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Computers—Is there a middle road?
EDITORIAL
Computers-Is
there a middle road?
T
oday’s orthodontist is being bombarded by often conflicting ideas on the role of computers in his field, but most of the attention seems to revolve around extreme viewpoints. On the one hand, we have the avante garde researchers exploring the fringes of potential applications as typified by the symposium in the March, 1972, JOURNAL and some who even suggest that a computer can select a treatment plan. These, in turn, lead to understandable and very justifiable cautions, such as those expressed in Salzmann’s editorial in October. What both of these ignore is the large middle ground where computers are being constructively applied today. The research efforts described in the symposium are very correctly presented as pure research, largely oriented toward computer-generated predictions. While they make use of highly sophisticated computer techniques, these fully computerized projections are still based on the most superficial concepts of facial growth. In their present stage of development, these might well be described as intellectual games, being played with all the intensity that others may apply to golf or chess. We need studies of this kind which may some day lead to improvement in the human state, and they deserve our support, but it is important that we maintain our perspective. It is one thing to play games with a government grant, and quite another to play those games with a living patient. As Walker states, it is now possible to simulate growth patterns but extremely difficult for a computer to predict the pattern for a specific individual. Even speculation on the future potential of such approaches is just another game, with no more predictive validity than the computer-generated simulations themselves. The most useful contributions of computer technology to growth projection still lie in exploration and in the relatively simple tabulation of growth increments for use with other methods of prediction more solidly based on the anatomy and physiology of growth. Meanwhile, computers are being applied to many of our problems today, with very positive results. There is a broad area between simple billing procedures which are familiar to us all and pie-in-the-sky goals of total computerization of diagnosis and treatment, and it is here that computer technology is making solid contributions to clinical orthodontics. A computer is merely a device for the storage, manipulation, and retrieval of information, and its practical application is limited to areas where we have 81
82
Editor&
Am. J. Orthod. January 1973
meaningful information to be processed. The orthodontist works with exactly this type of information whcnevcr he records and assesses clinical data, such as that derived from cephalometrics. Assigning the mechanical phases of these operations to a computer does not abdicate the thinking process to a machine, as is suggested when Salzmann says: “Man thinks; the computer responds.” In the rational application of computer technology, the thinking man follows those first steps with further thought and final diagnosis after he receives the computer’s initial mechanical response. The raw data-such as our familiar cephalometric values-are fed to the computer under close human supervision. The computer sorts and compares these data in far more detail than even the most ambitious among us could hope to accomplish, printing out a large volume of orga.nized data and evaluations which can include clear identification of deviations from average norms. When we can delegate these onerous paper-and-pencil operations to a computer, we expand the meaningfulness of our information at the same time that we make more time available for the thinking stages of diagnosis. A bonus side effect of this process is the ease with which the computer can continuously update our norms as the number of cases recorded and evaluated continues to increase. The computer printout is not the end; it is the beginning. The computer cannot even evaluate the significance of the norms and deviations from those norms which it reports. It merely responds to its originally programmed instructions. What this accomplishes is to provide the clinician with a new and greatly enhanced base of information from which he can develop his diagnosis. Deviations from norms are not answers ; they are questions which direct attention once more to the associated anatomy and physiology. It is quite true that computerization, taken by itself, dehumanizes the entire procedure. The clinician’s responsibility is to rehumanize the output once again before he translates it into action. This requires a high level of clinical knowledge, from the earliest programming and input stages to final formulation of the treatment plan. The dangers with which Salzmann is rightly concerned lie in possible misapplication by those nai’ve enough to believe that these instruments are a substitute for, rather than a supplement to, professional knowledge and skill. This is a real hazard, but if the hazards of misuse were a criterion in the selection of our armamentarium, we would have to discard everything about US. Our responsibility is to make the best use of all of the tools available to US. Far from abandoning his conventional diagnostic methods, materials, and skills to some mindless electronic monster, the astute orthodontic clinician is using the computer to augment and expand their potential. The new information which is placed before him provides more food for thought, which demands an ever higher level of clinical knowledge and skill. The resultant increase in breadth of clinical awareness must inevitably lead to a higher level of service to the patients we seek to serve. R. C. Thurow
Computers-Is
there a middle road?
