Before I introduce my topic of discussion I want to make perfectly clear that I fully understand and respect the fact that an implant fixture does not have to come from one of the major brands and cost $500 in order to be successful. I have personally used, and still do, Blue Sky Bio One Stage for many of my single unit posterior teeth but I make my patients aware that I am using a less expensive product for the specific procedure and I will pass the savings on to them via a discount. My go-to product and the one that I trust and promote is ZimVie TSVM but that is a personal preference based on my own personal experience after utilizing multiple products. As such my fee is set at a price point where I am comfortable utilizing genuine ZimVie parts and pieces. Because I feel so strongly that parallel walled tissue level fixtures have significant advantages in certain situations and I have had such good luck over the years, going back to 2009, with the BSB One Stage I still utilize it and fully disclose it to my patients. I understand that if a vehicle is taken in for repair and a mechanic uses aftermarket parts but charges the customer a premium then that mechanic can be sued for fraud. I also understand that the practice of dentistry is a circus and we are free to use whatever FDA approved products we choose and have no obligation to disclose to our patients our cost saving tactics. For those that routinely utilize discount products, regardless of the success of the product, are you in some way passing this savings on to your patients or are you practicing in a manner that could get an automobile mechanic in serious legal trouble??
This is definitely a loaded question but not easy to answer. We need to unpack the question into Legal, Moral, Ethical and Fraudulent aspects of patient care.
US DOJ defines, " Fraud is defined by nontechnical standards and is not to be restricted by any common-law definition of false pretenses. One court has observed, “[t]he law does not define fraud; it needs no definition; it is as old as falsehood and as versatile as human ingenuity.” Weiss v. United States , 122 F.2d 675, 681 (5th Cir. 1941), cert. denied , 314 U.S. 687 (1941). The Fourth Circuit, reviewing a conviction under 18 U.S.C. § 2314, also noted that “fraud is a broad term, which includes false representations, dishonesty and deceit.” See United States v. Grainger , 701 F.2d 308, 311 (4th Cir. 1983), cert. denied , 461 U.S. 947 (1983).
So it is fraud to utilize discount devices and charge a premium!!! If not fraud then certainly unethical…
I would assume that anyone who utilizes discount implants and charges a premium also uses the cheapest composite, cheapest bonding agent, cheapest impression material, cheapest burs, cheapest lab, and the cheapest available employees because after all they all work… Right!!
It is not a loaded question although I did not expect it to be an easy one to answer either. Unless of course the answer is “I don’t utilize discount implants” or “I utilize them but I pass the savings on to my patients and disclose my reason for the savings”…
Using Discounted / Relatively cheaper / promotion based products does not draw question of legality etc. It is viewed based on professional code of conduct ( ADA principles- Autonomy, Non-maleficence , Beneficence, Veracity, Justice ) and how would a reasonable, prudent dentist do.
So, you cannot have a satisfied singular answer for such matters. These are case by case review of whodunnit, how they did it, what they did and if the outcomes are achieved as desired.
So if whodunnit has a history of being cheap and always trying to cut corners then he/she is guilty. If whodunnit is just trying something new and stumbled across some cheap Neodent or Adin stuff then he/she is just practicing. What if whodunnit has advertisements for a specific brand like Zimmer/Nobel Biocare/Straumann in their office and pretends to use such but actually dispenses discount knock offs???
If the assumption is falsehood/pretension /dishonesty and if you can prove it then it is fraudulent.
Regardless it is a sad state when an automobile mechanic is held to a higher moral/ethical standard than someone who calls themself an “Implant Surgeon” or “Implant Dentist/Specialist”.
Scotty,
the last statement, or rather question, is very easy to answer, False advertisements, Bait and Switch, Charging for premium and then knowingly providing, “Lower Quality” (that in itself will be sliced a million different ways by both Lawyers and different professionals), all of those schemes are Fraud. And hence the Person would/should be reprimanded. Why do you ask?
Also, I vehemently DISAGREE with your statment that a Auto Mechanic is held to higher moral or ethical standard, THAN a doctor, or as you might put it, a mere dentist.
At the end of the day, you live in the grey. You are guided by your own moral compass or the choices you make for others that helps you sleep at night.
Auto mechanics most certainly are held to a higher standard than “I” a mere dentist am because I can use whatever aftermarket product I want to and charge a premium with no repercussions. That is a fact and I am not criticizing anyone who doesn’t choose to be criticized by my statement. If it offends you than you might be guilty of some perceived wrongdoing but we are not held to the same standards as the folks that are tasked with fixing our cars and that is a problem.
Whatever dude!! Good luck with everything. I have never met a More Dentist hating Dentist who JUDGES others and some how is Above All others. Just an FYI
Sorry you feel that way and yes I am very disappointed in the business of dentistry as it is not what I thought I was entering into 25 years ago. Good luck to you as well and I am sorry to have offended you or anyone else for that matter as I was just hoping to stimulate some thoughtful discussion regarding the quality of what we sell.
You didn’t offend me. Actually, I agree with most of the stuff that you say on this board. I believe in getting a lot of education before doing a procedure. Patients are Not there to be experimented on without proper preparation and understanding of complications. Agreed to all that.
Disagree with your Generalized statement about Dentists and their moral and ethical standing when compared to auto mechanics, without any data to back it up?
The only data to back it up is that fact that if a mechanic uses NAPA parts and charges for Mopar then they are guilty of fraud. If a dentist uses Neodent and pretends it is Straumann they are just saving money. This happens every day in our profession and we need to stop pretending that it ok and call a spade a spade.
Well,
I don’t understand, “Pretend”? Your contention is that a Patient should be informed about the manufacturing price and company that made it before doing the procedure? And then even if you do, how does that effect patient care?
BTW, have you heard of off-market parts for cars?
If by off-market parts for cars you are referring to things such as Fram oil filters and AC Delco spark plugs like I recently installed in my 1973 VW Thing then yes I am well aware of them. Fortunately my 73 Thing is no longer under any sort of warranty so my use of these aftermarket parts is not problematic. I am well aware that aftermarket/discount stuff is useful and can provide years of service at a lower price point. I recently did a remodel at my office and had to have a new HVAC unit installed. The contractor gave me 3 quotes for 3 different brands of units because while they would all meet my needs they are of different quality. I think any reasonable person would be upset, and justifiably so, if they paid a premium for a project only to later discover that the individual that constructed the project used discount materials only to increase their profit margin. The point is that dentistry is cluttered with folks doing just this and our patients are blind to it so to answer your question I suppose it has no effect on patient care as long as they stay blissfully ignorant. I had a case fail recently and when I went back to review I realized that I utilized a different, lower cost, collagen membrane than I would normally utilize and while I can’t directly point to that as the reason for the failure it makes me ill to think that I was using a material for the sole purpose of improving my bottom line. I suppose it is not a problem as long as my patient is not aware that I substituted a discount medical device for a proven brand name one all to save $80. I will continue to utilize my trusted BSB One Stage discount fixture for specific single unit posterior cases and I will continue to let my patients know that I am able to do this at a slightly lower price because I am choosing to use a less expensive product that I have confidence in. I will also continue to utilize ZimVie TSVM for the vast majority of my cases, at full fee, because I know that it is a trusted product from a trusted company and I can feel confident that my patients are getting exactly what they sign up for. I do not intend to ignite a heated discussion or to offend anyone but I do believe that we in this profession need to check ourselves… I know I have fallen into this trap and I am much happier when I am honest with my patients about the quality of the stuff going in them.