S. Terry Canale, MD
That’s the case with this issue of AAOS Now. One of the big stories in this issue is the discussion of the Standards of Professionalism (SOPs) on Orthopaedist-Industry Conflicts of Interest. Whether or not you want to read this story, you really need to read it.
The SOPs on Orthopaedist-Industry Conflicts of Interest were voted on and passed by the membership in 2007, but won’t be enforced until Jan. 1, 2008. The reason for the delay was to enable the AAOS to conduct an educational program so that fellows understood what they can—and, more importantly, what they can’t—do when it comes to relationships with industry.
Tell it like it is
These SOPs require orthopaedic surgeons to disclose any conflict of interest; define the limitations on gifts, subsidies, and financial support; specify the requirements for consulting agreements; define the industry support permitted for Continuing Medical Education; and encourage in-depth reporting of research results.
Alleged violations of the SOPs may form the basis for a formal grievance filed under the AAOS Professional Compliance Program. Under the Bylaws, only fellows and members may file grievances against other fellows and members, and there is a prescribed protocol for the handling of such grievances.
As most orthopaedists know, however, there are plenty of whistleblowers out there: employees, former employees, hospitals, competing surgeons, industry, competing companies—all just waiting to see your name on the front page of the Washington Post, accused by the Department of Justice (DOJ) of a conflict of interest. It’s the kind of story that corner newsboys need…“Extra! Extra! Read all about it!”
Sometimes the rules are hard to understand and comply with, but ignorance is not defensible. “I didn’t know” is not good enough for the DOJ—or for the AAOS. That’s why we should ask ourselves, “Will my relationship with industry withstand scrutiny on the front page of USA Today?” If the answer is an absolute YES, that’s good. If you have to think about it, disclose the relationship and, if so advised, dissolve it.
What’s black, white, and gray all over?
The AAOS developed these SOPs for a reason. As Murray Goodman, MD, chair of the BOC/BOS Professionalism Committee says, “Whenever a physician’s decision-making process might be influenced by financial considerations or other motivating factors, the potential exists for optimal patient care to become a secondary and not a primary goal. That is what we wanted to guard against.” (See “Patients come first,” page 1.)
In complex, difficult-to-understand areas—such as consulting agreements and CME activities—it can be easy to rationalize and blur the lines between legal and ethical. What you have to remember is that some things that are legal are not necessarily ethical, but almost all ethical behavior is legal.
That brings me back to my favorite definition of ethical behavior: “Doing the correct thing when no one is looking.” A more formal definition also applies, “Obedience to the unenforceable.” So when in doubt, regardless of the legality, ask yourself, “Is it ethical? Does it feel right? How would it look on the front page of The New York Times?” You don’t want your colleagues to be saying, “Extra! Extra! Read all about it!”
Getting to know the SOPs
That January 2008 implementation date is rapidly approaching, and AAOS educational efforts are kicking into high gear. If you haven’t already, take the time to read the complete SOPs. You’ll find them on the AAOS Web site and on the Orthopaedic Knowledge Online Web site at www.aaos.org/industryrelationships
On Nov. 13, the AAOS will hold a “Webinar” on the SOPs during which you’ll be able to earn CME credit and learn about how these SOPs apply to your practice. If you can’t participate, you’ll be able to hear it later on the Web. (See article on page 53 for more information.)
Finally, if you have any relationships with industry, now’s the time to revisit them and measure them against the minimum standards outlined in the SOPs. Although we all recognize that cooperation between orthopaedic surgeons and industry is necessary to improve patient care, none of us wants even the perception of impropriety to mar those relationships.
That’s the thinking behind the new AAOS disclosure database (featured on page 11). With the kind of transparency that the database provides—24/7 access to an individual’s disclosure information, available to all Academy members—no one should have to worry. In fact, if you want to see my disclosures, they are there. Feel free to check them after you’ve done yours.
I personally don’t think these SOPs are too restrictive or too burdensome. The Professional Compliance Program is our effort to police ourselves internally before some outside source starts policing us in a very punitive manner.
I believe that orthopaedic surgeons do behave ethically and that our actions are based on the best interests of our patients, but we have to be aware of how our actions are perceived by others and take steps to avoid unwelcome perceptions. The SOPs developed by the AAOS are designed to help you do just that, so that your name doesn’t end up on the front page of any newspaper—including AAOS Now—as an Extra! Extra! Read all about it!