Conflict of Intere$t: Medical Leader$ are Conflicted!

Public Health & Policy

Following the Money: Gold in Ivory Towers

Published: Apr 1, 2014

By John Fauber, Reporter, Milwaukee Journal Sentinel/MedPage Today

Academics who moonlight for drug companies have faced intense scrutiny in recent years, but new research suggests much larger sums of money are being paid to their bosses -- the leaders of medical schools and hospitals who serve on drug company boards.

Looking at the world's 50 largest drug companies, researchers found that 40% had at least one board member who held a leadership position at a U.S. academic medical center -- including medical school deans, chief executive officers, department chairs, and university presidents.

The average annual compensation from the drug companies was $313,000, according to the paper published today in the Journal of the American Medical Association.

"These relationships present potentially far-reaching consequences beyond those created when individual physicians consult with industry or receive gifts," the researchers wrote.

Big Jobs, Big Bucks

Others who were not involved in the study said such lucrative moonlighting for drug companies with vested interests simply should not be done by university leaders who oversee independent research and the instruction of medical professionals.

"I don't know how they can manage a conflict like that," said Susan Chimonas, PhD, who frequently writes and lectures on conflicts of interest in medicine. "My gosh, there is so much money they are making for a little side job."

Serving in dual roles raises so many potential conflicts that it would be wiser to eliminate them, said Chimonas, associate director of research for Columbia University's Center on Medicine as a Profession.

Unlike faculty or staff, top leaders of academic medical institutions are involved in business decisions and corporate partnerships, said Paul Levy, the former president and CEO of Beth Israel Deaconess Medical Center in Boston, which is affiliated with Harvard University.

Those decisions and partnerships could include performing clinical trials for drug companies, allowing drug samples to be given out in hospitals and clinics, allowing doctors to engage in drug company promotional speaking, endorsing and offering drug company funded continuing medical education (CME), and deciding what drugs to allow on a hospital's formulary, said Levy, who headed Beth Israel Deaconess from 2002 to 2011.

"You cannot serve two masters, even if you are highly intelligent," said Levy, who now blogs about the health industry and serves as senior adviser at Lax Sebenius, of Concord, Mass. "In fact, if you are highly intelligent, you will rationalize the problems away by saying that you cannot be personally corrupted."

By the Numbers

The JAMA paper did not list individuals, though it did name medical schools, universities, and academic hospitals whose officials served on drug company boards of directors. It also named drug companies, including Pfizer, Merck, GlaxoSmithKline and Johnson & Johnson.

For the study, the researchers only looked at the year 2012.

The Journal Sentinel and MedPage Today used proxy statements filed by the companies to identify some of the board members and find out how much they were paid.

From the Yale School of Medicine in New Haven, Conn., to the David Geffen School of Medicine at UCLA in Los Angeles, the institutions include some of the most prominent academic medical centers in America.

For instance, Robert Alpern, MD, dean of the Yale School of Medicine received $259,000 in total compensation serving on the Abbott Laboratories board of directors in 2013, according to the company's proxy statement.

As of Jan. 1, 2014, he also held 11,656 shares of restricted Abbott stock.

In its proxy, Abbott said Alpern's relationship did not impair his independence.

In an email, Karen Peart, a spokeswoman for Yale, said Alpern would have no role in any of the above decisions such as clinical trials, drug samples or drug formularies.

"If ever he had the opportunity to be involved in a decision affecting Abbott, he would recuse himself," she said.

She said the university encourages its faculty to consult widely and to engage in activities that may benefit the university and the public.

A. Eugene Washington, MD, dean of the UCLA School of Medicine, joined the Johnson & Johnson board of directors in November 2012. In 2013, he was paid $261,000 in total compensation by the company, according to its proxy statement. As of Feb. 25, 2014, he was listed as the beneficial owner of 5,129 shares.

In an email, a spokesman for Washington said UCLA does not allow drug companies to provide samples and prohibits faculty from promoting drugs.

