Bite Point

You Deserve Your Health, Dental "Insurance" Or Not

The American public needs to hear something vitally important about their health.
Especially since, as in many areas of public discourse today, powerful vested interests are making effective attempts to block and obscure the truth.

In this case, dental "insurance" companies.

First off, I need to say that there are three common diseases that we dentists mainly treat.

Cavities of course is one. Their end effects are far more serious than the word "cavities" makes it sound. Pain, loss of smile beauty, dangerous infections, loss of teeth, and with enough loss of teeth, loss of vertical dimension of the whole face ... Very serious stuff.

Periodontal disease, periodontitis, is the second. Periodontitis is a terribly serious systemic disease. Dangerous pathogens enter the bloodstream from the mouth with every meal, every toothbrushing, every heartbeat. Periodontitis dramatically increases the risk of heart attacks, strokes, various cancers, impotence, premature babies and a host of other ills. Periodontitis measurably shortens lives.

The third is oral cancer. When this occurs, early detection is vitally important.
Early treatment is a simple surgical incision.
Later treatment is surgery, radical neck dissection and chemotherapy. 
Really later treatment is a prolonged agonizing death.

And here's the thing. Cavities, periodontitis, oral cancer--none of them ever get better on their own. None of them ever stay the same. They all get worse, at a variable rate.

With that as background--

Seen through the lens of oral health, we can conceive of several categories of people in America.

One category is those who, dental "insurance" or not, visit their dentist on a schedule. These people understand the value of early treatment and, even more important, prevention of disease.

Another category is, sadly, those who truly cannot afford dental care. This is a huge societal problem. See above about shortening lives.
I and many colleagues perform pro bono treatment from time to time. Even these efforts, regrettably, are not enough to solve this vast challenge that our culture faces.

Another category, and the one I mean to speak to here in this post, is:
People who think they can't afford to come to the dentist because they don't have dental insurance.

Well, please allow me to utterly destroy that errant belief:

Dental "insurance" is NOT medical insurance!

It works completely differently.

Dental "insurance" has become a cruel, sick joke.

In 1967, when dental "insurance " became a force in America, the most common yearly maximum was $1,000. And there were generally no payroll deductions for it--dental "insurance" was a perk.

Fast forward to today, and 95% of the dental "insurance" plans we see today are $1,000 a year maximum.

Folks, you have to use an inflation calculator to understand any of these financial issues. $1,000 in 1967 is $9,400 today.

If you have dental "insurance," you are getting 1/9th the value of what your 1967 predecessors were getting, and you are paying payroll deductions for the "privilege." They were not. You should be very, very angry about this.

Another way of putting this is, in the 1990s, patients in my practice could need, say, two root canal treatments and two crowns in the same calendar year and have the cost of all this complex treatment offset by 50%. Now? One root canal treatment and you're done with benefits for the year.
Done.
No funds left for that one crown; that's all on you.

When does it all become absurd? Very, very soon, at current rates of inflation.

The other unbelievable thing going on here is that dental "insurance" companies, which operate as 501c non-profit entities, haven't raised payment rates in my region since 2014 with few exceptions, and several of them categorically refuse to ever do so going forward. But of course, they raise the premiums they charge to the employers who purchase their plans, year after relentless year.

This profit-mongering policy cruelly and blatantly ignores increases in dental staff salaries, ignores inflation generally, and ignores the cost of highly beneficial new dental technology. In essence, dental "insurance" companies are paying for extinct dental treatments on the basis of fees appropriate for the 1990s, if not the 1980s.

And so. For those of you who do not have dental "insurance":

You do not need it.

It's a big yearly coupon at best.

When it comes to the objection of  "I can't afford it":

First, you need to find out what "it" is. You need, and as a human being you deserve, your diagnosis. 

And then you would be wise to recognize that if you don't have dental "insurance," all that you're lacking is a yearly coupon. A big coupon, yes, but not a game-changer coupon.

In closing, it's best to be clear-eyed about the purely financial advantages of early treatment.
Let's say that for a given diagnosis, the cost of treatment is $X.
Waiting for a few years lets the destruction from cavities or periodontitis grow, until the cost becomes, say, 11 x $X.
Wait a few years longer, and if in the end you decide to do ideal treatment, something beyond extractions and dentures, or extractions and just have no teeth at all, the cost might become something like 53 x $X.

