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"ASOMAT - Who are they and what are they on about? A response"

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" ADA News Bulletin July 1998 "

by Roman Lohyn

The article by Dr. Butler ‘ASOMAT - who are they....’ was interesting for what it said as well as for what it did not say. The techniques used to discredit ASOMAT are time honoured ones, employed by a diverse range of practitioners, ranging from Herr Goebbels to today’s tabloid press.

Dr. Butler asserts that ASOMAT misrepresented the NHMRC position on amalgams. The fact is that Prof. Leeder was asked specifically whether the withdrawal of the brochure meant that the policy supporting the safety of dental amalgams was withdrawn. He answered unequivocally that.."Yes .. the withdrawal of the brochure means that the policy statement supporting dental amalgams is withdrawn" This is what ASOMAT reported. It may or may not have been mischievous but it certainly was accurate. It is now stated that NHMRC policy is unchanged but efforts by myself and others to get a statement on official NHMRC letterhead stating unambiguously what the current policy on amalgam is, have been unsuccessful. I welcome any attempts by the ADA, or anyone else, to prove ASOMAT wrong and to clarify the official NHMRC position. An explanation of the incongruence between what is being alleged now, and what was actually put down on paper last September would also be welcomed.

On the matter of legal liability, it appears that the advice given by Dr. Phillips from England, on behalf of the indemnifier, may be incorrect. In Australian law the concept of ‘state of the art defence’ no longer applies. This can be confirmed by asking a lawyer about ‘Rogers and Whittaker 1992', a case decided in the High Court where the state of the art defence was rejected. ASOMAT encourages dentists to contact their own legal advisers for advice on their potential liability.

Dr. Butler criticises Dr. Gammal for his views on root-canals and the magazine in which they appeared. Dr. Butler knows that ASOMAT has no opinion and no policy on root-canals, other than an open-minded willingness to listen to unorthodox views. Dr. Gammal’s views on root-canals are his own. Whatever Dr. Gammal feels about root-canals, and wherever they are published, is about as relevant to ASOMAT’s formal, scientifically referenced, views on amalgam as is the fact that I support Port Power in the AFL. Diehard supporters of other teams will no doubt feel that this explains a lot. Nevertheless, it does the credibility of Dr. Butler and the ADA no good at all when they create straw men to knock down as a substitute for informed debate.

In discussing Dr. Bartram’s problems, Dr. Butler neglected to mention that Dr. Bartram is a qualified acupuncturist and naturopath, legally registered as such in South Australia. Acupuncture, recognised for some time by mainstream Australian medicine as a valid modality, sees nothing unusual in a link between teeth and other parts of the body. Further, the Dermatron is an instrument commonly used by acupuncturists and naturopaths and is also widely used by the medical profession in Germany. In any case, it would have been more appropriate and credible for Dr. Butler to adhere to the convention of not commenting on this legal matter until its final conclusion.

As Dr. Butler pointed out, all the signatories to the recent mailout have basic dental qualifications but no recognised qualifications in toxicology or oral medicine. Nobody from ASOMAT has ever claimed otherwise or even raised the issue. Surely it is obvious that the words ‘oral medicine’ and ‘toxicology’ in ASOMAT’s title describe an interest in a subject rather than a mandatory requirement for postgraduate degrees. The obvious intent of Dr. Butler’s observation is to not only try to discredit the signatories, but to convey the impression that someone with only a BDS or BDSc, no matter how experienced or knowledgeable, cannot make a meaningful contribution to an issue, compared with someone with more letters after their name, even if that someone else has no experience in the matter under discussion nor any familiarity with the most recent research. Such contempt for the capabilities of general practitioners, the backbone of the Australian Dental Association, deserves the strongest condemnation. I have always believed that the truth of any matter lies in the evidence which backs it up rather than in who proposes it. The ADA could do a lot worse than to consider adopting such a philosophy.

The Federal Executive of the ADA refused an unconditional offer from ASOMAT to present what ASOMAT felt was relevant and cutting edge research. The Executive summarily rejected the offer asserting that they take their advice from others, such as NHMRC, RACP and the Centre for Environmental Toxicology. Let’s look at these others. NHMRC policy is presently in chaos. The brochure, which was withdrawn in August 1997, was adopted in 1992, and was the ONLY document on this matter held by NHMRC. In the absence of any official letter from NHMRC clearly stating otherwise, the only rational conclusion is that NHMRC does NOT presently have a policy. The Royal College of Physicians was also queried about its support of the ADA position. The facts, (copies of the letters are available) are that RACP has no document, no literature review, no list of literature perused and refuses to provide the names of the experts whom it allegedly consulted. In short we can’t tell how they arrived at their position, what they looked at, or even who looked at it. I can imagine the mirth within ADA circles if ASOMAT had offered a similarly constructed assessment of the amalgam situation. It will be no surprise that my experience with the Centre for Environmental Toxicology almost exactly mirrored the one with the RACP. One can legitimately start to wonder whose position is based on dogma rather than fact.

What IS ASOMAT’s position? We believe that amalgams should not be used in pregnant women, breastfeeding women, children under the age of six, people with kidney problems and people with neurological problems. This is almost identical to the recommendations of Health Canada which Dr. Butler approvingly quoted, as well as those of the German and Norwegian Health Authorities. The British Ministry of Health also just recently issued over 50,000 advisory notices to doctors and dentists recommending that amalgams not be used in treating pregnant women. ASOMAT also believes that amalgams should be phased out over a three year period, a position in line with the Swedish Social Services Department which announced in April that it would no longer reimburse dentists for placing amalgams after the year 2000. Three years is more than sufficient time to bring the profession up to speed with composite resin techniques.

Why do we persist? We persist because we see, on a daily basis, patients getting better after amalgam removal and correct detoxification treatment. This is not a dry academic debate but a situation where there is a definite problem, affecting a certain, but as yet unquantified, proportion of the population. We do not pretend to know all the answers, or even all the questions, but we do know that it is totally ludicrous to continue with the assertion that there is NO evidence of harm. We care about our profession and we are being true to the code of ethics which states that dentists have an obligation to share their knowledge. While Dr. Hammer yearns for the resignations of dissenting members, he should humbly reflect that ADA Presidents come and go but that the profession continues. It is to our profession and our patients, not to Dr. Hammer, that we fulfill our responsibility.

ASOMAT welcomes examination of its position. I give an unconditional undertaking that ASOMAT will accept any invitation by the ADA to present its peer reviewed evidence and to debate its critics. ASOMAT previously made such an offer to the ADA Executive but it too was rejected. If the ASOMAT arguments are not credible then they will not withstand the public scrutiny of the profession, and the ADA position will be seen to be clearly superior. It speaks volumes that the ADA Executive is not prepared to take the risk.

 

Roman Lohyn President ASOMAT

Melbourne

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