Scratch the surface and almost everything related to almost every corporation is bent.
How is it that we allowed corporations to own Dentistry? How is it we are allowing corporations to own general medical practices? Who thought it was a good idea to turn the National Health Service into a few organisations making colossal sums of money for their shareholders and their directors?
Not in these pages will I overwhelm you with examples of the problems that exist; today I will demonstrate one to make a point related to another. This week there was an article in the New York Times. You can read it here. The main thrust of the article relates to the fact that MyLam, the pharmaceutical company that manufactures EpiPens in the US, and has a monopoly on the production of these devices, has artificially fixed the prices of these life saving drugs. Despite enormous social, political and legal pressure and scrutiny they have refused to change their pricing structure. The story is much worse than this and the internal culture of the company is appalling and shocking.
This is a company that turned over 11 billion dollars last year.
This is a company who paid its chief executive 97 million dollars last year.
For the uninitiated an EpiPen is a syringe you keep in your handbag or in your pocket for severe allergic reactions, for example, to nuts. Allergies that can kill you without the pen being present. It is a first line treatment that we have in every dental practice and in every medical practice in the UK. One that parents and patients alike carry with them. These drugs go out of date regularly and need replacing. In the US it costs $609 to buy a pack of two EpiPens. The manufacturing costs are estimated at $1. Interestingly though if you read the article (and I encourage you to) the story of MyLam’s disregard for authority and pressure sounds very similar to stories that dentists have encountered in relation to their regulator.
The chief executive of MyLam has been up in front of a senate committee and bullishly refused to accept responsibility of failings within the organisation (sounds familiar to the dental guys?). The statements made by the chairman and the chief executive of that company are nothing short of appalling. Their absolute belief is that the pursuit of profit comes before anything else, including the lives of their customers (AKA patients). So this turns me to the main thrust of this blog, which I was going to write in any event before I read the article.
I occupy an extremely privileged position in my profession and in my clinical work. I have the trust of colleagues to refer patients to me who are in difficulty and have problems with previous implant treatment carried out. I am to assist where I can to help these patients and return them to a position of acceptable function and aesthetics. As a result of this I have seen many cases and problems, and have become quite experienced in managing this. (I’ve also seen many cases of my own through 20 years)
Over the past few years though it has come to my attention that there is a practitioner working for one of the large corporations in dentistry who moves around different sites. It appears from my small sample (and when I say small sample, I mean quite large relative sample) of patients who are attending to see me with significant problems in relation to substandard work that this could be deemed as verging on negligence. At the present time I do not feel I have sufficient evidence to ‘whistle blow’, but I feel the time is coming very soon. This is my professional responsibility. My professional judgment at this stage is that it would be inappropriate to do that, but I’m moving to a situation were it will be inevitable. But the main question is this, what the hell is the Clinical Director of that corporation doing to maintain and monitor the quality of this and all the rest of the individuals working for them?
I understand fully the responsibilities of a Clinical Director running an organisation with multiple clinicians – I am one of those. There is a sign on the wall in my office which says ‘The buck stops here’, it is clearly obvious that that is the case and is the case within my organisation. It is my growing belief that this individual and other individuals within that organisation are being ignored because they are grossing money from patients. In an informal conversation with a dentist from that organisation this week, the dentist in question told me of the difficulty they were having referring patients to me for remedial treatment in relation to this dentist, because they were under pressure from the corporation to refer ‘within the group’.
I know for a fact that they have no one within the group in any reasonable proximity that will be able to deal with this, but they are happy to put pressure on clinicians to send these patients who have already been significantly disadvantaged to other clinicians who are unsuitable for treating them in the name of profit for the group.
The counter argument to this is that if you leave dentists on their own as independent contractors out of the control of a ‘corporation’ they will just do the same. It’s easy to shut them down though and remove their licences to practice. They can’t go anywhere else. When the failing lies at the level of the organisation, and god knows this is a huge organisation, then the inference is that they’re failing all across the country and all across the system.
The discussions that go on in the bars and in the coffee rooms at conferences are that the dentists know that this is the case. The point of writing this today is to hope that someone might share this piece of writing along the way and it might reach the desk of someone in these organisations so they will get the message that they can’t hurt me and as soon as I have enough evidence I will call them out.
Blog Post Number - 1313
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