Since we wrote a couple pieces about KOL’s, what they say, why they say it and how you can learn about how much they are paid, this discussion has taken on a life of its own. If you’re not clear on the history, here are some related articles that will bring you up to speed:

Show Me The Money 9/26/18 on OrthoPundit

PostScript: Follow the Money 9/27/18 on OrthoPundit

Who Pays The Piper? An Influx of Key Opinion Leaders 10/15/18 on Kevin O’Brien’s Orthodontic Blog

As you can see, the general theme has been one of figuring out who is being paid for what, how much these payments influence the speakers and whether or not one can believe what is being said. As we think everyone will agree, we have no issue with orthodontists being paid for their time. The question is more about how much credibility an orthodontist can have when a substantial amount of their annual income comes from a company paying them to hock product. It’s only now that we realize that we stopped short of the biggest issue when it comes to who is being paid. We only recognized our short sightedness when we read the comment that DeWayne McCamish, former AAO President and former AAO Executive Director, posted on Kevin O’Brien’s Orthodontic Blog (see link above and screen shot of comment below):

Marc asked the logical question based on DeWayne’s assertion and Marc’s experience as a regular speaker at the American Association of Orthodontists Annual Session but there has been no response. (SHOCKING!) Now that we’ve realized the need to open this Pandora’s box, we have a few more questions and we are hoping some of our readers or the readers of Kevin’s blog may be able to help us find the answers.

  • Do individuals on the AAO Board of Trustees fill out and sign a disclosure of their corporate entanglements/ownership/payments from/etc. and reveal any/all possible conflicts of interest?
  • Do the AAO House of Delegates members and leadership fill out and sign a disclosure of their corporate entanglements/ownership/payments from/etc. and reveal any/all possible conflicts of interest?
  • Do members of the various AAO standing committees fill out and sign a disclosure of their corporate entanglements/ownership/payments from/etc. and reveal any/all possible conflicts of interest?
  • Do the Board members and examiners for the American Board of Orthodontics fill out and sign a disclosure of their corporate entanglements/ownership/payments from/etc. and reveal any/all possible conflict of interest?
  • Do the directors and others involved with the AAO/PAC fill out and sign a disclosure of their corporate entanglements/ownership/payments from/etc. and reveal any/all possible conflicts of interest?
  • Do the directors and others involved with the AAOIC fill out and sign a disclosure of their corporate entanglements/ownership/payments from/etc. and reveal any/all possible conflicts of interest?
  • Do the directors and others involved with the AAOF fill out and sign a disclosure of their corporate entanglements/ownership/payments from/etc. and reveal any/all possible conflicts of interest?
  • Do the AAO Executive Director and other key AAO employees fill out and sign a disclosure of their corporate entanglements/ownership/payments from/etc. and reveal any/all possible conflicts of interest?
  • Do the AAO in house attorneys fill out and sign a disclosure of their corporate entanglements/ownership/payments from/etc. and reveal any/all possible conflicts of interest?
  • Does the leadership of the various AAO constituencies fill out and sign a disclosure of their corporate entanglements/ownership/payments from/etc. and reveal any/all possible conflicts of interest?
  • Do speakers at the various AAO and AAO related events REALLY fill out and sign a disclosure of their corporate entanglements/ownership/payments from/etc. and reveal any/all possible conflicts of interest?
  • Do the leaders of the state orthodontic associations fill out and sign a disclosure of their corporate entanglements/ownership/payments from/etc. and reveal any/all possible conflicts of interest?

If they do fill out and sign disclosure forms, where can lowly AAO rank and file members like us find a copy? If they don’t, why don’t they?

And while we are on the subject, where can we find information on what the AAO and its various subsidiaries are invested in? This is important because, “your heart is where your treasure lies”. We did a story trying to find out about AAO investments back in May of 2016 titled IRS 990 Forms for the AAO, ABO and AAOF but no one seemed terribly interested at the time. Given recent events, perhaps someone out there can run this down now? For example, what exactly is the AAO’s high dollar investment in Central America?

Money is important. There is nothing wrong with getting paid. But transparency for those asserting knowledge, leadership, principle and honesty is also critical. We assume we will be stonewalled by the AAO and their minions as usual. The real question is whether or not this behavior and the AAO’s repeated refusal to share information is acceptable to the thousands of AAO members who pay dues to our member organization.

Marc Ackerman & Ben Burris

Related Reading:

Carriere Motion & MEAW – Birds of a Feather

6 thoughts on “AAO Conflict of Interest?

  1. The answer is yes that all of the AAO Boards and AAO Delegates are required to file annual disclosures statements and reveal any compensation that would be a conflict of interest. The forms would be cumbersome to publish as they involve a great number of people However, the forms should be available for anyone that wants to see them. If you have a particular person in mind and you are an AAO member, then you should request the AAO to provide the form for that person.

