Seven years ago, Kevin O’Brien and Jonathan Sandler wrote a guest editorial for this Journal entitled “In the land of no evidence, is the salesman king?” in which they cautiously celebrated the fact that the orthodontic profession was beginning to develop a strong evidence base behind our treatments. However, they advised that vigilance is required before accepting claims of superiority lavished on any new orthodontic product. The editorial concluded with a warning that if we as a profession do not hold orthodontic advertisers to account, then “we are in serious danger of letting down not only the general public but ultimately the entire profession.”
Unfortunately, it is still the case in the United Kingdom (UK) that some companies (those involved in manufacturing products as well as those selling them) continue to advertise orthodontic products in a potentially misleading manner.
Eschewing the tactics of “Dr A prefers treatment X for his or her patients” or “X% of patients prefer brand Y treatment,” it is commonplace for companies to make exacting claims that certain hi-tech, brand-new orthodontic treatments are superior to those provided by the Luddites practicing “traditional orthodontics.” This approach has resulted in several complaints to the Advertising Standards Authority (ASA).
In the UK, advertising is regulated by the ASA. It is an independent body financed by a levy on British advertisers, and it is responsible for ensuring that advertising in the media in the UK adheres to the relevant advertising codes. Each complaint is investigated; if necessary, a ruling is drafted and ratified by the ASA Council. In drafting rulings, the ASA will try to consult with the advertiser as well as the manufacturer of the product.
In March of this year, the ASA published 2 rulings regarding the advertising of “Fastbraces” by 2 practices in the UK. These rulings are freely available on the ASA Web site ( www.asa.org.uk/ ). The rulings originated from a complaint regarding claims that treatment with “Fastbraces” was faster, caused less pain, and caused less root resorption than the same treatment provided with other orthodontic appliances. The ASA ruled that these claims should not appear again in UK advertising without “adequate substantiation” because a “sufficient body of evidence” does not exist to justify them. There were “significant methodological flaws” in the evidence that was provided to justify the claims about “Fastbraces” treatment.
Two further rulings were published in May regarding advertising of the “Damon brace system” by 2 practices in the UK. The complaint revolved around similarly seductive claims that treatment with the “Damon brace system” was faster and less painful than treatment with traditional braces. In both cases, the manufacturer, Ormco, provided data from research studies to back up the claims. The details of Ormco’s evidence can be found on the ASA Web site. The ASA ruled that the studies provided “all exhibited methodological issues.” The evidence they provided was therefore “not adequate” to back up the claims, which were subsequently deemed to be “misleading.”
Each of these rulings could be considered as a victory for the specialty: the acknowledgment of facts over “alternative facts” in the battle to give our patients accurate information about the treatments that they are undertaking. However, these rulings are far from the end of the issue.
The acceptance of a manufacturer marketing its product as “superior” without the critical appraisal skills to dissect these claims is most likely the root cause for the misleading advertising described above. Subsequent replication of manufacturers’ marketing claims on practice Web sites is unfortunately both commonplace and unwise.
In the UK, this leaves us open to action from not only advertising regulators but also our dental regulator, the General Dental Council. Dentists have found themselves on the end of lengthy and stressful General Dental Council hearings questioning their fitness to practice on the grounds of potentially misleading patients about the services they provide.
Although this is incredibly unfortunate for the clinician involved, all dentists practicing orthodontics have a responsibility to put the interests of their patients first. In a competitive market, it can be tempting to claim that an innovation will speed up your patient’s orthodontic treatment, especially when respected colleagues are advocates of the product. However, do the claims stack up against the science? Would we be comfortable taking a new tablet that is claimed to reduce blood pressure with fewer side effects than the market leader if there were not a high-quality trial demonstrating this to be the case? If a doctor advertised these claims, we would rightly hold him or her to account if the promises fell short. We should hold our own advertising up to the same high standards.
As specialist orthodontists, we have a duty to scrutinize the advertising of companies making potentially misleading claims to our patients. We are fortunate not only to be trained to a high level as specialists in our field, but also to work with patients whose treatment is both personally and professionally rewarding. We are best placed to challenge potentially misleading advertising about orthodontic products. Should we stand by and let others bring the practice of orthodontics into disrepute? Have we progressed since the guest editorial by O’Brien and Sandler 7 years ago?
In the UK, it has been argued that the “Uberization of orthodontics” is alive and well, thanks to mail-order appliances helping patients bypass the clinician and the companies that promote and support them. Quite rightly, the British Orthodontic Society has released strongly worded press statements to warn consumers about the risks inherent in DIY orthodontics.
The British Orthodontic Society also gives its members specific advice on the use of advertising for orthodontic practices based on applicable national regulations. This advice has been shown to be quite pertinent given the recent findings by the ASA. In light of these rulings, it is of paramount importance that every dentist in the UK should dissect the claims made by orthodontic companies before repeating them in advertisements to their patients.
Although the majority of Web sites advertising orthodontic products are hosted outside the UK and are subsequently outside the jurisdiction of the ASA, it is heartening that these national rulings have been analyzed and have resulted in removal of the misleading claims from corporate Web sites targeting UK audiences.
I hope that this practice is continued and championed by those in the UK acting as advocates for orthodontic manufacturers. This will help protect our dentists from investigations by the ASA and the General Dental Council, while safeguarding our patients from encouragement to spend a significant amount of money on expectations that are unlikely to ever be met.