First, I really enjoy my monthly reading of Dr. Christensen's comments in Dental Economics. I do have a question about the efficacy of lights in conjunction with bleaching. Dr. Christensen stated in the March issue (Page 126), "... similar bleaching occurs whether or not light or heat is applied during the bleach application." I definitely agree with Dr. Christensen, as I, too, have seen no literature supporting a chemical conversion of bleach material from light or heat application. I've assumed the light application utilized with in-office bleaching to be a marketing tool with little clinical value. Recently, I read "Light augments tooth whitening with peroxide" by Tavares M, Stultz J, et al. JADA 2003; 134: 167-175. This seems to be supportive of lights to be augmentive with in-office bleaching. Their conclusion: "Light can increase the tooth-whitening effect of peroxide, thereby increasing the effectiveness of tooth-whitening procedures."
Unfortunately, I'm not certain what mechanism for whitening is truly happening when light is used. Are the lights generating heat, which temporarily desiccates tooth structure and results in whitening? This would produce a very short-term result. I was particularly disappointed in the JADA study because specific mechanisms weren't discussed adequately. Yet, at the six-month observation, light plus peroxide yielded superior results to peroxide alone. Perhaps the heat source is altering the organic component between the enamel rods and allowing enhanced penetration of peroxide? I simply don't know.
I'd really appreciate Dr. Christensen's views on this. His work with CRA has been at the forefront of pushing the research community to bring forth clinically relevant studies. Some have criticized CRA in its methods of research. However, no one can detract from CRA's efforts to make its testing clinically relevant. I can't stress enough how valuable this has been to our dental profession and the public.
Michael W. Davis, DDS
Albuquerque, N.M.
Market timing (not) for everyone
I take strong exception to the authors' contention in "Market timing" (Dental Economics, March 2003, The Practical Investor, Page 98), that the best time to sell is before a bear market hits. There is an axiom in investing that says, "Time in the market, not timing the market" is critical for long-term investing success. In one sentence, they clearly prove the superiority of index investing — which I support to the highest degree — and then they suggest the opposite. Again, they say to invest in time-tested mutual funds. They know that studies have shown that past performance is no indicator of future performance.
Again, we have people in the financial arena making statements that confuse the average investor even more. Dollar-cost averaging, diversification, the use of no-load index funds, asset allocation, and yearly rebalancing of your portfolio are all essential keys to long-term equity and bond investing. Market timing is an oxymoron. Avoid it.
Kenneth Tobin, DMD
Union City, N.J.
Response from Hufford and Appel
Dr. Tobin makes several points that require some clarification. First, as a practical matter, market-timing discipline is essential for most individual investors. The average bear market has seen stocks decline by approximately 30 percent. With people living longer than ever following retirement, many retired investors need the long-term growth potential that stocks have historically provided, but cannot bear the full brunt of the risks inherent in buying and holding. The market-timing and portfolio strategies that we have presented in these columns are simple and have been very effective in the past. We invite readers to look at these strategies and their performance histories in order to draw their own conclusions. Moreover, we have a long and successful history of applying the strategies in our columns as well as more sophisticated market-timing techniques on our clients' behalf.
Of course, as Dr. Tobin notes, past results do not guarantee future performance. This caveat applies equally to any of the passive strategies he advocates in his comments. Although such strategies have their place, relying entirely on passive, automatic investment axioms is akin to programming the desired course into an autopilot and then abandoning the controls. Indeed, even the venerated Peter Bernstein, an economic historian, has abandoned the academic orthodoxy that Dr. Tobin embraces. As reported in Pensions and Investments (March 17, 2003 issue), Bernstein has come out in favor of market timing because the potential returns from "policy portfolios" are too low to justify taking on the risk.
Finally, we and others have long observed that a certain minority of mutual funds has displayed long periods of superior performance in terms of reducing risk while preserving rewards. Some fund managers simply seem to have a knack for what they are doing, no matter how contrary to the academic theory of efficient markets they may seem to be.
Brian Hufford and Marvin Appel
Experience over "programs"
I am writing in response to your article on consultants (Dental Economics, March 2003, Viewpoint, Page 18). We have had a rocky road hiring what seems to be very expensive advice. Prior to hiring our first consultant, we checked references in various parts of the country. We know a dentist in town who used this consultant, called the dentist and heard rave reviews of the consultant. We met a few times with the consultant to ensure that we had an understanding of what was to be provided and what we needed. We were assured that our needs — marketing and increased production — would be addressed.
Despite doing our "homework," we were sadly disappointed. The practice monitoring we were promised was a spreadsheet that my 3rd grader could have done. These spreadsheets came infrequently with no analysis or recommendations. There was no evaluation of the marketing. After six months of financial monitoring and consultation services, we could no longer afford this consultant because our production was flat. One of our consultant's suggestions was to sell the practice.
Since they were monitoring us, we assumed they would have an understanding of what these low numbers meant and help more with marketing. We declined any more of their services and were willing to pay for the services we had already received despite receiving limited, if any, benefit. The consulting service felt that they could hire an attorney to get the rest of the money for "their program." This was a nightmare for us as we were already stressed to the breaking point. The consultant didn't ask why we were dissatisfied, but merely said they could get their money, and their attorney thought so as well. So, at this present time, we are making payments for a service we no longer want and with which we are extremely dissatisfied.