Do you want to pay $X?
Or 11 x $X?
Or 53 x $X?

"I can't afford to go to the dentist" is always the least true right now at this present moment, because it becomes more and more true the more time that passes.

Dental "Insurance" is Rapidly Becoming Irrelevant

There are several broad categories of people when it comes to dentistry. Three concern us for this discussion.

The first is those folks who visit their dentist regularly.
These folks benefit from early detection and treatment of:
-Oral Cancer
-Periodontal Disease
-Cavities (Caries) and all their damaging effects on teeth and smile.

We need to understand these three conditions with great clarity.
All three--Oral Cancer, Periodontitis and Caries--never stay the same. They never get better on their own. They only worsen, at various rates.
Also, not only is Oral Cancer a terrible, disfiguring and at times deadly disease. Periodontal Disease is a systemic disease. The pathogens that set up shop under the gums enter the entire human circulatory system with every heartbeat. Periodontitis is now known to be a major risk factor for all forms of heart disease, a condition that increases risk of various cancers, and a chronic disease that shortens lives. And of course unchecked Caries, through the damage it does to teeth, can wreck chewing function and disfigure smiles and facial dimensions if given enough time.

We can assert with great confidence that seeing one's dentist every 6 months (more often, with Periodontitis) enables prevention and early treatment efforts that are highly successful in managing all three of these conditions.

Another category of patients--and this one is a tremendous challenge for our American culture--is that group of people who truly cannot afford dental care. Many, many colleagues and I perform pro bono treatment periodically, yet this is not sufficient to solve this major societal problem. I'm not sure what is, but it concerns me greatly as well as breaks my heart that in a nation with as much wealth moving through the culture as America, so many cannot afford the pathway to oral health. 

But then again, our infrastructure is crumbling and schools don't have enough money, so ...

There is a third category of people which is also of concern, and I reckon this is the largest category by far, at this present moment in time.

This is the category of people who say to themselves,

"I should go to the dentist, but I can't, because I don't have dental insurance."

I am writing this post to assert that this is not true.

Dental "insurance" is rapidly becoming a cruel joke, impressed upon our culture by profit-hoarding 501c non-profit dental insurance corporations.

I could expound on this assertion with many, many words; instead, I shall limit the discussion to two key issues.

The first is: Yearly Maximums.

In 1967, when dental insurance first became a force in America, the most common yearly maximum was $1,000. (There were generally no payroll deductions; this was a perk!)
Fast forward to today, 2024, and over 95% of the dental insurance plans our patients have hold a yearly maximum of ... $1,000! (And they now have payroll deductions for the dubious privilege.)

Well, people, we need to use an inflation calculator here to understand any of this.

$1,000 is 1967 is worth approximately $9,300 as I write, in January 2024.

Thus, employees with dental insurance today are receiving less then 1/9th the value that their 1967 predecessors did, and losing payroll deductions as well.

One point of clarification. The yearly maximum is more a decision on the part of the employer, not the dental insurance company. One can design any sort of plan one wants. It's probably just that with medical insurance costs also rising so fast, employers are hesitant to increase premium costs on the dental side of things. (Although the premium difference between $1,000, $2,000 or even $5,000 is very small.)

So, back in the Swingin' Sixties, one could undergo a major oral rehabilitation of one arch of teeth one year, and the other arch the next, and enjoy some half of the cost being offset by this at the time novel concept of paying for care.

Back in the Nineties, a patient could have two root canal treatments performed and two crowns created, and have the whole enterprise offset by roughly half.

Now, in 2024? If root canal treatment is necessary and a crown is deemed the best restoration for the tooth, the patient has maxed out their dental insurance before the crown even enters the picture, assuming they also present for their preventive recalls twice a year and so on.

The other striking issue is--see my recent posts for details--if we examine the fees that dental insurance companies currently pay participating providers, and we use inflation calculations to determine when this would be an appropriate fee considering the dentist and staff skill and expertise, labor costs, laboratory costs, current technology costs and so forth, we end up with the stunning realization that these fees would be appropriate for the years 1985 to 1996, depending on the breaks. 

This is in my geographical location, anyway.

And yet in Pennsylvania, and probably in every other state, dental insurance companies have been collecting, as 501c non-profit enterprises, increasing premiums every year from Pennsylvania employers ever since that time.

