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They best way to get new patients?

By | Uncategorized

This will be controversial.  Remember, at no time am I trying to tell you what to do, I am merely relaying an alternate way of doing things that MIGHT be relevant to your practice.  So it’s important to never believe a word I say.

In this blog, I’m going to talk about the majority of practice.  Although some of what I say will be applicable, I’m not really aiming it at specialist and cosmetic practice.  This is about your bog standard family practice that is struggling and wondering why the wrong patients keep walking through the door.

So if you are 100% happy with the types of patients you are attracting, you can stop reading now and put your feet up.  For those of you still with me…

It amazes me the way many practices are run.  If you want the proof of this, just talk to any dental accountant to get an idea of how many of their clients are in trouble financially.  Better still, just go on the tired old websites, websites that are promising the earth whilst forgetting what the majority of patients are looking for.  You will see:

  • Some will be poorly designed to the extent it would likely be better that the website didn’t exist
  • Great claims about the cosmetic treatments that can be provided
  • A promise of implants and adult orthodontics
  • Some sort of offer regarding tooth whitening

Try it now.  Go on google and type “family dental practice” and see what the first 10 hits give you.  Some will be great, others not so.  Yeah, so what’s your point, Steve?

Where is the USP?  How is your average New Patient supposed to distinguish between practices based on a website?  Now I have no doubt that some of these are bringing in customers, but that right there reflects part of the potential problem.  The problem is that the banners draped over practice exteriors, the thousands spent on search engine optimisation and the radio adverts that nobody listens too are a poor way to FILTER new patients.

In my opinion, websites et al are an overused way to attract patients, and I never used one in my 16 years of practice ownership.  I preferred to make things easier for myself.

The system I used was very simple.

  • Take a patient base and build trust and rapport. For those that this can’t be achieved, you invite them to seek their dental care elsewhere (these patients WILL be better served by seeking their care elsewhere).  This is why it can be difficult to apply this to a squat or a referral practice, although not impossible.
  • Deliver the four key components to successful practice. Health, competence, customer service and cleanliness.  Help keep your patients healthy (so no supervised neglect) using a high level of skill (ask your lab technician for honest feedback on the impression you send) in a clean environment with a clinical team that CARE for the patients and show it.
  • Repeat that until the trust is established in your locality.
  • Use your existing patients as your unpaid referral force.

How many of you, reading this, are actively asking your existing patients to refer new ones?  How many of you have a system to do this so that it is effective and unobtrusive?  And how many of you are seeing patients you don’t like and who don’t like you?

Now what normally happens here is either I get a load of abuse (so spare me, I’ve heard most of it) or I get excuses.  Some of the excuses are valid, others not so much.

So why is this so powerful.  Mr’s Miggins, who thinks you are fabulous is rarely going to jeopardise that relationship with your practice that she has established by sending someone she knows is going to cause problems.  People associate with people they like.  So instantly that acts as a filter.

Your website or your banner with your phone number on it doesn’t have that filter.  I’m not saying don’t use those techniques, what I’m saying is the patient referral system is a qualifying technique that removes a lot of the risks associated with new patients.

I went one step further in my practice, by making it DIFFICULT to join the practice.  Let me share with you the system:

  • Existing patient X is asked if they know of anyone close to them who needs a dentist
  • If they say yes, patient X is given a TIME LIMITED referral card for them to give to this individual. The card, which you write patient’s X name on, states that there is a limited availability for appointments and that patient X has persuaded the practice to give the new patient the chance of coming on board.  At no time does it promise an appointment
  • The card gives the new patient the instructions of what is required of them as well as the practice terms and conditions.
  • The new patient brings the card to the practice which allows them to pick up a welcome pack. We never mailed them.
  • Once the welcome pack is returned in full (MH, Diet diary, etc) then, and only then, is a new patient consultation booked.

Phew, sounds like a lot of work.  And what’s the point of it all?

Well, in my diseased brain, I need rapport with my patients.  By getting a personal recommendation from someone the New Patient trusts, that rapport and trust are easier to obtain.  By increasing the difficulty of gaining MEMBERSHIP, we also introduced filters to sift out the time wasters and trouble makers.  I don’t have the time to go into that here, but check out the research by Robert Cialdini.

Did I ever end up with white space in my day book? – Yes

Did I ever not meet my financial targets or meet my UDA targets – No

By recruiting patients in this way, you save a bucket load on marketing.  You are giving the new patient the choice of choosing you based on the recommendation of someone they trust (with the perception of exclusivity), or another practice based on what their website and marketing promises.

Which do you think is more powerful?  What do you think happens when you fulfil the four promises of health, cleanliness, competence and customer service on this patient?  Do you think they might also be willing to recommend someone?  And when you build trust and something goes wrong, you are more likely to experience a patient who will let you fix the problem instead of jumping for the lawyers or the GDC.

You can still do all the usual Instagram, Facebook and website testimonial malarkey, but if you aren’t doing this, then I would argue that you are losing out.

Oh and I never saw new patient emergencies.  That was my own personal decision based on with the almost impossible task of getting rapport, trust and CONSENT on people who are in pain when you are time limited.

I discuss this more in my latest book.  For those who are interested, there is still a chance for one person to win a free copy.  Just follow the link in the picture (the contest ends today)

https://kingsumo.com/g/668nmd/win-a-free-copy-of-my-latest-dental-business-book/m840njr?

Am I right, or am I just blowing hot air?

Why not let me know on my Facebook page at https://www.facebook.com/GdpResources/.  Just look for the post with this blog in it and comment below.

The wisdom of grumpy old wo/men

By | Uncategorized

Have you ever found yourself chuntering at things that, in the great scheme of things, don’t really matter?  I have, and I still find myself doing it even now.

And much of my pointless ire is aimed at unnecessarily bad customer service, or situations where a system or automated process is completely dysfunctional.  You know what I’m talking about, don’t you?

 

  • The sales assistant who feels the contents of his/her navel are the most important thing on the planet
  • The dental manufacturer that quotes you a price, only to then send you an invoice with an extra 20% lobbed on (VAT)
  • The automated telephone system that makes you press an endless array of buttons only to then cut you off
  • The computer that demands you jump through hoops of fire to prove you actually exist
  • The salesman (and yes, it’s invariably a man who engages in this) who thinks 1980’s sales techniques are still applicable in today’s world
  • The social media company that has no human point of contact
  • The [LARGE GLOBAL GENERIC ONLINE WAREHOUSE] delivery person whose personality was shat out by a rabid goat
  • The hand dryer in the gents toilets that is about as effective as an asthmatic badger exhaling through a hessian sack.

 

All little things, but they strive to promote stress and indignation in you.  So common now is this, that when we encounter it, it’s almost not a surprise anymore.  When the opposite happens, when the expected shite experience turns into an example of glorious competence, you just feel the need to tell people.  Take for example my recent passport renewal.  Expensive, but all done in a week.  No stress, no hassle.  What the hell were they playing at?  Same with the DVLA as well.  I thought her majesties government was supposed to send you mad with their incompetence.

Now transfer this to the field of dentistry.  I’ve seen good and bad practices.  It’s now getting to the stage where I reckon I can walk in and tell you within an hour if the practice is a success or of it’s facing a whole heap of problems.  The good practices, the ones that are thriving, the ones that keep the complaints away and the bank manager happy are the ones who focus on being the exception to the norm we see in this country.

  • The patients are made to feel welcome
  • The patients feel they can trust the dentist and the staff
  • The patients recommend the practice to their friends and relatives
  • The patients come to the practice if there is a problem, not the lawyers and not the GDC
  • The practice is based on honesty, service and good competent dentistry, rather than gimmicks, ego and how much money can be extracted
  • The practice builds relationships with the patients rather than sheep dipping them in and out of the dental chair.

Stand out in the right way, and the right people will flock to your door.  Ignore the “look at me, look at mine, look at how much better I am” social media presence of some in our profession.  It is an illusion, a whisper of what ethics could be and is also high risk.  You make a mistake in THAT kind of practice and you are rarely forgiven.

There are some who say I am wrong.  There are some who say Instagram and Facebook et al are the way to go in promoting yourself and your practice.  There are some who say you have to make a name for yourself, be seen to be a “key opinion leader” (whatever the hell that is).

I say you just have to do good dentistry, with an ethical foundation based around prevention and health, to patients who you like and who trust you.  Then the referrals of new patients just flow in without you having to spend thousands on a fancy website with all the bells and whistles.  I know this because it is what I did for 10 years.  I appreciate there is probably room for both flash gimmicks and practices that rely on word of mouth, and I know which one I’d rather work in with today’s litigious society.

Maybe I’m wrong.  Maybe I’m old fashioned.

