“The only thing new in the world is the history that you do not know.”Harry S. Truman (1884-1972), 33rd president of the United States An advertisement in Dental Cosmos in 1900 boldly announced: “For the fitting of teachers and specialists in orthodontia. Two short sessions are held each year, beginning November 1 and May 1. Postgraduates in dentistry and only those thoroughly ethical received. Class limited to fifteen members. For information, address Edward H. Angle, MD, DDS, 1107 N. Grand Avenue, St. Louis, Missouri [italics added].”1Asbell M. A brief history of orthodontics.Am J Orthod Dentofacial Orthop. 1990; 98: 206-213Abstract Full Text PDF PubMed Scopus (7) Google Scholar One year later, in St Louis, Angle led a group of dedicated specialists to form the Society of Orthodontists several doors away from the Missouri Medical College. Two years of intense planning and organization culminated in this meeting; as a result, the specialty of orthodontics was born.2Shankland W. A summer's day in June.in: Pollock H. American Association of Orthodontists—biography of a specialty organization. American Association of Orthodontists, St Louis1971Google Scholar That same year, Dr Benno E. Lischer3Lischer B. Orthodontic education and literature.in: Lischer B. Time to tell. Vantage Press, New York1955Google Scholar (Fig 1), who eventually served as the Society's president and dean of the Washington University School of Dentistry, dined with his friend and next-door neighbor at the Union Dairy Cafe on the corner of Washington and Jefferson Streets in St Louis. His chum was a young physician named Charles V. Mosby, whose practice was located in Lischer's building. Their frequent topic of discussion was the possibility of establishing a journal dedicated solely to orthodontia. Mosby was then a general practice physician who was developing an enterprising interest in the publication of medico-dental specialty journals. Although the American Journal of Dental Science was established in 1840 in an effort to enhance dentistry's professional image in an era of professional mistrust, orthodontics needed a journal that was committed to its specific interests. Fourteen years later, with Dr Martin Dewey (Fig 2) as its first editor, the C. V. Mosby Company began publication of the International Journal of Orthodontia to meet that objective. This was the initial title of the publication we now call the American Journal of Orthodontics and Dentofacial Orthopedics. Lischer subsequently remained intimately involved via his regular contributions in the International Portrait Series as one of the journal's features. He continued to publish for years thereafter in a task he accepted graciously, since he believed that “orthodontic authors in those days were few in number.”3Lischer B. Orthodontic education and literature.in: Lischer B. Time to tell. Vantage Press, New York1955Google ScholarFig 2Martin Dewey, around 1921.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Ethics as applied to medico-dental practice and associated research is called bioethics.4Merriam-Webster's Dictionary. Available at: www.meriamwebster.com. Accessed September 20, 2014.Google Scholar From the Journal's inception, contributing authors have explored recurrent themes pertaining to bioethics. This early interest is a tribute to the keen foresight and enduring pride in professionalism that has persisted throughout the evolution of orthodontics. An early essay stressed that orthodontists' first obligation is to benefit our patients, in a responsibility that supersedes those involved in an art business or trade. The patient's interests remain premier.5Dewey M. The ethics of orthodontic patients.Int J Orthod. 1918; 4: 483-494Abstract Full Text PDF Scopus (2) Google Scholar The commitment has subsequently been described as a covenant rather than a contractual agreement, signifying that the doctor-patient relationship surpasses that of solely payment for a specific service. This distinguishes the patient-doctor relationship from that of a trade.6Greco P. More than a contract.Am J Orthod Dentofacial Orthop. 2012; 141: 134Abstract Full Text Full Text PDF PubMed Google Scholar Applicable ethical and bioethical topics have varied since the establishment of the Journal, but several have recurrently emerged. These have included issues related to transfer patients, unjustified criticism of colleagues, fee splitting, the need for ethical codes, professionalism, and more. The recurrence of these issues even a century after the Journal's first publication is testimony of their pertinence. Transfer of orthodontic care from one practitioner to another has consistently elucidated an array of ethical topics. Ranging from discussions of patient autonomy (self-rule) to veracity (truth telling) and to justice (providing the patient with that which he deserves), the issue of patient transfer retains a contemporary application. Although medico-dental treatment delivery followed a paternalistic approach until the late 20th century, a patient's decision to transfer from one orthodontic provider to another evoked an early emphasis on patient autonomy. In a 1918 editorial printed in the International Journal of Orthodontia, Editor Martin Dewey5Dewey M. The ethics of orthodontic patients.Int J Orthod. 