Published 1/1/2010

Conflicts of interest remain problematic

Congratulations to Dr. Canale on his November editorial, which expresses the strength of his convictions and his willingness to call it like it is.

The editorial centered around the New England Journal of Medicine article, “Conflict of interest disclosures reported by physicians” (Oct. 8, 2009). Dr. Canale digests the article, agreeing with some of its conclusions and disagreeing with others. He expresses optimism that the Academy will soon find a mechanism to ensure an appropriate and effective means of identifying conflicts of interest by those presenting scientific material at the AAOS Annual Meeting. Although I am not aware of any details regarding the proposed method, based on my past experiences, I venture to say it will not be good enough.

While serving as a member of the AAOS Board of Directors 20 years ago, I participated in the deliberations of its Planning and Development Committee, which proposed using an asterisk to identify presenters of scientific material who had conflicts of interest. Although the proposal was received with enthusiasm, I remarked that the system, rather than being an effective mechanism to achieve openness, was nothing but a joke, and that we could anticipate that within a few years, several people would be displaying not one but multiple asterisks before their names with the pride of highly decorated generals.

That has been the case ever since. Some orthopaedic surgeons sincerely believe that identification of financial support from industry is a badge of honor and recognizes their prestige and fame.

Dr. Canale paid special attention to the “black eye” the ortho-paedic profession received from the Justice Department’s investigation of the relationships between industry and surgeons. The names of some of those accused of improper behavior have been released. Some, I assume, were found to be innocent; I assume that others, however, justified their behavior by claiming that the large kickbacks and other practices were legitimate parts of educational transactions, and now state that “all conflicts of interest have been resolved.”

When I first heard of the investigation, I urged the AAOS to turn the embarrassing situation into an opportunity.

Dr. Canale expresses hope for a cleansing of whatever imperfect ways we may have used and looks forward to a better day. Only strong positions taken by our Academy and its fellowship will prove to be meaningful. The Academy should use its moral and political power to prevent the election of people with conflicts to positions of authority. Likewise, it should set criteria and strongly request that specialty societies, local, state, and other national organizations do the same.

Augusto Sarmiento, MD
Miami, Fla.

Editor’s note: Dr. Sarmiento is a past president of the AAOS (1991).

Setting Now straight
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The October 2009 issue of AAOS Now incorrectly identified the surgeon standing with Sgt. Evan Cole at the 2009 MORE Awards luncheon. He is Col. Richard A. Schaefer, MD. The November 2009 issue incorrectly stated that William M. Mihalko, MD, PhD, was from Southaven, Miss; he is from Memphis, Tenn. We regret the errors.