A MOST DISTURBING VISIT TO A DOCTOR
My dentist has done something that made me feel unsettled. I went in for my twice-a-year cleaning and checkup, and just when the hygienist finished my cleaning, she launched in to what kind of sounded like a commercial about a method of detecting Oral Cancer, called ViziLite Plus. She added that it cost $65.00, and that my dental insurance wouldn't pay for it.
Then the dentist came in and while he was washing his hands before he looked at my mouth, he launched in to a pitch for good-ol' ViziLite Plus; he mentioned that it costs $65.00, and that my dental insurance wouldn't pay for it.
I said that he hadn't even looked at my mouth to see if there were any problems yet. He then proceeded to look in my mouth and under my tongue (much more thoroughly than anyone had EVER looked before) and said that he didn't see any problems.
I then said that I do not have dental insurance, but anyway I did not want ViziLite Plus. He then told the hygienist that I needed to "sign the form."
She took me out to the waiting area and handed me a six paragraph form, pointed at the bottom and said "Sign there where it says "No" to the VisiLite treatment." I was actually feeling kind of pressured about this whole thing, didn't take time to read its six paragraphs, and I stupidly signed and didn't even demand a copy of what I was signing. Sigh.
I began to feel more and more uncomfortable about this, and a few days later I called back and asked that they send me a copy of the form I had signed, which they did.
THE PROBLEM
I have been trying to analyze just why I feel distressed about this event, and here is what I have come up with:
1) The doctor and the hygienist were NOT saying that I SHOULD have this test for Oral Cancer, they were ASKING me if I wanted it. I considered the issue as charitably as possible, and thought "Well, they were just telling me about a new product and giving me a choice; choices are good, aren't they?" But, as I thought further about it, I am paying what for me is quite a lot of money for the DOCTOR to tell ME what should be done. I had absolutely no idea of whether or not I should have an expensive Oral Cancer screening. There are quite a few optional medical tests that I would like to have done (a full-body MRI for example), but that I can't really justify unless there is actually a medical reason.
2) For cancer screenings there are three criteria that should be used to decide whether or not a test should be done:
3) Why on earth would they coerce me into signing a document stating that I do NOT want this test? There are tens of thousands of medical tests; are we going to be asked to sign a piece of paper that we don't want each and every one? Can you get Carpel Tunnel Syndrome from signing ten thousand pieces of paper?
4) What if I actually get Oral Cancer? Years later would my health insurer use that piece of paper against me to refuse treatment? They certainly use every other excuse that they can come up with. How scary is that thought?
Anyway, I did what anyone does when they are stressing about something these days, I researched the matter on Google. I can now see EXACTLY WHY dental insurance does NOT pay for ViziLite Plus tests.
WHAT I LEARNED
The form that the doctor made me sign said right near the top in BOLD letters, "One American dies every hour from oral cancer." WOW, that sounds bad, doesn't it? This is terrible!! I want the ViziLite Plus test right now, no matter what it costs, don't I? Well, don't I???!!!
Hmmmm...One American dies every hour. That would be (24*365) = 8760 deaths per year from Oral Cancer.
This does not agree with the National Cancer Institute which says "Estimated new cases and deaths from oral cancer in the United States in 2008: New cases: 22,900. Deaths: 5,390."
Americans are notoriously bad at arithmetic, so let's see if we should tremble with fear about Oral Cancer:
The National Cancer Institute does not list Oral Cancer as one of the "Common Cancers." They say, "To qualify as a common cancer, the estimated annual incidence for 2008 had to be 35,000 cases or more."
The population of the United States is about 302 million, so there is a ((5390/302,000,000)*100) = 0.00178 percent chance of anyone in the US dying from Oral Cancer. To put it another way, the chance of dying from Oral Cancer in the US is 1 in 56,029.
However, that's not all. The National Cancer Institute goes on to say, "Tobacco use (cigarettes, pipes, cigars, and smokeless tobacco) is responsible for most cases of oral cancer. Alcohol, particularly beer and hard liquor, are associated with an increased risk of developing oral cancer."
