A great personal view about being an orthodontic Key Opinion Leader

This is a guest post by Jason B. Cope. He is a highly respected orthodontist from the USA. He provides a great personal viewpoint on the tricky issue of being a Key Opinion Leader. I spotted the original version of this post on the excellent Orthodontic Pearls Facebook page and I asked him if he could write it for my blog.

I have published two posts on KOLs before. My first post was an overall comment. This, the second, was, in retrospect, a little disparaging.

Anyway over to Jason…

I’ve watched the discussions about products and Key Opinion Leaders’s for a while. I have been hesitant to say much because I have a very real bias. I am currently and have been a Key Opinion Leader for various companies for the past 15 years. However, I suspect my thoughts will be quite different than would be expected from a Key Opinion Leader. As I watch this continued downward spiral of vitriol and name-calling, I have to consider whether I should continue to sit idly by or try to effect change. I choose the latter.

My standard declaration of potential conflict of interest

First, let me do as I have done within the first 15 minutes of every lecture or presentation I have given for the past 15 years. After explaining my background and history, my last bullet point states that I am actively involved in product development and testing. That is my cue to state the following –

“I say that so you are aware of my biases. We all have biases based on our experiences, our interests, and our desires. They are neither good nor bad. They simply are. The only things I can truly talk about with expertise are my experiences and beliefs. They are mine; I own them and can’t change them, although sometimes I wish I could. Some of what I will discuss with you has good scientific evidence, some will merely be my opinion. I will try to point out the difference as we go along. If you are uncertain, please ask. You deserve to know.

I am a KOL for several companies. I also developed the IMTEC Ortho Implant System that was later acquired by 3M and sold as the Unitek TAD System and I receive royalties on that. Furthermore, I believe that clinicians being involved with product development is a good thing; it helps advance the specialty. But, there is a potential for bias so I want you to understand that. I suggest that you take everything I say with a grain of salt. You should question everything I say, as we all should do for each and every speaker when we are members of an audience.”

Some basic facts

I would also like to outline some basic premises from which I operate:

I am a lab tech (I started at age 13), I am a clinician (I started assisting at age 15), I am a researcher, a scientist, an academic, and multiple other unimportant things.

Importantly, I am not one of these things to the exclusion of the rest. I am all of them, all of the time. Some people are ethical and tell the truth. Some people are unethical and do not tell the truth, or stretch the truth, or tell half-truths. Unfortunately, we don’t walk around with these notices on our foreheads, so we have to use situations, circumstances, and experiences to discern the difference.

We need to remember that orthodontics is a field of basic and clinical science and art – it is both, to the exclusion of neither. Anyone who says it is all art, is not correct. Likewise, anyone who says it is all known science is also incorrect. The difference being that art is simply the subjective interpretation of an object, whereas science is the attempt at objective interpretation of the same object. There are certain basic scientific tenets with which we (should) base treatment. Importantly, there are many things that are known and there are many others that are not.

My perspective on KOLs

I would like to propose a different perspective on KOLs and product discussions/presentations and the questioning of KOLs. These are general statements and not directed to any one or more individuals. I have friends on both sides of this discussion today; I hope I can say the same tomorrow. This is really concerned with the situation in general, as it has unfolded over several months. Nevertheless, a particular post prompted me to say something.

Recently, a friend and colleague of mine responded to a discussion post with the following statement

“We are NOT in the field of questioning. Unless you are a philosopher, an academic or a researcher.”

Respectfully, I disagree with him and believe nothing could be further from the truth. If we do not question, then tacit acceptance of dubious comments becomes the norm.

Many young, impressionable eyes are watching and some are easily influenced and may readily accept these comments as fact. This is because it was posted by someone with stature “who should be believed”, or who had a louder voice. Others use bullying and sarcasm in an attempt to force their opinions on others. This necessitates the need for healthy, but respectful questioning.

A questioning approach

Personally and professionally, I respectfully question everyone and everything.. For example, how did you do that? Why did you do that? Did you base it on a hunch or an article, or were you just bailing out the only way you knew how at the time? If you don’t know, then just say it. No one has all of the answers, so stop any posturing that you do. To admit we don’t have the answer makes us believable and trustworthy. If you claim that it works 100% of the time, you just made yourself woefully unbelievable. Nothing works all of the time.

It is important to remember that those who don’t ask questions, should become acquainted with the phrase “buyer beware”, as they will most likely be haunted by it from this day forward. I also question my own treatment. Did it work? Did it not work? If not, why? Did I incorrectly apply the mechanics? Did I miss the diagnosis? How do I correct it? How could I have done it differently and better and faster?

