Major changes have taken place at the American Dental Association. Recently the board decided to terminate the employment of the two top individuals at the organization rather abruptly. While there no doubt were accumulative reasons for which this action was taken, I think there is little doubt that their position to allow a commercial company’s marketing rhetoric to become the face of the ADA oral cancer awareness program played a part in all this. Undoubtedly this will trigger a rethinking of the relationship with Oral CDx, and if that continues, it will likely take a very different form. This would be a good thing in my mind. It is hard to imagine that (now involved as they should have been in the beginning), the ADA’s Science Council – which has a fair sampling of oral surgeons and oral pathology individuals on it – will rubber stamp the CDx brush biopsy rhetoric which has played to date.
Those who have read previous postings here, may remember my observations on what happened at the American Medical Association when their hired leadership decided to become intimate with the Sunbeam corporation, adopting Sunbeam’s sales and promotional materials, and flying those corporate colors under the AMA banner…. the trustees showed them the door very soon thereafter. My observation that similar fates could be avoided by anyone who was paying attention at the ADA, proved out. Money for these professional societies is a powerful draw, and at the core of the ADA/CDx relationship it was there, more than 9 million dollars over three years. CDx had it, the ADA wanted it, and in the end the organization proved that their logo and identity could be bought. I do not find this unusual, or for that matter new when you look at the last couple decades of the ADA’s behavior. There is little doubt that the money generated from their ADA seal of approval program generated significant revenues for the association.
The public must remember that their charter is to serve the needs of their constituents, dentists. They should not think that any created illusion, for instance that the public interest is the ADA’s prime focus, is actually little more than a distortion of reality. I wish to make it clear. This is as it should be. Their charter is to see to the needs of dentists, and as a private society with only dentists as members, this is completely appropriate and expected of this kind of organization. But the ADA would like to appear to the public as less of what is essentially a trade union, and more as a benevolent public service organization. They are not a public service organization. Efforts to create this organizational persona confuse the public, and I am in favor of more transparency, or at least the ADA visibly being what they actually are. It doesn’t detract from anything, or make them bad guys to be the protectors of the interests of dentists. And this does not mean that they do not have programs that the public benefits from, it just means that those are secondary to their primary function. Pushing Oral CDx’s marketing agenda for profit in a world in which they are viewed as what they really are isn’t problematic. However it does become so when they try to appear a champions of the public welfare, and at the same time put out a message that has a for profit motive associated with it, which distorts the reality of what a biopsy brush is and can do.
While I feel this major change needed to happen, they were getting at least part of the message right. A message that the public does not hear enough. Oral cancer is out there, and an annual screening – done opportunistically – for oral cancer will save lives. My hope now is that they will continue with an awareness program that puts DISCOVERY in first place, and any techniques for DIAGNOSIS in second. But I have little hope that CDx will wish to fund something other than their position that their brush cytology system “prevents oral cancer,” which I and others strongly disagree with.
One has to wonder why the ADA has not partnered up with non competitive public service entities like the Oral Cancer Foundation to work together towards what would seem symbiotic goals. With dentists being one of the primary mechanisms to engage in opportunistic screenings to reduce the death rate and treatment morbidity, I think they should use their strengths to work with OCF and others to get dentists up to speed on screening, to institute mandatory CE credits in oral cancer and early detection (I mean how many more CE credits do you need on bleaching, veneers, and Invisalign tooth straghtening?), so we can be sure that they know what to look for, how, and where, and help a non profit with fewer financial and infrastructure assests fulfill a needed mission that is in the public (and the ADA’s) interest.
For years the ADA has always been the 800 pound gorilla in any relationship. Their way or the highway. I hope that the new leadership (supported by trustees who get all this) will reach out to make real change in the world though these kinds of relationships. None of this compromises their ability to be the champions of dentist’s interests, and it might make both them and dentists real champions in the long run….