Let There be Light – University of California Slogan
We received an anonymous letter at the offices of Orthopedics This Week in Wayne, Pennsylvania, this past week. The return address was just a name―“Dr. Jeff Wang”―who was the subject of an article we’d published the week before called “Jeff Wang Under Attack.” We opened the letter. It wasn’t, in fact, from Dr. Wang.
The author of the letter described him/herself as an “impartial non-voting observer of the board at UCLA.” The writer took sharp issue with our article and said, “Since this is a UCLA academic investigation and there may be an indictment, I cannot at this time divulge my identity.”
An anonymous letter, in other words. The letter attacked us for being misinformed. Then words like “lies, moral transgressions, deceptive reports, non-disclosure, unfortunate influence (demand) that his fellows and residents use his companies that he consults for and receives royalties from, when they get into practice (or he threatens to blackball them from the spine societies)” came tumbling out like so many cherry bombs to describe Dr. Wang.
In our article about Dr. Wang I was quoted as saying, “UCLA bears culpability in this matter.…Furthermore, UCLA itself suffers from a lack of transparency, which undermines the legitimacy of their actions.”
An anonymous letter from an “impartial observer” who, in effect, asserts that he/she knows more than we do speaks to a sense of powerlessness if not also a tendency to bypass institutional process and transparency. This letter didn’t help UCLA’s case.
We think the writer…if he or she is speaking from the heart…is probably missing the forest for the trees.
Dr. Wang is being accused of not disclosing his consulting and other financial arrangements to his employer, the University of California at Los Angeles (UCLA). The issue was first publicly disclosed in a July 22 story in The Wall Street Journal. According to the story, Dr. Wang had failed to fully complete his disclosure forms to UCLA. While the total amount of money and stock involved hasn’t been mentioned by UCLA, the amounts mentioned in the press were fees in excess of $550, 000 over several years and about 38, 000 shares of stock from a couple of companies. Dr. Wang has left his position as executive director of UCLA’s spine center.
Not surprisingly, given Dr. Wang’s contribution to research (more than 80 PubMed articles) this case is being discussed extensively by fellow surgeons, researchers and company managements.
Oh yes, and us.
We understand the $550, 000 plus 38, 000 shares of stock that Dr. Wang received over the course of many years from companies like Medtronic, Paradigm Spine, Fziomed, etc. Full disclosure now: Is this fight about ethics or is it also about something else? Money. Embarrassment. The glare of the spotlight.
Often, in high-profile firms, institutional embarrassment is a greater sin than the “crime” because embarrassment touches everyone―even folks off in Santa Clarita (where the anonymous letter was mailed).
When embarrassment becomes the issue, one well-known institutional response is to focus on one offending executive/officer/director (shift the spotlight away from the institution’s shortcomings) then strip him or her of the symbols of authority and in front of his or her peers ostracize the person to an academic “desert.” The anonymous letter we received was, we think, sent by a member of the UCLA institution to contribute to this process of drumming Dr. Wang out of the corps.
But the broader issue, which we tried to raise indirectly in our July 27 article about Dr. Wang, is that incentives are influencing UCLA as much as they might have influenced Dr. Wang (yet to be proven and, in our opinion, unlikely). We think, institutionally, UCLA is also vulnerable and must diffuse this suspicion by shining the light into its own dark corners.
Many pressures bear on modern, high-profile institutions like UCLA (or Harvard, Johns Hopkins, University of Pennsylvania, Stanford, Baylor, Duke, etc.). That makes cases like this difficult. The best researchers can be difficult and the least likely to bend to institutional rules. Herding cats is another way of saying it. So if the institutional processes are poorly constructed, communicated, understood or enforced, then a pattern will emerge of “feeding the big dogs” at the expense of bureaucratic forms (aren’t there enough in medicine already?).
UCLA, like many other institutions, was probably several steps behind their bread and butter research stars. That doesn’t mean researchers were doing anything wrong (like falsifying data); it just means that UCLA probably didn’t understand or prepare for the reality of modern, cutting-edge research and funding.
UCLA is, we think, nailing Dr. Wang because the tools being employed are all hammers. We continue to think that UCLA bears culpability because of its own inability to be transparent, because its own disclosure is poor, and because its internal processes and structure appear to this outsider to be antiquated.
Who Is the Writer?
