New Years Hopes and Dreams

Since I started my blog, I have done a post at the start of the New Year outlining my hopes and dreams for orthodontics and my blog. Here it is for this year.

Let’s start with orthodontics…

More high-quality research

I imagine that you are not surprised to see me mentioning this. I feel that orthodontic research has improved dramatically over the last 10 years. Investigators have done some great trials into clinically relevant subjects. But there is always room for improvement.  We can do this by considering the following;

• Starting research into more clinically relevant areas. For example, the benefits of orthodontic treatment for our patients or can we really make teeth move faster?
• Increase the sample sizes of trials to give us greater confidence in their results
• Writing up trials according to the CONSORT guidelines. This will make the papers easier to read and understand.

Please stop doing cephalometric research

I know that this view may be controversial. However, I do not want to read any more research that only reports cephalometric values. Cephalometrics has changed orthodontics, but the “trade-off” has resulted in orthodontics becoming a 0.5 of a degree speciality. I cannot help feeling that we have picked the bones of cephalometric analysis of research data and continue to present indecipherable tables in the endless search for statistical significance. Yet, we have not discovered much about our treatment.  A good way forward is for us to consider using outcomes that are relevant to our patients. Some good work is currently being done on this in the UK, as part of the COMET initiative.

Do we need another systematic review?

Currently, researchers are publishing a lot of systematic reviews. These are of variable quality and value. Again, we need to make some improvement to this valuable method of orthodontic research. We could consider;

• Not repeating systematic reviews that have already been done
• Only including trials in reviews. There is little point in carrying out a review if you are going to include low quality research from retrospective studies.
• Please reduce the number of comparisons in the search for significant findings.
• Journal editors should be more critical of systematic review submissions. I wonder if too many are getting through the review process?

Snake oil?

Posts on this issue have been a significant feature of this blog. I also know that I have occasionally gone on about this too much. However, the issue of selling “treatments and techniques” with no evidence that they work is an increasing problem.  This brings me to…

Key Opinion Leaders being like salespeople

I cannot help feeling that this is becoming a major problem for orthodontics and our patients. Currently, KOLs are promoting interventions with wild claims that cannot be supported. We need to remember that we are health care professionals with a duty of care to our patients. The highly paid KOLs need to adopt a higher code of ethics than the salesforce of the trade companies. I will continue to highlight this on my blog.

Now to plans for my blog…

Firstly, I would like to thank all those who donated funds so that I could keep the blog running and make improvements.  I now have sufficient funds to upgrade the servers,  commission a new website and cover my running costs until April of this year.  At this point, I will open a plan for further donations to cover the annual operating costs of £2,500 for 2019-20.

Other plans.

• I shall do more posts as I move towards full retirement from the University of Manchester. Hopefully, this will be the middle of the year, and I can spend more time on the blog.  This will also stop me hanging about the house resurrecting my computer game career!
• I will commision more guest posts. These were very popular last year. I think that it is a refreshing change for readers from my ramblings every week.
• I will consider including case reports and clinical tips. However, I need to be careful of consent and patient confidentiality.
• I will review the uptake and use of the free app. This is rather expensive and costs just over £1,000, and I am not sure that I can justify the use of donated funds to support the app.

That’s about it for now. I will start regular posting next week when I get back from the long UK Christmas break.