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Published 11/1/2011

Disclosure, diversity, and damages

I was quite taken by Dr. Canale’s excellent evocation of the heroes with white hats (“Where have all the ‘white hats’ gone?” AAOS Now, September 2011) and his call for all orthopaedic surgeons to strive to be “white hats,” to offer full disclosure, and to employ rigorous honesty in our reporting.

We certainly should avoid becoming “black hats.” One’s ties to industry, even economic ties, should not invalidate one’s research or bias one’s papers. Dr. Canale’s disclosure of his relatively simple financial ties is admirable and vetting of the portion of our literature supported by industrial money is wise and necessary. However, the concentration on direct industrial financial incentive as the source of biased or even dishonest reporting detracts attention from another, perhaps more common, source of bias and data manipulation.

Power and prestige in both medicine and orthopaedics are based on the publication of papers with positive and striking results. Negative results are often ignored or not pursued at all.

Someone who happens to be especially good at a certain procedure may well publish a paper on “complications of x,” which starts just after his or her last complication and ends just before the most recent. The title of such a paper, however, really should be “I’m great at x, send x to me and invite me to come to your meeting to talk about it.” Publishing the results of a procedure with which he or she has more trouble—and many complications—than most of his or her peers would be very useful, especially if it included the fixes for the complications that had and had not worked. But such a paper would not result in academic advancement.

If such a paper were presented, the result would likely be a snotty put-down of the brave presenter as being incompetent. It would not result in praise or referrals.

In addition to disclosing relationships to industry and monies received from same, perhaps authors should include a statement such as “I lust after the chairmanship of a major university program and am hopeful that the great results I present in this paper will get me there.”

John DeWeese, MD
Longmeadow, Mass.

Women in orthopaedics
I would like to compliment AAOS Now for the advertisement on pages 60–61 in the September 2011 issue. The advertisement “Your AAOS Benefits Start Here” shows 6 orthopaedic surgeons holding their membership cards. Those six surgeons just happen to all be women of diverse ethnicities. How refreshing it is to see that women orthopaedic surgeons are actually the norm!

As a female orthopaedic surgeon, who has been a member of the AAOS since early residency almost 20 years ago, I am very encouraged that the AAOS recognizes that women orthopaedists are not novelties, oddities, or tokens. Thank you for your efforts at inclusiveness.

Rina Jain, MD, FRCSC
San Diego

This isn’t reform
I and probably others read Dr. Seligson’s article in the August AAOS Now
(“Malpractice reform?”) with a combination of incredulity and anger. In citing references like the Bible, or an 1891 constitution, Dr. Seligson may be barking up the wrong tree. Times have changed and the old rules sometimes don’t apply.

Laws that count on integrity and fairness among our populace don’t apply any more. We live in the land of entitlement, where no one is ever responsible for his or her own misfortune. New laws are needed to preserve the rights of people, not abuse them. Checks and balances are needed—no matter what it says in the Kentucky constitution.

Nowadays, the law often protects the criminal more than the victim. In the United States, the concept of suing someone is probably not foreign to an average 6-year-old. Our cultural norms for law and politics have become a laughingstock for the rest of the world.

Is Dr. Seligson suggesting that there is or has ever been legislation anywhere in the United States that puts a $250,000 cap on damages? Including “medical bills”? Someone needs to look up the difference between “damages” and “noneconomic damages.” In an era of reality TV and hundred-million dollar athlete contracts, dollar values have become distorted and fantastical. I would love to trust a jury of my peers not to value loss of consortium to a claimant’s 80-year-old spouse at $500,000, but, sadly, I don’t.

Right now, lawsuits are a no-risk lottery ticket for most claimants, and with so many lawyers, someone with free time will take almost any case. Loser pays would at least make someone think twice about suing, or defending a valid claim.

Lawyers, a lot of them, are running our country without checks and balances, and it is damaging all of us. We ought to sue them.

Roger M. Blauvelt, MD
Auburn, Wash.

Setting Now straight
welcomes reader comments and efforts to “set AAOS 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 email them to aaoscomm@aaos.org