Letter To The Editor: A Return To Research?
A. Bennett Wilson, Jr.
Thirty-seven years ago, with funds from the United States Government, the National Academy of Sciences initiated a research and development program in artificial limbs because amputees in Army and Navy hospitals expressed quite vociferously their dissatisfaction with the artificial limbs provided at that time, and because there had never been, in this country, any concerted scientific effort to solve the problems of amputees. Although the research program, funded until the late 1950's largely by the Veterans Administration, was not looked upon with favor by many prosthetists during its early stages, with the help of a few of the more progressive prosthetists and orthopaedic surgeons sufficient progress was made by 1952 to warrant the initiation of a formal education project at the University of California at Los Angeles, which set the pattern for the present education program in prosthetics and orthotics.
The Department of Health, Education, and Welfare, about 1955, joined the VA in supporting research, development, evaluation, and education; orthotics was added to the mission in the late 50's; and progress continued to the point that by the early 70's nearly every aspect of prosthetics had been replaced by newer techniques and devices, and work in orthotics was progressing rapidly. Although it was, and is, recognized by many that further, continuing research was needed, the government agencies have all but abandoned research and development in prosthetics and orthotics, and as a result very few improvements have been introduced to the practice of prosthetics and orthotics during the last few years.
This unfortunate situation has been brought about because of a number of factors: the decision by the National Academy of Sciences to withdraw from the program; reorganization by the VA in 1973 that resulted in transferring research and development responsibility from the Prosthetic and Sensory Aids Service to general medical research, and to conduct most of the research and development in VA hospitals; and an unbelievable proliferation in all government agencies of "red tape" required in awarding contracts and grants.
During these 37 years, the prosthetics and orthotics profession has become healthy and strong, in part because the research and development program has provided a teachable body of knowledge and an education program that has produced a group of practitioners who are capable of communicating effectively among themselves and with other groups.
Given this set of circumstances, it seems reasonable that the prosthetists and orthotists in this country should consider taking responsibility for research, development, and evaluation, and relieve the government of most of the responsibility it has assumed in this area for the last 37 years. Certainly a program administered by AAOP-AOPA could be more efficient and more effective than one administered by the government. One way to finance this undertaking is to include in the price of each new prosthesis and orthosis an appropriate percentage of the price to be set aside for the research program. This sum would, of course, be a legitimate business expense.
The coordination and "clearing-house" functions would reside in the National Office, and R&D would be carried out in appropriate facilities and institutions. If properly managed such a program would have many obvious advantages, not the least of which would be improved patient care.
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