Whoever wrote the anonymous letter, transparency and disclosure must simultaneously frighten and excite him/her. Disclosure diffuses, yet also grants, power. For example, the letter was sent from Santa Clarita, California, home of the UCLA Jonssen Cancer Center. If, and this is hypothetical, one of the Center’s directors is the “impartial non-voting observer of the board” that the writer says he/she is, then disclosure of this letter in OTW and to his/her colleagues is a frightening prospect.
Yet, charging and convicting Dr. Wang in the public press without allowing him or his advocates an opportunity to respond probably intrigues and attracts the writer as well. After all, why would this anonymous author send such a letter to a large and widely read orthopedic publication? Striping Dr. Wang of his authority in front of 50, 000 readers may have been an attractive prospect to the writer.
University politics are vicious. We close this article with a selection of Dr. Wang’s better-known research citations―lest anyone lose sight of his contributions during this debate.
Enhanced effects of BMP-binding peptide combined with recombinant human BMP-2 on the healing of a rodent segmental femoral defect. Morishita Y, Naito M, Miyazaki M, He W, Wu G, Wei F, Sintuu C, Hymanson H, Brochmann EJ, Murray SS, Wang JC. J Orthop Res. 2009 Jul 28.
The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine. Morishita Y, Naito M, Hymanson H, Miyazaki M, Wu G, Wang JC. Eur Spine J. 2009 Jun;18(6):877-83. Epub 2009 Apr 9.
An update on bone substitutes for spinal fusion. Miyazaki M, Tsumura H, Wang JC, Alanay A. Eur Spine J. 2009 Jun;18(6):783-99. Epub 2009 Mar 12.
Kinetic magnetic resonance imaging analysis of abnormal segmental motion of the functional spine unit. Kong MH, Hymanson HJ, Song KY, Chin DK, Cho YE, Yoon do H, Wang JC. J Neurosurg Spine. 2009 Apr;10(4):357-65.
The use of allograft bone in spine surgery: is it safe? Mroz TE, Joyce MJ, Lieberman IH, Steinmetz MP, Benzel EC, Wang JC. Spine J. 2009 Apr;9(4):303-8. Epub 2008 Sep 19.
Anterior cervical fusion: the role of anterior plating. Daffner SD, Wang JC. Instr Course Lect. 2009;58:689-98.
The pathophysiology and nonsurgical treatment of lumbar spinal stenosis. Daffner SD, Wang JC. Instr Course Lect. 2009;58:657-68.
Radiographic parameters of segmental instability in lumbar spine using kinetic MRI. Jang SY, Kong MH, Hymanson HJ, Jin TK, Song KY, Wang JC. J Korean Neurosurg Soc. 2009 Jan;45(1):24-31. Epub 2009 Jan 31.
A porcine collagen-derived matrix as a carrier for recombinant human bone morphogenetic protein-2 enhances spinal fusion in rats. Miyazaki M, Morishita Y, He W, Hu M, Sintuu C, Hymanson HJ, Falakassa J, Tsumura H, Wang JC. Spine J. 2009 Jan-Feb;9(1):22-30. Epub 2008 Sep 19.
Early complications of surgical versus conservative treatment of isolated type II odontoid fractures in octogenarians: a retrospective cohort study. Smith HE, Kerr SM, Maltenfort M, Chaudhry S, Norton R, Albert TJ, Harrop J, Hilibrand AS, Anderson DG, Kopjar B, Brodke DS, Wang JC, Fehlings MG, Chapman JR, Patel A, Arnold PM, Vaccaro AR. J Spinal Disord Tech. 2008 Dec;21(8):535-9.
Rabbit Model for in vivo Study of Intervertebral Disc Degeneration and Regeneration. Kong MH, Do DH, Miyazaki M, Wei F, Yoon SH, Wang JC. J Korean Neurosurg Soc. 2008 Nov;44(5):327-33. Epub 2008 Nov 30.
Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Miyazaki M, Hymanson HJ, Morishita Y, He W, Zhang H, Wu G, Kong MH, Tsumura H, Wang JC. Spine (Phila Pa 1976). 2008 Nov 1;33(23):E870-6.
Hypothermia for spinal cord injury. Kwon BK, Mann C, Sohn HM, Hilibrand AS, Phillips FM, Wang JC, Fehlings MG; NASS Section on Biologics. Spine J. 2008 Nov-Dec;8(6):859-74. Epub 2008 Mar 10.
Musculoskeletal allograft risks and recalls in the United States. Mroz TE, Joyce MJ, Steinmetz MP, Lieberman IH, Wang JC. J Am Acad Orthop Surg. 2008 Oct;16(10):559-65.