If they haven't raised their fee schedules in years, yet they've collected greater premiums from employers every year since 1967--where is all that money going? A question for the Pennsylvania House of Representatives and the Insurance Committee, surely.

Here's my point, which I hope reaches at least some of the folks who believe they cannot visit a dentist because they don't have dental insurance:

You don't need dental insurance.
It's a cruel joke now. It's dang near useless, and edging closer to absolutely useless with every passing year, due to inflation and also the fact that it doesn't pay for half of the superb treatments that new science and technology have enabled us to perform.

Mercy, mercy--many plans downgrade composite resin restorations to dental amalgams, and don't cover porcelain onlays ever. Dental amalgam was invented in 1833. From U.S. coin shavings mixed with mercury. And that's what many plans pay for, to restore back teeth.

Pennsylvania employers, do you feel like you're getting your premium dollars' worth yet?

We haven't even mentioned the constant stream of payment denials, for spurious and contrived reasons that have nothing to do with reality.

To the "uninsured" I would say: Almost every non-corporate dental practice in this nation will work with you to figure out ways to afford care.

And remember the most important point of all:

Oral Cancer, Periodontitis and Caries never stay the same. They never get better on their won. They only worsen over time.

The first is extremely dangerous, even deadly. The other two, also dangerous and always, always less expensive and less difficult to treat the earlier we have a diagnosis.

 

Participating Provider Fees Are Appropriate for the Late Eighties!

Since the analysis is so profoundly disturbing, I thought I'd post a brief recap version of yesterday's post on how dental insurance participating provider fees have not kept pace with inflation, labor costs, new technology and also the yearly increases in premiums to Pennsylvania employers that 501c dental insurance corporations collect.

The question is:
How far would one have to go back in time until the current contracted fee for a participating provider would equal the 2024 National Dental Advisory Service survey of fees, at the 80th percentile? I took the current fees and adjusted them backwards for inflation.

I'll give the answers for four procedures for several dental insurance companies operating as 501c non-profit corporations in Pennsylvania.

Professional Dental Prophylaxis:

Cigna:        1988
Delta:         1988
Aetna:        1996
Guardian:   1990
Principal:    1990
United Concordia:    1995

Porcelain Fused to Precious Metal Crown:

Cigna:        1989
Delta:         1995
Aetna:        1996
Guardian:   1990
Principal:    1990
United Concordia:    1995

Molar Endodontic Therapy:

Cigna:         1990
Delta:          1994
Aetna:          1999
Guardian:      1993
Principal:       1991
United Concordia:    1995

Non-Surgical Periodontal Treatment:

Cigna:            1985
Delta:             1991
Aetna:            1994
Guardian:        1991
Principal:        1991
United Concordia:    1996

Cigna takes the grand prize with non-surgical periodontal treatment being paid for at a participating fee that would be acceptable in 1985. That's back when a gallon of gas was 83 cents and a gallon of milk was $1.89.

I suppose a gallon of corporate malfeasance is always priceless.

I have brought these matters to the attention to the Pennsylvania House of Representatives. On behalf of the public and also the employers who in good faith purchase dental insurance plans in Pennsylvania, I request that the House Insurance Committee look into dental insurance companies’ financial practices as 501c entities, and also to give great consideration to crafting a 2024 Ballot Question similar to Ballot Question 2 in Massachusetts in 2022, which stipulates a Medical Loss Ratio of 83% for dental insurance companies operating in the Commonwealth. 

Dental Insurance: Participating Provider Fees Versus US Inflation

Certain dental insurance companies offer extremely low fee schedules to participating practices, fees which are not anywhere close to adequate to pay for dentistry in 2024. There are many reasons to make this assertion. They include but are not limited to: infection control costs, staff labor costs, laboratory costs, materials costs, costs of new technology that improves patient care and costs of maintaining and upgrading a practice facility.

In my geographic area, Delta Dental has not raised Premier Provider participating fees since 2014 and absolutely refuses to do so going forward. Cigna Dental has followed a similar pattern. However, Pennsylvania state insurance audits reveal that these 501c non-profit corporations have raised premiums to the Pennsylvania employers that purchase their insurance products, each and every year going back to the 1960s.

In light of participating provider fee schedules not increasing with inflation in our economy, nor with increasing premiums collected, I wanted to explore this simple question:
In what year, going back in time and accounting for inflation, would the current Delta and Cigna participating fees equal an 80th percentile fee-for-service practice fee, not influenced by dental insurance?