"Dr. Washington manages any potential conflict of interest in accordance with university policies and makes no decisions regarding the purchase of pharmaceutical products or clinical trials," Dale Triber Tate, a UCLA spokesman said.

Mary Sue Coleman, president of the University of Michigan, also serves on the Johnson & Johnson board and was paid $276,000 in total compensation in 2013, according its proxy statement. As of Feb. 25, 2014, she was listed as the beneficial owner of 34,465 shares. That stock was worth nearly $3.4 million at Tuesday's price of about $98 per share.

In an email, Kelly Cunningham, a spokeswoman for the university, said the university already has banned drug company funded doctor education and drug samples from all companies.

She said Coleman is not involved in decisions involving Johnson & Johnson purchases or investments.

"The University of Michigan does not see President Coleman's service on the Johnson & Johnson board as a conflict of interest," Cunningham said.

In its proxy statement, Johnson & Johnson said it sells healthcare products and services to both UCLA and the University of Michigan. It also listed research grants and consulting fees with Michigan. It said neither of its board members from those institutions had any "direct business relationships" with the company.

The company also said its board determined that neither of the relationships conflicted with the interests of the company or impaired "the relevant nonemployee director's independence or judgment."

"It is a potential conflict of interest that is not often discussed," said senior author Walid Gellad, MD, with the VA Pittsburgh Healthcare System and an assistant professor of medicine at the University of Pittsburgh. "If a pen or a $150 dinner presents a conflict for a doctor, what does it mean if you get $300,000?"

Gellad noted that the research only involved drug companies. It did not include medical device companies and health insurance firms.

"I would say this is just the tip of the iceberg," he said.

Profitable Innovations: But Is Your Implanted Medical Device Safe?

http://well.blogs.nytimes.com/2014/03/31/the-device-makers-shortcut/?_php=true&_type=blogs&ref=todayspaper&_r=0

THE CONSUMER

The Device Makers’ Shortcut

By RONI CARYN RABIN MARCH 31, 2014, 4:31 PM 16 Comments

A few years ago, the Food and Drug Administration announced a stunning recall, saying that electrical wires in some St. Jude Medical heart defibrillators, which were implanted in tens of thousands of people, were defective. It was a rerun for cardiac patients: In 2007, Medtronic recalled its Sprint Fidelis cardiac devices because of faulty wires.

In both cases, the F.D.A. warned that the wires could cause painful shocks or fail when needed, and patients were left to choose between living with the leads under close monitoring or having dangerous surgery to replace them. Both companies reported deaths linked to the flawed leads.

Now a new paper by Harvard researchers, using records only recently made available by the F.D.A., explains how the faulty leads got onto the market, shedding light on a little-known process used by manufacturers to alter medical devices without putting them through human trials. (An approval pathway for lower-risk medical devices, called the 510(k) clearance, has received more public scrutiny, including harsh criticism from the Institute of Medicine.)

For so-called high-risk devices like heart defibrillators, the F.D.A. typically requires proof of safety and effectiveness in clinical trials with real patients under real-life conditions. But once such a device receives initial approval, the researchers found, an administrative maneuver permits companies to tinker with it — making the electrical wire thinner, for example — without testing the changes in a single patient.

The process, called a premarket approval supplement application, allows manufacturers to get upgrades and improvements to patients faster, medical device companies say. The application is “intended for a change to an already approved P.M.A. that has met the agency’s rigorous requirements for safety and effectiveness,” said Janet Trunzo, senior executive vice president for technology and regulatory affairs with AdvaMed, a trade association. She noted that the F.D.A. could require a more rigorous review process if necessary.

The problem is that a device can be modified over and over, even dozens of times, without ever being put through new trials in patients. From 1979 and 2012, the researchers found, the F.D.A. approved 77 new cardiac-implanted electronic devices like pacemakers and defibrillators. During that same period, the agency approved nearly 6,000 supplement applications.

