Dr. Nagler and Financial Connections to TRT (Tinnitus Retraining Therapy)

Hey @Dr. Nagler ,

I hope all is well, i was wondering if there was something you could address. Obviously you are an advocate of TRT and operate a tinnitus clinic. I was wondering if you could address your financial connection to TRT?
On more then one occasion i've seen people hint that you have a financial interest in TRT and keeping the "status quo" so to speak. I wonder if addressing this wouldn't put some of the people here more at ease since we are a support board first and foremost.

 

Hi @cullenbohannon -

Well, I guess this issue had to come up sooner or later. I sincerely appreciate the respectful way in which you worded your post.

I am going to try to answer your question thoroughly to address all concerns while at the same time trying not to run afoul of the rules of the board against advertising.

So the short answer is that I have no direct or indirect financial connection to TRT.

• I used to be Director of Tinnitus and Hyperacusis Services for one of the companies that manufactures devices used for TRT sound therapy. That was a salaried position; my compensation was not in any way connected to device sales. I do not and never did own stock or stock options in the company. I left the company last year. I receive no remuneration of any kind from the company. I receive no royalties from the sale of the devices I helped develop while I was with the company.

• I have been invited to participate in a number of Dr. Jastreboff's TRT courses in the US and abroad. I receive no financial remuneration for doing so.

• I have also delivered a number of doctoral level TRT seminars to graduate students in audiology at institutions of higher learning in the US. In every case I have donated the honoraria I have received for doing so to the scholarship funds of the universities granting the honoraria.

• TRT does involve sound therapy, but I do not sell the devices used in sound therapy and therefore do not profit from the markup on those devices. My patients are free to purchase devices from any source they care to use. I am totally financially insulated from that process and receive no financial benefit either directly or indirectly. Similarly, I am not involved in any aspect of audiological testing. My patients are free to undergo the necessary testing at any facility of their choice. As with the sale of devices, I am totally financially insulated from the testing process and profit from it neither directly nor indirectly. I do not employ any audiologists. My patients pay for my time and expertise in assessing the nature, the extent, and the impact of their auditory challenge and for helping them do something about it through the TRT counseling process when indicated.

• My clinic is set up as a for-profit company. I am the owner and sole employee. I sublet a small amount of space from an ENT practice, enabling me to keep my overhead to an absolute minimum. I draw a salary of $1 per year. 100% of the profits from my clinic are donated to research towards a cure for tinnitus as allocated by an independent entity; none of the profits goes to TRT research.

In summary, I have no financial connection with TRT whatsoever, and 100% of the profits from my work go to research that if ultimately successful will result in the demise of my own clinic.

I am an advocate for TRT for one reason and one reason only. And that is because TRT - done properly by knowledgeable and experienced TRT clinicians - is a highly effective treatment protocol for individuals suffering from severe intrusive tinnitus. TRT is not perfect ... but in 2014 TRT is, in my opinion, the very best thing out there.

Dr. Stephen Nagler

 

Thanks Dr. Nagler for the clarification. The non-profit approach of his clinic, donating any profit for the research effort, is admirable indeed. I can say reading so many of his posts all these years, from a former support forum he anchored, to Yuku and TT, I have never seen him soliciting the members to use his service. He is more referring people to the accredited TRT professional(s) in the member's local area. That to me is just facilitating the member to get some expert help. TRT is an established alternative treatment for tinnitus. I don't see anything wrong to refer people to see some established practitioners.

 

@Dr. Nagler You know i have great respect for you, and never thought that money was your motivation for what you do, considering the fact that you were a surgeon in one of the biggest cities in the US. Anyway I was still pleasantly surpriesd by your answer.

 

I can confirm that Dr. Naglar does not push TRT on any patient that does not need it.. I saw Dr. Naglar almost a year ago after a flight caused severe barotrauma in both ears and left me with tinnitus as an afterthought that never stopped. I was depressed.. It was the worse Christmas I ever had at that time and it was affecting my relationship with my wife and children. Googling for answers makes it worse. You get all the quacks trying to sell you books, drugs and therapies that do not even work.. We all have been there.. I wanted facts and not fairy tales.

Dr. Naglar is a straight shooter and will tell you like it is. I like that method personally because he gave me tons more information that any ENT could ever provide. He also recommended my wife attend the discussion with him. I think that is important so she can understand it a real problem..

He really cares about this condition and tries to help others cope. If that was not the case, he would not be posting regularly on this forum giving out information that he can easily charge for.

For the record, I did not know Dr. Naglar from this forum but from extensive Googling.. and have not done TRT. He is a good man and glad to see him on this board helping others.

 

Dr Nagler why aren't there more "proper" TRT clinicians all around the world if, as you said, TRT is considered to be a highly effective treatment.
I'm in no way trying to say it's not, but I wonder why after 20 years since you got t there is only a handful of TRT professionals who know what they are doing.
The rest??? Waste of money, waste of time, pure profiteers from t misery.