To do this, I chose four dental procedures. A routine prophylaxis, a porcelain fused to precious metal crown, an endodontic (root canal) treatment on a molar tooth, and scaling & root planing, the gold standard of non-surgical periodontal therapy.

The current fees I cite are all 80th percentile, and are cited from the 2024 National Dental Advisory Service, the NDAS.
All 2024 fees quoted here are based upon the 2024 report.
I chose the 80th percentile as a reasonable comparison point; this excludes practices that may have extremely high fees for reasons such as high-end, bespoke ceramists or boutique spa services and so on. The 80th percentile also excludes dental chains and the highest volume, lowest fee corporate dentistry.
All fees are considered to be dated January 1, 2024, so that no 2024 inflation has occurred yet.

The participating insurance fees for Delta Dental and Cigna Dental are taken from their fee schedules for Southeastern Pennsylvania. The Delta fees are for participating as a Premier Provider. Which, it strikes me, is a rather cruel double entendre, but ah well.

And away we go:

80th percentile prophylaxis: $138
2024 Delta participating fee: $54
$138 in 2024 equates to $54 in 1988.

80th percentile PFM crown: $1,591
2024 Delta participating fee: $800
$1,591 in 2024 equates to $647 in 1995.

80th percentile molar endodontic therapy: $1,548
2024 Delta participating fee: $760
$1,548 in 2024 equates to $664 in 1994.

80th percentile scaling & root planing: $368
2024 Delta participating fee: $165
$368 in 2024 equates to $165 in 1991.

 

80th percentile prophylaxis: $138
2024 Cigna participating fee: $54
$138 in 2024 equates to $54 in 1988.

80th percentile PFM crown: $1,591
2024 Cigna participating fee: $665
$1,591 in 2024 equates to $647 in 1989.

80th percentile molar endodontic therapy: $1,548
2024 Cigna participating fee: $667
$1,548 in 2024 equates to $664 in 1990.

80th percentile scaling & root planing: $368
2024 Cigna participating fee: $130
$368 in 2024 equates to $130 in 1985.

 

So there we have it.
My sampling of current, 2024 80th percentile national fees are equivalent to what Delta and Cigna pay on their participating provider scale—if we were currently living in 1985 to 1995.

And yet they’ve been collecting, as 501c non-profit enterprises, increasing premiums every year from Pennsylvania employers ever since that time.

Does this sound to you like they’re treating Pennsylvania employers, employees/patients, dentists and dental office personnel with financial fairness?

I, for one, have stopped participating status, and have brought these ethical concerns to the Insurance Committee in the Pennsylvania House of Representatives.

Cigna--the generous 501c.

 

This is the Penn Dental Journal from March, 1933. 
At the absolute depth of the Great Depression.

A Robert Edmond, LDS wrote an article for this issue, “Dental Benefit under the National Health Insurance of Great Britain.”
In the article, he stated that “the present scale is inadequate from the dentist’s point of view.”

One example:
The fee allowance for a denture in 1933 was 5 pounds 15 shillings, which was $29 US dollars at that time.
If we use an inflation calculator, $29 in 1933 is worth $679 in 2023.
The Cigna fee schedule just presented to me for 2024, as a participating provider, is  catastrophically, breathtakingly low. 
I decided to use a denture fee as a means of comparison, as a full denture is one of the very few dental procedures that has, in its essence, remained the same for over a hundred years, even with all our technological changes.

Well.
The 2024 Cigna participating practice denture fee is ... wait for it ...
$675.

Way to go, Cigna! Your 2024 denture fee is actually under the inadequate National Health Service fee for a denture in Great Britain at the absolute depth of the Great Depression, when adjusted for inflation.

Naturally I have made the decision to change to non-participating status with Cigna, as I have done with Delta for the same reason.

I have a question though.
These 501c non-profit dental "insurance" companies increase their premiums to Pennsylvania employers every year, year after year, relentlessly, without end.
And yet--they don't increase their payment rates to dentists for literally decades on end.

Where then, Cigna the 501c tax-exempt non-profit, do your continually increasing premium revenues go?

I have now brought this fascinating issue to the Insurance Committee in the Pennsylvania House.

The Disservice and Injustice Wrought by Dental Insurance

Dental insurance companies are causing significant harm to the oral health of Americans through several mechanisms.

