Clin Orthop Relat Res (2018) 476:1149-1153 DOI 10.1097/01.blo.0000533612.13677.63 Not the Last Word Published online: 26 April 2018 Copyright © 2018 by the Association of Bone and Joint Surgeons 06/24/2018 on KgFmXNLSMJ4u1p6ztYvHWfuNA76izQU/ztryAc8YUPUg15KyDgTVvpTaQzTGoIKNgAyziy6WtTNezqpqQwMgDi0uNFYqr1Rat5qdQOaDE3PeQvfkcBm6BbAt1x3hFPPcHF+EQ2lqcFd6rCUZYN2T9sf7yKZ7Uc7piPWjJQ+Mz8y/ndNrWqjoBQ== by https://mail.uphs.upenn.edu/owa from Downloaded Downloaded Not the Last Word: A Goldwater Rule for from Sports Medicine https://mail.uphs.upenn.edu/owa Joseph Bernstein MD by KgFmXNLSMJ4u1p6ztYvHWfuNA76izQU/ztryAc8YUPUg15KyDgTVvpTaQzTGoIKNgAyziy6WtTNezqpqQwMgDi0uNFYqr1Rat5qdQOaDE3PeQvfkcBm6BbAt1x3hFPPcHF+EQ2lqcFd6rCUZYN2T9sf7yKZ7Uc7piPWjJQ+Mz8y/ndNrWqjoBQ== resident Trump sure has kept the Lee, a psychiatrist at the Yale School and elite college athletes frequently nation’s amateur psychologists of Medicine, has recently edited are peppered with quotations from Pbusy. Self-appointed mental- a book, The Dangerous Case of Don- orthopaedic surgeons who have never health experts, including newspaper ald Trump: 27 Psychiatrists and examined the athlete in question. columnists, late-night comedians, and Mental Health Experts Assess a Presi- Twitter feeds are loaded with un- my wife’s Uncle Stanley, all have de- dent,to“warn against the president’s prompted comments from orthopae- tailed opinions to share about President psychological instability and the dan- dic surgeons. The information shared Trump’s state of mind. gers it poses” [12, 13]—without the by physicians is scrutinized rapidly But it’s not just the amateurs who benefit of a face-to-face evaluation. not only by sentimental fans with their are taking this approach. Dr. Bandy By publishing this book, Dr. Lee hearts on their sleeves, but by fantasy- allegedly violated Section 7 of the league participants [10] and gamblers American Psychiatric Association’s who have fortunes on the line [22]. A note from the Editor-in-Chief: We are Principles of Medical Ethics [23], the And while almost all of the statements pleased to present to readers of Clinical so-called Goldwater Rule, which states I have read over the years have been Orthopaedics and Related Research® the next that “it is unethical for a psychiatrist to reasonable, armchair medical com- Not the Last Word. The goal of this section is offer a professional opinion unless he mentary can be harmful, and explicit to explore timely and controversial issues that or she has conducted an examination” professional standards may therefore affect how orthopaedic surgery is taught, learned, and practiced. We welcome reader [2]. The Goldwater Rule is named after be helpful. feedback on all of our columns and articles; Barry Goldwater, the 1964 Republican A Goldwater Rule for sports medi- please send your comments to eic@ Presidential nominee who was labeled cine must start from the premise that clinorthop.org. by psychiatrists who never examined commentary about professional ath- fi The author certi es that neither he, nor any him as a “paranoiac” with “delusions letes can educate the public. People members of his immediate family, have any ” “ ” commercial associations (such as consultan- of persecution , irrationally cruel respond to stories much more than cies, stock ownership, equity interest, patent/ [20], and generally unfit to serve as facts and figures, and therefore a lesson licensing arrangements, etc.) that might pose president. Goldwater successfully sued woven around the experiences a fa- a conflict of interest in connection with the a magazine that printed these opinions; mous person is more likely to stick. In submitted article. the judgment was upheld by the U. S. The opinions expressed are those of the writ- my practice, recounting the un- ers, and do not reflect the opinion or policy of Supreme Court [8]. fortunate episode of Jerry Rice and his Clinical Orthopaedics and Related I wonder if there is a role for patellar fracture in a game just 14 Research® or The Association of Bone and a Goldwater Rule in orthopaedics, weeks after ACL surgery [21] does Joint Surgeons®. specifically regarding sports injuries of ✉ more to support my unhurried rehab Joseph Bernstein MD ( ), University of professional athletes. Pennsylvania, 424 Stemmler Hall, schedule than any speech about the on Philadelphia, PA 19104, USA, Email: Newspaper and online articles de- biology of healing. 06/24/2018 [email protected] scribing the injuries of professional With that in mind, I propose the following framework: All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Re- lated Research® editors and board members J. Bernstein, Department of Orthopaedic 1. Physician-commentators should are on file with the publication and can be Surgery, University of Pennsylvania, state explicitly that they have never viewed on request. Philadelphia, PA, USA met the athlete in question. Copyright Ó 2018 by the Association of Bone and Joint Surgeons. Unauthorized reproduction of this article is prohibited. 