American Academy of Ophthalmology

i
FEDERAL TRADE CQMMISSIBP;"
WASHINGTON, D. C. 20580
J c r a l d 	A. 	J a e s b s , 	E s q .
Ltfghton Conklin Lcmov
Jacobs 	a n d 	B u c k l e y , 	C h a r t e r e d
2033 M Street, N.W.
Washington, 	D,C. 	2 0 8 3 6
mar 	Mr. 	Jaeobsr
T h i s 	letter 	r e s p o n d s 	t o 	your 	request 	f o r 	a n 	advisory 	opinion
concerning t h e 	p r o p o s e d 	code 	0 6 	e t h i c s 	of 	t h e 	h r i e a n 	Academy
01 Ophthalmology. 	The Academy, 	an 	organization of physicians
-specimIizing i n medical 	a n d 	surgical 	@ a r c o f 	t h e 	eye, 	intends 	t o
a d o p t 	r 	code 	of 	e l h i e s 	l o 	govern 	t h e 	professional e s n ~ u c lof 	i t s
members. 	T h i s 	eode would 	become 	part 	of 	t h e 	A e a d e m y b 	t y y f a w s ,
t o which 	ophthalmologists 	a g r e e 	t o 	s u b s c r i b e when 	t h e y 	j o i n 	t h e
organization. 	You have 	r e q u e s t e d 	a h e l 	t b c 	i s s i o n 	advise 	t h e
Academy 	w h e t h e r 	t h e 	p r o p o s e d 	eo 	f 	cthicsL/ c ~ m g l l c sw i t h
S e c t i o n 	S 	o f 	t h e 	Federal 	T r a d e 	ission A e t 	an 	11 o t h e r 	bppli-
cable 	s t a t u t e s 	& M i n i s t e r e d o r 	r e e d 	by 	t h e G	*
The 	laws 	e n f o r c e d 	b y 	t h e 	ission 	do n o t 	p r o h i b i t 	p r s f e s -
sional 	a s s o c i a t i o n s 	from a d o p t i n g 	r e a s o n a b l e 	ethical 	esdcs 	d e s i g n e d
t o 	p r o t e c t 	t h e 	p u b l i e , 	S u c h 	s e l f - r e g u l a t o r y 	a c t i v i t y 	s e r v e s 	Icgi-
timate 	p u r p o s e s , 	a n d 	i n most 	e a s e s 	e a n 	b e 	e x p e c t e d 	t o 	b e n e f i t ,
r a t h e r 	t h a n 	t o 	i n j u r e , 	competition 	a n d 	esnsurner 	w e l f a r e . 	I n 	some
i n s t a n c e s , 	however, 	p a r t i c u l a r 	ethical 	r e s t r i e l i o n s 	een 	u n r e a s o n -
a b l y 	r e s t r i e l 	eompetilion 	a n d 	t h e r e b y 	v i o l a t e 	t h e 	a n t i t r u s t 	laws,
The 	legality 	of 	ta p r o f e s s i o n a l 	a o c i e P g P s ethical 	r u l e s 	uhdea
t h e 	a n t i t r u s t 	laws d e p e n d s 	u p o n 	t h e i r 	p u r p o s e s 	a n d 	c o m p e t i t i v e
effesrs.21 	The m a t e r i a l s 	a c c o m p a n y i n g y o u r 	request 	s t a t e 	t h a t
t h e 	p u r p o s e 	sf 	t h e 	p r o p o s e d 	code 	of 	e l h i e s 	i s 	a e x c l u s i v e l y 	t o
p r o t e c t 	a n d 	b e n e f i t 	p a t i e n t s 	sf 	o p h t h a l m o l o g i s t s 	w h o 	a r e members
o f 	t h e 	A e a d e m y e n 	In 	a e e s r d a n e e w i t h 	i t s 	customary 	p r a e t i e e 	w h e n
U 	Suhni t t e d 	on A u g u s t 	3 1 , 	1 9 8 2 	a n d modified 	by 	your 	s u b m i s s i o n
on 	J a n u a r y 	1 7 , 	i983,
L1 	S e e National 	S o c f y of 	P r o f . 	E n g 9 r s v . 	U n i t e d 	S t a t e r , 	435 U . S .
( 1 9 7 8 ) ; 	h e r i c a n 	Medical 	A s s % $ 9 4 F,T.G, 	7 8 1 	( ' 1 9 1 9 ) .

J e s a l d 	A, Jacobs, 	E s q ,
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cdnsldering 	a d ~ i ~ ~ r y 	relied	opinion 	requests, 	t h e 	C s m i s s i o n 	has
upon 	t h e 	Academy" 	s h a l m e n t 	as 	ts 	t h e 	good 	f a l l h p u r p o s e 	of 	t h e 	.