What do you think?

 

SH

 

Will you pass the TEST?

By | Uncategorized

Financial freedom is being in a position to never HAVE to work another day to pay for your living expenses whilst having a fair degree of enjoyment in their life.  This isn’t to say you stop working, it is to say you have the OPPORTUNITY to do so should you wish.  They have enough money and investments to cover any foreseeable expenses on a day to day basis.

Imagine being in that situation.  Imagine being able to work because you WANT to not because you HAVE to.  Seriously, take a moment.  What does that mean to you?  The problem is that most of you reading this are not in this position, despite the income you can generate.

Why?  Because you spend it all.

Parkinsons Law:  “Expenses rise to meet earnings”

I’m going to tell you about two different people.  Their names, locations and jobs have been randomised, but they do exist.

Person 1:  He takes home £500,000 a year easily.  He lives in a big house and drives several flash cars.  His children go to the best schools and he wears only designer clothing.   Recently he decided to add an extension onto his house and had to take out a bank loan to pay for it.  Why?  Because he spends more than he earns and is cash poor.  He probably has less than £10,000 in his bank account and has massive amounts of debt.  He has more month at the end of his money and needs to work hard, long hours to pay for his lifestyle.

Person 2: He does not work for a living and retired from his profession at the age of 45.  He lives in a modest house and drives a car that is seven years old.  He never earned more than £100K a year, and yet his investments bring in enough to cover all his weekly outgoings.  He has no debt and if he decided to do nothing but sit in front of a TV for a month it would have absolutely no detrimental impact on his income.  Last year he decided to spend two months travelling around the far east with his wife.

Who is in the better position?  Who is the richer person?  Person 2 escaped the Wealth Trap and passed the test.  S/he spent less than he earnt and saved and invested the difference.   Yes, s/he never drove the Ferrari, but that’s because s/he realised, early on, that the rush from the expensive nick nack quickly wears off and often, the things you buy end up owning you (Thanks TD).

Western society is now specifically designed to keep you in debt and keep you running your little feet on the treadmill… and it’s all part of the test.  If you are a low earner it does this through high fees for the basics (like travel and mortgages) as well as sucking you in to buy things you don’t need, with money you don’t have to impress people you don’t even know.  For the high earner, western society does the same, only more so.   The more you earn, the more you are enticed to “treat yourself”, to buy things at great expense that will rapidly become worthless.

Remember I’m not talking about billionaires here.  Those are rare individuals that have a craving to succeed.  But the average person, starting at the age of 18 can get to a point where they retire a millionaire at age fifty-five.

“But you might get hit by a bus tomorrow”

Yes, you might.  You might also suffer countless sleepless nights because of your debt situation.  You might lose your job and rapidly become homeless because you have no buffer to fend off your expenses.  You might send yourself ill working a treadmill of your own creation.  You actually have more chance of winning the lottery than being hit by a bus tomorrow.

You as a dentist have another consideration.  The GDC.  They have the ability to strip you of your ability to make a living as a dentist.  So when you think about it, living the “High life” actually caries increased risk.  Don’ think it can happen?  It only takes one complaint, especially if it’s to the ICO.

If only life was easier some say.  Life is exactly how it needs to be to create excellence, because only the most tenacious, the most committed can succeed.  Yes, some people get lucky….but some people also get hit by a bus ;)

That’s why I write my dental books, to try and get this message across.  If you want to check them out, visit my author’s page on Amazon.  There’s even a dodgy photo of me on there so you can actually see what this ranting madman looks like

https://www.amazon.co.uk/Stephen-Hudson/e/B06XTSQXLZ/ref=sr_ntt_srch_lnk_1?qid=1546086142&sr=8-1

Have a great and prosperous new year.

SH

Life is actually pretty damned good

By | Members, Uncategorized

Humans often have a tendency to see the bad in everything.  Sometimes that strategy works.  A lot of the time though it can send you down a negative spiral.

Personally, I think the trick is to be able to see the weaknesses in the society around her whilst revelling in its strengths.  You don’t live in denial but you appreciate the heights of human civilisation.  You have to remember we as a species have never had it this good.  Despite what the GDC and the politicians come up with, we have a quality of life that the Kings and Pharos of the past would have killed for.  The toil of a thousand slaves can be replaced by the flick of a light switch..  So let’s have a look at the best humanity has to offer.

  • How’s about the 18-year-old kid who discovered he could use his 3d printer to make replacement limbs for less than a $1000.  This has revolutionised the provision for amputees and those where were born without said limbs.
  • Stem cell therapy allows us to cure 3rd-degree burns without scarring or pain
  • The deadliest viruses known to humanity are being used to cure cancer by the Mayo Clinic
  • The level of excellence our entertainment has reached is astonishing.  Remember the stale acting in those old black and white movies.  Look at the films and the TV series that are being created now, where people can be swallowed up in a thousand realities.
  • You have access to the totality of human knowledge and understanding at your fingertips.
  • Yes, we go on about SJW’s and political correctness, but that is because we have raised a generation who have never had to suffer the trauma of war.  In the West, we don’t have to wake up to the fear that our cities will be bombed from the skies or that our sons will have to die in the fields of Europe for our freedoms
  • I can buy food from over 100 countries.  I can also visit those countries for a reasonable price
  • We still have the fear of war, but the technology of warfare invariable always finds its way into commercial hands.
  • Technology seems to evolve to solve any problem we face.
  • The science of human excellence had never been so advanced.  From business to success to the Olympics, humanity keeps defeating the odds set against it.
  • The greatest minds of our civilisation can now share their ideas with the world
  • The technology available for you to do your job improves every year

Forget the cretins in Whitehall and the letter from m’leanred friends…just for a few days.  Maybe now isn’t the time to feel down, and I’m not stupid enough to forget that some people struggle at this time of year.  For most people though, if we figure out what you are grateful for and ask yourself if things really are as bad as we keep telling ourselves.  Remember, for some people to get clean water for their children, they have to make a five-mile round trip.  Some people live in fear of genocide and true poverty.  Even that will be solved as humanity makes its strides forward.

We just figured out how to create oxygen from chlorophyll without the need for plants.  Think what that means for space travel.

Just some thoughts to keep Santa happy

“The world is like a ride in an amusement park, and when you choose to go on it you think it’s real because that’s how powerful our minds are. The ride goes up and down, around and around, it has thrills and chills, and it’s very brightly coloured, and it’s very loud, and it’s fun for a while. Many people have been on the ride a long time, and they begin to wonder, “Hey, is this real, or is this just a ride?” And other people have remembered, and they come back to us and say, “Hey, don’t worry; don’t be afraid, ever, because this is just a ride.” And we … kill those people. “Shut him up! I’ve got a lot invested in this ride, shut him up! Look at my furrows of worry, look at my big bank account, and my family. This has to be real.” It’s just a ride. But we always kill the good guys who try and tell us that, you ever notice that? And let the demons run amok … But it doesn’t matter, because it’s just a ride. And we can change it any time we want. It’s only a choice. No effort, no work, no job, no savings of money. Just a simple choice, right now, between fear and love. The eyes of fear want you to put bigger locks on your doors, buy guns, close yourself off. The eyes of love instead see all of us as one. Here’s what we can do to change the world, right now, to a better ride. Take all that money we spend on weapons and defences each year and instead spend it feeding and clothing and educating the poor of the world, which it would pay for many times over, not one human being excluded, and we could explore space, together, both inner and outer, forever, in peace.” – Bill Hicks RIP

 P.S:  The price rise for my new book “The Secret World of Dentists” has been postponed till after Xmas.  Buy it on Amazon – https://amzn.to/2SeaHyZ

SH

 

 

 

 

 

The power of feedback…

By | Members, Uncategorized

Patients give you feedback every day.

Some of it’s useful, even when the feedback is negative because it allows you to look at what you are doing from their perspective.  And from my 22 years in the profession, I’ve come to the conclusion that it’s rare that what people say should be ignored…especially when you have worked to select a patient base you are in rapport with.  Trust and rapport will often give the patient the permission they need to tell you when you need to improve.

And that’s fantastic.

Sometimes though, the patient isn’t right for your clinic.  It happens.  Either the ethos of how you do things isn’t right for them, or your personalities just clash.  And even feedback from these individuals can give you a powerful insight into the road you have chosen to travel on.  Accept it and move on,

It’s the same with writing books, which I’ve been doing for nearly 10 years now.  Sooner or later, something you write is going to hit a nerve.

Take for example this 1-star review to Stephen King’s classic, “The Stand”

“I found this book heavy on religious content, where good and bad are the only shades of being. Add to this the jingoism of the survivors, who I would imagine would loathe all things responsible for their plight and therefore I believe that this book is 1320 pages too long.”