1918; 4: 483-494Abstract Full Text PDF Scopus (2) Google Scholar identified 2 common reasons for elective patient transfer: personal incompatibility between the orthodontist and the patient, and the patient's dissatisfaction with the treatment plan. As the Journal's first editor, Dewey identified a common reason for dissatisfaction with the treatment plan as the patient's preference for removable rather than fixed appliance therapy. This is a contemporary issue. It was not uncommon for orthodontists of the pre-Depression era to deny the patient's right to transfer based on the initial orthodontist's financial interests. The concern was that the initiating orthodontist might remain unremunerated for his expense and effort in delivering the fixed appliance. Transfers involving patient relocation were also potentially problematic. Although it was then common courtesy for the second orthodontist to accept the fee schedule established by the initiating orthodontist, Dr Dewey objected to this practice. He recommended that the fees and choice of the appliance should be the prerogative of the second orthodontist. This opinion was later disputed by other authors who claimed that the second orthodontist should accept the fees of the initial orthodontist as an act of courtesy to both the patient and the initial provider.7Alstadt W. Professional ethics.Am J Orthod. 1950; 36: 419-427Abstract Full Text PDF PubMed Scopus (1) Google Scholar In 1921, Young8Young J.L. Ethical relations in conducting an orthodontic practice.Int J Orthod Oral Surg. 1921; 7: 347-355Abstract Full Text PDF Google Scholar admonished clinicians to refrain from commenting on the extent or quality of a transfer patient's treatment progress unless the original orthodontist accompanied the patient at the transfer visit. “The question … is [to identify] the proper policy to follow when a patient is under treatment by another orthodontist or dentist … desiring another opinion,” he wrote. “It is not advisable that the word of the patient, no matter how reliable he may be, should be taken against that of the practitioner, for it is not infrequent when misunderstandings arise between the patient and the professional man, that the patient gets the wrong impression or wrong point of view.” So true! He recommended that the second orthodontist should seek the initial orthodontist's written approval before a transfer is consummated, again citing the initial orthodontist's financial concerns as the motivation for this recommendation. He emphasized the responsibility of the initial orthodontist to locate a second orthodontist for the departing patient. Support of this opinion by luminaries such as Drs John V. Mershon, Oliver W. White, Charles A. Hawley, Guy G. Hume, and Lloyd S. Lurie was echoed. The essay of Editor H. C. Pollock9Pollock H. Orthodontic tolerance.Am J Orthod. 1949; 35: 541-542Abstract Full Text PDF Scopus (1) Google Scholar (Fig 3) entitled “Orthodontic tolerance” is well-written support of the application of the Golden Rule in the transfer process. “One thing is certain,” Pollock wrote. “The orthodontist to whom the case is referred must lean backward and employ a wholesome creed of the Golden Rule, not only because it is the right thing to do, but also for the very practical reason that he himself may be the next to have his patient fall into another's hands, where he will hope for tolerance with eyes uplifted … in the hope that his patient is in the hands of one with tolerance in his soul.” He wrote further that “intolerance by breaking public confidence can destroy the entire system upon which the specialty has been built.” Pollock10Pollock H. Orthodontics' weakest link.Am J Orthod. 