On October 5^th I appeared on NPR, discussing some of the problems with dentistry.

This was not the first time that I have pointed to problems of conflicts of interests.  In the past I have been vocal about conflicts of interests in Medicine and in Banking, but somehow this time I stuck a nerve and as a consequence I got lots of angry emails (see also the comments on NPR).

The basic email I got had the following form:

“Dan, you are an idiot.  I am a dedicated dentist who only does what is in the best interest of my clients.  But, it is true that there are a few bad apples in dentistry, as they are everywhere”

One of the responses came was from Ronald Tankersley, D.D.S. the President of the American Dental Association.  Among other things Ronald Tankersley writes:

Ariely’s assertion that patients stay with their dentists because pain, discomfort and having to “keep your mouth open” causes cognitive dissonance is pure nonsense— he sounds like someone who hasn’t visited a dentist for decades. Modern pain and anxiety control techniques have all but eliminated the discomfort that older patients may have encountered as children. In fact, younger patients today don’t think of dental care as being uncomfortable at all, partly because they rarely get disease and partly because the treatment they do get is rarely uncomfortable.

Particular details of the comments aside, I would like to take this opportunity and clarify my position on the pay-for-service model that we commonly use in dentistry and its effects on conflicts of interests (dentists that get paid for X want to do X), and on the quality of care:

1)   I don’t think that dentists are particularly evil, selfish, of greedy just that (much like the rest of us) when they face conflicts of interest they are likely to see the world in a distorted way.  They are likely to look, and find, problems that the treatments for are ore lucrative.  The same of course applies to bankers, MDs, financial advisors, expert witnesses, etc.

2)   The evidence for conflicts of interests is rather staggering, and I suspect that the majority of dentists would agree with me that this is a problem that is hurting their clients and in the long-terms also their profession.

3)   One of the hallmarks of conflicts of interests is that people don’t see themselves as being influenced by such forces (“I am always doing the right thing, other people succumb to conflicts of interests…”)

4)   I am easily influenced by data, and I would read carefully any study or data that would add to my understanding of this problem – so if you have such data, please send it my way.

5)   Rather than dismissing the problem completely, perhaps the American Dental Association should take this as an opportunity to study the standards of care and conflicts of interests in dentistry.  On my part, I am willing to help in any way I can.  I can help design studies, analyze data, propose ways to eliminate conflicts of interest and get patients to seek second opinion, etc.

It is easy to pretend that world of dentistry is working just fine, and that the error is entirely mine, but I suspect that this is not the right approach for patients, for dentists, or for the American Dental Association.

Irrationally yours

Dan Ariely