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Five Propositions

Some seven years ago, during a moment of angst, I agreed to provide the "entertainment" at an annual gathering of engineers involved in Orthopaedic research. I proposed that the format be a debate, between myself and a leading surgeon, of the resolution: "Orthopaedic research can be hazardous to your health." I, as one might easily guess, took the pro position; the surgeon, who shall remain nameless, took the con. Despite his "throwing the fight" by refusing to answer the bell for the second round, the evening was a modest success. Recently, asked to address a winter short course for surgeons in Colorado, I dug out the slides from the debate and decided to use some of them again. This piece deals with the central points which I made on both of these occasions, in the form of five pairs of theses and propositions, with accompanying notes and remarks. Time has passed but the situation, if anything has gotten worse!


Thesis #1: Research leaves no answer unquestioned.


Proposition #1: The "moving target" of knowledge confuses both the surgeon and the patient.


Thesis #2: Orthopaedic researchers are like Seabees: "The difficult we do right away, the impossible takes a little longer."


Proposition #2: The self-confidence of bioengineers raises unrealistic expectations in both surgeons and patients.


Thesis #3: Orthopaedic researchers practice the art of the possible.


Proposition #3: Much (Orthopaedic) research consists of answers looking for questions rather than vice versa.


Thesis #4: Novelty for its' own sake is vanity.


Proposition #4: Much (Orthopaedic) engineering research and development produces changes related more to market requirements than to scientific advances.


Thesis #5: Distinction without difference is discrimination.


Proposition #5: Orthopaedic (engineering) research discriminates against patients by encouraging innovation without functional change. The new (improved?) tends to drive out the tried and true.


The consequences of Orthopaedic research:


For researchers: A good life!

For surgeons: A good life?

For patients: A good life???


How did we get here:


By good intentions...:


"The road to hell is paved with good intentions." Karl Marx (1867)


"Sir, Hell is paved with good intentions." Samuel Johnson (1775)


"Hell is empty, the devils are all here." William Shakespeare (1612)


"We has met the Enemy and it is us!" Pogo Possum (Walt Kelly)(1971)


Epilogue: The shared problem has been that of living the so-called Philadelphia Joke: A man remembers losing his wallet on Walnut Street but is discovered by a policeman looking for it on Chestnut Street, because, "The light is better here!" Orthopaedic researchers, myself included, have spent too much time thinking about technical details and wondering "What if?," when we should have been giving more time and attention to actual patient problems and to consideration of what patients with musculoskeletal disabilities and disorders want (and need) to satisfy them and to enrich their individual lives. The current increasing emphasis on outcomes research (rather than mere technical evaluation of the results of procedures) is a call to return to a more traditional patient-oriented view of the discipline of Orthopaedic Surgery and its sub-specialty, Orthopaedic (engineering) Research.