I was very young when I first heard of the ancient tale from India of the blind men and the elephant. This tale spread far and wide, but the Indian version is probably the original and is definitely the most succinct.
From the Wikipedia entry,
http://en.wikipedia.org/wiki/Blind_men_and_an_elephant
Ramakrishna Paramahamsa used this parable to discourage dogmatism: "A number of blind men came to an elephant. Somebody told them that it was an elephant. The blind men asked, ‘What is the elephant like?’ and they began to touch its body. One of them said: 'It is like a pillar.' This blind man had only touched its leg. Another man said, ‘The elephant is like a husking basket.’ This person had only touched its ears. Similarly, he who touched its trunk or its belly talked of it differently. In the same way, he who has seen the Lord in a particular way limits the Lord to that alone and thinks that He is nothing else."
I shall refrain from any discussion of how this applies to modern American politics and the religious sphere. But to dentistry, it also has tremendous relevance.
For my entire career I've been intrigued by how 2-dimensional X-ray images represent, and misrepresent, 3-dimensional objects. I've posted before on how the level of bone or a small chip in enamel can be superimposed over the rest of the tooth in such a way that it looks like a cavity. Well, we took some X-rays recently that show a large cavity with tremendous variation in how it actually looks.
As we look at the images, recognize that the dark curvy lines inside the teeth are the outlines of the root canal. The white lines are an existing root canal treatment and post. The other white things are metal restorations.
In this first image, focusing on the tooth with the question mark, we see a hint of darker gray under the light filling, which could be a cavity:
However a dentist could perhaps be excused for thinking nothing of this shady shading and, if no open decay was visible to the eye (or touchable to those little sharp silver things that we're always poking around with), leaving this tooth be. Because, you see, the line of the dense bone throws a shadow right along this part of the tooth and it's supposed to look a little darker there. Same picture, with a line drawn along the bone crest:
Lighter below, darker above. Definitely a confusing area for interpretation.
Yet a Full Mouth Series of radiographs picks up different views of the same tooth. Much like those chaps investigating the elephant, we start to see different aspects of the same thing:
And for the win:
The bone may set the tone, but that's decay!
So multiple radiographic views of teeth are often vitally important in diagnosis. This is even more true when we get into diagnosing periodontal disease, endodontic lesions (infections in root canals), cysts and the like. The new 3-D scanners are a great advancement in this regard. They do not yet have the resolution to detect small cavities, but in short order they probably will. Until then, it's sometimes a challenge to know the tusk from the trunk.
Today, 3/5/2012, was Der Tag. "The Day." The moment when we transitioned from paper charts to eCharts.
Everyone survived!
We've been working with digital images for about five years now. We've been emailing letters to specialists and recieving theirs back in turn via electronic means. We've been treatment planning in our Dentrix software for quite some time as well. So this wasn't all new to us. Still, it took a leap of faith to change in this way. Now that the day is done it feels pretty good.
There are major advantages to this:
Faster! Because we work from pre-written Templates that we modify to fit the specific situation as needed.
Neater! Because no one has to read my meshuggenah handwriting.
More thorough! Because we don't have to worry about space concerns. The real world is often one of scarcity. We didn't want to waste paper because we'd have to order more. The digital world is one of abundance. We still won't waste space. But if we wish to write more- we'll write more. It entails no cost.
Environmentally friendly! We use a bit of power to run our computers, of course. But we turn them off at the end of the day, except for our server. And we no longer consume: paper, ink, the energy and chemicals required to make paper and ink, the energy and chemicals required to transport paper and ink, plastic in the casings of pens, etcetera, etcetera, etcetera.
Der Tag went well.
I went to Penn Dental in Philadelphia, graduating in the very late 80's. Hey- very late 80's, I'm not that old! I did not go there for undergrad; I attended Muhlenberg College, a small and truly remarkable college in Allentown.
The University of Pennsylvania is an excellent place to get an education; it is, however, a very... corporate place. It's the Ivy League school with the least heart and soul, in my considered opinion. I state that simply to increase your appreciation of what was happening when I was there.
In those days South Africa was in the throes of Apartheid and severe unrest, as the ruling class of white peoples struggled to keep an iron grip on the black population. P.W. Botha was still president, the relative reformer F.W. de Clerk hadn't yet come to power, and Nelson Mandela was still in jail, not being released until 1990 after many social and political upheavals had occurred.
