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Second Opinion Advertisements for Dentists

wisdom — Sun, 08 Jan 2012 00:13:12 +0000

An article in The Journal of the American Dental Association titled “Are Advertisements That Offer ‘Free Second Opinions’ Ethical by Rod B. Wentworth (October 1, 2011, vol. 142, no. 10, pages 1199-1200) talks about the ethics involved with dentists advertising “free second opinions.”

In the article it says

“So simply offering free second opinions is not in and of itself unethical. It is perfectly acceptable for a patient to seek a second opinion. In fact, dentists should consider suggesting that their patients obtain second opinions, especially when they have questions or concerns about the appropriateness of the recommended treatment.”

One issue raised in the article is that in a second opinion, if a patient has any x-rays they should be sent along with the patient for the second opinion to avoid unnecessary radiation.

The other issue raised is giving second opinions without making disparaging remarks about the patient’s dentist from the first opinion also known as jousting. Doing so can result in possible disciplinary action against the dentist and may have potential legal implications but as a patient if it was warranted I would like to hear the truth.

The purpose of a free second opinion would of course be to help dentists take patients away from each other.

I think second opinions from different dentists is a good idea in some cases but as addressed in this post http://blog.teethremoval.com/are-dentists-ethical-or-scam-artists/ knowing whether a dentist is being too conservative, too aggressive, or somewhere in the middle is difficult often for patients to know. I tend to think more dentists at least in the U.S. lean towards the aggressive side but certainly some are more conservative in their treatment approaches.

The author ends by saying

“Second opinions are not cut-and-dried in an ethical sense. Advertising them certainly is not unethical, and patients are free to select the dentist of their choice, which they may do on the basis of the information received in a second opinion. However, certain actions, such as criticizing a dentist unjustly, administering unnecessary tests or treatment, or misrepresenting fees, skills or experience may be unethical. Only the dentists involved know their motivation and whether it leads to unethical conduct. One hopes that dentists will take the high road to ensure that the oral health of the public and the welfare of patients are of primary importance”

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Astroturfing And How Your Thoughts Are Being Manipulated by Corporate Interests

wisdom — Fri, 29 Jul 2011 04:36:08 +0000

Astroturfing is a form of advocacy typically to support an agenda with the appearance of a fake grassroots organization that is usually sponsored by corporations or those with a certain political interest. They work in such a way so that you are not aware that the corporate or political backing is present and you are led to believe that just an independent public organization is speaking out. There are a lot of ethical issues raised by doing this and evidence shows that astroturfing can be effective.

A recent article in the Journal of Business Ethics titled “Astroturfing Global Warming: It Isn’t Always Greener on the Other Side of the Fence,” by Charles H. Cho, Martin L. Martens, Hakkyun Kim, and Michelle Rodrigue (online July 3, 2011) explores the issue of those who visited astroturf websites and how it affects the perceptions of global warming.

Before explaining the study let’s make it clear global warming is unequivocal and there is at least a 90% likelihood it is caused by human activity.

In the study the researchers used a final sample of 278 students enrolled in accounting classes at a Canadian university. The true intent of the study was disguised from the students and they were told the website they would be viewing was a marketing experiment about effective website design for social issues including fair trade, homelessness, racism, and global warming. Eight versions of websites all on global warming were set up by the researchers designed to either be an astroturf or real grassroots website and each student was randomly assigned to view one website. Each website either didnt have a funding source listed or included‘ ‘Funded from donations by people like you,’’ ‘‘Funded by ExxonMobil,’’ or ‘‘Funded by grants from the Conservation Heritage Fund.”

As one would hope to have found those who browsed a website from an astroturf organization found the information as less credible and the organization as less trustworthy, compared to those who browsed a website from a grassroots organization. Even so as astroturf organizations had intended to instill confusion and uncertainty in the general public regarding the global warming issue they did accomplish that and those who visited an astroturf like website had their beliefs about global warming significantly altered and had more uncertainty about the cause of global warming.

Even more shocking is that those individuals in the study who were highly involved and knowledgeable about climate change had their views significantly influenced by the astroturf message. In addition, those who were not highly involved in the issues of global warming had their views affected even more.

The researchers note

“Our findings not only indicate that corporations are successful in fostering their own interests through astroturfing, but they also imply that this corporate political activity is likely to be detrimental to grassroots organizations. Astroturf organizations take the social movement approach to fulfill corporate agendas. Such fraudulent replication of grassroots organizations is likely to raise questions about the legitimacy of those organizations in the mind of the public…Once aware that they have been manipulated by a fake grassroots organization, members of the public are likely to be much more cautious and skeptical with all grassroots organizations, whether they are genuine or fake.”

There are clear ethical and societal concerns with not having full transparency for any astroturfing organization.