    When I was on the Board of Trustees, each speaker was required to announce at the beginning of their presentation any financial involvement that they had with any software or hardware that was part of their presentation. I don’t know the current policy. While I support the disclosure before each lecture, I also believe that orthodontists are bright enough to realize immediately when a speaker has a financial interest in hardware or software. Carierre is a perfect example as his name is on his brackets. It is also perfectly obvious when Charlene White gives a lecture on practice management that she has services to sell.

    I have been responsible for an annual session, 2006, and choose a scientific program chair and gave general advice on what I wanted in the program. I wanted all fields covered: practice management, mechanics, new technology, surgery, etc. I was not bound by or nor did I give a single thought as to my practice philosophy and ideology. I wanted a broad program that appealed to the largest number of attendees as possible. At that time Damon was the hottest and most controversial thing in orthodontics. I was not a devotee of his bracket and treatment claims for that bracket but I wanted him to be on the program so all could hear, see, and make their own judgment. Since we had over 500 orthodontist speakers, it was impossible for one person to attend all the lectures but all had man choices which is the objective. I even had some orthodontists try to persuade me to not include speakers that they disagree with. sort of like your take on Carrierre. They argued inclusion on hte program meant the AAO was endorsing the speaker. That is patently false and I did not bend to that censorship as I respect the intelligence of our AAO membership. I have observed the preparation of many AAO scientific programs and while each one is different, the common thread in all has been an appeal to the broad base of members, not the endorsement of treatment modalities.

    As to investments, AAO, AAOF, and AAOIC have investment advisors that manage the investments of reserve funds. AAOIC has a different investor advisor than the AAO and AAOF. The huge majority of investment experts recommend a portion of assets be invested in international bonds or equities. The major fund managers that invest the foundation funds of Harvard, Yale, etc. invest a part of their funds in global investments. You may think that those experts are wrong but publish your investment results first and prove them wrong. AAOIC has to invest 78% of their investment funds in fixed income. We do have approximately 4% of our investment funds in international equities but our bonds are American. Since 2009 with our current investment advisor, we have averaged 4.8% annually. .In a low interest environment for fixed income for those years, we do not shy away from being happy with the results.

    1. That’s good info. Thanks. A few things.
      1) it would not be an issue at all to publish all the disclosures on the aao site behind the member paywall. This can ans should be done as there is no merit in disclosure unless members can see them. It’s the duty of the aao to make members aware of any conflicts not the other way around.
      2) I’m not advocating censorship and I print articles in ProOrtho magazine that I don’t agree with all the time. Also, many of the speakers and groups I’ve helped foster do not align with my preferences. I have no problem with opposing views but when legitimate questions are asked they shouldn’t be ignored by those who claim to be authorities as they have been by Carriere and Ted D on the FB exchange and with the ABO refusing to engage at NewConn 2019
      3) If the investments referenced on the 990 are in international funds then that’s not an issue at all. If, however, the aao or aaoic or aaof has a substantial stake in any of the ortho vendors who do business in central or South America that should be revealed. What I believe about investing or the efficacy of anyone’s investing policy is irrelevant. The point here is that there should be transparency and given the AAO and it’s satellite organizations collective history of obfuscation I don’t think it’s unreasoable to ask these questions.
      Thanks again for the info. You’re on point and relevant as always. Have a great day!

      1. Ben, there are no AAOIC investments in any ortho companies at all. We invest equity funds in six ETFs that covers a broad spectrum. The six ETFs are a large cap American, Mid Cap American, small cap American, International except USA, Emerging Funds, and an REIT. We have the least funds in the International and Emerging markets. We do not pick individual stocks. We are in effect buying the averages which greatly lowers the investment costs. It does not require a lot of thinking for an ETF to buy all the stocks in the S&P 500. The management cost of the S&P ETF (large cap) is 14 basis points annually or if you prefer it expressed in a percentage, it is .14%. The very low fees mean better net returns which is not that different than your advice to buy low cost brackets rather than the expensive ones with endorsements. Our bonds are managed by three bond managers who are paid 20 basis points annually. The investment committee interviews, evaluates, and hires bond mangers to buy a portfolio of bonds for us. We pick the manager based upon their performance but we do not pick the bonds. Our bond managers are measured against their performance against an index in their respective category. For instance, our two intermediate bond mangers are pitted against the Barkley Intermediate Bond Index. Our bond managers consistently out preform their respective indices except for very rare quarters where they are even or just below. Glad to provide the information as I agree with transparency. AAOIC has nothing to hide. The AAO and AAOF are very similar but I prefer not to comment specifically as I no longer am involved with their investments. Wish you a great day and continued success with our practice.

        1. Super. Thanks.
          Now we can move on to getting the conflict of interest disclosure forms posted so members can access them. Without access to them disclosures are pointless.
          Thanks for the info.

  2. I am an alternate delegate for the SAO and we were required to fill out the following forms prior to each annual session. If you hadn’t by the time of the meeting, the executive director wouldn’t begin the meeting until each person had completed it.

    https://www.aaoinfo.org/about/required-policy-forms

    1. Tyler:
      Thanks for the information. We think this is fantastic!
      It shouldn’t be too hard to post these forms for any member to review on the AAO member site.

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