A General Model for the Evaluation of Potential Research Projects in the Behavioral Sciences in Dentistry

This paper addresses the general topic of research ethics. It is based on the analysis of a specific mock research project in the behavioral sciences in dentistry. The preceding papers by Leske and Ripal and by Stamm2 have discussed similar issues in experimental therapeutic and nontherapeutic survey research. The thorough and comprehensive nature of these presentations makes it unnecessary to repeat material which has already been well covered. This paper will suggest a general model for ethical considerations in research and will focus on those aspects of behavioral research which distinguish it from other fields of dental investigation. The definition of behavioral or social sciences used in this paper includes any systematic empirical study of the way people act, independently or collectively. This definition would encompass all of the fields of psychology and sociology and most of psychiatry, education, anthropology, and economics. Dental behavioral science includes research with at least one dental variable and at least one behavioral variable. 3 Behavioral research has a high potential for being reactive. Individuals react to being studied to a much greater extent than does hard and soft tissue. The need for obtaining informed consent may raise serious questions of sample validity and bias caused by subjects’ interpretation of the study. The reactions of subjects to some experimental treatments may be significant enough to necessitate the use of deception. Behavioral research also tends to a much greater extent than other branches of dental science to study practices already accepted and in wide use. Current patterns of health care utilization, dental anxiety, communication, and home care might be modified by dental behavioral science research but, normally, they will not be started or stopped by the acquisition of data. New knowledge of how people behave will not have the same direct effects on practice as studies of clinical trials or therapeutic interventions because dental behavior is in the public, as contrasted to the professional, domain. To the extent that dental care delivery is based on custom rather than established behavioral principles, and that the public’s response to dental needs is rooted in ignorance and misconception, there is an inescapable ethical cost in not doing dental behavioral research. Finally, behavioral research tends to be complex. Human behavior is subject to the simultaneous and interactive effects of numerous personal and situational variables. Effective research designs are prone to reflect the complex nature of the subject. The relative immaturity of behavioral sciences adds further imprecision because fundamental laws of behavior have not been worked out in the detail which characterizes the physical sciences. Behavioral researchers are forced to make the trade-off between general explanations of significant, naturallyoccurring behavior and precise accounts of behavior under constrained circumstances the so-called Chambers Second Law of Human Behavior.4 These three characteristics of dental behavioral research subject reactivity, subject matter in the public domain, and the use of complex and imprecise constructswill form the background for this discussion. Through analysis of the mock protocol on waiting room anxiety, the following three hypotheses will be explored: (a) ethical choices can be illuminated and communicated using the framework of general decision theory; (b) decision theory can provide a general model for analyzing the likely benefit of potential research.