September 26, 2022

Crisis management steps for the orthodontic profession?

This is a great guest editorial by Tony Weir. He is an Australian orthodontist who has been in private practice for 32 years. In addition, he is Honorary Senior Lecturer at the Universities of Adelaide and Queensland. He is not a KOL. In this post, he outlines his thoughts on a great way forward for the orthodontic profession.

A version of this editorial has previously been published in the ASO.

Aust Orthod J 2022; 38: 278 – 280. DOI: 10.2478/aoj-2022-0029

Introduction

“The only thing necessary for the triumph of evil is for good men to do nothing,”

is a quote misattributed to the eighteenth-century Irish philosopher and statesman Edmund Burke. While the definitive source of this statement is yet to be found, the sentiment frames this editorial.

We are commonly presented with the idea that our profession is in crisis or similar. While we can debate the truth of this contention, the perception is unavoidable. For example, one only has to read online forums and posts by orthodontists on social media and listen to conversations at meetings (after COVID!).

Unfortunately, all too commonly, our response list includes weeping, wailing, tearing the hair, beating the breast, gnashing the gums, and generally whinging on social media as though venting like this will result in improvement in the situation.

Solutions: How can you help?

I admit to having little patience with complaints not backed up with positive action to address the issues. So I would like to suggest ways you, dear reader and colleague, can help your profession and yourself – ways that cost you little and offer rich rewards.

Be a reviewer

Consider acting as a reviewer for an orthodontic journal. I have done this for many years and have received far more from the experience than I have had to give back. Existing reviewers will be happy to help you through the process. You can learn a lot and help our journal publish high-quality, engaging, and clinically relevant material. It is another way for your voice to be heard.

Do not invite KOLs as speakers.

Do not get corporate-sponsored Key Opinion Leaders as speakers in scientific forums for orthodontic society and similar conferences. These people may be provided free of charge in terms of costs to the organisers. They may come with a handy sponsorship to the organisation. Still, if you genuinely believe there is no high cost for such actions, you are gravely deluded. While KOLs may speak honestly, they are ultimately beholden to their paymasters. We all know there are ways of telling the truth without telling the whole truth. KOLs who do not toe the corporate line strangely cease to be corporate-sponsored speakers. To sacrifice truth for money merely serves to perpetuate a decline in the intellectual standards of our profession.

Invite local speakers

Encourage local speakers, especially the new, the up-and-coming. Being local, they probably cost a lot less, are likely to be members of your orthodontic society, and will be people you will run into at meetings for years to come. They are likely to know and share your concerns. We have world-class people. They are not only our university academics but also recent graduates and external researchers. These people have award-winning research published in the best peer-reviewed journals.  We should choose them first.

Help with research

Reply to surveys – yes, we are all busy. But how else can we answer the questions you say you want to address if you do not participate and help them to help you? I am sure most of us enjoy reading survey results over almost any scientific article – I know I do. Help researchers help you. For the cost of maybe 15 minutes, you get a damn good read and perhaps some new ideas.

Help your universities

Volunteer your time and services to your nearby university or even one at a distance – the internet makes remote teaching very viable. Universities are perpetually starved of staffing and finances, and it seems increasingly so. They provide us with the future of our profession in the shape of postgraduate students and with research answers. It takes a company a bit of cash and a whirlwind tour by a KOL or staff member to put out a claim about an appliance, a treatment. It takes time and money to collect data, analyse that data and get it into a publication.

“A lie can travel halfway around the world while the truth is still putting on its shoes”

is another misattributed quote (this time to Mark Twain), but the sentiment is pertinent, at least. Remember – we were partially given our education by private practice orthodontists who put in a lot of time and effort out of the desire to advance our profession. Orthodontics has been good to us as a profession. We, too, should wish to “pay it forwards”.

Take part in the research.

If you would like to become involved with research, just ask. I am sure that all Orthodontic Departments would be happy to include you gently into what can be a new, exciting, and enriching world – a world that helps you grow in knowledge and forge relationships with the researchers – almost all of whom are not intense nerds like me.

Email, write or phone people who do research – at universities or outside them and tell them what you would like to see studied. It may not be possible or take time, but it is at least a step. I, for one, would welcome any input.

A personal example

On a personal note, you may be aware that I set up the Australian Aligner Research Database to obtain data on clear aligner treatment. I asked orthodontists in Australia, New Zealand, and the USA to provide their entire aligner databases (cherry-picking is not allowed!). I have not been knocked back once when I asked, which speaks volumes about the generosity and forward-thinking of these orthodontists. These people have trusted me to collect the world’s largest database of aligner cases outside of corporate hands (currently over 16,000 cases). Thus, allowing approximately 20 research projects to date in four universities in Australia and New Zealand.