1954; 40: 871-872Abstract Full Text PDF Scopus (1) Google Scholar returned with another jewel 5 years later. Labeling transfers as the “orthodontist's weakest link,” he viewed patient transfer as a potential vehicle for enhancing the specialty's image. He envisioned the transfer process as a method of demonstrating the specialty's communicability among its members. Likening patient transfer to that of a person giving directions to another with the intention of ensuring a safe arrival, the orthodontist should intend to facilitate the patient's “safe arrival” (ie, the completion of treatment). Although treatment techniques differ among providers, he believed that a minimal change in the initial treatment course was best. He called for the specialty's establishment of a conventional method of transfer. The requirement of veracity (truth) in estimating remaining treatment time was a recurrent theme, as was the second orthodontist's need to explain his reasons for replacing the initial fixed appliance with his own. The fee should be based on an “honest evaluation of the time spent and the appliance placed in relation to total fee quoted.”10Pollock H. Orthodontics' weakest link.Am J Orthod. 1954; 40: 871-872Abstract Full Text PDF Scopus (1) Google Scholar This applies to contemporary patient transfers as well. Total fee disclosure at the outset of treatment was then not universal but highly recommended. Unjustifiable criticism of the initiating orthodontist and commencement of treatment without production of adequate transfer records were discouraged.7Alstadt W. Professional ethics.Am J Orthod. 1950; 36: 419-427Abstract Full Text PDF PubMed Scopus (1) Google Scholar Rathbone and Reynolds11Rathbone J. Reynolds J. The management of transfer cases.Am J Orthod. 1969; 56: 252-265Abstract Full Text PDF PubMed Scopus (1) Google Scholar proposed an interesting classification system that included various types of transfer patients including student, permanent, and temporary transfers (eg, the summer tourist). Their recommendations pertaining to patient transfer were as follows.The mobility of the American people for vocational and educational purposes has greatly increased the number of orthodontic transfer cases. … The management of transfer cases provides the greatest challenge to our professional behavior, and the public's image of orthodontics rests upon our ability to meet this challenge. … Inherent in all transfer cases is the basic problem of who assumes responsibility; that the referring orthodontist is always correct in the eyes of the parents; that appliance design and treatment procedures will vary from operator to operator; that treatment will take longer and require more service; and that fee schedules are not uniform. … Transfer cases offer the orthodontist the greatest opportunity to prove the existence of professional ethics and to demonstrate professional courtesy. … In conclusion, there is no one answer to the many problems that confront the orthodontist in the management of transfer cases. … In the final analysis, the only real answer lies in the individual integrity of the orthodontists involved and the moral obligation which their consciences dictate. Contributors to the Journal have consistently viewed fee splitting, or commissions paid to a referral source, as unethical behavior. Early articles cited fee splitting as emanating from 2 origins. In 1923, Dr Dewey12Dewey M. Commercial x-ray laboratories and the profession.Int J Orthod Oral Surg Radiography. 1923; 9: 715-718Abstract Full Text PDF Google Scholar, 13Dewey M. The commission evil.Int J Orthod Oral Surg Radiography. 1925; 11: 972-975Abstract Full Text PDF Google Scholar advised against referring patients to those commercial radiographic laboratories that paid the highest commissions to referring orthodontists. These were laboratories that produced diagnostic films as prescribed by orthodontists. He advised against the use of dental radiology laboratories in which the operators were not licensed physicians or dentists. He asserted that a professional referral—for either patient care or laboratory services—should depend on the person or entity that provides the service rather than a financial impetus. The “trouble lies with the dentist who accepts rebates,” he declared.13Dewey M. The commission evil.Int J Orthod Oral Surg Radiography. 1925; 11: 972-975Abstract Full Text PDF Google Scholar In a strongly worded essay that denounced fee splitting, as well as dentists who accept commercial samples as incentives to prescribe products, Dr Clarence Simpson14Simpson C. Putting the kick in ethics.Int J Orthod Oral Surg Radiography. 1923; 9: 56-64Abstract Full Text PDF Scopus (1) Google Scholar was emphatic. He stated: “The x-ray laboratories will continue to ‘graft’ from the ignorant public, so long as the ‘piker’ dentists support them to produce low-priced, high mortality dentistry, and a code of ethics will never make professional men of the dentists who collect and carry a bag of free samples at every convention.” In that same article, Dr J. E. Jelenik authored a colorful narrative, calling for a strict ethical code that “should straighten some crooks and toughen the paths of slippery boys who try to cheat without losing their society affiliations.”14Simpson C. Putting the kick in ethics.Int J Orthod Oral Surg Radiography. 