I neither smoke nor drink. The National Cancer Institute does NOT define what "most" means, but ViziLite's web site states that "27% of oral cancer victims do not use tobacco or alcohol and have no other lifestyle risk factors." Thus, (5390 * 0.27) = 1455 deaths from Oral Cancer in non-smoker/drinkers each year. This changes my probability of death to be ((1455/302000000)*100) = 0.0004818 percent, or 1 in 207,560 each year.
The form also says "This enhanced examination is recognized by the American Dental Association code revision committee as CDT-2007/08 procedure D0431..." Well, it has a code, but I'll bet that the doctor picking his nose and charging you five dollars for it has a code; I've seen hospital bills and their millions of codes, so I don't know why having a code helps me make a decision. I looked up code D0431, and it is a very generic category into which VisiLite thinks that they fit: "D0431 - Adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including premalignant and maliganant lesions..." ViziLite Plus by itself is not in any way "recognized by the ADA code revision committee."
Dental Blogs.com reports that Vizilite has been denied the ADA seal of approval.
In an article in the Los Angeles Times, Dr. Valerie Ulene, a board-certified specialist in preventive medicine practicing in Los Angeles stated "The American Dental Assn. doesn't endorse ViziLite as a screening test for oral cancer."
ViziLite Plus seems to be quite profitable for the dentist. ViziLite's web site reports that "...The MSRP of one ViziLite examination ranges from $19.95/unit to $29.95/unit depending upon the volume purchased..." So, at the worst, the profit is ($65.00-$29.95) = $35.05 for each test. I estimate that the two hygienists that work at my dentist's office deal with a total of at least six patients each per day, so that means (2*6*5) = 60 patients per week, for 50 weeks per year which would be (50*60) = 3000 patients per year. My dentist wants to give the ViziLite Plus test to each patient once each year, and I will assume that the 3000 patients come in twice per year, so the potential PROFIT would be at least ((3000/2) * $35.05) = $52,575.00; all for a test that takes less than four minutes!
ViziLite's web site also reports that ViziLite "may etch" hybrid acrylics. "Make certain that any acrylic-based prosthetic is removed. If it is 'fixed', as in the case of an implant- borne denture, have the patient rinse for a maximum of 30 seconds." EEEK!!! It etches my brand new hugely expensive implant! Why would they give me something that does that if I don't REALLY REALLY need it!!!!
PERSPECTIVE
I then looked for some context to put Oral Cancer risk into perspective. The National Safety Council states the odds of dying EACH YEAR:
For me, sixty five dollars is a lot, and there are many many kinds of cancer; I certainly can't afford that much to test for each and every one.
Indeed, my chances are reduced even more because many many people with bad health habits don't go to the dentist EVERY six months, WITHOUT FAIL EVER, for fifty some odd years as I have done. And yet, this dentist is risking losing a visit for cleaning and check-up from me and my wife every six months each and every year (that would be a total of four visits per year at $125.00 * 4 = $500 total per year), not to mention the occasional crown or cavity repair, all for an unnecessary $65.00 scam - now I would call THAT high risk behavior indeed.
WHAT I WANT
I want to be able to trust my doctor and dentist COMPLETELY. I want them to prescribe tests or treatments only when they are MEDICALLY indicated. I do not want to feel like I have to be suspicious or wonder about the motives of ANYTHING that they tell me. I don't want them to ASK ME if I need a test. I want them to realize that medical care is extremely expensive, and I do not EVER want to feel cheated by a doctor or dentist. I want to not be sad about learning bad facts about the way my doctor or dentist do business.
CONCLUSION
This is NOT a common cancer, and I do not do the activities that "most" of the people that get it do. The probability of me getting Oral Cancer is EXTREMELY small. It would have been nice for the dentist to mention this.
The medical business in the United States appears to me to want us to live our entire lives in constant fear, and they do not provide information in any kind of context that allows us to make informed, rational decisions. They seem to be starting to use their medical knowledge and the huge power of advertising AGAINST us.
We are BOMBARDED with constant advertising of drugs and other medical products in the media, and now they are apparently extending their reach even into the offices of pliable or unethical doctors. This just totally destroys my trust in doctors, and I have always wanted to be very trusting of doctors, since I know nothing about medicine.
