Lap Band's Perfect Storm- The Rise and Fall of the Lap band, IT WILL RISE AGAIN THE...

I like this article by Dr Simpson, and I totally agree, the Lap Band WAS A VERY GOOD TOOL, before it got too big for it's britches and everyone wanted to get a band, those who NEVER should've gotten a band in the first place.

The lap band should ONLY be for a select group of people, it's not a ONE SIZE FIT EVERYONE like the Bypass, you don't have to do nothing and lose weight with the Bypass at least for the first 50 pounds..but you have to work for every pound lost with the band if you are doing it the right way.

People STILL WANT lap bands, it is still the most GOOGLED weight loss surgery, problem is it was misused by surgeons and patients, surgeons got greedy, they didn't care about aftercare, the California market was out of control, they had bill board signs everywhere...IT WAS outrageous!!!  

I've heard of people filling their OWN bands, having friends who are nurses fill and unfill their bands at will, bands so tight it nearly ripped apart the persons esophagus....it was wild!!!

People would post here crazy stuff here, many would not see their surgeons until years later, forget about monthly aftercare, some surgeons would only see patients every 3-6 months when people needed fills monthly to find their sweet spot it was a disaster....

Some people had their PCP filling their lap band and did not have a CLUE about the sweet spot or know how to detect a potential lap band problem....some people were letting their Gastro docs figure out their lap band complications.

NONE of these people are highly SKILLED to determine how the lap band work, or can fill the band properly or detect problems with the lap band.....the lap band is a specialized surgery, if you have issues please don't rely on the radiologist, gastro doc or PCP...you will need a  SKILL LAP BAND SURGEON...

Just like Dr Simpson said, in the height of the lap band market, some surgeons that REALLY DID NOT LIKE THE BAND, JUMPED ON THE LAP BAND WAGON AS A SIDE PROJECT to make money AND NEVER OFFERED ANY TYPE OF AFTERCARE...they would just place the band like a band mill and have a PA or someone else to do fills, if any fills were done at all...some sent patients to fill centers or their PCP....

So....who do I blame for the downfall of the lap band? GREEDY SURGEONS.....your banded life will be as good as the aftercare from your surgeon and your motivation to do well.

When Inamed had the band, it was just a simple surgery that was an alternative to the Bpypass, there were NO commercials, it was not this glamorous surgery, there were no surgery centers suppressing potential complications with the band, when I got my lap band there were no bill boards, it was just people who wanted HELP to assist them lose weight.

And the Lap band will turn around after a new owner gets it and market it like it was suppose to be like when Inamed had it and ......since it's adjustable and removable and that will continue to attract people like myself...

Edited to Add: I see a disaster in the future with the Sleeve too...it reminds me about how popular the band was, in fact the Lap band board used have more hits that the Sleeve board now....I see too many similarities.....every thing that glitter is not gold, I see some problems with the Sleeve already creeping up just like the band....which is scary...

Lap Band’s Perfect Storm and Turn Around

• Posted on 05.25.13
• Lap-Band

http://www.yourdoctorsorders.com/2013/05/lap-bands-perfect-s torm-and-turn-around/

When the adjustable gastric band (Lap-Band) was approved for marketing in June of 2001 few people noticed. But by 2004 it became the most searched term in weight loss. By 2007 it was responsible for being the major method people chose for their weight loss surgery.

Then, the perfect storm hit. The Lap-Band went from the darling of Allergan’s portfolio, to a business they are trying to sell.

When Allergan purchased the Lap-Band product line, a company called Inamed, it is said they were more interested in the breast implant that they sold than they were the band. But still, the band out performed sales estimates every year.  As with most companies that begin to ride a winner, Allergan pushed harder for the device to be sold more and more. When Johnson and Johnson’s surgical division, Ethicon, announced it purchased the “Swedish Band” and obtained approval, suddenly Allergan had competition, and while they didn’t lose sales, 1/3 of the band market was instantly belonging to Ethicon.

Allergan made a deal with the other large stapler company, Covidien (Then US Surgical) to help market the band to their bariatric surgeons. The reasoning was that if the non-Lap-Band surgeons who were in Ethicon’s camp would use the Johnson and Johnson brand, then Allergan would go to the other camp, Covidien, and have that group of surgeons trained to use their band.

