A ‘disappointing’ letter

services perform ed for fee-for-service and capitation p atien ts,” the author uses such scientific term s as “ the num ber of fee p er service patients and the num ber on the capitation plan are about equal.” W hen did scientific studies start using phrases like “ about equal” num bers of patients? M any studies may end up that way, but how many start out saying “ about equal?” Based on the table presented, it is quite apparent that the so-called sam­ ple of patients was not from similar backgrounds. I base this on the fact that the need for basic services should have been the same in patients from similar back­ grounds. T h ere are som e areas w here dental services are not really elective but alm ost m andatory—for instance, in the area of am algam restorations. T he capitation patients experience a higher (3:1) service ratio. T hat is, they had three times as m any services as the fee-for-service patients. All this proves is th at the author is one of our m ore honest practitioners. I com m end him for his honesty but how about being m ore scientific in our publications? ALLAN J. LASSER, DDS LIVONIA, MICH

■ We would like to com m ent on the article, “ A quantitative com parison of services perform ed for fee-for-service and capitation p atien ts,” in the O cto­ ber JADA. T h e author tries to m ake a com pari­ son betw een the services rendered capitation patients and fee-for-service patients by a dental group. T he figures cited are so incom plete as to com ­ pletely nullify any conclusion. C apitation patients are in essence “ in su red .” T he only appropriate com parison with fee-for-service pa­ tients, then, would be only with those patients who are insured. T here is no question in our minds that the exis­ tence of prepaym ent is a strong factor in patient utilization of dental trea t­ ment. T h e author lumps his uninsured and insured fee-for-service patients to ­ gether, w ithout even giving their pro­ portions to the total. T herefore, for all we know , he is combining the util­

ization o f an insured capitation group to a predom inantly uninsured fee-forservice group. N onsense. DONALD R. Y EN T, DDS CHAIRM AN, COUNCIL ON DENTAL CARE CALIFO RNIA DENTAL ASSOCIATION

A ‘disappointing' letter m I w as m ore than disappointed to find in your letters section a letter of considerable length devoted to vita­ min E benefits from F . R. Bertrand, E xeter, D evon, England. T o begin with, I do not know if vi­ tam in E is beneficial to the human body or not. I do know that my per­ sonal physician, a man with im pres­ sive medical training and board certi­ fied in the specialty of internal medi­ cine, considers it to be a medical fad and o f little value. W hat does upset me is the unscien­ tific approach that is displayed not only by D r. B ertrand’s rep o rt but also by the Shute Institute of London, O ntario, Canada. L et us exam ine D r. B ertrand’s re­ port first. Clinical evaluation of tartar form ation apparently rests solely on the judgm ent of the operator as to w hether there is m ore or less tartar. N o m easurem ents, no controls, no investigation of other factors such as im proved oral hygiene since the pa­ tients w ere made acutely aw are, ap ­ parently, of the ta rtar form ation, and so forth. W e are asked to believe th at patient reaction such as “ ta rtar felt so fter” o r “ notice form ation of ta rtar when he did not take vitam in E ” are an ac­ curate gauge of efficiency o f vitamin E in preventing tartar. We are given dosages by D r. B ertrand depending on w hether the patient has o ver 160mm blood pressure or has diabetes, or is taking contraceptive pills, and so forth. Y et, to my knowledge, no official dosage for vitam in E has been established. O ne also could w onder about the wisdom of prescribing vitam in E for diabetics since, according to the infor­ mation given, it does upset their rath er delicate balance. Instead, we are advised to w arn them to keep

sugar handy as they m ay have an in­ sulin reaction. M ake sense to you? I am not an avid reader, b ut I have been exposed to publications o f the Shute In stitu te and in my opinion they are unscientific. Exam ple: A boy cam e in with an abscessed tooth and cellulitis which was treated with incision and drain­ age, eventual extraction, and fairly high doses o f vitam in E. Result: com ­ plete recovery. T he implication seem ed to me to be vitam in E pre­ cipitated recovery. H ow m any o f you have treated similar conditions with­ out vitam in E and obtained equally spectacular results? I w ould hope that in the future you apply the same standards to your let­ ters that you apply to the scientific sections o f t h e j o u r n a l . Certainly, unsupported personal opinion on the efficacy o f m edication would not be allow ed elsew here in the pages of t h e j o u r n a l , and I would hope it would not be allow ed in the letters section. Again, I am m ore than disappoint­ ed th at you saw fit to print such ma­ terial in w hat I have alw ays felt was a scientific journal. W A LTER C. ERVIN, JR , DDS ELM IRA, NY

Compliments to editorial staff m We w ere well pleased with th e pub­ lication of our article (“ C om position and stru ctu re of dental enamel: ele­ m ental com position and crystalline stru ctu re of dental enam el as they re ­ late to its solubility’ ’) in the Septem ber 1975 issue of JA D A . Please send our com plim ents to the editorial office, especially the senior m anuscript edi­ to r, Sue Spencer, for a job well done. We have received many requests for reprints from abroad as well as from hom e and from the rem arks m ade I believe the publication has been well accepted. Y ou can take pride in publishing in the sam e issue the p ap er titled “ T reatm ent of tem porom andibular joint syndrom e with biofeedback training.” This is a step forw ard. FRANK C. BESIC, DDS C LEV ELA N D , W IS

LETTERS TO THE EDITOR / JADA, Vol. 92, February 1976 ■ 301