A spokesman for Medtronic said the company did test the Sprint Fidelis’s new leads in patients, but the trials were begun in November 2003, around the time the company also filed its supplement applications, and the resulting data were not shared with the F.D.A. before the thinner leads went on the market. The study was published only in 2007, shortly before the recall.

For each device that went through the full premarket approval process, 50 subsequent changes were made, researchers also found.

“Over time, the accumulation of changes may lead to a device that is substantially different than the original product,” said Dr. Aaron S. Kesselheim, senior author of the paper, published in JAMA, the journal of the American Medical Association.

“Most of top-selling devices that are out on the market now have all been approved via supplements for the last 10 years,” he said. They are “substantially different” from the versions originally approved, he said.

While some of the supplement changes were minor, like rewriting instructions or changing the color, 37 percent involved a change to the device’s design, Dr. Kesselheim and his colleagues said. Companies are not required to mention the changes on the package labels, and generally do not.

As a result, doctors are often unaware which version of the device they are implanting, said Dr. Rita Redberg, a cardiologist and professor at University of California, San Francisco, who has written on the topic. “These supplements are not just flying under patients’ radar screens, they’re flying under doctors’ radar screens,” Dr. Redberg said.

The recalled wire in St. Jude’s defibrillator was approved as a supplement to a device whose original design had been approved in 1996 but had undergone 78 supplementary revisions, according to the research. The recalled Sprint Fidelis lead was approved as a supplement to a device originally approved in 1993 and modified 91 times.

“These leads may have worked in the lab, but that is very different from what happens inside a human blood vessel,” Dr. Redberg said. “People move around, they’re very complex, and the lead is going to be exposed to a lot more stress and forces of resistance.”

Clinical trials don’t always find rare complications. But the failure rate in St. Jude’s device was high enough that it would have been noticed in a trial, she said.

The pace of supplements has increased significantly during the past decade, to 704 a year from 77, the researchers found. The last time an implantable cardioverter defibrillator went through a full rigorous premarket approval process was in 2000, the researchers said, “indicating that all models released since then have been supplements” to existing models.

But since a Supreme Court decision in 2008 determined that manufacturers were immune from liability for personal injuries as long as their devices had been approved by the F.D.A., injured patients who want to sue face an uphill battle. Dr. Kesselheim and his colleagues put forth several proposals in their article, suggesting the F.D.A. convene a panel of experts to review approved medical devices every five to seven years and determine whether the clinical data from the older models still applied to the newer versions.

But the agency appears to have rejected the idea. An automatic advisory panel review is not “a necessary or efficient use of F.D.A. or taxpayer resources,” said Susan Laine, a spokeswoman.

 FiDA comment

The JAMA article concludes by highlighting the importance of rigorous post-market data gathering to bolster the FDA assurance of ‘safe and effective’.  This could be done by PCORI (Patient Centered Outcome Research Institute) which is a new government non-profit agency commissioned and funded by Congress.  However, though the omission of implanted medical device patient outcomes research has been demanded by harmed patient and patient advocates, PCORI has resolutely avoided this responsibility.  http://www.americanprogress.org/events/2014/01/16/82429/high-priced-drugs-and-medical-devices/

http://www.investigatorawards.org/investigators/aaron-kesselheim

Aaron Seth Kesselheim M.D., J.D., M.P.H.