Allergan was more focused on Sales than Aftercare

In the background there was a group of surgeons talking to the heads of the Allergan division saying this was a mistake. By pushing the band, and training everyone to use the band, it ignored a simple fact: band success is less about surgically placing the band and more about follow-up. Many of the surgeons who were placing the band were more interested in the surgery and less interested in the follow up. That if the patients were not followed up on a regular basis and provided support and adjustments, they would become discouraged.  The surgeons also warned Allergan that many of these surgeons were not band-friendly- that they loved having the people come to their office for a band and then pulling a “bait and switch” talking them into another weight loss operation.

Riding the wave of sales, Allergan ignored those surgeons.  It turned out that a small per cent of Allergan surgeons were doing the vast amount of bands.

Allergan’s Lap-Band site, lapband.com, listed every surgeon that had been proctored to place the bands. At one point there were over 1500 surgeons on their website.  All a prospective patient had to do was put in their zip code and up would come the surgeons in their area who were doing seminars. Some surgeons learned to “game” the site- offering daily seminars, not by them, but by their staff so that the site was flooded with their seminars.

Low BMI Study

One shining study was Allergan funding a study about low-BMI patients. By doing a careful low BMI study Allergan showed that they could have remarkable success, and they didn’t fit the classic “need to be 100 pounds overweight.”  The study was done by surgeons who knew the band, knew how to take care of patients following the surgery, and had remarkable results.

BOLD Data

Allergan also had good news from the bariatric outcomes database put together by the first attempt at Centers of Excellence.  In spite of a number of surgeons not knowing how to care for patients after surgery, the first year weight loss for band patients was 53%, slightly lower than RNY. The complication rate and mortality rate showed it was the safest surgery.

The Recession

On September 15, 2008 the first blow to Allergan’s sales happened when the recession hit. When the economy was overheating many people would get second mortgages or easy financing and get a lap-band. Suddenly this financing was gone.

With the recession and unemployment many people were out of jobs, often affecting the group of individuals most likely to be obese. For the first time in 15 years the number of weight loss operations, of all kind, declined.  The Lap-Band division did not make their sales numbers, and would continue losing sales over time.

Marketing

During this time the direct-to-consumer advertising from Allergan stopped. It was expensive to purchase television, and the company with falling sales projections, stopped marketing in television.  They focused on their website, social media, and a number of attempts which did not get the same result.  As the recession moved into its second and third year, Allergan forgot what got them there.

Thinking many surgeons didn’t like aftercare, Allergan sought to get primary care doctors to do adjustments.  The core group of surgeons said this wasn’t a good idea- not only would those primary care doctors not know how to do an adjustment properly, they wouldn’t be able to deal with complications.  That the surgeon talking to the patient was every bit as important as properly placing the Lap-Band, and removing this from the follow-up would result in poor results.

The Sleeve

Meanwhile a large group of surgeons had been “trained” on the Lap-Band had offered the band simply as an adjunct to their practice. Someone would come to their practice wanting a band, and they would try hard to change their minds. Some of these surgeons had been concerned by the outcomes from the Roux-En-Y gastric bypass, and were hopeful the band would offer an alternative.

In 2002 Michel Gagner was talking about removing 90% of a patient’s stomach as a new approach to weight loss. More and more surgeons became interested in this as a surgical alternative to weight loss from the RNY. The American Society for Metabolic and Bariatric Surgery members (the parent organization for bariatric surgery) worked hard to have this covered by major insurance groups. Pushed by staple companies, as it would use their product, this became the new “darling” operation.

A number of surgeons liked it because it involved little aftercare.  The patients would have an operation, they wouldn’t require “adjustments” to it, and the operation was simple, good results at one  year, and the leak rate from staples – at 2.5%, while devastating for those, was a small enough number that it became less of an issue.
 

Wrong Information

The original model for the Lap-Band was it made a person “feel full with less.” This was preached by the sales force at Allergan to the surgeons who were placing the band. If you were not feeling “full” eating less, then they need to have their band tighter.