More here for those who love their history:
http://en.wikipedia.org/wiki/South_Africa_under_apartheid
http://en.wikipedia.org/wiki/P._W._Botha
http://en.wikipedia.org/wiki/Frederik_Willem_de_Klerk
http://en.wikipedia.org/wiki/Nelson_Mandela
So anyway, U Penn's massive endowment was invested rather heavily in South African business interests. Students got ahold of this and started to protest, much as the Occupy WallStreeters have done today. They set up actual shanty towns, just like in the Districts in South Africa, and in an astonishing move to show solidarity with the suffering people there, many well-off middle-class students started to actually live in their cardboard and sheet metal constructs:
http://dla.library.upenn.edu/dla/archives/image.html?id=ARCHIVES_20070627005
http://articles.philly.com/1986-04-09/news/26078005_1_penn-students-penn-officials-penn-board
(I'm sure their parents were thrilled about paying for room and board at the same time haha.)
Here's the thing, and my point in telling you all this: there were two extremely different viewpoints that came out of this protest.
The students said, "Divest from South Africa, it's wrong to be invested there when they treat people the way they do under Apartheid."
The Trustees of the University said, "By investing there, we can make a difference."
Wow.
If we think about this objectively, without coming in with any assumptions, each point of view has a chance of being valid. There really could be two partners in a tech or manufacturing firm, real people, people who would be happy to talk to you, named, say, Cecil Benoist and Kenward Fitton, who were gradually but steadily using their influence to change things for the better, and being absolutely transparent about it. I doubt it, but there could have been.
The thing was, in 1987 you needed an army of reporters, working for a mega-corporation news organization, running through insane levels of money and resources, to even have a tiny chance of finding out. Even then, they might be locked up by the repressive regime themselves. Game over. Nothing learned.
Now? Now, the free exchange of information via the Internet, and even more importantly, the ability of people to connect and make a difference, has changed that game, probably forever. As an example, the multiple revolutions in the Middle Ease in 2010-2011 all had as their proximate cause: the ability of people to really know what was going on outside of their narrow part of the world; the ability to know what terrible things their governments were responsible for, and what they were stealing from their citizens; and the ability of those citizens to connect and organize via technology.
The Internet. It's not just for posting Red-Cup Party Pictures anymore...
Actually, of course, it never was just for frivolous things, and although there is a great deal of misinformation and clutter out there, even evil things, we should respect all that and beware of it, but mainly we should be focusing on how it can connect us to folks who want to move forward together, and use it to change the world around us in ways big and small.
It is now extremely difficult for anyone- a government, a business, a person- to do evil in the dark. Not for long. The bright light of free flowing information brings everything out in the open in time. It's all a matter, though, of where we direct our precious Attention. Attention is a fixed quality, as there are only 24 hours in a day for all of us, and that's the thing that limits us.
If today's information technologies had been available in the late 80's, all the activities that UPenn's investments were leading to, good or bad in their effects on South African society, would have come to light. The trustees would have a choice to proudly trumpet their accomplishments, through the means of business investment there, or they would have had to divest and retreat in horror at the public relations scandal that their investments had caused. Back then, they successfully hid the truth, whatever it was. Now, they couldn't. Simple.
The Occupy Protestors are apparently trying to hide much of their own goals and tactics, falling into much the same pattern as the corporate entities against which they protest. Not a great strategy in today's world. Sigh. People as individuals learn so fast. People as large groups- they never seem to learn.
It pays to really examine the power of our Attention, though. If there's interest, I'll do just that in a future blog post. For now, let me say that our precious Attention is our most powerful weapon, far more powerful than guns or money or yelling in the streets. For if we turn our Attention away from anything in sufficient numbers, that entity will wither and die. Examples? If no one paid attention to those Kardashians, they wouldn't be rich and famous. If half of the people who now shop at Walmart suddenly stopped, say in protest against their treatment of employees, well then within two months Walmart would be brought to its knees and would change the way it treats its employees (I'm not saying we should necessarily do that, but we could.) If we didn't do business at a certain bank- no more bank. If we all voted against the incumbent just one time, on a local, state, and federal level- all politicians would be permanently afraid of us, and would actually respect us for the first time in a century.