The first problem is that dental “insurance” is no longer insurance; it’s a yearly coupon.

The reason? Shrinking yearly maximums.

When dental insurance started on a large scale in the US in 1967, the most common yearly maximum was $1,000, and there were generally no payroll deductions. It was a perk.

Now, in 2023, 95%+ of the dental insurance plans we see patients carry are set at a $1,000 per year maximum.

We must use an inflation calculator in order to make sense of this. $1,000 in 1967 is $8,800 today!

Thus, patients today are getting 1/9 the value of their 1967-era predecessors, and are paying monthly payroll deductions for the privilege.

The second major problem for patients and their employers (who deserve to enjoy a workforce not rendered ill or unproductive by avoidable dental disease) is Denial. Deny, deny, deny; dental insurance companies positively revel in not making payments. And when they can’t deny something, their next go-to strategy is Delay. Delay payment to dentist or patient as long as possible.

Dental insurance companies are corporations, and corporations generally thrive on what economists call Negative Externalities—when the production or consumption of a product results in a cost to a third party—a cost to you and me. Air and noise pollution are iconic examples.

The unjust thing here is, the employer paid for this insurance product, the employee/patient also likely paid via payroll deductions, and far too often, they are cheated out of a benefit that they purchased in good faith.

A third problem with  dental insurance companies—one that is downright holding back advances in patient care in the U.S.—is that they don’t raise their payment rates at anything close to the rate of inflation. As an example, Delta Dental’s last fee increase in our region was in 2014, and they absolutely refuse to raise rates at any time in the foreseeable future. Dentists who participate in such plans—who accept their fee schedules—not only cannot afford new technology at these rates. We are now approaching and in many cases passing a “coffin corner” where the cost of providing services is greater than Delta’s payment rates. Participating in such plans means running at a loss, and eventual bankruptcy.

In the interest of brevity, we’ll just mention one other maddening fact about dental insurance companies. That is, they are all 501c non-profit corporations. And yet, they amass tens of millions of dollars in profits every year. How is this fair to employer, employee, patient and dentist?

It is time for dental insurance reform. An excellent first step is the passage in Massachusetts of 2022 Ballot Question 2, which mandates that dental insurance companies operating in the state of Massachusetts apply at least 83% of their premiums collected to patient care.

As a culture, we must start recognizing that dental “insurance” is but a yearly coupon, because of how much less dentistry it covers than it did in years past. And those without dental insurance must be educated and informed that there are other ways to afford care.

The three primary threats to human health in dentistry’s wheelhouse are periodontal disease, cavities and oral cancer. The hard truth is that none of these three diseases ever get better on their own, and they don’t even ever stay the same. They only worsen over time. Relentlessly. It is best for human health, and also always less expensive, to diagnose and treat these diseases early, before infection sets in or worse.

I want to educate folks that dental “insurance” is not insurance at all, but a yearly coupon. There’s a vast portion of the population who does not have dental insurance, and gets the notion in their head that “I can’t go to the dentist because I don’t have insurance.” I want to break down that dangerous myth before yet more harm is done.

Disinformation

As the Covid-19 pandemic enters its third year, and as our culture sustains damage from the illness and death caused by the Covid-19 virus, from supply chain disruptions, from widespread chronic anxiety, from disruptive political forces and from a myriad of other causes, one harmful force stands out to me above all others:

Disinformation.

When I grew up, there were relatively few sources of public information, and they all were controlled by powerful gatekeepers. If one wanted to publish a letter to the editor, or a novel, or air a commercial, or get an original piece of music on the air—one had to ask a gatekeeper for permission first. And denials were far more common than permission.

This system had serious flaws, obviously. A great deal of human expression was held back or suppressed.

When the Internet—the greatest connection machine we’ve ever known—came along, a revolution in information flow occurred. This was the first communications medium in human history in which everyone who has a receiver—has a transmitter too. Now, we don't have to ask a gatekeeper in order to say something in public. We can write a blog post, share our music with the world, self-publish a novel or start a podcast, and we don’t have to ask anyone’s permission to do so.

A decade ago, I was extremely optimistic about this. So much so that the ending of my first (self-published) novel, The Man Who Wore Mismatched Socks, points to this great freedom as the beginning of a glorious historical period in the life of humanity.

