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Natural Selection 2011: Darwin Meets Wall Street

2011-10-23T18:02:13Z

Kenneth M. Schweitzer, DDS

Headline News - Darwin Files an IPO

“That’s incredible news,” I happily remarked when my neighbor Serge* told me the eight inch malignant tumor removed from his colon had no nodal involvement. The cancer, originally thought to be stage III, had been reduced to stage I and required no chemotherapy or radiation. He said the medical team was so amazed and mystified the neoplasm hadn’t spread they insisted he follow up for more testing, so possibly, they could identify the genetic marker that saved his life. Serge was complying but not before contacting his lawyer to inquire about protecting the "rights" to his own genetic superiority.

He’d better hurry up because a study in 2005 found approximately 20% of the 20,000-25,000 genes that make up our body are “owned” by biotech companies. “According to the American Civil Liberties Union, the U.S. Patent and Trademark Office grants patents on human genes, which means patent holders own the exclusive rights to those genetic sequences, their usage, and their chemical composition. Anyone who makes or uses a patented gene without permission of the patent holder is committing infringements and can be sued.” Reminiscing, I’m reminded of the race to capture domain names before the internet exploded.

Those genes are worth a lot of money. Genetic testing alone can cost thousands of dollars and one well known company, Myriad Genetics, has a market cap of 1.7 billion dollars.

Another genetic testing startup, 23andMe, founded by Anne Wojcikki, wife of Google co-founder Serge Brin, has a slightly different business model. Utilizing a combination of search and consumer driven research 23andMe recently discovered a gene that could reduce the risk of Parkinson’s disease. Wojcikki is banking on empowering the consumer to solve complex genetic disorders in shorter time periods than big pharma does because pharmaceuticals hoard their research for competitive advantage.

The merging of technology and medicine is only beginning to shift out of first gear. Perhaps the brightest economic stimulus for the foreseeable future lies in the forecast for continued synergy between healthcare and technology. The downside? Just look at the obstacles Darwin faced toppling the walls of demagoguery, politics and religion. Legal, ethical and privacy issues cannot be disregarded . But could it be different now? With the added incentive of Wall Street, genetic patents and the understanding that early disease prevention leads to better quality of life these obstacles may be resolved faster.

Just for fun, tickle your imagination by combining Anne Wojcikki’s and Charles Darwin’s DNA

+ . =

*Serge: Real character, fictitious name.

You are what you Eat? Ingestion vs. Absorption

2011-06-26T00:59:27Z

Kenneth M. Schweitzer, DDS

For the umpteenth time “nothing else matters without your health.”

When it comes to health and diet I can still hear my mother barking “you are what you eat, you are what you eat.” Organic foods, whole grains, lean meat, low fat, low carb, low calorie, high fiber, leafy green vegetables, fish, one a day vitamins....can it be really that simple? Doesn’t it all boil down to eating a nutritious diet? Yes, but simply stated it isn’t as simple as it seems.

Help!!!

The science of nutrition is, in part, a combination of biochemistry, physics, mathematics, physiology and pathology. Learning the fundamentals of just one of these sciences can require a lifelong commitment to reading, researching and learning. Trying to amalgamate these sciences and formulate recommendations for optimal nutritional intake based on evidence based research is as risky as munching on a greasy fat burger with extra salty french fries one week prior to quadruple bypass surgery.

Nonetheless, the public is relentlessly inundated with healthy food marketing from low fat dairy products to high energy nutritional grain products. The list is endless, and as nutritionally conscientious as many of us are, we are no more in control of the manipulated scientific data as cattle are awaiting their slaughter.

What science does know is improper dietary consumption causes many diseases. For example, excessive caloric consumption can lead to diabetes, vascular and heart disease and ingestion of certain food substances leads to greater risk of cancer (e.g. higher fat intake associated with higher incidence of colon cancer.) We also know that our bodies use ingested micro nutrients, vitamins, carbohydrates, proteins and fats to nourish, protect and build our organs, epithelial, musculoskeletal, immune, neurological and vascular systems. Millions upon millions of scientific articles have been published establishing cause and effect relationships between a seemingly infinite number of dietary variables. This data helps many of us organize our food preferences and dietary habits presumably enabling us to lead healthier lives. On the other hand, the data also allows product marketeers to make uncorroborated assumptions about the beneficial health effects of their product’s nutritional composition.

An unassuming public understands far less about how an individuals genetic makeup, environmental conditioning and the chemical interaction between food groups affects the absorption of ingested nutrients. Whereas humans require essential nutrients to ensure proper metabolic function, the cellular uptake and enzymatic transport of these nutrients is quite variable amongst individuals. For example, metabolic disorders like acid-base imbalance, lactose intolerance and coeliac disease, to name a few, affect the uptake and transport of nutrients in our digestive tract. Additionally, combining certain foods with medications can lead to complete neutralization of the medication.