How about this 1-star review to Ulysses by James Joyce.

” I actually got as far as page 3, then somehow lost the will to live.  At least I tried!”

And then there is this classic 1-star review for Lord of the Flies” by William Golding.

Bad

 

Are these reviewers wrong?

Well no, far from it.  A review is their own personal opinion on what they have read.  You can be critical of any factual inaccuracies in their review, but other than that you just have to sit back and accept what is written.  Have you noticed though how some of the reviews can actually be witty in their own way, cutting sarcasm often used to relay their disappointment.  Sometimes the review turns into a personal attack on the author, and that too can be understandable.  When you read a book you don’t like, you often feel disappointed because you put time and money into the whole affair.  You sit down, get comfortable and plough into something that you are often quite excited about…only for the words to sour because it wasn’t what you were expecting.

In essence, you lose the readers trust.  You do that with a reader, you might get a nasty review on Amazon.  You do that with a patient and the penalties can be much more severe.  That’s why trust and rapport become so important and why I keep on saying that if there is no rapport, there should be no treatment (except for perhaps urgent care).

My latest dental book got a 1-star review right off the bat, and I think that’s great.  It highlighted the deficiency in my Amazon description and solidifies the controversial nature of what I’ve written.  Of course, if all it gets is 1 stars, then we know that maybe I’ve been blowing smoke up my arse and should thus stick to writing zombie novels :)

 

Time will tell

 

Dentist, heal thyself

By | Members, Uncategorized

When I qualified, long before the dark days of the UDA, there was a phenomenon known as the ‘Old Boys Network’ who worked amongst themselves to maximise any benefit they could get from the NHS system and from dental politics. I saw it first hand, and much of that has evaporated as the elders of the profession passed into retirement. It was generally a benign unofficial structure that didn’t cause much harm to dentists unless you somehow fell afoul of one of their number.

From my personal experience, it didn’t do much to improve the patient experience.

From a dentists perspective, things have changed in that regard, but not for the better. It would appear there is a growing trend for a hard-core of dentists who seem eager to throw their fellow professionals under the bus. They do this in numerous ways:

  • They try to use the GDC as a weapon in business disputes.
  • They will be overly critical of another dentist’s work, often encouraging the patient to sue their last dentist.
  • Some have even taken to taking screenshots of social media posts that they deem offensive, posting these off to the GDC in the hope the regulator will impose some kind of sanction. Is this really what the GDC is for?
  • They flaunt their wealth on social media, giving an unfair representation of the financial rewards that can now be achieved (the days when the majority of dentists could make an astounding amount of money from dentistry are long gone). This is potentially damaging to the egos of younger, more naive dentists, who often don’t appreciate that some of the wealth on display is either rented wealth or, more annoyingly, parental wealth.  The really successful people don’t need to show it off because they have nothing to prove.
  • Expert witnesses working for the GDC who don’t understand their remit and who feel they should be an advocate for the complaining patient, rather than an impartial expert. By their actions, they break the code of what an expert witness should be and risk unfairly ruining the lives of their fellow dentists. Although it hasn’t happened yet from what I can tell, there will come a moment when an expert witness gets sued for this, and then all hell will break loose. There have already been cases where expert witnesses, by failing in their duty, have been referred to the GDC. This all makes the profession, as well as the GDC, look bad.

Seriously, this madness needs to stop because it’s reprehensible, and anyone who does it for the wrong reasons should be ashamed of themselves.  It is damaging people’s lives and fracturing the profession into camps that actively attack each other on formats such as Facebook.

A GDC referral for some can have devastating consequences. I would remind the bus throwers (who probably aren’t reading this, to be fair) of the research done by Sarndrah Horsfall[1].  In a ten-year period, twenty-eight doctors killed themselves whilst undergoing fitness to practice procedures. Is that worth a petty squabble? Do you really want such a thing on your conscience? And also, do you want the social media scrutiny that such a case would create? … it would almost be inevitable for your name to come out as the instigator of the complaint. And no, I’m not saying registrants should refuse to abide by their whistleblowing obligations, but dentist-on-dentist referral to the GDC has to be made for the right reasons.

And all the while the government sits back and chuckles as we do their job for them, self-imploding and stripping ourselves of any semblance of our once-lauded professionalism.

Dentists are already starting to pick the bones clean and have ordered pudding.

If you want more on this topic, get my latest book “The Secret World of Dentists”.  The price goes up saturday.

 

[1] https://www.gmc-k.org/media/documents/Internal_review_into_suicide_in_FTP_processes.pdf_59088696.pdf

Defensive dentistry

By | Members, Uncategorized

When health care professionals feel their careers are at risk through any and all patient interactions, their practising profile changes. This results in an overall decrease in the quality of patient care for subsidised care (NHS, insurance) or an increase in cost for private care. Defensive dentistry results in:

  • Some dentists will write great essays in the clinical notes, mentioning the slightest aspect of the patient interaction. This takes time – time that could be spent treating other patients. It also makes it difficult to see what treatment has actually been done because it is lost in a sea of batch numbers and pointless minutia.
  • Private dentists find themselves having to write huge, multi-page treatment plans to explain the risk benefits of the treatment involved. This raises the cost of treatment for the patient because that time has to be paid for … no dentist should now be doing such for free in my opinion.
  • Some dentists will avoid what they perceive as high-risk procedures (high-risk with regards litigation and regulatory complaint), referring patients on to an already overburdened secondary care system or on to well-respected private referral practices. This means patients either wait longer for their treatment (often getting trapped in a back and forth ping-pong between disenfranchised healthcare providers), or pay vastly more for treatment than perhaps they were expecting. It also de-skills the profession, which loses the ability to deal with treatment that dentists considered routine just fifteen years ago. This hits the most vulnerable, because the affluent, and those with the will, can be seen quickly via the private specialist network existing in the country. This is what happens when the population of a country embraces an adversarial, blame-led legal system. So perhaps there is some substance to the saying ‘A country gets the dentistry it deserves’.
  • Dentists also start referring more with regards soft tissue lesions, due to the fear that they might ‘miss something’, swamping Max Fax departments in a deluge of biopsy requests, which means it becomes harder for genuine cases to be seen and diagnosed. Clinical intuition becomes drowned out by the fear of being negligent.
  • It will likely go to the American extreme, where full-mouth radiographs become standard (absent from the other extreme, the worrying trend in many NHS practices, where supervised neglect is embraced due to time and cost issues), so as to ensure absolutely nothing is missed, irradiating the population above what is clinically necessary.

 

So, how is the patient served by a regulatory and litigation framework that promotes this?  Until action is taken on those issues, dentistry in this country will not be the career is should be.  Whilst we as individuals can change and adapt to combat the threats being hurled at us, only the government can fix this by radical overhaul of health care regulation and negligence law.  The fact that they haven’t tells me they fund the present situation desirable.

 

Just a thought.

The ethics of water fluoridation

By | Members, Uncategorized

Introduction

Water fluoridation is a controversial topic to some people and has, over the decades since its implementation, promoted furious debate, even within the dental profession.  The idea that the dental profession is 100% behind water fluoridation is nonsense, as can be seen by online forums and social media posts.  It is credited by many as being a public health miracle but is castigated by others who see it as a danger to the public.  So before we start discussing the ethical basis for water fluoridation, I feel it prudent to first briefly outline the legal position in this country that allows for it.

I will admit that I have an inherent bias against water fluoridation based on my own beliefs.  I feel it is therefore ideal to see if my opinions stack up when scrutinised by the ethical principles and the available evidence.

 

Legal basis

Fluoride in the drinking supply occurs naturally in some areas.  In others, it has been artificially added, and in the UK, the first instances of artificial fluoridation was in the year 1955.  Watford, Kilmarnock and part of Anglesey were chosen as the first sites and a 5-year study done against three control sites.  The results of that study indicated fluoridation lowered the caries rate.  Prior to 1974 responsibility rested with local authorities as part of their duties for promoting public health.  However, in 1974 this responsibility was passed to the newly created health authorities.

In 1985 the government passed the Water (Fluoridation) Act 1985.  This act allowed local health authorities to increase the fluoride content in the water artificially and also outlined what public consultation was required.  Something I find interesting when it considered consultation, is that the act used the word SHALL instead of MUST which suggested that perhaps it wasn’t a mandatory requirement.  Still, the need for public consultation did see the implementation of fluoridation stall, and by 1990 less than 6 million people were drinking fluoridated water.

