Reality Check

Jack F. Conley, DDS

Copyright 1998 Journal of the California Dental Association.

Over time, some readers have let us know that they have a preference for scientific articles that explore new frontiers of significance to the dental practitioner as opposed to review articles that summarize findings from the literature which support contemporary standards of care, treatment techniques, or scientific information. While there can be great value from a good review article, the dentist who understands the business environment of today, increasingly prefers information that is "cutting edge," because it may initiate consideration of new procedures that will position him/her as unique within their community.

The experts who serve as peer review referees for the Journal continually make us acutely aware of manuscripts that present a limited study on a new product or technique which has received little previous discussion or evaluation in the literature. The reviewers may point to lack of current references that validate the conclusions of the author (often referring to the supporting evidence supplied as anecdotal). They may also raise concern about the potential conflict of interest of the author due to their perception that the author might have a relationship with the company that developed or markets the product or technique, or funded the research study that is being reported in the manuscript.

A few events have helped to shape our concern with this developing dilemma faced by publications. A noted dental authority recently made a comment during a presentation to a dental audience, that there wasn't much that was really new in dentistry these days. While the statement could be actively debated, this person's point was that products and techniques that are decidedly new advancements are few in number. The "spin" of the marketing activity for materials and techniques used in the delivery of cosmetic dentistry may hold more promise to dentists and patients of something "new" than the properties of the materials or the techniques actually used in their application!

Another event that caught our attention was an editorial by a CDA component society editor who described an undesirable continuing education program experience. He correctly complained that the lecturer, a noted (and respected) dental authority had spent a considerable amount of time during an educational program shamelessly promoting a dental product. Many dentists have been exposed to this type of experience. This is a slightly different problem than the dilemma we will describe, as we believe there is a big difference between promotion of a product in an educational environment, and a published report of data that came out of an agreement that did involve financial support to the author or investigator.

Because there are few new developments, it seems that there is a tendency to "rush" anything that is even slightly new forward for appropriate approvals and immediate use in practice. There is also a prevailing attitude that suggests that clinical experience with new techniques and products will provide the data that was not forthcoming from the limited research that occurred before it was approved and sent to the marketplace. It seems that materials and techniques too often are promoted in the marketplace before scientific data is available to help the practitioner make important decisions toward their use.

One of the goals of a publication like CDA Journal is to provide readers with timely scientific information of educational merit as soon as it has received appropriate peer review. Based upon the scenario described, there are fewer opportunities to present scientific information that is really new. When something fitting the desired criteria does surface, then the dental clinicians/authors most likely to be experienced enough with a new product or technique to prepare a scientific manuscript are also most likely to have a financial relationship with a private corporation as a consultant to test or develop the modality in question. Gone are the days of the 18th century, when the "Father of Modern Dentistry," Pierre Fauchard, shared his considerable knowledge of dentistry with his colleagues in print without financial considerations.

It is a different world today! We were surprised to hear an estimate from the publisher of the Journal of the American Dental Association, that up to 80 percent of research articles submitted for publication review are funded by private corporations that utilize dentists as consultants.

The dilemma for publications is obvious. Should we withhold publication of information with merit to the practitioner because the author has a financial relationship with a company marketing a product, thus preventing practitioners from having any access to information that might help them in making an informed decision about a product? Or, can a disclosure attached to a peer reviewed manuscript permit the practitioner to receive important information that would otherwise be denied him/her due to the perceived fear of influence of a financial agreement between author and corporate entity upon the quality of the new research findings?

We believe that the only answer to this dilemma is an up front disclosure statement accompanying a scientific article, alerting the reader to the relationship of the author to the firm marketing products or technology to dentistry. We believe that this approach is the direction for a profession interested in providing the best level of care for the public it serves. To delay a reasonable discussion of a new material until significant new research becomes available does not seem to be in the best interests of a progressive profession.

The problem with a continuing education lecture is clearly different. A lecturer should not stray from the announced educational objectives by promoting products and technologies. To do so is a misrepresentation of the educational experience expected by the dentist attending a course. Further, unlike the printed word, it commandeers a captive audience.

If readers are to overcome the seeming lack of information on new entities being promoted in the dental marketplace, they must have access to new information so that they might assume some responsibility in evaluating the efficacy of new materials, equipment, and techniques. We believe that peer reviewed publications must fulfill the responsibility to provide this information.

This is a new reality as we inch ever closer to the 21st century! Dentistry has come a long way from the simple 18th century world of Pierre Fauchard.