Tuesday, June 26, 2007

The niche market for outpatient plastic surgery technology & Ivivi in the news

One of my geeky interests is emerging technology. When this overlaps with Plastic Surgery all the better. Like I got into a little bit before (with my rant on what I thought was revolutionary vs. obsolete or dead-end the other day), we're in an era where we're bombarded with products, each claiming to have built a better mousetrap. Be it skin care products, the newest laser, or some 'magic' surgical technique or device to facilitate surgery everyone is trying to sell you something. In most cases you see that the results are modest & the costs are significant.

There's a big niche waiting to be filled in Plastic Surgery as I see it. As more and more procedures are done as an outpatient (increasingly in an office OR suite), things that can facilitate an easier recovery or lower cost for surgery are going to find a place in the market. Post-operative pain control and nausea prevention are two of the single biggest fears patients report on surveys when they're considering having surgery done.

I'm still a believer in pulsed magnetic field tech. for post-operative pain control in Plastic Surgery. A recent presentation studying the Ivivi device in Europe showed 80% acceleration in pain relief in breast augmentation patients treated with the active PEMF technology as compared to patients treated with placebo units. Another paper presented at a Neurology meeting showed improved nerve cell survival in a standard animal cell model of brain inflammation which is used to test treatments for diseases like Parkinson's, Alzheimer's, Lou Gerhig's disease, and other neuro-degenerative disorders.

Another real interesting thing out there is a drug called Emend (aprepitant). It's a new anti-nausea medicine that works different from other medications in that it actually blocks receptors in your brain that mediate the nausea response on a biochemical level. It must be given prior to anesthesia and is very effective (apparently) at preventing post-operative nausea and vomiting (PONV) for 48-72 hours. This drug is being used mostly for chemotherapy patients currently, but the potential for use in the outpatient Plastic Surgery patient group is obvious.

What's the catch with Emend? Well, currently it runs in excess of $80 per pill for a single dose. Merck received an approvable letter from the FDA in May so expect to see this promoted more and the price to slowly drift down. If it works as advertised, I bet it becomes routinely used preoperatively for many surgeries just as Zofran has been.



Medical Spa MD said...

I'll take a wild guess that you're not a wild proponent of the 'featherlift' genre?

Dr. Rob Oliver said...

The company who sold the Contour thread-lift sutures recently pulled them from the market. They've decided the market is more lucrative in the general wound closure market. It's not going out too far on a limb to say that the thread-lift type procedures have been a failed experiment in large part. Too expensive. Too unpredictable. Too many unhappy patients requiring redo's or revision surgery.

What's not to like?

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The Angry Frenchie said...

You noted that one of the possible pitfalls for Emend is the high cost per pill, ~$80.

However, it seems to indicate that just one pill is required for 48 hours of effect, and is to be administered ~3 hours prior to anesthetization - surely patients will not mind the extra cost when they are already paying for an expensive procedure.

When reading their information, I was most struck by the relatively high rates of hypotension and bradycardia (5.7% and 4.4%, respectively) associated with the drug. It seems like this pill could potentially lead to some serious complications?

Dr. Rob Oliver said...


You make a good observation, but most of the time you have to put "side effects" listed in product inserts into context.

If you ever read a product insert or PDR entry on medications you get extensive laudry lists of any possible symptom that may have been reported during clinical trials. It can become very difficult to discern the actual problems that you're likely to see.

Emend was tested on groups of patients including a number of cancer patients who are usually older, with more medical issues, & frequently immunocompromised from their treatments.

I suspect the reports of bradycardia (slower heart rate) and low blood pressure were somewhat modest in nature or they'd be labeled with more "gusto". The approvable letter by the FDA in May also lends credence to this suggestion as they are very sensitive to these drug approval issues right now after some other publicized drug issues. Particularly on a drug that relieves symptoms, rather then one for some critical therapeutic need, you'd expect a higher bar for their approval.