Raising Questions About The Technologic Imperative At Podiatry Conferences

Allen Jacobs DPM FACFAS

A recent meta-analysis has suggested that the evidence for the utilization of orthobiologic materials in place of autogenous bone grafting is low level evidence at best.1 There is hardly a podiatric scientific meeting wherein at least one, if not more than one, lecture was devoted to the need for the incorporation of orthobiologics in surgery, even routine surgeries such as osteotomy or arthrodesis in the non-compromised patient.

I actually attended a meeting where five different speakers gave five different lectures, each touting a different product. I have heard some refer to the use of autogenous bone grafting as the "former standard" as opposed to the "gold standard." I have even heard one speaker suggest from the podium that the failure to utilize orthobiologics routinely may be negligent. Negligent? I am certain that the corporate support of these speakers has not influenced their opinions.

Locking plates are another issue. Locking plate technology is expensive. Although the company rep benefits from the use of this technology, is it required for the average patient with normal bone anatomy and physiology? Again, you are hard pressed to find a meeting wherein there is not a lecturer touting the need for locking plate technology in routine foot and ankle surgery. Oh, did I mention that the speaker had a corporate sponsor?

Advanced wound healing products are another quandary. While attending a recent meeting, a speaker intimated that the use of advanced wound care products in the treatment of an ulcer that had not reduced 50 percent at four weeks might just represent the “standard of care.” Standard of care?

It is interesting to me how many of the leaders in our profession use K-wires instead of screws, or standard screws and plates when necessary in deference to locking plate technology. These same leaders use plain old 4.0/4.5 screws for syndesmotic repair and generally heal wounds without hyperbaric oxygen or stem cells.

What concerns me is the ethics of the paradigm. Like any profession, we have a group of individuals getting rich at your expense. There is nothing wrong with that if they are providing you with truthful, accurate and useful information along the way. Alas, I am not certain that this is always the case.

Somehow, some way, our educational conferences need to start divesting themselves of the obvious influence of corporations on the meeting content. Charge them more to exhibit, let them make true unrestricted grants to meetings, and use the money to provide unbiased educational opportunities. The dependency on corporate sponsorship for speakers limits the academic content of our meetings to those topics likely to benefit the corporation paying the speaker and more importantly, deprives you of knowledge in many areas.

Not all meetings are so entangled in corporate obligation. The annual meetings of the North Central Academy of Ohio (No-Nonsense Seminar), the American College of Foot and Ankle Surgeons (ACFAS), the Midwest Podiatry Conference and the American Professional Wound Care Association (APWCA) are examples of meetings that provide education in “un-sponsorable” areas such as rheumatology, ethics, dermatology, surgical procedure selection and the like.

You, as a participant, society member and registrant, need to start demanding more complete and unbiased educational programs that allow you to expand your knowledge and capabilities.

Oh, one more thing. Corporations do not set the standard of care. You do.

Reference

1. Van der Stok J, Van Lieshout EMM, El-Massoudi Y, Van Kralingen, GH, Patka P. Bone substitutes in the Netherlands- a systematic literature review. Acta Biomater. 2011; 7(2):739-750.

Comments

Very well said!

As usual, Dr. Jacobs has come upon the essence of the issue. If we allow industry to define the"standard of care" for surgery instead of the profession, we will all be spending time defending our surgical judgments. Using more technology without a clear benefit for the patient is costly and unnecessary. I do not use the same technology I used 30 years ago, but the changes I have made have come along slowly and with clear benefits for the patient.

Sometimes less is more and traditional methods produce good clinical results and satisfied patients.

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