I personally think that you were very lucky to be in a position to receive the treatment from dr Jastrebof himself, that's what you can call proper TRT with good outcome.

 

I also appreciated @Dr. Nagler's answer, as well as @cullenbohannon's question. Thanks to all for civilized discourse.

And I particularly was interested in @xmierce's reply. I got tinnitus exactly the same way: barotrauma from an airplane flight. My ENT denied it was the cause, that it was impossible to get tinnitus that way. But specialists I consulted later said damage from the flight probably was the culprit. This gives me a chance to remind everyone: DO NOT fly with a sinus or upper respiratory infection!

 

I tried to explain why at:

https://www.tinnitustalk.com/threads/neuromonics-vs-trt-tinnitus-retraining-therapy.4288/

Lucky? I wasn't lucky. If I were lucky, I would never have had tinnitus in the first place.

No, I wasn't lucky to have been treated by a TRT clinician of Dr. Jastreboff's caliber. I realized I had an extremely serious condition - to me, it was as serious as a heart attack. More so, in fact. So after a few false starts, I researched it carefully. And once I learned about TRT, I sought out the best. How was that lucky? Sure, I was able to afford it - but that's because I had been working 80-100 hour work-weeks for the previous twenty years. Luck had nothing to do with it. If I could not have afforded it, I would have begged, borrowed, or stolen the money. It was not a matter of luck; it was a matter of priorities.

I do not wish to be harsh in my response, but I was dealt the same lousy hand we were all dealt.

Dr. Stephen Nagler

 

@Dr. Nagler
While I appreciate your response and reasoning, I still think it was very lucky for you to have him there to provide the proper help.
You could have as well wasted all your hard earned money going from one looser clinician to another, wasting time and money and still be going in more circles.
Many of us would steel, beg, borrow the money, for some it's not even a problem, but if there is no competent clinician....... you know the rest.
Thank you for your response.

 

Dr. Jastreboff wasn't exactly "there." He was some 700 miles away. And I had to make the trip four times. Now you typically only have to travel once to see a top drawer TRT clinician; the rest can be done via phone, Skype, etc.

I did. I tried a whole lot of worthless approaches.

I understand how you feel, I really do. But there is always a competent clinician.

Dr. Stephen Nagler

 

Hello. Some questions have come up in private communication regarding who owns my clinic.

I own my clinic and am its sole employee. I sublet a small amount of space from an ENT practice to keep my overhead to a minimum. Other than the sublease, I have no financial arrangement with that practice.

I have edited my response to @cullenbohannon's original question to reflect this clarification.

Dr. Stephen Nagler

 

@Dr. Nagler --I never thought you were trying to 'drum' up business . You were very helpful to me when I first came and never once said I should do TRT--you emphasized a strategy and supported the one I chose (CBT and anxiety workshop). I for one, am very happy to see you back. You are an example of living with T--really living--not just getting through life.

 

Thank you for the kind words, @Kathi. I am very glad that you are doing well.

Dr. Stephen Nagler

 

@Dr. Nagler from reading your comments I can see you are a good man, doing what you can to make things better instead of just talking about it. Thumbs up for that.
As for TRT and CBT, try anything as long you got the time, money and little common sense.

 

No "financial arrangement"? I see. And this...?

http://advancedentpc.com/meet-the-doctors/nagler-tinnitus/

https://www.prbuzz.com/health-a-fit...for-single-treatment-center-for-tinnitus.html

Quote from the 1st weblink:

"Advanced Ear Nose & Throat Associates [The ENT practice] is proud to have a close collaboration with a world-renowned leader [Dr. Nagler] in the treatment of individuals suffering from tinnitus, hyperacusis, and misophonia."

Quote from the 2nd weblink:

"The well-known doctor will be moving his office to the treatment center’s ENT office for the purpose of maximizing synergies with the ENT practice. Dr. Stephen Nagler will be working with the treatment center’s current audiologist Dr. Lyn Rushton, who is an audiology expert in Tinnitus and other related conditions such as mesophonia and hyperacusis."

Quote from 1st weblink:

"Dr. Nagler returned to clinical practice in Atlanta in early 2014 and now sees patients at the AENT office. Dr. Nagler works with Lyn Rushton, utilizing her extensive audiological experience to help evaluate tinnitus patients and offer appropriate state-of-the-art technology when applicable."

Quote from 2nd weblink:

"To be able to provide a single treatment center for severe Tinnitus in Atlanta, Advanced Ear Nose & Throat Associates has collaborated with Dr. Stephen Nagler, a medical doctor, to make this happen. Dr. Stephen Nagler will be seeing patients with severe Tinnitus in the Advanced Ear Nose & Throat Associates Atlanta office beginning October 2014. Dr. Stephen Nagler is a world-renowned expert in Tinnitus Retraining Therapy, which is the most scientific method of treating tinnitus and chronic ringing in the ears."