Unfortunately, I underestimated the dark side of human nature. Every tool we create, it seems, can be used for good or evil. And so now, disinformation, fearmongering and angermongering are a significant part of what is damaging our culture and disrupting our lives. There are people who spread disinformation because they can, and presumably because to do so is breathtakingly profitable.

Nowadays, I kind of miss Walter Cronkite.

Naturally, I’m not brimming with a solution to the vexing and harmful problem of disinformation. To paraphrase the iconic line by Dr. Leonard McCoy, “I’m a dentist, not a …” Well, who would it take to solve this, anyway? I’m not even sure. But I do want to share with you all a key insight that we need if we are going to, together, work our way out of this awful and dangerous mess.

Mary Parker Follett was an American social worker, management consultant, philosopher and pioneer in the fields of organizational theory and organizational behavior. She has been called the “Mother of Modern Management.” Ms. Follett passed away in 1933, so she performed her remarkable work a very long time ago. I have a great penchant for outliers, and for a woman in the 1910s and 1920s to be listened to, and respected, and her ideas acted upon by the male-dominated world of American business of her time was beyond remarkable. I’ve read her work and I can see why. Her unique brilliance was that she focused on the human element of business, and she regarded human beings as the most important component of any business enterprise.

Ms. Follett once told a little parable that is so relevant just now. I’ll present her parable here, in hopes that you gain insight and agency from her words.

“We need experts, we need accurate information, but the object is not to do away with difference but to do away with muddle. When for lack of facts you and I are responding to a different situation—you to the situation as you imagine it, I to the situation as I imagine, it—we cannot of course come to agreement. What accurate information does is to clear the ground for genuine difference and therefore make possible, I do not say make sure, agreement. The object of accurate information is not to overcome difference but to give legitimate play to difference.

“If I think I am looking at a black snake and you think it is a fallen branch, our talk will be merely chaotic. But after we have decided that it is a snake, we do not then automatically agree what to do with it. You and I may respond quite differently to ‘black snake’: shall we run away, or kill it, or take it home and make a pet of it to kill the mice? There is now some basis for significant difference.

“Difference based on inaccuracy is meaningless. We have not done away with difference, but we have provided the possibility for fruitful difference.”

Difference based on inaccuracy is meaningless. Indeed! Going forward, we all need to work together in order to re-establish a common cultural agreement on what Truth is. And we certainly need to be on guard against those who attempt to manipulate us with disinformation. Being on guard is critically important to protecting yourself and your family.

Stay safe and do good,

Rick Wilson DMD

Covid-19 Worldwide Numbers, Mass and Volume

I've wondered for a long time how many copies of the Covid-19 RNA there are in the world at any given time. Now, we have some good estimates.

Each infected person carries 10⁹ to 10¹¹ Covid-19 virions at peak of infection.

Assuming during most of the course of the pandemic there has been a total of 1–10 million infected people close to peak infection globally at any given time, including those undetected, we arrive at a total of 10¹⁷ to 10¹⁹ viral particles in the world at any given time.

Let's split the difference at 10¹⁸.That's 1,000,000,000,000,000,000 if we write it out longhand. One quintillion, if we use the accepted math word. To give some idea of how large a number a quintillion is: It's about fifteen quintillion miles from our galaxy, the Milky Way, to the Andromeda Galaxy.

A quintillion is a stupid-big number, for sure.

Each Covid-19 virion has a mass of ≈1 femtogram. Therefore even when the human body carries 10⁹ to 10¹¹ viral particles, these have a mass of only about 1–100 μg. When we consider the total number of infected people at any given time, the total mass of Covid-19 virions residing in humanity at that given time is on the order of 0.1–10 kg.

As for volume? All the Covid-19 virions in the world would likely fit inside a can of soda.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685332/

https://phys.org/news/2021-06-global-weight-sars-cov-viruses-kilograms.html

https://theconversation.com/all-the-coronavirus-in-the-world-could-fit-inside-a-coke-can-with-plenty-of-room-to-spare-154226

Leverage Perspective

The total weights of the atomic bombs employed in WWII were 64kg uranium + 6kg plutonium = 70kg, which killed 226,000 human beings in Hiroshima and Nagasaki. (This figure does not include long-term early deaths from radiation poisoning, which are much more difficult to calculate.)

The total estimated weight of all the Covid-19 virions in the world at any given time is 0.1kg-10kg. Let us use the high end estimate. We know that 10kg of Covid-19 virions has, so far, killed some 4,500,000 human beings worldwide.

