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Thursday, February 14, 2002

Orthopaedists serve own interest by supporting research

The orthopaedic community would be wise to follow the example of successful knowledge-based corporations and substantially increase funding for pure research, according to Thomas D. Brown, Ph.D, president of the Orthopaedic Research Society (ORS). During the ORS meeting on Tuesday, Dr. Brown urged a more equal partnership between orthopaedic clinicians and orthopaedic scientists and outlined steps both groups could take to improve interactions between the two communities.

Orthopaedic research has shifted from surgeons to engineers and scientists, noted Dr. Brown, but these two communities continue to need each other to succeed. "From its humble beginnings, orthopaedic research as an identifiable entity has evolved to the point where it can no longer realistically be guided by orthopaedic clinicians, and where the most innovative basic research depends primarily on the effort of committed scientists," he said.

Non-physician researchers
Dr. Brown, who is the Richard C. Johnston Professor of Orthopaedic Biomechanics at the University of Iowa, pointed out that for the first time, the majority of active ORS members in the United States are non-physicians. Several programs promote physician-scientists, such as the Kappa Delta awards, the AAOS/ORS-funded clinician-scientist staffing study and various grant and grant-writing programs. But, noted Dr. Brown, "It is a simple fact of life that the majority of laboratory orthopaedic research is now-and increasingly will be for the foreseeable future-conceived, directed, conducted, and reported by non-orthopaedists, primarily Ph.D. investigators and investigators-in-training."

If these investigators view their field of study as orthopaedic research, their findings may actually be focused on improving patient care. However, if they define it as finite element analysis or molecular biol-ogy or collagen biochemistry, the research may follow a path of scientific virtuosity for virtuosity's sake. This should be a matter of concern to orthopaedic surgeons who perform tried-and-true procedures, he warned.

"While society will always have a need for bone setters, just as it will for barbers," said Dr. Brown, "orthopaedics cannot expect to remain preeminent as a specialty unless it keeps pace scientifically." He pointed to decreasing Medicare reimbursement rates and decreasing incomes for orthopaedic surgeons compared to physician incomes in general as examples of this shift.

Competition is fierce
The movement of scientists and engineers from academic orthopaedic departments to scientific or engineering environments is another disturbing trend. "We live in a knowledge-based economy, one with keen and increasing competition for scientific talent," said Dr. Brown. "It is wishful thinking to expect the best and brightest researchers to enthusiastically stand in line for the privilege of being of service to orthopaedists.

Keeping researchers in orthopaedics, however, will demand increased support for research from orthopaedists, he noted. Based on an estimate of 18,500 practicing orthopaedists in the United States, each with an average annual income of $383,600 and average operating costs of 45%, orthopaedic surgical practices had total 1999 annual revenues of approximately $12.9 billion. Yet donations to the OREF for that year were less than $4.9 million, or approximately 0.038% of revenues. In contrast, the Microsoft corporation spent approximately 17% of revenues on research and development, while Sun and Intel each invested 10% of revenues on research. By comparison, the orthopaedic community seems somewhat at a disadvantage in attracting the best and the brightest as its allies in shaping the future.

"Orthopaedics needs a vibrant, cutting-edge research enterprise to capitalize on the rapidly accelerating pace of scientific and engineering progress, to provide ever-better patient care, and to maintain the profession's preeminence," con-tinued Dr. Brown. "More importantly, it brings immense logistical clout, both direct and indirect. Scientists and engineers, on the other hand, have the capabilities and expertise to make the advances actually happen."

Transforming relationships To bring the two groups closer together, Dr. Brown offered several suggestions. He urged scientists and engineers to work to enhance the visibility of musculoskeletal research, to push for more musculoskeletal-related content in academic curricula, more speakers from the ORS research community, and more musculoskeletal-related symposia and at national scientific and engineering meetings. He also encouraged basic researchers to make a concerted effort to learn what orthopaedic surgeons care about, and why, and for clinically-oriented laboratory investigators to keep that focus. Finally, he urged more scientists and engineers to apply to OREF, with the hope that grants to them would increase.

Orthopaedists, on their part, must recognize that the scientists and engineers in the orthopaedic research community are doing orthopaedics every bit as much as surgeons. He encouraged medical doctors to use their professional standing and influence to encourage the efforts of non-physician scientists. But, said Dr. Brown, "The most important thing you could do is to invest in the basic science efforts upon which the specialty's future depends. Putting 1% of operating revenues into R&D would be considered irresponsibly shortsighted in the corporate sector. Yet for the professional orthopaedic community, this would amount to a figure roughly on a par with the entire musculoskeletal component of the current NIAMS budget."

"If we are to realize the tremendous potential of orthopaedic research for improving the lives of many millions of patients," concluded Dr. Brown, "we need to understand and promote transformation of the relationships between orthopaedic clinicians and orthopaedic scientists. In a nutshell, we must recognize the uniquely valuable contributions of each, and enthusiastically promote an equal partnership in advancing the science that underlies advances in orthopaedic practice."

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Last modified 15/February/2002