THE ORTHOPAEDIC SURGEON

1
THE ORTHOPAEDIC SURGEONS RELATIONSHIPS WITH
INDUSTRY

• AAOS ETHICS COMMITTEE
• Kenneth C. Thomas, MD

2
Objectives

• Become aware of the AAOS Standards of
  Professionalism on Orthopaedic Surgeon-Industry
  Relationships
• Identify physician-industry conflicts of interest
• Become familiar with potential legal and ethical
  issues involving physician-industry relationships
  

3
Introduction

• According to a 2006 New York Times article, an
  orthopaedic surgeon was paid 400,000 by a device
  company for 8 days of work.
• Another doctor was paid nearly 700,000 in
  consulting fees for nine months.
• What constitutes ethical relationships with
  industry?

4
Introduction

• The primary goal of the orthopaedic surgeon is
  caring for the patient.
• Collaboration between orthopaedic surgeons and
  industry is essential for the advancement of
  orthopaedic technology.
• Relationships with industry must be done in an
  ethical manner and not distract from our primary
  goal.

5
Case

• Chip, a sales representative, works for a new
• implant company
• that is launching a
• computer navigated unicompartmental
• knee replacement. Comstock/Thinkstock
• He approaches Dr. Thomas, a busy orthopaedic
  surgeon who performs a large number of knee
  replacements.

6

• Chip offers Dr. Thomas a high profile consulting
  position with the company if he uses over 10 of
  his implants per month.
• The position would include a generous stipend and
  all expenses paid travel to educational courses
  for the implant.

7

• What would you do?
• What are the ethical issues?
• What are the legal issues?

8

• Dr. Thomas refuses
• the offer and explains
• to Chip that he cannot receive something of value
  based on his use of an implant.
• Comstock/Thinkstock
• Chip agrees and instead offers to cover the
  salary of a full-time research nurse to evaluate
  the outcomes of the new prosthesis.

9

• The hospital
• administration
• declines to hire
• a research nurse
• that would be
• paid for by the
• implant company. iStockphoto/Thinkstock
• Clearly dejected, the rep offers to fund another
  orthopaedic surgery residency position if the
  hospital uses over 10 of his implants per month.

10

• What would you do now?
• What are the ethical issues?
• What are the legal issues?
• Does the change in the deal make an ethical
  difference?

11

• Isnt the training of another orthopaedic surgery
  resident a worthwhile cause?

12

• Are there Mandatory Standards from the AAOS
  Standards of Professionalism on
  Orthopaedist-Industry Conflicts of Interest that
  are applicable?
• Which specific Mandatory Standards apply?
• Which guidelines from the AAOS Opinion on Ethics
  and Professionalism The Orthopaedic Surgeons
  Relationship with Industry apply?

13

• What events have you witnessed during your
  residency and/or practice that may be
  questionable?
• Should all gifts from industry be banned?

14

• What are acceptable relationships between
  orthopaedic surgeons and implant companies?
• How do you determine the fair market value of
  consulting agreements with orthopaedic surgeons?

15

• Case Conclusion
• Chip and the implant company are indicted for
  bribery and kickback schemes that took place at
  another area hospital.

16

• References
• Abelson R Whistle-Blower Suit Says Device
  Makers-Generously Rewards Doctors. New York
  Times,
• January 24, 2006.
• American Academy of Orthopaedic Surgeons
  Standards of Professionalism on
  Orthopaedist-Industry Conflicts of Interest,
  Mandatory Standards 2, 6, 9, and 10. Adopted
  2007.
• http//www3.aaos.org/member/profcomp/SOPConflictsI
  ndustry.pdf
•  
• American Academy of Orthopaedic Surgeons
  Opinions on Ethics and Professionalism-The
  Orthopaedic Surgeon's Relationship with Industry,
  Guidelines 1, 2, and 9. Adopted 1992 revised
  2004, 2005.
• http//www.aaos.org/about/papers/ethics/1204eth.as
  p
•  
• American Academy of Orthopaedic Surgeons Code of
  Ethics and Professionalism for Orthopaedic
  Surgeons, III.C. Adopted October 1988, revised
  2011.
• http//www.aaos.org/about/papers/ethics/code.asp

17

• Advanced Medical Technology Association
  (AdvaMed) Code of Ethics on Interactions with
  Health Care Professionals. Adopted 2004, revised
  and restated 2008.
• http//www.advamed.org/MemberProtal/About/Code
• Pharmaceutical Research and Manufacturers of
  America (PhRMA) Code on Interactions with
  Healthcare Professionals. Adopted 2002, revised
  2008.
• http//www.phrma.org/about/principles-guidelines/c
  ode-interactions-healthcare-professionals
• Orlowski J, Watseka L The effects of
  pharmaceutical firm enticements on physician
  prescribing patterns. Chest. 1992 102 270-273.
• Lexchin J Interactions between physicians and
  the pharmaceutical industry what does the
  literature say? CMAJ 1993149 1401-1407.