Another example of malabsorption that is somewhat counter intuitive is literature studying zinc deficiencies of children in third world countries. It has been shown that dietary zinc fortification does not increase plasma levels of zinc. Zinc deficiency has been seen in developing countries in which grain-based vegetable protein is consumed more often than animal protein. “The reasons for the observed differences in plasma zinc response after zinc supplementation and zinc fortification are unclear, but may be due to the lower efficiency of zinc absorption that occurs when zinc is delivered with food, the level of fortification that was used or the duration of the intervention, the chemical form of the zinc fortificants, or interference with zinc absorption by other micronutrients.”

What is clear is an individual’s absorptive capabilities are quite unique and influenced by a wide variety of factors. So whereas products touted for their nutritional excellence are recommended in specific portions, amounts or doses, their absorption cannot be predictably quantified without precise medical testing. In short, 100 mg of vitamin C may be 100 mg entering your mouth but depending on genetics, overall health and environmental conditions it may be anywhere from 0 to less than 100 mg absorbed into your cells.

What’s an educated consumer to do? Until body scans are optimized to identify an individuals absorptive makeup we all need to diet with moderation, know our own body chemistry, avoid expensive nutritional products that claim unique health attributes, minimize processed foods and above all use common sense when selecting food sources.

Mom, eating all those carrots made my skin turn orange so maybe you were right about “you are what you eat,” but there just might be more to it than meets the eye.

Green Dentistry: New York City Style

2011-03-27T18:52:00Z

Kenneth M. Schweitzer, DDS

Companies throughout the nation are embracing eco-friendly business practices partly motivated by altruism but also by just plain good business sense. Failing to recognize the advantages of adopting a green and sustainable business philosophy today is akin to being a late entry into the computer revolution of the 1980's. Not only do customers respect businesses that practice eco-friendly strategies but government has incentivized eco-conscientious firms to initiate programs. Green and sustainable are no longer the once maligned terms of the turn of the century. They are mainstream, cutting edge, avant-garde and pathways to growth and profit to say the least.

Dentistry is part of the movement but how can urban dental practices surf this wave when so many of the "sustainable" and "green" decisions are pre-determined and controlled by office building landlords?

Aside from the obvious benefits a rural enterprise can take advantage of (photvoltaics [solar], insulation, recycling water) that an urban renter/lessee cannot control, there are still many ways dental practices in urban office settings can green stamp their business. The first and foremost is for the business to communicate with all staff members its goal of devising a green and sustainable office policy and designing protocols to achieve the goal.

Once the team is on board, whether it be by incentives or admiration of the program, the task of implementation is much easier. Categories may include Low Energy Consumption, Reduced Utilization of Toxic Chemicals, Paperless Conversion, Recycling, Sustainable and Recycled Furniture, Waste Reduction, Innovation, Leadership and Community Interaction. The practice may elect to join the ECO Dentistry Association and become certified in the GreenDoc Program.

An efficient and organized eco-friendly dental practice will be able to address many of the concerns of a increasingly more informed and environmentally knowledgeable client base. Questions the doctors and staff should be acquainted with include:

QUESTIONS TO ASK YOUR DENTIST

1. Are you a member of the Eco-Dentistry Association? Is your practice EDA Certified?

2. Do you offer digital x-rays?

3. Are you a paperless office or do you use paper billing and paper patient charting?

4. Do you use disposable or reusable cloth patient bibs?

5. Do you use disposable paper cups, paper lab coats, or plastic chair barriers?

6. How do you dispose of mercury-containing silver fillings?

7. Do you have an amalgam separator installed?

8. Do you have a recycling program in your office?

9. Do you use steam sterilization methods instead of chemical sterilization?

10. Do you offer salivary diagnostics?

Dr. Schweitzer practices as a Prosthodontist in New York City and teaches Prosthodontics at Montefiore Medical Center/Bronx,NY

Eliminate Multi-tasking

2010-12-27T17:23:00Z

DOCTORMUSE is categorically a uni-task master.

Remember the days when you were praised for managing phone calls with one ear while simultaneously sending emails? Brain efficiency was judged proportional to how many concurrent tasks could be accomplished. Everybody tried to compete for the coveted multi-tasking efficiency office award and winners were assured raises and promotions. What happened to that turn of the century mantra? Now it's 2010 and where did all the multi-tasking professionals go? What many considered a "new paradigm" of the digital age quickly went up in smoke with the realization that gadgets are great for multi-tasking but people's minds are not. Some people earned a one way ticket to the funny farm while others ended up in federal prisons. Laws were created preventing people from multi-tasking like the cell phone use while driving law and soon we can expect a similar texting while driving law to pass thru congress. In 2009, Stamford University Communication professor Clifford Nass published an article in the Proceedings of the National Academy of Sciences on Communication Between Humans and Interactive Media Lab. The study showed heavy media multitaskers are paying a big mental price for their actions. "They are suckers for irrelevancy and everything distracts them."

A more recent study conducted by Etienne Koechlin, director of the cognitive neuroscience laboratory at the French National Institute for Health and Medical Research (Inserm) in Paris found that although humans have difficulty switching between tasks and cannot seem to do more than one thing at a time, the brain can simultaneously keep track of two separate goals and "can distribute two goals to different hemispheres to keep them both in mind--if it perceives a worthy reward for doing so." It suggests we're not as bad at multi-tasking as some studies suggest but there are still increased dual-task consequences.