Out of Australia the research was showing something different. The band was not making people feel full with less.  In fact, the band worked best when it was a bit loose and food went past the band.  As much as John Dixon preached this, the only ones who kept up with that data were those surgeons whose main interest was the Lap-Band, but not the entire bariatric community.

As a result, patients were getting heart burn, band slips, not losing weight, and feeling miserable. Especially among surgeons who didn’t learn how the band worked. As these patients got into trouble, their bands were removed, or ex-planted.

Now the group of surgeons who used the band a bit, were getting a bad feeling about the band. Those surgeons who used the band as the major focus for their practice, took the new information to their patients, and continued to have good results.

1-800-  The LA Market

It seemed like manna from heaven. In the height of the recession two brothers figured something out: the band could be marketed to consumers easily, and if they had insurance that had “out of network” benefits, they could charge a fortune and make tens of thousands of dollars on a band.  Typically an insurance company might pay a hospital $10,000 to place a Lap-Band, with a tidy hospital profit, and yet if a patient was out-of-network, they would pay almost five times that amount.

With a 5 million dollar a month budget, LA was flooded with radio advertisements, billboards, and some television. Almost every place there was a billboard, there was a sign for the Lap-Band.

The advertising increased band sales not only for that group, but for every Lap-Band surgeon in LA and San Diego.

A reporter for the LA Times was upset at seeing the billboards around his subdivision and began to “investigate” the band business. Several highly published deaths became public and the LA Times continued to pound at this marketing machine. A local US Congressman asked to investigate it- and Allergan made the decision to stop selling to this group.

The billboards came down, the advertising stopped, and the LA Market, which was the west coast jewel of sales, took a major hit.

The local LA surgeons not involved in that group noticed a decline in patients coming in and asking for the band.  Not understanding marketing, they blamed the bad press from the LA Times, instead of realizing that even bad press raised awareness of the band.

Out Of Network Sleeves

Not only was the sleeve a simple operation for a surgeon to do with minimal aftercare, it was much more lucrative than a band. Insurance companies were paying very little to have a band placed into a patient, but almost three times as much to have a sleeve performed.

They paid even more if the surgical center did it. Out-of-network sleeves were paying over 100,000 dollars to some surgical centers. And now they had a new market– their patients who had the band, but didn’t do well with it, now wanted something better and these surgeons offered them a sleeve. They had the same out-of-network benefits, and now they could get a sleeve.

Since the sleeve does not involve an FDA device, there was no reporting requirement for complications. The 5.5% leak rate which could cause devastating consequences, was only reported in the literature. Publications were coming out about how to deal with sleeve leaks, from using stents, to drains.  The leaks could happen anytime in the first 30 days

Allergan – It isn’t Working

Allergan’s numbers continued to slide. The loss of the LA market, the bad press, and lack of direct-to-consumer marketing was hurting them. They made the decision to sell the Lap-Band division.

Lap-Band Surgeons

In the mean time, that small group of surgeons talking to Allergan provided some feedback:

(a) Stop trying to sell everyone the Lap-Band.

(b) Surgeons who are doing bait and switch are ruining the band’s reputation

(c) By putting all those surgeons on the site who are not interested in after-care of the Lap-Band you have fueled the rise of the sleeve surgery.

(d) You have the safest surgery – don’t try to compete with sleeve, stop playing defense, tell your story

Nordstrom not Wal-Mart

In the last few months Allergan has quietly removed surgeons from its lapband.com website.  Those surgeons who are not doing many bands, or who actively promote other operations have been removed.  They began to concentrate on a the group of surgeons who have been band friendly.
The key to the band is good aftercare, and knowing how the band works. It means patients have to come back a lot in the first year and have their band adjusted, and talked to about what they are eating.

Band surgeons knew that at five years, their data and weight loss was every bit as good as any other operation. They knew that the key was lifestyle change, and by seeing patients frequently it meant having a chance to affect change in their patients.

Instead of focusing on being the Wal-Mart of the weight loss surgery, band surgeons learn that lifestyle is the key to great results and have become more like Nordstroms or Four Seasons than a quick check out.