1923; 9: 56-64Abstract Full Text PDF Scopus (1) Google Scholar He called garish signage and advertising “self elevation … equaling greed and selfishness.” He continued: “Patients that come to you through any other manner than that of personal acquaintance or by recommendation of other patients of yours are seldom desirable.” Dr Dewey15Dewey M. The ethics of advertising.Int J Orthod Oral Surg Radiography. 1924; 10: 245-248Abstract Full Text PDF Google Scholar warned that extending professional fee courtesies to dentists and physicians as a “bid for patronage” might infringe on the American Dental Association's ethical code. In the orthodontist's quest for new patients, Alstadt7Alstadt W. Professional ethics.Am J Orthod. 1950; 36: 419-427Abstract Full Text PDF PubMed Scopus (1) Google Scholar stated that “it is obvious that certain procedures such as kickbacks, tipping elevator girls, allowing unauthorized personnel to administer to patients and indiscriminate dental notices seeking patients are unethical.” Encouraging an ethical posture, he continued optimistically: “There have been but few instances where financial returns have not kept pace with ethical practices. … A gradual increase in clientele must follow, with augmented prestige in the community and in the profession” leading to respect and support within the community in which the professional practices. He advocated an ethical approach to marketing as the winning strategy for practice growth. Medicine's first formal ethical code was written in 1803 in England by Thomas Percival. The first American medical code was drafted in 1847. It was not until 1866, however, that a dental ethical code was developed.16Beemsterboer P. Presentation at the American College of Dentists. San Antonio, Tex; October 8, 2014.Google Scholar Although our specialty had no formalized ethical code until 1954, the Code of Ethics of the American Dental Association served as the respected reference until an orthodontic ethical code was established. Beemsterboer16Beemsterboer P. Presentation at the American College of Dentists. San Antonio, Tex; October 8, 2014.Google Scholar listed the benefits of professional ethical codes to include a definition of behavioral standards, a basis for self-regulation, unification of its members, and provisions for judicial review. Early ethical codes prohibited misleading advertising, and this admonition remains applicable today. A practitioner's announcement as a specialist was always discouraged to avoid projecting an image of superiority. The recommended alternative to early practice announcements that included the word “specialist” was the phrase “practice limited to orthodontics,” which connotes that the provider performs no other procedures than orthodontics. The concern of legal retaliation was mentioned as a potential sequel of superiority claims in advertising.17Dewey M. The code of ethics of the ADA.Int J Orthod Oral Surg Radiography. 1928; 14: 454-456Abstract Full Text PDF Google Scholar In a 1932 essay, Dr B. Frank Gray18Gray B.F. Ethics and business practice in orthodontics.Am J Orthod Oral Surg. 1932; 18: 450-456Google Scholar (Fig 4) expressed the need for a code of ethics including advertising guidelines as well as other appropriate sections from the ethical code of the American Dental Association. He stated: “It will be wholesome for the practitioner, whether young or old in the work, to think less of competition and more of rendering good, honest, scientific service. This will go far toward establishing one's place in the confidence of the public one seeks to serve.” Until our specialty established its own ethical code, the code of the American Dental Association was used as the basis for addressing ethical violations. Ethical violations are still addressed via disciplinary measures in local dental societies rather than by legal recourse. In the event of an appeal of an alleged ethics violation, committees from constituent societies can become involved. There are currently 54 constituent societies in the United States. A judicial council can also be consulted if resolution of a dispute at the constituency level becomes impossible. Although compliance with the American Association of Orthodontists' Code of Ethics is voluntary, internal enforcement remains necessary to uphold professional standards.19Garetto L. Presentation at the American College of Dentists; San Antonio, Texas; October 8, 2014; Beemsterboer P. Presentation at the American College of Dentists; San Antonio, Texas; October 8, 2014.Google Scholar Dr Gray addressed this subject with conviction.The common procedure is for a mother to start on a ‘shopping-tour’ among the various orthodontists of the community with a view of obtaining the lowest bid for correcting the malocclusion of her child's teeth. Usually the mother has been delegated this task by her husband who does not consider the subject sufficiently important to engage his attention. … Even the carpenter and plumber require time to study plans and specifications before entering ‘bids’ for their work. How much more important than the orthodontist dealing with the correction of human deformities to take time to study a case presented before committing himself as to methods of treatment and compensation. … With good casts and radiograms in hand, together with such other essential data as has been obtained, the practitioner can make a fairly intelligent study of the case. Then, and not until then, is he in a position to arrive at the requirements of treatment and state a fee that will be fair to everybody concerned. As to a consultation fee, a consultation worthy of the name involves considerable time, effort and office expense on the part of the orthodontist, for which a suitable charge should be made. Opinions and fees based upon snap judgment are hazardous. Here again is opportunity for educating the public as well as the dental profession. Fear of losing the case should not hinder following the comprehensive course suggested. The sooner all reputable orthodontists get a vision of what properly constitutes orthodontic treatment and are ready to take a stand for better methods of office practice and higher ethical considerations, the easier it will be for all to maintain a proper standard of business procedure. To the degree we awaken to our common responsibility, to that extent may all reach an equal footing in these matters.18Gray B.F. Ethics and business practice in orthodontics.Am J Orthod Oral Surg. 1932; 18: 450-456Google Scholar The ethics of interprofessional relationships remained a pervasive topic in early issues of the Journal. The topic of patient transfer again served as a common forum for the discussion of professionalism. Some authors suggested that the specialist should decline the opportunity to receive patient transfers from general practitioners. Others disagreed. The consensus was that the provider must refrain from making disparaging comments about the quality of previous care, based on both ethical concerns and an effort to avoid legal reprisal against the initiating orthodontist. “We must realize,” admonished Young8Young J.L. Ethical relations in conducting an orthodontic practice.Int J Orthod Oral Surg. 1921; 7: 347-355Abstract Full Text PDF Google Scholar in 1950, “that some men can get a result from one appliance while others can get results from another. … We can only give our personal opinion, which amounts to nothing more than stating our opinion against that of the other man.” He further stressed that we must “conduct ourselves both privately and publicly on a high plane.” If a second clinician discovers that the initiating orthodontist provided faulty treatment, the second orthodontist should administer correct treatment without making denigrating remarks to prevent “reflection on his predecessor.”15Dewey M. The ethics of advertising.Int J Orthod Oral Surg Radiography. 1924; 10: 245-248Abstract Full Text PDF Google Scholar Criticism of the initiating orthodontist was thus perceived as inappropriate and unethical.20Fisher W. Responsibilities of the specialist in orthodontics.Int J Orthod Oral Surg Radiography. 1924; 10: 90-92Abstract Full Text PDF Scopus (1) Google Scholar On the patient's behalf, Young8Young J.L. Ethical relations in conducting an orthodontic practice.Int J Orthod Oral Surg. 1921; 7: 347-355Abstract Full Text PDF Google Scholar wrote, “We know that the question of ethics from the patient's standpoint is a very large problem. … Very few of us have the moral conviction to approach the question and study things from the standpoint of the patient. That the patient has some rights must be recognized. The sooner the profession recognizes those rights and is willing to place themselves in the position of the patient, the sooner will the troublesome questions adjust themselves.” Early authors addressed orthodontic professionalism with timeless precision. Although a distinct definition of professionalism is elusive, Garetto, a contemporary ethicist, defined professional traits to include “honesty and integrity, caring and compassion, reliability and responsibility, maturity and self analysis, loyalty, strong interpersonal communication and respect of others and self.”21Garetto L. Presentation at the American College of Dentists. San Antonio, Tex; October 8, 2014.Google Scholar Claims of individual superiority, garish advertising, guarantees of results, and public deception were condemned throughout the first half of the 20th century. The use of publicity personnel for practice promotion was discouraged. Even the publication of successful case reports was considered to be inappropriate during those years. The Hippocratic tradition was related to orthodontic specialty care in a 1970 editorial written by B. F. Dewel22Dewel B.F. The oath and the code.Am J Orthod. 