This gives us a leverage perspective:

Each kilogram of Covid-199 virus kills 450,000 people at current conditions.
Each kilogram of fissile material killed 3,229 people, in the only example we know ... to date.

Covid-19 is thus approximately 140 times more effective, per weight of material, at killing human beings than are atomic bombs.

Memorial Day Practice Update

I hope all of our family of patients are well, as vaccines and natural immunity create positive change in the Covid-19 pandemic that has upended our lives in such profound ways for over a year now. Winston Churchill's words from November 10, 1942 come to mind: "Now, this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."

It is now with a fair measure of sadness that I must announce that our Dr. Dena Feinberg has left our practice, to take a position at the Wilmington Veterans Administration Hospital.

Dr. Feinberg completed her residency at the Lebanon V.A., after graduating from Temple University of Dentistry. When her former mentors reached out to her about opportunities in the V.A. system, she felt the call. On this Memorial Day weekend, one can do no better than to reflect upon the excellence of such service, and upon the professional fulfillment to be found in the service of our nation's veterans.

My Dad served in World War II, in the U.S. Army. He was first in Mourmelon-le-Grand, France, a small town near Rheims. Later in the conflict, he served in an army hospital in Marseilles. I always imagined this looking rather like the medical compound in the T.V. show M.A.S.H., but the scale of WWII was always immense. I've seen his photos of the hospital he worked in--it was most of the city of Marseilles at the time.

Dad, not a medical person, didn't say much about his service there but he did state several times to me that the most upsetting wounds he witnessed were the burns that tank crews sometimes suffered.

My Dad passed away on Memorial Day weekend of 2017. He had developed aspirational pneumonia, a failure of the muscles of the esophagus that is, unfortunately, untreatable by modern medical science. During my many visits to him during this difficult time, I came to understand that the story of his voyage across the North Atlantic in November of 1944 had a far more profound effect upon him than I had realized earlier in my life. You see, his convoy was attacked by German U-boats. Torpedo tracks streamed through the water at 30 knots. The Liberty ships carrying thousands of American troops (there's one preserved in Baltimore's Inner Harbor) were only capable of 11 knots, and zig-zagged frantically in evasive action. And in my Dad's evocative turn of phrase, "Our escorting destroyers were launching depth charges off their fantails, one after another after another."

This all certainly sounds scary. And yet, until my Dad was at this end-of-life phase, I never realized just how deeply the memory of this U-Boat attack had affected him, his whole life long. That 24-year-old boy of yesteryear was absolutely, abjectly terrified of drowning in the icy waters of the North Atlantic because of a U-boat's torpedo impacting the thin steel hull of his Liberty ship.

The fact that I'm here writing to you all is sufficient proof that this particular tragedy did not happen. But there's so much more ...

When I was a kid, my Dad bought a Sunfish, a small fiberglass sailboat, which I still have. And then, bitten by the sailing bug, he built a GP14 from a kit, a magnificent jib-and-mainsail dinghy made of mahogany, teak and spruce. Our boat was the most beautiful thing I'd ever seen, growing up. And once built, we sailed our GP14 together all over the northern Chesapeake and Little Egg Harbor at Long Beach Island. On the fresh and salty waters of home, we shared the best father-son experiences a lad could ever hope for.

What never occurred to me until 2017 was this: Here was a man who was haunted his entire adult life by a dark terror in the frigid waters of the North Atlantic that had almost ended his life in November 1944. And yet, he took to sailing like a natural; my Dad (a superb jazz drummer) was as comfortable and confident on the open water as he was at his drum set or in his easy chair, listening to his beloved Big Bands like Count Basie and Harry James and Ted Heath.

What strikes me most about all this is: every veteran I've ever met has a similar story of a severe wartime trauma, and then a quietly inspiring story of overcoming that trauma in civilian life in some way or other.

Each of us has faced something terrible in the course of our lives; perhaps more than one something terrible. To me, the lesson here is that the human spirit can overcome incredible challenges and just ... keep pressing on. My hope is that my Dad's efforts to overcome will serve as a gentle reminder to you all that you are incredibly strong, and can push through this pandemic and whatever other challenges you may face in the course of your lives.

Godspeed, Dr. Dena Feinberg, and thank you for serving our veterans.

Rick Wilson, DMD