June 2020

USBJI Delighted to Announce New Officers

Leigh Callahan, PhD was elected President-Elect by the USBJI Board at its meeting on Wednesday, May 20. She will serve as President from June 2021 to June 2023.

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Dr. Callahan has a history of involvement with the USBJI going back to the year 2000. She served on the Decade of Bone and Joint Disease Burden of Illness Task Force and also served on the World Health Organization’s Burden of Musculoskeletal Disease Working Group. She served on the USBJI Board of Directors for two different terms, once representing the Arthritis Foundation (AF) and later representing the American College of Rheumatology's (ACR) Rheumatology Research Foundation (RRF). She also served on the USBJI’s Executive Committee as treasurer from 2010-2012. In addition, Dr. Callahan has been actively involved in a number of different USBJI committees including Experts in Arthritis, the Chronic OA Management Initiative Steering Committee, the Burden of Musculoskeletal Disorders (BMUS) and the Young Investigator Initiative program. Dr. Callahan is the Mary Link Briggs Distinguished Professor of Medicine, Professor of Orthopedics and Social Medicine, and Associate Director, Thurston Arthritis Research Center at the University of North Carolina - Chapel Hill, and Director of the Osteoarthritis Action Alliance.

John Ventura, DC was elected Vice President by the USBJI Board at its meeting on Wednesday, May 20. He will serve as Vice President from June 2020 to June 2022.

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Dr. Ventura has served on the USBJI Board of Directors representing the American Chiropractic Association (ACA) since 2013. In addition to his board position he has been the board liaison to the Burden of Musculoskeletal Diseases in the United States (BMUS) and on the BMUS steering committee. He has also serves on the Low Back Pain task force, given public lectures using both the Experts in Arthritis and Fit 2 a T USBJI's public education programs. Dr. Ventura's role as Vice President of the USBJI will allow him to enhance the collaborative efforts and further bridge the gap between various MSK stakeholder groups.

Paul A. Ullucci, Jr., PT, DPT, PhD, CSCS, EMR was re-elected as Treasurer by the USBJI Board at its meeting on Wednesday, May 20. He will serve as Treasurer from June 2020 to June 2022.

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Dr. Ullucci represents the National Athletic Trainers' Association on the USBJI Board of Directors.

We would also like to recognize current President, Matthew B. Dobbs, MD, FAOA, FACS and Secretary, Bruce D. Browner, MD, MHCM, FACS, FAOA, FAAOS for their continued leadership of the USBJI.

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COVID-19 and Management of Bone and Joint Disorders

The current situation has led the USBJI to place more emphasis on ways of offering our programs which do not entail, for the moment, in-person gatherings. Notwithstanding COVID-19 the need to raise awareness and educate Americans on the prevalence, prevention, diagnosis and treatment of bone and joint disorders if of paramount concern. Indeed the need is more urgent at this time for many with bone and joint disorders. These disorders affect one in two Americans. Our work has not stopped, and we are adapting to circumstances.

Patient/Public Education
Patient education messaging is particularly important and relevant given the current situation – many people with bone and joint disorders, especially those with systemic auto-immune disorders, are concerned with access to their providers and to their medications, among other issues. People with rheumatic diseases face challenges as access to their medical team has been made more difficult (although some may have access to telehealth appointments). They must manage more on their own for the moment. Adherence to prescribed medication at a time like this is equally important. Stay-at-home confinement which makes sedentary behavior more likely is contrary to the daily physical activity recommended by the CDC that people need to remain healthy. Furthermore, patient access to formal in-person physical therapy has been drastically reduced forcing many to look for other alternatives to meet this need. The importance of USBJI programming in meeting patient educational needs is highlighted during this crisis.

We have created a page on our website (https://www.usbji.org/covid-19) providing resources to people with bone and joint disorders who are concerned about how COVID-19 may affect them. The page includes the following two videos, recorded by Dr. Elaine Husni.


COVID-19 and Osteoarthritis		COVID-19 and Rheumatoid Arthritis

Many organizations are producing and offering information relating to COVID-19, including for people with bone and joint disorders. The links to some of those organizations and the information they offer https://www.usbji.org/covid-19.

