Allergan In The News

[Jean McMillan 2,973]

Allergan, maker of the Lap-Band® and many other medical devices, made the bariatric headlines on October 30, 2012, when a news article (click the link below to read it) revealed that they’re considering selling the Lap-Band® part of their business. I don’t have all the details behind the story, but I do have plenty of opinions about it, so I’m sharing those opinions with you in this article.

http://www.reuters.com/article/idUSL3E8LU46K20121030

BIG NEWS IN THE BAND WORLD

On October 30, 2012, a Reuters article revealed that Allergan is considering selling the Lap-Band® to another medical device company due to declining sales of the band. Not surprisingly, this news has caused some excitement in the bariatric surgery community. When I first read the article, my immediate thought was that I don't have enough information to make it the subject of an article of my own. I'm still missing a lot of information, but have plenty of opinions about it (which can come as no surprise to you), so I've decided to give you my opinions with you in this article from today’s special edition of the Bandwagon® on the Road e-newsletter.

ALLERGAN PEDDLES THE BAND

I have a hard time drawing any conclusions (pro or con) about the band itself based on the Reuters report. The decline in Lap-Band® sales could be the result of management or other business problems rather than due to a problem with the band itself. It's highly unlikely that Allergan will ever reveal the whole story to anyone but their team of attorneys and board of directors.

So, what could this hot news story mean? As you read on, please remember: these are only personal opinions from an ex-bandster who’s fairly well-informed but not a medical professional and in no way associated with Allergan or any other medical device or other company in the world of bariatric surgery. For what it’s worth, here’s my take on the story.

The US economy is in tough shape, the popularity of bariatric surgery in general is leveling off, and insurance coverage for bariatric surgery is still a challenge. Allergan is not alone in this - Johnson & Johnson must face the same challenge in marketing the Realize™ Band. The story of what's really behind all this is clouded by the reactions of the media and of band-bashers who sing the "I told you so" song because they assume (without any credible basis at this point) that Allergan's decision is related to the safety and/or efficacy of the band.

SO, WHAT’S THE REAL STORY?

All the other bariatric surgery procedures now performed in the USA can have serious complications and failure rates, but it's easier to point the finger of blame at a single manufacturer of a medical device than it is to blame the thousands of surgeons who are doing bariatric procedures that don't happen to use a medical device. The FDA isn't looking over the shoulders of all those surgeons the way it scrutinizes Allergan or Johnson & Johnson. When Dr. John Doe stops doing bariatric surgery and goes back to yanking out gall bladders, no one leads a parade down Main Street waving banners about the dangers of the procedures Dr. Doe was doing. Except in rare cases (such as the sad story of my original surgeon), nobody's even discussing Dr. Doe's surgical expertise or behavior. It's an example of what I call the David & Goliath Syndrome. A big company like Allergan is an easy target thanks to its size and visibility. The general public may step on Dr. Doe's fingers but otherwise will kick him to the curb in eagerness to throw rocks at Allergan.

One of the hurdles facing any manufacturer of an adjustable gastric band is that it is (in my opinion) the bariatric procedure that requires the most patient education, aftercare, and support. In the 5 years since I was banded, I have encountered plenty of evidence of bariatric clinics doing a great job of that, but I've also encountered clinics that are failing at it, to the detriment of their patients. Not because they're doing something wrong, per se, but because they're directed by a surgeon (or team of surgeons) who was trained to think of surgery of any nature as an in-and-out deal. They're used to seeing the patient 3 times: a pre-op visit; in the operating room (with an unconscious patient); one post-op visit; and never again unless the patient experiences a complication that requires more surgery. That's fine when the surgery involves removing a gall bladder or a mole or a wisdom tooth, but it's a set-up for failure with band patients. The bariatric surgeon who vetted Bandwagon told me several years ago that the band manufacturers make few demands on the surgeons or clinics that buy their products because they don't want to marginalize the customers who don't follow the manufacturer's advice but have acceptable patient outcomes.

Avoiding marginalization of customers is a smart business decision but a poor medical decision, and I think it's a mistake for us to view surgeons only as super-wealthy, super-powered medical demi-gods anointed by a Supreme Being and the ASMBS. They're also customers, and just like you and me when we're shopping for a new car, they're looking for a product that has reliable quality and performance at a price they can live with. They are business people who want to make money (to pay their staff, their malpractice insurance premiums, their colossal student loans, and their kids' college funds). Sure they want to practice the art (and science) of medicine, but they can't do that very well if they can't pay their bills.

