I like it [AAOS Now]. More accessible, less boring, more likely to be read.

Desmond Brown, MD
Sherborn, Mass.

I really like the new publication—AAOS Now—and found lively content, attractive format, good reading. However, my team and I feel there is a conflict of interest in publishing a picture of Dr. Fu advocating “double-bundle ACL repair” in juxtaposition to a page advertisement from the University of Pittsburgh Medical Center (UPMC) that asserts that “the anatomic double-bundle repair restores more normal function to damaged knee joints than any previous surgical technique….” The article, in contrast, states that “other studies have shown no statistical difference between single-bundle and double-bundle ACL reconstruction…” and states that we need better testing methodology.

Elsewhere in AAOS Now is the information that the Committee on Professionalism will consider Standards of Professionalism for Advertising. To me, the publication AAOS Now, published by my Academy, for members of my Academy, may not be acting professionally by promoting an unproven advantage of a particular method.

Appropriate corrective action is to state a clear editorial policy about linking articles to paid advertising, an assertion that evidence-based guidelines will be followed in selecting content, and publishing a counterpoint to the assertions in the text by Dr. Fu of the alleged benefits of the double-bundle repair.

David Seligson, MD, FAAOS
Louisville, Ky.

Editor’s reply: The AAOS Now advertising guidelines are designed to keep advertising and editorial content separate, and editorial decisions are made independent of any advertising. The article and the ad were not linked or juxtaposed; the article began on page 1 and carried to page 44, while the UPMC ad appeared on page 9. By the way, the same ad appeared in the February issue of the Journal of the AAOS, which also included an article on double-bundle ACL reconstruction.

As we point out on page 5, “the AAOS specifically disclaims any and all responsibility for the contents, advertisements, and other material submitted to and contained in AAOS Now. A reference to a commercial product in an article or in any advertisement does not, either expressly or by implication, indicate that the AAOS endorses the product, its manufacturer or distributor.” As for your request to print a “counterpoint” article, we did. You’ll find Richard Hawkins, MD, disputing the assertions about double-bundle repair on page 44.

The initial issue of AAOS Now is superb. Congratulations on this initiative. The picture of my friend Freddie Fu on the cover shows him—as well as a nurse and one of his assistants—without eye protection. This is, I believe, a Joint Commission requirement. In Connecticut, we can be fined for not wearing [eye protection].

Robert Stanton, MD
Fairfield, Conn.

AAOS Now is definitely an improvement. The old Bulletin was too dry to spend time reading, so this is better. Thanks.

Sheila M. Algan, MD
Grants Pass, Ore.

The AAOS Now is huge! Why does it have to be so large and cumbersome? It’s bigger than Orthopaedics Today! The content looks good. It’s a great concept.

Andrew J. Paterson, MD
Durango, Col.

To be very frank, the new format in a “tabloid” format does not inspire confidence. It resembles so many other “throw-away” junk mailings. While I am sure that a great deal of thought went into this new project, it leaves me cold. It just doesn’t look like a serious publication distributed by a professional organization. I fear that it is likely to be thrown away with all the other junk mail cluttering our mailboxes. Please note that the content is just fine. It is the format that I do not like.

John H. Mahon, MD
Phoenix, Ariz.

Editor’s reply: Well, I’m glad to hear you think the content is fine. As my mother always told me, You can’t judge a book by its cover! And, while we do want to be taken as a serious publication, we don’t mind a little splashy look to our front page. If the design doesn’t grab you, we hope the headlines will, and will pull you past the format into the great content.

AAOS Now is very nice. Germane, timely, attractive.

Thanks,

Scott A. Smith MD
Austin, TX

Please understand we mean no offense to those who have developed this publication. We know a lot of effort and research has gone into the repackaging of this communication mode. At the recent Biomedical Engineering Committee meeting, three concerns were raised by our members:

The size and organization of the articles now makes it difficult to maintain selected articles in files. Many of us had frequently removed pages containing articles of interest and put them in files. To do this now, we will have folded pages and it will be more cumbersome.

The size also is less “portable” and difficult to carry in a briefcase for reading on planes or while waiting for other clinical activities.

The publication in general now looks like an Orthopaedics Today edition. There are concerns that the AAOS Now could be seen as a “light” version of the Bulletin or mistaken for another publication.

We appreciate the desire to maintain relevance and interest of the membership and acknowledge that we are a small group that may not be representative of the majority of the membership. We also appreciate the opportunity to bring forth our concerns.

John S. Kirkpatrick, MD
Jacksonville, Fla.

Editor’s reply: We purposely are trying to keep articles within specific “departments” so they will be easier to find. All practice management articles, for example, will be in one section. And we’re working on making the issue easier to fold and carry. We don’t intend AAOS Now to be a “lighter” version of the Bulletin; in fact, with the addition of clinical news and controversial coverage, we hope it becomes a more dynamic publication.

Reimbursement
As I read the Headline News abstract about how reimbursement has crashed in the last two years, I thought it would be instructive to review how reimbursement has changed over several decades. When I started practice in 1979, Medicare reimbursement for total hip and total knee replacements was about $1,800. But physicians could charge anything, and the patient made up the difference.

In 1984, when mandatory acceptance of the Medicare schedule was being forced on us, I was charging about $3,200 for a total joint replacement. Then the reimbursement began to fall and it has been falling ever since.

Now, 28 years of experience later, I am receiving about $1,400 reimbursement for a total joint replacement—a full $400 less than when I started, not even considering the impact of inflation. The Headline News item suggested that reimbursement will continue to decrease over the next couple of years. When will this insanity end?

We are accused of not spending enough time with our patients and pawning them off to physician assistants or nurse practitioners. Yet any business owner knows that to stay in business if your prices go down, you have to increase volume! We are in a trap that was set when Medicare was forced upon us. What can the individual practitioner do?

Douglas G. Nuelle, MD
Blue Ridge, Ga.

AAOS Now welcomes your comments and attempts to “set Now straight.” We reserve the right to edit your correspondence for length, clarity or style. Send your letters to the Editor, AAOS Now, 6300 N. River Rd., Rosemont, Ill. 60018, fax them to (847)823-8033, or e-mail aaoscomm@aaos.org