Research
Research is the driver to discovering how to improve our knowledge of the novel coronavirus and the prevention and treatment of COVID-19. We appreciate that investigators still have plans for research grant submissions and resubmissions. The USBJI does not want the current situation to delay those plans. Our Young Investigator Initiative program workshop was held in a modified manner this Spring and we encourage applications for the next cycle by July 15. The Fall workshop (scheduled for October 23-25) will continue to deliver the promised guidance, peer-interaction and mentoring so participants can continue to meet grant submission deadlines and advance their research careers.

We Hope You like Jammin' Too: A Study to Identify Risk Factors for Juvenile Arthritis

Colleen K. Correll, MD, MPH, Assistant Professor, Division of Rhematology, Pediatrics Department, University of Minnesota Masonic Children's Hospital, and a participant in the USBJI Young Investigator Initiative

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I am a Pediatric Rheumatologist and completed a Master’s degree in Epidemiology during my pediatric rheumatology fellowship training at the University of Minnesota. This background led to the establishment of the Juvenile Arthritis in Minnesota (JAMinn) study. JAMinn is a statewide population-based study and our goal is to enroll every child with JIA who lives in Minnesota to identify environmental and genetic risk factors for juvenile idiopathic arthritis (JIA). The initial funding for this study came from an internal award through the Department of Pediatrics at the University of Minnesota. We are well-positioned for such a study at the University of Minnesota because the majority of children with JIA in Minnesota receive their care at our center. There are a growing number of studies evaluating the association between genetic risk factors and JIA, however there are few studies investigating environmental exposures associated with disease activity. The initial goals of the JAMinn study included identifying and enrolling all children in Minnesota with JIA and collecting DNA samples from patients and their parents, environmental exposure data via parental self-report using questionnaires, perinatal risk factors using birth records from the Minnesota Department of Health, and disease activity measures using medical records.

As of November, 2019 we have enrolled 252 of 612 (48%) eligible patients with JIA through the University of Minnesota. Approximately 125/612 (20%) of eligible patients receive care from Mayo Clinic or adult rheumatologists in the community and we are working on enrolling these patients remotely. Of the 252 enrolled patients, we have sent all of them environmental exposure questionnaires, collected >200 blood samples from patients with JIA, >60 blood samples from parents and/or siblings, birth records from the Minnesota Department of Health, and Newborn Blood Spots (from 27 eligible cases). We recently received additional funding through the Rheumatology Research Foundation (RRF) Investigator Award to expand upon the JAMinn study and to evaluate the unique metabolomic profiles in a group of children JIA compared to healthy controls. We have also received funding through the University of Minnesota Department of Pediatrics to evaluate the saliva and stool microbiome in patients with JIA.

Mentorship through the University of Minnesota, USBJI, and the Childhood Arthritis and Rheumatology Research Alliance (CARRA) have helped me continue to secure funding to expand upon the JAMinn study and to pursue additional pediatric rheumatology clinical research. It was especially useful to have my grant reviewed through the USBJI’s National Institutes of Health (NIH) style mock study section and to have one-on-one mentorship and grant feedback from experts in rheumatology and epidemiology. The study section is comprised of researchers from all areas of the medical field and so it was useful also to receive feedback on my study from researchers who are outside the field of rheumatology.

My professional career has evolved through the last several years. I started as an academic clinician with the majority of my time being dedicated to treating patients. However, from the start of my career I had a goal of being a researcher. My biggest challenge has been working to secure funding to protect my time for research. I have been very grateful to have opportunities through the University of Minnesota, USBJI, RRF, and CARRA to spend more time doing pediatric rheumatology research. I advise others in my position to stay focused on their goals and find great mentorship.

Colleen K. Correll, MD, MPH
Assistant Professor
Division of Rheumatology
Department of Pediatrics
University of Minnesota Masonic Children’s Hospital
[email protected]

Understanding the Human Skeleton in Health and Disease

Edward Hsiao, MD, PhD, Associate Professor, Division of Endocrinology and Metabolism and the Institute for Human Genetics, University of California, San Francisco and a participant in the USBJI Young Investigator Initiative

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My interest in science grew out of my curiosity for how things work. As a kid, I really enjoyed the book The Way Things Work by David Macaulay. In addition, I was very good at taking things apart – toys, appliances, etc. I think this was partly curiosity, but also inspired by my father who fixed and built things around the house. Unfortunately, I was not always very good at putting things back together. There are numerous toys around the house that were relegated to the trash bin or cans of spare parts. I still find them in the garage when I go home to visit.

