Anthony Calabro

Editorial: The Complexity of Reporting Race and Ethnicity in Orthopaedic Research

Scientific research should serve the medical needs of everyone, regardless of race or ethnicity, but fewwould suggest that it now does. The NIH first sought to address disparities related to race, ethnicity, sex, and gender in healthcare research more than 20 years ago; among the goals articulated then were to “ensure that women and members of minorities and their subpopulations are included in all human subject research” [13]. But setting standards—whether by a federal agency in terms of balanced enrollment of research subjects, or by a journal that seeks to provide its readers with clear, accurate scientific reporting—is difficult, and can result in unintended consequences. We have covered scientificreporting standards on sex and gender in this space before [11], and those standards have since been adopted into the ICMJE’s recommendations on the topic [8, 19]. But at that time, we did not address race. In light of recent, updated guidelines from the FDA [23] and the NIH [14], this seems a good time to do so. We believe that the ideas that inform our standards will be of interest to all readers, regardless of whether they perform research or consume it in peer-reviewed journals. From the standpoint of scientific reporting, race and ethnicity are potentially important both for genetic and sociocultural reasons. With respect to the former, patients of different races may have genotypic differences that influence the efficacies or risks of particular treatments [15]. And on the latter, treatments may not be equally available to patients of different races (healthcare disparities) [20], or treatments may be differentially acceptable to patients of different races as a result of preferences arising from cultural differences or community norms [9]. But the concept of race as a genetic entity that can influence diagnosis or treatment carries little explanatory power in most of orthopaedics, and it is decreasing in importance across medicine more generally [24]. While there are genomic differences among individuals of different races, some studies have suggested that withinrace genetic variation is as important as between-group variation; assuming that important genetic similarities exist within races may be as misleading as it is helpful [16, 27]. The United States is not just a cultural melting pot, it is a genetic blender [4], and racial genotypes, to the extent they ever really existed at all, have grown increasingly blurred in the United States and around the world [1]. Even conditions like sickle-cell disease have proven to be less-closely associated with race than was previously believed [26]. Given the power of genetic testing, there is little reason now to use race as a biological screening parameter [16]. The authors certify that neither they, nor any members of their immediate families, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, anddonot reflect the opinionor policyofCORR or TheAssociation of Bone and Joint Surgeons.

A Remembrance of David B. Stevens MD (1929-2017)

David B. Stevens MD, former president of The Association of Bone and Joint Surgeons (ABJS), died on February 6, 2017 at his home in Lexington, KY, USA. He was 87 years old. A celebrated orthopaedic surgeon who cared deeply about public health, Dr. Stevens (Fig. 1) worked tirelessly to make Lexington a healthier community. It is a testament toDr. Stevens that when discussing his life of service, his colleagues point to both his accomplishments as an orthopaedic surgeon and as a civic leader in Lexington, where he served three terms as an at-large council member and as the 5 District representative from 1992 to 2008 (Fig. 2). “He was influential not only in his medical societies, but in the political arena as well,”Henry J. Iwinski, Jr. MD, Chief of Staff and pediatric orthopaedic surgeon at Shriners Hospitals for Children Medical Center—Lexington told Clinical Orthopaedics and Related Research. “He demonstrated a servant’s heart, always willing to step up and represent what he felt was right, be it for his patient or for the community.” In 2003,Dr. Stevens spearheaded the passage and implementation of Lexington’s first municipal indoor smoking ban, a monumental accomplishment considering the state’s high smoking rates among adults. Since its passage, more than 20 communities in the state have enacted some form of smoke-free legislation [1]. “Dr. Stevens was instrumental in getting the smoking ban enacted in our restaurants and other establishments,” Dr. Iwinski said. “It was an unpopular decision at first, but by force of will and knowing it was the right thing to do, he prevailed.” Raised in Louisville, KY, USA, Dr. Stevens and his wife Sallymoved to Lexington after he completed his residency in orthopaedic surgery at the University ofMichigan. After a 20-year career as a private practice orthopaedic surgeon, Dr. Stevens was named Chief of Staff at the Lexington Shriners Hospital, where he stayed for the next 20 years. During that time, he also joined the faculty at the University of Kentucky College of Medicine. As the first full-time Chief of Staff at the Shriners Hospital for Children Medical Center–Lexington, Dr. Stevens trained residents and medical students on their pediatric orthopaedic rotation. “He involved all staff, residents, medical students, nurses, therapists, and social workers in new patient presentations,” Janet L. Walker MD, pediatric orthopaedic surgeon at Shriners Hospitals for Children Medical Center—Lexington told CORR. “This served as education for all the professionals and encouraged team involvement in patient care decisions.” Dr. Stevens’s tremendous memory helped him build personal relationships with his patients and their families. He not only knew his patients by name, but often remembered a little fact about each patient’s background, where each lived, and perhaps even a historical fact about his or her county. “I hope to touch a fraction as many lives in my career as he did,” Vishwas Talwalkar MD, pediatric orthopaedic surgeon at Shriners Hospitals for Fig. 1 Dr. Stevens worked tirelessly to make Lexington a healthier community.

Obituary: A Remembrance of Gordon Andrew Hunter (1937–2015)

G ordon Andrew Hunter MB, FRCS, FRCS(C), long-time member of The Association of Bone and Joint Surgeons, passed away on June 11, 2015 at the age of 78. A renowned orthopaedic surgeon and educator, Dr. Hunter (Fig. 1) established himself as a leader in hip and knee trauma, foot and ankle surgery, and orthotics and prosthetics care during his 30-plus year career. Born in London, England, Dr. Hunter began his medical career at the University College of London in 1960. His postgraduate training included appointments at the Birmingham Accident Hospital, the University