Innovation or marketing ploy: How do we distinguish between the two?

Abstract

The relationship between medical/surgical companies and the professions is an important one that hinges on several different factors. They provide us with the instruments and products that are necessary to provide high-quality care for our patients. They provide continuing education in both the formal and informal settings: formal, by sponsoring structured courses, and informal, by discussions with the company representative in the office setting. Finally, these companies are continually striving to produce the most advanced products and techniques. We benefit by being able to offer to our patients the latest—and presumably the best—service, and the company benefits by having increased sales. The difficulty arises when the newest product is explained in the office setting. The representative, motivated by the need to make sales, and the doctor, motivated by the need to be “up-to-date in River City,” enter a relationship in which unsupported claims are made and believed. These relationships are fostered with free lunches for the staff, sponsored golf outings, and special low-price introductory offers. Which is to say, marketing in its basest form prevails and science is not visible. There are daily examples in our professional lives. A frequent one is in the area of dental implants and related products. P. I. Brånemark and his colleagues defined the principles of osseointegration many years ago. Since that time, an enormous number of changes have been proposed, presumably to improve dental implants, but also to sell more implants. Some of these proposals have had a major positive impact. A few examples are single-stage implant replacement, the need for precise fit between the implant and the abutment to prevent screw loosening, and rough implant surfaces—be they hydroxyapatite or titanium—to achieve higher initial integration rates. However, although the need to sell more of a product motivates change for improvement, it will also motivate change for change’s sake, (ie, for marketing benefit). The difficulty for the clinician is to discern which of the “new and improved” products is truly better and which is just different. So, what can we clinicians do? There are no easy, clear solutions, but some of the following suggestions may be helpful. First, doubt all claims that innovations are better. Unless the clinical problem is large and the new solution is genius (a rare condition indeed), the proposed improvement more likely has greater marketing benefit than patient benefit. Second, ask for some comparison data. The new product is better than what? Are there data comparing the new to the standard treatment—or to no treatment at all? Are there any data to suggest long-term superiority over standard methods? Third, ask “so what?” If the latest innovation results in a tighter fit, does the tighter fit result in greater clinical success over the long term or just a tighter fit with no clinical benefit? It may be different, but is it better? Fourth, ask if the new improvement is for general use or for very specific indications. Immediate functional loading may work well in the anterior mandible, but is it as successful as standard 2-stage surgery in the posterior maxilla? Improvement in patient care is everyone’s goal. Improvement in market share is industry’s goal. Enjoy the lunch, but remember—it isn’t free.