Finally, keep in mind that someone, somewhere is going to end up with the Lap-Band in some form. It is highly unlikely that Lap-Band® research & development, its technology and FDA approval, to say nothing of the existing customer base, will drop to the bottom of the bariatric pond and never be seen again. Both Allergan and the new owner will legally and ethically have to stand behind their product, with the details of that worked out to the last detail by teams of expensive attorneys and insurance companies. Even surgeons who stop doing band surgery to concentrate on other procedures will still have the basic skill and knowledge to provide fills and other aftercare to their band patients.

Although I lost my beloved band in April 2012, I do not regret having Lap-Band® surgery and if I were starting my WLS journey today, I would ask my surgeon's opinion about the Allergan decision and also ask how (or if) it will affect his/her practice. The answers to those questions would be towards the top of a long list of questions I'd be asking before deciding to have surgery. And if I still had my band, I'd be asking my surgeon the same questions so that I could go forward with some degree of comfort (if not 100% satisfaction) that I'd have someone to turn to should I need band help in the future. I most certainly would not be rushing off to make an appointment with the Speedy Weight Loss Surgery Revision Center, or at least not until I'd done plenty of homework on the procedures offered by the quacks at Speedy. Trading in a car just because it's 2 years old has never made sense to me, and if it isn’t broke, why fix it?

Although my journey from Lap-Band® to vertical sleeve gastrectomy ended up taking 6 months, I'm still nagged about it by a little doubting voice, especially when my sleeve is giving me trouble. Should I have chosen the sleeve, or not? Should I have risked the return to morbid obesity, or gamble on more surgery? There are no easy answers to questions like that. If there were a cure for obesity, I'd be first in line for it, but until that cure is invented, I'm making the best of what I've got.

[☠carolinagirl☠ 18,721]

i dont regret my band. hell, it saved my life.

my dr gave me the pros and cons and advised me its merely a tool

and i would have to help it. and i signed papers that they advised me of this and id adhere to the guidelines

i feel alot are thinking if i get the band, i can lose overnight and continue eating whatever they want

maybe they are the lucky ones but not the case to the majority.

there will always be new and improved and the next best thing....

but there will always be bashers and happies for any wls

again, as people, we choose what is right for us

i wish everyone luck.

as always, great article jeannie

[Maddysgram 6,159]

Another great article Jean! I always look forward to them. You give us food for thought.

When I first read the article I just looked at it as a business deal. Economy is down, more ppl going to other WLS. I just figured Allergan is moving on to bigger & better investments.

[Rojasanoll 920]

I talked with my sister who works for Allergan in Santa Barbara area and she hadn't heard of the company selling out of the band business. But all the literature I've been able to read prior to my band date was company studies on the band. It was all truly positive in very high results. Yes, some failures have occured but not different than any other product or experiemnet in the world. More people have probably have had a better quality of living than death results from the band. We can have side effects from a simple pulling of a wisdom tooth gone bad.

I am very happy that after a year of studing Allergan and having the capability to read their personal lab results that have been published to AMA of having my band installed on Aug 6, 2012. I have lost close to 67 pounds and my quality of life is getting better each day.

[♥LovetheNewMe♥ 1,216]

I understand your view Jean and I do have some basic knowledge of how the health care world works being a health care worker for 33 years. I also am one who does not regret getting a band but I do have personal concerns about the long term side effects of lap band. But lap band in the medical community is no different than any other implanted medical device, there are side effects and risks and benefits. The benefits have greatly out weighed the risks for me and many others on this site. My WLS surgeon has stopped placing the band in his patients and is promoting the vertical sleeve in his practice. His patients have not had the success with lap band and several have been converted to the sleeve or had their bands removed totally. I hope I can keep my band and I do what I can to protect it, but if I have to have it removed, like you, I hope I am in a place that I can maintain my weight loss without the band. You see if my band fails I will not have another weight loss surgery, that is why the emotional side of this journey is so important to me. I want to really understand, why I eat and why I react the way I do to everything. I am not only trying to lose weight I am trying to fix the total me in the process. Wish me luck because I still have a lot of work to do. As usual thanks for the great post.

[Jean McMillan 2,973]

Medical implants of any description can be a mixed blessing. A coworker of my husband's has had a medical nightmare since his hip replacement operation. Something in the materials used in the artificial joint caused major inflammation, he had complications from the second surgery he had to deal with the problems from the first surgery, and a year later he's still too sick and disabled to come back to work. On the other hand, I know plenty of people who've had hip and knee replacements with no problems and great success in restoring their mobility and reducing their pain.