My formal career in the sciences was driven by my interest in how the human body develops and works – how does one cell eventually specify all of the different cell types that make up our organs, and how do they communicate to make sure they function in coordination? I enjoyed learning about many different organ systems and so was attracted to endocrinology – a field that touched many different organs and was an exquisitely elegant system for coordinating organ function. I became interested in rare diseases since they represent natural changes that reveal how the normal signaling and developmental pathways work. By understanding rare diseases, one can get a much better handle on how common diseases develop and how all diseases can be treated.

In my postdoctoral training, I became interested in McCune-Albright Syndrome (MAS), a mosaic disease of abnormal G-protein coupled receptor signaling. MAS is extremely rare, and although it is a genetic disease, not all tissues carry the mutation. I wanted to know if we could model the severe bone malformation aspects of MAS (called fibrous dysplasia) in mice, and at the same time search for treatments for this debilitating disorder. We developed an artificial hormone system that allowed us to control when and where the G-protein signaling was active. The mice showed massive bone formation, resembling the most severe cases of fibrous dysplasia seen in humans. We showed that if we could block this signaling pathway, established bone lesions could eventually heal. This provided proof-of-concept that a drug therapy might be possible. We were also able to study other roles for G-protein signaling in bone fracture repair, hearing loss, hematopoiesis, and bone metabolism.

The USBJI/YII was instrumental for developing my research career. I was introduced to two wonderful mentors (Dr. Jennifer Westendorf and Dr. Edward Greenfield) who provided guidance about how to write grants and navigate career decisions. All of my research mentors supported my efforts to get valuable funding support from a NIH K08, the Doris Duke Charitable Foundation, and the March of Dimes. Together, these grants made it possible for me to get my first R01 and establish an independent lab studying human skeletal diseases.

I’ve been able to develop a strong translational research program that spans molecular biology, cell biology, mouse models, human samples, and clinical trials. The breadth of this approach has been inspiring and allows us to take a patient driven, bedside-to-bench-back-to-bedside approach. My research group focuses on two main pathways – G-protein coupled receptors (McCune-Albright Syndrome) and bone morphogenetic protein signaling (fibrodysplasia osssificans progressiva (FOP), a congenital disease of massive and progressive heterotopic ossification). I’ve been lucky to develop strong research programs in these fields, as well as be involved in the clinical care of these patients. In addition, I recently started doing clinical trials for therapies in FOP. This has been an eye-opening experience as clinical research and basic research are very different, but also very complementary. I am also now the fellowship director for the UCSF Endocrinology and Metabolism Fellowship Program, which has been a great opportunity to train and inspire the next generation of researchers and clinicians.

I am sometimes asked to give advice for trainees. First, never be afraid to ask for help, especially with things like grant-writing or how to navigate your institution. Outside perspective is extremely valuable, and programs like the USBJI/YII help introduce you to key resources and mentors that can complement your own local research mentors. Likewise, it is important to share your experiences and help your colleagues. A number of my collaborations started with this type of supportive interaction years ago.

Second, be focused, but maintain a diverse perspective. My lab is now heavily focused on the BMP pathway, but that wasn’t my original plan. It is only now, after almost 8 years of waiting for the right technology to come along, that we are able to go back and address our questions in FD/MAS. Keeping an open mind to take calculated risks helped open up many opportunities that I never imagined.

Finally, take care of yourself and enjoy what you do. Focusing on the things you enjoy (i.e., asking great questions as part of research, spending time with family and friends, and taking vacations) are infinitely valuable. It is OK to say “no” and to be selective about what other tasks you take on.

Good luck!

Ed Hsiao ([email protected])

Call for Applications -July 15 Deadline - Young Investigator Initiative Grant Mentoring and Career Development Program

Fall Workshop – October 23-25, 2020

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The deadline for young investigators to apply for the next cycle of the Young Investigator Initiative Grant Mentoring and Career Development Program is July 15, 2020.

Sixty-one percent (61%) of participants of the Young Investigator Initiative (YII) have been awarded more than $500 million in grants since entering the program. The YII is now open for the next round of applications from young investigators who seek funding to undertake research studies on musculoskeletal health questions and pursue a career in research. The YII provides early-career investigators an opportunity to work with experienced researchers in our field to assist them in securing funding and other survival skills required for pursuing an academic career.