The researchers also say

“Astroturf organizations are (1) successful in creating uncertainty about the importance of global warming in the mind of the public and (2) utilized by corporations to attack the emerging logic of climate change and defend the carbon based energy logic which encompasses corporate interests.”

In addition these astroturf organizations go against the ethical considerations to protect the environment for future generations.

These findings have broad implications that certainly extend beyond global warming. As I have indicated on an earlier post http://blog.teethremoval.com/lets-give-our-kids-a-chance-to-succeed/ today’s youth has a very difficult time distinguishing fact from fiction on websites and information they view online. The results of this study described above just seek to add to support this and in fact demonstrate that their views can be manipulated even though the views they are ‘planted’ with may not be in their own personal best interests.

This even has implications in our own personal health and yes even the decision to extract or not extract healthy wisdom teeth as I discuss on this site. For example the American Association of Oral and Maxillofacial Surgeons (AAOMS) states on their website http://www.aaoms.org/wisdom_teeth.php

“It isn’t wise to wait until your wisdom teeth start to bother you.”

In fact as discussed, scientific evidence does not currently support or refute removing healthy wisdom teeth removal. By AAOMS failing to provide this information on their website which is publicly available they are helping to create additional uncertainty in the minds of those who are trying to seek the best decision for their personal health and well being.

It is imperative that our educators recognize that we need to teach our youth how to effectively read and analyze information on the internet and determine facts from fiction. What really makes this difficult is highlighted in the article discussed on astroturfing and global warming:

“…Western Fuels Association [delivers], for free, to public and university libraries across the United States hundreds of copies of their Greening of Planet Earth video, which shows that plants on earth are lacking carbon dioxide, and that an increase in atmospheric carbon will provide a more fertile world….the Heartland Institute [sends] thousands of brochures and DVDs to Canadian schools, pushing them to teach their students that scientists have been exaggerating the effects of human activity on global warming.”

Again to reiterate global warming is unequivocal and there is at least a 90% likelihood it is caused by human activity.

Who is looking out for our children and our youth? They have more to worry about like the extremely high cost of education which has ballooned out of control in the U.S. at both the undergraduate and further graduate and medical school levels.

Source: http://www.kevinmd.com/blog/2011/07/medical-education-cost-health-policy-imperative.html

Additional Source: http://arstechnica.com/science/news/2011/07/astroturfing-a-major-challenge-to-climate-change.ars

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The American Association of Oral and Maxillofacial Surgeons Fails to Use Basic Statistics in Research on Wisdom Teeth

wisdom — Mon, 13 Dec 2010 07:41:38 +0000

I have previously reported how the American Association of Oral and Maxillofacial Surgeons (AAOMS) recently had a press conference on wisdom teeth in Washington, D.C. See http://blog.teethremoval.com/third-molar-multidisciplinary-press-conference/ for more information.

Shortly after the press conference they issued a press release available at http://www.aaoms.org/docs/media/third_molars/press_release.pdf which is titled “Conventional Wisdom about Wisdom teeth Confirmed: Evidence Shows Keeping Wisdom teeth May be More Harmful than Previously Thought.” One of the additional key findings listed in this press release is

“Most patients (60 percent) with asymptomatic wisdom teeth prefer extraction to retention.”

This finding comes from a recent article in the Journal of Oral and Maxillofacial Surgery, titled “Most Patients With Asymptomatic, Disease-Free Third Molars Elect Extraction Over Retention as Their Their Preferred Treatment.” The article is by Brian E. Kinard, BS and Thomas B. Dodson, DMD, MPH. It appears in the December 2010 issue in volume 68, issue 12, on pages 2935-2942.

The article uses a study sample from patients presenting to the Department of Oral and Maxillofacial Surgery at Massachusetts General Hospital between November 2008 and August 2009 for the evaluation and management of their third molars (wisdom teeth) by Thomas B. Dodson. In the article on Table 8 it is presented that a total of 319 patients were seen during this time who had asymptomatic disease free wisdom teeth. 129 of these patients chose to keep their wisdom teeth and 190 of these patients chose to extract their wisdom teeth. A simple calculation was performed by the authors of 190/319 * 100 = 60%. (it actually equals 59.5611 % but they rounded up). This is how they arrived at their statement quoted above that most patients with asymptomatic wisdom teeth prefer extraction and how they arrived at the titled of the article most patients prefer extraction.

Thomas B. Dodson admits that their bias in this result as “…it is possible for clinicians to present treatment options in a manner, consciously or unconsciously, that directs patients toward the clinician’s preferred treatment.” This is a valid concern. I also have a problem in that no statistical analysis was done beyond this point with this specific result.

During my undergraduate studies I took several courses on statistics. One popular program to use is MINITAB in addition to knowing how to do hand calculations.