I believe that the medical business RELIES on the fact that Americans are bad at arithmetic, and either won't analyze their fear mongering, or won't understand it if someone else analyzes it.
It is my opinion that the marketing of ViziLite Plus to me this way is wrong. Tests like these are being used to line the pockets of doctors and medical companies and relieve suckers of what little money they have left after the health insurance shakedowns. The test would cost me $65.00 and there is NO demonstrated need for me or indeed EVERY patient to get. Perhaps if one has lots of money, and if someone is a high risk - smoke, drink, have a family history of Oral Cancer, or whatever, there might be some justification, but in my judgment, the number of lives saved by this product will be very very tiny.
ACTION ITEM
A new dentist for my wife and I. Again. Sigh.
FINAL THOUGHTS
Trust in government - gone; hiding behind a bush.
Trust in telecommunication companies - gone with the slammers in the 1990's.
Trust in banks - gone, way too many fee and fine stings.
Trust in insurance companies - Long gone.
Trust in doctors and dentists - Very very sadly, gone.
The movie Vacation with Chevy Chase had a scene where he had wrecked his car out in the boonies, and he had it fixed by a shifty mechanic:
Clark: How much do I owe you?
Mechanic: How much you got?
Clark: No, I'm asking how much the repairs are.
Mechanic: I'm asking how much you got!
Clark: You're out of your mind. Look, I don't have time to fool around so how much is it?
Mechanic: All of it, boy!
That's the medical insurance and doctor industry in a nutshell in the United States today; they want "All of it, boy!", and they mean it.
The United States needs to re-think its approach to medicine; what is happening now stinks.
My dentist has done something that made me feel unsettled. I went in for my twice-a-year cleaning and checkup, and just when the hygienist finished my cleaning, she launched in to what kind of sounded like a commercial about a method of detecting Oral Cancer, called ViziLite Plus. She added that it cost $65.00, and that my dental insurance wouldn't pay for it.
Then the dentist came in and while he was washing his hands before he looked at my mouth, he launched in to a pitch for good-ol' ViziLite Plus; he mentioned that it costs $65.00, and that my dental insurance wouldn't pay for it.
I said that he hadn't even looked at my mouth to see if there were any problems yet. He then proceeded to look in my mouth and under my tongue (much more thoroughly than anyone had EVER looked before) and said that he didn't see any problems.
I then said that I do not have dental insurance, but anyway I did not want ViziLite Plus. He then told the hygienist that I needed to "sign the form."
She took me out to the waiting area and handed me a six paragraph form, pointed at the bottom and said "Sign there where it says "No" to the VisiLite treatment." I was actually feeling kind of pressured about this whole thing, didn't take time to read its six paragraphs, and I stupidly signed and didn't even demand a copy of what I was signing. Sigh.
I began to feel more and more uncomfortable about this, and a few days later I called back and asked that they send me a copy of the form I had signed, which they did.
THE PROBLEM
I have been trying to analyze just why I feel distressed about this event, and here is what I have come up with:
1) The doctor and the hygienist were NOT saying that I SHOULD have this test for Oral Cancer, they were ASKING me if I wanted it. I considered the issue as charitably as possible, and thought "Well, they were just telling me about a new product and giving me a choice; choices are good, aren't they?" But, as I thought further about it, I am paying what for me is quite a lot of money for the DOCTOR to tell ME what should be done. I had absolutely no idea of whether or not I should have an expensive Oral Cancer screening. There are quite a few optional medical tests that I would like to have done (a full-body MRI for example), but that I can't really justify unless there is actually a medical reason.
2) For cancer screenings there are three criteria that should be used to decide whether or not a test should be done:
- First is like a colonoscopy where they say "Since this type of cancer is quite common, past the age of 50 you should have one of these tests every five years,"or whatever.
- Second is where the doctor says "I see something not right, we should do this test to see if this is something that needs treatment."
- Third is if your parent had something, your grandparent had something, and there is a high probability that you could have it as well.
