Key Opinion Leaders at the AAO Congress. Who stuck to the rules?
I attended the virtual AAO Congress this year. Several Key Opinion Leaders spoke at the meeting. I thought that I should “fact check” some of them. Here is what I found.
Dealing with a conflict of interest
While it is common for Key Opinion Leaders to sell their companies’ products on the trading floor, some of them appear on the meetings’ main programmes. While they may have interesting and relevant things to tell us. We need to be aware that companies pay them to promote products. It is, therefore, incumbent on them to declare their conflicts when they speak. This simple step lets us consider their presentation and recommendations in the light of any conflict.
Many orthodontic societies recognise this. For example, the AAO requires that all speakers complete a conflict-of-interest declaration. They also require that they make a positive or negative declaration on a slide at the beginning of their presentation. These requirements are obvious.
I have written about Key Opinion Leaders in the past, and I have always emphasised that there is nothing wrong with being a KOL as long as a conflict is declared and they underpin their claims with research evidence. However, in the absence of evidence, there is nothing wrong with making claims based upon their clinical experience. However, they should be clear about this.
What did I find?
If we consider conflicts and evidence, how did the Key Opinion Leaders do at the meeting? I decided to look at three factors when I viewed their presentations. These were:
- Did they declare a conflict of interest in the lecture?
- Did they make a claim the benefits of a product that was not evidence-based?
- Was their presentation predominantly clinical tips etc.?
I decided to stick to the major KOLs. These were Drs Chang (Ormco), Nicozisis (Invisalign), Dayan (Invisalign), Moshiri (Invisalign), Frost (Ormco) and Carriere (HSO).
He declared a conflict of interest in the presentation. His presentation was his usual style. He did not make any claims for the benefits of the products.
Declared interest at the start. He talked about early treatment with Invisalign and showed a series of cases that he had treated early. He explained that he could not have done this treatment with braces. I thought that this was interesting. Significantly, he did not over-promote Invisalign. I felt that his enthusiasm for early treatment with Invisalign reflected his clinical experience with this treatment method. However, I could have done all the cases with braces. I am sure that this is a reflection of our different clinical experiences.
Declared an interest. He talked about alternatives to ideal treatment with aligners. However, he made no claims for the benefits of any product.
Declared an interest in his first slides. Really interesting presentation on using aligners for orthognathic treatment. Nicely treated cases and no claims for the product.
No declaration in the lecture. His presentation was on using lasers for gingival contouring. This subject was interesting, and he gave many clinical tips. However, he did not make any claims for any product.
He did not declare an interest at the start of the lecture. He made multiple claims for the Carriere Motion appliance. These included
- It decreases treatment complexity.
- The appliance brings the mandible forwards.
- It repositions TMD structures.
- Somehow, it reduces the pressure of the upper lip on incisors.
- It improves the airway.
- Finally, it preserves maxillary volume.
There is no robust research evidence to support these claims. I have discussed this before in this blog post.
What did I think?
When I initially viewed the programme for the meeting, I was concerned that there were several KOLs speaking. Furthermore, I have been somewhat critical of them for not declaring an interest on social media etc. I was, therefore, impressed that most of them reported a conflict as the AAO had instructed.
When I looked at the talks’ content, nearly all of them based their presentation on clinical cases and tips. Notably, almost all of them did not make claims for the effects of appliances that the companies pay them to sell.
The only person who made unsubstantiated claims and did not make any disclosure in his presentation was Dr Carriere. The Carriere appliance has been featured in my blog posts before. In many, ways it was a shame that Dr Carriere made the same claims. I will leave it to you and congress organisers to come to your own opinion on this.
Emeritus Professor of Orthodontics, University of Manchester, UK.
Have your say!
Excellent write up dear Sir.
As we all are aware any appliance and claims have to be supported with proper clinical evidence of the highest form.
Your articles are eye-openers always straight from the heart.
Superb! Thank you
The shame is that the designers of these programs cannot find lecturers without an affiliation with a major company that pays them to flog their products.
So true. Hope you’re well Larry
Very nice critical review on KOL’s as speakers at the AAO meetings. I sincerely hope they pay closer attention to this issue. Science before commerce should be at the heart of the AAO.
The “Sunday bite” to correct Cl II still lives. Amazing how many different ways the Specialty has contorted to justify the technique.
I think you’re observations are what should have been expected.
KOLs are their own brands and their value relies on credibility and influence. To appear as objective as possible to a broad audience where there will always be alternative and critical views is wise from their point of view.
Carrier is almost equivalent to his brand.
Marketing through social media or other avenues where they can reinforce existing notions or aspirations is the game. Gabbays, “Guidelines and mindlines” showed us the effectiveness of this in an evidence based way.
We had an incident of a lecturer at an Australian Dental Association Conference using poor evidence of his own to override two very good SRs, one from Cochrane, and an advertisement, to promote a diagnostic device. He declared no conflict of interest.
The ADA went into coverup mode and equivocated on the devices use as did the specialist body who proposed the lecturer.
Internal power and influence in our own professional bodies can be as influential on information dissemination as KOLs.
Being a KOL is not necessary a good thing or a bad thing for an orthodontist to pursue. It is a fine line to walk. Selling vs educating? The KOL should, in my opinion educate the company that it is representing. The orthodontist does have opportunities to be involved in educating his or her peers. Obviously full disclosure is expected. The fact that the companies now seem to, ” pimp out “, the KOLs they employee and the KOL often become the prostitute. Then we have the professional organizations getting their cut by offering the companies a larger lecture room at the meetings so they get their cut of the action. The more the company is welling to pay the organization, whether it be a state or national organization, the larger the lecture hall the companies has their KOL lecturing. We are not sure this is good for patients nor is it good for the specialty. As the world turns.
Are like the fact checkers that some of us look to separate the cheese from the chalk.
Unfortunately it is the sign of the times and human nature to be attracted to shiny promises without an iota of evidence.
This aspect pervades all aspects of our lives. From politics to minuscule choices, everything is being thought out for those who refuse to think for themselves.
I do endorse Larry’s point of view, there are hardly any speakers in all forums, without any ‘commercial interest’ l
Guess a sad state….
In the end, organizations and their scientific committees have choices with respect to speakers etc. Exercising these choices is a different matter, and nowadays is plagued by many issues which influence programs. The time has come to exercise those choices in the best interests of the future of the specialty. This has not been happening in many instances