Assistant Professor

Department of Medicine

Harvard Medical School

Email: akesselheim@partners.org

Discipline: Medicine, Drug Development, Law

Investigator Award

Sources of Transformative Innovation in Medication Development

Award Year: 2009

How can the engine of pharmaceutical innovation in the United States, sluggish now despite substantial investment, be jump-started again? Whether the right pathway involves increased government support of basic research or a transformation of industry product development and clinical trial work, patent law will play a key role. Aaron S. Kesselheim, M.D., J.D., M.P.H., explores a number of questions related to this issue, including how basic, translational, and product-development research combine to create breakthrough drugs and how patent-based incentives facilitate or impede drug development. His project, Sources of Transformative Innovation in Medication Development, will identify the most transformative drugs that have emerged in the past 25 years, examine their scientific origins, and assess the intellectual, social, and financial factors that influenced their development. Dr. Kesselheim also will analyze whether patents have rewarded the most important contributors to new pharmaceutical breakthrough products and test an alternative to the current patent system. His project addresses whether new legal or resource-allocation strategies are needed to reinvigorate pharmaceutical innovation and how possible reforms might encourage drug development, apportion rewards more appropriately, and help contain research costs.

Background

Aaron S. Kesselheim is an assistant professor of medicine at Harvard Medical School, based in the division of pharmacoepidemiology and pharmacoeconomics, department of medicine, Brigham and Women?s Hospital (BWH). He graduated from Harvard College and received his postgraduate training at the University of Pennsylvania School of Medicine and Law School, and most recently at the Harvard School of Public Health. He is board-certified in internal medicine, serves as a primary care physician, and attends on the general medicine inpatient service at BWH. He is a member of the New York State Bar and is a patent attorney. His research focuses on the effects of intellectual property laws and regulatory policies on pharmaceutical development, the drug approval process, and the costs, availability, and use of prescription drugs both domestically and in resource-poor settings. He received a career development award from the Agency for Healthcare Research and Quality to study comparative evidence, regulation, and trends related to prescribing off-label drugs. He has contributed commissioned works on market-based incentives for pharmaceutical R&D to the Institute of Medicine and the Robert Wood Johnson Public Health Law Research Program. He has also investigated other issues at the intersection of law and public health, including health care fraud, expert testimony in malpractice cases, and insurance reimbursement practices. His numerous articles and book chapters related to these topics have appeared in leading medical and health policy journals, including the New England Journal of Medicine, JAMA, and Health Affairs. In 2010, he received the Alice S. Hersh New Investigator Award from AcademyHealth, the main professional organization for health services/policy research. The Hersh award is given annually to an outstanding health services researcher under age 40 in the U.S. In addition to his research, Dr. Kesselheim has taught on law and public health issues at Harvard Medical School, Law School, and the School of Public Health. He has testified before the U.S. House of Representatives and addressed different state legislatures on drug policy matters, and he has consulted for the federal government?s clinical trials registration website (ClinicalTrials.gov). He has also served as an ad hoc peer reviewer for numerous medical and scientific journals (earning a commendation for his work from Annals of Internal Medicine in 2009), the Harvard Law Review, and the London School of Economics.

1.       BOOK CHAPTERS

2.       SELECTED JOURNAL ARTICLES

                  Kesselheim, A.S. Innovation and the Orphan Drug Act, 1983-2009: Regulatory and Clinical Characteristics of Approved Orphan Drugs, In Rare Diseases and Orphan Products: Accelerating Research and Development, eds. Field, M.J., Boat, T.F. Washington, DC: N

http://www.sciencedaily.com/releases/2014/01/140121164748.htm

Featured Research

from universities, journals, and other organizations

Many cardiac devices approved by process that often does not require new clinical data

Date:

January 21, 2014

Source:

The JAMA Network Journals

Summary:

Many cardiac implantable electronic device models currently in use were approved via a Food and Drug Administration review process in which the models were assumed safe and effective based on approval of prior versions of the device, according to a study.

Many cardiac implantable electronic device models currently in use were approved via a Food and Drug Administration review process in which the models were assumed safe and effective based on approval of prior versions of the device, according to a study in the January 22/29 issue of JAMA.