eadc. 	T h u s , 	t h e C o m i s s i o n 	has 	focused 	i t s 	a t t e n t i o n 	on 	t h e
p r o b a b l e 	e f f e c t s 	on 	eompelllion 	of 	t h e 	v a r i o u s 	p ~ o v l s l o n s c o n t a i n e d
I n 	t h e 	Academy" 	p n s ~ p o s e d code 	of 	e t h i c s *
The 	A c a d e m y f s p r o p o s e d 	code 	o f 	e l h i e s 	contains 	t h r e e 	sec-
tions: 	4 1 ) 	n P ~ i n c j p l e sof 	EORles," w h i e h 	a r c 	a s p i r a t i o n a l 	guide-
l i n e s 	f o r 	professional 	conduel 	a n d 	a r e 	n o t 	cnfdrctable; 	( 2 ) 	'Rules
sf E l h i c ~ , ~	w h i e h 	establish 	specific cnforec8blc standards of 	eon-
d u e l 	foe' onrehers 	of 	t h e 	Aeademyi 	a n d 	( 3 ) 	RABPrfnistralivc Proce-
d u r e s , " 	which 	s a t 	f o r t h 	t h e 	s t r u c t u r e 	and operations 	o f 	t h e
A c a d e m y P s E t h i c s 	mmitttt 	a n d 	t h e 	procedures 	f o r 	investigative a n d
- d % s e i p l i n a r y p r o c e e d i n g s 	concerning 	e l h i e s 	c m p l a i n l s , 	a m b e r s
f o u n d 	t o 	h a v e 	violated 	t h e 	r u l e s 	of 	e t h i c s 	m y 	be 	r e p r i m n d e d ,
suspended 	f r o m 	t h e 	A c a d m y 	f o r 	a 	definite 	lime period, 	o r 	per-
manently 	e x p e l l e d ,
The 	e t h i c a l 	p r i n e l p n e s 	e x p r e s s 	t h e A e a Q m y 9 views 	r e g a r d i n g
t h e 	d u t i e s 	of 	an 	ethical 	o p h t h a l m o l o g i s t , 	T h e y 	s t a t e , 	f o r 	c x m p l e ,
t h a t 	o p k t h a l r n o l s g i e a l 	s e r v i e e s m u s t 	be 	p r o v i d e d 	w i t h 	e m p a s s i o n 	a n d
i n t e g r i t y , 	c o m p e t e n c e m u s t 	b e m a i n t a i n e d 	t h r o u g h 	e o n t i n b l e d . s t u d y s
c o n f i d e n t i a l i t y 	sf 	patient 	e s m u n i e a b i o n s must 	be 	r c s p e e l c d , 	l e t s
s h o u l d 	n o t 	exploit 	p a t i e n t s 	o r 	o t h e r s , 	o p h t h a l m o l o g i s t s 	d e l f e i e n l
i n 	e h t l a a s t e r . s h o u l d 	be 	r e g o r l e d 	t o 	t h e 	proper 	~ u l h o r i l f c s , a n d 	t h e
p a t i e n t " 	w e l f a r e 	m u s t 	be 	t h e 	ophthalmologist% 	p r i m a r y 	e o n s i d e r a m
l i o n , 	The G o m i s s i o n 	does 	n o t 	f i n d 	a n y 	significant 	t h r e a t 	Is corn-
p e t i t i o n 	p o s e d 	by 	t h e s e 	g 	~ 	~ 	p 	~ 	~ 	e 	d 	EI	g u i d e l i n e s , 	Is 	the C
s i o n t s opinion 	t h a t 	adoption s f 	t h e 	proposed 	m P r i n c i p l t s of 	E t h i c s R
f o r 	t h e 	p u r p o s e 	d e s c r i b e d 	by 	t h e 	Academy 	w o u l d 	n o t 	v i o l a t e 	tke
F e d e r a l 	T r a d e 	C o m i s s i o n 	Act 	o r 	a n y 	other 	s t a t u t e 	e n f o r c e d 	by 	t h e
C o m i s s i o n ,
The 	s e c o n d 	s e e t i o n 	o f 	t h e 	code 	contains 	t h e 	e t h i e a l 	r u l e s ,
w h i e h 	t h e 	Academy 	i n t e n d s 	l o 	e n f o r c e . 	As 	t h e i r 	t i t l e s 	i n d i c a t e ,
t h e s e 	r u l e s 	a d d r e s s 	various 	a s p e c t s 	of 	prsfessisnal 	csnduel:
C o q e t e n c e
Informed Consent
Clinical 	Experiments 	a n d 	I n v e s t i g a t i v e 	P r o c e d u r e s
O t h e r 	Opinions
The 	I m p a i r e d 	O p h t h a l m o l o g i s t
P r e o p e r a t i v e 	Assessmcnl
D e l e g a t i o n 	sf 	Services 	.
P o s t o p e r a t i v e 	Care

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J e r a l d 	A. 	J a c o b s , 	E s q .
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I * 	Medical 	a n d 	Surgical 	P r o c e d u r e s
Je 	Procedures 	a n d 	Materials
e r e g a l 	R e l a l l o n s h B p s
L. 	C a m u n i e a l i o n s 	t o Colleagues
Comunicatfons 	60 	t h e 	Publie
Most 	o f 	t h e s e 	r u l e s 	do 	not 	r a i s e 	significant 	antitrust
Issues, 	For 	e x m p l e p t h e 	Academy 	has 	p r o p o s e d 	r u l e s 	t h a t 	w ~ u l d
a s s u r e 	t o 	patients 	s u c h 	important psolcetions 	as 	informed 	consent,
careful 	preoperative 	evaluations, 	a n d 	a p p r o p r i a t e 	consultations,
O t h e r 	ethical 	r u l e s 	i n 	t h e 	p r o p o s e d 	eodc 	prohibit 	psaetlecs 	t h a t
c a u s e 	i n j u r y 	8 0 	patients, 	s u c h 	a s misreprcsentrllons 	of 	scsviecs
performed 	o r 	t h e 	ordering of 	unnecessary 	procedures 	f o r 	pecuniary
g a i n * 	Suck 	r u l e s 	a p p e a r 	u n l i k e l y 	t o 	Rave 	antdcompctitivc 	effects
t h e 	p r o v i s i o n s 	a d d r e s s i n g 	clinical 	experiments 	a n d 	$ n v c s t i g a t i v c
a n d mayD i n 	some 	instances, 	promote 	@owetition,
A 	few of 	t h e 	e t h i c a l 	r u l e s 	-- 	because 	of 	t h e 	nature o f 	t h e
r e s t r a i n t s 	t h a t 	t h e y 	impose 	-- 	require s e p a r a t e 	dfssussisn. 	These
a r e
p r o e e d u r c s , 	d e l e g a t i o n 	of 	sphthalmslogieal 	s c r v i e e s , 	p a s t o p e r a l i v e
c a r e , 	a n d 	c o m u n i e a l i ~ n s t o 	t h e 	publie,
R u l e 	C o f 	t h e 	Academy" 	proposed 	code 	r e q u i r e s 	ophthalmologists
t o 	obtain 	approval 	from 	R s d e q u a P e r e v f e w mechanisms" 	before 	u n d e r -
