I recently had the pleasure of meeting one of North America's most experienced NA practitioners, Dr. David Kline of Oregon who has now completed over 1,000 procedures. He is unique in that he *himself* has this disease. Researching his options, he chose NA over OS as the way to preserve his hands and continue his surgical practice.

Already in Boise anyway I took the opportunity to receive a number of cortisone shots on my right hand, treated three years earlier by Dr. Eaton.

Mission Accomplished, along with my fifth interview of an NA practitioner. As with Denkler, Kline believes that Collegenase will be more elegant and more powerful that NA. However at over $5,000 per patient, NA will remain the most cost effective by far.

According to Kline the amazing and completely unfounded anti-NA bias is alive and well in his aria. He's none too popular with the local CHS. These guys *still* just don't get it. And, as I suggested in an earlier post, part of these CHS's problem with Dr. Kline is that he is not a CHS himself. Just not in their league, right? Fortunately for us he's not. Not when it comes to what is quite apparently a bad case of narrow mindedness and flat out self imposed ignorance. Not being a fellow CHS, and under their scrutiny for his work in NA, Dr. Kline is a little more frank than most about the existing level of professional ignorance that currently exists re: NA.

In another thread Stephanie asked my opinion regarding this continued bias. I have never been one to suspects it was “about the money”, however Dr. Kline does not rule that out. In doing more corrections than the CHS in is aria *combined* he has taken away business from those who once ruled the Dups domain. Like Eaton, Kline feel its just a matter of time until NA is the majority procedure. He gives it about 10 years. From my perspective, what we are seeing in CHS is an ultra orthodox conservatism from a highly rarefied men's insider fraternity. Please, don't confuse them with the facts unless you wanted to be treated as someone's who's opinion is not worthy to be heard.

(Am I being too harsh? Is there a reason anti-NA CHS should be defended for their position?)

Kline is also believer in radiation treatment for early stages of Dups. He is currently referring candidates to a local specialist who is completely on board with the idea. I am considering taking his advise and finding someone in LA who would be willing to learn the ropes as developed in Germany. My right hand is still in good shape. That's Wolfgang's recommend for me as well, so I may just do something about it.

Kline doesn't have as cool a local Oldies radio station as Eaton plays :-), but we have a good surgeon up there.

Have a look at http://www.dupuytren-online.info/NA_list_North_America.html for addresses. People from all over the US fly into Florida to see Charles Eaton. You are lucky to to live there!

Wolfgang

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I live in Florida...does anyone know a practitioner in this area? The local Ortho I went to see, after waiting 2 months to get in, spent less than 5 minutes and told me he would operate when I couldn't stand it any more. He told me surgery was the only treatment.

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Jim, as you know, *everyting* medical cost more in the US than in Europe. The AMA has done a good job for their members.

No, I personally don't see money as the driving factor behind the Glacial rate at which CHS are accepting NA. They all seem fairly hopeful about Collegenase even though most of the money will go to Auxilium and BioS. At $5,000 per vial how much will the MD charge to inject it? It will actually be quicker and far easier than NA, requiring less training and expertise. If it does what it's designed to do it will only attack the diseased tissue. You can miss by a mile and still cause no damage. My guess is that CHS fees above the cost of the drug will be similar to that of NA.

Eaton set the price of NA and everyone else followed. I believe he set it according to an equivalence of what he would be paid in dollars per hour in the Operating Room. I don't think he was willing to reduce his income by becoming the lightening rod for NA. He just shifted his income from one procedure (OS) to another.

Kline, who is not a CHS, is thinking that *any* good GP should be able to use Collegenase. He too was at Eaton's ASSH presentation. It's a no brainier to use according to him. Why do you need a CHS at all? He's thinking that the advent of Collegenase will greatly reduce the rate of OS and eventually take this entry level treatment out of the hands of the specialty. After all, in Europe most of the NA isn't even done by surgeons, and NA actually takes some talent while Collegenase doesn't.

What I meant by the "miss by a mile" is that in Kline's opinion you don't need to be all that exact with Collegenase like you do with NA. Regular munitions will do, no smart bombs.

"I don't see why an hour of this sort of work on my hand should cost more than, say, a root canal procedure."-Jim

I don't blame a CHS for wanting to make the same $$$/hr doing NA as he does doing OS. If the rate is set lower he is less inclined to offer NA. Just human nature.

As you say, the *real* cost is the travel at this point. All we can do is keep banging away at educating patients who are fortunate enough to find this Forum. After last year's ASSH meeting CHS know darn well that other CHS are doing NA. Then, as they see their patients literally "fly away" out of their offices to other cities, we've got to be making a dent in the Wall. This is all we have the power to do, but in doing so we now have over 10 NA guys so far. Remember when we had none?

It's still *way* worth the travel money. Some actually fly hours to see Eaton and then fly home immediately with no overnight. I'll do that with Denkler from LA if and when. I'm three years post NA and just fine so it may be a while. Not a bad idea to keep the nodules at bay with cortisone shots since cords grow out o them.