|skepticism and orthodontic procedures?|
I do medical research for a living (not clinical - I work on mouse cells mostly) so I am not an expert on this topic. However, I read the latest medical journals and this is the summary of what I found out. In light of the facts, I found the whole mammography propaganda machine so disturbing that I decided to write this up.
If you are female and 40 or over I know you have been advised, pushed, maybe even told that you are risking your life if you don't get a mammogram every year. Personally, I take the ALARA (As Low As Reasonably Achievable) principle for radiation exposure, drilled into me in the research environment seriously, and try to avoid all X-rays unless I'm in severe pain AND it seems warranted. So, when I got my first push to get a mammogram at age 40, skeptic that I am, I read the studies. What I found amazed me. As of 2005, 7 large clinical trials have been completed to look at whether or not regular mammograms reduce death from breast cancer. These have been carefully analyzed for their adherence to good scientific methods in a Cochrane Review.
The conclusion of all these studies amazed even skeptical me. At best, the results indicate that if 1000 women over 50 years old are screened for cancer by mammography for 10 years, AT MOST one life will be saved from breast cancer. The best, most carefully done study found NO DIFFERENCE in breast cancer mortality between women who received regular mammography screening and those who had none. And overall mortality was not reduced in any of the studies- in other words, women who got regular mammograms did not live any longer on average than women who didn't.
Worse, mammography was not harmless. For every 1000 women screened for 10 years, 3 will get mastectomies and 2 will have "tumorectomies", and over 100 will be made to have additional tests due to false positives and all the anxiety that comes with that - all for at most one and most likely no lives saved from breast cancer.
How then can it be that women are being told to get screened now at younger and younger ages? I think there ia ample evidence to say that medicine is a ship that is slow to turn, especially when health care providers have spent hundreds of thousands of dollars on fancy mammography equipment that unlike CT scanners or X-ray machines can be used for nothing else. And there is big, big money in mammography at $100 per woman per year on average. Women's health programs are great PR for hospitals as well. Makes you think they really care about you.
I welcome any thoughts on this or other evidence you've heard to the contrary, but for now my conclusion is that this is a medical test I can safely skip forever.
Are we the only parents that think the "rapid palate expanders" that are being recommended by orthodontists for so many kids these days are barbaric? Our daughter has the unruly teeth of any 9 year old - some are too big and some are too small and a few are loose (a stage we now know is referred to as "mixed dentition"). Her teeth are crowded, and we would have thought that was a natural consequence of her adult teeth growing into a child's mouth that will catch up later. However, a few months ago an orthodontist recommended we have a palate expander put in her mouth. For those of you unfamiliar, it is a set of metal wires anchored to a molar on each side of the mouth that is steadily expanded with a key every day for weeks to push the sides of the mouth apart. This can be done on both the upper and lower jaw and as you can imagine, it makes eating, brushing and talking a challenge. And it hurts. It also costs about $3000.
Then after a wait period, when most of the adult teeth are in, the kid is put in regular braces for another year or two or three (and another $3000).
My initial reactions were (1) Cranking our daughter's perfectly normal face apart with a key every day is barbaric (2)To make all that extra time with wires in your mouth worth it there has to be some amazing benefit. Our regular dentist and hygenist think it's terrible of us not to do it if the orthodontist says to!
My second reacton was to search Pubmed (www.pubmed.gov) a free database online of thousands of peer-reviewed medical journals. Well it turns out that some orthodontists did some blinded clinical trials on palate expanders in kids with normal mouths except they were in mixed dentition with crowded teeth, and guess what - by the end of the treatment, experts couldn't tell the difference.
In one study, kids were randomized to early treatment with palate expansion, headgear, or observation without treatment. Then these three groups were randomized again to be treated by one of four dentists who did not know their early treatment history. At the end, when all patients had completed treatment, other experts were asked to look at each patient and grade the way their teeth were lined up according to standard orthodontic criteria. The average grades were the same for all groups. In addition, there was no difference in the number of permanent teeth pulled between the groups, so palate expansion didn't make enough extra room to save adult teeth.
In another study, the researchers sent X-rays and mouth casts to a number of orthodontists and asked them say whether or not the child needed orthodontic treatment, how they would do it, and how difficult it would be. Half the X-rays and casts were from kids who had had palate expanders already, and half had not. Again, except for the palate expander group being rated a little less difficult on average, there was no difference between the groups.
And if the experts can't tell the difference, will your kid's significant other, or teacher, or job interviewer? We're saving our $$ and letting our kid be a kid without metal in her mouth from the age of 8 on.