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SpaceOAR is discussed often here on SDN. In the summer of 2021 (in the "RadOnc Twitter" thread), @TheWallnerus et al calculated how much the authors of the 2015 SpaceOAR Phase III trial paper (crucial for FDA approval) were paid. To recap:
Neil Mariados received $100,000.
John Sylvester received $210,000.
Dhiren Shah received $100,000.
David Beyer received $2500.
Steven Kurtzman received $25,000.
Rodney Ellis $7,000.
Edward Soffen $56,000.
Peter Rossi $220,000.
Daniel Hamstra $100,000.
Jeff Michalski received $9000.
TOTAL: ~$830K to the SpaceOAR authors.
All of this is verifiable on openpayments.org (as in, I want to be clear - no one is hiding anything).
Other interesting items from the internet:
Using OpenPayments, Augmenix has made $1,659,900.87 in general payments (mostly to physicians) since 2015.
From 2015-2017, you can see how much Augmenix paid in ownership and investment interest. Starting in 2018, that information is no longer available. Why? Because Boston Scientific acquired Augmenix in September 2018 for $500 million in up-front cash and up to $100 million for reaching sales-based milestones.
Again looking at OpenPayments, 2017 is the busiest/"most expensive" year for Augmenix, which makes sense - SpaceOAR had FDA approval at that point, and it was the last full calendar year before being acquired by Boston Scientific.
In 2017, Augmenix made 1,110 payments to JUST physicians. Some of these are multiple payments to the same person. You can download all this data in Excel. So, that's what I did. Drilling down further, it appears that 1,110 payments were made to 727 physicians in 2017 alone. It's the government, and they make you report payments for even a $2 coffee. Excluding those small $2-$5 payments...you can see a lot of $200 dinners. Excluding those payments, we're still left with ~112 payments of at least $300, with the highest payment being $28,228. This is JUST for 2017.
But who are these physicians? Are they "just" those greedy private practice docs no one has ever heard of? Of course not.
Sorting through the Augmenix and Boston Scientific OpenPayments data, some of the highest paid folks from 2015 to now include:
Peter Orio - Vice Chair of Network Operations for Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) Department of Radiation Oncology (formerly Assistant Chief of Radiation Oncology at Brooke Army Medical Center) - $285,045 from Boston Scientific, $213,135 from Augmenix
Daniela Hamstra - Chair, Department of Radiation Oncology, Baylor - $100,961 from Augmenix, $6,426 from Boston Scientific
Michael J. Zelefsky - Vice Chair, Department of Radiation Oncology, Clinical Research; Chief, Brachytherapy Service; Steven A. Greenberg Chair in Prostate Cancer Research - $356,681 from Boston Scientific, $132,570 from Augmenix
Paul L. Nguyen - DF/BWCC Genitourinary Clinical Center Director for Radiation Oncology, Vice-Chair for Clinical Research in the Department of Radiation Oncology, and Professor at Harvard Medical School - $300,744 from Boston Scientific, $132,575 from Augmenix
Brian Davis - Mayo, committee member of American Board of Radiology on certification exams and member of the American College of Radiology Appropriateness Criteria Committee on Prostate Cancer - $28,512 from Augmenix, $7,243 from Boston Scientific
James Yu - Professor and Executive Vice Chair, Department of Radiation Oncology, Columbia (formerly Associate Chief Medical Officer for Radiation Oncology, Yale) - $84,388 from Boston Scientific, $57,616 from Augmenix
I think SpaceOAR is a very useful tool. I like that we have it. However, there is literally nothing like this in modern Radiation Oncology. Our treatment does not generally revolve around drugs or multiple medical devices. Unlike other specialties, we are rarely targeted by pharma/device companies and offered consulting fees for our efforts. Enter: Augmenix.
Augmenix starts generating seed funding in the late 2000s/early 2010s. OpenPayments only goes back to 2015, so who knows what happened before then. What is clear is that Augmenix and Boston Scientific have paid literally thousands of physicians (mostly Radiation Oncologists) literally millions of dollars over the last 7 years (at the very least, maybe longer).
The people listed above, some of whom have personally received several hundred thousand dollars from Augmenix/Boston Scientific, hold a lot of influence. At the very least, they have trained (and continue to train) a significant number of residents. At most, they are KOLs, Chairs of Departments, invited faculty delivering the GU ASTRO Spring Refresher lectures, and ABR board examiners. Just these six people alone have a tremendous impact on how Radiation Oncology is practiced in 2022. These are six people out of literally thousands who have received some form of payment from Augmenix/Boston Scientific.
Prostate cancer is one of (if not the) most common diseases treated by Radiation Oncologists. The payments by Augmenix/Boston Scientific is unrivaled in Radiation Oncology.
Why am I posting this? Because everywhere I turn, there's a near universal application of SpaceOAR in prostate cancer in America. EPE, covering nodes - doesn't matter, SpaceOAR! What about the hundreds of thousands of prostate patients treated between the development of IMRT and the release of SpaceOAR, or the prostate patients treated in other counties where SpaceOAR hasn't been approved/adopted to this degree? Were their outcomes SO BAD that near universal application of SpaceOAR was required? I don't think so.
Really, to reiterate - this is a useful tool. I don't want it to go anywhere. What I do want, however, is for everyone to think a little harder about the use of SpaceOAR in their own practice and department. If you really think putting SpaceOAR in a guy with EPE who you're planning on covering nodes is worth it, then I have no problem with your personal practice. If, however, you're putting SpaceOAR in everyone simply because one of the faculty members in your department receives A LOT of money from Augmenix/SpaceOAR and it's now the culture to just put the gel in every prostate patient...are you choosing wisely?
