. : Mr could you forward yourselves?

.: I am called Jean Pierre and I am 57 years old. I am of Marseilles origin. I was a pupil of the good fathers Jesuits and then I made my medicine in Marseilles. I passed the boarding school and I made all my course in general surgery. At the time there was little individualized csotcina.comedic surgery. The instructor had the pulpit of surgery infantile and csotcina.comedic and I spent much time near him. I also made a stay in neurosurgery and in thoracic surgery in the Instructor Jacques then I am turned over as Senior registrar in my Master. After one year of , it sent to me to open a center of traumatology in a department of general surgery at the hospital Michel Levy in Marseilles. I thus had, as senior registrar, the responsibility for a department of traumatology and csotcina.comedy. At that time, there had been some discussion about putting to me about a list of aggregation with an obligation of lapis lazuli displacement. But like, at the same time, one proposed to me a post of csotcina.comedy at the Saint-Joseph hospital which enabled me to keep a contact with faculty, to have interns and private customers. I thus went to Saint-Joseph while keeping my post of head of private clinic to the hospital Michel Levy, during the years 72-77. A service with Saint-Joseph and a hospital part time, it was the ideal in 1972.

. : The hospital system in Marseilles changed!!!

.: Yes. Michel Levy does not exist any more. Of old hospital as were completely remade there are about fifteen years. The hospital of the design was remade there is not even ten years. In 77, while going from one hospital to another I had an motorbike accident. I was always motorcyclist and I always liked speed. Following this motorbike accident I found myself with a total paralysis of the left arm during 3 weeks then I started has to recover a little sensitivity in the shoulder and of motricity in the biceps but it was all. I remained like that during a certain number of months. I consulted on the right and on the left, me divided opinions were given. I had sent one of my interns to make a training course in Montreal and it had met there a woman surgeon-plastics technician, , which had specialized in the . She had learned how with my intern to make and to deal with the lesions of the brachial plexus. After disappointbeing disappointed by some European consultants, I went to see in Canada.

.: You êtiez-groom?

.: Yes and that with influenced my destiny much. I was married and I lived in Marseilles with American whose parents were New-Yorkais. Here me is party for Montreal with obviously as bases American rear rotation the parents of my wife. My father-in-law, Doctor was reprocessed neurosurgeon because at the time it was 83 years old. After my intervention, I understood that my wife had a deep desire to remain close to her already old parents.

. : Did operate you?

.: Not but it gave me consultings and one of his/her young collaborators made me a . There was not anything else to make besides. At the time of the traumatism my plexus by a bone fragment and the cicatricial tissue involved a constriction of the brachial plexus on the level of the clavicle but There was no section . With this simple the things improved. I then made a long rehabilitation. I went in an island where I worked with my left hand against sand, at the edge of water. But I recovered only partially. Even today I have neither the sensitivity nor dexterity of my left hand of formerly. This partial recovery made me remain in the United States. I could not operate any more but I did not have the temperament to remain sitted on a chair to look at television also I were going to visit the hospitals while trying to find something which can interest me.

.: How did the health system arise?

.: There are two types of surgery and medical practice in the United States. There are what is called the “” and the “” which correspond respectively for France to the private clinic and the . In the United States medicine is also practiced in the two types of institutions but the training of the doctors is done during three to six years of “residence” in an accredited service of a “”. The student after four years of university obtains a license limited to the practice of medicine in the hospital where it was accepted like “resident”. At the end of the years of residence one or two years of super specialization is possible as “a ”. The dedication is given by the “” in two examinations, one written the other oral examination at two years of interval during which the new specialist exerts either in practice private or in an university hospital. Neither my French diploma nor equivalences and can exempt years of residences to arise to the examinations “” of csotcina.comedy.

.: And paid medicine?

.: It is something relatively again. An American company (that would be called a mutual insurance company in France), decides to create an healthcare system. It joins together a staff of doctors and sometimes it has a hospital or several hospitals. Then it sends publicity to people so that they adhere to this system. There exist thus channels of hospitals which are constructed in staff by paid doctors of an insurance company. It is another way of practicing the medicine in the U.S.A. which would tend to spread. None of these systems interested me, wanting search and teaching; I thus immediately went towards the university.