 

Friends, I have received an e-mail notification regarding the above post (#15). I have ATEOS on "Ignore," but have taken him off in order to see the post about which I was notified.

OK. Point by point.

When I turned 65 this past December, I retired from the corporate world. My intention was to fill my time with travel, reading, and my hobbies - photography and music. But after a couple of weeks I decided to start seeing a few tinnitus patients. (I guess full-time retirement just isn't for me!) Anyway, I accept one new patient a week 38-40 weeks a year - mostly from across the US, but some from abroad. That comes to an average of just over three new patients a month, which in anybody's book is "a few." This week's patient is coming from Southern California. I spend an average of four to five hours with every new patient - usually over two consecutive days.

I do not understand how ATEOS could possibly take exception to my words:

"I am retired. I do see a few tinnitus patients a month from across the globe because I am very very good at what I do, and there is a lot of suffering out there."

... because those words are 100% accurate.

I started out subletting space in an office across town one day a week (actually two half-days a week). This week I move to a new location, subletting space from an ENT practice just ten minutes from my home - again two half-days a week. Other than the sublet arrangement, I have no financial connection with that practice or any of the ENTs or audiologists there. We do plan to closely collaborate on occasion. When they have a challenging tinnitus patient, they will ask me for my thoughts on the case. There is no additional charge to the patient for my input. It is what colleagues do for each other in the best interests of their patients. If a patient comes to me with an audiogram I don't understand, one of their audiologists will help me out - again at no charge to the patient. Same thing if I have a question for their ENTs about a report or the significance of a scan. I get no "cut" from any testing that their audiologists might do. Just like I get no cut from the testing any of the other audiologists in town or across the US might do. I get no cut from any mark-up or any profits from the sale of devices, regardless of where those devices are purchased. Patients can get tested or purchase devices (when indicated) wherever they choose. Next month their tinnitus audiologist will be giving a presentation to the Atlanta Tinnitus Support Group. I plan to go over her slides with her. I guess that sort of thing falls under the umbrella of collaboration - and I am only too happy to help her prepare. But I am not getting paid for doing so. The ENT group is using my name in their promotions because my clinic is located in their office, and I suppose it is a draw for them. But I am not part of their practice, nor do I see their tinnitus patients as my own. They have their own tinnitus audiologist for that. The sublease arrangement enables me to keep my overhead low, and since all my profits (save for my $1 annual draw) go to research towards a cure for tinnitus, it seems to me that that's a good thing! Plus I get to collaborate with some pretty wonderful people. It's a Win-Win.

ATEOS's recent postings have saddened me greatly. Early on I helped Neuromonics design some studies for clinical trials and addressed their board twice about various aspects of habituation. But that was more than a decade ago, way before any of their products went to market. I have had nothing whatsoever to do with the company since 2004 and most assuredly never profited from the sale of any of their devices.

I do not like it when ATEOS impugns my integrity.

I am putting ATEOS back on "Ignore" and will never again acknowledge him.

Dr. Stephen Nagler

 

crikey....things never change. I'm sorry I read the preceding note from the troll in Switzerland (or so he/she/it claims). I can remember the unusually harsh naysayers 15 years ago...they just never change. They either pick a preferred course of action (or work for a competing course of action) and hammer away.

Glad to see you in T-Talk doing what you always do. Thanks!!

Dan Turner
Conyers, Ga

 

Thanks for the kind words, Dan.

Just tryin' to make a small difference in the lives of those who now suffer as I once suffered.

All the best -

Dr. Stephen Nagler

 

@Dr. Nagler

I commend you for your time and knowledge that you impart to those of us on the TT who wish to move forward in their journey. It is comforting to know that we have someone who can set speculation straight or provide your insight as a fellow who has training in this area and has PERSONAL experience, not just theory from a book or lack of knowledge as I have experienced from the general medical community.

 

I just don't get why @Dr. Nagler gets so much negativity. He could just retire and do nothing. Instead he continues to help us all go through tough times. Yes it's tough when trt is still a mystery not experienced by one but why hate somebody who tries to help on every occasion?

 

I hope we won't see more ATEOS vs Dr. Nagler type of post on TT any more. Let's move on and spend time to answer for support threads. Dr. Nagler's reputation shouldn't be constantly challenged by him just trying to help others here in TT. Hate to turn it into an inquest of his integrity and moral character.

 

I am tired of this ATEOS's dissing Dr. Nagler. Dr. Nagler has helped far more that any of the Dr's I have seen for T and has never asked for anything in return, other than to get out and help others less fortunate. I am not putting Dr. N on a pedestal, just telling it like it is. This ATEOS is going on my ignore list also.