3) Why on earth would they coerce me into signing a document stating that I do NOT want this test? There are tens of thousands of medical tests; are we going to be asked to sign a piece of paper that we don't want each and every one? Can you get Carpel Tunnel Syndrome from signing ten thousand pieces of paper?
4) What if I actually get Oral Cancer? Years later would my health insurer use that piece of paper against me to refuse treatment? They certainly use every other excuse that they can come up with. How scary is that thought?
Anyway, I did what anyone does when they are stressing about something these days, I researched the matter on Google. I can now see EXACTLY WHY dental insurance does NOT pay for ViziLite Plus tests.
WHAT I LEARNED
The form that the doctor made me sign said right near the top in BOLD letters, "One American dies every hour from oral cancer." WOW, that sounds bad, doesn't it? This is terrible!! I want the ViziLite Plus test right now, no matter what it costs, don't I? Well, don't I???!!!
Hmmmm...One American dies every hour. That would be (24*365) = 8760 deaths per year from Oral Cancer.
This does not agree with the National Cancer Institute which says "Estimated new cases and deaths from oral cancer in the United States in 2008: New cases: 22,900. Deaths: 5,390."
Americans are notoriously bad at arithmetic, so let's see if we should tremble with fear about Oral Cancer:
The National Cancer Institute does not list Oral Cancer as one of the "Common Cancers." They say, "To qualify as a common cancer, the estimated annual incidence for 2008 had to be 35,000 cases or more."
The population of the United States is about 302 million, so there is a ((5390/302,000,000)*100) = 0.00178 percent chance of anyone in the US dying from Oral Cancer. To put it another way, the chance of dying from Oral Cancer in the US is 1 in 56,029.
However, that's not all. The National Cancer Institute goes on to say, "Tobacco use (cigarettes, pipes, cigars, and smokeless tobacco) is responsible for most cases of oral cancer. Alcohol, particularly beer and hard liquor, are associated with an increased risk of developing oral cancer."
I neither smoke nor drink. The National Cancer Institute does NOT define what "most" means, but ViziLite's web site states that "27% of oral cancer victims do not use tobacco or alcohol and have no other lifestyle risk factors." Thus, (5390 * 0.27) = 1455 deaths from Oral Cancer in non-smoker/drinkers each year. This changes my probability of death to be ((1455/302000000)*100) = 0.0004818 percent, or 1 in 207,560 each year.
The form also says "This enhanced examination is recognized by the American Dental Association code revision committee as CDT-2007/08 procedure D0431..." Well, it has a code, but I'll bet that the doctor picking his nose and charging you five dollars for it has a code; I've seen hospital bills and their millions of codes, so I don't know why having a code helps me make a decision. I looked up code D0431, and it is a very generic category into which VisiLite thinks that they fit: "D0431 - Adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including premalignant and maliganant lesions..." ViziLite Plus by itself is not in any way "recognized by the ADA code revision committee."
Dental Blogs.com reports that Vizilite has been denied the ADA seal of approval.
In an article in the Los Angeles Times, Dr. Valerie Ulene, a board-certified specialist in preventive medicine practicing in Los Angeles stated "The American Dental Assn. doesn't endorse ViziLite as a screening test for oral cancer."
ViziLite Plus seems to be quite profitable for the dentist. ViziLite's web site reports that "...The MSRP of one ViziLite examination ranges from $19.95/unit to $29.95/unit depending upon the volume purchased..." So, at the worst, the profit is ($65.00-$29.95) = $35.05 for each test. I estimate that the two hygienists that work at my dentist's office deal with a total of at least six patients each per day, so that means (2*6*5) = 60 patients per week, for 50 weeks per year which would be (50*60) = 3000 patients per year. My dentist wants to give the ViziLite Plus test to each patient once each year, and I will assume that the 3000 patients come in twice per year, so the potential PROFIT would be at least ((3000/2) * $35.05) = $52,575.00; all for a test that takes less than four minutes!
ViziLite's web site also reports that ViziLite "may etch" hybrid acrylics. "Make certain that any acrylic-based prosthetic is removed. If it is 'fixed', as in the case of an implant- borne denture, have the patient rinse for a maximum of 30 seconds." EEEK!!! It etches my brand new hugely expensive implant! Why would they give me something that does that if I don't REALLY REALLY need it!!!!