Ketorolac and spinal fusion: does the perioperative use of ketorolac really inhibit spinal fusion? Pradhan BB, Tatsumi RL, Gallina J, Kuhns CA, Wang JC, Dawson EG. Spine (Phila Pa 1976). 2008 Sep 1;33(19):2079-82.
A novel application of high-dose (50kGy) gamma irradiation for demineralized bone matrix: effects on fusion rate in a rat spinal fusion model. Alanay A, Wang JC, Shamie AN, Napoli A, Chen C, Tsou P. Spine J. 2008 Sep-Oct;8(5):789-95. Epub 2007 Aug 3.
The adjunctive effect of a binding peptide on bone morphogenetic protein enhanced bone healing in a rodent model of spinal fusion. Alanay A, Chen C, Lee S, Murray SS, Brochmann EJ, Miyazaki M, Napoli A, Wang JC. Spine (Phila Pa 1976). 2008 Jul 15;33(16):1709-13.
The effects of lentiviral gene therapy with bone morphogenetic protein-2-producing bone marrow cells on spinal fusion in rats. Miyazaki M, Sugiyama O, Tow B, Zou J, Morishita Y, Wei F, Napoli A, Sintuu C, Lieberman JR, Wang JC. J Spinal Disord Tech. 2008 Jul;21(5):372-9.
Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration. Miyazaki M, Hong SW, Yoon SH, Morishita Y, Wang JC. J Spinal Disord Tech. 2008 Jun;21(4):288-92.
Comparison of lentiviral and adenoviral gene therapy for spinal fusion in rats. Miyazaki M, Sugiyama O, Zou J, Yoon SH, Wei F, Morishita Y, Sintuu C, Virk MS, Lieberman JR, Wang JC. Spine (Phila Pa 1976). 2008 Jun 1;33(13):1410-7.
Stem cells from human fat as cellular delivery vehicles in an athymic rat posterolateral spine fusion model. Hsu WK, Wang JC, Liu NQ, Krenek L, Zuk PA, Hedrick MH, Benhaim P, Lieberman JR. J Bone Joint Surg Am. 2008 May;90(5):1043-52.
A porcine model of intervertebral disc degeneration induced by annular injury characterized with magnetic resonance imaging and histopathological findings. Laboratory investigation. Yoon SH, Miyazaki M, Hong SW, Tow B, Morishita Y, Hu M, Ahn SJ, Wang JC. J Neurosurg Spine. 2008 May;8(5):450-7.
The use of bone morphogenetic protein in spine fusion. Hsu WK, Wang JC. Spine J. 2008 May-Jun;8(3):419-25. Epub 2008 Apr 2. Review.
Comparison of human mesenchymal stem cells derived from adipose tissue and bone marrow for ex vivo gene therapy in rat spinal fusion model. Miyazaki M, Zuk PA, Zou J, Yoon SH, Wei F, Morishita Y, Sintuu C, Wang JC. Spine (Phila Pa 1976). 2008 Apr 15;33(8):863-9.
The effects of the degenerative changes in the functional spinal unit on the kinematics of the cervical spine. Morishita Y, Hida S, Miyazaki M, Hong SW, Zou J, Wei F, Naito M, Wang JC. Spine (Phila Pa 1976). 2008 Mar 15;33(6):E178-82.
Missed lumbar disc herniations diagnosed with kinetic magnetic resonance imaging. Zou J, Yang H, Miyazaki M, Wei F, Hong SW, Yoon SH, Morishita Y, Wang JC. Spine (Phila Pa 1976). 2008 Mar 1;33(5):E140-4.
Surgical outcomes of elderly patients with cervical spondylotic myelopathy. Holly LT, Moftakhar P, Khoo LT, Shamie AN, Wang JC. Surg Neurol. 2008 Mar;69(3):233-40.
Kinematic analysis of the relationship between the grade of disc degeneration and motion unit of the cervical spine. Miyazaki M, Hong SW, Yoon SH, Zou J, Tow B, Alanay A, Abitbol JJ, Wang JC. Spine (Phila Pa 1976). 2008 Jan 15;33(2):187-93. Erratum in: Spine. 2008 Apr 1;33(7):830.
A comparison of commercially available demineralized bone matrix for spinal fusion. Wang JC, Alanay A, Mark D, Kanim LE, Campbell PA, Dawson EG, Lieberman JR. Eur Spine J. 2007 Aug;16(8):1233-40. Epub 2007 Jan 5.