The moral of the story; multi-tasking is mostly a myth that even the most efficient brainiacs can't handle, and with vehicular manslaughter convictions for texting/driving related accidents on the rise the consequences are much more severe than those for pushing emails to unintended recipients. Stick to doing one thing at a time and doing it the right way. You'll reach your goal a little more slowly but you'll get there predictably and with better results.

Health Care Reform - Raging Battle Within the Middle Class

2009-09-05T04:02:00Z

If only it were as easy as heads or tails, black and white or yes and no. This week Facebook subscribers inundated their walls with the statement “No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree, please post this as your status for the rest of the day.”

Sounds great to me, noble, humane and magnanimous. I stopped short of posting it when a trickle of doubt seeped to the fingertips controlling the keyboard of my computer. Within minutes I was glad not to have posted it, my doubt blossoming into a full-fledged disdain and remorse for those supporting such a measure without adequately understanding its consequences.

Putting my head on the guillotine, I’ll matter of fact say the statement is a meaningless hype for political reform, ill conceived, callous and subversive in its message. The fact is no one dies because they can’t afford health care, they only "sort of "die. And no one goes broke because they’re sick they only "sort of" go broke.

I’ll even go so far as to say many people die because they can afford health care, paying for unnecessary medical procedures that go awry that lead to premature death.

On the surface equal access to health care is a subject we think of as being a right more than a privilege. As noble as the thought may be the right to equal access health care is so intertwined with every aspect of our lives that unfortunately, putting it on such a pedestal will never work.

Health care reform is not a battle for the poor nor is it a problem for the rich. It is a middle class conundrum whose solution lies with regulating lifestyles and risks but not by increasing income tax. Poor people will always have access to health care. In times of dire need they can and will show up at emergency rooms across our nation and never be denied treatment. This is an undeniable fact. Wealthy people find ways to access the best medical treatment and procedures technology can offer. Steve Jobs is living proof.

The Health Care Debate Lies Within The Middle Class

For those of us still working we feel blessed having an employer supplying health insurance even though the future of company supplied health insurance lies in jeopardy. We all agree health care costs are running out of control, businesses can’t afford to offer blanket policies to their employees and still run profitable operations. Employees can’t afford to absorb the cost of the policies as they struggle to make ends meet without added insurance costs.

Who pays?

This is the same question we asked our government when unscrupulous bankers and lenders exercised poor judgment and unprecedented risk with our countries assets. The solution to our economic meltdown appears to have been absorbed by we the taxpayers with few consequences being realized by the institutions responsible for mismanaging risk. Why, because, the government had no choice. The damage had been done and forcing the banks and lenders to compensate for their poor decisions would destroy the banking industry, the heart and soul of the world’s economy. Changes may evolve in the future that identify and regulate risk in the financial system but this time around the taxpayers are footing the bill.

Health Care Reform Can And Should Be Different

Medical science has evolved to a point where hereditary diseases are well differentiated from environmentally induced pathology and lifestyle induced pathology. Insurance companies regulate premiums of policies based on actuarial statistics. They assess lifestyle and are able to quantify it by charging risk premiums. Universal health care should go one step further by instituting a “risk” consumption tax. Lifestyle risks can be correlated to nutritional intake of certain types of food groups and behavioral patterns. For example, if someone chooses to eat junk food they should be taxed a premium for that food or if someone chooses to drive a car fast they should be taxed a premium for violations and the proceeds can be used for universal health coverage.

Should a non-smoking 5’11” 170 lb middle class train conductor who exercises everyday and eats organic natural food products pay the same health care premium as his overweight, smoking and soft drink consuming colleague who has three speeding tickets on his driver’s license? Most would say no, and if health care premiums were linked to lifestyle consumption taxes a rewards system would be in place that would level the playing field for people with different risk profiles.

We live in a society where an increasing number of consumers are being supported by a decreasing number of producers. Rewarding a healthy lifestyle means paying less for universal health care. Taxing unhealthy lifestyles will ultimately force people to change the way they live and support technologies and industries that improve the quality of life.

The statement on Facebook should read "No one living a healthy lifestyle should die because they cannot afford health care, and no one living a healthy lifestyle should go broke because they get sick. If you agree, please post this as your status for the rest of the day."

Holistic Dentistry: Eliminate Toxic Marketing before Toxic Fillings.

2009-03-23T10:09:00Z

Holistic dentistry is raging hot, rapidly emerging and rivals in popularity with cosmetic dentistry. Generation X is living an age of environmental awareness, toxin free lifestyles, green planet initiatives and holistic, alternative or integrative medicine beliefs. What took the Chinese two thousand years to develop is finally being appreciated by Western civilization. Following this path is a logical progression for dentistry, developing less invasive treatment modalities, minimizing hazardous material exposure and incorporating more natural remedies into treatments. Why then, does the public majority still perceive holistic dentistry as granola dentistry, Coop dentistry and quackery?

