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Jesse Jupiter and Scott's Parabola

October 1, 2019

Dear CSS Members and Colleagues:


Enclosed is an article written by one of the most influential orthopedic surgeons of our time. Dr. Jupiter is truly generational. But it is not the skill he has acquired over all his years as an upper extremity surgeon that makes him so impactful, but the wisdom and thoughtfulness he brings to his view of our philosophy of carrying for patients. Indeed, his writing reminds me of similar writings by Albert Einstein. Einstein was not only a force of nature as a physicist, but he was an incredibly creative philosopher with a great sense of humor. He once said, “The True sign of intelligence is not knowledge but imagination.”


In the enclosed article Jesse speaks about “Scott’s parabola and the rise of the Medical-Industrial  Complex”. He discusses conflict of interest vs the patient interest and does so from a vantage point  selflessness. While I take issue with some of what he says as I don’t think it considers the principles of behavioral economics as defined by Kahneman and Taversky (The Undoing Project by Michael Lewis), this is an incredibly thoughtful consideration of what we do for our patients. Many younger surgeons  and business people will not remember the impact of thermal capsular shrinkage, and Vioxx on patients. Most will remember the outcome of metal on metal hips.


For those unfamiliar with Scott’s Parabola, it is the shape of the adoption curve for promising technology which is ultimately determined to be ineffective. See the image below:




Whatever you believe, ask yourself if what you read in our journals by way of level 4 cohort studies with small patient groups is presenting truth or a wish? Ask yourself if when we innovate, we are creating value and if so for whom? This is what we should do as part of CSS.


Kind Regards,


JP Warner, MD

Founder CSS


**REMINDER: The Codman Shoulder Society will soon be using Slack as our primary form of communication starting October 7th, 2019. Please go to under the menu labeled “Slack” to find instructions on how to create an account and join our workspace.**



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