Participants consider this program instrumental to their success. They rate highly the one-on-one mentoring with experienced researchers, the opportunity for inter-disciplinary and peer-to-peer exchange, and collaborations established during workshops.

YII is open to promising junior faculty, senior fellows or post-doctoral researchers nominated by their department or division chairs seeking to pursue a career in clinical or basic research. It is also open to senior fellows or residents that are doing research and have a faculty appointment in place or confirmed. Basic and clinical investigators, without or with training awards, are invited to apply. Investigators selected to take part in the program attend two workshops, 12-18 months apart, and work with faculty between workshops to develop their grant applications. The unique aspect of this program is the opportunity for attendees to maintain a relationship with mentors until their application is funded.

Apply: https://www.usbji.org/programs/yii/application-information

The United States Bone and Joint Initiative (USBJI) and Bone and Joint Canada, which jointly offer the program, are dedicated to increasing research of musculoskeletal diseases. To keep pace with the high and increasing burden of these diseases, a higher level of research in the musculoskeletal diseases is required. Thus the number of young investigators skilled in the development of highly competitive grant proposals must be increased. This is particularly important given the current environment for research funding, and academic careers.

American Society for Surgery of the Hand (ASSH): Advancing the Science and Practice of Hand and Upper Extremity

Tamara D. Rozental, MD, ASSH Research Director

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The Research Division of the American Society for Surgery of the Hand is charged with advancing the science and practice of hand and upper extremity surgery. The Research Division awards as much as $500,000 in grants each year, working toward innovative advances in our field.

Research awards include clinical grants as well as basic science grants. Fast track grants designed for residents and fellows are also available. Since 2007, ASSH has supported $3,715,000 in research grants which has resulted in $32,787,551 in extramural funding. In the last decade, seven grant recipients have subsequently received extramural funds in excess of 2 million dollars from the NIH and DOD. Among these, topics have included the regenerative capacities of nerve allografts, the effect of growth hormone on nerve regeneration, the inhibition of scar formation in tendon repair, the molecular mechanism of contracture in neonatal brachial plexus injury and the evaluation of mechanics in the thumb carpometacarpal joint.

Each year, the ASSH encourages and sponsors new talent to apply for the USBJI Young Investigator Initiative. Over the last decade, ten individuals have attended the workshop and have universally found it a positive and valuable experience. Among these, six were subsequently successful in receiving extramural funding.

As evidenced by our track records, the ASSH is at the forefront of musculoskeletal research and are engaged in developing researchers for the next generation. Many of our funded investigators are now current opinion leaders in MSK health. We look forward to continued collaboration with USBJI to grow and develop the research pipeline in upper extremity conditions.

Learn more about ASSH research opportunities by visiting https://www.assh.org/afsh/s/research.

Arthritis Foundation 2020 Osteoarthritis Clinical Studies (OACS) Forum Series

The Arthritis Foundation is launching the 2020 Osteoarthritis Clinical Studies (OACS) Forum Series—a monthly digital debate on hot topics in OA clinical research by leading investigators. This program is curated by David Felson, MD (Boston University) and Martin Lotz, MD (Scripps Research).

Ewa Roos, PhD (University of Southern Denmark) leads our first exciting topic: “Does Strong Muscle Matter in OA?”

Dr. Roos is joined by an international panel of leading experts in the field:

Steve Messier, PhD (Wake Forest University)
Lynn Snyder-Mackler, PT/ATC/ScD/SCS/FAPTA (University of Delaware)
May Arna Risberg, PhD/PT (Oslo University Hospital)

The group will discuss the role of muscle function in OA and debate evidence that increased muscle strength may lead to more OA.

The meeting will be held virtually on the Zoom platform and follow the agenda below. At the end of the discussion, 5-person breakout rooms will be opened for networking with other clinical researchers in attendance.