"In the United States, the Food and Drug Administration (FDA) reviews high-risk medical devices -- those that support human life, prevent illness, or present an unreasonable risk -- via the premarket approval (PMA) pathway, through which manufacturers collect preclinical and clinical data as necessary to provide 'reasonable assurance' of the device's safety and effectiveness," according to background information in the article. That process has attracted attention in recent years after recall of device components, like leads from Medtronic Sprint Fidelis and St. Jude Medical Riata implantable cardioverter-defibrillators (ICDs), that were not tested clinically in human trials prior to approval because they were design changes to prior-marketed devices and considered 'supplements' to PMA applications submitted almost a decade earlier.

The process of approval by premarket approval supplement "allow[s] patients to benefit from incremental innovation in device technology by providing efficient and inexpensive FDA review pathways for smaller device changes. Supplements may include major or minor design changes as well as routine changes in labeling, materials, or packaging. By statute, the FDA must seek only the 'least burdensome' supporting data necessary for review."

Benjamin N. Rome, B.A., of Harvard Medical School and Brigham and Women's Hospital, Boston, and colleagues used the FDA's PMA database to review CIEDs (including pacemakers, ICDs, and cardiac resynchronization therapy [CRT] devices) approved as PMA supplements from 1979 through 2012. They identified the number of supplements to each original PMA and characterized the nature of the changes in each supplement.

Seventy-seven approved PMA applications for CIEDs (46 pacemaker devices, 19 ICDs, and 12 CRT devices) were the basis for 5,829 PMA supplement applications, with a median (midpoint) of 50 supplements per original PMA. In the last decade, the number of approved supplements annually increased to 704. Excluding manufacturing changes that do not alter device design, the number of supplements approved each year averaged 2.6 per PMA per year.

Thirty-seven percent of supplements represented at least minor alterations to the device's design or materials. Among 180-day supplements (a type of FDA review process) approved between 2010 and 2012, 23 percent included new clinical data to support safety and effectiveness.

"… Our results should not be interpreted to indicate that the FDA is failing to review PMA supplement applications to determine safety and effectiveness," the authors conclude. However, clinicians and patients should … be aware … that clinical data are rarely collected as part of PMA supplement applications prior to marketing. The recalled Medtronic Sprint Fidelis and St. Jude Riata ICD leads were both PMA supplements -- Fidelis a 180-day supplement and Riata a real-time supplement [a type of FDA review process]. Neither lead was studied in human trials prior to FDA approval. The FDA's approval of many supplements without new human trials, as in the case of these recent ICD changes, highlights the importance of collecting rigorous postapproval performance data," the authors write.

Story Source:

The above story is based on materials provided by The JAMA Network Journals. Note: Materials may be edited for content and length.

Journal Reference:

Benjamin N. Rome, Daniel B. Kramer, Aaron S. Kesselheim. FDA Approval of Cardiac Implantable Electronic Devices via Original and Supplement Premarket Approval Pathways, 1979-2012. JAMA, 2014; 311 (4): 385 DOI: 10.1001/jama.2013.284986

Cite This Page:

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Chicago

The JAMA Network Journals. "Many cardiac devices approved by process that often does not require new clinical data." ScienceDaily. ScienceDaily, 21 January 2014. <www.sciencedaily.com/releases/2014/01/140121164748.htm>.

Consumers Union communicates to AAOS: 50,000 patients want hip/knee warranty

 Activists Take Fight to Obtain Hip,Knee Product Warranties to AAOS. Will They Succeed?

Posted in Orthopedics by Arundhati Parmar on March 12, 2014

FiDA highlight

At AAOS, Consumers Union, through its Safe Patient Project, is asking surgeons to support their demand to obtain hip, knee warranties from device makers when implants fail early. 

A consumer advocacy group has seized upon the fairly mundane concept of product warranties to turn the heat on medical device makers.

Consumers Union, the lobbying and advocacy arm of Consumer Reports, sent letters to six top hip and knee makers last September asking them to provide product warranties for early implant failures. The letter quoted the American Academy of Orthopaedic Surgeons in saying that 10% of implants fail.

