After teaching clinical neurosurgery at Johns Hopkins Hospital and Temple University Health Sciences Center in Philadelphia the Editor founded the Department of Neuroaugmentive Surgery at the Sister Kenny Institute in Minneapolis with the assistance of Earl Bakken (founder of Medtronic) and Drs. Loren Leslie (then Director of the Sister Kenny Institute) and Charles Ray (who had been an assistant professor of neurosurgery at Johns Hopkins). 

The purpose of this innovative facility was to apply the new discipline of  implanted electronic devices designed to "augment" function of the nervous system in the rehabilitation of patients with problems not otherwise amenable to treatment.  Because the most effective neuroaugmentive devices, at that time, turned out to be the spinal cord neurostimulators for relief of intractable pain the neuroaugmentive group had many "failed back surgery" patients referred to the facility.  

This experience provided important insight in regard to why some patients were worse after surgery than before. The related research in regard to this issue demonstrated that failure to adequately diagnose, or treat, lateral spinal stenosis was the most common reason for surgical failure. 

This experience, and additional related research, led to efforts to develop better diagnostic and therapeutic measures needed to decreased the incidence of  failed back surgery cases as well as providing insight as to how preventive care and subsequent health maintenance programs could could be used, in many situations, to avoid the need for surgery in the first place.

This focus on spine care led to the creation,  of the Low Back Clinic of the Sister Kenny Institute, the Institute for Low Back Care (Minneapolis), and the present Center for Restorative Spine Surgery located in St. Paul in 2003. 

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 explore the Soviet Medical system.  "Informed Consent", as we know it simply did not exist.  Specialty care was device poor but theoretically advanced.  Basic care, although less sophisticated than that in the United States, was more readily available. 

During the 1970's the Editor represented 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 real world of politics and how things really happen. 

Some of the "eye openers" have been the government's political agendas.  The editor, as the chairman of a Food and Drug Administration medical device panel observed the process by which experienced and knowledgeable consultants were removed from serving on FDA panels because of potential or real conflicts of interest.  Rather than protecting the public interest by the application of "sunshine" principles, these true experts were often replaced by politically "correct", but inexperienced minorities for the apparent purpose of maintaining a "balance." Effective means of keeping experts as consultants while at the same time negating their potential conflicts of interest were not utilized at that time.

As a member and chairman of local and national ethics committees the Editor became progressively aware that it was not popular to bring up discussions as to what was in the patient's best interest rather than those of the physician or hospital.   Minnesota physicians have been well-known in the past for placing their patients best interests at the forefront in the physician-patient relationship based on Charles Mayo’s (1865-1939) dictum that: “The patient’s best interest should come first”.  Unfortunately this is not always the case and it is distressing to note that in many quarters it seems that the only thing that matters is money and lack the awareness that the purpose of medicine is to furnish those in need with safety and the blessings of good health. .

To assist in helping to promote the awareness that the patient's welfare is the highest law of medicine the Burton Report will continue its attempt to baffle by being perfectly honest.