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.