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SPRING/SUMMER '00 This is the forty-fourth newsletter circulated to all of our patients, parents and colleagues.  As always, we hope that you will find its content both informative and thought provoking.  As well, we hope that it encourages you to feel comfortable expressing suggestions and opinions that will help us to continue to improve our services to you.  Please feel free to speak with any of us at any time. THE WAR THAT WASN'T About thirty years ago, a film was made which rapidly sank into obscurity.  Its title was, "What if they gave a war and nobody came?"  Clearly the much-vaunted disaster of "Y2K" never materialized much to the relief of the world-population.  Many of us would observe that we never should have expressed the level of concern and spent the vast sums of money preparing for something that turned out to be an electronic "phantom".  However, in reflection, the problem was much like deciding on treating or not treating a patient.  If one treats the patient in such an instance, one can never know whether the same result would have been achieved without treatment.  In all probability, because the problem was approached so intensively, it avoided potentially disastrous problems in a society that has become so dependent upon computers.  The maddening realization, however, is that many second and third world countries did virtually nothing and somehow managed to survive without interruption of any substantial magnitude.  Indeed, we were all very fortunate and as the title of the television show says, "Life Goes On". SUPER-COMPUTERS Westwalk Orthodontic Group has always been proud of its quest to remain in the forefront of technology and as we start the new century and millennium, we are proud to announce that our Diagnostic Computer Imaging Technology is now driven by a new "SUPER COMPUTER". With the aid of this marvel of computer-technology, we now have the ability to analyze orthodontic problems to a degree, which was almost unthinkable just five years ago.  The beauty of this technology is that it allows us to analyze, diagnose and test various treatment modalities before our treatment consultations in a way, which should be fully comprehensible to the patient prior to the commencement of any treatment.  Therefore, we will be able to easily demonstrate what the problem is, what the recommended treatment plan should be and to a greater extent what the end result of treatment should produce.  Armed with this information, the patient will now have the best information available to make a truly "informed-consent".  An added bonus is that should it be necessary to transfer treatment in progress to another orthodontist it will provide him or her with a clear understanding of our rationale for treatment.  Treatment approaches vary from office-to-offices so transfer case are frequently fraught with problems based on a lack of understanding of the previous orthodontist's approach.  With this better analytical tool, we should now be able to provide a smoother transition for the patient should that become necessary.  As well, should the patient decide that a "second-opinion" is warranted, it will allow him or her to better weigh the options available based on differing opinions.  Please feel free to request a demonstration of this technology at any time. HEALTHCARE / MANAGED CARE As those of you who have read our newsletters know, this subject has always been very popular with our readers.  Perhaps "popular' is a malapropism due to the "morass" of our current day healthcare system.  It is quite probable that like all of us, you have been exposed to the built-in frustrations in the area of "claim-processing".  Most companies require a mound of repetitive paperwork for either "pre-approval" or "claim-re-imbursement' and it is rare that a single submission produces a positive outcome.  Equally unusual is the ability to communicate with a "live human being" before being forced to wait an endless amount of time on a telephone followed by the need to select "menu options' only to find out that the person to whom you finally speak is not the person one needs to communicate with.  And when one does finally connect with such a person, frequently one is told that he or she is not in the division that handles such problems, requiring yet another transfer. Then, one finds that after submitting a claim that frequently there is no prompt response from the company requiring yet another call which must traverse the same obstacle course.  When successful contact is made, one usually is told that the required information was, "never received" or "incorrectly filled out" and must be "re-submitted".  All the while, in most cases, you are receiving bills from the "provider" seeking payment creating considerable angst for both parties.  In reality, it is in the interest of most insurance companies to delay payment as long as possible.  In financial terms this process is called 'kiting".  Money held by insurance companies earns "interest' which is a substantial amount of the company's income stream and so there is a great incentive to delay payment as long as possible.  Unfortunately, you and the " provider" are not earning the interest so in essence both of you are paying a 'premium' on top of a premium.  In some instances, this has become so flagrant as to force many "providers" to declare bankruptcy due to unpaid bills in practices, which were highly dependent upon patient insurance as a source of income. What is the solution?  Many states observing the collapse of HMO's and the healthcare system have enacted laws, which require more prompt payment by third parties to maintain their charters.  However, because of the claim complexities, these laws are quite difficult to enforce and we foresee little if any improvement.  In our practice, we make every effort to assist you in claim filing and if you are experiencing any problems, we encourage you to speak with our office managers who stand ready to assist you as best we can. ELECTION-2000 At this writing we are approximately nine months away from electing a new president and a substantial amount of our senate and Congress.  Clearly the past eight years have presented us with one of the greatest dichotomies of all time.  Unquestionably, we have a prosperous economy beyond the most optimistic of expectations, but at the same time, a chief executive who has done much to undermine the confidence of the electorate in his sense of morality.  Proof enough has been Vice-President Gore's intense effort to disassociate himself with Bill Clinton.  As most of you probably have gleaned from my writings, I have never been a "fan" of the President, but I suspect that history will only highlight the apparent prosperity.  And, in all probability, Gore has not forgotten that Clinton's accurate perception eight years ago was highlighted by the phrase he often repeated, "It's the economy stupid" when he correctly adjudged the concerns of the electorate in 1992. Less clear at this time is who will oppose Gore, the likely nominee of the Democratic Party.  Unfortunately, the aloof and pedagogical Bill Bradley has not been able to strike a responsible chord with his own constituency.  The maverick senator John McCain is creating a great deal of havoc within the Republican Party and on close examination has, for most of his time in the United States Senate been alienated from the bulk of his hard core colleagues.  