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5 — Principle: Veracity ("truthfulness")
The dentist has a
duty to communicate truthfully.
Report and Advisory Opinion of the Council on Ethics, Bylaws and
Judicial Affairs: Marketing or Sale of Products or Procedures
Background: A
small but significant number of dentists
sell or market dental products to
their patients.
One survey puts the figure as
high as 17%.1 They may also engage
in the sale or marketing to their
patients of non-dental products, such
as vitamins and nutritional supplements.2
The sale or marketing of products in the dental office is a
potential source of income. Income enhancement is a common
inducement for dentists to participate in multi-level marketing
programs or distribution networks.3
No one knows more about oral health care
or is better qualified than the dentist
to make recommendations about the safety
and efficacy of dental products. Indeed,
patients look to their dentists for
this kind of advice. In a 1994 ADA survey,
the dentist topped the list of sources
Americans rely on for dental information.4
Dental manufacturers report that the
dentist’s recommendations can have substantial influence
on the consumer’s decision to buy a particular dental
product.5
The fact that the dentist derives income
from the sale or marketing of products
does not, by itself, make the practice unethical;
after all, dentists also derive income
from the delivery of dental services.
Any transaction for profit involves the potential
for conflict between the interests of
the buyer and the seller. However,
dentists, as professionals, have an ethical obligation
to put the interests of their patients
above their own financial gain. As
stated in the Preamble to the ADA Principles of Ethics
and Code of Professional Conduct (Code), "The American
Dental Association calls upon dentists
to follow high ethical standards which
have the benefit of the patient as their primary
goal."
Section
5 – Principle:
Veracity of the Code states:
This principle expresses the
concept
that professionals
have a
duty to be honest and trustworthy
in their dealings with people.
Under this principle,
the dentist’s primary
obligations include respecting
the position of trust inherent
in the dentist-patient relationship,
communicating truthfully
and without deception,
and maintaining intellectual
integrity.
The principle of veracity is directly relevant to representations
dentists make about products they sell or market to their
patients.
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Top Ethical Considerations Involved in
Marketing or Sale of Procedures: Some dental
practices offer financial incentives to their
staff as a way to increase office production.6
The ethical considerations that apply
to these incentive programs are
similar to those involved in the marketing
or sale or products. First and foremost
is the principle of veracity. Staff should
not be allowed to "oversell" procedures to patients
by misrepresenting their value.
Providing financial incentives to staff
based on production also raises concerns
about the appropriate use of auxiliary
personnel. Dentists are ethically obliged
to protect the health of their patients
by only assigning to qualified auxiliaries
those duties which can be legally delegated
and by supervising the patient care
provided by auxiliaries (Code, Section
2.C. Use of Auxiliary Personnel). Only the
dentist is qualified by education
and training to diagnose dental disease
and prescribe treatment. Auxiliaries
under the dentist’s
supervision should not be permitted to
recommend treatment until the dentist
has examined the patient and determined
that the treatment is appropriate.
In May 1995, the Council adopted Advisory Opinion 5.D.2 covering
the sale or marketing of products in the dental office. The
Council subsequently amended the advisory opinion in February
1999 to address the sale or marketing of dental procedures.
As amended by the Council, Advisory Opinion 5.D.2 reads as
follows:
5.D.2.
Marketing or Sale of Products
or Procedures.
Dentists who, in the regular
conduct
of their practices, engage in
or employ auxiliaries in the
marketing or sale
of products or procedures to
their patients must take care
not to exploit the trust
inherent in the dentist-patient
relationship for their own financial
gain. Dentists
should not induce their patients
to purchase products or undergo
procedures by misrepresenting
the product’s value, the necessity of the procedure
or the dentist’s professional expertise in recommending
the product or procedure.
In the case of
a health-related product, it
is not enough for the dentist
to rely on the manufacturer’s or distributor’s
representations about the product’s safety and
efficacy. The dentist has an independent obligation
to inquire into the truth and
accuracy
of such claims and verify that
they are founded on accepted scientific
knowledge or research. Dentists
should disclose to their patients all relevant information
the patient needs to make an
informed
purchase decision, including
whether the product is available elsewhere
and whether there are any financial
incentives for the dentist to recommend the product
that
would not be evident to the patient.
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1 Grove, SJ, et al. Root Canals
and Retailing. J Health Care Marketing. 1994;14:36-40.
2 Gabriel, T. Many Trade a Briefcase
In For the Sample Case of Sales. New
York Times. January 28, 1997.
3 See, e.g., Position Statement
on PharmAssist AP-24, Oral Care System.
Council on Dental Therapeutics; January 2, 1994; Kaster,
D. Fresh Breath Centre. The Profitable
Dentist. 1995;89:5-6.
4 Survey on Dental Health Care Issues.
American Dental Association; November
1994.
5 Schwartz, DM. Should Selling Products
Be a Part of Your Practice? Dental Management. 1989:29(1);28-37.
6 ADA Council on Dental Practice.
Employee Office Manual: A Guide for the Dental Practice (1995);
ADA Council on Dental
Practice. Recruiting and Retaining Staff:
A Guide for the Dental Office (1998).
Adopted May 1995; Revised January 1997, June 1999
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