[icestorm12132008 39]

Allergan may have compitition with the Realize system wich is just a lapband but made by a different manufactuer. with different material and guideline(realize folks get their bands filled right off in the OR).

I think the real question lies in the medical community themselves, alot of the sucess of banding comes from not only the patient and their adherance to MD and nutrtional orders, but the MD's dedication to their patient.

If you have a surgon who maybe does not fully understand the workings of bariactric medicine and how Adjustable Gastric Banding is supose to work, then there are going to probally be problems.

I'm so glad I decided to have surgery last fall when I attended my surgon's informational session on the lap band. I've lost well over fifty pounds(close to 70 i think) in not quite a year.

The Lap band has been around for a while, the sleve is still a new procedure and it is still the new kid on the block as far as the treatment in obesity. It is unfortunate that for some the band fails or does not work for the patient, and for some switching to a sleve works or a typical RNY is what does the trick for them. All that is important is that those with bands take care of their bands by following the rules and going to see a compitent surgon who knows how to care for a banded person.

[dee257 1,516]

Great artical Jean....

I have the Realize Band and didnt get any fill in the OR...after 6 weeks I did get one...

[Scorpio Girl 88]

Allergan may have compitition with the Realize system wich is just a lapband but made by a different manufactuer. with different material and guideline(realize folks get their bands filled right off in the OR).

I think the real question lies in the medical community themselves' date=' alot of the sucess of banding comes from not only the patient and their adherance to MD and nutrtional orders, but the MD's dedication to their patient.

If you have a surgon who maybe does not fully understand the workings of bariactric medicine and how Adjustable Gastric Banding is supose to work, then there are going to probally be problems.

I'm so glad I decided to have surgery last fall when I attended my surgon's informational session on the lap band. I've lost well over fifty pounds(close to 70 i think) in not quite a year.

The Lap band has been around for a while, the sleve is still a new procedure and it is still the new kid on the block as far as the treatment in obesity. It is unfortunate that for some the band fails or does not work for the patient, and for some switching to a sleve works or a typical RNY is what does the trick for them. All that is important is that those with bands take care of their bands by following the rules and going to see a compitent surgon who knows how to care for a banded person.[/quote']

Actually, realize doesn't recommend OR fills at time of implantation, lap band does, but not all surgeons do a primer fill.

[missybear 86]

Im banded and work on mergers and acquisitions day to day. I read the proposed sale news as well with interest, although its the deal aspects I wanted to provide my insights on below.

Allergan is a publicly listed company and needs to maintain and grow its sales and EBITDA, to continue to support both it's share price and deliver returns to shareholders.

Yes, it's evident sales of the lapband have declined in recent years due to a number of factors including, but not limited to, realize competition, general economy, efficiency in the procedure concerns as well as a the potential that the band like any product may have reached its peak in terms of sales increases and now leveling off to longer term sustainable sales levels.

Allergan would have assessed both the sales and profitability, cashflows and strategic fit of its lapband product unit to start to canvass for potential interested parties.

I've always found the lapband to be a slight unusual fit to the Allergan business which I've otherwise known more so for its multi faceted business units of cosmetic injectables and implants, and medical intervention often tied back to one of its earliest products, Botox. As the board and management team no doubt assessed the financials and strategic fit associated with the lapband business unit, its likely to be an easier carve out opportunity to improve the return on investment metrics across the entire Allergan business.

I wait with interest to see the outcome of the sale. Whilst we are unlikely to know of all the potential parties who explore the opportunity to purchase. I anticipate interest will come from a wider range of pharmaceutical, medical devices and lesser known private equity funds businesses, who may choose to proceed to offer or not depending on financial performance, product fit, opportunity to integrate or expand into into new chan

[jaciqltz 0]

I just attended a seminar by the countries 3rd leading WL surgeon. He covers ALL surgeries and all the info abou them. He said he just learned that within 5 years the lapband will be extinct. They are finding that it fails more often than any other sugery in that is does NOT alter the metabolism the way the other surgeries does. It also does not reduce the diabetes the way they claimed at first!

SO has anyone else been getting this info. I called my insurance company and was told that they still do not recognize the sleeve, but that it is up for consideration this year and that yes, they are reevaluating the lapband and may drop it within the next 2-3 years!

[tipsyb 71]

This is interesting to read as its posted I think in 2008 . It's now 2013 and the lap and is going from strength to strength