Kevin Lewis: Is this the brave new world of dentistry?

Brave new world?: Kevin Lewis suggests that the future is not made any brighter by ignoring lessons from history.

It is 92 years since Aldous Huxley described a future world that suffered the consequences of having become too dependent upon science and technology (and also too trusting and blind to its risks), and which devalued humanity, individuality, emotions and interpersonal relationships.

Like most dystopian novels, Brave New World (BNW) was challenging, uncomfortable and controversial – precisely as Huxley had intended, of course.

Questioning the inherent worth and claimed infallibility of science and technology should have some resonance for us in current times.

The new may be exciting and enticing but history tells us that initially the benefits are always more apparent than downside risks and unintended consequences. AI and fake news, failures in complex IT systems (even ‘robust’ ones like Horizon!), hacking, trolling and the latest scamming, online fraud, and identity theft epidemic illustrate this.

But having just survived a feisty and finger-pointing general election campaign, we should also know all about the ‘illusory truth effect’ – a term first coined in the pre-internet 1970s – whereby if you utter a mistruth, and say it convincingly enough and often enough for long enough, people are increasingly likely to believe it to be true.

Finding the truth

Politicians are well aware of that and have taken full advantage of new media channels to turn the ploy into an artform.

As for the rest of the population, ‘I read it in the newspaper, so it must be true’ has given way to ‘I read it online, so it must be true’ and now, more worryingly, to ‘it’s all over social media, so it must be true’.

But for many, ‘I don’t know what’s true and what’s not these days’ is their exasperated riposte.

Add a drizzle of confirmation bias into that toxic mix and we have a recipe for misinformation, disinformation and a dystopian vision of the future direction and values of our profession, as well as wider society. One side of the truth is what you want to hear, and the other is what you can get away with.

‘One believes things because one has been conditioned to believe them’ were words placed by Huxley into the mouth of one of the characters he created in BNW.

The character wasn’t a dentist, but might just as well have been. In BNW, humans were created in laboratories, and modified into one of five classes, led by the alphas (the smartest and most admired) and with the poor unsung epsilons doing all the hard, unfashionable and unrewarded graft at the bottom of the heap.

In between were the betas, gammas and deltas, and one of the thought-provoking insights from BNW was the mindset of these three ‘in between’ groups and how they viewed themselves, each other and not least the alphas and epsilons above and below them.

Elite?

I have an uneasy feeling that the perceived pecking order of the UK dental profession is being similarly redefined and manipulated to create a new, artificial ‘elite’.

Its self-appointed members view with a mixture of indifference and disdain the efforts of those poor misguided epsilons who still strive valiantly against the odds to maintain their patients’ oral health, keep them pain free and offer them a rounded service, even on the NHS and often to their own disadvantage. In short, they care.

Meanwhile the new alphas cherry-pick the sexiest and most lucrative versions of dentistry, know how best to access potential punters for those services and yet still want to claim all the benefits of their privileged status as professional people.

It seems not to occur to them that in reality they have abandoned that status in order to become part of the extended makeup department for wannabe Love Island contestants, influencers and Instagrammers.

Maintaining public confidence in the profession falls squarely within the remit of each country’s regulator, but under pressure from the influential consumerist lobby here in the UK, the GDC’s approach remains supine and hands-off in comparison to much of the developed world, from which we can learn important lessons.

Promotional regulations

For example in Hong Kong, the equivalent regulator to the GDC advises registrants that ‘promotion of dentists’ services as if the provision of dental care were no more than a commercial activity is likely both to undermine public trust in the dental profession and, over time, to diminish the standard of dental care’.

To underline and enforce that unambiguous stance, there is an absolute prohibition of any advertising or practice promotion that is designed to attract or solicit for patients, and/or designed to be persuasive in influencing the thinking or decisions of patients or potential patients. Similar prohibitions on touting for patients apply in Malaysia.

In Singapore, dentists are forbidden from seeking reflected status from any ‘celebrities’ they might have treated, while here again, strict prohibitions apply in terms of any activity designed to attract patients.

Dentists are specifically reminded that they are part of a healthcare profession, not of the beauty industry. Makes you think, doesn’t it?

Consumerism

In many countries, however, the consumer lobby is blind to any such distinction.

What the consumer wants, the consumer gets and dentistry is reduced to a mere commodity. If any profession ends up looking and behaving like a bunch of dodgy secondhand car dealers, that is supposedly a price worth paying for having an open market.

I’m not so sure about that. Members of a profession must have a collective responsibility to each other or we descend into a self-serving and grubby free-for-all, which will ultimately benefit nobody.

The challenge is that developments in society (and in technology) will always tend to move much faster than the regulatory legislation can keep pace with. Yet the regulators in countries like Canada, New Zealand and Australia as well as Hong Kong, Malaysia and Singapore are fighting an admirable rearguard action.

Similarly in Trinidad and Tobago, the council has been wrestling with these issues for several years now – with the support of the overwhelming majority of the profession (more than 90% in one survey) who supported stronger controls over professional advertising and more proactive enforcement of the standards to deter those who think the rules apply to everyone else – but not to them.

And yet exactly a year ago in Brazil, the Tribunal of the Administrative Council for Economic Defence (CADE) convicted and fined the Brazilian Dental Council (CFO) for prohibiting the use by dentists of group discount schemes and taking disciplinary action against offenders who violated the code of ethics agreed and published by the council.

This extraordinary censure was applied on the grounds that the council’s restriction made in the interests of professionalism was considered not to be in the interests of consumers, was anti-competitive and in breach of antitrust legislation.

Breathless

We are witnessing a pincer movement between the consumerist belief that paying less for something must always be a good thing, while people paying sky-high prices for procedures of doubtful benefit or which actually harm them is also a good thing if that’s what they want.

I almost stopped breathing when reading two recent articles in the dental press (read on, I hear you say). One of them – written by a dentist – argued that recruiting patients off the back of past successes posted on social media paid a double dividend, not just in the pocket but also in reducing time wasted on the consent process as the patients arrive already knowing what they want.

The other article was from a marketing ‘expert’ who set out a pathway to ensure that patients consistently ‘go ahead’ with ‘recommended’ treatment, based on past case studies showcased online and on social media and testimonials from satisfied patients, both of which could be enhanced by the use of AI and the skills of a digital marketing agency.

Not a single word in the article mentioned the consent process or the need for treatment to be beneficial (and not harmful) to the patient.

The old order

Patient testimonials and images of past cases are strictly prohibited by many dental regulators around the world, precisely because it is impossible to know if they are real, borrowed or fabricated.

In Australia, the regulator even defines the term ‘purported testimonial’ in case over-eager dentists couldn’t work it out for themselves. In contrast, pretty much anything goes here in the UK and our reputation as professional people goes with it – down the plughole right under the nose of the GDC.

If this is really the brave new world of UK dentistry, I am starting to appreciate the benefits of the old order (which I baulked against at the time, as much as anyone else).

Back in the day when the media consisted of print and only print, in its various forms, the (then) GDC made rules about the size of lettering and prohibited the use of bold type or ‘display’ advertising. The rules were slightly relaxed from 1989 onwards, but the internet changed everything in the years that followed and the GDC has struggled to keep up ever since.

I will leave the final words in the hands of Aldous Huxley and another quote from BNW: ‘What I’m going to tell you now,’ he said, ‘may sound incredible. But then, when you’re not accustomed to history, most facts about the past do seem incredible.’