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Is Public Health and the First Amendment At Odds with Each Other

Posted on 25. Jan, 2014 by .

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An interesting article appears in the vol. 2 and 3. edition of the American Journal of Law and Medicine in 2013 titled “The First Amendment and Public Health, at Odds,” by Seth Mermin and Samantha Graff. The article talks about how the interpretation of freedom of speech in the First Amendment has, in recent years, been altered to benefit corporations. Usually when one thinks of the First Amendment they think of protecting individual’s rights to express their opinions and thoughts. The authors essentially state that with recent changes in the interpretation of the law now companies can push products without much regard to their effect on the health of their customers.

The authors state

“There has been nothing comparable to an uproar over the Supreme Court’s granting…in the infamous Citizens United versus Federal Election Commission. It is time – well beyond time – … to develop an understanding of what is at stake…a broad range of government initiatives to prevent threats to public health could stand or fall depending on the outcome.”

The authors in the article go on to discuss 4 problems they see with the so called commercial speech doctrine.

1. The Myth of the Rational Consumer

The authors point out that recent research in behavioral economics and psychology suggests humans are irrational economic actors. The authors state that much of the information involved in advertising does not allow for rational decisions to be made even if they could be made. Hence the authors suggest that some consumers are being manipulated into buying products counter to their health. (Note that I have talked about this before as it relates to the decision to remove or not remove healthy wisdom teeth, see here http://www.teethremoval.com/wisdomteeth.html)

2. The vulnerability of Children and Adolescents

The authors describe how the current Commercial Speech Doctrine provides no constitutional protection for information that is false or misleading. This is particularly problematic for children. The authors state

“An extensive body of scientific literature confirms that children up to the age of twelve are generally unable to handle the bias and self-interest of advertising messages and then to apply that understanding…”

The authors also address how adolescents are particularly vulnerable to some types of marketing and that various industries exploit this. (Note I have previously raised this point and pointed out some studies in the blog post Let’s Give our Kids a Chance to Succeed)

3. Evidentiary Hurdles

The authors point out how an evaluation has taken place as to whether a speech restrictive measure taken by the government is useful. The issue at hand is that a governmental agency needs to have evidence that a particular warning on some product causes less harm then before implementing such a warning. However, as discussed later by the authors their are limits on scientific evidence even with double blind studies.

4. The Expanding Scope of Free Speech

The authors point out a few illustrative cases. The first case is that a tobacco companies ability to distribute free samples does not fall under an act of commerce  but as an expressive activity and commercial speech. The second case is that a database containing a record of prescriptions is considered a form of protected communication and hence information is speech.

The article goes on to suggest some brief call to actions for each of the 4 points and provides some more examples. I think the issues in the paper raised are important to understand and don’t get that much play and discussion in the media.

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Should you Consider a Lasik procedure: Is it worth the cost?

Posted on 19. Jan, 2014 by .

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Many people wear glasses or contacts regularly. Some think glasses make them look bad or nerdy. Others may try contacts for a while and then stop wearing them because they take time and can be a pain. The following infographic gives some useful information on the LASIK procedure for those who are tired of the hassle of contacts and glasses. Over time, having a LASIK procedure can save you money and time when compared to contacts or glasses.

The Price of Sight 600px Should you Consider a Lasik procedure: Is it worth the cost?
Via: King Lasik

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New Website For Oral Surgeons Group: MyOMS.org

Posted on 18. Jan, 2014 by .

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A new website was launched last month by the Association of Oral and Maxillofacial Surgeons (AAOMS), a U.S. based oral and maxillofacial surgeons group, MyOMS.org. The press release for the website launch is located over at http://myoms.org/assets/uploads/documents/myoms.org_website_news_release.pdf and titled Web site Gives Patients New Insight into Oral and Maxillofacial Surgery. It was known several months ago that a new website was coming, see the post Upcoming Changes to JOMS and AAOMS in 2014.

The website is described in the press release as easy to navigate and designed to allow the public access to vital information on conditions of the face, mouth, and jaw. The press release also describes how videos and illustrations explain many of the procedures offered. Furthermore, a Find a Surgeon feature allows patients to find oral surgeons near where they live or work.

Reviewing the website, the design is definitely different from before and is fresh and modern. The Find a Surgeon feature has been present on the old AAOMS.org site for many years but it seems to just have had a new interface added and moved to MyOMS.org. Much of the content appearing on MyOMS.org seems to have just been migrated to the new site and format from the old AAOMS.org site. There is now a link for wisdom teeth management which provides information on wisdom teeth and says wisdom teeth may not need to be extracted but should be monitored regularly for any changes. A large orange box says the worst thing to do is to ignore your wisdom teeth. A few other paragraphs are provided on wisdom teeth and then a link on the side goes to a more expanded ebook on the topic. Most of this information was provided before on the old AAOMS.org site but some of it appears to have been modified/re-written. One thing that does seem to be newer to me is the discussion of how oral bacteria can travel through your bloodstream and potentially lead to systemic infections.