The intentions of KOLs

I have been in this game for way too long to believe everyone has altruistic intentions. Although some do, they are few and far between. Others want a soapbox. Others want notoriety. Still others do it to feed their ego. Others do it for money. And usually, it’s a combination thereof.

Hopefully, I’m a better version of myself than I was 10 years ago, 5 years ago, and even 5 days ago. But to not question someone because we should first assume everyone has integrity is a fool’s errand. Trust but verify! And for those whose skin is too thin to be called to task, and asked the tough questions regarding proof, then you might consider staying out of the arena.

A way forward

We should be able to professionally and respectfully disagree without the name-calling, which is all too easy to do, particularly when safely tucked behind a keyboard. And this applies to both sides of the discussion. I have witnessed people posing questions that were completely unwarranted and unprofessional. Consequently, some of the responses to those questions have been equally distasteful.

I frequently try to remind myself of a story, the moral of which is that people who resort to name-calling are usually those that are not intelligent enough to win an argument. My higher self, the one that appears all too infrequently, has saved me a few times, albeit not enough, by forcing me to hit the Delete key instead of the Enter key.

The burden of proof

The burden of proof always lies with the person making the claims. This does not apply only to KOLs. It applies to anyone who makes a claim without evidence. If a person makes a statement that is hard to believe, then the burden of proof is theirs alone. If someone stands on a stage and makes claims, they should expect to be questioned. When they post something on Facebook, they should expect to be questioned and asked for proof. Although, the absence of proof is not proof of absence – it is lack of proof.. We should not make claims that we cannot support. Instead, a better approach might be,

“I tried this and it appeared to work. Although I have no proof, here is what I think is happening and why. I’ve tried to base it on scientific principles, but admittedly, some of it is trial and error.”

At least that is the approach I have taken with my clinical techniques and presentations.

Orthodontic magic

Unfortunately, various people are proclaiming “magical” techniques and products with little proof. This, of course, is nothing new – we’ve all seen the magic brackets that reportedly grew bone. By all accounts, the products appear to offer benefits, but that does not make them “magical”. It simply makes them an alternative, and perhaps an even better appliance than what we currently use, but still, at this point, just an alternative. The scientific proof is lacking. Period. Time will tell. But for now, it’s so much easier to simply acknowledge those facts already in evidence instead of applying circular logic, or deflection, or redirection to avoid acknowledging the simple fact that the product is too new to have real proof. It appears to me that this, above all else, is what is being met with such resistance. I think that people are just tired of this approach.

Solutions?

We should come together as professional and respectful colleagues. We need honest conversation about important issues. But, it can’t happen without the honesty, the respect, and the ability to disagree with professionalism. Hopefully, that will happen sooner rather than later. We could desperately use some unification.

The people in the audience, at least the discerning ones, are already suspicious that they are being sold based on these auspicious claims. The speakers can save their credibility by acknowledging the facts publicly. Otherwise, they run the risk of being labeled a company spokesperson instead of a person who speaks for a company. It takes years to build a reputation, and but seconds to destroy it.

Final thoughts

Lastly, I take the statement that “WE on Facebook are not the guardians of our profession” quite seriously and personally.

I freely acknowledge my bias here. I come at this from the position of the son of an orthodontist. My Dad felt like he received the single golden ticket when he was accepted to orthodontic school. Everything I have is inextricably tied to my Dad’s choice to join the orthodontic specialty. Education, knowledge, speaking, travel, patents, friendships, my wife, our baby – the list is far too long to post here, but is all due to orthodontics, both the tangible and intangible blessings that it provided, and my Dad’s passion for it.

I decided long ago, that if I did not give back as much as I had received from orthodontics, then I had failed miserably. As most will no doubt understand, that’s an utterly impossible goal set by a naïve guy many years ago, but a driving force nonetheless. It’s not a job or a profession; it is a love, a mission, a passion that cannot be quenched. So to be involuntarily lumped into the collective “WE” whose responsibility it is not, I opt out. I hereby self-select out of the WE group.

If I have to choose between a bracket and the specialty, then I choose the specialty. If I have to choose between a company and the specialty, then I choose the specialty. Finally, if I have to choose between someone or something in the specialty and the specialty, then I choose the specialty. There will be other brackets and other companies, but there will not be another orthodontic specialty. Instead, I prefer the If not me, then who? group.

Sorry for the heaviness, but someone needed to say this. And I figure if not me, then who?