.: Explain to us the operation of the University.

.: There are two types of universities. There is initially the university of state. Each state of the Union must have at least a university of state but can have several of them. Sometimes the university of state has hospitals of state which are governed by the laws of each state. They are not private hospitals but hospitals of state in which the doctors are also some share of the officials. These hospitals are nevertheless very few. Then there are the large private universities. You heard certainly of the “” (literally: league ivy). The name of these worthy universities comes from the old ships built by the English in Massachusetts, , or in the state of New York and on which push ivy. It is in these old ships that the first diplomas of were delivered, of avocado, engineer etc… They are the oldest universities and they are impregnated tradition of Oxford and Cambridge. They are located for the majority on the east coast, because the colonization of the west coast was made only after and a kind of tradition allots more value to the members of . These universities are completely private and have large capital. Not only of real estate but for example of the goldmines or of copper in Zaire which was bought at last century. I was attracted enough by these private universities because I very quickly understood that in the United States Money is the sinews of war. But in fact, people who have this money constitute a superior council of the university which directs the investments with a double preoccupation of output and a scientific excellence. As I had met many people of Harvard, I was interested in first in this university and I went to see one of these figureheads which I admired much: John Hall, who was instructor of spine surgery. In his service, I met a surgeon of “Columbia ” with which I sympathized and that I followed a few days in his hospital. I was fascinated by the intellectual productivity which existed in all the specialities. There were people of all the countries and one proposed to me to take part in the indoctrination residents. The “resident” in the U.S.A. finished the medical school but did not pass a contest as to France; “resident” is not a bond like “intern”.

. : With which bond one did propose you this post?

.: Under instructor. I am obliged to make a bracket to explain all the bonds of use in the American university. When one is resident and that his speciality was finished one becomes . It is the equivalent of senior registrar but limited to one or two years of specialized teaching. At the end of “the ” the university and ” which is affiliated for him recruit the candidate with the double bond of “” and “assistant ” #D1FFFF “”. It is the level low, and the French equivalent must be assistant. Thus as instructor-attending one can make medical practice and one can teach. After a certain number of years and good states of service, one is appointed “assistant-professor”. After “assistant-professor” one can postulate for a bond of “”, it is a little as lecturer; then it is “”, and finally, if one obtains a pulpit the summit of the hierarchy is “” or “”. In what relates to me, I planned to continue an university course and to develop my academic production as much in clinical research that in teaching.

. : But how did you enter the die?

.: I was French and I had in all and for only one diploma of . The boarding school of the hospitals that did not count since there was no American equivalent. The does not exist besides either. It was necessary me to initially pass an examination of equivalence in medicine, the , of which the “English” party gave me many concern, then he was necessary to pass an examination of license, the . The gives the right to deal with patients and to make regulations. It thoroughly tests knowledge by an examination which takes three days: one day of fundamental science, one day of medical science and a day of private clinic. This license which the “ gets is only limited that to the institution which accepts you in “training”. I thus obtained a “ license” to work in Hayes affiliated to “Columbia ” and to begin my” training ".

.: What did you make during all this period of preparation of contest?

.: The first year was devoted to obtaining the theoretical examinations. Then I worked in the csotcina.comedic department and I could devote part of my time to teaching. Having had in France a solid training in anatomy, I thus replugged myself immediately in the United States on the anatomy. As I knew the rachis particularly well, I made the teaching of the anatomy of the rachis. During this period from 80 to 84 I was paid like a resident and was limited by my license to a clinical practice supervised without access to the private customers. During these years my functions of teaching were compensated to me by two years of “” and I could be candidate and then be accepted like “” with Columbia Medical and assistant instructor in Columbia College off Surgeons where I am still.

. : How did you live 1977 year of the accident until 1981?