r a k i n g 	a 	" c l i n i c a l 	e x p e r i m e n t " 	o r 	an 	" i n v e s t i g a t i v e 	p r o e e d u r e l W 	The
o p k l h a l m o l o g i e a l 	p r o e c d u ~ e ss u b j e c t 	t o 	t h i s 	~eguiscmcnta r c 	defined
i n 	t h e 	r u l e , a s 	" t h o s e 	c o n d u c t e d 	t o 	d e v e l o p 	adequate 	inlornuntion 	on
which 	t o 	base 	prognostic 	o r 	t h e r a p t u l i e 	decisions, 	o r 	t o 	determine
etiology 	o r 	p a t h o g e n e s i s , 	i n 	eiseurnstanecs 	I n 	w h i c h 	insufficie68
i n f o r m a t i o n 	e x i s t s * " 	The 	r u l e 	does 	n o t 	r e q u i r e 	a 	parlleular 	t y p e
o f 	review mechanism 	f o r 	a l l 	e a s e s , 	I n 	s u p p l e m e n t a l 	m a t e r i a l s , 	t h e
Academy 	has 	indicated 	t h a t 	t h e 	eaneept 	of 	an 	" a d e q u a t e n 	review
mechanism 	i s 	i n t e n d e d 	t o 	b e 	f l e x i b l e , 	a n d 	t h a t 	t h e 	r u l e 	h a s 	b e e n
d r a f t e d 	I s 	permit 	u s e 	o f "infsrmaf" 	review mechanisms, 	s u c h 	ras 	a
t e l e p h o n e 	c o n f e r e n c e with 	a 	c o l l e a g u e , 	w h e n 	formal 	review would 	be
i r n p r r s ~ t i c a b l e ~The 	r u l e 	a l s o 	p r o v i d e s 	t h a t 	informed 	c o n s e n t l o r
c l i n i c a l 	e x p e r i m e n t s 	a n d 	i n v e s t i g a t i v e 	procedures 	" m u s t 	recognize
Dhcia 	special 	n a t u r e 	a n d 	r m i f i e a l i o n ~ ~ ~
A l t h o u g h 	u n n e c e s s a r i l y 	s t r i c t 	c o n t r o l s 	on 	t h e 	u s e of 	new
oghlhalmologieal 	p r o c e d u r e s 	c o u l d 	u n r e a s o n a b l y 	restriel 	e m p e l i t i o n
a n d 	i n n o v a t i o n , 	t h e 	Aeedemy- 	p r o p o s e d 	r u l e 	a p p e a r s 	Q o p r o v i d e 	s a f e -
g u a r d s 	t o 	p a t i e n t s 	-- 	t o 	protect 	them 	from uncontrolled 	e x p c r i -
mentalion 	-- 	w i t h 	no 	a p p a r e n t 	lessening 	of 	eompetilion, 	S e p i a u s

antitrust 	eoneerns would 	b e 	raised, of 	c o u r s e , 	r h o u % d t h e 	r u l e 	be
applied 	I n 	a 	Q i s c r % m i n a t o r y manner 	t o 	d i s e ~ ~ a a g c 	i n n o -	v f g ~ r o u sa n d
v a t d v e 	eompctitors 	o r 	be 	otherwise 	a b u s e d 	i n 	an 	a t t m b 	t o 	r e s t r a i n
l e g i t i m a t e 	c s q e t i t i o n .
R u l e 	G a d d r e s s e s 	delegation 	o f 	e y e 	c a r e 	services, 	This 	r u l e
d e c l a r e s 	t h a t 	certain 	e y e 	c a r c 	services may 	n s l . b e 	delegated 	l a 	n o n -
physician 	h e a l t h 	c a r e 	p r o f e s s i o n a l s 	(referred 	t o 	by 	t h e Aeademy 	i n
i t s 	r u l e 	as 	"auxiliary 	h e a l t h 	earc 	petssnncf@), 	Under 	t h e 	r u l e ,
n o n - d e l e g a b l e 	services a r t 	R I h e s c aspects 	of' eye 	c a r c w i t h i n 	t h e
unique competence of 	t h e 	ophthalmologist 	gwhfeh 	do 	n o t 	include 	t h e s e
p e r m i f l e d 	by 	Osw 	"Z 	bbc.r>er%srmedby 	s u x i l l a ~ f e s ) ~ ~	Materials 	aceom-
p a n y i n g 	your 	r e q u e s t 	s t a t e 	t h a t 	t h e 	t e r m 	m a u x % 1 3 a r i t s e as 	used 	I n
t h e 	code 	ineludes o g t m e t r l s t r , 	nurses, 	tcchnlclans, 	srthoptlsts a n d
o t h e r s , 	R u l e G 	f u r t h e r 	p r o v i d e s 	t h a t 	w h e n 	an 	ogRIRalmolsglst m a i n -
tains 	responsibility 	l o 	t h e 	patient 	f o r 	e y e 	e a r @ services 	not
wwithin t h e 	u n i q u e 	competence 	of 	t h e 	these	o p h t h a l m ~ l o g i s l , ~ 	s e r -
viecs 	m y 	Be 	delegated 	l o 	q u a l i f i e d 	non-physician 	h e a l t h 	c a r c 	pro-
fessionals w i t h 	a d e q u a t e 	supervision,
R u l e 	G 	a d d r e s s e s 	p r a e l i e e 	arrangements 	between 	e p h t k a l m o l o g $ s t s
a n d 	n o n - p h y s i c i a n 	h e a l t h 	e a r c 	p r o l t s s l s n a l s , 	a n d 	does 	not 	a p p l y 	t o
arrangements 	b e t w e e n 	o p h t h a l m o l o g i s t s 	a n d 	o t h e r 	p h y s i e l a n s , 	since
p h y s i c i a n s 	a r e 	n o t 	mauxiliarlcs.m 	The Gomlssisn 	u n d e r s t a n d s 	t h a t
" r e 	r u l e 	w o u l d 	n o t 	p r e v e n t 	ophthalmologists 	lrm m a k i n g 	a r r a n g e m e n t s
f o r 	d e l e g a t i o n 	o f 	eye 	@ a r e s e r v i c e s 	t o 	n o n - p h y s i e l s n s 	as 	long 	as
t h o s e 	a r r a n g e m e n t s 	a r c 	s t r u c t u r e d 	and 	c a r r i e d 	out 	i n 	a e e o ~ d a n e ew i t h
applicable 	s l a t e 	law, 	S t a t e 	laws 	r e g u l a t i n g 	h e a l t h 	e a r c 	p ~ o f e . s -
sionals 	p e r m i t 	t h o s e 	n o n - p h y s i c i a n s 	t h a t 	t h e 	Aeademy 	has 	d e s c r i b e d
as 	n a u x i l i e ~ i e s NLo 	p r o v i d e 	a 	v a r i e t y 	of 	e y e 	e a r c 	services, 	some-
limes 	a s 	i n d e p e n d e n t 	p r a c t i t i o n e r s 	a n d 	I n 	o t h e r 	eases 	under 	t h e
s u p e r v i s i o n 	of 	a 	licensed 	physician. 	U n d e r 	t h e 	code, 	s u c h 	services
a r e 	n o r 	t h e 	a p k t h a l m o l o g i ~ t , ~	"witbin 	t h e 	u n i q u e 	e o m p e l e n e e 	of 	a n d
therefore 	t h e y 	may 	b e 	d e l e g a t e d .
