August 2004 Bulletin

Corporate Advisory Council focuses on ethics issues

Supports Annual Meeting, scholarships, USBJD

By Mary Ann Porucznik

Orthopaedic surgeons and industry representatives get together nearly every day to talk shop, but at the June 10 meeting of the AAOS Corporate Advisory Council (CAC), the subjects ranged from the Annual Meeting to ethics guidelines. Composed of approximately 40 companies serving the orthopaedic market, the CAC serves as a vital link between the AAOS and industry. The meeting was co-chaired by Jack Parr, PhD, chief scientific officer, Wright Medical Technologies, and AAOS chief executive officer Karen L. Hackett, FACHE, CAE.

Annual Meeting news

The Academy announced that an online mapping tool will be available at the 2005 Annual Meeting in Washington, D.C., so that attendees can locate company exhibits easily and quickly. Annual Meeting Committee chair Colin Moseley, MD, and AAOS director of convention and meeting services Susan McSorley outlined sponsorship opportunities and other ways for industry to work with the Academy during this premier educational event.

For the fourth year, the CAC agreed to sponsor the International Scholars Program, which enables international orthopaedic surgeons from developing nations to attend a skills course at the Orthopaedic Learning Center in Rosemont, Ill. In 2005, the CAC will expand the program to include bringing an Iraqi orthopaedic surgeon to the Annual Meeting.


AAOS and industry leaders gather during the CAC meeting: (from left) Jennifer Zar, manager, Pfizer Pharmaceuticals; Perry Tomasetti, senior product manager, Hologic; Jeff Rutan, director, musculoskeletal medicine, Wyeth Ayerst Pharmaceuticals; AAOS President Robert W. Bucholz, MD; Jack Parr, PhD, CAC co-chair, chief scientific officer, Wright Medical Technology; Richard F. Kyle, MD, AAOS second vice president; Karen L. Hackett, FACHE, CAE, CAC co-chair, AAOS chief executive officer.

DTC advertising

Peter J. Mandell, MD, chair of the AAOS Direct-to-Consumer (DTC) Advertising Project Team, reported on the project team’s efforts to prepare a position statement on DTC advertising by pharmaceutical and device companies. The United States is one of only two countries in the world with DTC advertising, and spending on DTC advertising exceeded $2.8 billion in 2001.

Acknowledging the beneficial effects of DTC advertising, Dr. Mandell noted that it can help create more informed patients, foster shared decision making between patients and physicians, increase physician-patient communication, improve patient compliance and de-stigmatize diseases.

However, DTC advertising also has the potential for negative consequences. Consumers may be confused by minor differences among competing products or may be unaware of potential side-effects, possible drug interactions and less expensive, but just as effective, alternatives.

Involving industry in reform,research

Stuart L. Weinstein, MD, AAOS first vice president and chair of the medical liability reform campaign oversight committee, presented information on efforts by AAOS and Doctors for Medical Liability Reform to achieve meaningful medical liability reform. He noted that a culture change among physicians is needed so they become more active advocates for reform with both politicians and, when appropriate, patients. The ensuing discussion also focused on the need for the public to step forward because the crisis is now affecting access to health care. For example, there is no neurosurgeon willing to practice in southern Illinois due to the costs of medical liability insurance.

The CAC also renewed its support for the Bone and Joint Decade, particularly for Project 100, which aims to bring a required course in musculoskeletal education to 100 percent of medical schools by the end of the Decade. Currently fewer than half of the country’s medical schools require such a course. Not surprisingly, research has shown that recent medical school graduates lack both cognitive mastery and confidence in their ability to treat musculoskeletal conditions. (See related story on p. 61.)

Industry’s role in research was underscored during the presentation on the American Joint Replacement Registry (AJRR) by Joshua J. Jacobs, MD, chair of the Council on Research and Scientific Affairs. Data collection and research on hip replacements conducted by the AJRR will have far-reaching benefits, including the ability to track implants and identify patients who need follow-up.

Victor Goldberg, MD, chair of the Board of Trustees of the Orthopaedic Research and Education Foundation (OREF), reported that in 2003, corporate contributions to OREF totaled $4.7 million, just over half of which ($2.6 million) was restricted to specialty societies. The interplay between research and improvements in both devices and patient care will be part of OREF’s 50th anniversary celebration next year.

A look at three ethics codes

The liveliest discussions followed presentations on ethics by James D. Capozzi, MD, a member of the AAOS Ethics Committee; Tom Winkel, administrative vice president at Stryker Corporation; and Jennifer Zar, manager, and Mike Parini, JD, an attorney with Pfizer Pharmaceuticals. They reviewed the AAOS Opinion on Ethics and Professionalism on Gifts and the Orthopaedic Surgeon’s Relationship with Industry, the Advanced Medical Technology Association’s (AdvaMed) Code of Ethics on Interactions with Health Care Professionals and the Pharmaceutical Research and Manufacturers’ Association (PhRMA) Code on Interactions with Healthcare Professionals.

All three codes acknowledge that interactions between industry and health care professionals that lead to improvements in patient care are beneficial. However, they differ in many respects, and an understanding of the differences is needed to ensure compliance. For example, the AAOS code does not place a specific monetary value on gifts, while the AdvaMed code limits gifts that “benefit patients or serve a genuine educational function” to a fair market value of less than $100 (other than the gift of medical textbooks or anatomical models used for educational purposes). The PhRMA Code limits items primarily for the benefit of patients to a value of $100 or less, but also permits giving items of minimal value associated with the professional’s practice.

Industry representatives noted that the codes, which were originally presented as voluntary guidelines, are now seen by the federal government as minimum standards. The stakes are high: Improper relationships or exchanges between industry and physicians can result in criminal as well as civil penalties. Health care professionals and industry share responsibility for compliance and must work together to ensure that all interactions are to the benefit of the patient in this new environment. The consensus of the group was that the new guidelines are changing the relationships between physicians and industry, with the need for industry to be very careful to observe both the spirit and the letter of the new rules.

“The breakout groups on ethics codes were very lively,” said AAOS CEO Karen Hackett. “It was clear that both our industry partners and our board learned a great deal—and that, in this area, we have an education job to do for the benefit of our members.”

Mary Ann Porucznik is manager, communications. She can be reached at porucznik@aaos.org

About CAC

The Corporate Advisory Council (CAC) functions as a forum for the exchange of information of mutual concern to the AAOS and orthopaedic industry, within policy, ethical, judicial and legislative constructs that govern the relations between industry and organized medicine. The CAC has four major goals:

  1. To coordinate and oversee the activities of existing groups that address Academy and industry relations, such as the Advisory Task Force on Industry and Continuing Medical Education (CME) and the Exhibitors Advisory Council.

  2. To encourage and support public education and public relations programs that increase the public’s awareness of the special skills of the orthopaedic surgeon and the efficacy of orthopaedic health care through joint and complementary public education and public relations programs.

  3. To share information and periodically review the CME activities of industry and their relationship to the Academy’s efforts.

  4. To coordinate the financial support of industry for the Academy’s educational courses and research projects.


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