.: For this terrible period I was materially and morally constant by my marvellous wife. It was very hard morally and physically. In spite of my optimism, I thought sometimes that I will never recover. During this period what professionally enabled me to cling, it was the unconditional support of my family and the possibility which was offered to me to teach the anatomy. I noted from the start, as of my first contacts, that there were large gaps in anatomy in the United States. I knew residents in surgery who had never seen a corpse of their life and who had only book learning. As soon as I could, I instituted run of topographical anatomy.

. : After this route of search and teaching, are you become again surgeon?

.: I obtained all certifications into 84 but that did not change what I did. I thought of benefitting from most enthralling from the possibilities offered in America: to be the mainstay of a great educational program in a university of foreground. Moreover, in the United States, when one succeeded in a field, people use you for that! I had the control of my teaching and it went well.

. : And then?

.: Then, a new opportunity was offered to me with the American adventure of and . When went the first time throw its instrumentation in to Kentucky, it was received with enthusiasm by , it then forwarded its instrumentation with John Hall to Boston. Of John Hall was such as it will have quickly gave a North-American dimension to the instrumentation of right because it agreed to operate a case with them. And with this intervention, I was there. I knew and because one had met in congresses and then I them had contacted because I had understood the value of their idea and the quoted revolutionist of this new concept implemented to the spine surgery. The day when Mr and Jean went to operate in Boston I were with them, the following day Jean was at home and the instrumentation was at home; it then came to operate with me the first in New York. I then exposed the technique to a score of American surgeons come to New York to learn it in Columbia. I was convinced that it was necessary that the American surgeons of the rachis learn how to use this new instrumentation but at the same time I realized that the latter badly understood what tried to tell them, the words of Jean did not mean the same thing in the ears of French and American. One of the problems of communication between French and American can be illustrated for the example of a radiography of a lung with a bulky tumor to comment with students. In France, the teacher will explain readily: “the first thing that you look in a radio it is the ribcage, in fact the coasts is intact it is the cardiac shade, they is the sinuses on the right and on the left, then you look at the bronchi stocks, then you go towards the small bronchi and you realize that in the pulmonary there is something of abnormal”. American will tell: “look at this radio, see the fisheries right in the middle of the posterior lobe”. The remainder it does not have anything of it to make. He says essence. French, by preoccupation with a precision can sometimes kasher what they want to say. Jean tried many times to transmit his message without reaching always that point; and it is not the fault of its English who is excellent. One day I understood that I was the ideal intermediate. In fact CD became what I call my “Zulu principle”.

.: Zulu principle?

.: I always taught with my students the “Zulu principle”. The history is the following one. It there has very a long time, a friend of my father, a charming man, had eaten all the fortune of his parents following several bad deals, but always very nicely and very honestly. With the last property of its heritage which it had sold, it left to make a forwarding in Africa in an area where there were Zulus. It returned from there with photographs but completely mown. Rotary Club was created in France and there my father advises to him to go to make a conference. He went to forward his photographs and he spoke about his voyage. At that time, people had never heard of Zulus and even less place where they lived and some were interested. Our traveller receives soon a letter of a Mr who writes to him “I would be very content if you could make an item in my newspaper in connection with what you told the other day with your conference on the Zulus”. This letter was supplied with a check in advance on the item. It thus took again its boat, it set out again at the Zulus to make new photographs, to question people and it returned with a serious item. At the end of one year, one asked him to make conferences on the Zulus. One day a young scenario writer called tells him “I in general make a documentation on the tribes; I read your items and you appears is the large specialist in the Zulus. Would you like to be my technician for film?” It was 50 years ago and they made the documentary one. It became after this documentary Mr Zoulou and one called it in the whole world to make conferences and until the end of his life. It finished at the Collège de France and when it died at the 83 years age, it was very known.

.: And to return from there to the rachis…

.: I thus told myself that the conjunction of the anatomy and the spine surgery, my double French and American crop and of the of which it was necessary to explain in the USA could be my Zulu principle. I worked much above and became in the United States an authority as regards pathology of the vertebral column. It is besides the role of the instructors in the United States which in a voluntarily limited field.

.: Can you detail this professorial function?