1970; 58: 509-510Abstract Full Text PDF PubMed Google Scholar (Fig 5). The Hippocratic Oath originated in the fifth century bc at Hippocrates' birthplace on the island of Cos in ancient Greece. “In all likelihood,” wrote Dewel, “the Oath had its origins in the ethical codes that were formulated by Egypt's famed physicians, possibly even including the great Imhotep in about 2700 bc. A thousand years later, in 1700 bc, the Babylonian Code of Hammurabi combined enlightened laws with barbaric punishment, including amputation of the fingers of a physician whose patient failed to survive.” Although contemporary digressions from the Hippocratic Oath and acceptable professional behavior incur far less punitive measures, the Hippocratic Oath remains widely referenced in assessing a practitioner's level of professionalism. Dewel's editorial explained the American Dental Association's revision of its Principles of Ethics from a “specific rules and regulations” approach to a principle-based code in an effort to provide applicable professional standards to parallel the Hippocratic philosophy. This principle-based strategy permitted clinicians to use their knowledge of bioethics in a cognitive manner toward resolving ethical dilemmas and to conduct themselves professionally. Access to dental care irrespective of race, ethnicity, or financial status (justice) was also advocated. Integrity to maintain the specialty's professional reputation was highlighted. Maintenance of professionalism remains especially pertinent since the Federal Trade Commission's 1975 ruling permitting professional advertising. Discretion in advertising is paramount. Advice pertaining to appropriate fees for emergency treatment for visiting patients was discussed. Recommendations varied and spanned an unlimited “gratis” service based on respect for an orthodontic colleague, to fee assessment for all emergency visits after the first.8Young J.L. Ethical relations in conducting an orthodontic practice.Int J Orthod Oral Surg. 1921; 7: 347-355Abstract Full Text PDF Google Scholar Again, preservation of collegiality and maintenance of trust in the specialty were highlighted. The mid-20th century saw the challenge of the “mail-order orthodontist,” reminiscent of available commercial procedures of today.23Pollock H. Mail order orthodontics.Am J Orthod Oral Surg. 1941; 27: 282-283Abstract Full Text PDF Scopus (2) Google Scholar, 24Pollock H. Laboratories again.Am J Orthod Oral Surg. 1941; 27: 465Abstract Full Text PDF Scopus (1) Google Scholar, 25Pollock H. Now orthodontic prescriptions for the laboratory.Am J Orthod. 1950; 36: 860-861Abstract Full Text PDF Scopus (2) Google Scholar In the early 1940s, laboratory services arose in which dentists could submit diagnostic records to a laboratory, without prescription or directives on appliance specifications. The dentist would then receive a diagnosis and treatment plan with a preformed appliance. According to AJO Editor Dr H. C. Pollock, “The dentist [would] take an impression and send it to the dental supply house. He in turn would receive bands, arches and ligatures for the particular case in hand, a case ensemble, so to speak, all artistically arranged in a plush box, much like jewelry.”25Pollock H. Now orthodontic prescriptions for the laboratory.Am J Orthod. 1950; 36: 860-861Abstract Full Text PDF Scopus (2) Google Scholar Dr Pollock25Pollock H. Now orthodontic prescriptions for the laboratory.Am J Orthod. 1950; 36: 860-861Abstract Full Text PDF Scopus (2) Google Scholar likened laboratory-dictated treatment to eyeglasses purchased from mail-order catalogues. He wrote that this approach “has no place in modern orthodontic practice…[and that] orthodontic devices made over the plaster model are as far from the modern concept of orthodontic treatment as the ‘mail order eyeglasses’ are from the scientific correction of the eye.” Pollock23Pollock H. Mail order orthodontics.Am J Orthod Oral Surg. 1941; 27: 282-283Abstract Full Text PDF Scopus (2) Google Scholar quoted Dr Edwin J. Blass's recommendation for the implementation of “mail-order” orthodontics: “Try this simple formula: For your first step, try a case that appears not too complicated. Then submit the models of the arches together with x-ray pictures of the complete mouth to a dental laboratory competent to accept such