Orthodontic marketing: Are researchers behind the times?
I have written several times about the poor evidence base of heavily marketed new orthodontic materials and techniques. This post is about a recently published paper that takes an interesting look at this problem.
Over the past few years, there have been several developments that companies have heavily promoted in the absence of clinical evidence. For example, self-ligating brackets, micro-osteoperforation and application of vibration. When independent researchers have studied these developments, they have concluded that they have few advantages over conventional methods. I have posted about this before and I have been accused of being over critical, bullying or preaching from an electronic pulpit. Therefore, I was very interested to see this new paper published in Progress in Orthodontics. This was a systematic review to assess the prevalence of clinical trials in orthodontics that evaluated commercially promoted products after their release.
A team from the East End of London and Bern, Switzerland did this study.
Seehra et al. Progress in Orthodontics (2017) 18:14 DOI 10.1186/s40510-017-0168-y
What did they do?
They did a standard, well-carried out, systematic review that included all the orthodontic randomised trials done between 2012-2016. They recorded data on the following:
- Region of authorship
- The marketed intervention and comparator
- The direction of the treatment effect (positive/negative)
- Declaration of sponsorship/funding/conflict of interest
What did they find?
They found 84 RCTs. Europeans did most of these (48%), non-American and Europeans published 33% and only 17% were done in the USA.
Interestingly, 45 % of the trials involved an analysis of marketed products after their introduction. The remaining trials assessed non-clinical interventions and non-marketed interventions, for example, growth modification, closing loops etc.
They found a positive effect of the treatment in over 50% of the total number of trials.
Their overall conclusion was:
“Half of orthodontic trials involved marketed products and almost 44% report no improvement related to the product”.
What did I think?
I thought that this was a well carried piece of research. I particularly liked the discussion and the authors raised the following important points.
Firstly, we need to have adequate research as part of the development of new products.
Secondly,they found that a third of trials focused on speeding up treatment and they showed little meaningful difference in the rate of tooth movement.
They pointed out that the licensing of new products does not require supporting clinical data. Nevertheless, people should not make claims about speeding up treatment, or reducing extractions, when clinical evidence is absent.
Finally, I thought that they made a really important point. This was that academic based research comes at a price in terms of financial and opportunity cost. Importantly, if the companies had done the research before the release of the product, then the Universities could have spent their time and funds on other useful research. This has resulted in a waste in research.
My last comment is a plea to the Key Opinion Leaders, and it may fall on deaf ears? Please think carefully about (
taking the money) promoting developments that lack an evidence base. Remember, you have a responsibility to our patients, fellow orthodontists and academic researchers.
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Emeritus Professor of Orthodontics, University of Manchester, UK.