Safety and efficacy of implant removal for patients with recurrent back pain after a failed degenerative lumbar spine surgery. Alanay A, Vyas R, Shamie AN, Sciocia T, Randolph G, Wang JC. J Spinal Disord Tech. 2007 Jun;20(4):271-7.
Internet-based reference case managers for clinical practice and research collaboration. Bess RS, Brodke DS, Wang JC, Youssef JA, Dickey ID. J Am Acad Orthop Surg. 2007 Feb;15(2):135-6.
Minimally invasive 2-level posterior cervical foraminotomy: preliminary clinical results. Holly LT, Moftakhar P, Khoo LT, Wang JC, Shamie N. J Spinal Disord Tech. 2007 Feb;20(1):20-4.
Disc regeneration: a glimpse of the future. Tow BP, Hsu WK, Wang JC. Clin Neurosurg. 2007;54:122-8. Review.
Surgery for neck pain. Wieser ES, Wang JC. Neurosurgery. 2007 Jan;60(1 Supp1 1):S51-6. Review.
The osteoinductive properties of Nell-1 in a rat spinal fusion model. Lu SS, Zhang X, Soo C, Hsu T, Napoli A, Aghaloo T, Wu BM, Tsou P, Ting K, Wang JC. Spine J. 2007 Jan-Feb;7(1):50-60. Epub 2006 Nov 17.
Total disk arthroplasty. Lin EL, Wang JC. J Am Acad Orthop Surg. 2006 Dec;14(13):705-14. Review.
A thoracic and lumbar spine injury severity classification based on neurologic function grade, spinal canal deformity, and spinal biomechanical stability. Tsou PM, Wang J, Khoo L, Shamie AN, Holly L. Spine J. 2006 Nov-Dec;6(6):636-47. Epub 2006 Oct 10.
Cervical epidural steroid injections for symptomatic disc herniations. Lin EL, Lieu V, Halevi L, Shamie AN, Wang JC. J Spinal Disord Tech. 2006 May;19(3):183-6.
Biomechanical analysis of allograft bone treated with a novel tissue sterilization process. Mroz TE, Lin EL, Summit MC, Bianchi JR, Keesling JE Jr, Roberts M, Vangsness CT Jr, Wang JC. Spine J. 2006 Jan-Feb;6(1):34-9.
An outcomes analysis of the treatment of cervical pseudarthrosis with posterior fusion. Kuhns CA, Geck MJ, Wang JC, Delamarter RB. Spine (Phila Pa 1976). 2005 Nov 1;30(21):2424-9.
Demineralized bone matrix and spinal arthrodesis. Lee KJ, Roper JG, Wang JC. Spine J. 2005 Nov-Dec;5(6 Suppl):217S-223S. Review.
Percent spinal canal compromise on MRI utilized for predicting the need for surgical treatment in single-level lumbar intervertebral disc herniation. Carlisle E, Luna M, Tsou PM, Wang JC. Spine J. 2005 Nov-Dec;5(6):608-14.
The efficacy of different commercially available demineralized bone matrix substances in an athymic rat model. Lee YP, Jo M, Luna M, Chien B, Lieberman JR, Wang JC. J Spinal Disord Tech. 2005 Oct;18(5):439-44.
Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Parts1- 17 Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, Mummaneni P, Watters WC 3rd, Wang J, Walters BC, Hadley MN; American Association of Neurological Surgeons/Congress of Neurological Surgeons. J Neurosurg Spine. 2005 Jun;2(6):737-40.
The mechanical and thermal effects of focused ultrasound in a model biological material. Feng F, Mal A, Kabo M, Wang JC, Bar-Cohen Y. J Acoust Soc Am. 2005 Apr;117(4 Pt 1):2347-55.
Genetically modified human derived bone marrow cells for posterolateral lumbar spine fusion in athymic rats: beyond conventional autologous bone grafting. Peterson B, Iglesias R, Zhang J, Wang JC, Lieberman JR. Spine (Phila Pa 1976). 2005 Feb 1;30(3):283-9; discussion 289-90.
Lumbar disc arthroplasty. Gamradt SC, Wang JC. Spine J. 2005 Jan-Feb;5(1):95-103. Review.
The effect of uniform heating on the biomechanical properties of the intervertebral disc in a porcine model. Wang JC, Kabo JM, Tsou PM, Halevi L, Shamie AN. Spine J. 2005 Jan-Feb;5(1):64-70.