Gedankenexperiments, yes. Impractical "thought experiments"- but they demonstrate, through extreme examples, what could happen.
We all have tremendous power now. Our Attention is more valuable and powerful than it has been since we inhabited tiny Villages and there were no kings, no corporations, no gatekeepers of information and power at all.
What, then, shall we do with it?
Commentary: Epidemic of Malingerers Driving Up Insurance Costs
We have a very insightful and powerful guest post written by a private detective who wishes to remain anonymous, for reasons that shall be apparent. Here we go:
No one really knows the true cost of fraudulent insurance claims that plague our health care system; however, estimates by several fraud associations in the United States attribute anywhere from $50 billion to $110 billion in total healthcare spending annually. The problem with detecting this type of fraud is that individuals who are intent upon 'cashing in' do so in a manner that is generally undetectable. To curb these costs, insurance companies dutifully hire adjusters to monitor claims and detect fraudulent activity; however, their investigations are generally limited to perusing papers and digital databases from behind a desk. Hence, a private detective may be called upon to 'check-up' on various individuals to determine their daily activities and provide an objective opinion of one's physical capabilities utilizing overt and covert video documentation. This is where my expertise lies. As a private detective who has investigated workman's comp claims spanning seven states over the course of a decade, I have documented over 2,000 'malingerers' conducting their day-to-day activities yielding video evidence that has disproven their claims. Granted, I have also observed individuals whose activities were so limited that their claims were warranted. However, if I were to establish a percentage of illegitimate claims based on total files, the numbers would be astonishing. In my experience, I estimate approximately 90% of total assignments to have been fraudulent. And it is my belief that this high number is due to an epidemic of individuals in our society that want 'something for nothing' and know that under the current system they can actually get it with little to no recourse.
I have worked cases where Claimants have sought anywhere from $15 thousand to nearly $6 million in damages, testified against them in court, and seen the life and dollar signs drain from their eyes as images of them working construction, painting houses, mowing lawns, chopping wood, deer hunting, riding roller coasters, rock climbing, kayaking, water skiing, lifting weights, shoveling snow, and even pole dancing flash across a jumbo screen. Alas, there is no greater satisfaction. But don't let me mislead anyone in saying that every case yields some fantastic 'movie-trailer' for attorneys to drool over.
There are cases where Claimants state that they cannot operate a vehicle and therefore cannot return to work. For example, this woman worked as a home inspector, requiring her to utilize her personal vehicle to transport herself to and from locations during the day to inspect residential properties. Surveillance was conducted, and for three consecutive days she operated her personal vehicle to over twenty different locations. On the fourth day, she requested that she have her employer provide her with transportation to and from her appointment as, of course, she could not drive.
Then there are your typical Claimants who are temporarily totally disabled. This gentleman diving into the swimming pool worked as a delivery driver for a very well known soda company and received disability payments for nearly four years after claiming to have fallen and injuring his shoulder and back. There was no witness to his 'accident' on the job, but there were at least ten other witnesses to his belly flop in the pool on this day.
Perhaps the most common case is that of the 'double-dipper'. This Claimant received comp payments for ten years due to neck and upper back pain from heavy lifting as a medical supply salesman. Since he resided in a very rural area, the insurance company felt as though surveillance would not be beneficial and therefore made "announced" wellness check visits with him twice a year. Records from those visits documented that the Claimant stated he had limited mobility and that he had no quality of life as he rarely strayed from the couch.
A new adjustor reviewed the file and felt as though surveillance should be conducted. This Claimant was investigated over the course of two weeks, and was caught working a full-time job as a medical supply salesman, even lifting and carrying all the wheelchairs and walkers in and out of the building to a transport van or other customer vehicles. But this guy wasn't just satisfied in scamming his former company, this Claimant took his current company van during an actual work day and ran errands for family members, at one point he even picked up his father's push mower from the repair center at Sears, drove it to his father's residence, and unloaded the mower. What you cannot see in this photo is a sign on the rear of the business van that clearly states "This vehicle carries medical supplies only." Not only did this Claimant work a full-time job conducting the exact same duties that he claimed he could not perform, but he was also caught taking a two-day kayaking trip. I wonder what his definition of 'quality of life' is exactly.
