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Humanity above Profitability Options · View
jmailankody@gmail.com
Posted: Tuesday, August 5, 2008 12:30:55 AM

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Joined: 5/14/2006
Posts: 8
This has reference to the letters by Hayes and Haeger and also the editorial of July, 2008 issue of JCO.
First of all one has to admit that there is active debate on raising commercialism of doctors in general and orthodontists in particular.(Editorial AJODO:132:1) In the dot com era more and more clinical and therapeutic procedures will be vanishing from practice, in favour of more profitable 'modern'techniques. Corporate institutions are spending a lot of money on creating 'evidence' and getting it published in 'business friendly'journals! (advertising in the same journals.)
Secondly, cases like cleft palate will have less takers. Some years back, Adrian Becker lamented on the orthodontists' lack of interest in cleft palate discussions and treatment.(ESCO Digest)Are we loosing the humane element and compassion mandatory for a health care(?healing/Noble) profession ? In an excellent article'Orthodontics justified as a profession-' authors Rinchuse and Rinchuse(AJODO:121:1p93-96) have demonstrated that we have to continue to stay as Health care Professional.
Thirdly it is to be noted that many of our colleagues are joining the bandwagon of glorified beauticians' business domain. They float the concept of 'Social Six',giving the patient what they want rather than what is best(of course within our knowledge and experience)in the name of patient autonomy(against paternalism).
Unfortunately the three M's for the orthodontist choosing commercialism are Money, Marketing and Manipulation. Let prudence prevail to distinguish between the surgeon and the butcher, while making decisions on humanity and profitability!
Jayaram Mailankody.
ronredmond@orthodontist.com
Posted: Tuesday, August 5, 2008 1:23:52 AM

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Joined: 4/20/2006
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Dear Dr. Mailankody,
I'm afraid I cannot accept your characterization of our profession as "Surgeons or Butchers". Unless you practice in an environment that doesn't require compensation, such as a government controlled health care system, or you are fortunate enough to be independently wealthy, compensation is a vital part of your practice. If you chose to view practice efficiencies as a pathway to excessive compensation, then I can take the view that practice efficiencies allow for reduced costs to the patient and a superior model for treatment delivery. There will always be those that take your view, and those that take mine, but to describe one as a surgeon and the other as a butcher is inappropriate.
Sincerely,
Ron Redmond DDS, MS
jmailankody@gmail.com
Posted: Thursday, August 14, 2008 10:50:27 PM

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Joined: 5/14/2006
Posts: 8
Hullo Ron,
I agree with your right to disagree with my views. You are right for one thing, I work in a large Government teaching Institution with more than 25,000(Twenty Five Thousand) child births a year. Our tertiary care centre caters to a large number of cleft palate patients as well. I also practice exclusive orthodontics for the last 26 years.
I am really sorry, if I had hurt anybody.
My only rebuttal was that we should not be greedy Shylocks in the name of corporate, business management systems. That doesn't imply one should starve! Like life, there are easy and financially better rewarding cases in practice, and difficult with minimum margins of revenue. Only sweet with no bitter or sour cannot be reality in life.
I was also impressed by Ron Wolk's Guest editorial (Angle Orthodontist-July 2008) on the subject. So also Katz's letter in a recent AJODO. I would also like you to see my (unpublished) letter in response to AJODO editorial on commercialism.(sent as a seperate attachment to Ron Redmond)
Still, I respect your stand.
sincerely yours,
Regards,
Jayaram Mailankody
orthoj_j@go.com.jo
Posted: Wednesday, August 27, 2008 5:02:16 AM

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Joined: 8/25/2008
Posts: 10
This is in reference to Humanity above profitability. I envy your courage in raising such a sensitive subject. The balance between profit and patient's health is becoming more and more difficult. Since the compensation for our orthodontic work is some times not as rewarding as one would expect. Hard enough to maintain this balance and keep the patient's best interest as the first priority, we are yet faced with another challenge. The challenge of differentiating between what product works and is evidence based and what is commercial. A good example in this respect would be the extensive talk regarding friction and loss of anchorage. Although it is known since years that reduction of friction is good in the initial stages of treatment, the quantity of friction that jumble orthodontic biomechanics has to be clarified. Thomas E. Southard of Iowa clearly stated that (Emphasis on employing reduced-friction brackets during sliding mechanics to prevent added posterior anchorage loading is unwarranted and based more on bracket salesmanship than on orthodontic biomechanics) AJO-DO March 2007.

Any clinician would know that undimpled arches usually slip from one side to another regardless of the type of brackets used. Why the friction did not stop that movement if it is tremendous!!!! Keeping in mind that Self ligating brackets are three times more expensive than the conventional ones.



Lama Jarrah
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