I t 	i s 	& ] s o . t h e C o m i s s ; i o n B s u n d e r s t a n d i n g 	t h a t 	t h e 	s u p e r v i s i o n
requirement 	contained 	i n 	$ h e 	r u l e , 	applicable w h e n 	an 	ophthalmolo-
g i s t 	r e t a i n s 	r e s p o n s i b i l i J y 	f o r 	e y e 	c a r c 	t h a t 	may 	be 	d e h e g a t e d , 	I s
n o t 	i n , t e n d e d t o mandate 	a 	p a r t i c u l a r 	t y p e 	o r 	d e g r e e 	01 	s u p e r v i s i o n
f o r 	a l l 	s i t u a t i o n s . 	S u p e r v i s i o n 	r c q u l r e m c n t s 	u n d e r 	s t a l e 	law v a r y
grc&llg, 	a n d may 	r a n g e 	f r m d i r e e l , 	on-site 	s u p e r v i s i o n 	t o 	praeliee
u n d e r 	s t a n d i n g 	o r d e r s 	or 	t e l e p h o n e 	eonsullalisn, 	The 	Aeaderny 	has
indicated 	in 	s u p g l m e n l a r y m a t e r i a l s 	p r o v i d e d 	t o 	t h e 	C 	issisn 	t h a t
t h e 	l e v e l 	of 	s u p e r v i s i o n 	required by 	t h e 	r u l e 	w i l l 	b e 	determined 	by

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J e r a l d 	A. 	J a c o b s , 	E s g ,
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r e f e r e n c e 	t o 	applieable 	s t a t e 	l a w , 	Fiwa%ly, t h e 	A e a d m y 	h a s 	s p e c i -
f l c a l l j provided 	f o r 	f l e x i b i l i t y 	i n R u l e 	G by 	t h e 	l a s t 	sentence of
t h e 	r u l e p w h i c h 	s l a t e s : 	"itrr 	sphthalms%oglst m y m a k e 	d i f f e r e n t
r r r r n g m e n t s 	% O F 	t h e 	d e l e g a t i o n 	of 	eye 	c a r t 	i n 	special 	e l r c m -
r t a w e e s , 	s u e h 	as 	emergencies, 	i f 	t h e 	p a t i e n t 9 	welfare 	a n d 	r i g h t s
a r t 	p l a c e d 	above 	a l l 	other 	e o n s i B e r a l i o n s m R
Serious antitrust 	c o n c e r n s would, 	of 	eaurst, 	b e 	r a i s e d 	by 	an
etfoierl 	r u l e 	t h a t 	u n r e a s o n a b l y 	fnterlcred with-legitimate esmpcli.-
t i o n 	by 	ophthalmologists working 	I n 	eonjunction w i t h 	nsn-physician
h e a l t h 	c a r c 	prsftsslsnals, o r 	prevented 	optometrists 	o r 	others 	f r o m
p r o v i d i n g 	scrvdees 	t h a t 	they a r e 	legally a n d 	p r o f e s s i o n a l l y 	q u a l f -
f f c d t o 	p r o v i d e , 	I t 	I s 	t h e 	C 	issionPs opinion* 	t h o u g h , 	based on
I t s 	u n d e r s t a n d i n g 	s e t 	f o r t h 	above 	and 	t h e 	A e a d e m y f s suppIcmtntal
assuranecs 	and 	explanations, 	t h a t 	Rulc C s h o u l d 	n o t 	have 	these
e f f c e t s ,
Rule H a d d r e s s e s 	arrangements 	f o r 	e a r * 	lollawing 	e y e 	s u r g e r y ,
Like Rule G , 	i t 	eoncerns 	aspeels 	sf e y e 	c a r c 	-- 	i n 	t h i s 	partieulsr
r u l e 	p o s t o p e r a t i v e 	eye 	c a r c 	-- 	t h a t 	a r e 	Rwilhin t h e 	u n i q u e 	e m -
petenee 	of 	t h e 	oghthadmologist 	( w h i c h 	do 	n o t 	i n e l u d e 	t h o s e 	permitted
by 	l a w 	l o 	be 	performed 	by 	a u x i l i a r l e ~ ) , ~ R u l c 	H d e c l a r e s 	t h a t 	t h o s e
a s p e c t s 	of 	p o s t o p e r a t i v e 	e y e 	@ a r cmust 	be 	p r o v i d e d 	either 	by 	t h e
o p e r a t i n g 	opktkalmolsgisl 	o r 	by 	another 	opkthalmologist 	w i t h 	whom 	a
r e f e r r a l 	a r r a n g e m e n t 	has 	been 	made, 	I d 	i s 	t h e 	C o m i s s I a n P s u n d e r -
s t a n d i n g 	t h a t 	t h e Academy 	p r e f e r s 	t h a t 	t h e 	o p e r a t i n g 	ophthalmologist
p r o v i d e 	t h e 	a s p e s t s 	of 	p o s t o p e r a t i v e 	e a r c 	covered by R u l c H, but
t h a t , 	n o n e t h e l e s s , 	t h e 	code 	has 	been 	d r a f t e d 	I s 	l e a v e Aeadmg m m -
b e r s 	f r e e 	l o 	r e f e r 	patients 	l o 	a n o t h e r 	ophthalmologist 	f o r 	t h i s
p o s t o p e r a t i v e 	e a s e .
The 	r u l e 	a l s o 	p r o v i d e s 	t h a t 	w h e n 	a 	p a t i e n t 	i s 	referred 	f o r
p s s l o p e r a t i v e 	c a r e , 	t h e 	o p e r a t i n g 	o p h t h a l m o l o g i s t 	must 	m a k e 	t h e
a r r a n g e m e n t s 	b e f o r e 	s u r g e r y , 	a n d 	t h e 	p a t i e n t 	a n d 	t h e 	o t h e r 	o p h t h a l -
mologist 	m u s t 	a g r e e , 	The 	r u l e 	f u r t h e r 	d e c l a r e s 	t h a t 	l e e s 	f o r 	p o s t -
o p e r a t i v e 	c a r e 	s h o u l d 	refleet 	t h e 	arrangements 	t h a t 	have 	b e e n 	m a d e ,
" w i t h 	advance 	d i s s l o s u r e 	t o 	t h e 	patleoteR 	F i n a l l y , 	R u l e H s t a l e s
t h a t 	" d i f f e r e n t 	a r r a n g e m e n t s " 	f o r 	p o s t s p e r a l i v e 	eye 	c a r e may 	b e made
f n m e r g e n e i e s 	o r 	o t h e r 	s p e c i a l 	c i r e m s t a n c e s , 	as 	l o n g 	as 	t h e
patient" 	welfare 	a n d 	r i g h t s 	a r e 	t h e 	p r i m a r y 	c o n s i d e h a t i o n e 	Expla-
nrlqry materials 	~ c c m p a n g i n gyour 	request 	slate t h a t 	special 	c i r -
e m s t a n c e s 	Inelude, 	l o r 	e x m p l e , 	csses 	i n 	w h i c h 	n s 	o p h t h a l m o l o g i s t
I s 	a v a i l a b l e 	l a 	perform 	t h e 	p o s t o p e r a t i v e 	c a r c 	On 	t h e 	g e o g r a p h i c
a r e a 	w h e r e 	t h e 	p a t i e n t 	r e s i d e s .

