AAOS Bulletin - June, 2005

Orthopaedic surgeons and industry

Stuart L. Weinstein, MD

I have received many e-mails and letters from the fellowship following the recent publication of several articles in the media concerning the relationship between orthopaedic surgeons and industry. As a result, I felt that it would be appropriate to address this issue in the public forum of the Bulletin.

The New York Times (March 31, 2005), USA Today (April 1, 2005) and the Wall Street Journal (March 31, 2005), as well as many regional newspapers, have reported on the Department of Justice’s probe into orthopaedic device companies.

These media reports followed subpoenas issued by the Department of Justice (DOJ) seeking information regarding consulting and service agreements with orthopaedic surgeons, primarily with surgeons who implant artificial knees and hips.

These articles may be disturbing to our patients and already have been to many members of the Academy. These allegations, even prior to the investigative process, threaten the public trust in the medical community. This trust is the foundation of the doctor/patient relationship and is fundamental to our contract with society.

The Academy proactively responded to these articles by sending a letter to the editor of the Wall Street Journal. This editorial outlined the important relationships that do exist between orthopaedic surgeons and companies for which they consult. It emphasized that optimal patient care requires collaboration between orthopaedic surgeons and industry manufacturers. This collaborative effort ensures that patients have the best surgical outcomes through the invention and testing of new technology; research and evaluation of existing technologies; and continued education of orthopaedic surgeons.

The Academy has developed very clear ethical guidelines to balance the needs of patients with those leading to advancements in technologies and procedures. These parameters were developed in 1992 and revised by our Ethics Committee in 2004. These principles clearly state that it is the orthopaedic surgeon’s sole responsibility to provide the finest care to patients.

If orthopaedic industry, including device manufacturers and pharmaceutical companies, can assist in the development of new beneficial technology, then an orthopaedic surgeon should collaborate with industry. However, “orthopaedic surgeons must never lose sight of their primary ethical responsibility to provide competent, compassionate patient care, maintaining professionalism and objectivity at all times.” Any and all relationships that orthopaedic surgeons have with industry must be able to withstand public scrutiny.

The Academy, in its “Opinions on Ethics and Professionalism,” clearly outlines the appropriate relationship between orthopaedic surgeons and industry. It is acceptable for industry to provide financial and other support to orthopaedic surgeons if such support has significant educational value and has the purpose of improving patient care. All relationships between the orthopaedic surgeon and industry should benefit the patient. This may advance patient care through invention of new technology; basic and applied research; evaluation of new technology and device efficacy; and continuing education. It is clearly unethical for an orthopaedic surgeon to receive compensation of any kind from industry for using a particular device or medication.

Our ethical guideline clearly states, “When an orthopaedic surgeon receives anything of significant value from industry, a potential conflict exists, which should be disclosed to the patient. When an orthopaedic surgeon receives inventor royalties from industry, the orthopaedic surgeon should disclose this fact to the patient if such royalties relate to the patient’s treatment.

Reimbursement for reasonable administrative costs in conducting or participating in a scientifically sound clinical trial is acceptable.”

As Jerome P. Kassirer, MD, wrote in his book On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health (Oxford Press 2005):

“Patients must be able to trust that their doctors’ motives are not subverted by financial gain, that their doctors are recommending treatments that benefit them, and that their doctors are involving them in research projects for the right reasons. Their doctors must not only be at their sides, but on their sides.”

Stuart L. Weinstein, MD


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