Neil Mariados received $100,000.
John Sylvester received $210,000.
Dhiren Shah received $100,000.
David Beyer received $2500.
Steven Kurtzman received $25,000.
Rodney Ellis $7,000.
Edward Soffen $56,000.
Peter Rossi $220,000.
Daniel Hamstra $100,000.
Jeff Michalski received $9000.
TOTAL: ~$830K to the SpaceOAR authors.
All of this is verifiable on openpayments.org (as in, I want to be clear - no one is hiding anything).
Other interesting items from the internet:
Using OpenPayments, Augmenix has made $1,659,900.87 in general payments (mostly to physicians) since 2015.
From 2015-2017, you can see how much Augmenix paid in ownership and investment interest. Starting in 2018, that information is no longer available. Why? Because Boston Scientific acquired Augmenix in September 2018 for $500 million in up-front cash and up to $100 million for reaching sales-based milestones.
Again looking at OpenPayments, 2017 is the busiest/"most expensive" year for Augmenix, which makes sense - SpaceOAR had FDA approval at that point, and it was the last full calendar year before being acquired by Boston Scientific.
In 2017, Augmenix made 1,110 payments to JUST physicians. Some of these are multiple payments to the same person. You can download all this data in Excel. So, that's what I did. Drilling down further, it appears that 1,110 payments were made to 727 physicians in 2017 alone. It's the government, and they make you report payments for even a $2 coffee. Excluding those small $2-$5 payments...you can see a lot of $200 dinners. Excluding those payments, we're still left with ~112 payments of at least $300, with the highest payment being $28,228. This is JUST for 2017.
But who are these physicians? Are they "just" those greedy private practice docs no one has ever heard of? Of course not.
Sorting through the Augmenix and Boston Scientific OpenPayments data, some of the highest paid folks from 2015 to now include:
Peter Orio - Vice Chair of Network Operations for Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) Department of Radiation Oncology (formerly Assistant Chief of Radiation Oncology at Brooke Army Medical Center) - $285,045 from Boston Scientific, $213,135 from Augmenix
Daniela Hamstra - Chair, Department of Radiation Oncology, Baylor - $100,961 from Augmenix, $6,426 from Boston Scientific
Michael J. Zelefsky - Vice Chair, Department of Radiation Oncology, Clinical Research; Chief, Brachytherapy Service; Steven A. Greenberg Chair in Prostate Cancer Research - $356,681 from Boston Scientific, $132,570 from Augmenix
Paul L. Nguyen - DF/BWCC Genitourinary Clinical Center Director for Radiation Oncology, Vice-Chair for Clinical Research in the Department of Radiation Oncology, and Professor at Harvard Medical School - $300,744 from Boston Scientific, $132,575 from Augmenix
Brian Davis - Mayo, committee member of American Board of Radiology on certification exams and member of the American College of Radiology Appropriateness Criteria Committee on Prostate Cancer - $28,512 from Augmenix, $7,243 from Boston Scientific
James Yu - Professor and Executive Vice Chair, Department of Radiation Oncology, Columbia (formerly Associate Chief Medical Officer for Radiation Oncology, Yale) - $84,388 from Boston Scientific, $57,616 from Augmenix
I think SpaceOAR is a very useful tool. I like that we have it. However, there is literally nothing like this in modern Radiation Oncology. Our treatment does not generally revolve around drugs or multiple medical devices. Unlike other specialties, we are rarely targeted by pharma/device companies and offered consulting fees for our efforts. Enter: Augmenix.
Augmenix starts generating seed funding in the late 2000s/early 2010s. OpenPayments only goes back to 2015, so who knows what happened before then. What is clear is that Augmenix and Boston Scientific have paid literally thousands of physicians (mostly Radiation Oncologists) literally millions of dollars over the last 7 years (at the very least, maybe longer).
The people listed above, some of whom have personally received several hundred thousand dollars from Augmenix/Boston Scientific, hold a lot of influence. At the very least, they have trained (and continue to train) a significant number of residents. At most, they are KOLs, Chairs of Departments, invited faculty delivering the GU ASTRO Spring Refresher lectures, and ABR board examiners. Just these six people alone have a tremendous impact on how Radiation Oncology is practiced in 2022. These are six people out of literally thousands who have received some form of payment from Augmenix/Boston Scientific.
Prostate cancer is one of (if not the) most common diseases treated by Radiation Oncologists. The payments by Augmenix/Boston Scientific is unrivaled in Radiation Oncology.
Why am I posting this? Because everywhere I turn, there's a near universal application of SpaceOAR in prostate cancer in America. EPE, covering nodes - doesn't matter, SpaceOAR! What about the hundreds of thousands of prostate patients treated between the development of IMRT and the release of SpaceOAR, or the prostate patients treated in other counties where SpaceOAR hasn't been approved/adopted to this degree? Were their outcomes SO BAD that near universal application of SpaceOAR was required? I don't think so.
Really, to reiterate - this is a useful tool. I don't want it to go anywhere. What I do want, however, is for everyone to think a little harder about the use of SpaceOAR in their own practice and department. If you really think putting SpaceOAR in a guy with EPE who you're planning on covering nodes is worth it, then I have no problem with your personal practice. If, however, you're putting SpaceOAR in everyone simply because one of the faculty members in your department receives A LOT of money from Augmenix/SpaceOAR and it's now the culture to just put the gel in every prostate patient...are you choosing wisely?