His "Straight-Talk" express has resonated in many states during the primaries where people are tired of politics as usual.  However, it remains to be seen whether or not McCain can win back the old line Republicans who will decide in the "closed" primaries who in fact will be the Republican nominee. Governor George W. Bush is clearly the choice of the old line Republican party "machine" and prior to the primaries he had accumulated an unprecedented amount of money with which to conduct his campaign; more than $80 Million dollars.  But, as of this time, senator McCain's successes have forced Bush to deplete most of those funds to the point where both have about an equal amount to spend which should make the next few weeks and months something of an interesting horse race.  Bush, in my opinion, seems confused and blundering with a resume that is quite unimpressive.  And his less than forthright admissions about his youthful past make him appear about as substantial as our beloved Dan Quayle.  What is most distressing about the two Republicans is the accusatory tone taken in the form of "unsolicited" phone calls to each state's electorate, a return to the dismal, but effective "negative attack campaigns" despite an initial pledge between the two to eschew such tactics. Less clear are the real positions of each of the potential nominees because, at this time, none has submitted any written plans as to what their priorities are and how they intend to implement the changes that all seem to indicate are warranted.  My uneducated prediction is that in the final analysis, the choice will be between George W. Bush and Al Gore, which at the moment seem quite un-inspiring.  Bush's performance to date in debates has been less than stellar and I give Gore a large edge in such confrontations.  Bush will undoubtedly try to link Gore to questionable fund raising practices to portray him as just as political immoral as the President. Indeed we are seeing the birth of a "new economy", perhaps even a new world order, but there remain dangers and challenges which will require a vigorous and strong leader committed to the betterment of the world.  Hopefully, one of these two will rise to the occasion, but candidly, I am quite dubious.  Hopefully, this new president will select a fine cabinet and cast of supporting characters, which I believe, has been the key to those things at which Clinton has been successful. Our democratic election process is precious and has been paid for with the lives and blood of our forefathers.  It is critically important that we all exercise our privilege to participate fully in the process, if we are to chart the proper course for our children’s futures. WESTWALK'S WEBSITE As some of you may know, Westwalk Orthodontic Group has developed our own "website".  It can be accessed on the Internet at www.westwalkortho.com.  We have now incorporated a "virtual office tour".  In this way, if you wish to refer another patient to us, you can suggest that they visit our site to see the office and meet the doctors and staff.  We also have a section devoted to frequently asked questions, FAQ's so that anyone considering us can obtain most pertinent information even before calling the office for an initial appointment.  We also will endeavor to continuously update our information relative to treatment technology and general information relative to the operations of our offices.  The site was created by Dr. David's son Mark who is a full-fledged "webmaster" and who will be graduated from American University this May, an extremely talented "chip-off the old block" We would appreciate any comments you care to make after having made your visit. MEDICAL ADVANCES As we all have been made aware, early diagnosis is often the key to successful and often life-saving treatment.  For many years, the MRI (Magnetic Resonance Imaging) procedure has virtually replaced the old fashioned x-rays for diagnosis.  The accuracy of this technique is one hundred fold more than the convention x-ray and can reveal tumors that would not be detected on the x-ray until they had reached a stage where treatment prognosis would be much poorer.  The advantage of the MRI is that it is based upon a huge magnet, which "excites" the nuclei of cells in such a way that even small tumors are very visible.  This "radiation" is about one-hundredth of the normal x-ray and therefore creates very little negative effect on "normal" tissue. The National Institutes of Health (NIH) recently announced that they have developed a technique of "magnetizing Xenon gas" which can be infused into the patient.  This gas attaches itself to tumor cells, which appear as bright objects on the MRI film.  The huge advantage this implies is that the normally huge MRI machine can be replaced by a portable detection machine, which can be placed at the patient's bedside or even in the emergency department of hospitals at a fraction of the cost of the current day machines costing millions of dollars to purchase and maintain.  The NIH has found this particularly effective in detecting cancers of the lung in extremely early stages and represent one of the greatest causes of death in the United States.  An alternative method, which does require some amount of radiation, is the "CAT SCAN" (Computerized Axial Tomography), which can detect these tumors at an early stage with concomitant low dose x-ray.    As a reminder, early detection and screening are always the keys to a good outcome for serious illness.  As physicians of the oral-cavity, (mouth) we examine all structures routinely.  Fortunately, we rarely find anything which could be considered significant because we deal with a fundamentally young and healthy population, but the key to useful detection is maintaining a "high index of suspicion."  My father was an exceptional physician and said many times to me, "Generally, how you feel is how you are."  Most patients really know what their health status is and listening carefully to what they say often leads one to a correct diagnosis.  If you feel that something is not right it is wise to relate those concerns to a trusted physician who is familiar with you and your family's medical and social history...better safe than sorry. TRADITION All of us share a unique status.  We all can claim experience in two centuries and two millennia.  We at Westwalk have always tried to deliver the finest treatment results possible.  More than that, however, we have always tried to deliver more than just a pretty smile.  Because we spend years with most patients and their families, we come to know those things, which are even more important in their lives and thereby develop many friendships.  I have always loved the rhetorical phrase, "If a tree falls in the forest and there is no one there to hear it, does it really make a sound?"  We share many joys and even a few sorrows within our "orthodontic families" which enriches our life experiences and we hope, yours.  We really care about all of you and revel in being allowed to share our community with you.  We have a "tradition" of feeling that we are honored by your presence in our offices.  All of us at Westwalk wish you and your families a wonderful "first Spring and Summer" of the new century and the new millennium and we thank you for choosing us as your orthodontists.