Probably because “holistic dentistry” has its roots more anchored in marketing than scientific evidence. With a deluge of publicity surrounding the “green” movement, holistic practices have jumped on the bandwagon, aligning themselves with this concept hoping to achieve greater recognition. Just as organic food, cannibalized by large multinational food conglomerates, so too is holistic dentistry, commandeered by patient starved dental practices.

Definitions of holistic include:

1. Emphasizing the organic or functional relation between parts and the whole.

2. Relating to holism; relating to an analysis of the whole instead of separation into parts.

3. All encompassing view based on the knowledge of the nature, functions, and properties of the components, their interactions, and their relationship to the whole.

The proponents of holistic medicine and dentistry should be mortified. Outstanding efforts to legitimize Integrative Medicine by utilizing evidence based scientific methodology are being undermined by savvy marketers, riding the coattails of a new paradigm in medicine. Punching an Internet search of holistic dentistry yields hundreds of links to “holistic dentists” throughout the country. Once into their website you are lured by all the buzz words such as “mercury free”, “nutritional based”, “biofeedback”, “TMJ” and “metal free restorations” to name a few. Conspicuously absent from web content is any link to evidence based literature published in refereed journals. What can be found are bulleted postings of “facts” concerning a variety of dental therapeutics and materials such as dental amalgam, root canals, and conventional dental anesthesia. Without evidence to back these “facts” however, self-anointed holistic dentists stand to do more harm to their cause than good.

Legitimate holistic dentists and mainstream dentistry may not be as far apart as one would think. "A lot of what I've heard holistic dentists advocate is what most dentists should already be doing," said Chicago dentist Robert Brandstatter. "At our office, we try to prevent dental diseases by explaining how overall behaviors to the whole body, such as drugs, medications, nutrition and smoking can affect the teeth." http://featuresblogs.chicagotribune.com/features_julieshealthclub/2008/05/holistic-dentis.html

The tenets of Integrated Medicine, alternative health care and holistic approaches to wellness all share one common ingredient, listening and educating their clients to formulate therapeutic approaches best suited to their client’s interests and needs. This is also what every DDS or DMD candidate is taught throughout their lengthy educational process. What happens after graduation is largely dependent on philosophy, ethics and personal beliefs. Holistic dentists argue that traditional dentists fail to see the big picture. For example, reading a radiograph taken on a new patient, a traditional dentist might be more focused on how to remedy the pathology on a decayed first molar. The holistic dentist, taking a different path might first resolve to evaluate nutrition or immune system response prior to reconstructing the tooth.

In fairness to the holistic approach understanding the primary disease entity is always a better long-term approach to achieving health. Restoring a decayed tooth in a bulimic patient doesn’t solve anything unless the underlying pathology is eliminated. On the other hand, waiting for a patient to undergo interventional therapy while the tooth rots away doesn’t help either.

Society has a place for both extremes. For example, the benefit of nutritional counseling to high carbohydrate intake susceptible populations can have profound dental and medical implications, yet filling a painful carious lesion on a death row inmate serves his/her needs better than nutritional counseling. What’s the common link? Communicating with the patient/client, understanding their needs, constructing a philosophy of care commensurate with their long-term goals. We’ve come a long way from the doctor/god model. Modern day care is not about the doctor saving the patient but about the patient saving themselves under the guidance of teams of medical consultants. Holistic dentistry is not about changing mercury-based fillings or denigrating municipal water fluoridation programs. It’s about grappling with counterintuitive human tendencies, thinking outside the box when traditional therapeutic approaches strike out and relying on evidence based scientific methodology alternatives.

Care provider character qualities cannot be judged by a web site. They are best found by asking close friends or referrals from objective medical professionals. Be wary of web sites that offer unconventional treatment services. For example, contrary to popular belief and unknown to most dentists “metal free” restorations are not metal free. The majority of “all ceramic” restorations include the element zirconium http://www.crystalzirconia.com/. Although zirconia is biologically stable, its purest element form of zirconium is still classified as a metal. Similarly, stains used to color ceramic materials on crowns are metal-based http://ceramic-materials.com/cermat/education/273.html and some of these metals, in free form, are considered extremely toxic. The same naysayers that expound the toxicity of dental amalgam due to its mercury content harp on the purity of ceramics in part because they are “metal free.”

The message to the public is:

1. A holistic approach to dental treatment is a good thing.

2. Paramount to a successful outcome for your individual needs is an open dialogue with your practitioner regarding philosophy of care and working together to achieve realistic treatment expectations.

3. Ultimately, you need to trust your doctor.

4. When patients do their own research they need to screen for documents lacking commercial or political corruption, a task extremely difficult for even well trained individuals. Bare in mind anything is publishable today. A good friend and colleague once said to me “Ken, when I look around I’m concerned at what I see, so much so that I’ve taken to believing nothing of what I read and only half of what I see.”

5. An educated consumer is a happy consumer.

Macro Economics 101:Let's not over think this Kenneth Schweitzer, DDS

2009-03-01T01:09:34Z

Macro Economics 101: Lets not over think this.

