Greed: A Tale of Power and Abuse in Medicine
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And the data that are available are not always reassuring. The Cochrane organization , a highly respected arbiter of evidence-based medicine, has conducted systematic reviews of oral-health studies since In these reviews, researchers analyze the scientific literature on a particular dental intervention, focusing on the most rigorous and well-designed studies. In some cases, the findings clearly justify a given procedure. For example, dental sealants—liquid plastics painted onto the pits and grooves of teeth like nail polish—reduce tooth decay in children and have no known risks.
Despite this, they are not widely used, possibly because they are too simple and inexpensive to earn dentists much money. But most of the Cochrane reviews reach one of two disheartening conclusions: Either the available evidence fails to confirm the purported benefits of a given dental intervention, or there is simply not enough research to say anything substantive one way or another.
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Fluoridation of drinking water seems to help reduce tooth decay in children, but there is insufficient evidence that it does the same for adults. As for common but invasive dental procedures, an increasing number of dentists question the tradition of prophylactic wisdom-teeth removal; often, the safer choice is to monitor unproblematic teeth for any worrying developments. Little medical evidence justifies the substitution of tooth-colored resins for typical metal amalgams to fill cavities.
When Cochrane researchers tried to determine whether faulty metal fillings should be repaired or replaced, they could not find a single study that met their standards. They are more akin to surgeons than they are to physicians. We suffer a little from that. The general dearth of rigorous research on dental interventions gives dentists even more leverage over their patients. Should a patient somehow muster the gumption to question an initial diagnosis and consult the scientific literature, she would probably not find much to help her. He spent every weekend for the next nine months examining the charts of hundreds of patients treated in the preceding five years.
In a giant Excel spreadsheet, he logged every single procedure Lund had performed, so he could carry out some basic statistical analyses. The numbers spoke for themselves. Year after year, Lund had performed certain procedures at extraordinarily high rates. Whereas a typical dentist might perform root canals on previously crowned teeth in only 3 to 7 percent of cases, Lund was performing them in 90 percent of cases. As Zeidler later alleged in court documents, Lund had performed invasive, costly, and seemingly unnecessary procedures on dozens and dozens of patients, some of whom he had been seeing for decades.
Terry Mitchell and Joyce Cordi were far from alone. In fact, they had not even endured the worst of it. A crown is a metal or ceramic cap that completely encases an injured or decayed tooth, which is first shaved to a peg so its new shell will fit. Crowns typically last 10 to 15 years.
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Lund not only gave his patients superfluous crowns; he also tended to replace them every five years—the minimum interval of time before insurance companies will cover the procedure again. A typical adult mouth has 32 teeth. According to one lawsuit that has since been settled, a woman in her late 50s came to Lund with only 10 natural teeth; from to , he gave her nine root canals and 12 crowns.
It takes longer, can cause significant discomfort, and may require multiple trips to a dentist or specialist. Read: Americans are going to Juarez for cheap dental care. Root canals are typically used to treat infections of the pulp—the soft living core of a tooth. A dentist drills a hole through a tooth in order to access the root canals: long, narrow channels containing nerves, blood vessels, and connective tissue. The dentist then repeatedly twists skinny metal files in and out of the canals to scrape away all the living tissue, irrigates the canals with disinfectant, and packs them with a rubberlike material.
The whole process usually takes one to two hours. Afterward, sometimes at a second visit, the dentist will strengthen the tooth with a filling or crown. In the rare case that infection returns, the patient must go through the whole ordeal again or consider more advanced surgery. In some cases the dentist slips a small rubber tube into the wound, which continues to drain fluids and remains in place for a few days.
They should be used only to treat severe infections, which occur in a minority of cases. Zeidler asked many of those patients about the treatments, but none of them recalled what would almost certainly have been a memorable experience. In addition to performing scores of seemingly unnecessary procedures that could result in chronic pain, medical complications, and further operations, Lund had apparently billed patients for treatments he had never administered.
Zeidler was alarmed and distressed. To find, I felt, someone was doing the exact opposite of that—it was very hard, very hard to accept that someone was willing to do that. Zeidler knew what he had to do next. As a dental professional, he had certain ethical obligations. He needed to confront Lund directly and give him the chance to account for all the anomalies. Even more daunting, in the absence of a credible explanation, he would have to divulge his discoveries to the patients Lund had bequeathed to him.
