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Patients’ Views on Surgeons’ Financial Conflicts of Interest
Mark W. Camp, MD, MSc1; David A. Mattingly, MD3; Allan E. Gross, MD4; Markku T. Nousiainen, MD, MSc, MEd5; Benjamin A. Alman, MD6; Martin F. McKneally, MD, PhD2
1 Division of Orthopaedic Surgery, University of Toronto, Banting Institute, 100 College Street, Suite 302, Toronto, ON M5G 1L5, Canada. E-mail address for M. Camp: mark.camp@mail.utoronto.ca
3 Department of Orthopedic Surgery, New England Baptist Hospital, 830 Boylston Street, Suite #106, Chestnut Hill, Massachusetts, 02467
4 Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Suite 476(A), Toronto, ON M5G lX5, Canada
5 Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 43 Wellesley Street East, Room 621, Toronto, ON M4Y 1H1, Canada
6 Division of Orthopaedic Surgery, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Service Floor/Elm Wing, Room S-107, Toronto, ON M5G 1X8, Canada
2 Department of Surgery, University of Toronto, Banting Institute, 100 College Street, Suite 211, Toronto, ON M5G 1L5, Canada
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  • Disclosure statement for author(s): PDF

Investigation performed at Mount Sinai Hospital, Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery and Joint Centre for Bioethics at the University of Toronto, Toronto, Ontario, Canada; and the Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jan 16;95(2):e9 1-8. doi: 10.2106/JBJS.L.00270
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The U.S. Department of Justice’s investigations into financial relationships between surgical device manufacturers and orthopaedic surgeons have raised the question as to whether surgeons can continue to collaborate with industry and maintain public trust. We explored postoperative patients’ views on financial relationships between surgeons and surgical device manufacturers, their views on disclosure as a method to manage these relationships, and their opinions on oversight.


From November 2010 to March 2011, we surveyed 251 postoperative patients in the U.S. (an 88% response rate) and 252 postoperative patients in Canada (a 92% response rate) in follow-up hip and knee arthroplasty clinics with use of self-administered questionnaires. Patients were eligible to complete the questionnaire if their surgery (primary or revision hip or knee arthroplasty) had occurred at least three months earlier.


Few patients are worried about possible financial relationships between their surgeon and industry (6% of surveyed patients in the U.S. and 6% of surveyed patients in Canada). Most patients thought that it is appropriate for surgeons to receive payments from manufacturers for activities that can benefit patients, such as royalties for inventions (U.S., 69%; Canada, 66%) and consultancy (U.S., 48%; Canada, 53%). Most patients felt that it is not appropriate for their surgeon to receive gifts from industry (U.S., 63%; Canada, 59%). A majority felt that their surgeon would hold patients’ interests paramount, regardless of any financial relationship with a manufacturer (U.S., 76%; Canada, 74%). A majority of patients wanted their surgeon’s professional organization to ensure that financial relationships are appropriate (U.S., 83%; Canada, 83%); a minority endorsed government oversight of these relationships (U.S., 26%; Canada, 35%).


Most patients are not worried about possible financial relationships between their surgeon and industry. They clearly distinguish financial relationships that benefit current or future patients from those that benefit the surgeon or device manufacturer. They favor disclosure with professional oversight as a method of managing financial relationships between surgeons and manufacturers.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Scott Gordon, MD
    Posted on February 18, 2013
    Professionalism and ethics - pending changes in health care in the USA
    In private practice, Kissimmee, FL, USA

    I found this article fascinating in light of the current changes in healthcare that are about to occur in the USA. More interesting is that I've noticed that most of you, the authors of this article, are from Canada, a country that has had State run medicine for years, so I will appreciate your insight.

    Your article gets to the core of professionalism and ethics but I am amazed that you centered your study on such trivial matters regarding industry promoting and marketing their medical device and products to surgeons.

    The major concerns for me regarding my professionalism and ethical care of my patients is when doctors become hired employees of the State. Does the doctor's allegiance lie with the (individual) patient or with the (collective) State? Is it the State that dictates to the doctor how the limited resources of the State will be used, distributed and divided amongst its healthcare needy citizens? Is it the State that will determine the "approved" medical products that are to be used on their citizens? Would it be equivalent to say that lobbying efforts by these companies to those in government match their marketing efforts to surgeons? Are the political decisions that are made regarding healthcare products better than a surgeon's decisions for what they use when providing healthcare? It is the State that will determine what the best medical practices are? It is the State that will fund and perform these studies to determine the evidence based medicine practices? Is it the State that will hold doctors accountable for providing the State with their citizens private medical information (and more) such as: smoking, drinking, std's, gun ownership, etc...? Is it the State that will make sure doctors comply with reporting this data or face financial penalties or possibly worse?

    I can't even start to imagine what would be going through a citizen's mind seeing me in my office when I become an employee of the State, but I know what will be going through many doctors' minds... Their patients are no longer their patients, they are citizens of the State and have now become a doctor's workload. The doctors will act to provide these citizens exactly what the State has determined to be provided and what the State has determined what their citizens are entitled to; no more and no less. The doctors will be fighting among themselves to receive their "fair" share of the government resources.

    Are you planning to do another study asking citizens about these much more important conflicts of interest? How about exploring the post-operative views (if a patient is lucky enough to be chosen for surgery) on the financial relationships (including the fines if they don't obey) between the surgeons and the State?

    I bring this up because I would like to know if this concerns you as much as it concerns me.

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