Editorial   |    
Patient Care, Professionalism, and Relationships with Industry
James D. Heckman, MD
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The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Feb 01;90(2):225-225. doi: 10.2106/JBJS.9002.edit
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Patient care is the primary focus of the orthopaedic profession. The enhancement of patient care has required and will continue to require orthopaedic surgeons to collaborate productively with industry to develop new medical technology and techniques that improve patient care. The relationship between orthopaedic surgeons and industry is of critical importance to the shared ultimate goal of improving patient care. Orthopaedic surgeons are well qualified to provide innovative ideas and feedback to industry, conduct research trials, serve on scientific advisory boards, and serve as faculty to teach the uses of new technology. The relationship between orthopaedic surgeons and industry is important and necessary, but it must be carefully scrutinized to avoid the pitfalls of real or perceived conflicts of interest that could ultimately affect patient care. Recent events regarding this issue have shone a spotlight on several orthopaedic companies and numerous orthopaedic surgeons.
In 2007, the Fellowship of the American Academy of Orthopaedic Surgeons (AAOS) adopted Standards of Professionalism (SOPs) on Orthopaedist-Industry Conflicts of Interest. Of those Fellows voting (5549), approximately 96% voted to adopt these SOPs. These SOPs establish mandatory, minimum levels of acceptable conduct for Fellows and Members of AAOS who engage in relationships with industry. They focus on practices that enable orthopaedic surgeons to serve the best interests of the patient and the profession while participating in academic or commercial ventures. There are seventeen standards relating to industry; it is in every surgeon's best interest to be familiar with all seventeen. The SOPs address such topics as consulting agreements, industry-sponsored events, inappropriate financial arrangements, continuing medical education courses, and gifts from industry. Each of these standards addresses a real or perceived conflict that has the potential to influence decisions about patient care in a way that is not in the best interests of the patient or that may ultimately increase risks for or even cause injury to the patient.
The AAOS SOPs emphasize the patient-physician relationship. The mandatory standards call for orthopaedic surgeons to tell patients about their relationships with industry that create real or perceived conflicts of interest and to resolve these conflicts in the best interest of the patient. Some orthopaedic surgeons may find that the SOPs validate their existing practices. Other orthopaedic surgeons may wish to revise how their practices address possible conflicts.
AAOS has begun to enforce these SOPs for acts occurring on or after Jan. 1, 2008. As with the other AAOS SOPs, allegations that a Fellow has violated any of the SOPs on Orthopaedist-Industry Conflicts of Interest may result in a formal grievance under the AAOS Professional Compliance Program. Orthopaedic surgeons found in violation of the SOPs may be censured, suspended, or expelled from AAOS.
I encourage each of you to become familiar with the SOPs on Orthopaedist-Industry Conflicts of Interest and to discuss them with your colleagues. Avoiding the pitfalls of real or perceived conflicts of interest with industry enhances your personal professionalism. Maintaining productive relationships with industry that advance patient care enhances the entire orthopaedic profession.

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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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