Orthopedic progress — Researchers, industry have common goals

The private sector has assumed an increasing role in funding academic research.

Issue: November 2003

ByDouglas W. Jackson, MD

Douglas W. Jackson, MD [photo] --- Douglas W. Jackson, Chief Medical Editor

My interaction with and perceptions of the orthopedic industry have changed and have continued to evolve over the years. It is somewhat of an exaggeration to say the industry was once regarded as the “evil empire,” but as a young resident I was told that the potential for conflicts of interest were great. It was implied by some of my mentors that forging relationships or accepting funding from industry could potentially taint one’s reputation.

I must say that some of those initial impressions on my part were naive. Much has occurred over the years to change my thinking concerning interactions between our profession and the industry that provides us with our devices, tools and supplies. We both have common goals and needs for ongoing and basic research, education and public advocacy.

In the years since my residency, I have become more aware of the correlation between the scientific clinical arena and the research in the preclinical arena that supports and makes it possible. This has been particularly dramatic in some of the new and emerging technologies. During my orthopedic career, I feel fortunate to have witnessed many rapid technological advances in our specialty in such areas as joint replacement, trauma surgery, spine surgery, arthroscopy and orthopedic sports medicine.

Rapid advancements

Today a greater percentage of the total funding in our specialty comes from industry, private foundations and other nonfederal sources.

Many advances developed rapidly in our specialty since the 1960s. Reputations were made, reimbursements associated with the new technologies were good, and funding was readily available for developing newer technologies for clinical use. During this period, some observers had heightened suspicions and questioned some of the incentives of those who played an integral part in technological advancements in our specialty.

Not all of those making contributions during these years were receiving funding from industry. The academic centers in the 1960s prided themselves on their preponderance of federal funding supporting their research. Many felt this removed them from being perceived as having conflicts of interest. During the 70s and 80s, we started to see an increasing number of clinicians working in private office and clinic settings increasingly contributing to the developing new technologies. In some instances, because of the cost of bringing rapidly changing technology into the operating room settings, it was more difficult for the academic centers to be as responsive.

The research funding sources for both private and academic centers during this time was changing to meet the demands to support this research and technological development. As a result, today a greater percentage of the total funding in our specialty comes from industry, private foundations and other nonfederal sources.

Dr. Bennett I.Bertenthal recently summarized these changes (The Pfizer Journal 2003;8): “In the 1960’s, federal funding for academic centers peaked, when 80% of the funding came from the government. Since then, the private sector has assumed an increasing role in funding academic research and now accounts for as much as 50% in some disciplines.” He went on to point out the benefits of different types of research and support when he said, “Basic research without any direct application in the 1960’s led to discoveries like nuclear magnetic resonance. It took 20 years to realize a return on investment.”

Certainly, research can be a large hole that money is poured into unless the research is peer-reviewed, monitored and there is a reasonable expectation of progress. Research is a high-risk financial activity for those who invest in it.

Dr. William L. Ditto made this point in the same article: “Without some funders who are risk tolerant, the research becomes 100% incremental. It is funded in most part by risk-tolerant investors.”

Invest in research

In orthopedics we need to continue to invest in our clinician scientists and the PhDs working in related research. Our profession and industry both benefit by maintaining and developing funding sources for new innovators in musculoskeletal research. Some of my colleagues in other specialties have said, partially in jest, that orthopedics is riding on yesterday’s technological advances and that our pipelines are not what they once were.

Many of us in orthopedics would argue with this point of view, but we must keep up our vigilance and support. As you attend the upcoming annual meetings of the ORS and AAOS in March 2004, take your own survey. As you look and listen during the meeting, take notice of what is new and innovative that is emerging and what are the incremental improvements. Notice where the funding is coming from to support these advances. The interrelationship of the funding to achieve these goals, particularly in our specialty and associated industry, has gradually changed. We are in this together. Working together with industry in ethical, open and new ways is our future. Our patients and profession will benefit.