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Year : 2015  |  Volume : 5  |  Issue : 1  |  Page : 1-2

The economy for clinical science in oral and maxillofacial surgery

Professor of Developmental and Surgical Sciences, Dean, University of Minnesota School of Dentistry, MN 55455, USA; Past Editor-in-Chief, Journal of Oral and Maxillofacial Surgery (

Date of Web Publication20-Jul-2015

Correspondence Address:
Leon A Assael
Professor of Developmental and Surgical Sciences, Dean, University of Minnesota School of Dentistry, MN 55455, USA; Past Editor-in-Chief, Journal of Oral and Maxillofacial Surgery (

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DOI: 10.4103/2231-0746.161033

PMID: 26389025

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How to cite this article:
Assael LA. The economy for clinical science in oral and maxillofacial surgery. Ann Maxillofac Surg 2015;5:1-2

How to cite this URL:
Assael LA. The economy for clinical science in oral and maxillofacial surgery. Ann Maxillofac Surg [serial online] 2015 [cited 2020 May 31];5:1-2. Available from:

For every human action that affects our lives, there is an underlying economy. Every economy depends upon the principles of supply and demand. Regarding supply, are there sufficient resources, motivation, and intellectual/physical capacity to carry out the economic act? With regard to demand, is the product being produced of value? Is there a demonstrable need? Do people want that product? Does having that product change anything? Consider clinical research as it appears in the Annals of Maxillofacial Surgery as a representation of our clinical scientific economy. Is there a good supply of our clinical scientific product? Is there a good demand?

Clinical research of value has been termed a Patient Oriented Evidence that Matters (POEMs). The economy of our clinical science depends on the supply of great clinical research. A great clinical investigation can be defined. When a paper is written, does it change anything in clinical practice? Clinical research worth publishing should supply new information within the context of existing information that will positively affect the outcome of patient care.

The purpose of all new knowledge in research (and the acquiring of all new knowledge by the clinician reader) is singular; it is to make a decision in the care of a patient. Clinical science is unique in that regard. It is not only valued for its internally valid scientific merit. Excellent clinical research creates value through improved clinical care and clinical outcomes.

The value (utility) of a POEMs has been reduced to a formula by Shaughnessy, Slawson, and Bennett as the product of the relevance of the study (R) and the validity (V) of it divided by the work (W) needed to access and understand the study. [1] On deciding to perform clinical research, the investigator must consider the " R", the relevance of the study. Does it address an important clinical problem for which current practice needs improvement? As an example, a study that demonstrates increased bone contact with a new implant surface may not be clinically relevant if current surfaces offer adequate bone contact and nearly universal integration rates. On the other hand, if the study is performed in compromised host or bone mineralization, where functional outcomes are a known clinical problem, a superior result in bone contact resulting in ability to sustain functional loads could influence clinical practice. A study with a good " R" will change the way a surgeon thinks and change the way a surgeon acts.

The (V) validity of the study depends on its design and its performance. Will performing the study influence the practice of other skilled clinicians? Is the information to be acquired generalizable? If others provide a similar approach to patient care, will they obtain similar results? For example, a single operator clinical study by a skilled and charismatic clinician of temporomandibular joint surgery for disk dysfunction may not offer other clinicians meaningful information that will improve their patient decision making or surgical outcomes.

The " W" of a study is the denominator of this equation " W", work to access information, is a changing process in the era of searchable information utilizing ever more accessible data management tools. Any simple Google or PubMed search reveals that the reader is able to access too much information with too little filters that will often misdirect and mislead the reader. Hence, experts to filter clinical research have emerged more so in this decade than ever before. While this was formerly done in textbooks, the review article, structured reviews, and meta-analysis are the most sought after and cited articles today.

As with the demand for any product, the wisdom of the marketplace will guide how the product is accessed and used. Today, online accessing of information and download reports, citation indices among others indicate that the worldwide demand for excellent clinical research is exploding. It is not unusual for an exceptional article in the field of maxillofacial surgery to have tens of thousands of downloads.

Clearly, the economic forecast of supply and demand for clinical research in oral and maxillofacial surgery will become ever stronger in the coming decades. The economic environment for clinical papers is a global one, nearly entirely web-based, with seemingly universal supply and demand. The consumers of this economy are not the traditional ones segregated by educational and financial privilege. Patients, health care professional of all types, and policy makers will all access and use this information through their own perspectives. This will make the Annals of Maxillofacial Surgery, an even more inviting product for us to contribute to and consume in the coming years.

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Conflicts of interest

There are no conflict of interest.

  References Top

Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: A guidebook to the medical information jungle. J Fam Pract 1994;39:489-99.  Back to cited text no. 1

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