Since October 2007, how many hours has the public logged listening to CNBC? Ratings agencies probably could quantify the number, but my guess is the number is surprisingly if not shockingly substantial. Take the number, do a cost/benefit analysis using variables like ad revenue generated, lost worker productivity cost, psychological trauma attributed to bad news, media jobs created, etc. Take all these variables and come up with a positive or negative number. A positive number implies the program has created value to the public and a negative means the program has left us worse off than had we never watched the program.

Singling out CNBC is unfair. We could just as easily look at the War in Iraq, the porn industry, cosmetics, health care, etc. and conduct similar cost/benefit studies to determine overall value to society of each sector. For example, had the conflict in Iraq been quick, efficient, low in casualties and resulted in a Democratic government that was self-sustaining one could argue the cost/benefit value was strongly positive. On the other hand, judging from the overall outcome; dollar cost, lives lost, greater worldwide instability all in exchange for the ousting of a terrible dictator many would argue the cost/benefit reward of the war was strongly negative.

I don’t claim to have the highest IQ and I didn’t attend an Ivy League College. Einstein fascinates me but I don’t apply his theories when balancing my checkbook. So when I think about the War in Iraq it helps if I simplify my thought process. A white fence surrounds my house. The fence keeps my dog from running out into the street chasing cars and dogs. It also keeps animals from coming in, thereby protecting my cat, dog and vegetable garden. Occasionally, a rabbit or dear may breach the fence and look for a tasty meal of Hosta, Day Lily, or lettuce. When the dog and cat are outside the dear and rabbit look elsewhere to satisfy their dietary needs. It’s a pretty good balance, the fence cost me less than one percent of my annual income, it has some esthetic value, is not obtrusive and I feel a little safer with it in place. Is it Star Wars, certainly not, but it works, and it adds value to my life. February 24, 2009 President Obama assured US citizens that soon the dollar cost of the Iraq war would be transparent. I am guessing, but one doesn’t need a high school diploma to predict the cost will be greater than one percent of our GDP. The question is how much greater will it amount to? Did we realize any value for the expenditure and what are the consequences of overspending for this war?

How about Wall Street? In 1976 the financial services sector grew to 6% of the S&P 500 index when 40 firms were added. Three decades later the market capitalization of the S&P grew to an astonishing 21% of the S&P 500, by far the largest component of the index.

According to the skilled investor.com http://www.theskilledinvestor.com/wp/

“Financial services sector equity market values rose, crashed, and will rise again, in part, because the mass of American consumers are just like trusting, docile sheep regarding their personal financial affairs and the amount they are willing to waste on overpriced financial services.

Far too many US consumers pay far too much and get woefully little value in return from the financial services industry, including its securities and investment sector. The industry repeatedly scrapes the consumer excess off the table and stuffs it into its salaries, bonuses, and corporate earnings reports. Consumer overcharges just drive up the portfolio values of those who own its financial services industry equities. There really is no reason to believe that things will ever change.”

While industrial, agriculture, technology and service industries were plodding along making their products, financial firms were growing exponentially, creatively finding ways to extract value from businesses by dividing them up, repackaging them and selling them to the highest bidders. The fees generated were enormous but nobody seemed to care because their client corporations were also benefitting with oodles of cash generated from stock and bond offerings. The question people should have been asking and most certainly will be asking in the future is was the product provided by the financial services industry of intrinsic value to the public or was it self serving? In hindsight, we now realize that a large part of the industry was selling financial packages to investors where the primary intent was creating revenue for financial firms. Had we only taken to heart the lesson Richard Gere learned when he so masterfully portrayed a corporate raider wooed by Julia Roberts in the movie Pretty Woman maybe we wouldn’t be in this devastating predicament.

Don’t nail the financial firms to the crucifix so fast. These firms serve a useful function especially in a society vastly dependent upon currency exchange. Managing transactions, lending for startup companies, financing expansion in existing companies are all necessary for economic growth. Somewhere, however, the scales began to tip in favor of the financial companies. When the banks, lending institutions, brokerage houses and insurance companies discovered they could collateralize debt and sell it as derivatives their profits began to skyrocket. As profits escalated investors bought more shares in the companies. Insiders made millions and bonuses became entitlements. Wall Street argued what was good for Wall Street was good for the economy. Millionaires spent their millions, stimulating other businesses, and the cycle continued. The only problem was the financial companies weren’t servicing the public with a product commensurate with what they were being paid. They were serving themselves more than the public. The companies had no tangible assets and in effect their value was based on expectations the cycle would continue. When so much of our economy’s asset base is contained in a sector whose value to the public is significantly less than its value to stockholders an unsustainable imbalance will eventually occur. In simple terms it was a pyramid business model.

Several of my friends and clients are “trust fund babies.” Some consider them blessed and others call it a curse. Although they live with little financial duress, many function outside normal parameters of society because they don’t work. When I’m having a bad day I think they’re lucky and on a good day I feel sorry for them. If a disproportionate number of “trust fund babies” made up our population the system would fail. Inadequate supply of services and products available for consumption leads to inflation and currency devaluation. For example, if every person capable of entering the work place decided they didn’t want to work because they had trust funds to support them a dearth of product, entrepreneurial activity, and GDP would result. The argument that they support the economy with their spending doesn’t hold water. It’s the same argument Wall Street bonus people used and it’s the same answer. Their “trust fund economy” is self-serving and fails to generate anything of value to the overall population.