Using this proportion data it is possible to do in MINITAB and by hand a 1 proportion test and determine a confidence interval. A 95% (two sided) confidence interval of this data is (0.539505, 0.649924). This is calculated by calculating an estimator for the standard error. This estimator is the square root of [(p * (1-p)/n] where p is in this case 190/319 corresponding to the sample proportion which is an estimator of the population proportion and n is the sample size which in this case is 319. We then look up in a t table or use MINITAB to determine the test statistic, which in this case is 1.96745. The 95% confidence interval is then calculated as 190/319 +/- sqrt[(190/319 * (1-190/319)/319] *1.96745 . We then arrive at our 95% confidence interval of 53.9505% to 64.9924% which means we are 95% confident that the true population proportion of those who keep their asymptomatic wisdom teeth falls in this range.

The other important piece of information we need to asses is if we have enough samples in our data. A total of 319 patients were used in this study who had disease free wisdom teeth but it turns out we need more than 319 patients to make an accurate assessment before we can even calculate a 95% confidence interval.

If we look at the Statistics Department at Penn State University we can easily find an educated guess and conservative method to determine the required sample size. In this case our educated guess is calculated as [ (1.96)^2 * 0.595611 * (1 - 0.595611) ] / (0.05)^2 which equals 370.113 and our conservative method is calculated as [ (1.96)^2 * 0.5 * (1 - 0.5 ] / (0.05)^2 which equals 384.16. Thus we determine that it is necessary to have at least 371 patients in our study to be able to even come up with a statement as to whether or not we can be 95% confident that patients prefer either to extract or retain healthy impacted wisdom teeth.

The authors only used 319 patients in their study and thus the data does not allow them to make such as statement as they did which AAOMS subsequently reported in a press release.

I encourage Thomas B. Dodson and other oral surgeons to consider using some basic statistics in their research before releasing such information to the the public who should be receiving information that can allow them to make informed decisions about their health.

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The American Association of Oral and Maxillofacial Surgeons Fails to Use Basic Statistics in Research on Wisdom Teeth

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U.S. Dental Schools Teaching little on Sleep Disorders

wisdom — Sat, 14 Aug 2010 00:16:15 +0000

American adults suffer from sleep disorders and the number is quite large, around 70 million. U.S. dental schools are not teaching their graduating soon to be dentists the importance of screening their patients for sleep disorders.

A survey sent out by researchers from the University of California — Los Angeles (UCLA) School of Dentistry, indicates that dental students spend an average of 2.9 instruction hours during their four years of dental school studying sleep disorders.

The main problem is for those 18 million Americans that suffer from Obstructive Sleep Apnea (OSA). It estimated that 80 % to 90 % of patients with OSA are not diagnosed and this can consequently raise the patients risk for many diseases and problems.

The researchers feel since dentists see patients on a regular basis, they can notice early warning signs of sleep disorders. This greatly makes sense and thus U.S. dental schools should increase the amount of time during the 4 years of study that students receive on sleep disorders.

Source: http://www.sciencedaily.com/releases/2010/06/100605112529.htm

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The Role of Dentists in Diabetes Screening

wisdom — Tue, 16 Feb 2010 05:10:06 +0000

A study, led by Dr. Shiela Strauss, Associate Professor of Nursing and Co-Director of the Statistics and Data Management Core for New York University’s Colleges of Dentistry and Nursing, examined data from nearly 3,000 adults in the 2003-2004 National Health and Nutrition Examination Survey who had not been diagnosed with diabetes. The results appear in the Journal of Public Health Dentistry in the article titled “The dental office visit as a potential opportunity for diabetes screening: an analysis using NHANES 2003-2004 data.” The results indicate that the majority of people who have periodontal (gum) disease are also at high risk for diabetes. In addition, half of those at risk had seen a dentist in the previous year. This one can draw the conclusion that dentists should consider offering diabetes screenings in their offices.

Dr. Strauss and colleagues determined that 93% of those examined had periodontal disease, compared to 63% of those without the disease, were considered to be at high risk for diabetes and should be screened for diabetes. Diabetes screening is recommended for people at least 45 years of age with a body mass index (BMI) of 25 or greater, as well as for those under 45 years of age with a BMI of 25 or greater who also have at least one diabetes risk factor. Dr. Strauss’s study indicated that a first-degree relative (a parent or sibling) with diabetes and high blood pressure were reported in a significantly greater number of those examined with periodontal disease than in those without periodontal disease.

Dr. Strauss said that dentists can screen patients for diabetes by evaluating them for risk factors such as belonging to a high-risk ethnic group (African-American, Latino, Native American, Asian-American, or Pacific Islander, being overweight, a first-degree relative with diabetes, having high cholesterol, and/or having high blood pressure.

Dentists can use a glucometer which is a diagnostic instrument for measuring blood glucose. This could potentially be done in one of two ways, 1) analyze finger-stick blood samples, or 2) use the glucometer to evaluate blood samples taken from pockets of inflammation in the gums. Both methods have been shown to be correlated and provide correct results as indicated in an earlier study by Dr. Strauss.

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