J e r a l d 	A. 	J a c o b s , 	E s g .
Page 	6
= 	R u l e H a d d r e s s e s 	aspects 	o f 	p o s t o p e r s n t i v e 	eye 	c a r e 	falling
within 	t h e 	r a n g e 	o f 	services 	t h a l 	o n l y 	p k y s l c f a n s 	a r t 	q u a l i f i e d by
law t o 	p c ~ l o r n r , 	POF c x m p l c , 	t h e 	r u l e 	would 	n o t 	p r e v e n t
o p h t h a l m s ~ c g i s t s f r m a r r a n g i n g 	f o r 	optometrists 	t o 	grovlde
p o s t o p e r a t i v e 	eye 	c a r c 	s e r v i e e s 	consistent w i t h 	s t a l e 	law, 	'It
appears, however, 	t h a t 	t h e 	r u l e 	c o u l d 	a f f e c t 	p o s t o p e r a t i v e 	c a s e
arrangements w i t h 	p h y s i c i a n s 	w h o 	a r c 	not 	ophlhatnologisls, 	The
question a r i s e s 	w h e t h e r 	Rule H 9 s identilieallon sf s m e 	p o s t o p e r a -
tive 	eye 	c a r t 	s e r v i e c s 	a s 	" w i t h i n 	t h e 	unique 	c m p c t c n c c 	o f 	t h e
ophthalmologistm m i g h t 	unreasonably 	p r e v e n t 	Academy 	members 	from
r e f e r r i n g 	patients 	t o 	qualified 	physicians 	who a r c 	n o t 	s p e c i a l i s t s
i n 	ophthalmology, 	tither 	i n d i v i d u a l 	p r i v a t e 	praetdtfsncrs 	o r 	t h o s e
i n 	h e a l t h 	maintenance 	srganizatlons 	a n d 	other group 	settings,
u r e m e n l s 	mong 	e o m e t i t o r s 	t o 	exelude a n o t h e r 	g r o u p 	o f
competitors 	from a m r k c t 	a r e 	h i g h l y 	suspect 	under 	t h e 	antitrust
laws. 	T h u s , 	I f 	R u l e 	H were a. 	s t r i c t 	prohjbitfon 	t h a t 	had 	t h e 	e f f e c t
of 	categorically 	e x e l u d i n g 	non-ophlhalmsloglst 	physieians 	f r m s m e
a s p e c t s 	o f 	m e d i c a l 	p r a e t i e c , 	i t 	m i g h t 	r a i s e 	serious a n t i t r u s t 	qucs-
lions. 	I t 	u n d e r s t a n d i n g , 	however, 	t h a t	is 	t h e C ~ m i s s i o n ~ s 	bht
Academy 	bas 	e n d e a v o r e d 	t o 	p r o v i d e 	f o r 	f l e x i b i l i t y 	f n Rulc H e 	One
c x m p l c 	of 	t h i s 	f l e x i b i l i t y 	i s 	t h e 	l a s t 	scntcnec 	of 	t h e 	r u l e , 	u h 4 c h
p r o v i d e s 	f o r 	other 	r e f e r r a l 	a r r a n g e m e n t s 	I n 	"opeeial 	e i r e m -
stances." 	m o t h e r 	a r e a 	o f 	l l c x i b l l l l y 	involves 	t h e 	determination
o f 	what 	e y e 	c a r c 	functions 	a r e 	unique 	t o 	ophthalmology,
The C s m i s s i s n 	u n d e r s t a n d s 	t h a l 	f l 	i s 	t h e 	A c a d e m y ' s 	position
t h a t 	t h e 	p r e c i s e 	e y e 	e a r c 	f u n c t i o n s 	d e m e d 	t o 	be 	"wtthin 	t h e 	u n i q u e
competenee 	of 	t h e 	ophthalmologist" 	will 	v a r y 	depending upon 	t h e
c i r c m s t a n e t s 	invalvtd, 	A l t h o u g h 	t h e 	p r o p o s e d 	code 	d e f i n e s 	aa
msphthalmoPogisB" a s 	" a 	physician who 	i s 	e d u c a t e d 	a n d 	t r a i n e d 	t o
p r o v i d e msdieal 	a n d 	surgical 	c a r e 	of 	t h e 	e y e s 	and 	r e l a t e d 	s t r u e -
t u r c s , " 	s t a t e 	s t a t u t e s 	e n d 	regulations 	d o 	n o t 	d e f i n e 	a r e a s 	sf
medical 	s p e e i a l i z a b i o n , 	s u c h 	a s 	ophthalmology, 	and 	t h u s 	do 	n o t
d e l i n e a t e 	an 	a r e a 	sf m e d i c i n e 	t h a t 	might 	be 	e o n s i d e r e d 	"within t h e
u n i q u e 	c o m p e t e n c e 	of 	t h e 	o p h t h a l m o l o g i s t e n 	Niorasvtr, 	t h e 	Academy
s t a t e s 	i n 	i t s 	e x p l e n a t o r y 	m a t e r i a l s 	s u b m i t t e d 	w i t h 	t h e 	p r o p o s e d 	c o d e
t h a t 	i t 	i s 	n o t 	seeking 	t h r o u g h 	i t s 	e o d t 	of 	t d h i e s 	t o 	d e f i n e 	t h e
a p p r o p r i a t e 	scope 	of 	practice 	sf 	h e a l t h 	c a r e 	p e r s o n n e l , 	R a t h e r ,
t h e s e 	s u p p l e m e n t a r y 	m a l e r i a l s 	s e t 	f o r t h 	a 	flexible a p p r o a c h , 	a n d
s l a t e 	t h a l 	I n 	determining w h a t 	eye 	care 	s e r v i e e s 	f a l l 	w i t h i n 	t h e
special 	s p h e r e of 	% h e ophthalmologist, 	t h e 	AeaQmy will 	l o o k 	t o 	" t h e
e i r e m s t a n e e s 	o f 	eaek 	situation" 	and 	" w h a t e v e r 	governing mandatory
o r 	v o l u n t a r y 	e r e d e n t i a l i n g meshanisms 	m i g h t 	e x i s t , @ 	T h u s , 	as 	t h e
Csmisrisn 	u n d e r s t a n d s 	i t , 	R u l c EI w o u l d 	n o t 	p r e c l u d e 	an Aeademy