Reduction of leg pain and lower-extremity weakness for 1 year with Oxiplex/SP gel following laminectomy, laminotomy, and discectomy. Kim KD, Wang JC, Robertson DP, Brodke DS, BenDebba M, Block KM, diZerega GS. Neurosurg Focus. 2004 Jul 15;17(1):ECP1.
Adjacent segment degeneration in the lumbar spine. Ghiselli G, Wang JC, Bhatia NN, Hsu WK, Dawson EG. J Bone Joint Surg Am. 2004 Jul;86-A(7):1497-503.
Adjacent two-level lumbar discectomy: outcome and SF-36 functional assessment. Sun EC, Wang JC, Endow K, Delamarter RB. Spine (Phila Pa 1976). 2004 Jan 15;29(2):E22-7.
Perioperative complications of threaded cylindrical lumbar interbody fusion devices: anterior versus posterior approach. Scaduto AA, Gamradt SC, Yu WD, Huang J, Delamarter RB, Wang JC. J Spinal Disord Tech. 2003 Dec;16(6):502-7.
A cost analysis of bone morphogenetic protein versus autogenous iliac crest bone graft in single-level anterior lumbar fusion. Polly DW Jr, Ackerman SJ, Shaffrey CI, Ogilvie JW, Wang JC, Stralka SW, Mafilios MS, Heim SE, Sandhu HS. Orthopedics. 2003 Oct;26(10):1027-37.
L5-S1 segment survivorship and clinical outcome analysis after L4-L5 isolated fusion. Ghiselli G, Wang JC, Hsu WK, Dawson EG. Spine (Phila Pa 1976). 2003 Jun 15;28(12):1275-80; discussion 1280.
Reduction of radiculopathy and pain with Oxiplex/SP gel after laminectomy, laminotomy, and discectomy: a pilot clinical study. Kim KD, Wang JC, Robertson DP, Brodke DS, Olson EM, Duberg AC, BenDebba M, Block KM, diZerega GS. Spine (Phila Pa 1976). 2003 May 15;28(10):1080-7; discussion 1087-8.
Graft migration or displacement after multilevel cervical corpectomy and strut grafting. Wang JC, Hart RA, Emery SE, Bohlman HH. Spine (Phila Pa 1976). 2003 May 15;28(10):1016-21; discussion 1021-2.
Effect of regional gene therapy with bone morphogenetic protein-2-producing bone marrow cells on spinal fusion in rats. Wang JC, Kanim LE, Yoo S, Campbell PA, Berk AJ, Lieberman JR. J Bone Joint Surg Am. 2003 May;85-A(5):905-11. Erratum in: J Bone Joint Surg Am. 2003 Sep;85-A(9):1801.
Bone graft substitutes for spinal fusion. Whang PG, Wang JC. Spine J. 2003 Mar-Apr;3(2):155-65. Review. No abstract available.
Evaluation of neck pain, radiculopathy, and myelopathy: imaging, conservative treatment, and surgical indications. Boyce RH, Wang JC. Instr Course Lect. 2003;52:489-95. Review.
Single-level lumbar spine fusion: a comparison of anterior and posterior approaches. Pradhan BB, Nassar JA, Delamarter RB, Wang JC. J Spinal Disord Tech. 2002 Oct;15(5):355-61.
Epidural injections for the treatment of symptomatic lumbar herniated discs. Wang JC, Lin E, Brodke DS, Youssef JA. J Spinal Disord Tech. 2002 Aug;15(4):269-72.
Publication rates of presentations made at annual meetings of the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America. Yoo S, Oh G, Wang JC. Am J Orthop. 2002 Jun;31(6):367-9; discussion 369.
Effects of polyaxial pedicle screws on lumbar construct rigidity. Shepard MF, Davies MR, Abayan A, Kabo JM, Wang JC. J Spinal Disord Tech. 2002 Jun;15(3):233-6.
Bone grafting alternatives in spinal surgery. Vaccaro AR, Chiba K, Heller JG, Patel TCh, Thalgott JS, Truumees E, Fischgrund JS, Craig MR, Berta SC, Wang JC; North American Spine Society for Contemporary Concepts in Spine Care. Spine J. 2002 May-Jun;2(3):206-15. Review.
Enhancement of pedicle screw fixation through washers. Shepard MF, Wang JC, Oshtory R, Yoo J, Kabo JM. Clin Orthop Relat Res. 2002 Feb;(395):249-54.
