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We Need More Doctors Who Are Scientists (nytimes.com)
60 points by johnny313 on Sept 23, 2019 | hide | past | favorite | 19 comments



What we really really need are more dentists who are scientists. Dental practice has changed a lot, but at the end of the day, we still drill holes in our teeth and fill them up.

Most dentists spend three years in school, where 2.25 of them are spend just learning the hand skills of dentistry. By the end of it, they are highly motivated to not want to advance dental science because it could put them out of a job.

If someone developed a drug that would remove cavities, or a device that made it so you didn't have to brush every day, these would be huge quality of life improvements for people, but the people who are most expert at discovering such things are the ones most motivated to keep the status quo.

I say this as someone who has multiple family members involved in dentistry. Every time I even mention a new possible treatment, their immediate response is "hmmm I'm not sure that's a good idea that's not how we usually do things". It's something that their training has engrained in them.


Just today my dentist, who recently took over the practice from my previous retiring dentist, said the old guy pushed metal fillings on most patients even though composite is a better alternative for most fillings (he did describe for which fillings metal is still preferred).

I bet the worst medical advancement or study result for dentists would be the one that definitively shows six-month checkups aren't better than annual.


> I bet the worst medical advancement or study result for dentists would be the one that definitively shows six-month checkups aren't better than annual.

It depends on the person and the chemical makeup of their mouth in conjunction with their brushing and flossing habits.

Some people can be fine even if they go years between checkups. Other people like me need to go three times a year even though I brush and floss every day.

Gee, I wish someone would study why I need to go three times a year and maybe figure out how to change the chemical makeup of my mouth so I didn't have to!


> Gee, I wish someone would study why I need to go three times a year and maybe figure out how to change the chemical makeup of my mouth so I didn't have to!

People are too profitable for the system to be motivated to figure out actual causes behind common problems.

Your quip reminds me of a comment from 2 weeks ago, where someone shared how vitamin K supplementation helped reduce buildup on their teeth: https://news.ycombinator.com/item?id=20902899

I understand that people usually get adequate Vitamin K2 from their intestinal bacteria. Perhaps the buildup on your teeth is due to your microbiome.

I brush with salt and baking soda, but still have some plaque on my occasional visits to the dentist. I’ll have to think about this some more.


I have one tooth that has pain in it because one dentist convinced me to drill it even though it wasn't causing me issues. I still don't know what scientific evidence there is that doing fillings early is a justifiable procedure rather than just a revenue stream for the dentist. I would love to see good studies on this.


Same thing happened to me as a teenager. I was told I had a cavity, dentist started drilling, there was an 'oops oh wait there's nothing here', he stopped then filled the hole he'd made. It's the only tooth I have that causes me problems. It's sensitive to hot and cold and I'm pretty sure the filling came out a long time ago. It's made me distrust dentists ever since.


> Most dentists spend three years in school

Where can you get a dentistry degree with just three years of university? I thought in the US you needed an undergraduate degree of four years just to get into the postgraduate dentistry degree, so at least seven years in total, which seems like a long time to me! In the UK it's at least five years.


In the US you need an undergrad plus 4 years of dental school. Most dentists then start practice immediately, although some go on to do a residency in Orthodontics or other area.

Oral surgeons do a 5 year residency after dental school, and are usually awarded an MD as well as the DDS from dental school.

Physicians do undergrad + 4 year med school + 3-9 years of residency / fellowship.


There are professions that no matter how good they are at fixing things, new clients just keep coming. Dentists would still have work even if cavities were eradicated. Maybe you don't have cavities anymore, but want a perfect smile?


That's more orthodontics. Sure, they would still have business fixing broken teeth and such, but their bread and butter is cleanings and fillings, which would be eliminated.


Aren’t most cleanings done by dental assistants? For as long as I can remember, my twice a year cleanings have been done by an assistant who completed a local community college program. Dentist only looks at my teeth for 10 seconds afterwards.


Yes, but your dentist who owns the practice gets to keep the bulk of money because DAs don't get paid that much.


As a board-certified specialist physician engaged in research, and now starting to teach others how to engage in research, I predict that the road out of this is going to be very long and hard. As research has lost support (not just financial, but cultural), it has become increasingly difficult to justify to department chairs. In the course of the last 8 years I was kicked off my own project twice while in training.

So, what I predict you will see, is it will become progressively harder for a hopeful young researcher to make the transition, not to research, but to adding research to their already full-time+ job. It is quite likely you will be in a department where no one has research experience and few contacts with academics. And if you're doing research and there's even a hint of a perception that it could interfere with any element of your clinical duties, you can bet there are people who will be happy to burn you and your research.

The most supportive stance I got from anyone in my department during training "Don't talk to any of us about it." That was my PI and program director.

So, the current status quo is "Toil, in addition to your other, formidable responsibilities. Don't ask for anything. Don't ever talk about it, don't even mutter under your breath." That does not align very well with the open-mindedness of research.

On the flip side, if you are a PhD, the current state of medical practice in the US is such that many medical centers are ripe for research if you can cultivate a relationship with an MD. I know, I know the perception, which I have been told directly by a biochemist who didn't know I was an MD "MDs aren't knuckle-dragging idiots." But maybe, just maybe, make a friend and see where it takes you. Which may be hard. You will probably have to go to tumor boards and grand rounds and suffer through a bunch of people kibitzing about things you know are 20 years behind the state of the art. Yep, that's true. But the entrances to the mines collapsed. You will have to do the hard work of opening your own shaft. And so it goes.


I agree for an additional reason: critical thinking and root cause analysis. I am not going to go into detail but a family member had several years of misdiagnoses because she has a lot of weird symptoms don't fit a common disease pattern. After being correctly diagnosed with a blood test, once in awhile she will still be told by a doctor that she has something else. Even when shown the results of the blood test, they persist in their nonsense. A scientist would never think they are right when there is objective evidence to the contrary.


Oh dear $DEITY, and please let's add reasoning about probabilities in there. ("There are virtually no problems" can mean anything from "we're just overly cautious" to "it's a coin flip if you won't be worse off after" - and nobody is willing to attach a percentage, or talk about false negatives vs. false positives)


we need more statisticians doing medical research.


and more training for doctors on how to read those stats. Amazing the stories some companies can tell that are completely misleading.


We need free medical school.


It is usually free for those who pursue a Phd. Just takes a bit longer...




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