But perhaps one of the most rare claims that I have investigated is that of a woman who was employed at a hospital and stated that she could not work because she believed she had been exposed to swine flu while working in the ER. She also claimed to have had persistent respiratory distress symptoms and required the use of an oxygen tank. Eventually, her claim was denied as the hospital was able to prove that there had been no confirmed cases of swine flu and the video evidence of her smoking (essentially a pack a day over the course of three days) was enough for her attorney to excuse himself from the case.
If stiffer penalties for fraudulent claims were instituted or if more people reported these individuals to proper authorities, maybe the costs to our society would be reduced. But inevitably, where there is an opportunity to make a quick buck, or quite a few bucks, someone will always be waiting in line to cash in. In the meantime, I have job security.
Written by: Anonymous 2011
New evidence from the Oxford Radiocarbon Accelerator Unit in England on fossil teeth and jaws shows that modern humans ("modern" in the sense archaeologists use the word, not meaning "with an iPad2") have been in Europe for 45,000 years. Since Neanderthals went extinct 30,000 years ago, that means we co-existed with Neanderthals for 65 times as long as America has been a country. Sobering thought, that.
Actually, if we include the U.S. Congress as part of our considerations, we are STILL coexisting with Neanderthals...
Every treatment that I've ever done in my entire dental career has been as beautiful and cosmetic as I can make it, given the patient's circumstances and the technology of the time.
That doesn't mean I'm a "cosmetic dentist."
Have a look at this case (which is 20 years old and predates me!):
A dentist who practices cosmetically, with patients' oral health as the most vital goal, would lighten this patient's teeth if the patient desired that, and then restore those two front teeth with a new restoration that: matched the surrounding teeth in color and opacity, was symmetrical, fit within the arch, and gained better health of the gums, among other things.
An aggressive "cosmetic dentist" might suggest (read: present as the only reasonable treatment) a restoration for these two teeth that was as white and opaque as a sample of toilet bowl porcelain, and also veneers for at least the surrounding six teeth, three on a side, making a restoration of eight teeth in all. Hey, that way, they'd all match, right?
Caveat Emptor. Here are two principles for you, the dental consumer, to be guided by when it comes to esthetics:
-Every treatment should be based on sound biological principles and designed to promote oral health; this can be completely consistent with beautiful esthetics.
-Excellent dentistry is cosmetic dentistry; and yet there are times when those who present themselves as a "cosmetic dentist" are going to be aggressive in their approach. Understanding the distinction will protect you.
These two water bottles, perched with casual insouciance in my vegetable garden, may look similar but there are vast differences between them:
The bottle on the right, like all the bottles we've purchased and drank from and recycled or thrown away in our lives, is plastic, made from petroleum. One of the many issues with this is that plastics don't biodegrade in our environment. Formed of long-chain hydrocarbon molecules, plastics don't degrade into basic elements like carbon, nitrogen and hydrogen. Rather, they break down into smaller and smaller bits until the smallest pieces still remain on land or in the sea- and these bits are still plastic. It doesn't go away.
The Wikipedia entry on plastic http://en.wikipedia.org/wiki/Plastic makes reference to the enormous quantities of plastic human garbage that ends up in ocean gyres. This is the article on these structures:
http://en.wikipedia.org/wiki/Great_Pacific_Garbage_Patch
(There's one in the Gulf of Mexico as well.)
From that article:
"The Great Pacific Garbage Patch has one of the highest levels known of plastic particulate suspended in the upper water column. As a result, it is one of several oceanic regions where researchers have studied the effects and impact of plastic photodegradation in the neustonic layer of water. Unlike debris, which biodegrades, the photodegraded plastic disintegrates into ever smaller pieces while remaining a polymer. This process continues down to the molecular level.
As the plastic flotsam photodegrades into smaller and smaller pieces, it concentrates in the upper water column. As it disintegrates, the plastic ultimately becomes small enough to be ingested by aquatic organisms which reside near the ocean's surface. Plastic waste thus enters the food chain through its concentration in the neuston."
Toxic chemicals from plastic degradation in seawater eventually make their way up the food chain to humans...
Such is the end result of the disposable side of the civilization that we've built.
The bottle on the left is made from plant materials. The company is called Green Planet Water and their website is here: http://www.greenplanetbottling.com/
Potential advantages of plant-based beverage bottles are:
-They biodegrade in the environment and are compostable.