The Future

The band will ultimately become either known for what it is, the safest weight loss operation that promotes lifestyle change – or a major failure by a company that didn’t listen to its core group of surgeons.

Re-tooling the band, and focus on aftercare and marketing to consumers began to have an effect.

No longer was Allergan sending patients to surgeon offices who didn’t care about the band. On their site there are now less than 400 surgeons listed, down from over 1500, and probably more surgeons will be removed.

Patients, who inherently understand they have to change their lifestyle, and know that losing fat mass slowly over a couple of years is safer, continue to seek the band.

Of all google searches for weight loss surgery the Lap-Band is still the most sought after search by two to one over the sleeve. The major push for the sleeve are those surgeons who don’t like the band.

Allergan’s new commercial features George Fielding, a surgeon who had the band placed a number of years ago, does all the operations, and recommends the band over all other operations. The commercial is sincere, well done, and because the advertising budget was so small from Allergan to the Lap-Band division it was written by the Vice-President.

But it is working, and new companies are interested in purchasing that division.  Having the governor of New Jersey getting the band was a major coup.

Teaching that the band works two hours after a person eats, not over filling the band is key. Sales have started to increase.

The new Lap-Band will come back smaller, but focused on after-care. Those surgeons not interested in doing that will do other operations, but the data from the Low BMI study, from those who have great results, continue to show that the cure for obesity isn’t just an operation, it is lifestyle change. 64% excess weight loss at one year.

Very interesting article, Naomi. Thanks for posting it!

So what's the word on you now, Jean?  Didn't your band have to be removed?  Do you support the band or sleeve at this point?

Yes, my band was removed in April 2012. I revised to the sleeve in August 2012.

I support all types of WLS.

Someone drew my attention to this thread and I thought I would add the comments of my own surgeon. Please note, he is employed by the NHS so is not involved in making a profit, does the bypass, the sleeve and the band. Has been doing the band for ten years. Was trained in Australia where the band is still the preferred surgery of many doctors. I have not given his name as I have not asked his permission to do so.  He is a surgeon and consultant in a major teaching hospital . I am not sure you have  the rank Consultant in the US, I have not seen anyone refer to it. A hospital Consultant in the UK is the most senior doctor in a hospital department with the ultimate responsibilty for all work carried out by the medical team. Not sure what your equivalent is. 

Thank you very much for your email and the concerns you express regarding the problems that can develop with gastric bands over the medium to long term.  You have very clearly highlighted the problems that can be associated with the gastric band.  Some of the well recognised problems are, I think, bad luck but many of them can relate to the band not being used and adjusted correctly.  If the band is adjusted correctly, then the band is I think a very helpful tool in terms of helping patients to change their eating behaviour.  The band, if not used and adjusted correctly, will simply cause obstruction in the upper gut and the natural consequence of this is acid reflux, oesophageal dilation and, because people cannot eat an appropriate diet, maladaptive eating with consequent poor weight loss or even weight regain.  Band erosion through the wall of the stomach should now be less common because of the approach to dissecting the space around the stomach to place the band.

I think that the key with the gastric band is to keep it appropriately adjusted and to maintain a sensible and appropriate level of eating and physical behaviour.

Unfortunately no operation , including the gastric band, sleeve gastrectomy and gastric bypass, is perfect and they all have their own particular problems or complications.  In terms of frequency of problems or complications, my experience is that approximately 10 - 15% of patients will have some sort of significant band related problem or another within the first five years that may require a further intervention to treat.

I am aware that the gastric band has had something of a bad press recently.  If, however, you look critically at the available published evidence, then none of the operations are perfect and we are in fact just about to start a randomised study comparing the gastric band and the gastric bypass in NHS patients in the UK - the BYBAND study.  We would clearly not be embarking on such a study unless we felt there was uncertainty regarding outcome comparing the two operations.  I am also well aware of the popularity of the sleeve gastrectomy but there are a number of potential problems and complications with the sleeve, some of which are very difficult to manage.

I think your outcome with the gastric band is a reflection of your preparedness to work with the gastric band and to demonstrate what can be achieved.  I am pleased to say that I do not think your experience with the gastric band is particularly unusual.