mehber 	f r m r e f e r r i n g 	patients 	t o 	a 	non-ophthalmological 	specialist
f o r 	p o s t o p e r a t i v e 	e y e 	c a r e , 	as 	l o n g 	a s 	t h e 	i n d i v i d u a l 	p h y s i c i a n P s
training 	and 	c x p e r l e n e c 	q u a l i f i e d 	h i m 	o r 	h e r 	t o 	p r o v i d e 	t h e 	parti-
cular p o s t o p e r a t i v e 	s e r v i e c s ,
I n 	l i g h t 	o f 	t h i s 	I l e x i b i O i t y , 	I h t 	G o m i s s i o n 	eonelodes 	t h a t
R u l e 	H 	i s 	a 	reasonable 	r u l e 	t h a t 	eould 	p r o v i d e 	valuable 	protection
t o 	e o n s m e r s * 	AS 	long 	as 	i t 	i s 	a p p l i e d 	f a i r l y 	a n d 	sbjeelively, a n d
i s 	n o t 	interpreted m o r e 	b r o a d l y 	t h a n 	necessary 	l o 	aekieve 	i t s 	Eegi-
timate g o a l , 	i t 	s h o u l d 	n o t 	unreasonably 	impair 	csmpetltism, 	Careful
attention will 	have 	t o 	be 	p a i d 	t o 	interpretation 	and 	enforcement 	of
R u l e H, because 	t h e 	l a c k 	o f 	o f	a n y 	e l e a r 	definition f o r 	n a ~ p e c t ~ 	e y e
c a r e within 	t h e 	unique 	competence sf t h e 	o p h t h a l m o l o g i s t R may make
t k 	r u l e 	s u s c e p t i b l e 	l o 	abuses 	I n 	applieatioa. 	Obviously, 	i f 	t h e
e f f e c t 	of' 	t h e 	r u l e 	were 	t o 	f m t d e 	new and 	p o t e n t i a l l y 	cost-effective
m e t h o d s 	f o r 	t h e 	d e l i v e r y 	of 	qualily 	eye 	c a r e 	o r 	t o 	e x e l u d e 	u n a c s -
s o n a b l y 	I m i l y 	physicians 	o r 	o t h e r 	doctors 	I r m certain aspects 	o f
medical 	practice, 	serious 	antitaust 	c o n c e r n s w o u l d 	be 	a e l s t d . 	None-
t h e l e s s , 	Based 	on 	t h e 	a v a i l a b l e 	i n f o r m a t i o n , 	i t 	appears 	t h a t 	adop-
t i o n 	o f 	R u l e 	H would 	not 	pose 	an 	unlawful 	t h r e a t 	t o 	eornpctlbjcsn 	o r
8 e o n s m e r 	w e 1 t a r e ,
~ o m u n i e a l i o n sIs 	t h e 	Public
Rule M 	s e t s 	f o r t h 	s e v e r a l 	r e s u i r m e n t s 	f o r 	a d v e ~ t i s l n aa n d
o t h e r 	c o m u n i e a t i a n s 	l o 	t h e 	p u b l 1 6 , 	The 	r u l e bans 	f a l s e 	0 ; 	deeep-
t i v e 	c a m u n i c a t i o n s , 	b o t h 	affirmative m i s r e p r e s e n t a l i o n s 	a n d m i s -
r e p r e s e n t a t i o n s a r i s i n g 	from 	t h e 	failure 	t o 	disclose 	a m l e r i a l
f a e l , 	I t 	does 	not 	ban 	a n y 	gertieular 	form of 	e s m u n l e a l i s n , 	s u c h 	as
testimonials 	O P 	p i e t o r i a l 	representations; 	r a t h e r , 	i t 	p r o v i d e s 	t h a t
t h e s e 	a n d 	s t h e r 	f o r m s 	of 	e o m u n i e a t i o n s 	m u s t 	n o t 	convey 	f a l s e 	o r
d e c e p t i v e 	information.
R u l e M 	a l s o 	p r o h i b i t s 	certain 	s p e c i f i c 	t y p e s 	o f 	r e p r e s e n t a -
t i o n s . 	The 	r u l e 	b a n s 	eomunieations 	t h a t : 	" a p p e a l 	$ 0 an 	i n d i -
v i d u a l " 	saxxietg 	i n 	an 	e x c e s s i v e .or 	unfair 	wayw; R e r e a t e u n j u s t i f i e d
e x p e e t a t i o n s 	of 	r e s u l t s " ; 	"misrepresent 	an 	o p h t h a l m o l o g i s t 3 	e r e -
d e n t i a l s , 	training, 	experience 	or 	a b i l i t y m ; or 	"contain material
elaims sf 	s u p e ~ i o r i t y t h a t 	cannot 	be 	s u b s t a n t i a l e d e n
The- 	p ~ o v i s i o n s e l a b o r a t e 	en 	t h e 	r u l e ' s 	general 	p r o s c r i p t i o n
of 	f a l s e o r 	deceptive 	e o m u n i e a t i s n s , 	W i t h 	r e s p c e t 	l o 	a p p e a l s 	t o
rnxiity, 	t h e 	Academy 	has 	t a k e n 	i n t o 	aecount 	t h e 	I a e t 	t h a t 	infor-
matiqn 	on 	h e a l t h 	e a r @ t o p i c s may 	o f t e n 	c r e a t e 	anxiety 	a n d 	has
d r a f t e d 	t h e 	r u l e 	l o m k e 	c l e a r 	t h a t 	i t 	i s 	aimed 	a t 	t h o s e 	e o m u n i -
earions 	t h a t 	u n f a i r l y 	s r 	o p p r e s s i v e l y 	c a u s e 	anxiety, 	The 	@ o m i s s i o n

J c r a l d 	A. 	Jacobs, 	E r q ,
Page 	8
un-dcrslands 	t h a t 	t h i s 	provision 	w i l l 	be 	enforced 	r e a s o n a b l y 	a n d 	.
o b j c e l f v c l g , l o a v o i d 	discouraging 	t h e 	d i s s e m i n a t i o n 	of 	v a l u a b l e
I~fsrmationt o 	e s n s m e r s , 	The 	ban on 	e o n a n u n l c a t i ~ ~ n st h a t , " e r e a t c
u n j u s t i f i e d e x g e e t a t i o n s 	c s l " r c s u l l s m p r o h i b i t s 	d e c e p t i v e 	repre-.
