide. www.vidacare.com
I would like to make it clear that I do not work for Vidacare. And they have never paid me to represent them. The company did buy several hundred of my first book, Living with Multiple Myeloma, a few years back to distribute to myeloma patients that their field reps would run into from time to time. And I did a book signing for them at ASCO that year.
Habit is part of human nature. It is one of the things that makes it so difficult for innovations in medicine to become new standards of care. I’m sorry, but if I get a choice between someone leaning on me and pressing hard–using what amounts to a corkscrew–or using a fast, clean-cutting power drill, I choose the drill!
I’m going to write tomorrow about why I may need to undergo an unscheduled BMB myself next month. And when I do, I am going to request they use an OnControl driver.
Even though they are full of holes, I have hard bones. The decision is an easy one for me! I’m just glad that Moffitt Cancer Center is using Vidacare’s power driver.
Feel good and keep smiling! Pat
October 18th, 2012 at 9:26 pm
Hi Pat, OnControl deserves all the awards that it can possibly be awarded. I first learned about it in January 2012. I had three BMB’s during 2011, my first year with MM, and at that point if I never had another one it would be too soon. I sent my doctor at UT Southwestern in Dallas an email about it and asked if he could please look into acquiring one before my next BMB. Low and behold when I arrived for my fourth BMB in August 2012, they had the power driver. I could not believe the difference! Don’t get me wrong, it is still not something to look forward to but OnControl made such a difference in the procedure that at least I won’t sit and dread my next one. Good Luck on yours if you have to have one next month. Please keep us posted.
October 18th, 2012 at 10:02 pm
I’ve had 8 (eight) NOT that I’m counting…bone marrow biopsy’s since my diagnosis fifteen months ago on 24 May 2011. I’ve had all 8 without conscious sedation, because it is not offered at the University of Colorado Hospital. However, I am given oral morphine and oral Ativan just prior to the bone marrow procedure.
My Bone Marrow Biopsy History:
1. 24 May 2011 (Diagnosis at Dr. Moore in Ft. Collins, Colorado)
2. 20 Aug 2011 (1st at UCH with Glen, NP)
3. 1 Sept 2011 (Karley, NP)
4. 2 Nov 2011 (Karley, NP)
5. 9 Mar 2012 (Karley, NP and 1st with OnControl Driver)
6. 3 May 2012 (Shannon, NP with OnControl Driver)
7. 12 July 2012 (Trish, NP with OnControl Driver)
8. 17 Oct 2012 (Angela, NP with OnControl Driver)
I’ve had half with the old manual boring trocar and half with the new OnControl Driver.
I have to say the OnControl Driver is easier and faster, but not always less painful at the time of the bone marrow biopsy. However, the post-recovery period is WAY BETTER with a lot less bruising and pain! I wouldn’t want to go back to the manual trocar.
I documented a bone marrow biopsy with the OnContol Driver on my blog at: http://www.blogger.com/blogger.g?blogID=7114773328403392659#editor/target=post;postID=8302164943287054102
October 18th, 2012 at 11:37 pm
Glad it helped, Denise! Me, too!
October 18th, 2012 at 11:39 pm
Interesting, Judy. Is it the infamous “sucking” pressure change thing when they pull-out the core? I don’t recall experiencing that, but I only had one unsedated BMB. That was enough!
October 20th, 2012 at 12:17 pm
My first BMB used the corkscrew technique Pat describes. While I am normally fond of corkscrews, when it comes to a BMB I was sore for a month afterward. The MD took 2 rest periods while operating the corkscrew. The withdrawal of the aspirate was the most painful part of this fully conscious procedure but only lasted a few seconds (maybe the sucking pressure). I consider this procedure to be barbaric. At Moffitt, for my second BMB required as an applicant for a clinical trial, they put me out with propofol and used a “gun” and sampled at two sites. I don’t think that was the OnControl system. I like to say the only pain was in removing the bandage. No more fully conscious BMBs for me.
October 20th, 2012 at 1:57 pm
Actually Kent, Moffitt does use OnControl, and it is the only FDA approved “gun.” Sedated only for me! And yes, the old corkscrew method is barbaric!
October 22nd, 2012 at 9:34 am
Hi Pat…the info about the On Control system is really interesting! Good to know about that…I don’t know if it is used at our cancer centre, but I will ask. It sounds like it is an improvement on the manual methods.
October 22nd, 2012 at 1:33 pm
I believe it is an improvement. If enough of us ask, our docs will get the message and it will hopefully become standard of care soon.
January 2nd, 2013 at 12:17 am
Hi Mr. Killingsworth, I really appreciate your writing about this. My brother was diagnosed with cmml-2 over thanksgiving this year and has had, I think, 3 bone marrow tests already. He has been in great pain (rsd) for 3 years from a foot injury suffered in a motorcycle wreck, and now this. He suffered some kind of crisis a couple of days before Christmas that sent him into septic shock and he almost died. He is just now out of icu. He is so sick, still. He is at UAB in Birmingham, and I’m sort of shocked that they don’t use the OnControl system. I printed out their brochure and gave it to one of the drs, but he told me a day or two later that taking the bone marrow sample manually gives the operator better “feel” for where they need to go in the bone (?) and better control. He was either told that by other drs or read it somewhere, I suppose. So they seem to have no interest in the system. I wonder if you’ve ever heard this objection to the Oncontrol system?
I do not want to give up on asking them to look into it. Also, can you advise me on how to work around their reluctance to provide sedation for the procedure? They did give him ativan and morphine for the 3rd one, which was effective, simply because he’s so very tired and they took pity on him, I guess. But we don’t want him ever to have to go through that unsedated again. Thanks again for writing about all this, I’m looking forward to reading your four controversial articles. I hope you’re doing well these days.
Jeri Tanner
January 2nd, 2013 at 4:06 pm
It is his right to request sedation. Most if all insurance will pay for it. They may not be set-up there to do a lot of them. Reluctance to change for changes sake–and maybe cost and most definitely profit margin–probably play a part, too. Firmly but politely demand one or the other. If Moffitt and Mayo and many others can do it, so can they. Best part is after using (most often propofol) sedation correctly, should feel pretty good less than an hour following. Can be a bit of a hangover – but not like ativan and morphine if not used to it!
January 4th, 2013 at 12:40 pm
Thanks so much. We did request sedation for this last time and they gave him morphine and ativan; afterwards, he had a terrible episode in the wee hours in which he was not thinking straight and pulled some tubes out of his body. It was terrible! Today, finally, he seems to be awake. I hope propofol will work better for him, as you say, and we will certainly demand it for next time. I have to say again how much I appreciate your writing about these things. You and your family are in my prayers.
January 4th, 2013 at 3:34 pm
Thank you, Jeri! Remember, you may get some resistance because a real sedated BMB is administered by a real anesthesiologist. No problem for larger centers. Good luck!