Published 10/1/2010

Integrity in delivering care, making disclosures

The study of SLAP lesion repairs by young orthopaedists is most disturbing. It shows repairs on patients as old as 88 years old, and our newly minted orthopaedic colleagues, far from starting their careers by practicing medicine conservatively, are performing these repairs at 3 times the rate deemed appropriate by our orthopaedic literature. These repairs accounted for an astonishing 10 percent of all shoulder surgery performed by the ABOS candidates in the final year of Dr. Weber’s study.

As an orthopaedist who has been in private practice, I fully understand that the incentives all weigh heavily upon these young doctors to generate these surgical cases. We must teach young surgeons the fundamental rule of medicine: the patients are not there to service our desires, whether this is for status, ego fulfillment, or financial reward. Rather, we are practicing medicine for the benefit of our patients. The overuse of surgical procedures to benefit the surgeon has absolutely no place in compassionate or ethical medical care; it is a violation of the trust that our patients place in us and we must respond aggressively whenever it is discovered.

James B. Rickert, MD
Bloomington, Ind.

To paraphrase “Big Daddy” in Cat on a Hot Tin Roof, “I smell the powerful obnoxious odor of mendacity.” The Archives of Internal Medicine published an article on Sept. 13 that was reviewed the same day in the New York Times. This interesting but disturbing article cleverly compared 2007 physician payment data released by the orthopaedic implant companies (as required by the Department of Justice investigation of physician kickbacks) to the disclosures in articles published by the same individuals in 2008. The study was limited to the 41 physicians who received more than $1 million per year from these implant companies.

Of the 32 individuals who were $1 million richer in 2007, only 7 fully disclosed on all the articles they published, 11 never disclosed any interest from the implant companies, and 14 partially disclosed in some of the articles that they wrote. Unfortunately, the study did not name names, but the clear inference is that the money from implant companies, combined with the lack of veracity of the authors, has severely corrupted the medical literature and undermined its reliability of same.

I am personally tired of having to defend my profession and tens of thousands of fellow hard-working orthopaedists because of the greed and avarice of the few. This leaves a clear impression of systemic and widespread corruption of medicine and, in particular, orthopaedic medical literature.

The question is what can we do about this? I have the following suggestions:

  1. If any journal—including the Journal of Bone and Joint Surgery and the Journal of the AAOS—discovers an author who has willingly falsified their disclosure, it should no longer accept any article authored by that individual. Further, journals should require full and complete disclosures (relative or not) on articles and let the reader decide whether there is relevance to the text of the article or not.
  2. The AAOS should terminate the membership of anyone who willingly and knowingly falsifies disclosure.
  3. The American Board of Orthopaedic Surgery, protector of ethics and competence, should also terminate the Board certification of any individual for the same cause.

William Renda, MD
Louisville, KY