The 1985 act was possibly a reaction to one of the few court cases regarding water fluoridation.  In Scotland, McColl v Strathclyde Regional Council [1983] S.C. 225, Lord Jauncey found that “It was beyond the council’s legal authority to fluoridate, it might harm consumers, it constituted a breach of duty, and that fluoridation was supplying a medicinal product without the required licence”.  He ruled that that fluoridation should fall under the Medicines Act 1968.

The later consolidation of the 1985 act into the Water Industry Act 1991 sections 87 and 88 also impacted this.  It was under the Water Industry Act 1991 that the court case R. (on the application of Milner) v South Central SHA occurred. Here the judge determined that

Public opposition was only one argument to be weighed in the balance by a health authority in reaching its decision and could not trump any public health argument in favour of fluoridation

Possibly one of the causes of the lack of fluoridation was the wording of the actual legislation in both the Water Fluoridation Act 1985 and the Water Industry Act 1991, an idea put forward on the British Fluoridation Society website: “To a large extent, it was disagreement between health authorities and water companies over the meaning of the word ’may’ that blocked progress on fluoridation…

There were further amendments to the law by S.58 of the Water Act 2003.  The judicial stance that public opposition was not a deciding factor in water fluoridation was also adopted in further legislation that impacted fluoridation.  The Health and Social Care Act 2012 amended the Water Industry Act 1991 with the effect that responsibility for conducting public consultations on fluoridation was moved from Strategic Health Authorities (SHAs) to first tier Local Authorities with effect from 1st April 2013, taking everything pretty much back to where it started.  Interestingly, this statutory instrument required the local authority to judge both local support and also the strength of the scientific evidence whilst also considering the cost.  So we can already see some of the four ethical principles creeping into the legislation there.

Finally, we mentioned the 1985 judicial opinion that fluoridation the water supply was the delivery of a medicinal product.   The Medicines and Healthcare Products Regulatory Agency (MHRA) disagrees with this stance: “As drinking water is quite clearly a normal part of the diet the MHRA does not regard it (fluoridation) to be a medicinal product

This does contradict the European Union’s definition of a medicine – “presented as having properties for treating or preventing disease in human beings” – See infra, Article 1.2 of the EU Directive 2004/27/EC on Medicinal Products for Human Use.  This may however not be relevant two years from now. So because we have differing views, I am not able to reach a conclusion on this particular aspect.

 

Arguments for Water Fluoridation

It is unsurprising to find advocates for water fluoridation among the dental profession. But it is not just the dental profession. The American Centre for Disease control and prevention named water fluoridation one of the 10 great public health achievements of the 20th century.  The American Dental Association have set out the 4 main reasons why they recommend water fluoridation (although they provide no evidence to back up any of their statements).  These reasons are

  • Prevents tooth decay, protecting all age groups
  • Safe and effective
  • Saves money compared to treating tooth decay
  • Because fluoride is naturally occurring in some water supplies it can be deemed to be natural

But is there any evidence that it actually works?  This is an important question, because that will greatly impact the ethics behind its use.  There have been several major studies on water fluoridation, and the results have been inconclusive.

Jones (1996) argued that  “low levels of fluoride, less than 0.1 mg l–1, were associated with high levels of dental decay”.   The research done by Whelton and O’Mullane (2003) in Ireland also came to a similar conclusion: “The study shows that decay rates in Northern Ireland (un-fluoridated) are of the order of 50% higher than in the Republic (fluoridated)

A report by Public health England in 2014 found that 15% fewer five-year-olds experienced decay in fluoridated areas and that 11% fewer 12-year-olds experienced decay.  The report did seem to demonstrate that fluoridation is an effective preventative method for tooth decay However, not all the research found this.  For example, the Cochrane Review did a systemic review into Fluoridation.  They stated that “We did not identify any evidence, meeting the review’s inclusion criteria, to determine the effectiveness of water fluoridation for preventing caries”.

Also, the much touted York Review seemed to give a big thumbs up to water fluoridation.  However, when looked at more closely, the results were not as positive as were first thought.  As reported in the British Dental Journal (2002) The review was critical of the body of evidence that was identified.  The authors of the report even went so far as to write a follow-up statement to their review in the CRD (2003):

We were unable to discover any reliable good-quality evidence in the fluoridation literature worldwide. What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children’s teeth

Further research from Saudi Arabia by Dosari (2004) indicated that “There was no linear correlation between water fluoride level and caries experience”.  There are also arguments against water fluoridation, and we shall look at those as we examine the four ethical principles.

 

The key ethical questions relating to water fluoridation

To my mind there are several key questions that need to be answered

  • Is fluoridation mass medication, and if it is, is it acceptable to mass medicate a whole population in a way that makes it almost impossible to avoid without their full consent?
  • Do the benefits of fluoridation outweigh any risks?
  • If we are mass medicating, is it acceptable to do this when the dose cannot be controlled?
  • If the benefits are as described, is it acceptable to deprive fluoridation to those who could benefit from it?
  • Is it for the people to decide or the state?
  • And the most important question of all: does fluoridation meet the four ethical principles?

I will try and answer these whilst determining how the ethical principles relate to fluoridation.

 

Does Water Fluoridation respect the concept of autonomy?

For this essay, I will be utilising the Three Condition Theory of autonomy put forward by Beauchamp and Childress to assess whether fluoridation meets this ethical standard.  It would be very easy to get wrapped up in a long discussion on autonomy and whether fluoride is a medicine, but I think what would be easier is to simply accept that fluoride is added due to its reported therapeutic effect.

Intentionality: To meet this standard for autonomy the individual must intend to drink the water for the purpose of obtaining the benefits of fluoridation, even if that is only part of their intention.  If their intention is purely hydration, it could be argued that the addition of fluoride breaches this part of the ethical principle.  If I am thirsty and I drink water that is fluoridated, is my intent even remotely concentrated on the therapeutic benefits of that fluoride?

Understanding: Can the British population, whose average reading age is eleven, understand the proposed benefits of water fluoridation?  And what about people who have not been informed, who do not know the water contains fluoride?  When I bought my practice in 2000, I wrote to the local water supplier to ask if the water they supplied to my practice and the surrounding neighbourhood was artificially fluoridated.  Whilst they did show me that there had been 3 episodes in the last 6 months where the water supply was accidentally contaminated with faecal matter, they were unable to answer my question about fluoride. One would hope matters are different now, but how can the local authority ensure everyone is informed that the water they are drinking has been altered so as to provide a therapeutic effect?  What about people travelling to the area from a non-fluoridated area, businessmen and tourists?  If even one competent adult is drinking the water without the knowledge that it contains fluoride, surely this means again this ethical principle is breached.

Non-Control: There should be no coercion.  The problem arises in that we, as human beings cannot live without water.  It is a requirement for life.  So whilst there are alternatives available (bottled water, filtration systems), these are more expensive than drinking tap supplied potable water, and this discriminates against those of a lower wage.

Also, drinking is not the only way humans consume water.  We use it in cooking and bathing, and there is some speculation that fluoride can be absorbed through the skin, which negates its therapeutic effect. Unfortunately, there is very little that the average person can do to negate this aspect, thus should they wish to avoid fluoridated water completely, as is their autonomous right, it is almost impossible to do so.  This is one of the big arguments against water fluoridation, that it is mass medication of the population without consent, and that argument does seem to hold ground when scrutinised.

As fluoridation is now the decision of the local authority there is the argument that this is part of the democratic process.  But if that is the case:

  1. a large proportion won’t have voted for those representatives
  2. whilst there is a requirement for public consultation, there is no overriding requirement for the publics views to be the primary deciding factor on whether water should be fluoridated.

Is this not classic paternalism, the very opposite of autonomy?, Water is life, and so it can be strongly argued that the coercion, whilst not coming directly from the state, can come indirectly due to our inherent need to consume the product.  One cannot even use the principle of therapeutic privilege here, because the pop, on the whole,e whole could not arguably be harmed by being informed their water is fluoridated.

Up until now, we have been discussing adults who are competent to make decisions about their own health.  If water fluoridation is potentially paternalistic (even if it is more a soft rather than hard form), especially to those on a low income, what about children and those deemed mentally incompetent?  Who decides for them?  The state or those with either parental or legal responsibility?  Does fluoridation risk compelling the incompetent to drink fluoridated water?

My initial opinion, therefore, is that water fluoridation fails the ethical principle of autonomy because the prevention of tooth decay can be achieved by other means that allow for autonomous choice.  A counter-argument to this is that the very alternatives to water fluoridation may not be readily available to those with limited funds or limited understanding of the issues, and I will address this later.

And there is also another issue that comes to mind.  If Fluoridation is done for therapeutic benefit, then does this not set a precedent?  There have already been talks about adding other compounds to the water, for example, Lithium and Statins.  I believe that water fluoridation therefor also risks the nefarious slippery slope of paternalism that threatens the very concept of personal autonomy.  The argument that fluoridation is OK because it occurs naturally in some areas does not hold merit to me, because in its additive form it is far from natural, being in some instances an entirely different compound.