OACS FORUM SERIES: June 17^th, 2020
“Does Strong Muscle Matter in OA?” Discussion Chair: Ewa Roos, PhD
Begins at 11:30AM	Virtual Check-In
12:00 PM – 12:10 PM	Welcome Remarks and Program Overview Overall Forum Chairs: David Felson, MD/MPH and Martin Lotz, MD
12:10 PM – 12:15 PM	Introduction of Discussion Topic and Panel Members Discussion Leader, Ewa Roos, PhD
12:15 PM – 12:45 PM	Overview of Discussion Topic Two (2) Presenters Selected by Discussion Leader 10 min per data-focused presentation
12:45 PM – 1:45 PM	Discussion by Panel Members, including Lynn Snyder-Mackler, PT/ATC/ScD/SCS/FAPTA Steve Messier, PhD and May Arna Risberg, PhD/PT
1:45 PM – 2:00 PM	Closing, including Announcements
2:00 PM – 3:00 PM	Open Breakout Rooms for Networking

Limb Lengthening and Reconstruction Society - Train the Trainers: Is It Possible Create Limb Deformity Centers in Resource Limited Countries?

Raymond W. Liu, L. Reid Nichols, Austin T. Fragomen

The international nature of orthopaedics has blossomed over the past decades, with multiple United States societies dedicating specific committees and focuses on care in resource limited countries and education of the local surgeons. As limb deformity specialists, members of the Limb Lengthening and Reconstruction Society (LLRS) have been struck by the level of pathology in these regions. With substantial geographic and financial barriers to care, these countries seem to have countless patients in need of care for chronic osteomyelitis, nonunion, malunion, and deformities secondary to neglected pediatric care. Treating these patients on short-term trips is challenging given the common need for gradual correction and careful follow-up, while training the local surgeons to treat these complex techniques is daunting and questioned by some as impractical.

For several years surgeons from SIGN Fracture Care International, including Richard Gellman, M.D., have been traveling to Nigeria and its neighboring countries to help teach the local surgeons deformity care. Through repeated follow-up trips and continuous contact through a WhatsApp chat group, the local surgeons have been working through the steep learning curve of limb deformity surgery and have been able to offer solutions to their complicated patients.

In 2014 the LLRS began its four week traveling fellowship, spearheaded by Joseph Hsu, M.D. Fellows spend one week at four different LLRS sites, allowing enough time to gain valuable surgical training at each center. As the fellowship began to develop its reputation there were positions available to train two surgeons from Nigeria: Emeka Izuagba, MD, and Anirejuoritse Bafor, MD.

These two separate training paths converged when Dr. Gellman invited LLRS leadership to participate in a training course in Lagos, Nigeria in June 2019. There, it was clear that the two Nigerian surgeons trained by the LLRS traveling fellowship had developed busy and successful limb deformity practices incorporating high level acute and gradual correction techniques. The accomplishments of our Nigerian colleagues was proof that complicated limb deformity, including circular external fixation, can be accomplished in their circumstances. In addition they had helped form the Limb Lengthening and Reconstruction Society in Nigeria (LLRS-N). The lecture, sawbones and live surgery based course focused on instilling key limb deformities concepts into the leading deformity surgeons in Nigeria, and was appropriately named the “Train the Trainers” course. The LLRS-N has become an affiliated society of the LLRS, with the intent for LLRS surgeons to help support future training courses and develop systems for sending used external fixator parts to Nigeria.

The progress made in Nigeria was incredibly rewarding to discover, but there was concern about the future. The LLRS traveling fellowship has grown to the point where there is less common availability for international surgeons. Through the generosity of Lew Zirkle, MD founder of SIGN and previous recipient of the AAOS Humanitarian Award, LLRS and SIGN have been able to develop a pilot program where additional LLRS traveling fellowship positions are dedicated to surgeons from resource limited countries each year. The first surgeons this summer will be Jun Valera, MD from the Philippines; Henry Ndasi, MD from Cameroon and Omelade Lasebiken, MD, from Nigeria.

As a society the LLRS is excited about the potential of helping to train multiple surgeons from regions in severe need of limb deformity expertise, and facilitating the development of additional local societies in those countries over the coming years. We hope that our positive experience encourages our colleagues and provides a model for how a society can support international care.

If you would like to donate your used external fixator parts, please contact:
Joel Gillard
3518 SE 21^st Ave
Portland, OR 97202
[email protected]
(P) 503.464.6121

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Live surgery demonstration at the LLRS Nigeria course in June 2019

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The Nigerian surgeons were asked to choose routine limb deformity cases to allow the course to focus on basic principles. This adult patient has a severe residual deformity secondary to Blount disease.