I never was a big fan of Mario Cuomo while he served as Governor of New York. Don’t ask me why because it was too long ago for me to remember. Recently however, On February 5, 2009 Tom Keene of Bloomberg radio interviewed Governor Cuomo about President Lincoln. The interview revealed Cuomo’s in depth knowledge as a historian and in particular of President Lincoln. He described Lincoln as the greatest president of our nation using terms like “common sense and benign pragmatism.” Towards the end of the interview the subject switched to religion and the two common ingredients of every religion. Simply stated they are:

1. To love one another.

2. To work to make the place better.

Cuomo’s simple yet elegant description is relevant to this essay because of the similarities between “making the place better” and creating products and services of “value” to the population. Looking at the big picture, economies thrive when people work to create a better quality of life for the populace. When Bill gates and Steve Jobs competed to bring personal computing to the general population economies prospered, communication was enhanced and most would agree the world became a better place. On the other hand, whereas drug trafficking sales support economies of several third world countries, the worldwide destructive cost of illegal drug use greatly outweighs the benefits of prosperity it creates in miniscule sects of the drug trafficking countries.

Bush signed onto and Obama inherited a large fiscal stimulus package. Journalists were quick to recognize the significance of the legislation. Where private enterprise and capitalism had failed, the US government now had an opportunity to succeed. Media’s advice to Obama was “spend the money wisely.” CNBC has invested hundreds of hours debating where the money should be spent. Should the money be spent bailing out financial institutions, automakers, homeowners or the very taxpayers who will eventually pay for the stimulus? There doesn’t appear to be a clear consensus, however, most agree the money’s purpose is akin to applying defibrillator paddles to a patient in cardiac arrest. The sooner the patient’s heart begins to beat on its own the sooner the economy can recover. Congress and Wall Street are duking it out over utilization of the money for short-term or long-term initiatives. Wall Street wants all the money put to use right away and Congress is reverting back to Macro-economics 101.

The public is left wondering who to believe, a private capitalist sector responsible for mismanaging its people’s future or a government caught sleeping while the kids raided the cookie jar. The answer, and unfortunately, at least for the time being rests with government supervision. Wall Street’s reaction to Congress’s long-term initiatives was more pain, albeit necessary pain to clear the path for gain. The message is clear. Businesses lacking relevance and devoid of meaningful value will be stressed. Their long-term viability will be challenged even if their balance sheets are currently viable. Mismanaged industries that are paramount to our culture’s continuity will be jump started, restructured and reinvented with our government’s supervision and blessing.

CNBC’s thousands of hours spent beating this crisis to death should be captioned. “Macro-economics 101: Let’s not over think this.”

For Lack of Evidence- Kenneth M. Schweitzer, DDS

2009-02-22T21:02:34Z

You've just read a sensational blog; stimulating, thought provoking and inspirational enough to discuss with your friends and colleagues. OK, lets say it was a magazine article, maybe even a book or newspaper article. The content of the published information swirls around in your head challenging some of the basic tenets of truth, values and beliefs you've always aspired to.

Where do you go with this? What do you do with this insightful content? If you're looking to have fun with the information you'd be tempted to shout across the room to a co-worker and spill the information as quickly as possible, amused by being the first to announce the news, information or opinion. Once blurted out, you feel like you're ahead of the curve. Before you can say, "I'm in the know" ten times fast, the news has spread throughout the floor, onto people's PDAs and into digital space.

On the other hand, if you're interested in delving more deeply into the subject matter, seeking greater objectivity and clarity before discussing the content, you might do a search on the author or check the sources of information before talking publicly about the material.

In this day and age media content is ubiquitous, it channels into our heads through cell phones, Blackberry's, computer terminals, radios, magazines, newspapers, books, TV, and yes, even blogs. Sometimes, like a paradoxical Einstein theory, we even imagine the news travels to us faster than it actually occurs.

Transition to digital media has stifled growth of conventional newspapers and magazines. Many pundits have predicted the demise of printed media in its present format unless measures are taken to change the value of its content. Philp Meyer, professor emeritus in Journalism at the University of North Carolina at Chapal Hill and the author of "The Vanishing Newspaper: Saving Journalism the Information Age," wrote an article in American Journalism Review October/November 2008 titled, "The Elite Newspaper of the Future." http://www.ajr.org/Article.asp?id=4605 . In it he states, "A smaller, less frequently published version packed with analysis and investigative reporting and aimed at well-educated news junkies that may well be a smart survival strategy for the beleaguered old print product."

Meyer is honing in on what the medical profession has known for years. With so much content readily available simply by clicking a mouse the only salable feature a newspaper can now offer is credibility. Medical science refers to it as Evidence-based Research/Practice/Writing. Evidence-based accountability was partly a response to the FTC's 1975 ruling allowing advertising in the medical professions. Although the concept took years to evolve, peer reviewed scientific journals became the trusted solution to the mayhem created by free trade practices in the healthcare professions.

