This focus on spine care led to the creation, in 1978,  of the Low Back Clinic of the Sister Kenny Institute.  This organization served as the impetus for the founding of the Institute for Low Back Care in Minneapolis in 1981and the Center for Restorative Spine Surgery in St. Paul in 2003. 

The Editor's colleagues queried him as to why a well-trained neurosurgeon would "waste their time" in the field of spine care (where everyone knew that few patients ever "really" got any better).  This was exactly the challenge.  It was also evident that this poor attitude toward spine patients was an important cause of the problem (and remains so today). 

In 1972 the Editor was a member of a United States Biomedical Instrumentation delegation to the Soviet Union led by Dr. Joseph Saunders.  This experience was quite and eye opener.  The Russians worked hard to keep American delegations busy, comfortable, and uninquiring.  Because the editor's brother-in-law was the resident United Press International correspondent in Moscow the group was provided with unusual insight and opportunity to determine what was really going on.   "Informed Consent", as we know it did not exist.  Specialty care was device poor but theoretically advanced.  Basic care, although primitive, was more readily available.  The Soviet system has served as a good reference point.

During the 1970's the Editor was a representative of organized neurosurgery in the drug and device areas.  This involved the writing of standards and it wasn't unusual for standards groups to create rules which "were smarter than they were."  Being in Washington at the genesis of medical device legislation the editor experienced firsthand the sport of "character assassination" so well described by Vincent Foster prior to his suicide.  In providing testimony to the Congress of the United States government the editor observed a prominent consumer advocate providing false testimony.  When this was later brought to his attention in private he acknowledged that he had lied but retorted: "but I made the point didn't I?."  This also was quite an eye opener regarding the true nature of the "playing field."  

Other "eye openers" have been the government's political agendas.  The editor, as a Food and Drug Administration medical device panel chairman observed the process by which knowledgeable consultants were removed from serving on FDA panels because of potential or real conflicts of interest.  Rather than protect the public interest by the application of "sunshine" principles, these experts were replaced by politically "correct" minorities for the purpose of "balance."  Unfortunately, these choices reflected an expediency dictated by the wrong motives and thus deprived the public of important guidance in the areas under consideration.  Effective means of keeping experts as consultants while at the same time negating their potential conflicts of interest were not utilized.

As a member and chairman of local and national ethics committees the Editor became aware that it was not a popular deed to bring up discussions as to what was in the patient's best interest rather than those of the physician or hospital.   Minnesota physicians are well-known for placing their patients best interests at the forefront in the physician-patient relationship.  The Burton Experience has been that this ethic deteriorates rapidly as the issues go beyond those of immediate patient needs.   

Few medical professionals have evidenced to the Editor an awareness of what ethics are or the reasons as to why they are important in health care.  Those who have appeared to understand ethics frequently suffer from memory lapses when confronted by self-interest.  Medical ethics has been, and continues to be, an afterthought in the medical community.  It needs to be reinvented.