12/31/2025 Allen M. Jacobs, DPM
Fulgent to Acquire Bako Diagnostics
The announcement of the Bako sale at the published
value should tell you something with reference to
industry marketing of podiatrists: "there is gold
in them there hills". Bako is proof that
podiatrists as an entity provide a large potential
sales market for a variety of services and
products such as pharmaceutical, device, therapy,
wound care products. I am old enough to remember
the days when other than a few topical creams, no
sales representative from any industry called on
podiatrists.
Times have changed with the growth of the
profession. I recall a paucity of exhibitors at
our meetings. Now look at meetings such as some
regional or state meeting or local society where
the ratio of exhibitors to registrants is less
than 4 to 1, yet the exhibitors continue to be the
"gift that keeps on giving " like the jelly of the
month club cited by Uncle Eddy. Conversely, look
at meetings such as ACFAS with expansive exhibit
halls and large registration.
My caveat is and has been a call for the end to
corporate influence in our CME programs. Over 100
years ago, Sir William Osler expressed his concern
over the undue influence of the pharmaceutical
industry "which has enslaved medicine in a
PSEUDOSCIENCE". Pseudoscience, in my opinion, has
been given too much free reign in our meetings,
unchecked by CPME and those charged as organizers
of local, state, and national meetings. The result
is frequently the adoption and application of
technologies which are essentially unproven, and
may result in patient harm while denying patients
legitimate care. Don't believe me? How many of you
continue to use the Cartiva implant, whose success
was attested to by numerous foot and ankle
orthopedic surgeons, most of whom were paid
consultants of the manufacturer.
When is the last time you employed a suture anchor
to reduce the IM angle in bunion correction in
deference to an osteotomy of arthrodesis. Yet very
accomplished thought leaders appeared at our CME
programs advocating its utilization. Now, in order
to maintain market share, the same "thought
leaders' who told this profession that the Lapidus
procedure was the end all be all of bunion
surgery. Now we are told by the same industry paid
consultants that distal metaphyseal osteotomy
utilizing MIS technique is the cats meow. So much
for CORA consideration, adios the hypermobility
argument, goodbye mandatory frontal plane
correction. As suggested by William Osler,
industry has enslaved podiatry in a pseudoscience,
and we will hear about frontal plane correction in
osteotomies which do not allow frontal plane
correction.
So exactly how much absorbable fixation do you
employ? With what frequency do you implant two
component1st MPJ implants? When do you choose to
drill holes in the calcaneus from the treatment of
heel pain ? Or last performed a Young
tenosuspension? Under what circumstances do you
employ a Pegasus horse pericardium graft for
inter-positional arthroplasty?
The problem with all of this is that patients are
denied legitimate care, and a times harmed by the
use of unproven products. This is not a matter of
advancing knowledge and science. It is the matter
of corporate influence, whose first job is profit
not patient safety, to exert undue influence in
our post-graduate educational system. CPME cannot
be relied upon to enforce the legitimacy of the
literally hundreds of podiatry seminar. They have
neither the staff nor capability. This must be
done at the local level by those who have accepted
responsibility for the proper organization of
seminars and lectures qualifying for CECHs.
At best, the speaker shows a slide for a
nanosecond and states "these are my conflicts". If
you blink you miss it. I'm surprised that
corporations do not use subliminal suggestions
within their presentations "use this product". In
my opinion, the greatest violation that occurs
with regularity is presented with a unrestricted
educational grant". Believe me, the grants are
seldom unrestricted. The only company with whom
I've worked has been EBM. Go ahead, ask a
dermatology lab for money to offer a lecture on
surgery for progressive collapsing foot deformity.
Good luck with that.
Ask an orthopedic device manufacturer for grant
money to provide education in neurology, or
rheumatology, or endocrinology. That ain't gonna
happen. I have served to chair and organize
hundreds of seminars in my lifetime, including
state meeting, regional meetings, local meetings,
my own seminar for 38 years, and even the APMA
national for 3 years and ACFAS for one year. Not
only is the "unrestricted educational grant"
dependent on the topic being relevant to their
product or products, they will insist on the
speaker to be provided from their list of speakers
who they pay and control and know will tow the
party line.
Some years ago, a national meeting held a seminar
on "current status of total ankle replacement
surgery". I did some research. EVERY member of the
"unbiased and objective" panel was a paid
consultant with royalties for one major ankle
arthroplasty producer. Unbiased ? The examples
need not be as dramatic as surgery. There are
speakers who have literally advocated just about
every topical and oral anti-fungal. And I mean
every one. I suppose the answer is they all work,
and by coincidence they all have paid me as a
speaker.
When I see an announcement of a lecture such as
"understanding microwave technology " or "new
approaches to bone healing", I know this is a
lecturemercial. How? It states "supported by a
grant from a company producing a product relevant
to that lecture. What is wrong is not the topic.
Corporations have the right to provide knowledge
about their products, and you have the right to
make a decision to attend such presentations. What
is patently wrong is to award CECH for an obvious
sales pitch, disguised as "educations". Those
granting the CECH for this should be replaced.
They are not guarding the responsibility of
protecting the profession and the public from
industry manipulation of our educational process.
In the end, the consultant/lecturer/investor
profits. The product manufacturer profits. Your
patients on the other hand, are poorer for the
experience.
The solution is obvious to any thinking podiatric
healthcare provider. Demand change in program
content or make changes at the local level or do
not support this continuing unethical behavior.
Seminars may survive while still being responsible
for speaker cost. Insist on UNRESTRICTED
educational grans. Do not construct seminars
around corporate sponsored speakers. Note bias in
your program evaluations.
I recall the days when you were honored to be
invited to speak. It was the ultimate recognition
by your peers. They wanted you to share your
thoughts and insights. You were reimbursed travel
and costs. There was not major profit. Yet, you
were disappointed not to be asked to speak. If
there was an honorarium, it came from the program
and was miniscule by todays standards. Now, if
contacted by a seminar organizer, the first and
foremost query in "who do you have that will
sponsor you".
CME in podiatry reminds me of the old admonition,
:it’s not what you know but who you know'. That is
fine for politics, but not for the continuing
education and update that your state and the
trusting public expects you to complete in order
to provide them with optimal care and decision
making.
Over 100 years ago, Sir William Osler was correct.
Then and now.
Allen M. Jacobs, DPM, St. Louis, MO