OI Foundation’s New Programs Off to a Strong Start

The Osteogenesis Imperfecta Foundation (OI Foundation) and the Rare Bone Disease Alliance are excited to announce the Rare Bone Disease TeleECHO Clinic Series. The goal of the program is to build capacity in the medical community to safely and effectively diagnose and treat rare bone diseases and disorders. Four sessions have been held with positive feedback from the attendees. The next session will be presented by Dr. Peter Byers on Non-Accidental Trauma. For more information about the series, or to register, please check out the OI Foundation’s website or contact Michael Stewart at [email protected]. Want to catch up with the series? The short didactic presentations presented by experts in the field are featured on the website.

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In addition to the TeleECHO series, the OI Foundation has been approved for a funding award through the Eugene Washington PCORI Engagement Awards program, an initiative of the Patient-Centered Outcomes Research Institute (PCORI). This project aims to engage the OI Community as well as the physicians and researchers to create a community of stakeholders that are trained in, or are training in and committed to engaging in patient-centered outcomes research, with specific attention that the OI community regards as high priority. To learn more about the project, please check out our website or contact Rachel Stivers at [email protected].

The OI Foundation is proud of its ability to provide programming that aims to improve the quality of life for people with OI. We believe that these new programs are a great way to strengthen the field of OI research so that it is truly focused on what the community feels is important and to make research more of a bidirectional process for both communities.

ORS2025 - Committed to Making an Impact in the Fields of Musculoskeletal Research

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The ORS Board of Directors approved a five-year strategic plan: ORS2025. ORS2025 defines a new mission, core values, and four main strategic objectives. Now, more than ever, the ORS is committed to making an impact in the fields of musculoskeletal research and research related to orthopaedics.

The new mission “accelerate musculoskeletal discovery to improve health” highlights the purpose of the ORS, and the important role our members play in basic, translational and clinical sciences that improve the health of patients around the world.

With one in two people over the age of 18 affected by a musculoskeletal condition, our vision remains “a world without musculoskeletal limitations.” Although ambitious, it is possible to find cures for diseases that most have accepted as a part of life or the aging process. Improved treatments, medical devices, and preventive care can decrease the time we spend with limited mobility.

It was also important to define our core values – what is most important to us as an organization representing a diverse community of scientists, engineers, surgeons, clinicians, and their teams from around the globe. After reviewing our core values, we realized they have as much to do with research and education as they do with the community we want to nurture and enhance.

Excellence & Integrity
Diversity, Equity & Inclusion
Innovation & Impact
Respect & Accountability
Connection & Collaboration
Education & Career Development

Lastly, ORS2025 defines our strategic objectives and what we must focus on to achieve our mission, strive towards our vision, and live out our core values. Our ORS2025 strategic objectives remain true to the foundation on which the ORS was established in 1954: Research, Education, and Communication. However, there are some notable updates that reflect the challenges of today and increased possibilities for the future.

RESEARCH
Strengthen the ORS as the hub for musculoskeletal research and increase its impact

EDUCATION
Empower current and future ORS members with the knowledge and resources needed to thrive in a dynamic musculoskeletal research environment

COMMUNITY
Cultivate a diverse, inclusive and engaged ORS community by increasing access and opportunities

ADVOCACY
To increase awareness and understanding of the burden of musculoskeletal conditions, the impact of research, and the importance of funding

This is an exciting time to be a part of the ORS community! We are committed to making an impact for our members, their research, careers, institutions, in the field of musculoskeletal science and orthopaedic care.

Ashtin Neuschaefer, CAE, Named Executive Director of the Scoliosis Research Society (SRS)

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Ms. Ashtin Neuschaefer, CAE, has been named Executive Director of the Scoliosis Research Society (SRS) as of May 4, 2020.

SRS is a global spine society with a membership of 1,400, an annual budget of over $5 million, and is managed by Executive Director, Inc. (EDI), an association management company specializing in medical organizations.

Ms. Neuschaefer has served SRS since 2013 in various capacities. She has assumed the role of Tressa Goulding, CAE, who recently retired after a 30-year tenure with SRS, including 26 years as the SRS Executive Director. Since 2018, Ms. Neuschaefer has been the organization’s Director of Administration. “I am humbled to have the opportunity to continue to serve the SRS and its wonderful members. While these are interesting and challenging times to be assuming this role, I know that the strength of our membership and staff will carry us through,” said Neuschaefer.