The group has now made a big push in publicizing its message by organizing a campaign outside the annual meeting of the American Academy of Orthopaedic Surgeons, which kicked off Tuesday and ends on Saturday, March 15.

Activists were handing out flyers outside the Morial Convention Center in New Orleans that urged orthopedic surgeons to text their support for manufacturer warranties. Here's what the flyer looked like:

In an interview at AAOS Wednesday, Lisa McGiffert, director of Consumers Union’s Safe Patient Project, said that only Smith & Nephew formally responded to the letter sent to orthopedic manufacturers in September. Two others acknowledged receving the letter via email but never actually responded to the request. The others did not respond. McGiffert couldn't recall which two companies sent the acknowledgment.

What the group is asking for is not unprecedented in the medical device world, she said.

"Biomet provides a warranty for a partial knee and cardiac products have warranties," she said.

After receiving Consumers Union's letter, Smith & Nephew responded that it is a "complicated issue" because hips and knees can fail for a number of reasons, McGiffert said. It could be the caused by the patient, the surgical technique or the device, McGiffert recalled the company as saying in its response.

But McGiffert clarified that the group is focused on "when the products are the problem." In other words, Consumers Union is not looking for a blanket product warranty, but wants device makers to take responsibility and stand behind the products when device-related problems cause the joint replacement to fail.

"You get warranties for flashlights, toasters and cars, for almost everything in the U.S.," she declared. "I know they are less complicated, but this is something that is going inside people's bodies. We think they ought to stand behind their products for a certain number of years. They can decide how long."

The purpose to bring the campaign to AAOS is to win support from surgeons and get feedback from them, McGiffert said.

However, Consumers Union may not win too much sympathy from the top brass at AAOS.

In a phone interview Wednesday, outgoing AAOS president Dr. Joshua Jacobs said that the "vast majority of orthopedic implants for joint replacement perform exceedingly well - 90% of total joint replacements work 10, 15 years and beyond."

Jacobs did acknowledge that "sometimes implants fail early, " but argued that "while warranties seem like a good idea on the face of it, the issue is more complex." 

Echoing McGiffert's portrayal of Smith & Nephew's response, Jacobs said that early failures could be caused by patients, due to the manner the surgeon did the procedure or it could be because of device problems. But sometimes "a complex interaction of the three" can also lead to early implant failure. So it may not be as easy to tease out which of the three factors caused the implant to fail.

And then there is the potential for infection, which is out of everyone's control, that can contribute to a failure.

"That cannot be addressed with a warranty," Jacobs declared. 

Overactive or obese patients can also lead to implant failure, Jacobs noted. 

However, another well-known orthopedic surgeon and healthcare social media maven, Howard Luks, disagreed with that assesment. 

"I don't think it's fair to blame the patient," he contended. "Once the joint replacement is done, it's stable, it's done. They should  be ready to go. If the patient is obese, then why did you put it in? Device makers understand who these implants are going into and the implants should meet those needs. Or there should be a big red sticker on that says 'Do not put in a patient with a BMI over 30.' So I think the patients have a right to ask for a guaranty or a warranty on a product that is going in their body."

Luks said that unless surgeons push the issue, device makers wouldn't move to provide such warranties.

And it certainly appeared that way. In an interview with DePuy Synthes Joint Reconstruction at AAOS, executives punted the question of warranties to the company's spokeswoman Mindy Tinsley, who responded like this:

"We understand the position that Consumers Union has taken. We are interested in continuing to have a dialogue about this. But I think with joint replacements, it's a complex interaction of factors and revisions have sometimes to do with the implant, sometimes with the patients, sometimes with the technique. We acknowledged the letter but we haven't taken a position. This is an issue we are continuing to explore."

