Ethics

Ethics Summit on Commercialism

(Ethics Summit IV)

A Collaborative Project with the American Dental Association

David W. Chambers, PhD

Excerpted from News & Views, May 2006, 34(2):1

Commercialism encompasses the attitudes and methods that excessively emphasize profit or business success. Participants in the February 28 and March 1 Ethics Summit on Commercialism feel that commercialism is on the rise in society generally and in dentistry, that it damages both the patients’ oral health and the profession, and there are steps that can be taken to reverse this trend.

The fourth Ethics Summit was sponsored with the American Dental Association and took place at the ADA headquarters building this winter. It was attended by 63 leaders from organized dentistry, specialties, insurance, research, education, and journalism. The program was keynoted by Dr. Gordon J. Christensen, who provided numerous examples of subtle and not-so-subtle ways dentistry is being fragmented by unhealthy financial concerns. Participant in the Summit agreed that there is a necessary financial component of any undertaking such as dentistry. But that must not be allowed to be the driving force; it must never call into question the relationship of trust between dentists and patients.

Participants focused on understanding the origins of commercialism. Twenty-four factors contributing to commercialism were identified and ranked, grouped, and discussed. The basic groupings to emerge were: (1) general, including the attitudes of society and individual practitioners; (2) the education of dentists; (3) leadership in organized dentistry; and (4) regulatory matters. The most obvious outcome of this analysis is that commercialism is pervasive, rising, and multifactorial. In addition to this general wave of commercialism, a more fine-grained analysis revealed pressures coming from what might be termed the "near profession." This includes practice management courses that emphasize profit and personal success, some continuing education gurus who promote a gospel of profit, publications with a strong commercial tone, professional meetings with heavy emphasis on commercial exhibits, and lack of enforcement of professional codes. A third pattern was identified consisting of positive forces countervailing commercial interest. Prominent among these are leadership from organized dentistry and ethically sound education in dental school. There was also concern expressed over the fact that patients are increasingly forming their impressions of health and health care from non-professional sources and are asking for fragmentary care.

The heavy lifting at the Summit began with identifying the levers most likely to make an effective difference in addressing commercialism. The following threats to oral health were identified: (1) demand for non-health care will undermine the health dimensions of dentistry and further exacerbate concerns over access; (2) segmentation of the delivery system will erode quality and increase regulation; (3) weaker codes or lack of enforcement will open the door for undesirable intervention; (4) the public will further accept unrealistic views of what constitutes appropriate oral health care; (5) questionable advertising, CE, and other claims will cloud the scientific assessment of progress; (6) dentists will lose credibility as the source of information about oral health; (7) the foundation of dentistry in science will be softened; and (8) professionalism and the cohesion of the profession will be damaged.

Tackling the most critical of these concerns, five working groups developed potential strategies for addressing commercialism in dentistry. The team working on inappropriate commercialism stressed that the professional must take the lead in addressing access issues and mount significant campaigns to promote comprehensive oral health and dentists’ role in promoting it. The team that focused on segmentation in the delivery system proposed incentives for practice in underserved communities, increased reimbursement levels (especially for the underserved), clarity on guidelines for non-specialty practice areas, increased dental office productivity, and bringing young practitioners into the profession early in their careers. The third team addressed matters around codes. Creation of a patient bill of rights, mentoring young professionals, and engagement of components in education and enforcement were identified as potentially valuable efforts. The fourth team, dealing with public perceptions, emphasized the need for activity creating realistic expectations in the public reinforcing the message that oral health is part of overall health, and developing media for patients. The final group recommended developing "information" initiatives, including educating the public about comprehensive oral health, developing standards for disclosure and other commercial activities, and reemphasizing that dentistry is grounded in science.

Participants in the Ethics Summit on Commercialism left with a sense that something can and should be done to address commercialism in dentistry. The frustration of the opening session, where it was so obviously necessary and easy to point fingers at others, evolved into a positive action orientation by the end of the meeting. One of the strong messages is that it will be of limited value to tell others what they should not do. Instead, the profession can be every active in promotion oral health. We can create the strong impression that all patients are entitled to and such expect and ask for competent care, comprehensive care, continuous care, and fully informed consent.