Several years ago, I sent a letter to the editor of a non-peer-reviewed orthopaedic journal in which I commented on the difficulties encountered by surgeons when they perform revision hip surgery without having the means to identify before surgery the manufacturer of the implant about to be revised. The editor informed me that the letter would soon be published. When the letter did not appear in the next month's issue, I inquired of the editor about his "change of mind." He responded that the publisher of the journal had expressed concern that my comments could be offensive to the implant manufacturing industry because industry was the main financial supporter of the publication.
Later, while I was looking for a publisher for a book I had written, a major firm accepted the project. Within a short time, the book was printed in hard and softcover editions, both in English as well as in Spanish. I was then informed that a financially powerful pharmaceutical firm had ordered 4200 copies of the Spanish translation to distribute, at no charge, to orthopaedists in Spain and Latin America.
However, I began to notice what appeared to be a lack of enthusiasm for marketing. Eventually, I was informed by the person with whom I had dealt from the outset that the sales and marketing of the book had been brought to a halt. According to him, the giant pharmaceutical firm had found unacceptable my criticism of actions committed by industry in its dealings with the orthopaedic community.
I could have followed the legal route against the publishing firm. However, I elected not to follow that avenue, which I am confident would have been settled in a manner favorable to me, simply because the litigation would have been a long and expensive process I could not afford. Although I have overwhelming evidence to support the veracity of the arguments I have disclosed in this commentary, I have, for the same reason, refrained from identifying the journal, the publishers, and the involved industrial concerns.
The two experiences I have described are vivid examples of the sad state of affairs when it comes to the overwhelming power of industry and the resulting dependency and subjugation of our profession to its wishes and goals1-11. Industry has successfully gained major control of the education of the orthopaedist through the subsidy of many of the specialty's educational activities and, not infrequently, through kickbacks and other unethical means, which the Justice Department has recognized and is forcefully investigating3-12. Now, industry has reached the point at which it has no qualms about using its economic power to silence members of the orthopaedic profession and to prevent the free expression of opinions.
There are no longer logical excuses to justify the silence before the advancing onslaught on our profession. The prevailing pusillanimous attitude must be ended and supplanted with determination and fortitude. In the absence of such a positive agenda, the disgust we now experience must make room for loudly voiced outrage. It can be anticipated that if our profession does not courageously assume the responsibility of addressing the problem, sooner or later the government will, in a draconian manner, bring about a solution to the festering crisis. If it takes the nationalization of the surgical implant industry, let it be1,2,4,5,12. To allow powerful industrial concerns to prevent the written or oral dissemination of ideas that run contrary to their economic interests cannot and should not be tolerated.