I am therefore in agreement with Cohen and Locker (2001) in their statement that “the demands of moral autonomy cannot be made compatible with what could be regarded as the involuntary medication of populations.”

 

Does Water Fluoridation respect the concept of Nonmaleficence?

Whatever else, we should do no harm, or the least harm to create the most benefit.  We will therefore need to investigate the safety of water fluoridation because any harm must be outweighed by the benefits (for example a dental anaesthetic injection can be uncomfortable, but it is preferable to the pain that can be caused by its absence).  There are a lot of scare stories on the internet about fluoride and water fluoridation.  The image in the mainstream media is far from favourable.  From conspiracy theorists like David Icke and Alex Jones, to conventional media like the Daily Mail, there is a message that fluoride should be avoided, with headlines like:

  • “Is fluoride good for us?” (Briffa)
  • “Is your tap water poisoning you? The troubling question on everyone’s lips as scientists warn fluoride put in water to protect teeth could spark depression” (Naish 2015)
  • “Fluoride ‘could give you bone cancer’ claim experts as they call for a halt to adding the chemical to drinking water” (Curtis 2015)

It is therefore important to examine the arguments made against fluoridation, which I think are best summed up by Peckham (2014) who suggested that the benefits do not outweigh the risks:

This review argues that the modest benefits of ingested fluoride in caries prevention are thoroughly counterbalanced by its established and potential diverse adverse impacts on human health

So what are the reported risks?

 

Cancer:  Opponents often claim that fluoridated water is carcinogenic in nature, and a lot of research has been done in this area.  From the research I have read, there is no evidence that there is any carcinogenic risk from fluoridated water.  This was a finding backed up by the York Review on page 58 of the report, stating that “from the research evidence presented no association was detected between water fluoridation and mortality from any cancer

Fluorosis:  Fluoridation causes fluorosis, there is no denying this, and this can vary from mild to severe.  The York Review found high levels of fluorosis, as reported on page 45: “The prevalence of fluorosis at a water fluoride level of 1.0ppm was estimated to be 48%”.  The question then arises, is this an acceptable price to pay for the reported benefits of fluoridation?  As there are alternative approaches to providing fluoride, and as tooth decay could better be addressed by removing the cause, local and central government has a challenge to say that this potentially disfiguring condition is an acceptable price to pay when children can readily access sugar so easily and so often.  As a professional, I am challenged by the lack of public information awareness campaigns, by the prevalence of vending machines in schools and the poor attendance of children at a dental practice.  To think that fluoridation is somehow a silver bullet concerns me.

Hypothyroidism: Professor Peckham, who seems to be an opponent of water fluoridation has done several research papers on the safety of fluoridation.  Whilst not proving a correlation, his 2015 paper did suggest there might be a link between an underactive thyroid and water fluoridation.  I could find no evidence to prove this link, however, and as such, I have chosen to reject this risk.

IQ: “The Nazi’s put in the water to the death camps” is an accusation often hurled at fluoridation, the idea being that it lowered the IQ of the inmates.  I have not been able to find any evidence that the Germans actually did this, but there has been a significant amount of research done on this particular aspect.  Mindal (2016) found that “Children residing in areas with higher than normal water fluoride level demonstrated more impaired development of intelligence and moderate dental fluorosis.”  Sebastian (2015) found that “School children residing in an area with higher than normal water fluoride level demonstrated more impaired development of intelligence when compared to school children residing in areas with normal and low water fluoride levels”.  And Anna (2012) also found that “In conclusion, our results support the possibility of adverse effects of fluoride exposures on children’s neurodevelopment”.  All these conclusions, and dozens more like them, have come post York Review which found that there was no effect on intelligence.

Skeletal Problems: On page 53 of the York Review, the authors showed they found no evidence for this risk, and that there were no associations between water fluoridation and hip fractures.

 

Much of what is put out by the anti-fluoride lobby is pure fiction and scaremongering.  They tout the fact that fluoride is a poison but fail to mention that poisons are dose-dependent.  From an ethical stance, we are purely concerned with whether the benefits outweigh the risks. It is my personal opinion that they do not.  It is an imperfect means to provide a benefit which has dubious evidence for its efficacy at best and where there is clear evidence that it can cause harm.  Is it right for the population as a whole to accept those risks for the reported benefits?  I would argue it is not and I feel that I have no option but to take the stance that fluoridation fails the ethical test when it comes to Nonmaleficence.

 

Does Water Fluoridation respect the concept of Beneficence?

This theory advocates that the best interests of other people are met.  A moral society should do whatever it can to protect and ensure that the next generation (the children) are allowed to grow to their true potential.  I mention this because it is primarily children that fluoridation is aimed at.  However, one cannot escape that, in trying to perform this beneficent act, the fluoridation of water is an imposition on the population at large, with a disproportionate impact on those with lower social status, what some would call the working class.  It thus creates a definite conflict with personal autonomy.  Perhaps a better alternative that respects both autonomy and beneficence is the use of public health campaigns like free toothpaste and supervised brushing in schools.  These directly involve the people involved through education, direct delivery and supervised care, rather than the more haphazard, shotgun blast approach of fluoridation.

Advocates of fluoridation would argue that this treatment benefits everybody equally, but this does not answer this conflict between autonomy and beneficence.  This also presupposes that the benefits of fluoridation have not been exaggerated.  The available evidence seems to indicate that there is a reduction in dental caries experience in fluoridated areas, but the proof is far from definitive, mainly due to the poor quality of the available research.  Really, therefore, before we can show that fluoridation can be used for the benefit of all, the evidence needs to be there.   I do not feel that the benefits significantly outweigh the risks already discussed with the available evidence.  Prove to me that it works, then we can have a proper debate.

Tooth decay causes pain and suffering, but it is rarely life-threatening, and even if the evidence behind fluoridation is to believed, it is not a cure for the disease.  It merely lowers the risk.  Once cannot use the arguments that would be used to combat national medical emergencies because caries is rarely a threat to life. It may be considered that we have a moral duty to protect those who cannot help themselves (children) but is it for the state to do this in this fashion for something that, as we have seen, has been proven to cause definite harm?  Most of Europe has seen marked reductions in caries rates over the decades without having to resort to water fluoridation, something that has been seen across this country also.  I feel the best interests would be met by a national dental public health campaign, with the empathise on sugar reduction.

 

Does Water Fluoridation respect the concept of Justice?

There are different theories on justice, and there is little room for me to discuss them in this assignment in great detail.  When we come to the four traditional theories of justice:

  1. Utilitarian theory, which states that the greater good goes to the greatest number of people, it would seem at first glance that fluoridation meets this (if we assume it is effective)
  2. Libertarian theory favours an individual’s rights. Clearly, fluoridation contravenes this.
  3. Egalitarian theory, which states that people should be treated the same. Yes, they all get the same water supply, but do we all take delivery of it in the same way?
  4. The Communitarian theory asks “is what I am doing make society better?” It is all about the good of society

In basic terms though, Justice is concerned with fairness and equality.  Is water fluoridation a just way of distributing resources?  Well if it works, then it will reduce dental caries.  Roughly forty-five thousand, six hundred children had teeth extracted in hospital under general anaesthetic in the 2013-2014 tax year in England, costing tens of millions of pounds.  This was also theatre space that could have been used for other conditions, thus stretching available resources and delaying operations.  For a condition that is predominantly preventable, this is an unacceptable burden on socialised medicine, not to mention the burden it imposes on the young bodies undergoing the procedure.

Surgical intervention is always going to be the more costly form of dealing with the problem.  But it is very easy to concentrate on tooth decay, rather than what is causing it, the predominant causative factor being dietary sugars.  As we know there is a recent surge in empathise that sugar is a cause of a great many of our ills.  Heart disease, high blood pressure, obesity and diabetes are all linked to high sugar intake and wreak havoc within the health service costing it billions.  Whilst water fluoridation (if the advocates are to be believed) reduces caries and thus saves money from dentistry, does it perhaps add a perverse incentive?  An understanding of human nature might suggest that, if people felt that there was some “magical” protective chemical in their water, they might not be so inclined to reduce their sugar intake, thus increasing the risk of other, more serious diseases.