sentatlens 	r e g a r d i n g 	t h e 	likely 	r e s u l t s 	of 	o p k l h a l r n o l o g l c a l 	t r e a t -
m e n t , 	The 	l a s t 	two 	pravlslons 	i d e n t i f i e d above 	address 	f a l s e 	o r
misleading 	statements 	a b o u t 	t h e 	q u a l f f i c a l l o n s 	of 	an 	ophlhal-
nnologist. 	The 	Cowmission n o t e s 	t h a t 	%Re r u l e 	prohfbits 	Rmalcrial
elaims of 	superiority 	t h a t 	c a n n o t 	be 	s u b s l a n t l a t c d " 	a n d 	docs 	n o t
contain a 	b a n 	on 	mseP%-laudatsryH o r 	AscBb-aggrandizlngm statements,
Finally, 	R u l c M contains 	two 	d i s c l o s u r e 	requgremcnts, 	D i s e l s -
sures 	r e g a r d i n g 	s a f e t y , 	c b f i e a c y , a n d 	t h e 	a v a i l a b i l i t y 	of 	a l t e r n a -
t i v e s 	m u s t 	be m d c 	2 % 	a 	comuniealion 	r e f e r s 	t o 	" b e n e f i t s 	o r 	other
a t t r i b u t e s 	o f 	ophlhalmlc 	proecdures 	o r 	produels 	t h a t 	involve 	s i g n i -
lieant 	risks,* a n d 	i n 	# m e c a s t s 	descriptions 	or 	assessments 	of
a l t e r n a t i v e 	treatments m u s t 	be 	g i v e n , 	. Ira 	a d d i t i o n , 	a 	eomunieation
m u s t 	I n c l u d e 	a 	d i s e l s s u r c 	t h a t 	i t 	m r c s u l t s 	I r m p a p e n t 	by 	an
o p h r h a l m o l o g i ~ t , ~ 	i s 	t h e 	ease 	a n d 	i t 	Is 	not 	o b v i o u s 	from	when 	t h i s
t h e 	n a t u r e , 	f o r m t , 	o r 	m c d i m 	of 	t h e 	c ~ m u n i c r l i o n ~
The - m i s s i o n 	u n d i r s t a n d s 	t h a t 	a l l 	sf 	t h e 	disclosures 	i d e n t i -
f i e d 	i n 	t h e 	r u l e 	a r e 	required 	o n l y 	w h e n ' a t e e s s a r y 	l o 	a v o i d 	dcecp-
t i o n . 	The Aeademy 	h a s 	s p e e i f i e a l l y 	r ~ p r e s e n t c d t h a t 	t h e 	d l s c l ~ s u r c
r e q u i r e m e n t s w i t h 	respect 	l o 	e o m u ~ i e a t i o n st h a t 	" r e f e r 	t o 	b e n e f i t s
o r 	o t h e r 	a t t r i b u t e s 	of 	ophthalmic 	p r o c e d u r e s 	o r 	p r o d u e t s 	t h a t
involve 	significant 	risksR a r e 	i n t e n d e d 	a n d 	w i l l 	be 	construed 	by
t h e 	Aeadcmy 	t o 	r e q u i r e 	diselosures 	o n l y 	t o 	t h e 	e x t e n t 	ncecssarg 	t o
p r e v e n t 	d e c e p t i o n 	sf 	t h e 	publie* 	The G 	ission 	a l s o 	u n d e r s t u d s
t h a t 	m e r e 	identifieation 	sf 	an 	ophthalmic 	proetdurc 	or 	produet 	t h a t
i n v o l v e s 	s i g n i f i c a n t 	r i s k s , 	without 	r e f e r e n c e 	t o 	i t s 	b e n e f i t s 	o r
o t h e r 	q u a l i t a t i v e 	a t t r i b u t e s , 	w i l l 	nsl 	t r i g g e r 	t h e 	d i s c l o s u r e
r e q u i r e m e n t , 	F u r t h e r m o r e , 	t h e 	Academy 	has 	r e p r e s e n t e d 	t h a t 	an
a d v e r t i s e m e n t 	f o r 	r o u t f n c eye 	c x m i n a t i o n s , 	s u e h 	as 	R s a f e g u a r Q y o u r
h e a l t h ; 	g e t 	y o u r 	e y e s 	c h e e k e d ; 	c a r e f u l 	a n d 	t h o r o u g h 	eye 	e x m i n a t i o n s
by 	a p p o i n t m e n t , " 	w o u l d 	n o t 	n e e d 	t o 	eonlain 	t h e 	d i s e l o s u r e s 	i d e n t i -
f i e d 	i n R u l c M e 	Similarly, 	t h e 	diselosuac 	eequirsmenls 	of 	t h e 	r u l e
would 	n o t 	be 	t r i g g e r e d 	by 	a 	e o m u n i c s t i o n 	t h a t 	a d v e r t i s e d 	t h e
f i t t i n g o r 	provision 	o f 	eonlaet 	lenses 	a n d 	n o t e d 	s u c h 	a t t r i b u t e s 	as
improved 	a p p e a r a n e c , 	user 	o r	e ~ m f o r t ~ 	I n e ~ p e n s f ~ e n ~ ~ s ~
Based 	on 	i t s 	u n d e r s t a n d i n g 	of 	Aufc M and 	t h e 	Acaderny" 	s u p p l e -
menla'l 	assurances 	a n d 	e x p l a n a t i o n s , 	t h e 	C o m i s s l o n 	belleves 	t h a t
t h i s 	rul'e 	does 	not 	pose 	sn 	u n r e a s o n a b l e 	t h r e a t 	l o 	e m p e l l t i s n 	o r
e o n s m e r s , 	R u l e s 	t h a t 	a r e 	tailored 	t o 	p r e v e n t 	f a l s e 	o r 	d e c e p t i v e
a d v e r t i s i n g 	s e r v e 	t o 	enhance 	the 	c o m p e t i t i v e 	p r o c e s s 	and 	p r o v i d e

vc1'1uablc c o n s u e r 	grctcctlon. 	C a r e 	s h o u l d 	b e 	exercised, 	o f 	e o u r s e ,
t o 	e n s u r e 	t h a t 	I n t e r p r e t a t i o n and 	c n f s r c m c n l 	of 	t h e 	r u l e 	does 	not
have 	t h e 	c f f e e t 	sf 	s u p p r e s s i n g 	n o n d e e e p t i v e 	a d v e r t i s i n g o r 	o t h e r
unieations 	I s 	t h e 	publie.
