amalgam as “potentially risky,” they would ask no further questions; they would certainly not understand that the classification was temporary. The impact on subsequent spending for dental products would overwhelm the ability of the public to pay for the additional services. Consider that it would take $930 to replace existing amalgam surfaces with composite in the average adult. Ifjust 10 percent of these amalgamfilled surfaces were replaced with a necessary posterior gold restoration the cost would escalate to $1,318. With total U.S. dental expenditures at approximately $25 billion annually, if 1 percent of the adult population chose to replace their amalgams, total expenditures would increase by 10 percent; a 5 percent replacement group would increase expenditures by 50 percent. If one-tenth of our adult population acted in a similar manner, it would double the yearly spending for dental care and still leave 90 percent of our population with unsafe amalgam restorations. It is unlikely that many Americans would be able to afford the out-ofpocket expense necessary for this replacement program. It is equally unlikely that dental insurance companies would be able to offset ANY of this additional expense without massive increases in premiums. We are left with a situation in which only the very affluent would be able to replace their restorations. Seeing that only the wealthy were able to avoid the “supposed” serious consequences of amalgam would initiate massive public concern. The government would be called on to address their imperative need. With government spending presently limited to less than 5 percent of total dental expenditures a federal response to this public outcry would be an impossibility without a radical change in the entire dental economic delivery system. Neither the public nor the profession should be required to address this difficult situation unless it becomes scientifically evident that those with dental amalgam restorations are, in fact, at risk. Such evidence does not exist and, in fact, research presented in the March JADA clearly refutes earlier anti-amalgam claims. The FDA must be made aware of the chaotic potential of product reclassification. Knee-jerk, emotional reactions in response to an unsubstantiated television documentary have no place in public policy decisions. Systematic, scientific evidence must prevail in the decision making process of our nation’s health community. ■ 1. Singleton G., Executive Secretary, Dental Products Panel, Dept HHS, FDA. Letter to panel members and consultants, Feb. 1991.
JADA, Vol. 122, April 1991
LETTERS RESPONSE TO “6 0 M IN U TE S”
We, the members of the ADA, are quick to criticize the leadership and staff of the ADA when they fail to meet our expectations. I know I am speaking for most members when I say thank you for a job well done in responding to the “60 Minutes” misinformation program dealing with amalgam. The “Special Report” dealing with the scientific aspects and the ethical considerations [packaged with the January JADA] will prove useful in our practices, I’m sure. I must tell you, though, that after reading the remarks concerning the “plastic fillings,” I wonder if it is unethical to place them any place in the mouth? John D. Thorpe, D.D.S. Chicago AMALGAM REMOVAL
I would like to state several reasons why I am uncomfortable with the ADA policy of amalgam removal based on physician referral. They are based on very personal reasons. My daughter has juvenile rheumatoid arthritis. Ironically, several very wellmeaning people have approached my family about the “60 Minutes” episode as a possible cause/cure of her arthritis problem. I realize the ADA policy leaves the door open a crack for the very rare case of legitimate amalgam removal. I am afraid, however, that more quacks will take advantage of that crack. Few as they may be, both dentistry and medicine have them. It is also possible that legitimate physicians may not understand the technical aspects
of amalgam removal or the com plications. They may approve such action as a placebo or innocuous treatm ent, especially for a distressed patient. I fully understand the com pulsion of a patient with the dem on of a chronic disease, or a p aren t of one as myself, to w ant to do anything to get rid of it. Like the priest in “Exorcist I,” would gladly say “take m e.” However, today especially, it is im portant n o t to be debased by the latest media fad or frenzy. Medicine shows are alive and well. Specifically, parents of a JRA child are distressed and may have th at compulsion. They m aybe u n d er a financial burden from the illness. The JRA child may find any dental treatm ent physically dem anding. There is a greater risk of medical-dental-pharmacologic complications w hen treating these patients. Even with a physician referral, I would consider it both outrageous and unethical to put a sick child through hundreds or even thousands of dollars of amalgam removal, to offer the child and the distressed parents a snake oil false hope. The dentist’s role is to stand ground as a doctor/scientist/ friend. As an anecdote, my daughter w ith arthritis has never had a cavity. My two children w ithout arthritis have had a few amalgams. Using the irrational, anecdotal “60 M inutes” reasoning, perhaps I should place some amalgams in my arthritic daughter as a cure!?!? A ndrew P. Tanchyk, D.M.D. South Amboy, N.J.
JADA, Vol. 122, April 1991
TH E SC A R LET LETTER
The cover of the February 1991 issue was inappropriate and could be considered inflammatory. As caring health professionals, the dental com m unity should treat patients w ith compassion. The cover seems to indicate that organized dentistry would prefer that those infected with HIV be treated differently, with a scarlet “A” on their chest to let us know. At a time w hen public concerns about the possibility of the spread of HIV by health care providers are on the rise, and with dentistry apparently being singled out, this type of sensationalism indicates a lack of both editorial judgm ent and sensitivity. While m any people would like to see HIV-positive persons m arked and segregated from the rest of society, this cannot be the image portrayed by any credible health care group. Our goal, as m em bers of organized dentistry, should be toward reducing the sensationalism surrounding this issue. As health professionals, we m ust not place ourselves in the position of appearing to support unscientific, irrational, knee-jerk responses, such as that suggested by the cover illustration. Regardless of the content of The Journal, it is by its very nature, the graphic portrayal on the cover th at will be remem bered. M ichael J. G leason, Ph.D, D.D.S. Virginia A. M erchant, M.S., D.M.D. University o f D etroit School o f D entistry
E ditor’s note: Am erican author Nathaniel Hawthorne is well know n fo r his critical portrayals o f Puritan tradition.
In his 1850 novel “The Scarlet Letter, ’’Hawthorne exposed the practice—and the awful consequences—of requiring a wom an convicted o f adultery to wear a red “A ”as a badge of shame. The book presents a sym pathetic portrait of a wom an unjustly ostracized fro m her comm unity. Hawthorne does not condemn her; he condemns those who would presum e to judge her. It was in this spirit that the editor chose this particular allegory fo r the February cover. No offense was intended. T A K IN G A C H A N G E
I was surprised, even shocked, to see the dram atic change in The Journal of the American Dental Association. I looked at the front cover and it looked a little strange, but I said to myself, “Well, th at can happen.” Then I turned to the table of contents. To my dismay, there was not a long list of article titles I could quickly go through and discard. I had, in fact, to read what the articles were about. This was an aggravation until I realized th at instead of scanning for key words hoping th at I could find an excuse to avoid reading the article before even knowing w hat it was about, I actually began to learn that some of the articles m ight be pertinent. Next, I came upon the cornball editorial discussing how somebody had “m eddled w ith my ADA Journal and they hoped th at I would like it.” I thought to myself: a likely story; they couldn’t think of anything else to do so they changed it. A perfectly good, familiar journal and they changed it. I read on.