ADAVB Chief Executive Officer's Comments
November 2019 Hide Comments
Building and keeping patient trust
 
Members may be aware of recent media stories about the provision of clear aligner orthodontic treatment. Articles published in The Age have focused on the role of social media influencers in promoting this type of treatment, and the growing number of direct-to-consumer providers offering these services directly to patients. The most recent of these articles reported that the Australian Health Practitioner Regulation Agency was investigating three direct-to-consumer operators – Smile Direct Club, EZ Smile and WonderSmile – for potential breaches of section 133 of the National Law. The law states that ‘a person must not advertise a health service, or a business that provides a regulated health service, in a way that directly or indirectly encourages the indiscriminate or unnecessary use of regulated health services’. One aspect of the alleged complaint is these direct-to-consumer companies’ use of social media influencers to promote aligner products without adequate disclosure of their financial arrangements with the companies, and the advertising unduly encourages dental treatment that may be unnecessary.
 
We understand that the Therapeutic Goods Administration and the Australian Competition and Consumer Commission may also be involved as part of the investigation that relate to various aspects of advertising of clear aligners. 
 
The ADA and Australian Society of Orthodontics have been extremely vocal in their advocacy to the various regulators about the potential risk to the public when dentists or orthodontists are not directly involved in diagnosis and treatment, and I recently discussed this issue on ABC radio.
 
However, there was another issue raised in the reporting, with allegations that dentists and orthodontists are receiving discounts from Invisalign based on the number of cases they undertake, and that these financial incentives are not adequately disclosed to patients. The concern is that these discounts may influence the way that dentists and orthodontists recommend treatment, and this inference was put to me on ABC radio.
 
The Dental Board of Australia (DBA) Code of Conduct stipulates that dental practitioners have a duty of care to ensure that the interests of their patients are their primary concern, and to be ethical and trustworthy in their dealings with patients. It also specifies that ‘practitioners must be honest and transparent in financial arrangements with patients or clients’. This means: 
 
Being transparent in financial and commercial matters relating to work
 
Declaring any relevant and material financial or commercial interest that a practitioner or their family might have in any aspect of the care of the patient or client 
 
Declaring to patients or clients any professional and financial interest in any product or service a practitioner might endorse or sell from their practice 
 
Not making an unjustifiable profit from the sale or endorsement.
 
Dentists are fortunate to enjoy a high level of trust in the community, with a recent Roy Morgan poll showing 79 per cent of people rated dentists as ‘very high’ or ‘high’ for ethics and honesty, behind only nurses, doctors, pharmacists, teachers and engineers. Trust is hard earned but easily lost. News reporting of these issues has the potential to damage the reputation of the whole profession and lessen the trust that our patients have in us.
 
Dentists need to be aware of the advertising guidelines and Code of Conduct in their dealings with patients and the way they market treatment to patients. We will continue to call on the regulators to protect the public from direct-to-consumer operators but must ensure that our members are also complying with the regulations. 
 
Another area of potential concern that has been flagged by the DBA is the dispensing of medicines by dentists, particularly when this is framed as a way of generating additional revenue by prescribing and dispensing medications. Dental dispensing is also covered by the following provisions in the Code of Conduct:
 
Ensuring the care of the patient is the primary concern for health professionals in clinical practice
 
Providing treatment options based on the best available information, and not influenced by financial gain or incentives
 
Conforming to the legislation in the relevant states and territories, including about self-prescribing 
 
Maintaining adequate records, including being mindful of additional informed consent requirements when supplying or prescribing products not approved or made in Australia.
 
Dentists who are considering dispensing medications in their practice must be mindful of these provisions, and understand that this is now on the radar of the regulator.
 
A/Prof Matt Hopcraft
ceo@adavb.org


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Clinical A/Prof Matthew Hopcraft
BDSc MDSc BA PhD FICD
Chief Executive Officer
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