T
oday’s orthodontist is being bombarded by often conflicting ideas on the role of computers in his field, but most of the attention seems to revolve around extreme viewpoints. On the one hand, we have the avante garde researchers exploring the fringes of potential applications as typified by the symposium in the March, 1972, JOURNAL and some who even suggest that a computer can select a treatment plan. These, in turn, lead to understandable and very justifiable cautions, such as those expressed in Salzmann’s editorial in October. What both of these ignore is the large middle ground where computers are being constructively applied today. The research efforts described in the symposium are very correctly presented as pure research, largely oriented toward computer-generated predictions. While they make use of highly sophisticated computer techniques, these fully computerized projections are still based on the most superficial concepts of facial growth. In their present stage of development, these might well be described as intellectual games, being played with all the intensity that others may apply to golf or chess. We need studies of this kind which may some day lead to improvement in the human state, and they deserve our support, but it is important that we maintain our perspective. It is one thing to play games with a government grant, and quite another to play those games with a living patient. As Walker states, it is now possible to simulate growth patterns but extremely difficult for a computer to predict the pattern for a specific individual. Even speculation on the future potential of such approaches is just another game, with no more predictive validity than the computer-generated simulations themselves. The most useful contributions of computer technology to growth projection still lie in exploration and in the relatively simple tabulation of growth increments for use with other methods of prediction more solidly based on the anatomy and physiology of growth. Meanwhile, computers are being applied to many of our problems today, with very positive results. There is a broad area between simple billing procedures which are familiar to us all and pie-in-the-sky goals of total computerization of diagnosis and treatment, and it is here that computer technology is making solid contributions to clinical orthodontics. A computer is merely a device for the storage, manipulation, and retrieval of information, and its practical application is limited to areas where we have 81
82
Editor&
Am. J. Orthod. January 1973
meaningful information to be processed. The orthodontist works with exactly this type of information whcnevcr he records and assesses clinical data, such as that derived from cephalometrics. Assigning the mechanical phases of these operations to a computer does not abdicate the thinking process to a machine, as is suggested when Salzmann says: “Man thinks; the computer responds.” In the rational application of computer technology, the thinking man follows those first steps with further thought and final diagnosis after he receives the computer’s initial mechanical response. The raw data-such as our familiar cephalometric values-are fed to the computer under close human supervision. The computer sorts and compares these data in far more detail than even the most ambitious among us could hope to accomplish, printing out a large volume of orga.nized data and evaluations which can include clear identification of deviations from average norms. When we can delegate these onerous paper-and-pencil operations to a computer, we expand the meaningfulness of our information at the same time that we make more time available for the thinking stages of diagnosis. A bonus side effect of this process is the ease with which the computer can continuously update our norms as the number of cases recorded and evaluated continues to increase. The computer printout is not the end; it is the beginning. The computer cannot even evaluate the significance of the norms and deviations from those norms which it reports. It merely responds to its originally programmed instructions. What this accomplishes is to provide the clinician with a new and greatly enhanced base of information from which he can develop his diagnosis. Deviations from norms are not answers ; they are questions which direct attention once more to the associated anatomy and physiology. It is quite true that computerization, taken by itself, dehumanizes the entire procedure. The clinician’s responsibility is to rehumanize the output once again before he translates it into action. This requires a high level of clinical knowledge, from the earliest programming and input stages to final formulation of the treatment plan. The dangers with which Salzmann is rightly concerned lie in possible misapplication by those nai’ve enough to believe that these instruments are a substitute for, rather than a supplement to, professional knowledge and skill. This is a real hazard, but if the hazards of misuse were a criterion in the selection of our armamentarium, we would have to discard everything about US. Our responsibility is to make the best use of all of the tools available to US. Far from abandoning his conventional diagnostic methods, materials, and skills to some mindless electronic monster, the astute orthodontic clinician is using the computer to augment and expand their potential. The new information which is placed before him provides more food for thought, which demands an ever higher level of clinical knowledge and skill. The resultant increase in breadth of clinical awareness must inevitably lead to a higher level of service to the patients we seek to serve. R. C. Thurow