PERSPECTIVE
I then looked for some context to put Oral Cancer risk into perspective. The National Safety Council states the odds of dying EACH YEAR:
- Pedestrian - 1 in 49,139 (And yet I walk a lot - outside!!!)
- Fall on and from stairs and steps - 1 in 179,278 (I go up and down stairs often!)
- Car Occupant - 1 in 19,216 (Gasp, and I drive quite a bit as well!)
- Bitten by a Dog - 1 in 139,617 (I'm safe, we have a cat.)
- Complications of medical and surgical care - 1 in 101,858
- Odds of being considered possessed by Satan - 1 in 7,000 (OK, I got this statistic from http://www.med-help.net/real-mrsa-odds.html, but still...)
For me, sixty five dollars is a lot, and there are many many kinds of cancer; I certainly can't afford that much to test for each and every one.
Indeed, my chances are reduced even more because many many people with bad health habits don't go to the dentist EVERY six months, WITHOUT FAIL EVER, for fifty some odd years as I have done. And yet, this dentist is risking losing a visit for cleaning and check-up from me and my wife every six months each and every year (that would be a total of four visits per year at $125.00 * 4 = $500 total per year), not to mention the occasional crown or cavity repair, all for an unnecessary $65.00 scam - now I would call THAT high risk behavior indeed.
WHAT I WANT
I want to be able to trust my doctor and dentist COMPLETELY. I want them to prescribe tests or treatments only when they are MEDICALLY indicated. I do not want to feel like I have to be suspicious or wonder about the motives of ANYTHING that they tell me. I don't want them to ASK ME if I need a test. I want them to realize that medical care is extremely expensive, and I do not EVER want to feel cheated by a doctor or dentist. I want to not be sad about learning bad facts about the way my doctor or dentist do business.
CONCLUSION
This is NOT a common cancer, and I do not do the activities that "most" of the people that get it do. The probability of me getting Oral Cancer is EXTREMELY small. It would have been nice for the dentist to mention this.
The medical business in the United States appears to me to want us to live our entire lives in constant fear, and they do not provide information in any kind of context that allows us to make informed, rational decisions. They seem to be starting to use their medical knowledge and the huge power of advertising AGAINST us.
We are BOMBARDED with constant advertising of drugs and other medical products in the media, and now they are apparently extending their reach even into the offices of pliable or unethical doctors. This just totally destroys my trust in doctors, and I have always wanted to be very trusting of doctors, since I know nothing about medicine.
I believe that the medical business RELIES on the fact that Americans are bad at arithmetic, and either won't analyze their fear mongering, or won't understand it if someone else analyzes it.
It is my opinion that the marketing of ViziLite Plus to me this way is wrong. Tests like these are being used to line the pockets of doctors and medical companies and relieve suckers of what little money they have left after the health insurance shakedowns. The test would cost me $65.00 and there is NO demonstrated need for me or indeed EVERY patient to get. Perhaps if one has lots of money, and if someone is a high risk - smoke, drink, have a family history of Oral Cancer, or whatever, there might be some justification, but in my judgment, the number of lives saved by this product will be very very tiny.
ACTION ITEM
A new dentist for my wife and I. Again. Sigh.
FINAL THOUGHTS
Trust in government - gone; hiding behind a bush.
Trust in telecommunication companies - gone with the slammers in the 1990's.
Trust in banks - gone, way too many fee and fine stings.
Trust in insurance companies - Long gone.
Trust in doctors and dentists - Very very sadly, gone.
The movie Vacation with Chevy Chase had a scene where he had wrecked his car out in the boonies, and he had it fixed by a shifty mechanic:
Clark: How much do I owe you?
Mechanic: How much you got?
Clark: No, I'm asking how much the repairs are.
Mechanic: I'm asking how much you got!
Clark: You're out of your mind. Look, I don't have time to fool around so how much is it?
Mechanic: All of it, boy!
That's the medical insurance and doctor industry in a nutshell in the United States today; they want "All of it, boy!", and they mean it.
The United States needs to re-think its approach to medicine; what is happening now stinks.