-Plastic bottles can leach petrochemicals into the beverage; these bottles do not, being made from plants.
-Plant-based bottles are recyclable.
-Plastic bottles, at the end of their life cycle, release carbon into the environment. (It was sequestered underground for millions of years.) Plant-based bottles are carbon neutral. Plants take carbon out of the atmosphere and soil as they grow, and a bottle made of plants will put its carbon back into the ground if composted.
-"For every 72 bottles produced by Green Planet, one gallon of oil is saved from being used in beverage bottles and containers. They are recyclable, commercially compostable in 80 days and contain zero greenhouse gas." -from Green Planet's press sheet.
I'm sure there is a downside. But I also cannot imagine that it is anything close to the devastating effects of the Great Pacific Garbage Patch. It also occurs to me that plastic shopping bags would be the next target for this kind of innovation, as well as the myriad medical and dental disposables that are made of plastic. Plastic will probably always have a major role in manufacturing consumer and other goods, but disposable plastic is a concept that should be retired once and for all.
Note that for a few years now, there are starch-based packing peanuts that are an excellent substitute for styrofoam:
http://www.starchtech.com/biodegradable-packing-peanuts.html
They're compostable, they dissolve in water, and they're even edible. Yes, I've tried.
As happens with all change, the mature and highly profitable plastics industry will be reactionary. No doubt even my post here will be attacked at some point. But the status quo exists for a perfectly good reason: to be torn down and destroyed at intervals when a better way is found to do the things that we humans rely upon in the running of our world.
I have a stock letter in my office that I mail or email to shippers who send us orders wrapped in styrofoam packing peanuts. In it I encourage them to change to starch based packing materials. They may not listen to just me so much- but imagine what would happen if every one of their customers wrote the same thing to them. They'd simply have to change...
Integrative Medicine is a relatively new concept that goes beyond the treatment of symptoms to address the causes of disease. It involves personalized care and is highly concerned with prevention, not only treatment.
Here to explain Integrative Medicine in a guest post is Michelle Niesley, N.D., M.S. Her website is http://www.theaspireclinic.com/
Dr. Niesley introduces us to the field:
“Integrative medicine”—it’s the newest buzzword in medical care. Almost everyone knows someone who received acupuncture for chronic pain or to help them quit smoking, or saw a chiropractor for back or neck pain. Integrative medicine is not ‘alternative medicine’, which is used in the place of standard medical care.Integrative medicine blends the best of our scientific understanding used in standard medical practice with lifestyle interventions to provide patients with unique care that is optimal for them.
The word ‘doctor’ comes from the Latin word docere which means ‘to teach’. Most doctors received medical education that centered on surgical interventions and prescribing of medications. These are vitally important to the healthcare of many. But medical doctors who do not seek out additional training receive approximately 8 hours of education on ‘nutrition, vitamins, and minerals’—which makes it challenging to ‘teach’ patients about lifestyle changes they can make to improve their health. As such, many patients are looking for ways to fill in their healthcare gaps, and seek out healthcare providers who have expertise in lifestyle modifications such as dietary changes,herbal or nutritional supplements, exercise physiology, homeopathy, acupuncture and Chinese medicine, or chiropractic care. Most patients could greatly benefit from an ‘integrative care team’, with medical doctors sharing patients with acupuncturists, chiropractors, therapists, naturopathic doctors, nutritionists, and other providers who were provide their own expertise in helping you achieve and maintain optimal health.
For example, many are taking medications for high blood pressure. But the reason(s)whythey have high blood pressure can vary greatly from one person to the next. Integrative care will provide you with a ‘roadmap to wellness’ that includes detailed dietary recommendations, a feasible exercise regimen, and guidance on herbal or nutritional supplements (such as magnesium, fish oil, and CoQ10). We also determine if any other factors may be contributing to the condition—such as stress at work or home, too much alcohol, cigarette smoking, etc… and can help provide resources to help you change your environment to ensure success.
Many integrative providers analyze the same labs your family physician does—but we look to see if the results are ‘optimal’ as compared to ‘within normal limits’. Most patients don’t want to be ‘okay’; they want to feel as well as possible. The goal is provide you with the tools you need to put control of your healthcare back into your hands. Integrative providers believe that everyone would benefit from an individual analysis of our health so that we can pinpoint which small lifestyle modifications may lead to big changes in how we feel.
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