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Professional Controversy

Misleading The Masses

How High-Level Professional Conflicts Are Not Unique To Dentistry.

A Shorter version of this article was published in the Journal of the British Society for the Study of Craniomandibular Disorders (BSSCMD), summer of 2022.

One of the most significant challenges of my 20-year dental career was coming to terms with the differences between NHS and Private dental care in the UK.

As a private dentist, I often felt guilty about how expensive private dental care was compared to NHS (National Health Service) dentistry. I also worried about those with more limited means accessing good services if the high costs made them unobtainable. Eventually, I had to resolve the argument with myself, in that my mission was to provide the best care possible. I was doing a disservice to myself and my patients if I compromised my skills to fit into a system that I perceived as dysfunctional. Therefore, the private sector won the dispute, and I felt justified in continuing to focus my efforts on that sector.

I entered dental school in 1992, just as the UK government significantly cut the fees paid to dentists for their services through the NHS. So began the migration of UK dentists into the private sector as the government attempted to subdue the profession to keep the costs of providing dental services reasonable.

The increasing crisis in NHS dentistry is now becoming a frequent news item in the UK. For many years the UK government has struggled with the profession to keep their expectations within reasonable limits. When dentists have previously threatened a mass exodus from their NHS contracts, the government and corporate response was to recruit within Europe to keep the NHS alive and avoid the collective power of the disgruntled professionals. Brexit disrupted this strategy, and with the additional pressures endured during the recent pandemic, the proverbial straw has now broken the camel’s back. Dentists are leaving the NHS in droves. Finally, the power dynamic may be shifting, but many humble dentists have had their self-esteem shattered by the manoeuvrings of government, and the battle of wills fought over the last 30 years.

In the process of this combat, quantity has triumphed over quality. Evidence-based dentistry, founded on group think science, has become a religion rather than a tool to facilitate groundbreaking thinking. Specialisation versus generalisation has become a source of conflict, as those who read this journal are painfully aware. Truths are hidden under technical misdirections and convoluted thinking. Ultimately it is the patients but also the profession that suffers. The majority know no better and are blind to where they must focus; to identify the source of their betrayal and disappointment. 

For those of us who recall the use of actual science and logic to govern our thinking, we are now aware that our undergraduate training has missed some critical elements. We discovered this only by exploring those factors that made no sense. In our mission to reconcile the anomalies, we have come to understand the integration of the body with the teeth in a brand new way. 

It has not been easy, and many fall at the first hurdle as they seek to understand their training in this new way. Unless one works in a sympathetic practice, finding the time and resources to examine and assess patients in the manner necessary is the first obstacle—access to testing and equipment that differs from the standard provision is the second. Explanations to patients vary compared to answers they receive elsewhere. Conflicts arise with colleagues who do not comprehend an alternative way of thinking and are quick to criticise what they don’t understand. In more unfortunate situations, this can lead to legal challenges. It can be even harder to find support where the more popular methodologies have become fossilised and unmoving due to prior legal precedents built on previous misunderstandings. The minefields are numerous, and negotiating them to lead a new path forwards is a treacherous task. 

The common thread in all of these battles is access to resources. To fight a legal battle requires resources, to challenge science requires resources, and to provide new equipment for sophisticated tests requires resources and time – the most precious resource in a busy dental practice. The struggle becomes even more complicated when the private sector needs to compete with a service run by a government-funded monopoly such as the NHS. Finding the time to provide sufficient analysis to a tricky clinical problem that is new to us or even to discuss it thoroughly with the patient must be funded. This resource struggle is why healthcare professionals can only deliver holistic treatment methods incorporating orthopaedics under private contracts. The NHS abandoned such methodologies through ‘scientific’ and ‘legal’ precedents for more economical solutions some decades ago.

As costs escalate, dental practices suffer from both sides. Increasing energy prices affect everyone without discrimination. So not only are the energy costs to the business higher, but these increased costs affect the cost of supplies and their delivery; dentistry and medical services are already some of the most cost-intensive services. Increases in costs for individuals will lead to a demand for increases in wages, but at the same time, if a small business tries to increase their prices to keep up with this demand, its ability to do this is limited – because their patients are compromised financially as well. 

Our understanding of financial matters can be limited as it is not our primary area of expertise. We are usually too busy intensely focusing on patients and our businesses to give much time to research what is happening within the more extensive financial system. Healthcare professionals tend to be blind to what is happening in other industries. However, the advent and fortunes of the NHS, with its unfair competition, are directly linked to how our financial system has evolved over the last 100 years. 