Fluoridation might not be as fair as we think.  From a cost perspective in treatments avoided and the relative cheapness of its implementation (Studies in the USA show that, in 2017, fluoridation costs an estimated $1.04 per person-year on the average) it may appear at first glance that it might be the most cost-effective use of available resources (reportedly lowering surgical intervention for tooth decay).  It could, however, be argued that this cost saving is offset by the later need to intervene and treat fluorosis.  This might not even be an impact on the public purse, because as we hear time and again from the NHS (NHS Choices. 2017), cosmetic dentistry is not generally available.  So if the state is not willing to repair the damage caused by their intervention, is this not again impacting the lower social classes?  Where is the fairness there?

 

Summary

One of the conclusions I have come to is that fluoridation is a form of mass medication.  It is not an essential nutrient; in fact, the human body limits the amount in human breast milk no matter what the concentration of that consumed by the mother.  The only reason to add it is for its therapeutic effects. And I would argue that no health professional would want to prescribe a medication without some means of controlling the dose.  This cannot be done with water fluoridation.

So to answer the highlighted key ethical questions:

1) Is fluoridation mass medication, and if it is, is it acceptable to mass medicate a whole population in a way that makes it almost impossible to avoid without their full consent?  From the research I have done I would argue that it is.  Whilst beneficence is often placed above autonomy when it comes to matters of public health, they have to be taken together with the other ethical principles.  With the harm that is potentially caused, and the lack of any definitive evidence, I cannot see how the autonomy of the individual can be overridden through mass medication that allows the wealthy to escape its impacts should they wish to.

2) Do the benefits of fluoridation outweigh any risks?  No.  I feel that the evidence for fluoridations benefits are poor, whilst the evidence for its evident risk of harm are strong.

3) If we are mass medicating, is it acceptable to do this when the dose cannot be controlled?  For fluoridation to be effective, the water has to be consumed, and like with any medication that is taken outside of direct medical supervision, there is no way to control this.  So there is no way to determine if the people it is aimed at are even drinking it.  I have often heard the comment from a parent that their child “doesn’t drink water”.  Whilst at one part per million there is very little risk of overdoes from the water itself, we have to remember this is not the only source of fluoride, and that the effects could be cumulative.  If we are going to argue that fluoridation is a form of medication, then it’s dose must be controlled, and this cannot be done through the public water supply.

4) If the benefits are as described, is it acceptable to deprive fluoridation to those who could benefit from it?  Fluoride is limited in breast milk and it is not an essential nutrient suggesting it is not required for health.  To just rely on water fluoridation is lazy and risks being ineffective.  From an initial cost benefit it appears attractive, but as I have stated, I believe that this in itself is a form of inequality.  To use the emotional argument that its “for the children” deflects from the public duty that we as a society should be doing more for our children than dumping fluoride in the water they might not even be drinking.  I think it actually risks harming proper oral health delivery.

5) Is it for the people to decide or the state?  Our constitutional monarchy states that the people, through their elected representatives have the final say in how the country is run.  However, it is fair to say that the average person, with a reading age of 11, might not be able to understand complex medical issues and that policy should be guided by experts in the field.  Until definitive evidence is discovered the proves water fluoridation works however, I feel it is for local populations to decide on fluoridation.

6) Does fluoridation meet the four ethical principles?  From what I have found, I don’t believe it does.  It definitely doesn’t meet the principle of autonomy.  Its lack of clear evidence puts a question mark on its beneficence and the fact that it has been proven to cause harm indicates it fails the Nonmaleficence test.  I could not reach an opinion with regards to Justice.

 

I Therefor reject the concept of water fluoridation as unsound when based against all four principles of medical ethics.

 

 

Bibliography

American Dental Association.  5 reasons why fluoride in water is good for communities.  Available at: http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/5-reasons-why-fluoride-in-water-is-good-for-communities (Accessed 24.04.17)

Anna L. Choi,1 Guifan Sun (2012).  ‘Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis’. Environmental Health Perspectives 2 volume 120 | number 10

Briffa, D. http://www.dailymail.co.uk/health/article-71246/Is-fluoride-good-us.html (Accessed: 24.04.2017)

British Fluoridation website.  Legal aspects and decision-making.  Available at https://media.wix.com/ugd/014a47_843402a2d7b740a79307b32f038cec11.pdf (Accessed 01.05.17)

Buachamp T, Childress J (2013)  Principles of Biomedical Ethics. Oxford University Press, 7th edition

CDC (2001)  ‘Centers for Disease Control and Prevention.Recommendations for using fluoride to prevent and control dental caries in the United States’. MMWR Recomm Rep. 50(RR-14):1–42. PMID 11521913.

Centre for Reviews and Dissemination (2003) What the ‘York Review’ on the fluoridation of drinking water really found Originally: 28 October 2003 A statement from the Centre for Reviews and Dissemination (CRD). Available at https://www.york.ac.uk/media/crd/Fluoridation%20Statement.pdf (accessed 24.04.2017)

Cohen H, Locker D (2001).  ‘The Science and Ethics of Water Fluoridation’. J Can Dent Assoc 67(10):578-80

Curtis, J (2015)  http://www.dailymail.co.uk/news/article-3374613/Fluoride-bone-cancer-claim-experts-call-halt-adding-chemical-drinking-water.html#ixzz4fA5rR1mp (Accessed 24.04.2017)

Das K, Mondal NK. (2016). ‘Dental fluorosis and urinary fluoride concentration as a reflection of fluoride exposure and its impact on IQ level and BMI of children of Laxmisagar, Simlapal Block of Bankura District, W.B., India’. Environmental Monitoring & Assessment 188(4):218.

Dosari, A etal (2004) ‘Caries prevalence and its relation to water fluoride levels among schoolchildren in Central Province of Saudi Arabia’. Int Dent J. 54(6):424-8.

EU Directive 2004/27/EC – http://www.biosafety.be/PDF/2004_27.pdf, accessed 02.05.17

Health and Social Care Act 2012, London:  The Stationary Office

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Peckham S, Lowery D, Spencer S (2015).  ‘Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water’ J Epidemiol Community Health 69:619-624.

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Sebastian ST, Sunitha S. (2015). ‘A cross-sectional study to assess the intelligence quotient (IQ) of school going children aged 10-12 years in villages of Mysore district, India with different fluoride levels. Journal of the Indian’.  Society of Pedodontics and Preventive Dentistry 33(4):307-11.

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The Void

By | Non registered, Uncategorized

Hello again

This will be the last newsletter in this format that you will receive. Next Friday my new website goes LIVE, and the newsletters will be delivered via a different system. You will each receive an opportunity to become members to the new site, which will allow you continued FREE access to this newsletter, plus the new newsletter archive that will be available.

It’s been a long time coming, let me tell you. I had planned this revamp three years ago, but life got in the way. But when life kicks you, you just have to get up off the floor, dust yourself off and fight back. Because if you stay down on your knees…. well, you just make a much easier target.

“Never, never, never, never, never give up” – Winston Churchill

This is why I preach what i preach about saving and investing rather than spending every last penny you have and more besides. If you have a financial buffer set aside, it makes it easier to deal with the shite that life can throw at you. Worrying about money is the last thing you want to be dealing with in times like that.

But, I’m getting side tracked. With the new website comes a brand new product with another 3 in the pipeline. The new product is a 6 month personal development course that comes with 6 hours of verifiable CPD. I will be adding vCPD to most of the new products as well, to help you guys deal with the ever growing burden being put upon your shoulders. Of course what I discovered was just how bizarre the CPD requirements of the GDC are. They don’t actually check the course content or the course organisers. They are not prescriptive as they say. Now where have I heard that before…….

Ah yes, the CQC

Have you noticed that they haven’t actually told you exactly what evidence they want to see for proof of compliance? Have you noticed you are having to employ the services of third parties to help gather this evidence. How the hell can you have a contract (which is effectively what registration is) between 2 parties, if the party that has the power to impose sanction doesn’t tell the other party EXACTLY how they are to comply? Now I’m no expert, and that sounds like breach of contract to me.

I believe this has been done deliberately. It’s the same reason you can’t go a week without breaking one of many laws out there, laws that you may not have even known existed. It is done deliberately to control you, to keep you watching the great box ticking exercise whilst the real agenda is unfolding behind the curtain. And this isn’t the CQC’s fault, they are victims here as well. They have had the Health and Social Care Act dumped on the from a great height, and I actually think they are doing the best they can with the resources they have. So you can get angry at them if you want, but all you will be doing is shooting the messenger.

But why do I say it is about control? Well, you see governments don’t want a financially independent middle class with time on their hands to engage in critical thought. They want you busy busy busy jumping over hurdles and leaping through ever smaller hoops of fire, sucking up the opinions and the advertising hypnosis from your TV. They want you worried and cowed, living in fear so that you don’t cause them too many problems. They want you in debt, so that you will bow down to your corporate and banking masters.

“Crikey Steve, what on Earth have you been smoking?”

