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Aug. 12, 2022

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Q&A: A Pittsburgh surgeon’s struggle to find the right sales pitch for his products

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Ernest K. Manders is a plastic surgeon best known for designing a tool that vastly improved breast reconstruction operations, revolutionizing the procedure worldwide.

Using silicone filled balloons, Dr. Manders came up with a way of stretching the patient’s skin to create a more life-like breast shape for those who were undergoing reconstructive surgery after a mastectomy. Until then, standard skin expanders could only make a sphere breast shape, which had an abnormal appearance for the patient.

Dr. Manders also formed Uptown-based Promethean LifeSciences Inc. in 1997, which makes skin graft products that he says have helped save the lives of injured soldiers in Afghanistan and Iraq. The company employs three people and involves 30 others in the manufacture of its products.

But his skin patch products, made from cadaver skin that is sterilized and treated with radiation in a patented process, didn’t always sell well. The company doesn’t release financials.

Sales have lagged, Dr. Manders says, because their products didn’t align well with a marketplace where financial incentives can influence treatment decisions.

Instead of marketing to just physicians, privately held Promethean began calling on insurers and hospital systems that also sold health insurance. These organizations have a vested interest in how well a product works and costs, so they have been more willing to lend an ear during the past two years.

The COVID-19 pandemic has dampened sales since then, so it’s unclear whether profits have risen as the result of the new focus.

Dr. Manders, 77 and a native of Ocean Falls, British Columbia, is a Harvard Medical School graduate who taught in the University of Pittsburgh’s medical residency program until 2018 when he became an emeritus professor of surgery.

Before that, he headed the Division of Plastic and Reconstructive Surgery at the Hershey Medical Center for 10 years. During a career lasting nearly 40 years of reconstructive, hand and aesthetic surgery, he produced some 275 publications, posters, videos and patents.

Most recently, he was named recipient of the Scientific Achievement Award by Life Sciences Pennsylvania, a Wayne, Pa.-based advocacy group for the biotech industry.

But soliciting customers for his company’s skin graft product schooled him in just how upside-down the medical products world can be.

His product, which is designed to treat burns and slow healing diabetes-related wounds, stores at room temperature and has a shelf life of six years.

Burn victims treated with the Promethean’s skin patches can usually go home after treatment in the emergency room, no dressing changes or home health visits are needed and they can safely shower after the procedure, depending on the extent of the burn.

PG: Tissue expanders have been a big part of your career. How did that all start?

At the dining room table one evening, I had scissors, typewriter paper and scotch tape. I made a bunch of mockups of balloons to see how different parts of the balloon would expand.

I described a way to make a balloon, a silicone expander, that would expand more at one end than another. If you make an expander that grows more at the bottom, then the upper pole is constrained and you get a teardrop breast shape. I said, ‘Hey this would work perfect for scalp reconstruction. And this would work well for breast reconstruction.’ And it worked like a charm.

PG: When did you first become interested in finding alternative treatments to slow healing wounds and burns?

In 1992, I was a visiting professor at a burn unit in Brazil. Because of the HIV crisis, we didn’t have a skin bank. Only after a skin allograft from an infected cadaver did we sometimes learn the donor was HIV positive. And there was no treatment whatsoever and that shut down tissue banks.

That’s when I realized, hey, skin doesn’t have to be alive to be a perfectly good dressing for a burn or other injury. As a medical student I’d irradiated viruses, like hepatitis, to inactivate them. I said, I bet we could have a sterile skin graft that could be stored at room temperature. And you wouldn’t need to have big freezers or liquid nitrogen.

PG: When did you introduce AlloGraft?

We started the business in 1997 and we rolled out our product at a big national meeting in 1999 to the American Burn Association.

PG: What are some of the advantages of the product?

The beauty of this skin dressing is that it closes the wounds. It has all the layers of normal skin. It sticks by itself and it’s an effective vapor barrier. It can persist for weeks longer than living skin. No dressing changes are needed and it takes pain away. And this became a godsend for our troops treating soldiers. We sent a lot of skin to the front lines.

PG: What are the product’s downsides?

We have enough skin that you could cover a whole body, but you probably wouldn’t want to do that. For a big burn, you may well want to use living skin.

PG: What are the comparative costs of your product?

For competitors, depending on the size of the graft, the cost would be $1,500 to $2,000 rather than $170 for our product.

PG: What setbacks did Promethean experience in marketing AlloGraft?

Here’s the deal: patients love us. Doctors have been users for 20 years. But we realized that at long last, we are not good for a fee-for-service medical practice. That’s an eat-what-you-kill, do-as-many-cases-as-you-can-kind of system, a misalignment of economics.

Selling to the fee-for-service guy is not good because we have a disruptive technology. Doctors actually get paid more for putting on the higher-priced products. Furthermore, they don’t need to see the patient as often, which reduces their revenue. Individual practitioners, they want to see people every week. We just don’t align with that. Who’s the health care economist who thought that up?

PG: What stands out for you in a medical career that spans 40 years?

I was very lucky. Life presents you with all kinds of opportunities. You just choose the good ones and go with them.

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