1150 Bernstein Clinical Orthopaedics and Related Research® Not the Last Word 2. Physician-commentators should “squander the profession’sauthority before the league’s opening game not disparage the famous patient and goodwill” [19]. That rationale closed with the powerful message: with speculation, even with state- might apply to all fields of medicine. “The best entertainment in the world is ments that are generally true. For But the need for guidelines goes beyond back. Let the show begin” [15]. instance, fifth metacarpal neck that. The Goldwater Rule was enshrined This marketing strategy capitalized fractures may be associated with following a successful lawsuit, in which on the fact that, today, professional poor impulse control and wall Mr. Goldwater convinced the court athletics are grounded not just in com- punching. Osteonecrosis of the spurious psychiatric opinions met the petition or teamwork, but in entertain- femoral head may be associated legal standard for libel. Along those ment. More than just participants, with alcoholism. Wondering with- lines, inappropriate comments about athletes have become commodities that out evidence whether those gen- a professional athlete’s injury or its fans consume through attending games, eralities apply to a particular treatment may be similarly damaging to viewing televised competitions on their athlete, however, is unfair. the reputation of the athlete or physi- televisions and smartphones, supporting 3. Physician-commentators should cian. All of us—doctors, patients, and media coverage of elite athletes, en- take care to not disparage the society at large—will be better served gaging in fantasy leagues, or simply treating providers, either. A team by eliminating inappropriate comments purchasing team merchandise. physician’s treatment strategy may in the first place. Dr. Bernstein’s column presents on the surface seem strange, but it The rules above merely codify a thoughtful response to the potential may be driven by facts the public common decency, so some may say dangers of armchair medical com- does not know. These facts may that they are not needed. Orthopaedic mentary, including damage to the include elements of the past med- surgeons have certainly been more reputation of the athlete or the physi- ical history or the preferences of the circumspect than their colleagues in cians themselves. I agree that to enact patient-athletes or their agents. psychiatry regarding political com- afull-scaleGoldwaterRuleforsports Plausible justifications for non- ments. After all, when candidate medicine would be to dismiss the very standard approaches should be Trump could not remember which foot nature of this multibillion-dollar en- offered. had the bone spurs [7] that exempted tertainment industry, one which 4. Nonstandard approaches to di- him from the Vietnam war, no ortho- derives nearly as much from the agnosis and treatment should be paedic surgeon wrote a book entitled observers—the fans and reporters and placed in context. Immediate sur- The Curious Feet of Donald Trump: 26 commentators and physicians—as gery for a fifth metatarsal fracture Bones That Might Be Affected. from the athletes themselves. may make sense for a football Well-formed rules promoting a fair Further, full-scale extension of the player hoping to salvage the sec- and accurate discussion about pro- Goldwater Rule might improperly con- ond half of the season, but not for fessional athletes’ injuries can educate flate expressing a negative opinion with many other people. That distinction the public and improve musculoskele- having deliberate malice. Senator Gold- should be stressed. tal health. water’s lawsuit was successful because 5. Ignorance should be confessed. If Benjamin G. Domb MD the publication’sinflammatory com- you don’t know, say “I don’t know”. Medical Director, American Hip ments met the high standard required of Much of sports medicine concerns Institute libel cases involving public figures [5, orthopaedics, but not all of it: Nu- Past Head Team Physician, Chi- 11, 17, 20], but only in extreme scenar- trition, cardiology, and psychology, cago Sky, WNBA ios might the same be said of a sports to name just a few examples, may At the start of the 2017-2018 sea- medicine physician’s evidence-based be the topic of the day. If the sub- son, the National Football League and professional diagnostic opinion. ject is outside of one’s expertise, no (NFL) launched a new ad campaign, Most importantly, this piece identi- commentary should