He would have to tell them that the man to whom they had entrusted their care—some of them for two decades—had apparently deceived them for his own profit. The idea of the dentist as potential charlatan has a long and rich history. Sometimes the results were disastrous. Barber surgeons came to America as early as By the 18th century, dentistry was firmly established in the colonies as a trade akin to blacksmithing Paul Revere was an early American craftsman of artisanal dentures.
Itinerant dentists moved from town to town by carriage with carts of dreaded tools in tow, temporarily setting up shop in a tavern or town square. They yanked teeth or bored into them with hand drills, filling cavities with mercury, tin, gold, or molten lead. For anesthetic, they used arsenic, nutgalls, mustard seed, leeches. Mixed in with the honest tradesmen—who genuinely believed in the therapeutic power of bloodsucking worms—were swindlers who urged their customers to have numerous teeth removed in a single sitting or charged them extra to stuff their pitted molars with homemade gunk of dubious benefit.
In the midth century, a pair of American dentists began to elevate their trade to the level of a profession.
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But no definitive proof of this encounter has ever surfaced. Becoming a practicing physician requires four years of medical school followed by a three-to-seven-year residency program, depending on the specialty. Dentists earn a degree in four years and, in most states, can immediately take the national board exams, get a license, and begin treating patients. Some choose to continue training in a specialty, such as orthodontics or oral and maxillofacial surgery. When physicians complete their residency, they typically work for a hospital, university, or large health-care organization with substantial oversight, strict ethical codes, and standardized treatment regimens.
Read: Why dentistry is separate from medicine. Throughout history, many physicians have lamented the segregation of dentistry and medicine. Oral bacteria and the toxins they produce can migrate through the bloodstream and airways, potentially damaging the heart and lungs. Poor oral health is associated with narrowing arteries, cardiovascular disease, stroke, and respiratory disease, possibly due to a complex interplay of oral microbes and the immune system.
And some research suggests that gum disease can be an early sign of diabetes, indicating a relationship between sugar, oral bacteria, and chronic inflammation. Most major medical associations around the world have long endorsed evidence-based medicine.
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The idea is to shift focus away from intuition, anecdote, and received wisdom, and toward the conclusions of rigorous clinical research. Although the phrase evidence-based medicine was coined in , the concept began taking shape in the s, if not earlier some scholars trace its origins all the way back to the 17th century. In contrast, the dental community did not begin having similar conversations until the mids. There are dozens of journals and organizations devoted to evidence-based medicine, but only a handful devoted to evidence-based dentistry.
In the past decade, a small cohort of dentists has worked diligently to promote evidence-based dentistry, hosting workshops, publishing clinical-practice guidelines based on systematic reviews of research, and creating websites that curate useful resources. Part of the problem is funding: Because dentistry is often sidelined from medicine at large, it simply does not receive as much money from the government and industry to tackle these issues.
The standard euphemism for this proclivity is overtreatment. Whereas medicine has made progress in reckoning with at least some of its own tendencies toward excessive and misguided treatment, dentistry is lagging behind. I think the majority of dentists are pretty good. Studies that explicitly focus on overtreatment in dentistry are rare, but a recent field experiment provides some clues about its pervasiveness.
A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage.
Despite this, 50 of the dentists suggested unnecessary treatment. It could be a helpful tool for reaching a common understanding of the failings of our characters, customs and institutions. After all, individuals who examine themselves carefully usually uncover hidden depths of greed, and this self-criticism can reduce their susceptibility.
An open and humble debate could do the same for our prosperous society. We welcome comments that advance the story through relevant opinion, anecdotes, links and data. If you see a comment that you believe is irrelevant or inappropriate, you can flag it to our editors by using the report abuse links. Views expressed in the comments do not represent those of Reuters.
Law 1: Never Outshine The Master
This is nothing more than a pathetic attempt at obfuscation to deflect charges of greed against the wealthy class. Synonyms avarice, avidity, cupidity, covetousness; voracity, ravenousness, rapacity. Greed means avid desire for gain or wealth unless some other application is indicated and is definitely uncomplimentary in implication:.