Stryker declined comment via email. A Zimmer spokesman at AAOS said that "it's a complex issue and has a lot of factors surrounding it." The spokesman, James Gill, also forwarded a statement from AdvaMed, the device industry association, which argued that warranties for hip and knee implants that involve complex procedures and involving many different players, involving the patient and the hospital, may not be appropriate. However, it left the decision to provide warranties to individual manufacturers.

Meanwhile, McGiffert said that Consumers Union has secured the support of 50,000 patients who have sent emails to the top orthopedics device makers asking for product warranties-- By Arundhati Parmar, Senior Editor, MD+DI
arundhati.parmar@ubm.com

Great Reporting

Submitted by falascoj on March 14, 2014 - 9:32am.

Great graphics and story. I believe you have only hit the surface on this story. Hopefully we will see followup stories on you asking the medical device companies to come clean on why they are fighting the idea of warranty. They are the only major industry or activity that operates that way. The arguments that Mr.Gill has mentioned and the ortho surgeon are lame and I can just see an automotive guy saying --- well be can't do bumper to bumper because an F-150 is different then a Mustang. -Not
I've forwarded this article to numerous groups as an example of a publication actually getting out in front of the biggest deception on the American public since the Warren Commission.

AAOS conference on joint repair: closed meeting to Consumers

AAOS Opens in NOLA With Joint Repair Topping Agenda

Published: Mar 10, 2014  FiDA highlight

By Sarah Wickline , Staff Writer, MedPage Today

NEW ORLEANS -- An appearance by Louisiana governor Bobby Jindal (R) is among the highlights of this year's annual meeting of the American Academy of Orthopaedic Surgeons, which begins here Tuesday and runs through Saturday.

Jindal will address the meeting on Wednesday. He is a former assistant secretary of the Department of Health and Human Services, as well as former secretary of the Louisiana Department of Health and Hospitals.

AAOS President Joshua J. Jacobs, MD, is also excited about the 825 papers, 569 posters, 217 instructional courses, and more than 88 scientific exhibits being presented at this year's meeting.

Live streaming of 13 symposia via webcasts will be available on demand through March 23.

Featured symposia to catch either in person or via webcast include "Lessons on the Outcomes of ACL Reconstruction Surgery from International Registries," "Tips, Tricks, and Technical Pearls," "Hot Topics and Controversies in Shoulder Surgery," "The Multiple Ligament Injured and Dislocated Knee," and "Complex Skeletal Reconstruction in Infection, Post Trauma, and Tumor."

A last-minute addition to the schedule, the "Health Care Reform: How Can We Adapt?" symposium, will start at 8:00 a.m. on Friday. At the same time, "Can We Improve Surgical Outcomes for Orthopaedic Patients? A Compelling Need for Change," will be moderated by James H. Herndon, MD, of Massachusetts General Hospital in Boston.

There will also be "Ask an Expert" sessions for attendees to pick the brains of leaders in hip and knee, spine, hand and elbow, trauma, shoulder, tumor, foot and ankle, hand, pediatric, and sports medicine orthopedic surgery.

A special electronic skills pavilion will provide attendees with a chance to learn about the latest technology and applications to help further their practice. Several presentations will focus on social media, managing reputations on the Internet, marketing, and privacy in the realm of medical health apps.

The AAOS tradition of hosting a Guest Nation will continue this year, with France as this year's guest.

_______________________________________________________________

Consumers Union media at New Orleans airport baggage claim

Consumers Union Safe Patient Project will be outside the convention to elicit opinions/support of orthopedic surgeons about/for warranty on implanted joint products.  Please text your thoughts to 30644 

________________________________________________________________

The text reads:  The safest, most successful surgeries happen when physicians and patients team up as active partners.  Which means plenty of candid questions and honest answers from each.  Bone up on patient safety at orthoinfo.org/patientsafety.  A public service message from American Academy of Orthopedic Surgeon, who remind patients and doctors that communication is the best medicine.

Knee Replacement Marketed to last 30 years: where is the warranty?

Smith and Nephew Verilast Knee Replacement commercial.