February 2003 Bulletin

From our readers

Write to The Editor, AAOS Bulletin, 6300 North River Road, Rosemont, Ill. 60018-4262

Academy finances

I agree 100% with Dr. Cleary (December 2002 issue). Instead of raising dues, these times require cutting expenses. There seems a lot of excess bureaucracy and feel-good programs that need to be pruned. If the good times return, we can grow again, but in case you have not noticed, physicians are under assault on all sides—malpractice, declining reimbursement and costly HIPPA regulations. It strikes me as arrogant of MY Academy to decline to show fiscal responsibility.

Richard A. Hurd, Jr., MD
Alpharetta, Ga.

Dr. Cleary raises a number of provocative points regarding the Academy’s finances, and questions the wisdom and need for some of its activities. I share most of Dr. Cleary’s concerns and strongly applaud his closing remarks, "But what is worst, is our dependence on the ‘contributions’ from orthopaedic industry, as Dr. Bucholz (AAOS second vice president) pursues additional sources of revenue from these corporations. As we continue to accept expanded ‘unrestricted grants’ from the medical-industrial complex, we run the risk of losing our independence and objectivity. Even the appearance of impropriety is improper."

Dr. Cleary should not fear "losing" our independence and objectivity in this regard, since, to a great extent, we lost these two precious commodities a long time ago. We buried our heads in the sand and refused to pay attention, let alone respond to the fact that industry was obviously seeking control of the education of the orthopaedist. It now does so. The awesome financial power of industry won the day and currently we simply dance to the tunes it plays for us.

Augusto Sarmiento, MD
1992-93 AAOS President
Miami, Fla.


It is ironic that Dr. John .J. Gartland’s letter on diversity appeared in the same issue as the article, "Evidence Based Practice" (August 2002). What evidence exists based on studies that there is any benefit to diversity other than to the concerned minority?

The Bakke decision clearly indicates that quotas are unconstitutional unless cleverly disguised; yet Dr. Gartland advocates a quota system based upon demographics. Why limit advocacy of diversity to gender and race? Why not include political, age, geography, and other comparable distinguishing characteristics for purposes of diversity?

R. Theodore Nussdorf, MD
Laguna Hills, Calif.

New PhRMA Code

Dr. Jeanne DelSignore’s article on PhRMA’s New Code on Interactions with Health Care Professionals (December 2002 issue) reflects her serious commitment to respond to the charges that the Ethics Committee has given her. She is trying to right many of the wrongs she perceived in the current system. Some of her comments make that clear. I submit that the education of the orthopaedist can be carried out without financial contributions outside the medical profession, particularly contributions that may be tainted with suspicious unethical concerns. Today we have available a large number of opportunities for maintaining and upgrading the education we need to appropriately practice our discipline. The large number of medical publications, meetings of specialty societies, local, state and regional society educational activities, the Internet and Medical school departments of orthopaedics (though the latter are rapidly becoming vehicles to serve industry’s interests) are effective sources of education.

The Academy’s heyday of CME took place in total absence of financial support from the manufacturing industry. At different times I served on several educational committees of the Academy and chaired the Committee on Injuries and the Committee on Continuing Education. During my five-year tenure in the latter position we conducted as many as 30 courses a year. These successful ventures took place without industry’s support. My eight-year tenure on the Board of Directors of the Academy and my year as president of the organization gave me a deep appreciation of continuing education.

Although I commend Dr. DelSignore and the other members of the AAOS Ethics Committee for their efforts on our behalf, I have surmised their efforts, to a great extent, have been a waste of their time. The growth in industry’s subsidy of education that Dr. DelSignore has illustrated confirms the futility of the Committee’s efforts in this regard.

I do not see the light at the end of this long tunnel and I am concerned that the ‘horse is out of the barn.’ Only a moral awakening of the medical profession with a parallel growth of the intestinal fortitude needed to face the challenge will bring about the changes the Ethics Committee is trying to accomplish.

Augusto Sarmiento, MD
1992-93 AAOS President
Miami, Fla.

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