I read with interest the “Ethics in orthodontics” column in the November issue (Greco PM. When the tail wags the dog. Am J Orthod Dentofacial Orthop 2011;140:603). Although I definitely agree with the problem, I have a different view of the solution.
Dr Greco did a great job describing the risks of orthodontic manufacturers’ influence through “gifts, meals, or other sales strategies,” potentially leading students to unwise decisions regarding specific appliances and treatment modalities. He then proposed that our specialty programs should follow the model being used by a hospital for its medical students and residents to protect them from falling into the sales trap.
The hospital approaches the problem by “clearly documenting the limitations of marketing involving medical students, residents, and personnel. Among other restrictions, the policy forbids these people from accepting gifts from commercial entities, regardless of the value and the location of the offering.” Dr Greco mentioned further obstacles to unfiltered access to the vulnerable targets, concluding, “Now is the time for our specialty programs to consider the same limitations on commercial entities that our medical colleagues have implemented.”
Although the goal of prevention of influence is admirable, aren’t our students better served if we advise them how to fend for themselves? Is it really the role of the teacher to filter the real world before it reaches the pupil? I don’t think so. We, and the highlighted hospital, should prepare our students and residents to think critically, using their own judgment on the front line without insulation from the institution or its instructors. If not, what happens when we hand them their diplomas? Who later protects them from something they haven’t seen as we sheltered them from the reality outside?
As practical as the approach proposed by Dr Greco might seem, I think it weakens our education and preparation of the student to become a responsible decision maker. Let the sales representatives have access to them. Let them hear lectures by presenters with financial interests in commercial entities. Let them hear it all. Then sit them down to talk about it. Point out the weaknesses in the presentations, the lack of scientific validity, the potential reasons that the presenter might not want to share the whole truth. Help them to see what lies behind the curtain. They are about to begin the journey to Oz and need to know how to analyze what they will encounter on their own. What they need first is to be exposed to it in its unfiltered form so it’s no surprise.
Let’s all commit to teaching through our word and example how to do what Dr Greco so nicely stated. “Moreover, let us, as clinicians and educators alike, use highly critical thinking to guide our decision process rather than succumbing to sophisticated advertising or promotional techniques.” Isn’t it really our duty to help our future colleagues learn to think critically as well through experience rather than being shielded by us? Maybe more of us would have been better prepared.