To The Editor:
I was disappointed with "Editorial. Conversations with a Cab
Driver" (80-A: 1407-1409, Oct. 1998), by Dr. Rangaswamy. When sports
medicine was first starting out, it was a favorite ploy of academic
and pseudoacademic orthopaedic surgeons to make fun of sports medicine
and those who specialize in it. They could not see the depth of
our goals. I think it is unseemly for The Journal of Bone and Joint
Surgery to do that now. Dr. Rangaswamy does this by quoting a cab
driver and a lay author, and by adding a few barbs of her own.
Dr. Rangaswamy condemns us for studying the knee so frequently.
It is the joint most often injured with long-lasting sequelae. To
me, it seems reasonable to address the biggest problem. Not incidentally,
some of the papers on the knee presented at the 1998 Annual Meeting
of the American Orthopaedic Society for Sports Medicine included
"IGF-I Induces Chondrogenesis in Periosteum Explants," "The Effect
of the Female Menstrual Cycle on Lower Extremity Neuromuscular Performance
and Anterior Knee Laxity," and "The Effects of Hyperbaric Oxygen
on Healing MCL in a Rabbit." These are basic orthopaedic issues,
and although the research could have been done on any joint it was
performed on the knee. Would that be characterized as a "morbid
interest"?
Neither Dr. Rangaswamy nor the author she quoted paid any attention
to the fact that sports medicine has been at the forefront of the
effort to prevent injuries. We do not devise knee operations and
rehabilitation procedures in the hope that people will go out and
injure their knees; we devise these treatments to cure the ailment.
We are responding to our patients' needs.
Sports medicine has expended much effort in research and education
related to the knee and in focusing on the prevention of injury.
One of the benefits of this effort has been an improvement in industrial
medicine, as the concepts of prevention, treatment, and effective
rehabilitation have helped to produce a quicker return to work.
Dr. Rangaswamy states that "it seems as though everyone concerned
. . . prefers to avoid reflecting on possible long-term adverse
effects." I would refer her to an editorial entitled "What Price
Glory?" in The American Journal of Sports Medicine1.
The Journal of Bone and Joint Surgery has been and continues
to be the outstanding publication in the field of musculoskeletal
disorders. In the next-to-last paragraph of the editorial, Dr. Rangaswamy
tells us that The Journal insists on accurate scientific methodology
and by inference seems to imply that the rest of us do not. I think that
most journals try very hard to maintain standards of excellence,
and some succeed better than others. To start out by criticizing
the American Orthopaedic Society for Sports Medicine for having
too many scientific papers on the knee and to include that criticism
in the same article with a discussion of unscientific studies of Ginkgo
biloba is, I think, unfair and not worthy of the high standards
of your journal.
Robert E. Leach, M.D.
The American Journal of Sports Medicine
230 Calvary Street, Waltham, Massachusetts 02453
Dr. Rangaswamy replies:
The purpose of the Editorial was not to denigrate sports medicine
as a field of practice or research but to address "hasty publications
in prominent medical journals" that lead to modes of practice. Some
examples included articles on herbal medicines, hormone treatment,
and the relationship between the consumption of coffee and carcinoma.
The focus was on insatiable and partially informed consumer groups;
it was not a diatribe against the providers.
It is well established and documented that medical practice varies
widely in different areas of the country and is contingent on numerous
factors besides pure, objective scientific criteria. Thus, it would
be expected that orthopaedic surgery or sports medicine in particular
would be no more or less affected than general or gynecological
surgery.
The reference to the editorial standards of The Journal did not
mention, or preclude, similar efforts by other journals.
Leela Rangaswamy, M.D.
Special Projects Editor
The Journal of Bone and Joint Surgery
Needham, Massachusetts