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 Table of Contents  
EDITORIAL
Year : 2018  |  Volume : 52  |  Issue : 4  |  Page : 227-228

Braving the winds of change


Prof. and HOD, Department of Orthodontics, SRMC, Chennai, Tamil Nadu, India

Date of Web Publication17-Oct-2018

Correspondence Address:
Dr. Sridevi Padmanabhan
Department of Orthodontics, SRMC, Porur, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jios.jios_207_18

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How to cite this article:
Padmanabhan S. Braving the winds of change. J Indian Orthod Soc 2018;52:227-8

How to cite this URL:
Padmanabhan S. Braving the winds of change. J Indian Orthod Soc [serial online] 2018 [cited 2018 Nov 14];52:227-8. Available from: http://www.jios.in/text.asp?2018/52/4/227/243607





Recently, two events happened within a short time of each other, both rather momentous in their own way.

The demise of Dr. William R Proffit led to an outpouring of eulogies, messages, reminiscences, and doubtless, the orthodontic fraternity around the world found different ways to respect the memory of this remarkable man and the life he lived. His textbook Contemporary Orthodontics which is one of the most read orthodontic textbooks in the world is currently in its 6th Edition and has been printed in 12 languages. The textbook in its several avatars was eagerly devoured by generations of orthodontists and serves as the holy grail of Orthodontics, the foundation of learning on which careers were built. During his career, Dr. Proffit published more than 200 scientific papers, 20 book chapters and invited contributions. For those who did not know him personally, the genuine and palpable sentiments which reverberated around us is a reflection of the immense respect and regard that people had not merely for the doyen but for the immense knowledge he shared which has always been so important for the orthodontic community.

The second event was probably less noticed in orthodontic circles but created ripples through the medical and academic world. This was the moral governance crisis that shook one of the most respected scientific organizations in the world. The Cochrane Collaboration [1] (named after Archie Cochrane) is an organization devoted to organizing medical research findings, facilitating the standard of healthcare by helping evidence-based choices by health professionals, patients, and policymakers. It is a non-profit, nongovernmental organization founded by Iain Chalmers in 1993. For 25 years, the rigorous new tools of an evidence-informed approach have been used to collectively produce systematic reviews making the Cochrane Review the gold standard in evidence-based care.

While it would be impossible to present completely all the facts of the Cochrane crisis, briefly the Governing Board of the Cochrane Collaboration voted to expel one of its founder members, Peter Gøtzsche, for activities which allegedly threatened to bring the organization into disrepute. Four of the thirteen members resigned in solidarity leading to a mass exodus.[2] The crisis unfolded rapidly with various viewpoints published on the subject.[3],[4],[5]

However, Peter Gøtzsche's concern that “ increasingly commercial business model” taking root at Cochrane that “threaten the scientific, moral and social objectives of the organization” gives one food for thought. Fifteen years ago, the Cochrane Collaboration opted to tighten its policy and firmly rejected the idea of companies sponsoring Cochrane reviews. Yet, the policy renewed again in 2014 allowed individuals with financial ties to pharmaceutical companies to review evidence about those same companies' products – if they constitute a minority of the review team.[5]

Many recognize that in addition to the Cochrane crisis, there is a much bigger crisis and that is the threat to the reliability of healthcare evidence and delivery which is posed by the financial entanglement between industry and those who evaluate and use its products. The influence of commercial interests in medical science is not new and readers of Robin Cook's books would wonder how much of the fiction we read is inspired by truth.

The influence of commercial interests has been felt in the orthodontic world too. As early as 1916, the International Journal of Orthodontia ran an editorial.” Is our dental literature free from commercial influence.”[6] With time, as the presence of commercial interests has become stronger and more evident, organizations and institutions have recognized the conflicts of interest it poses.[7] The subject has sparked numerous debates on whether practice is grounded on evidence or the power of marketing.[8],[9]

Commercialism is not all bad. Progress is possible only when research is translated into usable products by industry and marketing is an inevitable part of it. Companies sponsor research, meetings, and publications all of which contribute to the dissemination of knowledge. However, the conflicts of interest, it poses needs to be recognized, and international organizations do have policies which address these concerns.[10]

Historically, companies depended on orthodontists to evaluate and to endorse their products and many still depend on competent orthodontists who serve as brand ambassadors. However, in recent times, we have been witness to a rather disturbing trend which makes one wonder whether the balance of power has tipped. It appears now that companies are endorsing orthodontists to use their products, and orthodontists are not merely accepting of this but are happy to display this certification as a mark of their skill and excellence. Is this applicable to all of dentistry or perhaps just Orthodontics?

While there is no doubt that the interrelationship between financial interests and healthcare providers is extremely knotty and questionable even in the medical world, I am yet to see a manufacturer of medical supplies endorse the skills of a cardiac surgeon, ophthalmologist, radiologist or any other medical specialist.

If orthodontists believe that certification by companies is important to maintain and to enhance our status quo in the challenging practice scenario, is it then going to become a race for more and more company endorsements or would only the megabrands be the coveted ones?

The Indian Orthodontic Society (IOS) and its public awareness committee have taken great pains to propagate the importance of the public going to a qualified orthodontist, i.e., an IOS endorsed orthodontist. Would the display of several other company certifications and their promulgation on social media lead to confusion in the minds of the public who seek our services and distract attention from the basic and most important certification that we possess? That of Orthodontists!

Ironically, one such company recently told a colleague that they would not accept office bearers of societies as brand ambassadors since it creates a conflict with their governing and ethical policies. While the IOS also encounters increased commercialism, we will need policies to establish greater transparency and facilitate maintenance of our long valued ties with commercial establishment while protecting our own interests.

We have seen companies come and go. Some have and would go beyond the orthodontic community and even to the public. The orthodontic community is at the crossroads. Do we succumb to the allure of commercialism and flash our “company certified orthodontist” badges of honor? Or do we believe as the die hard followers of Proffit and other orthodontic messiahs that “knowledge is power-We have it and would like to retain it. “

”The aim of education is the knowledge not of facts but of values”

– William S. Burroughs



 
  References Top

1.
Available from: https://www.cochrane.org. [Last accessed on 2018 Oct 01].  Back to cited text no. 1
    
2.
Available from: https://www.nature.com/articles/d41586-018-06727-0. [Last accessed on 2018 Oct 05].  Back to cited text no. 2
    
3.
Available from: https://www.blogs.bmj.com/bmjebmspotlight/2018/09/16/cochrane-a-sinking-ship/. [Last accessed on 2018 Oct 05].  Back to cited text no. 3
    
4.
5.
6.
Editorial. Is our dental literature free from commercial influence? Int J Orthod 1916;2:734-6.  Back to cited text no. 6
    
7.
Turpin DL. Commercialism on the rise, again. Am J Orthod Dentofacial Orthop 2007;132:1-2.  Back to cited text no. 7
    
8.
O'Brien K, Sandler J. In the land of no evidence, is the salesman king? Am J Orthod Dentofacial Orthop 2010;138:247-9.  Back to cited text no. 8
    
9.
Schismenos CK. Don't throw the scientific self-ligation baby out with the commercial bathwater. Am J Orthod Dentofacial Orthop 2012;141:2-3.  Back to cited text no. 9
    
10.
Turpin DL. Financial conflicts of interest policies: From confusion to clarity. Am J Orthod Dentofacial Orthop 2010;138:245-6.  Back to cited text no. 10
    




 

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