More than a dozen publications have been published in high-quality peer-reviewed journals and several national and international awards. Many more are in the pipeline. My sincere and profound thanks to all those who have contributed selflessly – they do so on the condition of anonymity, so I will not name names. Still, you know who you are, and you should be proud of your help to your educational institutes and our profession through research. There is always room for more data, so if any reader wishes to contribute their data, please contact me.

Our conferences and meetings

conference crisis orthodontic

When the opportunity comes to support orthodontic meetings such as your local or national orthodontic society meetings and study groups, do so with your attendance. Furthermore, give it a go if they have the opportunity for tabled cases or interactive forums! No one will judge you – okay, they will judge you – but it is appreciated beyond belief and is way better than sitting quietly.

Engage with your orthodontic society executive with topics of interest, speakers you may wish them to invite, ideas for forums, and initiatives you feel worthwhile.

Build relationships

Mentor new graduates – we were them once. For many of us, the kindly help of an experienced orthodontist made a tremendous difference. Experiences like this encourage these new members of our profession to “pay it forward,” and that is a lot of goodwill over the professional lifespan of an orthodontist.

Ask your speakers questions, challenge them to provide evidence for what they say to you, and use your brain.

Foster relationships with general dentists in a non-confrontational way. We can fight, or we can, by example, encourage a better relationship.

Find a mate, sit down, and have lunch and a damn good chat – but don’t just bemoan fate – think of a way forward. Some of the most cherished moments in my career have come from informal discussions with my peers.

If academia is just not your thing, then there are other committees at both local and national levels. These include many areas that would provide both fulfillment and camaraderie with just a little effort. You would be welcome with open arms and forge new friendships and connections. Ours can be an insular profession. Reach out and enjoy!

Final thoughts

John F. Kennedy’s historical words in his inaugural address – “Ask not what your country can do for you – ask what you can do for your country,” challenged every American to contribute in some way to the public good. Your national orthodontic society is your society.

The fact that you are reading this editorial means you are likely to be a member of the organisation and this profession. Orthodontics is our profession, our speciality. If these things are to remain that way, and we are to survive and thrive and advance our careers and profession, consider taking some of the steps above.

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Have your say!

  1. Plenty of healthy ideas!

  2. During my time as “KOL” and having the privilege of speaking in Australia numerous times, the company sponsoring those presentations placed no pressure on me personally to sell products. None. However, with time and heat from the competition, their corporate position shifted to a darker side. Rather than “clinical decisions based on science”, today’s scorecards are, in large part, clinical decisions based on cash flow. Paraphrasing Prof. Lysle E. Johnston, clinical science is now seen as a hurdle to the orderly flow of commerce. Tony Weir offers substantial advice. It will be a delightful surprise if a perceptible change in USA orthodontic culture is the result.

    • Insider insights…I like it.
      Without naming names can you give an example of principles that have moved to the dark side or ideas that are pushed for the advancement of the almighty dollar?

  3. Fabulous post, agree with all the sentiments completely. Thanks for posting.
    The quiet majority needs to shout louder!

  4. Obrigado pelo excelente post. O que vemos hoje, é uma tendência cada vez maior, de afastar do diagnóstico e do plano de tratamento o cirurgião dentista. Hoje vale mais o quanto fica no caixa do que a ciência verdadeira. Empresas tem se empenhado na criação de colegas “premiun” na divulgação de produtos que na maioria das vezes só vai resolver o fluxo de caixa das tais. Vamos continar reagindo ao desmonte de nossa nobre profissão. ist

  5. Fabulous set of ethics and behavioural standards. Thanks Heaps, Tony

  6. Well written Tony. Tony doesn’t just write. He also walks the walk; or perhaps runs the run (being an ultra marathon competitor; he has far too much energy). He is a fantastic contributor to our profession in so many ways and I am honoured to sit on the Australasian Orthodontic Journal Editorial Committee with him. I appreciate, as Dr Samson points out, not all KOLs just totally swallow the company line. But we all know many who have and do. As a profession, KOLs should not be our go to for evidence based information. Can’t help thinking of the sad landscape and history of KOLs and the drug/pharmaceutical industry.

  7. Excellent post! We, as honest orthodontists, should always support science and condemn dishonesty.
    “The only thing necessary for the triumph of evil is for good men to do nothing,”

  8. An excellent post giving me courage to propagate these ideas more loudly. Thank you.

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