Stormy Weather

In spring of this year, the most serious concern of many practitioners was whether the long, hot summer would bring rolling blackouts. Most colleagues we talked with who were in areas that might expect power emergencies had planned alternatives that would enable them to satisfactorily cope with the loss of power while they provided dental care. By mid-summer, much of the anxiety surrounding the California power crisis had been temporarily avoided by much milder than usual temperatures.

But in another arena, the socio-political temperatures surrounding the safety of dental amalgam were sizzling. We cannot recall another time when the California Dental Association has been sitting at the center of a virtual quagmire of related matters. As this is written, there are three issues that have become almost inextricable. They are:

* The Proposition 65 saga, on which CDA legal staff have been diligently working for some time to resolve on behalf of California dentists;

* Lawsuits filed in Los Angeles and San Francisco in June by consumer groups claiming, among other things, that CDA has misled the public about alleged dangers of mercury in amalgam fillings; and

* Legislative activity (SB 26) seeking to eliminate funding for the Dental Board of California and thus terminate the activity of the current membership of the Board.

By the time this column is read, we hope there will have been some positive resolution of these intertwined matters. Until then, CDA leaders and staff will be at the front and center of an undesirable storm at the very time they are undertaking efforts to implement a new knowledge-based governance model that has resulted from the applied strategic planning process in place for more than a year and a half.

Those who have been closely following comments here, or the news and comments in the CDA Update in recent months, will probably agree that there have been allegations, charges, and assertions from outside the profession that simply have no merit. Starting with the Proposition 65 case and continuing with the suits that have been filed (but, as of late July, not served on CDA), representatives and legal advisors of the consumer interest groups central to the anti-amalgam campaign appear to ignore scientific evidence that amalgam poses no health risks, in favor of an agenda that accuses the American Dental Association, CDA, and the Dental Board of California of covering up the truth about mercury in amalgam and misleading the public.

While some progress has been made in the efforts to resolve the Proposition 65 issue, it appears that CDA’s efforts on behalf of dentists in that matter have been used against the association in the suits seeking to ban mercury from the dental office. And, the consumer legal adviser negatively links the association to supporting the thus far unsuccessful efforts of the Dental Board to adopt a Dental Materials Fact Sheet acceptable to their cause.

The Dental Board matter in total is far more complex and involves many more issues than just the safety of dental amalgam. Yet, in late July, the public assaults by consumer groups on the Board’s effectiveness were focused on the failure of the Board to approve a Dental Materials Fact sheet that would be acceptable to these groups. In a letter from the attorney representing "Consumers for Dental Choice" to the president of the Board attacking the Board’s efforts to develop an acceptable Fact Sheet, CDA was also pulled into the complaint and accused of "double self-interest": "The CDA’s economic self-interest is to protect the revenues of the ADA’s ‘Seal of Acceptance’ program," and "The CDA’s institutional self-interest is to protect dentists from tort scrutiny for failing to warn their patients of the risks of these fillings."

At the time of this writing, the possibility of the Board being able to develop a fact sheet acceptable to their key detractors before legislative activity determining its fate concluded seemed unlikely. The public goal for the consumer groups is a fact sheet that is easy to read and will facilitate a practical discussion between dentists and patients on the comparative merits and demerits of restorative materials used in dentistry. The real agenda of the consumer groups would seem to be a document that would set forth "facts" that support the anti-amalgam agenda rather than the scientific facts that the dental world, and in this case the Board and their independent consultant on the matter, know to be the truth. It seems that the consumers and their legal advisers will not accept anything less than a document that will fly in the face of current scientific knowledge. The other part of the strategy being employed by the public groups in this three-eye storm might be to keep public pressure on the Board and on organized dentistry until they extract a large monetary settlement from the profession that is to their satisfaction. If that were to occur, we might see the storm over amalgam subside for a few years. Based upon the fury out there now, that seems unlikely.

At the same time that this storm was raging, ADA released data from a year 2000 public opinion survey conducted by an independent survey firm in which dentists are identified as the leading source of patient information on oral health issues (44 percent). The next-most-used source was consumer magazines (10 percent). If we relate this information to our existing controversy, it would seem that we are headed for a situation where dentists might continue to be the leading and trusted source of information on restorative materials, but the quality of information received by the public could be determined and approved by consumer groups and other agencies rather than by dentistry. Even if the concerns are well-intended, it is another case of third-party interference, this time into the science of dentistry.

In response to the significant amount of concerning information released by these consumer advocates, the CDA Board of Trustees was asked in August to approve a short-term Proactive Public Awareness Strategy to educate the public about these visible dental issues. The strategy includes training spokespeople, issuing news releases, running radio spots in the top five state markets, and buying print advertising. The intent is to reinforce CDA’s reputation as the trusted source to the public on dental issues. It is hoped that this educational campaign will move public emotion in this storm away from concerns fostered by the unsupported claims and charges by those groups and individuals with motives that are, at best, questionable. Public sentiment should be based upon the facts, and only the facts.