Dentists have stopped being strung along by the great flossing yarn. About time | Ollie Jupes

Having had to swallow American jibes about “British teeth” for all these years, my little chest swelled with dental pride on Tuesday when I learned that the Americans don’t know absolutely everything about teeth – and dental patients in particular. For dental floss has now officially been declared dead in the US.

Well, I say dead. A great many American dentists still want it kept on a respirator just in case it shows a flicker of life – like when there’s a piece of Cajun chicken lodged between the most distant molars, or you need to make a video of your child’s tooth being pulled out by a homemade space rocket.

The fact is, the British dental profession gave floss a quiet burial years ago after sneaking it out the back and finishing it off humanely with a lump-hammer. Yes, in the UK we realised ages ago that – and if you still religiously floss daily, look away now – flossing simply doesn’t work as a health measure (or a fetish).

Related: Everyone recommends flossing – but there’s hardly any proof it works

Let me say that again. FLOSS DOES NOT WORK. Not at all. There’s not a shred of evidence that it does any good whatsoever. I mean, it seemed a good idea at the time – 1882 to be precise – but modern evidence would demonstrate that it doesn’t improve gum health one jot (to use the scientific term).

The British Society of Periodontology, the organisation that specialises in gum health, has known about the black heart of floss for years and currently recommends the use of single-tufted interdental brushes for effective cleaning between the teeth. The American Dental Association and the American Academy of Periodontology however, are largely ignoring the fact that their government’s latest Dietary Guidelines for Americans has quietly dropped its recommendations for flossing because under the law, the guidelines must be based on scientific evidence.

The enthusiasm with which American dental professionals promote flossing despite the evidence, has raised the notion of a conspiracy with floss manufacturers. I don’t believe for a second that American dentists are in cahoots with floss makers, but why do they cling to the notion that floss is a good idea and keep recommending it? Perhaps because, like flossing, it’s a habit and after over a century of promoting the use of floss, it must be extremely difficult to backtrack and say: “Houston, we may have a problem.”

The Brits never had that dilemma. As a nation we were never great flossers anyway and now we know that our patients had an uncanny and instinctively accurate inkling that the lacklustre recommendations of their dentists and hygienists were best ignored.

Related: The secret life of a dentist: some patients think superglue will fix their toothache | Anonymous

I can see why Americans like to promote floss. As a dentist I can appreciate that if flossing is done “properly”, the technique is precise, even elegant. If you have a regular flosser in the chair, you know the patient cares about their teeth, having dedicated a fair chunk of their day to a particularly tedious and often unpleasant task.

But even with the best technique, the evidence doesn’t support flossing as an adjunct to brushing. Most patients, even if they bother to get the minty-waxed out the box, are exceptionally heavy-handed and macerate their gums like they’ve been chewing on bare vacuum cleaner flex. Even in controlled studies, after instruction, the patients taking part couldn’t floss properly. I know of no dentist who flosses. Not one. And of the colleagues who don’t walk away bored witless when I have broached the subject of flossing, most admit that when they tried it, it was really difficult to do effectively, even with their assumed level of dexterity.

Nowadays in the UK, we (I hope, how I hope) all recommend single-tufted interdental brushes as an adjunct to regular brushing. The studies prove beyond doubt that they significantly reduce plaque deposits, decreasing gum inflammation and reducing the risk of gum disease and bone loss. They either have a conventional toothbrush handle or look a bit like a toilet brush on a stick, though it’s best not to think about lavatories while you are using them. The only time I reluctantly suggest floss is when a patient has an area so crowded, floss is the only way of getting between the teeth. And even then I cross my fingers.

Floss is dead. Long live the single-tufted interdental brush.

Dentists have stopped being strung along by the great flossing yarn. About time | Ollie Jupes

We need to tread cautiously along the path to assisted dying

I think the goal of the briefing was to stimulate an write-up on roughly the lines that you see before you: approximately, that is, but not precisely. Often you begin a discussion with a standard prejudice to agree with somebody – and then, as the conversation goes on, you locate yourself prey to misgivings.

The youthful female from Dignity in Dying was charming and persuasive, but as we talked about the precise terms of the Bill, I started to be concerned that it may possibly indeed pave the way for one thing unintended – one thing unsightly and distressing: not precisely a culture of death, but a globe in which it was just too simple to opt for this state-accepted self-extinction.

The dilemma lies in the initial couple of paragraphs, exactly where the Bill defines individuals who would be eligible to consider the “medicine” (a euphemism if ever there was a single) or to have it administered to them. They should be somebody who has a terminal sickness and who “as a consequence of that terminal sickness is reasonably anticipated to die within 6 months”. Now I am certain that infinite care has gone into the drafting of that phrase, but it absolutely encompasses a potentially quite broad group of people.