Issues with costs in the economy are rapidly bringing the problems with finance to a head and increasing the need to elevate our comprehension if our businesses and the services we provide are to survive. 

The story is more significant than the rise in energy; it is bigger than the rise in food prices. The issue of resources affects everything we can do for our patients and their ability to reward us. The system we work under, whether under the NHS or privately, is under increasing stress, and the economic issues will make these even greater soon. 

As a dentist, it was a massive revelation to me that there was a different school of thought and approach to orthodontics than I was taught at dental school. A method that made much more sense to me and was relatively straightforward to implement as a general dentist without having to commit myself to an additional five years at university and in the hospital sector. Twelve years as a general dentist gave me a sound experience of patients’ daily problems with their teeth. My experience provided a foundation for understanding the long-term implications of traditional orthodontic approaches. 

When shown how to approach orthodontics differently, I was ready to understand the longer-term problems I could solve using an alternative analysis. An approach that took into consideration the rest of the body. I could comprehend the implications of not analysing problems correctly by taking shortcuts, such as the goal of focusing on a Class I occlusion with a Class I molar relationship and an overjet as were introduced by Edward Angle and his Angles classification in 1907. A methodology eventually adopted by the profession and subsequently the NHS as it focused just on the relationship of the teeth, making treatment quicker and more cost-effective by avoiding the orthopaedic elements. 

The tragedy is that the disadvantages of such treatment, whilst not contributing to mortality, undoubtedly contribute to morbidity by not factoring in subsequent damage to the boney structures and the other health implications of this. Even more ironically, because the harmful effects occur at such a distance from the cause of the problem in terms of time, it is easy for such results to be ignored. Those who point them out are persistently “gaslit” by those who believe they know better and can point to several “scientific” articles that prove their point. 

My purpose in bringing this up is that I have recently been taking a sabbatical from dentistry, which has given me time to look further into what is happening from a bigger-picture perspective, specifically with our financial system. I was particularly affected by the 2008 financial crisis, which eventually motivated me to study this subject. What I find fascinating is that as much as we suffer from controversy within our profession over some fundamental diverging of ideas, a similar controversy exists within the financial domain. Having studied the subject with some depth, I now consider Orthopaedic orthodontics akin to Austrian economics.  The Austrian economic system based on a Gold Standard appears to hold more responsible and reliable truths. Whilst traditional orthodontics strikes me as akin to Keynesian economics – fraught with convoluted science to fulfil an altogether different agenda than serving the industry with truth and integrity. If such an idea intrigues you, I encourage you to explore the differences between these two schools of economic thought – you will find it fascinating! 

The current signs of inflation in the economy are worrying, but to a much greater extent than many of you are likely to realise. The idea behind Keynesian economics is that bureaucrats can manage the flow of money into and out of the economy behind the scenes so that the general population rarely experience the worst effects of inflation – keeping it at their proposed range of 2% a year. That the inflation rate is no longer within that 2% margin and that we are aware of rapidly increasing prices in the economy; is a significant warning sign, and I encourage you to pay attention.  

Few realise that every great revolution throughout history has occurred due to corruption of the people’s money and its final death throes of failure. The Roman Empire collapsed when they started mixing their gold coins with other metals; the Roman soldiers eventually refused to accept them so that the Roman Senate couldn’t defend the empire any more. 

The French Revolution occurred after the French government tried to issue a new currency known as Assignats that based their valuation on all the property in France. The elites at the time made a mint as they understood what was happening and could take advantage of the situation. Still, the peasants who knew no better ended up starving, so they eventually stormed the Bastille. 

World War II occurred after hyperinflation in the Weimar Republic of Germany, leading to Hitler’s rise. This hyperinflation arose due to Germany’s inability to pay the war reparations they were billed after the loss of World War I. What made this bill so big, you may ask? Well, World War I was only able to become so lengthy and devastating because European leaders ‘temporarily’ suspended the original gold standard to pay for it. A measure that secured Europe’s prosperity throughout the late 1800s and a break with which we have been struggling ever since; in terms of the value of our money. 

In 2007, nowhere in dentistry did I see an article warning me or advising me of the deeper problems the profession faced due to the economic issues in the broader economy. But now that I know these things, I am making it my mission to inform everyone wherever possible. I have written several articles on this subject. If you are interested in more of what I have to say on such topics, you can find them on the latest news page of my website at Satoshispage.com.

Play Video about Bitcoin for Dentists and Business Owners

Bitcoin for Dentists and Business Owners

Dentists are now discussing the changes occurring in the Financial System. Watch my discussion with Lawrence Parnis of Megladental to learn more.

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