Dr. Paul Sponseller, SRS President stated, “The SRS presidential line, Board and other volunteers look forward to working with Ashtin in her new role. Given her knowledge of our organization and our members, we are certain that she will serve SRS well. We thank Tressa for her work in making SRS what it is today.”

The Scoliosis Research Society (SRS) is a non-profit, professional organization, made up of physicians and allied health personnel. Our primary focus is on providing continuing medical education for health care professionals and on funding/supporting research in spinal deformities. Founded in 1966, SRS has gained recognition as the world's premier spine deformity society. Please visit www.srs.org for further information.

Opinion Comments - Medical Professionalism and Humanitarian Health Care in the American Age of “-isms.”

Augustus A. White, III, MD, PhD and David Chanoff, PhD

In 2003 the IOM report Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare brought together research that had surfaced in many hundreds of studies, but had been sufficiently scattered so that it hadn’t galvanized attention or created a call for action. The report documented in detail the fact that African Americans and Hispanic Americans received healthcare far inferior to that provided to their white fellow Americans.

Seventeen years later we know that it’s not just African Americans and Hispanics who suffer from disparate care and inferior outcomes, it’s women, the elderly, gays and lesbians, the Appalachian poor and others—thirteen groups in all have been documented. In plain language that means that in terms of relieving suffering, curing disease and saving lives, physicians are for some reason or reasons simply not living up to the standards of care we set for ourselves. That includes orthopedists and other musculoskeletal specialists. Studies, for example, have shown that African Americans and Hispanic Americans received far less pain medication for long bone fractures than white patients. How strange that is, when almost all physicians consider themselves and strive to be humane, compassionate, egalitarian caregivers.

We know that some of this disparate care is due to income inequality, the neighborhoods patients live in, the lack of insurance, and other inequities built into the social, political, and economic structure of our society. But the statistics reveal distressing discrepancies in outcomes even when insurance coverage and socioeconomic factors are accounted for. Why then does this happen?

That’s the question my collaborator, David Chanoff, and I attempt to answer in our book Seeing Patients. We assume that even with physicians there’s at least some degree of overt racism, sexism, ageism, etc. involved, but we were far more interested in looking at unconscious bias, feelings about patients hidden deep in the brain’s processes for cognition and emotion.

In this regard we focused on two major elements that figure in unconscious bias. In his seminal book, Descartes’ Error, neuroscientist Antonio Damasio spells out how the mind with its cognitive functions has evolved from the older limbic system for emotional response. Our thinking mechanism he tells us, is nested in our organs for feeling. Jerome Groopman, my colleague at Harvard, has written on the same subject. Most errors in diagnosis, he says, are mistakes in thinking. What causes these cognitive errors is our inner feelings, which we often simply do not recognize.

Could our diagnoses and treatments, then, be molded by our unrecognized feelings of like and/or dislike for our patients? David Schneider, a professor of cognitive science at Rice, gives us at least one explanation for why this could be. Stereotyping, he says, leads us all to make discriminatory judgements. “It happens with race,” he says. “It happens with disability. It happens with gender, age and physical appearance. It happens because that’s the way it is. Our mental apparatus was designed to facilitate quick decisions based on category membership.”

So, if we are designed such that our judgements are pervaded unseen by our emotions, and our feelings stem from stereotyping that we can’t really avoid, is there any way to counteract the unconscious bias that is in large part responsible for the glaring disparities evident in the statistics?

The answer, we think, is in two parts. One is awareness. If we are aware that we do harbor biases, and we all do, despite how we like to think of ourselves as models of egalitarianism, then we can take measures to counter their influence on us. We can practice mindfulness, culturally competent care, and conscious commitment to the individuality of each of our patients. Second, and this is perhaps more difficult, we can embrace the personal side of our interaction with patients, with all their diversity of color, gender, age, ethnicity and other uniquenesses. We should understand that empathy lifts up the spirit. It reduces stress and strengthens resilience. Empathetic care enhances the well-being of the doctor as well as the patient. It brings a level of satisfaction and enjoyment that gives a richer dimension to the practice of medicine. Is this or isn’t it crucial to us in the way we measure our lives? We would argue that it most certainly is.