Traces of evidence-based medicine suggest its roots may have originated in ancient Greece or China but the modern birth is attributed to a Scottish Epidemiologist named Archie Cochrane. In 1972 Cochranes' work, Effectiveness and Efficiency: Random Reflections on Health Services led to increased acceptance of evidence-based concepts. Later, in 1992, the term evidence-based medicine was first coined in a paper written by Guyatt et al. (JAMA. 1992 Nov 4;268(17):2420-5 ). In 1996 Adrian Smith, as President of the Royal Statistical Society proposed evidence-based policy should be used in education, policing and all areas of government. (Smith, A.F.M. (1996). "Mad cows and ecstasy: chance and choice in an evidence-based society". Journal of the Royal Statistical Association, Series A 159: 367–83.).

Meyer references the term evidence-based journalism in his paper. He reckons the savior of newspaper journalism will be not reporting on new information that streams in from everywhere but in the processing, analyzing and formatting of the data. He states, "The raw material for this processing is evidence-based journalism, something that bloggers are not good at originating."

Comparing print news media and medical science might be far reaching, but logically, evidence-based thinking might be the common thread that re-establishes integrity and viability within these professions. Although medicine is by no means held in as high esteem as it was in the 1950's, evidence-based protocols and philosophy have done a lot to re-establish sorely needed integrity lost as a result of HMO's and competitive marketing in the health care professions. Post-Graduate doctoral students are trained to decipher the validity of published scientific literature by carefully reviewing experimental design, methodology and sponsorship of the research. Literature that passes the litmus test can be used as reference for evidence-based clinical decision making.

Can a parallel be drawn between preserving printed media and rescuing medical science? Possibly yes. Medicine took the high road, accepted advertising and marketing but established advanced guidelines for research and clinical practice. Likewise, journalism cannot stop the stampede of published content flooding the digital airways but it can elevate the standards of written material chosen for distribution. In this manner educated and intelligent people will look towards select printed media for truth and interpretation of the published data.

Cosmetic Dental Makeovers: Pros and Cons

2009-02-01T21:30:34Z

Ready to Jump?

You've spent considerable time thinking about your teeth. You're not happy with the way they look and everyday you get up, stare at your smile in the mirror and wish something could be different. Your dentist agrees that your smile needs improvement.

Fig. 1 Fig. 2

Before you jump, first ask yourself is this an aesthetic improvement or a cosmetic enhancement? What's the difference? Unbeknownst to many the two words are far apart in meaning but are often used interchangeably. Lets look at the meaning of both words.

Aesthetic: Concerning or characterized by an appreciation of beauty or good taste. http://wordnet.princeton.edu/perl/webwn
Cosmetic: Serving an aesthetic rather than a useful purpose. http://wordnet.princeton.edu/perl/webwn

Simply stated, cosmetic procedures are performed to change the aesthetic appearance of an object or being. What is aesthetic? Aesthetics is perceived, cultural and may change with time. The female aborigine fails to evoke a sense of aesthetics among most westerners yet she is perceived as beautiful in the Aborigine culture. Similarly, Twiggy sensationalized her era as the face of the swinging sixties yet her emaciated figure lacks an aesthetic appeal for people today.

Aborigine Twiggy(1960's)

A posed but powerful portrait of a ‘Female Aborigine of N.S.Wales’ , showing the different standards applied to black and white women. It may have been drawn by Francois Peron, an ethnologist with the French expedition, commanded by Captain Nicholas Baudin, which visited Sydney in 1802.

(GPO 1 – 06391, Government Printing Office Collection, State Library of New South Wales.)

So what! You still want big white teeth and you're willing to do whatever it takes to get them. It's no wonder you've become self conscious about your smile after reading material like Sara's Teeth Whitening Blog . http://www.sarahsteethwhitening.com

According to Sarah Richards, "The embarrassment of ugly teeth is something I am no stranger to! I was mortified when people took my picture before I had a chance to close my mouth and smile carefully. I often covered my mouth when I laughed so people wouldn’t see the colour of my teeth."

When so many magazines inundate you with large chalkboard chicklet smiles it's hard not to fall prey to the psychological magnet drawing you closer to chalkboard white. This is the society we live in, this is the society that manufactures aesthetics with billboards, magazine covers and Entertainment Tonight on HD TV. Sarah's blog shouldn't be too heavily criticized however. After all, the only real harm in tooth whitening is to your bank account. And if the benefits make you happy and more productive then one could easily argue its value.

What happens when tooth whitening just doesn't cut the mustard? Now the price of aesthetics takes on an entirely different meaning. Not only does it hurt your pocketbook considerably more but if your teeth had vocal chords they'd probably shout STOP! Ever see what a porcelain veneer tooth preparation looks like? It ain't pretty. For decades porcelain veneers have been marketed as minimally invasive. I'm not entirely sure what "minimally invasive" implies but when it comes down to elective dental procedures it smells a lot like being a little pregnant.

Fig.3 Teeth Prepared for Veneers

99% of porcelain laminate veneers are irreversible! Once they are placed they need to be maintained, replaced when chipped or broken and considered a life long financial commitment. A ten-year life-span for the restorations is realistic. If placed during a patient's twenties they might need to be replaced several times during that person's lifetime.

