I wish to compliment you for 2 fine articles in the September issue: “Financial conflicts of interest policies: From confusion to clarity” (Turpin DL. Am J Orthod Dentofacial Orthop 2010;138:245-6), and “In the land of no evidence, is the salesman king?” (O’Brien K, Sandler J. Am J Orthod Dentofacial Orthop 2010;138:247-9).
Regarding the editorial, I have practiced orthodontics for 50 years and still practice three days a week. I admit to having succumbed to the allure of beautiful advertising and the misplaced belief that a particular appliance was going to change the quality of my orthodontic treatment. Thinking is what determines the quality of your orthodontic treatment, not some appliance. I have tried self-ligating brackets from 2 different companies and found that, in my practice, they caused more problems than they solved and I am now back to using standard twin brackets with my prescription of choice. Time-wise at the chair, I might be 10 seconds behind; quality wise, I think I am back in control of my practice. I have also tried implants for temporary anchorage and I found that an 80% percent success rate did not justify utilizing them.
I have been on the Louisiana State Board of Dentistry for a total of 24 years. During most of that time we have required continuing education. What I see happening across the board in the specialties and general practice is that most of the courses put forward for approval in our licensing process involve some sort of company sponsorship. It is very difficult to find “pure” presentations that have enough glitz and glamour. You correctly touched on the financial burden of the schools and societies presenting the programs and how much easier it is to close your eyes to what I call tainted research in the interest of attracting large crowds and participation in state, district, and national society meetings and school-sponsored continuing education.
On the state board level, at least in Louisiana, quality of care is the byword. The problem is who determines what is quality care? It seems it is the manufacturers of dental products.
I agree that transparency in research and lecturing is the key but with the current budget crisis in dental education I find that it is not always the most respected educator who gets hired but the researcher who can attract the most grants. Thanks for your attention to this very difficult problem.
I would also like to compliment Dr. Kevin O’Brien and Jonathan Sandler on their paper. They presented excellent examples of the hype not living up to the sales presentation and our reluctance as practicing orthodontists to give up outdated and unscientific modalities of treatment. “Faster, better, and more comfortable” does not assure quality care. Personally, I have not found any “functional” appliance that lived up to its hype. I have certainly gotten stung and stung a number of patients’ parents with the early treatment rage that was going on years ago. It did not take long for me to figure out that early treatment was effective in only about 10% to 15% of patients, if that; unless, of course, you are counting the increase in fees collected with 2 phases of treatment.
Marketing is king both in orthodontic product and practice. However, a beautiful ad in the phone book or sales brochure does not always compute to beautifully treated patients.