We respectfully refer the reader to the following article:
White, A.A. and Chanoff, D. Medical Professionalism and Humanitarian Health Care in the American Age of “-isms.”, Journal of Racial and Ethnic Health Disparities, (2020). https://doi.org/10.1007/s40615-020-00725-7 Available at this link https://rdcu.be/b3IyK

This cited article presents some of these thoughts with a discussion of their relevance to issues of medical professionalism and burnout.

USBJI Upgrades Public Education Programs Experts in Arthritis and Fit to a T

Experts in Arthritis

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Experts in Arthritis, which provides guidance to people with arthritis and those who care about them, has a new look and feel, with enhanced content on managing pain and fatigue. Redesigned to encourage discussion between expert presenters and participants, there is greater focus on addressing the major concerns of participants, and maximizing retention of the educational messages. Experts in Arthritis has always primarily been designed for presentation at live community gatherings, but because of COVID-19 the USBJI is offering webinar presentations, led by a local expert on arthritis, so community centers, senior centers and other organizations can continue to offer this important education activity to their members at home during this time. Some of the messages are particularly relevant at this time, as people are confined and unable to exercise and move around as freely as they would be normally. A recorded version will be available as well.

The program and accompanying materials are provided at no cost, and comes with a ready-made slide set, handouts, and logistical support.

The presentation is structured around four main modules:

Module 1: What is Arthritis? Types and Symptoms
Module 2: Taking Control—The Concept of Self-Management
Module 3: Different Aspects of Taking Control
- What Does Self-Management Look Like?
- Finding Ways to Control Symptoms: Pain, Fatigue, Sleep, Emotion
- Physical Activity and Exercise
- Good Nutrition
- Being Judicious with Supplements and Alternative Medicines
- Educating Those Around You
Module 4: You and Your Healthcare Provider, Treatment and Shared Decision-Making, and Take-Home Messages

To find out more, and to register interest in receiving the program, visit, www.ControlArthritis.org, email [email protected], or just complete and return the Registration Form.

Fit to a T - Fracture Prevention and Osteoporosis

F2T Slide.JPG

Fit to a T presents the necessary steps to understanding why bones break suddenly and apparently without warning, and how to prevent such events which can cause people, particularly older people, to lose their independence. The incidence of these fractures in the US was declining, but in recent years this improvement has reversed. Covering bone health throughout the lifespan, the new version of Fit to a T focuses especially on those at highest risk of a fracture, and how to prevent these from occurring. The program covers the basics of bone health and how bone quality can deteriorate as people age or due to other health factors, race or ethnicity. It covers the prevention, early detection, diagnosis, and treatment of osteoporosis, and fall prevention, the leading cause of osteoporotic fractures. The new structure and content align with the American Society for Bone and Mineral Research and the Fracture Prevention Initiative Coalition’s roadmap to alter the recent increase in fractures in the US.

Redesigned to encourage greater discussion between healthcare professional presenters and participants, there is greater focus on addressing the major concerns of participants, and maximizing retention of the educational messages. Fit to a T has always primarily been designed for presentation at live community gatherings, but because of COVID-19 the USBJI is offering to set up webinar presentations, led by a local expert on bone health, so community centers, senior centers and other organizations can continue to offer this important education activity to their members while at home during this time. Some of the messages are particularly relevant at this time, as people are confined and unable to exercise and move around as freely as they would be normally. A recorded version will shortly be available as well.

The program and accompanying materials are provided at no cost, and comes with a ready-made slide set, handouts, and logistical support.

The updated program is structured around six modules:

Module 1: Introduction and Background on Bone Health and Osteoporosis
Module 2: People at High Risk of Fracture or Who Have Already Suffered a Fracture
Module 3: Fall Prevention
Module 4: Screening, Prevention, Treatment
Module 5: Red Flags, Ethnicity and Osteoporosis
Module 6: Take-Home Messages

To find out more, and to register interest in receiving the program, visit, www.fit2t.org, email [email protected], or just complete and return the Registration Form.

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June 2020

In This Issue

Calendar of Events

Fall Workshop – October 23-25, 2020

Experts in Arthritis

Fit to a T - Fracture Prevention and Osteoporosis