l t 	i s 	opinion, b a s e d 	on 	t h e 	foregoing 	a n d 	t h e	t h e ~ o m i s s i o n ~ s
Academy's 	s u p p l m t n t a l 	a s s u r a n e c s 	a n d 	explanations, %Rat a d o p t i o n 	o f
t h e 	proposed 	"Rules of 	Ethics" 	would 	n o t 	v i o l a t e 	t h e 	Federal 	T r a d e
issioo Aet 	o r 	a n y 	o t h e r 	l a w s 	e n f o r s c d 	by 	t h e 	issisn, 	The
ission nates 	t h a t 	t h e Academy 	has 	stated 	t h a t 	ajm 	i s 	t o
m a s s u r e t h a t 	t h e 	code 	6 s 	i n t e r p r e t e d 	a n d 	e n f o r c e d 	objtetively and
with 	fairness,' 	T h i s 	i s 	essential, 	f o r 	even 	t h e most 	carefully
d r a f t e d 	clhleal 	r u l e s 	can 	e r e a t e 	antitrust 	probIems 	$ 1 t h e y 	a r t
a6ustde 	Rule 	K, f o r 	exismple, 	declares 	t h a t 	an 	sphbhalms~sgislm u s t
n o t 	l e t 	h i s 	o r 	h e r 	elinisal 	j u d p e n a 	a n d 	p r a e t i c c 	be 	a f f e c t e d 	by
c o m e r c i a 1 	interests, 	T h i s 	rune 	could 	r a i s e 	serious 	eoneerns 	1 B 	Bt
were 	b r o a d l y 	interpreted 	t o 	e f f e c t 	r 	f l a t 	ban 	on 	certain 	t y p e s 	o f
~ c g S I i m a t ce o m e r e i h l 	r e l a t i o n s h i p s .
The 	f i n a l 	s e c t i o n 	of 	t h e 	p r o p o s e d 	code 	of 	t t h l e s 	B c s e r i b e s 	t h e
a * i n i s t r a l i v e 	p r s e e d u r e s 	t h a t 	w i l l 	be 	u s e d 	I s 	i m p l e m e n t 	t h e 	tthieal
r u l e s , 	The 	procedures 	e s t a b l i s h e d 	by 	t h e 	e o d c 	inelude: 	notice 	t o
t h e 	aeeused of 	t h e 	e x i s l e n e e 	of 	an 	i n v e s t i g a t i o n ; 	o p p o r t u n i t y 	f o r 	8
h e a r i n g ; 	r i g h t 	t o 	c o u n s e l ; 	o p p o r t u n i t y 	l o 	e r o s s - e x m i n e 	w i t n e s s e s
a n d 	o f f e r 	e v i d e n c e ; 	r i g h t 	t o 	a p p e a l 	an 	a d v e r s e 	decision; 	and 	pre-
s e r v a t i o n 	o f 	a w r i t t e n 	record,
Courts 	Rave 	h e l d 	t h a t 	when 	m m b e r s h i p 	i n 	rn,srganization of
competing 	f i r m s 	or 	i n d i v i d u a l s 	c o n f e r s 	a 	significant 	e o q c t i t i v e
a d v a n t a g e , 	d i s c i p l i n a r y 	measures 	s u e h 	a s 	suspension o r 	termination
may 	n e t 	be 	imposed without 	a d e q u a t e 	p r o c e d u r a l 	s a f e g u a r d s , 	The
p r o p o s e d 	eade 	p r o v i d e s 	significant 	p r o c e d u r a l 	s a f e g u a r d s , 	I t 	i s 	t h e
@ s m i s s i o n 9 s 	oppinion 	t h a t 	a d o p t i o n 	a n d 	use 	of 	t h e 	" A h i n i s t r a t i v e
P r o s e d u r e s H 	contained 	i n 	t h e 	proposed 	code 	w o u l d 	n o t 	v i o l a t e 	t h e 	'
a n t i t r u s t 	l a w s 	o r 	a n y 	o t h e r 	l a w s 	e n f o r c e d 	by 	t h e 	G
Ascsrdingly, 	t h e C o m i s s l o n 	caneludes 	t h a t 	a d o p t i o n 	of 	t h e
h e r l e a n 	Aeademy 	sf Ophthalmology" 	p r o p o s e d 	eode 	of 	e l h i e s 	would
n o t 	v i o l a t e 	Seetion 	5 	sf 	t h e 	F e d e r a l 	T r a d e G 	ission A c t 	o r 	a n y
o t h e r 	s t a t u t e 	e n l o r e e d 	by 	t h e C o n m i s s i o n , 	T h i s 	a d v i s o r y 	o p i n i o n ,
like 	a l l 	t h o s e 	i s s u e d 	by 	t h e G o m i s s i o n , 	fs 	limited 	t o 	t h e 	p r o p o s e d
, e o n d u c t 	described 	i n 	t h e 	p e t i t i o n 	b e i n g 	c o n s i d e r e d , 	I t 	d o e s 	n o t , 	o f
eourse, 	constitute 	a p p r o v a l 	f o r 	specific 	instanecs 	sf I m p l e m e n t a t i o n
of 	t h e 	code 	t h a t 	m y 	become 	t h e 	s u b j e c t 	of 	litigation b e f o r e 	t h e
C o m i s s i o n 	o r 	a n y 	e o u r l , 	s i n c e 	i n t e r p r e t a t i o n s 	and 	e n f o r c e m e n t 	of

J e r a l Q A * J a c o b s , 	E s q ,
Page 	I @
t h e 	code 	fw gartieular 	sjtuations m y 	p r o v e 	f o 	Cause 	dignffieant
i n j u r y 	ts 	csrngstltdsn 	a n d 	c o n s w e r s , 	a n d 	t h e r e b y 	v i o l a t e 	t h e 	Federal
Trade G o m i s s l s n 	Act. 	The C o m l s s l o n m l n t a f n s 	t h e 	r l g h t 	t o 	reeon-
r i d e r 	t h e 	q u e s t i o n s 	involved a n d , 	w i t h 	notiec 	t o 	t h e 	r e q u e s t i n g
party 	i n 	a e e o r d a n e e w i t h 	Section 	l 5 3 ( b 1 	o f 	t h e C s m l s s l o n 8 s R u l e s
o f 	Braelice, 	I s r e s c i n d 	o r 	revoke 	i t s 	opinion 	I n 	t h e 	event 	t h a t
i q 9 e m e n t a t i o n 	of 	t h e 	proposed 	code 	of 	ethics 	results 	I n 	significant
anlieompetillve 	c f f e e t s , 	should 	t h e 	purposes 	of 	t h e 	code 	o r 	a n y 	o f
i t s 	i n d i v i d u a l 	p r o v i s i o n s 	be 	f o u n d 	n o t 	t o 	be 	legitimate, o r 	s h o u l d
t h e 	p u b l i c 	interest otherwise 	s o 	require,