Ethical guidelines for orthopaedists and industry.

During the past decade, there has been a gradual erosion of the ethical principles that guide relationships between physicians and industry. Two areas in which the decline has been most notable are gifts to physicians and the relationships of industry to educational and research activities. The gifts have become more valuable and industry representatives make gifts available under circumstances where frequently there is no educational program. Research support continues at a high level but researchers increasingly find themselves in positions that present conflicts of interest with the interests of patients who are research subjects. These changes have taken place during an era in which professionalism also has declined and physicians are losing control of their practices to government and to the corporate sector. A solution to this dilemma is suggested through strict adherence to the existing ethical principles by physicians and industry. Physicians must renew observance of professionalism and improve oversight and discipline. Medicine cannot impose restrictions on the pharmaceutical and manufacturing industries but can appeal to industry's leadership. Oversight and discipline also must govern marketing and sales representatives of industry. There must be an ethical common ground if a new physician and industry relationship is to succeed in producing a climate of mutual respect and higher ethics; patients will benefit and physicians and industry will regain the public trust.