This isn’t some great conspiracy. It isn’t men in suits in a smoke filled room plotting the overthrow of the free world. It is just a natural progression of democracy, where the gravy train requires more and more of the public’s money to finance itself. Unfortunately there comes a point where there is no more money, and we are close to that now. The so called Austerity cuts are a mirage, an illusion. If they were really serious about cutting the budget, they could cut £100 billion a year, without removing one single part of the socialist benefit system……. but of course it would mean decimating the tracks of the elite’s gravy train. And that isn’t going to happen, so they do the next best thing. They take more money from YOU. And YOU let them.

Now some people will look at their rising taxes, burdensome red tape and obnoxious officialdom and will get angry. Some will be overwhelmed by fear and despair. This is the reaction the Powers That Were want from you. They want you ranting and quivering in your boots. They want you to write them nasty letters and to fear the post man. Those who are afraid will not listen to those that are angry. And those whose faces are red with fury will do little when push actually comes to shove, as we have seen time and again. The protestors always go home. Only when people get absolutely desperate, only when they are close to losing everything, only then do they lose it. And whilst we will see protests and riots over the coming years in this country, the Powers that Were will do everything they can to keep the middle class just above the threshold of losing it, because they know that every revolution in history has been instigated by the middle class. The Powers that Were have learned much from history. I wish them luck with their balancing act.

No, some say what the Powers that Were fear are those who look at them with a cold critical eye. Who smile knowingly when they release their latest fear propaganda, who shake their heads in amusement at the latest regulatory noose. It is said that they fear people who read books, and who don’t get trapped in dogma and mindless opinions of topics they know little about. Perhaps they fear those who can calmly see through the spin, through the lies to uncover the real agenda. Maybe what they truly fear is that the middle class will start to reject the system itself, will reject the whole concept of a constitutional monarchy. We give them their legitimacy, we give them the right to rule. But they can only do that if the social contract exists. Without the middle class, the system will not work, will not function. The wheels will not be oiled, and the gears will not be greased without the middle class. And that is what they fear the most, that their precious system will grind to a halt. And I for one would not want to see the system fail. Despite the inequality, despite the corruption and despite the festering cancer at its heart, the benefit privileges of the society still vastly exceed the realistic alternatives. I am happy to admit that I am invested in the system, even though there are parts of it I despise.

So the Powers that Were will play their games of control and manipulations. I say let them have their games, you don’t have to take part. Switch off your TV. Shut down your computer. Throw away that newspaper. They will play groups off against each other, and parade their nobility across the media, but you won’t be watching. Remember, living in fear and anger does nothing for your health. You can’t make effective decisions in this mindset

So let me ask you this question. When was the last time you just sat, eyes closed, and did nothing for an hour? No talking, no distractions, no TV, now video games. Just sat, and listened to the gentle wind, to the tree branch caressing the window. I challenge you to find time to do this over the weekend. Just sit and ask yourself questions and wait for the answers to come. In other words, relax.

Victor Frankle, the Jewish psychiatrist who survived the German death camps proved that it is an individuals choice how they react to events. Living in fear and anger are a choice you make. It is not the CQC, the GDC or the lawyers that make you afraid. The one doing the fear is YOU. Why would you do that to yourself?

So just sit, breathe deeply and slowly. There is time for fear and anger, but it isn’t now. Now is the time to be still, and to realise that in the great scheme of things, none of it actually matters. It doesn’t matter at all.

Yours in commerce

Stephen: Hudson the authorised representative for the legal fiction Dr Stephen Hudson BDS, MFGDP, DRDP

May you live in interesting times

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Hello again.

We have reached a point in our civilisation where government no longer works. Government has become ineffective, bloated and dangerous. The wheels move slowly and churn up anyone who is unfortunate to get in the way. The more government sticks its nose in, the more barriers there are to progress. More and more boxes have to be ticked, which means there are less and less people available to oil the wheels. Eventually, they will grind to a stop and we will look out at a society strangled to death with red tape.

It’s happened before. It will happen again.

It is my firm belief that there are 3 books everyone should read.

Atlas Shrugged by Ayrn Rand

This book explores the concept of what happens when government becomes a bloated bureaucratic nightmare, where progress is stifled and society collapses under the weight of red tape.

1984 by George Orwell

This book explores the final stages of totalitarian government. It shows how evil straw men are used to keep the population in fear and justify oppressive domination of the populace. It introduces us to the concept of Newspeak where the meaning of words are reversed to instil Cognitive Dissonance. Everyone is watched, and the truth is changed at the whim of a faceless official.

Brave New World by Aldous Huxley

This book explores the ultimate corporate dream. People are grown in vats to become wards of the state, brought up to believe that material goods are the centre of happiness and that emotional connection with other human beings is to be avoided at all costs.

Of course our present world is nothing like those three book, but we are starting to see snippets of their teachings emerging in our society. Here are two examples:

Bloated government

As an example of how ineffective government has become, we need only turn to that small hole a mile down in the Gulf of Mexico. The Governor of Louisiana has, for the last month been trying to get oil extraction barges sent out to the gulf to suck up the oil threatening the coast. The barges are there, the people to man them are there, but they are sat in port. The reason being that, even though the Governor is supposedly in charge of the state, he is powerless against a myriad of Federal agencies that keep stepping in the way to beat their chests and display their incompetence. The fishing and tourist industries of over 4 states are very close to being wiped out for the foreseeable future.

Corporate incompetence:

Allegedly (got to be careful about those lawyers now don’t we) it is reported that there were problems with the well head and the casing weeks before the explosion that killed eleven people and resulted in the worst environmental disaster the USA has ever seen. It is also alleged that BP knew of this problem, but actually cut corners and ignored basic safety controls that had been long established. Now we have millions of gallons of oil collecting in huge plumes under the surface of the Gulf killing the entire ecosystem. And the oil keeps coming, despite what you hear on the news. There are alleged reports that the drilling well casing is fractured a thousand feet below the sea floor, allowing the oil to escape through fissures in the sea bed…… miles away from where all BP’s cameras are.

There is a lesson here, our society needs to change. It no longer works to the benefit of the planet and mankind. Yes you can go to the computer store and buy the latest gadget, but you don’t really need one. We are manufacturing useless objects (that are NOT made to last) with an ever dwindling resource base. Despite seeing the truth of things in 2008 we are still trapped in the illusion of infinite growth. Spend spend spend is still the mantra that millions adhere to.

Buying things will not make you happy…… most people learn this eventually, even if it’s just subconsciously. And yet most of us still continue doing as we did before.

It’s a sign of madness. Our society is clinically insane

The slight challenge that has occurred in the gulf is due to us wasting resources. America consumes 25% of all the world’s oil. They live in huge suburbs which could not exist without the motor car, fuelled by cheap petrol. The fact that we are now trying to get oil from under a sea bed 5000 feet down shows how desperate we are getting to keep our madness going. Our society can only survive on cheap plentiful oil…..unfortunately we’ve used most of that up already. Now we are left with the hard to get, dangerous to extract stuff.

We therefore have 2 choices

We can revel in our madness and ride an inevitable collapse down into resource wars, totalitarianism, and societal break up

Or we can realise that now is the time to change, whilst we still can. And we are the ones who have to change. Government won’t, corporations won’t. We have to be the change we want to see in the world. We have to accept that infinite economic growth is not possible. We have to accept that some time in the future the oil will start to run out. We have to accept that it is better to take the pain now whilst we are still able to survive. That way we can come out stronger than ever.

Mine is not a message of doom and gloom. There is enough of that on the internet already. And I am not going to tell you what you should do. I am merely here to show you two paths. Which one we take I leave up to you.

It’s up to us. It’s up to you. If we do nothing, if we take the easy path of doing what we have always done, it’s highly likely that we may not be there to witness the consequences of out inaction. But our children will. And they will be far from pleased.

What kind of a legacy do we want to leave our children?

Warning – Opinions enclosed

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Hello again

It’s another week in austerity land, and our glorious leader (who has replaced the previous glorious leader) is asking for your opinions. Yes that’s right, they want to know what you THINK. It’s like a huge country wide version of that pointless programme “Question time”.

Your government would like you, the public to nominate laws and regulations they would like to see abolished. It’s all Radio 4 seem to be talking about at the moment, and it’s absolutely masterful.

Masterful?

Yes, masterful. The British public (especially the middle class) loves to chunter. We might not be any good at football, but boy can we tell you our opinions. Well here’s my mindless opinion………….. nothing will come of this.

It’s a smoke screen. It’s a way of saying “See, we are listening.” Yes they might alter one or two things to try and prove this exercise had a point, but no great changes will amount from this. It is simply a tool to divert your attention and give the media another means to tell you how to think.