.: The statute of instructor in the USA is to be really teaching. The instructor when it does his work well, examined in detail the patient who will be operated with his staff. The resident for his period of formation on the rachis sees the patients, discusses them in conference by making diagrams of the provided for intervention. Each week it forwards items of the literature to a meeting of bibliography to 6:00 of the morning when the recently published articles are discussed. These items are peeled and sometimes demolished but it leaves a teaching there great value. Each serious operation is discussed deepened with the evocation of the possible options including the nonsurgical treatment and the role of the instructor is a little the role of devil's advocate. Then comes the logistic preparation and the residents theoretically have the complete knowledge of the operation which will proceed. Generally there are two residents per intervention, one is senior the other junior. The senior already saw how one makes the approach i.e., if it is about a thoracic surgery, he saw how one enters the thorax, how one removes if necessary, a coast. The day when it will do it itself, there is always a “old man” who will supervise. There can also be a , and if it is the which makes the operation, the senior resident is put in second position. The resident assigned with the operation is designated by the chief resident of the program. The owner and his staff indicated chief-resident. The distribution in the operational programs is thus done by the residents themselves. When the preparation of the intervention is correct, that it is my hand or the hand of a “senior reside” or of a “” which makes the gesture, that does not have any more importance.

.: That implies a perfect coordination of the couple Master-apprentice…

.: There does not need to be an engineering to cut the skin with a bistoury. Then to detach, by posterior channel, of the muscles of the spinal column that requires only one short formation: I could train a gardener to do it. What there is the difficult one in surgery it is the comprehension of the gesture. The problem for example, when one owes a spinal column of child it is of knowing how much one will leave free discs in bottom and how much one can take vertebrae; it is only one question of thought. And that takes much time to know where to stop in its arthrodesis. The control of the subject of the experiment and a comprehension of biomechanics, biochemistry of the disc, anatomy… All the problem is to arrive so that our pupils have a head well done. This system of surgical formation which is that of the University of Columbia is a system which I adhere to much because it is the perfection of the trade-guild; what precedes it is the concept not the technique. There exists an interdependence between the owner and the pupils which is very remarkable if one with what was done in France at the time of my boarding school.

. : Do you from time to time put the hand at the paste?

.: Yes when something leaves ordinary and that the case was not provided for or was programmed, which is very rare. For example, we have just developed a novel method of intervention with Dr. Mark which consists of a former and posterior simultaneous approach to discuss the vicious cal as well as other localized lesions of the rachis. At the beginning, the operation was not really known and there were reserves, he was necessary to convince of the validity of the technique by proving the time-saver, the saving in blood, and the improvement of the results. An exploratory study was installation with all documentation necessary and led to a publication. All the problems including the positioning of the patient on the table carefully were studied and solved. My active participation in all the phases of a novel method is necessary but then I do nothing but supervise.

. : Which is your bond now?

.: I am “”. I have functions of teaching in anatomy and spine surgery. I.e. in the system I am instructor of csotcina.comedy. In the program of csotcina.comedy I deal with the spinal column. With regard to the anatomy, that consists of the ones and directed work of cadaveric dissections. In pathology, the patients of Columbia are allotted to us according to our square pulses. Me I deal with the great rachidian deformations. The patient sees me as a consultant. I.e. I examine it, I discuss his case with the residents and the other colleagues and I explain the diagnosis and the processing to him. The patient knows that within this team it is Mr so-and-so who will hold the knife, but that it is dealt with by group, it is what we like to call: “TEAM ”. Nothing is hidden with the patient who must sign a “ agrees” before surgical operation is made.

. : Do you have an research activity?

.: I work primarily on the intervertebral disk and more particularly on a replacement of the posterior articular breakages. For the moment it is not a question of prosthesis but of an experimental model which enables us to reflect and to collect data.

. : You often to France, which impression do you have come when you turn over in the hospitals?