When porcelain laminate veneers were first introduced during the 1980's tooth whitening hadn't been introduced. It took several years for the tooth whitening and bleaching phenomenon to explode and by that time thousands if not millions of patients had already been treated with porcelain laminate veneers. Many of the clients treated with porcelain veneers early on regretted the shade selected for their veneers. By the time the bleaching craze was in full swing the early porcelain veneers were considered too dark. What was considered aesthetic in 1985 was no longer as attractive in 2005. Within twenty years changing cultural norms in the United States had diminished the luster of the original porcelain veneers. How will cultural norms change over the next twenty years?

The teeth of this young patient (Fig. 1-4) were severely abraded due to acid erosion. The enamel was completely stripped from the inner surfaces of the teeth.

Fig.4 Fig.5

The subsequent restoration of the teeth (Figure 2,4) was both a cosmetic restoration that improved aesthetics and a functional restoration that covered exposed dentin. Without the restorations the patient's teeth would have eroded and abraded at an accelerated pace. Therefore the restoration was preventive in nature. In this situation porcelain veneers proved to be a more conservative solution than full coverage restorations such as caps (crowns).

Before agreeing to strip the enamel from your teeth and forever holding yourself captive to your dentist make sure you are doing the right thing for the right reasons. Be aware that in the end aesthetics is about achieving balance between you and nature and not matching your body image to a current fad. The best dental aesthetics is a blend of the dentition with the surrounding body parts so others see the the entire face as one. If the teeth stand out the first thing people will question is if the smile is artificial.

Dental Makeover Part One. The Creation of Necessity

2009-01-27T14:15:40Z

How many times have you looked in the mirror and cursed that rotated lateral incisor, worn canine or discolored and stained central incisor? How many times have you sat in the dental hygiene chair looking at promotional pictures of glamorous white teeth and sexy smiles and wondered if that could be you? Ready to pull the trigger and feel better about yourself? Ready to join the dentate elite?

If you're on the edge but can't muster the courage to make that call, fear not. The solution lies in your six month re-care visit. Invariably, sometime during the scraping and polishing of your dentition, in between the chit chat and local gossip shared between you and your hygienist, the subject will come up. The door will open; a seemingly innocent invitation into the world beyond natural teeth. You're beckoned with a smile, a vision of health and beauty and the promise of deep inner satisfaction. These are powerful forces.

There is no harm walking through that door as long as you bring your good sense of objectivity with you. My advice? Don't go food shopping on an empty stomach, don't drink and drive and certainly don't sign off on a cosmetic tooth makeover before you leave the dental office.

A bountiful collection of expletives describing our politicians, bankers and mortgage lenders circulates indiscriminately. Few people have survived the current economic environment unscathed or unblemished. Fortunately, as bad as it out there, a glass half-full and a cloud with a silver lining embellishes many of us. Amazingly, the adaptability of our species has rarely been more evident than in these uncertain times. As bank accounts shrink, stock portfolios implode and retirement plans are set aside an incredible survival mechanism has kicked into gear. During times of crisis, with the efficiency of a laser guided missile, the human mind is capable of filtering its vast cache of perceived necessities into a manageable basket of priorities. We tend to draw upon inner strength, seek the refuge of human interaction and become less reliant on materialistic infusions to satisfy our boredom. Could it be that many of us have subconsciously yearned for this?

Within our American urban sanctuaries not a day goes by without Madison Avenue bombardments. A swanky slathering of opulence smothers us. Handbags, shoes, jewelry, performance automobiles, plastic surgery enhancements and yes, porcelain laminate veneers abound. I've often imagined what the mastermind behind the creation of all these extravagances was like. A larger than life individual, perceptually light years ahead of others and likely responsible for creating necessity, fear and entitlement out of thin air. Or was he just a meager man masked behind a curtain of advertising dollars? The year was 1939. The man was Frank Morgan aka "The Wizard of Oz". I ask myself was the Wizard the prototype of the Madison Avenue executive and are today's tumultuous times a modern day reenactment of Dorothy's adventure into Oz and eventual return to her grass roots in Kansas? We need to ask ourselves are we better off in Kansas or Oz?

Friday, January 23, 2009 Allergen, Inc. formally introduced Latisse http://www.latisse.com, the first FDA approved formulation of bimatoprost for eyelash enhancement. Prior to its introduction the drug formula was solely marketed under the name Lumigan to treat eye conditions stemming from glaucoma. According to Allergan the drug could generate up to $500 million in annual sales. CNBC covered the story and subsequently debated the relevance of drugs such as Latisse given the fragile economy, need for health care reform and history of drugs thought to be safe such as Vioxx and Celebrex. The pro argument for drugs such as Latisse was that profits can be channelled back into their parent companies and used to subsidize R & D for other life sustaining drugs. In reality, the debate is a vortex for which every aspect of health care, finance, marketing and politics channels into. Dental makeovers are a spoke in the wheel of this debate.

Next. Cosmetic Dental Makeovers 2. Pros and Cons.

Welcome

2009-01-25T00:23:17Z

Welcome to my blog. Please check back soon for new entries.