Beware of the herd.

Abstract

You enjoy the interaction with your colleagues, especially on social media. Your membership in that online study club provides you with the opportunity for exposure to new procedures, emerging techniques, and dialogue with colleagues throughout the country, often regarding controversial cases. One site to which you belong takes a near absolute stand against extraction of permanent teeth in the treatment of almost all cases. Various appliance designs and treatment strategies are proposed to accommodate the teeth within the arches, even at the expense of profile considerations, stability, or periodontal ramifications. The site has an ample number of followers. Its readership chimes in about the benefits of nonextraction therapy as a practice builder and as a state-of-the-art philosophy of modern orthodontic therapy. You certainly understand that any parent or patient would prefer a nonextraction approach, but sometimes presenting conditions necessitate the removal of permanent teeth. So does much of the research that supports long-term stability and health of the dentition. Yet this group of orthodontists seems oblivious—or contrary—to the application of evidence-based information. Researchers at the University of Leeds in England conducted an experiment in which subjects in a large office building were instructed to walk around the halls without direction. Approximately 5% of the subjects were then asked to travel in a distinct route. No communication was permitted between the subjects, except that each was directed to walk at arm's length of each other. The remaining 95% predictably followed the leader in a “snake-like,” single-file configuration without apparent reason. The investigators concluded that when people have no strong commitment toward one decision or another, they follow the herd. This phenomenon is seen not only in humans but also in animals such as sheep and birds, and is labeled “herd mentality.”1Nauret R. “Herd” mentality explained.https://psychcentral.com/news/2008/02/15/herd-mentality-explained/1922.htmlDate accessed: April 10, 2019Google Scholar Herd mentality can have positive or negative consequences. It can be useful in coping with emergency circumstances such as evacuations after catastrophes. Herd mentality is not only a phenomenon of nonverbal communication, but also prevails in consumerism—and has evolved in orthodontic care, in part because of the ease of Internet communication. It is a strategy used to entice potential consumers toward the product or service choices of large groups.2Morin A. Study shows the power of social influence: 5 ways to avoid the herd mentality.https://www.forbes.com/sites/amymorin/2014/07/25/study-shows-the power-of-social-influence-5-ways-to-avoid-the-herd-mentality/Date accessed: April 10, 2019Google Scholar Consumer preference for high-profile products such as Starbucks coffee, Mercedes Benz automobiles, or North Face outerwear are examples of herd mentality in product selection. Even our patients feel validated when they meet people they know as they enter our reception room. There is a sense of security in knowing that many others have also enrolled in a certain service or product. Orthodontic vendors are no different, and they encourage us to follow the preferences in bracket designs or imaging systems that have been accepted by our contemporaries. This is herd mentality at its best—but can represent a dangerous predicament. When commercial enterprises manipulate our product preferences, or worse, our treatment philosophies, their motivation can become specious at best. The science that should be the basis of our therapy might be disregarded or ignored—especially if the result we provide is accepted by patients who know no better.3Johnston L. 21st century orthodontics: would Angle be pleased? Presented at the annual meeting of the Edward H. Angle Society of Orthodontists, Angle East Component, Toronto, Ontario, CanadaApril 13, 2019Google Scholar And ethical decisions can be distorted by the herd mentality. A hygienist I knew in dental school felt justified in pirating postage stamps from her employer because “everyone there does it,” from the reception staff to the dental assistants to the young associate dentist. We must avoid seduction toward a certain appliance type or treatment philosophy, as well as inappropriate ethical behavior, instigated by the allure of herd influence. A combination of evidence-based decision making, tempered by clinical experience, with a dash of patient preference and ethical reasoning should be the recipe for what we provide to our patients. As my mother used to say, “You have a brain. So use it.”