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PubMed1980

Ethical and legal considerations associated with clinical field trials.

As members of a hypothetical review board, we have evaluated the protocol of a clinical caries trial following the recommendations proposed by the National Commission. The potential risks to the subjects were described as well as the potential benefits that both the participants and society might derive from the study. A new element of the institutional review process was the determination of the scientific validity of the study. The Commission was cautious in indicating that, while such a review should be conducted, studies of marginal scientific importance might be allowed, as long as the risks were minimal. Clinical studies of cariostatic agents traditionally use children as subjects. The rights of children as research subjects were addressed in detail by the Commission. Its recommendation that "assent" of the children be secured is significant. Nevertheless, the Commission distinguished between consent and assent. Consent of parents must be actively secured while assent of the children is acquired by their passive acquiescence to participation. We have raised questions at a practical level throughout this presentation in order to stimulate discussion. These questions, however, do not have simple answers. In the time remaining, we trust the complex issues involved will be discussed further.

Child↗
PubMed1984

Organized dentistry and the pursuit of entry control.

Organized dentistry spent nearly a century laboring to obtain control over entry into the profession. The first attempt, the American Society of Dental Surgeons, failed because the issue of using amalgam so split the Society that collective action became impossible. The second attempt, state licensing during 1870-1900, gave preferential treatment (automatic licensing) to dental school graduates and appeared at first to be the solution to the entry problem, given the small number of schools in operation. However, dental school entrepreneurs recognized a profitable opportunity, and the supply of dental schools expanded rapidly. Thus, in the third and final attempt at obtaining entry control, organized dentistry attacked the for-profit schools. The dental practice acts were amended to require all candidates to pass a licensing examination, provided first that they were graduates of a school considered "reputable" by the state board of dental examiners. Moreover, rising costs generated by increased school standards took the profit out of for-profit operation, and by 1930 such schools ceased to exist. However, the competitive nature of the 1930s made altogether clear that entry control was a necessary, but not sufficient, condition for the maximization of dentist profits, and thus organized dentistry began its turn inward, focusing on the competitive behavior of existing dentists.

American Dental Association↗