It is generally accepted that you have to use a new word three times before it is yours. Just yesterday, I discovered zeitgeist,* and now it is mine. I wanted to share my vocabulary growth after I discovered its meaning and realized how much it expresses what I often think about in orthodontics. I suspect most of you do the same.
The orthodontic intellectual climate of today is perhaps relatively least ambiguous. Certainly, there has been real intellectual progress. Evidence-based practice is almost a household (office) word. Technology has had an unbelievable impact on clinical procedures, and the availability of information today would be unimaginable to past generations. One big change is that the dominance of intellectual activity has moved to widespread global locations. Having said all of that, the biological basis of many clinical procedures is still elective and empirical and without substantive information on the cost-benefit ratio to the patient. Much remains to be done.
The moral climate is harder to assess and hard to measure. Our health care colleagues in medicine have probably lost more public support in this area, and this should be a wake-up call for us. Much of their loss probably comes from the increasing commercialization of health care. To paraphrase Eisenhower's 1961 farewell address, we should stay aware of the potential for a health care (orthodontic) industrial complex.
Who can not be aware of the changing relationship between physicians and pharmaceutical companies? Those who have witnessed the changes have seen the increasing role of commercial interests in all health fields grow, and orthodontics has not been only a bystander. This change can be positive, but it unquestionably carries with it considerable risk for the profit motive (ie, a commercial firm's justifiable pursuit and responsibility) to come into conflict with the patient care role we hold as our primary objective.
From a fiscal perspective, both many commercial firms and many orthodontists have been exceedingly generous. However, both orthodontists and commercial firms have an obligation to support orthodontics and how it is perceived by the public, taught, and practiced.
The orthodontic-commercial firm relationship has historically been largely a symbiotic relationship, and it is in the best interest of both groups for this to continue. The profession and the commercial firms depend on each other. One cannot be healthy if the other is struggling. Still, it is pause for concern if one should become too dependent on the other.
Clearly, the role of our supporting commercial firms has grown and increased in visibility. Most orthodontic meetings today are heavily dependent on commercial support. Orthodontists lend themselves to programs sponsored by commercial interests. No one I hear has suggested anything improper about these activities, but the future can go many ways.
For example, witness the recent events in several states where a commercial enterprise attempted to build an intimate relationship with the academic orthodontic community. Obviously, such a thrust has the potential for profound changes in the orthodontic specialty. This wake-up call should provide an incentive to constantly reassess the strings, however subtle, that may come attached to financial support. A short-term fix can lead to long-term changes. The development of orthodontics must always consider the best interest of the patients first.
The third leg in this triad is cultural, and the public plays a clear role in developing our societal culture, influenced at least in part by the times. One of the overriding cultural changes has been the switch from the role of health care from primarily treating disease to prevention with an equal change in the emphasis on esthetics and quality-of-life issues. This has changed the nature of dental practice profoundly and, indirectly, the demand for orthodontics. What we learned in school in recent eras is largely obsolete today, and professional growth is imperative.
No one can live in a vacuum today, and there are tremors of change happening all around us. Unavoidably, change will occur, and our responsibility is to lead the change and not to stand by and plead victimization. This leadership role cannot be avoided.
We each pursue individually busy worlds and development of our individual trees. It is important to remember that our trees are all part of a greater forest, and the forest must prosper for our trees to continue to prosper.
* zeitgeist, n, the general intellectual, moral, and cultural climate of an era.