We have a new consultant now, recommended by our lending service. If you all don't check this woman out, you are not doing yourselves any favors. She is an up-and-coming dental superstar! We met and outlined what would be a hard road to financial recovery. She has been nonjudgmental and totally turned our practice around within a few months. She always addresses our concerns and questions. She has gone beyond what we expected from her time and time again. What's more, she has helped us cope emotionally with what seemed like an impossible task. I'll enclose her contact info for you. (Werner Consultants, (630) 969-9100.) The most important things were that she listened, took down numbers in a very scientific way, and told us honestly how much we could improve within a particular time frame. She doesn't use a "program" — she uses her experience. Her experience has so far proven to be priceless.
Thank you for publishing the article. Consultants are necessary and helpful. It matters how "ripe" the dentist is for change, too. But, my advice is to stay away from prescribed programs. Choose a consulting firm that has a periodic evaluation of its performance as part of its service. Ask for a money-back guarantee.
Dr. Stewart P. and Rose Wignall
Chapel Hill, N.C.
Of dreams and nightmares
I find it curious that every dentist who sets up a "dream office" experiences an increase in production, and that it is usually attributed to the fact that "the patients just love the new surroundings!" Time for a reality check.
Production increases because the dentist now has a monstrous nut to crack every month to pay for the dream office. "Necessary" treatment is now discovered on every recall patient. I've seen it — over and over again. The charade of patients loving the new surroundings so much that, by god, they have decided to get more dental treatment is just obnoxious. If you set up a new, expensive office, just be honest — you have to push for higher production just to pay the bill. All the other reasons just make you feel warm and fuzzy.
Rick M. Singel DDS
Cincinnati, Ohio
Crime and punishment ...
It was refreshing to read the concerns expressed by Dr. Milton Houpt in your April issue (Insurance fraud, Page 18) regarding the apparent ease with which some of our colleagues routinely engage in insurance fraud and misrepresentation. Dr. Houpt diplomatically refers to such misconduct as "fudge." Let's be clear, fudge is what you buy on the Atlantic City boardwalk. What Dr. Houpt describes is fraud — not fudge — and has no place in our profession.
The proclivity of some dentists to engage in insurance fraud may explain why these dentists and their defense experts stoop to fraud, misrepresentation, and outright perjury attempting to defend malpractice claims arising from clearly negligent care. Bearing witness to such unethical behavior is discouraging and disheartening.
While the vast majority of dentists take their professional responsibilities seriously and are troubled by such misconduct, the rank and file must demand greater integrity from their wayward colleagues. The primary obligation of any profession is to establish ethical standards and administer meaningful discipline to those who stray. A profession that publicly decries such misconduct but privately gives it a "wink and a nod" fails its membership and squanders the public trust.
Kenneth O'Connor, DMD, JD
Toms River, N.J.
... California style
I hope that you might find the following letter an interesting adjunct to Dr. Houpt's article that you just published about insurance fraud. In response, there are a couple of interesting points that I would like to add. I included my email address so that anyone with an interest in this might contact me directly.
I hope that we can all agree that mistakes happen that do not make a dentist a criminal, but there are dental practices that routinely bill for services that are not done or materials that are not provided. This is a deliberate billing practice that should not happen.
I have had dealings with the National Health Care Anti-Fraud Association (NHCAA). When presented with a massive billing fraud documented by billing records, the NHCAA expressed no concern or any ability to deal with that massive billing fraud. When I pursued the issue with several insurance carriers, the response was that it was easier to raise premiums than to correct the problem. In pursuing the fraud issue with the U.S. Attorney General's office, the response was that a multimillion-dollar fraud case was not large enough for them to become involved! Sad, but true.
But most important is that, in California, a dentist was criminally charged with fraud based on two points: 1) Billing was incorrect. 2) Billing was done in the dentist-owner's name by people working for her.
Regarding the first point, the billing records that were being examined covered four years. The criminal fraud charge was based on three instances that included billing for alloys that were actually composites and billing for amalgams that were really stainless steel crowns — honest mistakes turned into criminal acts. Mistakes do happen, but to be charged criminally when making a mistake in the insurance company's favor really seemed perverse and excessive. No pattern was shown that these acts were intentional. It also violated a provision of the professional code. The provision allows for honest mistakes by allowing a dentist to make the correction when the error is presented to the dentist.
The second point is an issue that should make dentists sit up and take notice. The state also was attempting to say that billing for treatment under the dentist-owner's name, but done by associates and staff, was fraud. If this point had been proven in court, all dental practices would have become fair game for this charge. The fact that the state would even attempt to pursue such a criminal charge shows the dangers that are lurking for the practitioner and the need for vigilance to protect the profession from those who would dictate how you practice — those having no knowledge of the business side of the profession.
Barry Levy, DDS
Redondo Beach, Cal.
[email protected]
