Instagram, lies and orthodontics.

This post is about people making untrue claims about orthodontic treatment on Instagram. This was analysed in a new paper investigating marketing in orthodontics. I thought that the results were disappointing .

I will start this post by considering the definition of lying. This is;

“Speaking untruthfully with intent to mislead or deceive”.

Social media is a very effective method of marketing. Indeed, social media significantly influences orthodontic demand and treatment decisions. This is becoming increasingly important because many orthodontists and patients extensively use social media. When we consider social media platforms, Instagram is very popular. Posters use this platform to “influence” by making clinical and scientific claims. However, we do not know if these claims are accurate. A team from London, South of England, did this study. The Angle Orthodontist published the paper.

What did they ask?

They did this study to

“Look at the accuracy of marketing claims made in professional Instagram posts and to evaluate their accuracy”.

What did they do?

They did an excellent cross-sectional study of relevant Instagram posts published from January to March 2021.

Firstly, they identified Instagram posts using the following inclusion criteria:

• Inclusion of marketing about Class II correction, self-ligating brackets, clear aligners, non-surgical accelerated tooth movement, surgical acceleration, and myofunctional orthodontics.
• The posts were from orthodontic or marketing accounts.
• They translated non-English subtext with Google translate.

The authors then analysed the posts to identify the content, number of likes, and account type.

Then, two authors carried out pilot coding of the themes and evaluated the accuracy of a subset of the claims made (n=50), with conflicts resolved by discussion. Both intra- and inter-rater reliability (using weighted Cohen’s kappa) of the accuracy of claims were high, (k=0.89) and (k=0.79), respectively.

Finally, they categorised the accuracy of the claims against best evidence (systematic reviews or expert judgment if scientific evidence was not available) using a five-point scale. This classified the claims as being

• Objectively true
• Selected facts
• Minimal facts
• Non Facts
• False

What did they find?

The authors identified a target number of 300 posts. 75% of these were non-English. They identified 472 claims. It appeared that  #Myobrace was associated with 22% of the claims, and the fewest were linked to #carrieremotion (12%).

They found that claims related to shorter treatment times were the most frequently coded items (26%).

Notably, 60% of the claims were judged to be false. I was disappointed to see that only 1.7% were objectively true.

When they looked at the individual claims, they found that the most common accuracy level for the #carriere was 41%, for #invisalign, it was 65% for “selected facts”. Importantly, the levels of “false claims” for #damon braces was 48%,  #acceledent was 88%, #propelorthodontics (97%) and #myobrace 77%.

Their final conclusion was:

“Most claims related to six popular marketed orthodontic products concerned treatment duration. Less than 2% of these claims were found to be objectively true”.

What did I think?

This was a nice well-done study providing helpful information. The methodology was sound. Notably, the authors built in several standard safeguards; for example, they measured the repeatability of assessments. We also need to consider that this was a snapshot of posts over a short period. However, it is difficult to see if this is a significant problem.

I thought that the results of this study were concerning for several reasons. Firstly, if we consider that some of the untrue claims were made by clinicians. This is clearly unethical. I know that I have raised this many times before. 

The authors prepared a nice set of recommendations to avoid misleading claims on social media. I suggest that you have a look at the article to see this. The suggestions are obvious and sensible. There is no real reason why the promoters of these products should not follow these recommendations.

Declarations:

This paper was first blogged about by Alex Ditmarov on his excellent Orthodontic Grammar blog.

The Senior Author of the paper is Padhraig Fleming, who is co-editor of this blog.

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