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THE EDITOR'S CORNER

Lessons from AIDS and SARS

Lessons from AIDS and SARS

Anyone who has not been stranded on a desertisland for the last six months is well acquainted with theoutbreak of severe acute respiratory syndrome. It hasbeen a lead item on the evening news practically everyday since SARS was first described as a public healththreat. Even during the height of the combat in Iraq,SARS made the headlines.

A recent article in the New York Times highlightedthe effect that the SARS outbreak has had on doctor/patient relationships in Toronto. In this city, identified bythe World Health Organization as a SARS hot spot, itseems that many patients are staying away from theirphysicians' offices--in effect denying themselves adequatecare--out of fear of contracting the virus fromother patients. It has been recommended by local hospitalsthat doctors wash their hands with alcohol after eachpatient and that they always wear surgical masks whenmeeting patients face-to-face. At least one Toronto physicianhas expressed the concern that these measures dehumanizethe doctor/patient relationship. In this case, Iwould definitely tend to err on the safe side. But perhapssome lessons can be learned from the public and governmentalreactions to the AIDS epidemic.

More than a decade ago, we all implemented the"Universal Precautions" mandated by OSHA in responseto the incident in which one dentist allegedly infectedseveral of his patients with the HIV virus. Everybodyassumed that this transmission was due to inadequateinfection-control measures. It was later shown that thedentist in question passed the virus to his patients viaintentional injection, as a deliberate criminal act. Underthose circumstances, no governmental restrictions couldever have prevented the tragedy. Still, the regulations(now called "Standard Precautions") remain in effect.

Zealous protection of patients, staff, and self alikefrom infectious diseases is of critical importance to eachand every orthodontist. None of us would deny or evendebate that point. What is debatable is the need for governmentregulatory intervention in the matter. As a group,orthodontists are among the most intelligent, themost highly educated, and the most conscientiousof all professionals. We are entirely capableof choosing appropriate measures for the protectionof our patients and ourselves. It is our dutyto keep ourselves abreast of the latest developmentsin infectious-disease control and to implementsterilization measures at the highest level,and I personally do not know of any clinicianswho do not do just that. Past government regulationshave not even distinguished between orthodonticoffices, where the possibility of cross-contaminationwith patient bodily fluids is minimal,and other types of dental practices, where suchcontamination is much more likely. Most governmentregulators simply do not know the veryreal differences between orthodontic practice andgeneral dental practice. The reasoning seems tobe that what is good for one type of dental practiceis good for all.

Many of the restrictions and regulations imposedin the wake of the AIDS scare can now bejudged as overkill. And in this age of evidence-basedhealth care, there is little evidence to supportthe need for new government-imposed measuresto control the spread of SARS. The Torontodoctor's concern about feeling less human andless humane in his interactions with his patientscertainly applies to orthodontists and dentists aswell as to physicians. Increased government regulationwithout sound scientific backing not onlydetracts from the doctor/patient relationship, butadds significantly to the cost of health care, furtherdegrading that relationship.

The SARS outbreak will likely be containedin due time. As this is being written, infact, WHO has already eased its travel advisoryfor Toronto, and has announced that Vietnam hascontained the spread of the disease in that country.The numbers coming out of Beijing continueto climb, but to date there have been no SARS-relatedfatalities reported in the United States.This may well be at least partly due to the moresophisticated infection-control practices alreadyin place in U.S. health-care providers' offices.

Until SARS is contained in its entirety,however, we would do well to take it seriously.Even if no cases have been passed from patient topatient in any type of dental office, orthodonticor otherwise, it is our responsibility to make thechances of that occurrence as infinitesimal aspossible. By keeping abreast of the latest recommendationsregarding disease prevention andinfection-control procedures, and by puttingthose recommendations into effect immediatelyon a voluntary basis, we will not only be providinga duty-bound service to our patients (and ourselves)--but we may also be avoiding the ever-presentmenace of further government regulation.

ROBERT G. KEIM, DDS, EDD, PHD

Editor, JCO

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