You didn’t think this was being done for your benefit did you? Hell, I even found myself getting wrapped up in the spin…….. for about 5 minutes. But that’s the amazing thing about radios, they come with off buttons. If only we used them more often. Now how’s that for an opinion?

You see, we are about to enter a very difficult period in the history of this country. If you think the public spending cuts being proposed are harsh, well you aint seen nothing yet. These are just the appetisers, mere canapés. The main course arrives next year.

For a while there, I actually thought the government was going to try and hyperinflate away our debt. But with billions being pulled from public spending, and banks still refusing to lend, the numbers show we are heading in the opposite direction. That’s not my opinion by the way, just the opinion of someone else who claims to know how to read the numbers.

Deflation seems to be where we are heading. And that’s fine if you haven’t got any debt or don’t own any assets, because with deflation, cash is king.

Could I be wrong here? Hell yes. I’m wrong all the time. And it would be nice to imagine that the economy can tick over as it has been, but that isn’t going to happen, not in the short term. In the short term, millions will be made unemployed, the economy will shrink and your public services will suffer. I know this because it said so on Radio 4 yesterday ………….. erm, hang on.

I know that opinion sounds bad, but it’s better than the alternative. Inflating and debasing the currency would have been a disaster…. in someone else’s opinion. It would have been like trying to cure an alcoholic by getting him drunk. Our debt must be repaid before it gets too big to service. If it gets too big to service, we go into default, and then the currency goes down the toilet….. along with any and all of your wealth. And think of the opinions the population would have about that.

As an example, just do a bit of research into what happened in Argentina. The middle class were destroyed. At least in deflation there will be a middle class left in this country.

Does this mean I agree with the Tory spending cuts? No! I don’t think they are cutting enough, and where they are cutting is in the wrong places. But then that statement is based on my opinions…… most of which aren’t actually mine. They were “borrowed” from the minds of others and lumped together into something I claim to be mine. My knowledge of economics is limited, so really, how the hell can I have an opinion that is actually valid?

I can’t. And that’s the point that most people don’t realise. Most of our opinions are meaningless. But then, that’s just my opinion.

Ok, ok, enough. I hope you see what I am trying to do here. I am merely trying to point out that most of our opinions aren’t actually ours. They were given to use by someone or something. Now ask me how to do a composite, that’s something I can have a valid opinion on. Why? Because it’s my field of expertise and I do them daily. But ask me about Climate Gate or whether I should be using plastic bags for my shopping and really have no idea. Whatever I say would merely be a guess based on the information I have collected over the years.

And my opinions change constantly. What about yours?

One of my opinions that has not changed is my belief in the importance of systems in business. I know I’m preaching to the converted (I know because my records show that most of the people reading this have bought my Practice Systems Templates, and in 5 years only 1 person has ever asked for their money back), but systemisation is key to the smooth running of your practice. Yes you can still make money without them, and yes you can still enjoy dentistry, but systems make things so much easier.

But why make things more difficult for yourself? Doesn’t make any sense to me.

Keep smiling

The CQC

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Hello again

As you may be aware, the CQC will soon descend upon us. Unfortunately for you lot, I have a small problem with the CQC. Whilst I admire the idea logic behind protecting the public, the CQC in my eyes is not about protection, Quangos never are. It is about increasing the power of government and those connected to government, whilst tightening the regulatory noose around the neck of the profession even further. I say government, I doubt those we elected actually know what is going on. The wheels of the civil service are just rolling on from the last administration regardless. I would like to think that the present administration would stop this juggernaut in its tracks if it new the truth.

You have to remember, this isn’t just us this is happening to. Virtually every industry is having regulation after regulation dumped on it from a great height. And I don’t even blame the CQC. From where I’m standing, they are as much a victim as anyone here. They have been tasked with something they are ill prepared for, and have little in the way of understanding about what dentistry actually entails. Much of the problems that will arise will do so because they don’t understand what it is exactly that we do, but the registration rolls out regardless. They, in their eyes, have a job to do and the growing aggression and resentment from the profession will only harden their stance. And they haven’t even gotten to the doctors yet.

However, with that being said, there is something you have to remember. The government doesn’t care about you, it only cares about itself. It only cares about feathering it’s own nest and about justifying itself by exerting more and more control to counter perceived threats.

And despite my mention of growing aggression from the profession, really most of us do nothing. We bend over and take it. Some of even ask for more.

But let us for a moment look at the big picture. There are 600 people who are signed up to this website, most of them being dentists. And I am talking to you all when I ask the following question.

What kind of a country do you want your children to grow up in? Do you want a country where they are free to speak their minds, to express their ideas, to go about their business with the minimum hassle from government pen pushers and their lackeys? Or do you want them tagged, monitored, cowed and conformative, where they dread the day agents of the state nock on their door and say “Citizen, your papers please”?

Which do you want? Because now it’s time to choose. Yes that’s right, you have a choice in the matter. You can bow down to the CQC and let them descend upon you twice a year like locusts, or you can tell them NOW that their regulation is not needed. You can let them know what you think, they are after all inviting you to do this. So have you? Have you been to their website and told them what you think, given them your ideas?  They have aafter all ASKED you to do just this.

So here is a proposed action plan:

  • Write to your MP and tell him/her that the CQC is unwanted, dangerous to the public unless it is properly run and an unnecessary burden
  • Contact Tony Jacobs at tony@jacobs.net who wants a list of names to go along with a letter to the editor of one of the big newspapers.
  • Read the Health and Social Care Act 2008
  • Take their issued guidance and ask for them to send you a copy in a form of English you can understand. It is incomprehensible.
  • Research what they are proposing. Does it breach anti competition rules? Does it breach the EU human rights legislation?
  • Write to the head of the CQC and tell them that much of their proposed regulations are already covered by our existing regulator the GDC. Ask for clarification on whatever points you do not like.
  • Write the GDC and tell them the same.
  • Go onto the CQC website and engage them in their consultations.
  • Go to the upcoming meetings and ask the CQC representatives questions.
  • Write to the newspapers, to Private Eye, and let them know that the CQC are a risk to the public and will reduce access to dentistry.
  • Write to the BDA and insist they do more to counter the CQC or you will cancel your membership

Or you can sit on your hands, and moan into your beer in a years time

And now here is your warning. The proposed actions, if done as an individual will put a big spotlight on you, and you do them at your own risk (see the disclaimer for this website). You will be noticed. Files may well be opened on you, and you may come under scrutiny. You may even go to the first in the line when it comes to inspections and investigation. Men in overcoats and hats may follow you down the street when you pop for a chip butty (ok, ok, that won’t happen). Who can say? What I can say is that sitting on your hands doing nothing is the safer, and easier option….. at least for you, at least initially. But what about your children? What about ten years from now when there are two more regulatory bodies just as damaging, just as unwarranted and just as expensive? When the regulation affects other aspects of your life and the life of those around you.

“Oh come off it Steve, the CQC are hardly the Stasi”.

No they aren’t. Most of the people working there are decent, honest individuals who are just trying to make their way through life (as evidenced by the low satisfaction ratings people have with working for the CQC). They are not the Stasi, the KGB or the CIA. They are, to some however, a symbol.

A symbol?

A symbol of what this country has become. A symbol of where this country is going. It is a symbol of where you as an individual can make a stand, now, in this instant. A stand for yourself, a stand for those around you, a stand for your children. As an individual your stand will feel meaningless, an ant against a Lion.

But together, your voices will be heard, and the Lion will run. You will be able to shout from the rooftops and hear the quivering of those in power. They do not care if you stand alone. They do mind if you stand on masse, if you shine a spotlight on the darkness of their proposals.

Together we can bring some sanity to this and send a message that this tightening of the noose stops NOW. You send a message that you have had ENOUGH. Yes the CQC might get through, but at the very least your legal, non-violent rebellion will instigate concessions, and give them pause. It will make them think “if this is the rejection we get from the dentists…………”

Now some of you won’t see what all the fuss is about. Some of you won’t have a problem with the CQC or what they represent. Some of you may even see it as a good thing. Perhaps it is, who am I to say otherwise?

And you know what, I have no challenge with that. If that is your belief then I respect it.

If however you feel in your heart what i feel, if you see with your eyes what I see, then how can you roll onto your back and expose your belly? How can you look yourself in the mirror knowing what you know?

Fear is no longer an excuse. Fear is their weapon, their power. I no longer care. The choice is yours. You have a moral right, no a moral duty to act with your beliefs. What does you heart say? Find out and act accordingly.

Yours in commerce

Stephen: Hudson the authorised representative for the legal fiction Dr Stephen Hudson BDS, MFGDP, DRDP