The issues that Dr. Yeager raises are important. We agree with his general concerns about the potential for bias when a supplemental issue of JADA is associated with just one sponsor. As guest editors of this issue, perhaps we can provide some perspective and clarifying information.
It is clear that there is a biological revolution in the field of molecular biology, as evidenced by the recent completion of the working drafts of the human genome project by the National Institutes of Health. However, we have a more conservative view about how quickly the benefits of molecular biology will be used to cure or prevent dental caries and periodontal diseases.
First of all, even with unlimited funds, the time from basic scientific discoveries to clinical applications for clinical procedures and products, to regulatory approval for marketing, is substantial, probably decades.
Presently, the main funding sources for product development are the pharmaceutical companies. But they tend to focus on so-called "blockbuster drugs," which produce between $500 million and $1 billion a year in revenues. There is no such market in dentistry for blockbuster drugs, and even when science does develop early diagnostics and/or medical-type dental therapies, the funding for such product development may fall through the cracks of the health care product developmentsystem.
Once clinical trials are initiated, the process can be at least a seven- to 10-year effort.
Finally, for the dental profession to emerge into an oral medicine profession will take the retraining of dentists and a major behavioral shift in the home self-care habits of the population in general. These significant professional, cultural and patient behavior changes may take several generations to occur.
So while it is theoretically possible that molecular biology could completely change the diagnostic and therapeutic approaches to oral diseases, we believe that dentistry may be several generations away from the realization of the practice of medical dentistry except in isolated demonstration practices with closely monitored patients. As a result, we chose to take a more short-term view of future dental practice and instructed our authors to focus their manuscripts in this direction.
With regards to bias, let us first say each of the articles in the special supplement went through the regular peer-review process that has been established by JADA. As guest editors, we can certainly testify that the reviews were fair and very critical when needed. The review process, which included two outside reviewers and the two guest editors, improved every article.
As regards to the promotion of only DENTSPLY products, we believe the articles themselves show that this is simply not the case. A closer reading of several of the articles demonstrates this.
For example, the article "21st-Century Endodontics" describes a number of procedures, products and instruments that are not manufactured or sold by DENTSPLY. Similarly, "Trends in Surgical and Nonsurgical Periodontics" mentioned products that are marketed by competitors of DENTSPLY.
"The Science of Bonding: From First to Sixth Generation" enumerated bonding materials and their appropriate uses. The article addressed the science behind bonding materials rather than specific brands. Similarly, with regards to composites, the article described the types of composites and their uses.
With these facts in mind, it is simply not true that an educational grant provided by DENTSPLY to JADA resulted in a series of articles that are de facto advertisements for DENTSPLY products. A number of DENTSPLY products were mentioned because the authors often were reporting on clinical research or clinical practice techniques, and DENTSPLY does manufacture and market a broad array of dental products.
Finally, the conflict of interest concern was directly addressed by disclosing and acknowledging that the support for the special supplement came from DENTSPLY International. We can assure Dr. Yeager that no one in DENTSPLY ever made any statements of any kind to the guest editors or authors regarding materials or procedures that they would like to see included in specific articles or suggested that competitors’ products be deleted. There was no interference in the production of the manuscripts or in the editing process.
As guest editors, we can certainly say that it was a pleasure to work with the authors, and we were pleased to have been asked to serve as guest editors of this special supplement. The articles are high-quality summaries of a wide variety of forward-looking clinical issues. We hope that the majority of readers will benefit from being able to read a summary of clinically relevant issues brought together within a single issue of JADA.
Thank you for the opportunity to respond.