.: With regard to the I have two impressions contradictory. On the one hand I realize that there are people who work and who are with the point of progress, but there are also on the other hand people who encrust themselves. Many of my comrades instructors increased their fame, their surface political and they passed at more directional levels, but I do not have the impression that they succeeded in all increasing their academic potential. The thing more striking when one returns from the United States, it is the impression which in France all is politicized. The positions of instructor in France depend on organism like etc… The ultimate decision is ministerial thus that becomes very political. My French colleagues, to obtain posts for their pupils, are some share obliged to become politicians.

. : You think that it do not have any more time to deal with surgery…

.: Of course that not, but I have the impression that they must pass a certain time to Paris to preserve their political influence whereas they work in Lyon, Nice or Strasbourg… Personnellement I do not have any idea of the name of the Minister for the health of the State or the United States.

. : The American Universities would be free whereas the university in France east…

.: Completely dependant! This centralization is one of the causes of the scientific stagnation of the and too often of the poverty of the secondary hospitals.
But here, there is a problem chronic and unsolved the medical ones in this hospital. A friend of my daughter contacts an influential policy and the changes will be made. It seems that while following the rules of the game administrative without the intervention of a minister this hospital would have had its medical new just only at the time to be unused.

. : It is a little caricatural!

.: Of course and I want to in no case to make smile French medical structure only I adhere to and where I received all my formation; however aggregation too often appears as an end which deserves all the efforts and all the sacrifices. It seems sometimes that the scientific ambition blunts when the aim is reached.

. : There is however the feeling which technological advances are made in France, and which they are rationalized in the United States. How do you explain that?

.: It is rather easy to explain. In Europe the owners have all the rights. The others have only to be inclined. The United States which knew neither royalty nor centralizing republic is a democracy and do not recognize “”. There are of course other problems but not that one. Thus in France, an original idea can be quickly put in experimentation. If the idea is good it goes, if not one stops after two or three unhappy tests. The difference with the USA, it is that precisely, these two or three failure do not pass. When an experimentation starts, it is necessary that a maximum of parameters are controlled. It is the raison d'être of the FDA which the foreigners have of the evil to understand and which they take, wrongly for a political organism.

. : But if one takes the example of the pedicular screw on the rachis, one notes that it has been used now for 7 years in the United States that then others published much on the subject and that it is still not accepted. There must be heavinesses in the system…

.: I can really tell, as an adviser on this file, which it is not accepted yet. There are two reasons with that. The first it is that there is according to the studies up to 20% of incidents and accidents with the pedicular screws. The second reason it is that an approval by the would put the “pedicular screw” between all the hands. The cannot limit the use of an implant if it gives its approval. It thus requires a rigorous experimentation to ensure the safety of the patient.

. : How thus make, in practice, the users?

.: Certain manufacturers make screws which are not accepted by the FDA but which is used. The surgeon must make accept his surgical method by the patient who signs a form that I already mentioned: “ agrees” in which the advantages and disadvantages of the implant are explained thus that the possible hazards of the implant which are clearly enumerated. The patient understands and he tells “I want live pedicular because that gives me more a great chance stabilize my rachis”. It is a contract between the patient, the doctor and the hospital. The state does not want to be interfered. There are besides some lawsuits brought for complications allotted to the pedicular screws but not more than for other implants. I am accustomed to explaining to the patient whom the screw does not have the agreement of the but that it is an option which I offer to the patient to increase the chances of success of the arthrodesis.

. : You agree all the same that this screw renders service?

.: Absolutely but there is a problem of reliability; this technique cannot be put between all the hands and it is what will occur in the event of accreditation. I carried out with a group of six colleagues an investigation on the complications of the pedicular screw. It appears that independently with the hand which works there are approximately 6 to 12% of incidents or accidents relateds to the application of these screws. The problems are of unequal seriousness but certain complications like the wounds and the nerve injuries cannot be neglected.

. : To conclude, which balance-sheet do you make your terrible motorbike accident?

.: That enabled me to make an American career as a teacher, to discover a new crop, another dimension and a dynamism that permanent confrontation with the young people, regenerates unceasingly. I however kept France a nostalgia which pushes me to return there very often and to keep the professional contacts which brought all to me that I developed in the United States.