Many hundreds of thousands of people, old and youthful, locate themselves living on with terminal illnesses – cancers and other afflictions – for a very extended time and clearly a wonderful several will favor lifestyle to the different. It goes with out saying that numerous are capable of taking continuing interest and pleasure in their lives. But it is also accurate of these men and women that their situations could deteriorate fairly quickly – and that they could die within a comparatively brief area of time.

In other phrases, there are a huge amount of men and women whose deaths would not come as a massive shock to a medical professional – and who could therefore be described as people who could “reasonably be anticipated to die inside 6 months”. I would like to see this language tightened up, so that the class of those who may well be eligible for the “medicine” is not as broad as it presently appears. Definitely it cannot be past the abilities of the parliamentary draftsmen to amend the phrase slightly, so that assisted dying could be offered only to these who “could not reasonably be expected to survive more than six months”.

You may say there is not a lot difference among the two categories. I consider the difference is extremely significant. It is the difference between the sturdy probability of death inside 6 months, and the overpowering probability of death within 6 months. It is the big difference in between the group of individuals who could very effectively be claimed by the Reaper at any time within the up coming six months, and the group of individuals who are obviously not going to survive significantly longer. This change would restrict the amount of individuals eligible for assisted dying – even though naturally it would nonetheless drastically increase the choices for alleviating suffering at the finish of our lives.

I believe it appropriate to be cautious, since we are proposing to make a very huge alter in our strategy to death and dying: providing men and women a lot more of a proper to decide on when to die, and over all offering the state an obligation to support us consciously to do away with ourselves, if specified problems are satisfied.

I am positive it is a adjust the public broadly supports, and 1 whose time has come. But lifestyle is valuable and our psychology fragile. Individuals struggling terminal illnesses can very easily uncover themselves under strain – external or inner – to make selections from which, naturally, there is no going back.

If we are going to take this step, we must make it a tiny 1, and see how it goes. I would like to see the Falconer Bill apply not to all these who may possibly properly die in the next six months, but only to individuals whose lives are overwhelmingly probably to be extremely close to the end.

We need to tread cautiously along the path to assisted dying

Insurers Fret Hepatitis C Pill Charges Along With Obamacare

As wellness insurance companies reveal much anticipated very first-quarter earnings, it’s the unpredictable impact from the five-figure price of new Hepatitis C treatment options that are the topic of as significantly  Wall Street worry as the Affordable Care Act.

This week, UnitedHealth Group UnitedHealth Group (UNH) executives invested a lot more time answering inquiries about the mounting value to the giant health insurance firm and its customers of new Hepatitis C drugs than the rollout of the well being law, which promises a boon of business to wellness insurers.

UnitedHealth, a perceived bellwether in the well being insurance coverage market as the country’s largest publicly-traded overall health prepare, stated the drug value $ one hundred million to the company in the quarter “across the Medicaid, commercial and Medicare element D” plans it sells.

UnitedHealth CEO Stephen Hemsley described the predicament as a “rapid launch of an effective and really pricey new hepatitis C therapy.’

“The aggressive US pricing practices on this has been well publicized and continues to be very controversial,” Hemsley mentioned for the duration of a 70-minute call Thursday discussing the company’s first quarter earnings. “We are working diligently to make sure this medication is utilized underneath clinically proper specifications.”

At problem is the $ 1,000 per pill cost of Sovaldi, produced by Gilead Sciences Gilead Sciences. (GILD) The business and its pricing technique have come beneath intense criticism from insurers, government well being plans and other individuals.

The value of a course of treatment has been pegged at more than $ 80,000. The market place is large with the liver disease afflicting a lot more than 3 million Americans.

And there are much more Hepatitis C medicines to come, this kind of as one expected to launch later this year by Abbvie (ABBV), the drug business spinoff of Abbott Laboratories Abbott Laboratories (ABT). It’s unclear no matter whether Abbvie (ABBV) will launch at a lower price tag, probably triggering some competitors that would enable overall health programs to reign in some of the fees.

“We’re not discussing our pricing strategy before launch,” Abbvie spokeswoman Jennifer Smoter explained. “We anticipate to launch in the US before the end of the yr.”

Numerous other health insurance coverage companies are reporting their initial-quarter earnings in the coming weeks. Across the industry, the value of Hepatitis C prescription drugs could run much more than $ one billion in the very first quarter alone.

Wellpoint, which owns and operates Blue Cross and Blue Shield programs, is scheduled to report its earnings April thirty and Humana Humana (HUM) reviews its earnings the initial week in Could. Other gamers to report are Aetna, which will report up coming week and Cigna, which will report May possibly 1.  

Insurers Fret Hepatitis C Pill Charges Along With Obamacare