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He comes to town, a stranger, in a horse-drawn cart full of rattling bottles at the back.

He sets up his stall in full view (of anyone who cares to watch) and creates a noise and a fuss to get your attention.

It’s a bit like Del Boy in the market with Rodney.

He picks someone out of the crowd (does he know them? are they a plant? might this just work?) and gives them the tonic, which is the medicine, the treatment, the procedure and they’re cured.

This remarkable, instantaneous result leads to a flurry of activity as people try to buy the tonic, which of course he’s running out of, and the price goes up and he makes a fortune.

He packs things up and heads out of town and maybe even meets the guy that he ‘cured’ on the road outside of town and takes him to the next place.

It’s an age-old story with visions of the Wild West and a wonderful song from Big Audio Dynamite, which you can listen to here. 

But it’s still here.

I found myself (unfortunately) on Facebook again the other night and sucked straight into case presentations by “experts” and various procedures that were being carried out.

I understand that some of the big hitting implant Profs have now been sucked into Facebook as they try to redress the balance of the medicine show that much of Facebook dentistry has become.

Perhaps an example would help in this debate and discussion.

In 2007 – 2009 there was a flurry of activity in publications related to immediate dental implants in the anterior maxilla following extraction.

As is predictable in these matters, camps developed and cognitive dissonance was in the air and ripe and people shouted from their corners because that’s where they were and their corners needed to be protected.

For better or for worse I have made a bit of a detailed study of the stuff that was produced at that time because it informed my own practice going forwards (cognitive dissonance on my part – possible)

It was pretty clear that there was some significant unpredictability in immediate implant placement by some good guys at that time, most notably Stephen Chen, who produced some wonderful stuff examining and dissecting and battering his own practice for the greater good.

Later, much later, I would have the privilege of sitting beside him at an ITI Fellows Meeting in London for one of the most enjoyable professional meetings of my life.

Chen and others were able to show that there was a huge amount of unpredictable recession in immediate implant placement in the pre-maxilla – up to 40% in some cases, which is and can be a problem if you don’t get this thing right.

But forget that, because there are 60% of cases which might turn out well which you can show on Facebook to suck your tribe in.

It’s not that there aren’t some people out there that can make some of their immediate implant cases look amazing, and there are and I’m pretty sure we could too, it’s the fact that were trying to do the most amount of good for the most amount of people – aren’t we?

Worse still is when the man who draws into town in the medicine show teaches other people how to do the medicine show.

Maybe he has the ingredients, maybe he has the tonic, maybe he has the healing hands but do the other guys? Does his teaching benefit or harm the greater good?

Always in these circumstances I’ll return to two different people, neither of whom I’ve met, who have taught me some of the most important lessons in these difficult situations. The first was Andre Schroeder. He said (paraphrased) “if you want to introduce a new technique to your clinical practice it must be clinically proven to be better than that which you are currently using or clinically proven to be the same and cheaper”

Secondly is the still-living genius (I believe) that is Margaret McCartney who is a hard-working GP in Glasgow, committed to evidence-based practice who said recently “if it’s not evidence-based, it’s homeopathy”

I try not to watch the Facebook dentistry stuff because the bias, both in terms of confirmation and cognitive dissonance is just staggering, but sometimes it comes under my face and I can’t help it.

I know you can make things look good when you fit them, and I know that when you see one of the ones that have worked in two or three years you can post it again and I know it still looks good.

But think what you’re doing as you post it to the people you are encouraging to do this because several things can go wrong.

1. They might not be able to do what you can do. You’re using a technique that is so sensitive to individual operators that there might be much more harm going on as a result of your humble bragging and egotistical posting that it detracts from anything good you’ve ever done.
2. We have techniques for these situations that are proven and proven to work in the hands of normal, reasonable practitioners like me and not geniuses like you?

It’s fine to research, it’s great to research and we should push the boundaries as safely but as far as we can towards improvement for patients to make things faster and cheaper, more accessible and cheaper.

But did you tell the patient you were doing that?

Were you researching in your own practice?

Because if there is an accepted technique that has been proven in research with a good body of opinion then we should be using that and letting the researchers research.

Commercial healthcare doesn’t work like that, it has to be new and it has to be big and it has to create a massive amount of noise, because that’s what drives your practice and your business and your lecturing and generally just your feel-good factor.

I am sure there is some good stuff on Facebook, I’m sure there are some groups who are trying to do the right thing but they are drowned out by the noise and the volume and the garbage that exists in other people’s selfish and egotistical world of self-promotion.

It got me again didn’t it?

I got sucked in to social media and it made me mad.

I’ve calmed down now. I’m going to go back to work.

Blog Post Number: 1805