Another feature that is new to MyOMS.org is the tagline for AAOMS which now says “oral and maxillofacial surgeons: the experts in face, mouth, and jaw surgery.” I feel this tagline better suits them than the old one “saving faces, changing lives,” although they used the latter on their press release so it is not clear what they will use on official letterhead in the future.

Overall I think the concept of the new website was a good idea, but I don’t really like the final product. My main complaint is the size of the font and text on the site is much larger than what I see on other sites, so depending on your screen resolution, the site may not fit that well on the screen. I think the site overall looks fresh and modern, but the large text and not fitting well on the screen is an issue which detracts from the experience for me as it makes it more difficult to navigate. So I am not sure what resolution the designers had in mind.

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Wisdom Teeth: Perspectives from the Military

Posted on 11. Jan, 2014 by .

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In previous discussions on this blog such as Third Molar Morbidity Among Troops Deployed and elsewhere, a discussion has been made about whether or not wisdom teeth should be extracted in those involved in the armed forces. A new article from Hurlbert Field titled “Wisdom teeth: Should they stay or go” provides a perspective by Staff Sgt. Jeff Andrejcik, was written on December 3, 2013, and is located over at http://www2.hurlburt.af.mil/news/story.asp?id=123372876. The article is written by a special operations dentist who performs wisdom teeth extractions. He says he has removed over 300 wisdom teeth and once removed 8 in one patient. He says in the article that most people don’t have room for wisdom teeth and they grow in sideways and are not cleansable. Larkin discusses how pericoronitis can occur in patients who have wisdom teeth that erupt but not fully leaving the gums to cover partially the teeth and when pockets of infection occur. Larkin then mentions how more serious problems then pericoronitis such as space infections can occur. He says that space infections can be a problem for those deployed in the field.

In the article Larkin is quoted as saying

“With anything in life, people tend to focus on the negative, we don’t enjoy putting people in pain, we like taking them out of pain. Trust your dentist.”

In the previous post that I mentioned, I discuss guidelines from SIGN and NICE which stated that armed forces should strongly consider having wisdom teeth removed because they can be in situations for a while without easy access to dental treatment. Another article I mention in that post, discusses how deploying a helicopter to transport a patient with significant wisdom teeth problems in the field to an oral surgeon can be a very costly and time consuming process. It is even possible that in certain situations transporting a patient to an oral surgeon will not be an option. Thus it is important that any service personnel discuss the benefits and risks of removing versus retaining any third molars (wisdom teeth) with an oral surgeon and carefully considers the options before being deployed.

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Osteonecrosis of the Jaw As a Complication After Wisdom Teeth Removal

Posted on 04. Jan, 2014 by .

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Removing wisdom teeth or a wisdom tooth has risks and in some instances complications can occur. I have discussed numerous complications of wisdom teeth over at http://www.teethremoval.com/complications.html.

One of the complications discussed is Bisphosphonate Related Osteonecrosis of the Jaw (BRONJ). What happens is that when a patient is on bisphosphonates and has a tooth extracted (any tooth a wisdom tooth or not) bone that is exposed can fail to heal. A case of this occurring is described at the Daily Mail titled “Grandmother in agony for FOUR YEARS after dentist removed wisdom tooth without checking her medical records,” by Steve Robinson, published on March 19, 2013.

In this case a 72 year old woman had a problem where she kept catching her teeth with her cheek and noticed blood. She went to her general practitioner who performed a biopsy and diagnosed an ulcer. The doctor referred her to a maxillofacial unit and wanted her wisdom teeth extracted.

When the woman went to the maxillofacial unit the dentist asked if her wisdom tooth hurt and she said no. The dentist wanted to remove the wisdom tooth anyway and did so without reviewing the medical notes. Soon after the woman began to experience pain. She was then later told that the problem was caused by the medication she was taking for her osteoporosis. She had been taking the osteoporosis medication for over 3 years.

The woman has had part of her jaw removed since the extraction. A panoramic x-ray taken in 2008 before the wisdom tooth extraction and then again in 2010 clearly shows that part of her jaw has been removed. The woman reached an out of court settlement with the dentist for £50,000 because the dentist did not review her medical records before performing the surgery. The woman continues to take pain killers all the time and says that she has lost her retirement.

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