cases. They will advise you as to what to do, step-by-step, and construct the necessary appliances. If such initial efforts of yours are rewarded with some degree of success, which I have every reason to believe they will be, you will be spurred to greater heights.” Orthodontists Charles R. Baker, Paul Spencer, and T. W. Sorrels condemned the treatment as “much in the same manner as the layman that takes an impression of his own mouth and sends it to the prosthetic lab … and by return mail he will receive a satisfactory denture, along with a bag of peanuts to try it out on [italics added].”23Pollock H. Mail order orthodontics.Am J Orthod Oral Surg. 1941; 27: 282-283Abstract Full Text PDF Scopus (2) Google Scholar The process of laboratory-dictated treatment was viewed as detrimental to the profession as well as to the public. “The state dental board should revoke his license and issue the [dental] license to the laboratory,” recommended Dr Pollock23Pollock H. Mail order orthodontics.Am J Orthod Oral Surg. 1941; 27: 282-283Abstract Full Text PDF Scopus (2) Google Scholar of the patron of the mail-order orthodontic laboratory. He further stated that “the trained orthodontist never followed these methods, for the good reason that such methods worked just about like … catalogue eyeglasses, and just about as efficiently.” Legislation eventually emerged in which formal prescription forms and a clear description of the laboratory work were required from orthodontists and dentists, after treatment planning by the practitioner. With regard to some contemporary therapeutic options, have we again become too reliant on laboratory treatment planning and appliance fabrication? A crucial topic of the early 1960s was the “short course” of orthodontic training that was offered to general dentists. This practice was perceived to violate the Principles of Ethics of the American Association of Orthodontists (AAO). Described in a statement written by AAO President Dr Earl Shepard26Shepard E. President's page: to bend a meaning.Am J Orthod. 1964; 50: 305-306Abstract Full Text PDF Scopus (2) Google Scholar (Fig 6), the resolution of the AAO's Principles of Ethics in 1963 addressed this issue. It declared that any courses offered to orthodontists or other dental practitioners must remain under the control of a university orthodontic department that is under the jurisdiction of the AAO. In defense of the AAO and the American Board of Orthodontics, both of which advocated such legislation, Dr Shepard stated that the ruling was intended to maintain the public's protection as the first priority. It mandated that the development of any “short course” must be in conjunction with a representative of the AAO and offered within a component of the American or Canadian dental associations. The intent of the resolution was to prevent recurrence of the proliferation of insufficiently educated “orthodontic specialists” that occurred in the 1930s. In the autumn of 1995, AJO-DO Editor-in-Chief Thomas M. Graber enlisted Dr Laurance Jerrold as editor of the Litigation, Legislation, and Ethics section in the Journal, emphasizing the value of these topics. Dr Jerrold's column continues to be an invaluable feature of the Journal. His dual education as both an orthodontist and an attorney, coupled with his experience in clinical practice and academia, provides the readership with a timely perspective on ethical and legal issues. In January 2011, Editor-in-Chief Vincent G. Kokich, in conjunction with the AAO's Council of Membership, Ethics and Judicial Concerns, established 2 separate editorial columns: one pertaining to legal and legislative issues written by Dr Jerrold and a second devoted solely to ethics. Dr Peter M. Greco was appointed as associate editor of the Ethics in Orthodontics column, which appears monthly in the AJO-DO. An enduring tribute to our specialty's ethical commitment was articulated in a highly pertinent statement authored by AAO President Dr Eugene Blair in 1977.27Dewel B.F. Constituent society presidents discuss current orthodontic issues.Am J Orthod. 1977; 71: 223-225Google Scholar He wrote that “the specialty's image is a composite of the images projected by individual orthodontists.” Dr Blair challenged each reader to initiate a self-assessment of his or her ethical awareness via the exploration of several timeless questions that are paraphrased below.1.Is the orthodontist an entrepreneur—or the practitioner who treats oral health problems?2.Is the orthodontist a helpful dental colleague—or is the pursuit of the dollar his or her primary goal?3.Are we, as orthodontists, perceived to improve society and teach others to do so—or are we seen merely as sportsmen and world travelers as afforded by our affluence?