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Orthopaedic Surgery, Medical Publishing, and the First Amendment of the United States Constitution

Marcus, Randall E., MD

Clinical Orthopaedics and Related Research®: July 2018 - Volume 476 - Issue 7 - p 1369–1370
doi: 10.1097/CORR.0000000000000343

R. E. Marcus, Professor, Charles H. Herndon Professor & Chair (Emeritus), Department of Orthopaedic Surgery Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

Randall E. Marcus MD, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-5000 USA, Email:

The author certifies that neither he, nor any members of his immediate family, 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, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Received April 10, 2018

Accepted April 18, 2018

For the last 9 years, I have had the privilege of chairing the Board of Trustees of Clinical Orthopaedics and Related Research®. During that time, this journal has had two outstanding Editors-in-Chief and many excellent Senior, Deputy, and Associate Editors who have authored scores of editorials, some of which were quite controversial [1, 2, 4-6].

I believe most readers agree that editorials in scientific journals should be thought-provoking. After all, a key goal of the editorial page of any vibrant publication—whether a newspaper, a magazine, or a medical journal—should be the generation of thoughtful dialogue. But unlike editors of magazines, the editors of scientific journals are in a unique position: They spend their time immersed in the science of their profession. And perhaps because of that vantage point, their perspectives sometimes differ from those of their readership. As the chair of CORR’s Board of Trustees, I am glad that our editorial pages are so engaging. I believe thoughtful editorials help catalyze changes that improve the health of our patients.

The Board of Trustees sometimes receives feedback from CORR’s readership about its editorials. Although the comments occasionally are supportive, more commonly, we receive dissenting viewpoints and even complaints. This does not surprise me; we all are busy, and most of us would not make the time to write a sleepy letter of agreement. We’re more likely to submit a letter when our passions are provoked. The letters-to-the-editor page reflects this, as does the mailbag of the Board of Trustees.

What does surprise me are the occasional notes I receive from readers who are so inflamed that they suggest the Trustee Board control what our Editor-in-Chief publishes or even fire him for the opinions he and his team express on the editorial page of CORR. The Board and I have always pointed out that we strongly believe in the right of free expression, a right that emanates from the First Amendment to the U.S. Constitution and has always been fundamental to our democratic society.

Technically, constitutional amendments such as freedom of speech do not apply to our journal’s editorial page, since neither CORR nor is its parent society (The Association of Bone and Joint Surgeons®) are public entities. For the same reason, freedom of the press does not apply here. In principle, CORR’s Board of Trustees could determine that it prefers a journal without an editorial page; this is not the same as a government restricting publication, since a society that owns a journal can make reasonable determinations about what it wants its journal to look like. At that stage, an editor—who was, after all, hired by the Board of Trustees—could choose either to comply or quit the job.

But what kind of a journal would that be? One that shies away from difficult or controversial topics? Do we need or want “safe spaces” as now exist at many schools and universities?

I am proud that CORR provides a forum for the free exchange of ideas within our profession, and I am proud of the Editor-in-Chief for using the editorial pages to promote this exchange. I don’t always agree with him, and when I don’t, I sometimes do what I suggest to those who complain to me: I write a letter to the editor [7]. Sometimes, he writes back [3].

When I am faced with a demand to lean on CORR’s Editorial Board because they have written something contrary to a reader’s dearly held opinion, I recall the words of the late Justice Brandeis of the U.S. Supreme Court [9], who once opined that “if there be time to expose through discussion the falsehood and fallacies, to avert the evil by the process of education, the remedy to be applied is more speech, not enforced silence”. Or, more poignantly, a quote often mistakenly attributed to Voltaire: “I disapprove of what you say, but I will defend to the death your right to say it” [8].

I ask that you keep reading. Feel free to agree or disagree with the editorials (or the scientific contents) in CORR. If you feel strongly, write a letter to the editor and express your point of view. CORR publishes the vast majority of letters it receives because its editors believe so strongly in the importance to our specialty of thoughtful, frank, and wide-ranging dialogue. I am proud to support them as they do so.

Randall E. Marcus MD

Randall E. Marcus MD

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I am grateful to Justice Jacques L. Weiner, Jr. of the U.S. Fifth Circuit Court of Appeals for his advice in the preparation of this editorial.

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1. Leopold SS. Editorial: Appropriate use? Guidelines on arthroscopic surgery for degenerative meniscus tears need updating. Clin Orthop Relat Res. 2017;475:1283–1286.
2. Leopold SS. Editorial: Getting evidence into practice—or not: The case of viscosupplementation. Clin Orthop Relat Res. 2016;474:285–288.
3. Leopold SS. Reply to the Letter to the Editor: Editorial: Do orthopaedic surgeons belong on the sidelines at American football games? Clin Orthop Relat Res. 2018;476:169–170.
4. Leopold SS, Beadling L. Editorial: The opioid epidemic and orthopaedic surgery—No pain, who gains? Clin Orthop Relat Res. 2017;475:2351–2354.
5. Leopold SS, Dobbs MB. Editorial: Orthopaedic surgeons should recommend that children and young adults not play tackle football. Clin Orthop Relat Res. 2016;474:1533–1537.
6. Leopold SS, Dobbs MB, Gebhardt MC, Gioe TJ, Rimnac CM, Wongworawat MD. Editorial: Do orthopaedic surgeons belong on the sidelines at American football games? Clin Orthop Relat Res. 2017;475:2615–2618.
7. Marcus RE, Barnes CL, Amendola A. Letter to the Editor: Editorial: Do orthopaedic surgeons belong on the sidelines at American football games? Clin Orthop Relat Res. 2018;476:167–168.
8. Tallentyre SG. The Friends of Voltaire. London, UK: J Murray; 2006.
9. Whitney v California, 274 U.S. 357 (1927).
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