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SPRING/SUMMER 99 This is the forty-second newsletter circulated to all of our patients, parents and colleagues.  We hope that you will find its content both informative and thought provoking.  As well, we hope that it will encourage you to feel comfortable in our offices by giving you the opportunity to candidly express your thoughts and feelings.  In so doing, this will help us  to continue to strive toward improving our services to you.  Please feel free to speak with any of us at any time. HEALTHCARE / MANAGED CARE Because we have received very positive reviews of this section of our Newsletter since its inception over three years ago, we are endeavoring to keep you abreast of current developments in this most important topic in society.  Obviously, we are all affected by HMO'S, Insurance companies and government health protection. We are all aware, or should be, that the cost of health services continues to rise at a rate faster than inflation.  Unfortunately, our incomes have not kept pace with this rise. At this writing, we have seen an economic expansion that has lasted for over ninety-six (96) months and a stock-market which is approaching a Dow Jones average of 11,000.  Ninety-six months ago, the stock market was around 2000.  As I have made very clear in the past, I have a personal antipathy for President Clinton.  However, he must deserve some credit for the state of the economy, ...on his watch.  This, in my opinion, is the reason he will escape removal from office.  Despite this, HMO's continue to show signs of collapse.  Cases in point are: The Oxford Health Plan based in Connecticut and HIP (Health Insurance Plan) based in New Jersey.  Health choice of Connecticut finds itself being refused for payment by many local physicians due to late payments and fees which are insufficient. Our own plan, Physicians Health Services has been purchased by the Foundation Health Plan, headquartered in Los Angeles, California.  As we have indicated, PHS has been excellent in providing coverage, albeit one of the most expensive of plans.  In my own case, the cost of coverage for my wife and myself is now in excess of $11,000 annually.  Government officials have predicted yet more increases ranging from 10-30 percent for most plans this year, so do your own calculations.  Foundation is known for its aggressive cost-cutting measures and therefore we anticipate a combination of premium increase plus a decrease in previously covered services- the usual "more for less..." The more for less usually comes in the form of premium increases concomitant with higher co-payments, higher deductible out-of-pocket expenses and limits upon prescription drug payments for the calendar year.  As well, we would anticipate that physicians can expect to see fees for approved services lowered.  If the latter is severe enough, many groups of participating physicians may be forced to opt out of the particular networks, limiting our choice of doctors.  History has shown that these "for profit HMO networks" have less concern for the quality of services rendered than for their net profits.  Any HMO which is a publicly stock traded entity is ultimately answerable to its investors in the form of dividends and stock-price appreciation.  So, place your tray tables in the upright position, fasten your seatbelts and expect a very turbulent ride this year...... and on into the future. DENTAL SERVICE MANAGEMENT ORGANIZATIONS What are "Dental Service Management Organizations”, DMSO'S?  In the case of Orthodontic treatment, two examples come to mind.  Perhaps you have seen television advertisements for Connecticut Orthodontic Specialists and Apple Orthodontics.  These are two examples of a DMSO.  In the case of the former, this group which is under the parent company, Orthodontic Centers of America has five offices which are owned by two orthodontists.  In the case of "Apple", it purchases existing private practices and then has the previous private owner as an employee of the parent company.  The former, Orthodontic Centers of America relies upon high daily patient volume to support the cost of operating multiple offices. Because of the volume, the bulk of orthodontic treatment is rendered by trained auxiliary personnel with the orthodontist overseeing their activities.  As far as we can determine, this leaves the orthodontist very little time to personally see the majority of patients.  In the case of the latter, purportedly, the previous owner orthodontist can continue to treat patients in any manner that he or she deems appropriate.  However, the financial compensation for purchasing the practice and concessions to the parent company generally increase pressure to produce higher and higher income which usually must come in the form of higher volume or higher fees. The advertised attraction to "Connecticut Orthodontic Specialists" for example is, "No down payment and a fixed monthly payment.." at last viewing of $98.00 per month.  However, every service is "a-la-carte" so to speak.  Interested observers have determined that the typical total fees for treatment are not much lower than that which one would encounter in an ordinary private practice.  Therefore, in the end determination one would have to equate the loss of personal service by the orthodontist to a few less dollars.  What is their quality of treatment?  Candidly, we have not personally observed their treatment results.  However, what we have been told by those who have had discussions with the company is that they try to see at least one hundred patients per day in each operating office.  If that is true, and assuming that they work ten hours per day, that would mean that each patient cannot spend more than six minutes with the overseeing orthodontist.  Again, if that is actually the situation, our personal observation is that this is truly inadequate to properly conduct treatment.  I must stress, however, that this is only conjecture.  With respect to the "Apple” franchises we have no pertinent information.  Further, our office offers a variety of "payment plans" of which one has an option for 'no down payment'.  This option is available through "The Orthodontists Fee Plan".  Brochures are available at the reception desks in each office.  'Our office managers treat every person as an individual and. will work with you to help give your budgetary needs every consideration. STATISTICAL STUDIES- RIPLEY'S BELIEVE IT OR NOT Just recently, the prestigious New England Journal of Medicine released the results of a sixteen year study with ninety (90) thousand female participants which dealt with the effect of a high-fiber diet in prevention of colon cancer.  For years, we have been encouraged to eat diets containing high amounts of oat bran, broccoli and other fruits and vegetables containing high amounts of fiber as a way of reducing the risks of cancers of the stomach,, large and small intestines.  As well, this study also focused upon reducing the amount of fat in the diet that has been implicated as a contributor to these diseases.  The statistical result of this study is that the group that followed the high-fiber/low fat diet had the same incidence of these cancers as the control group which ate a 'normal' diet.  By "normal' diet we do not mean one which is inherently healthy.  Most nutritionists point out that this "normal' diet contains far too much fat and is usually quite deficient in foods containing' soluble fiber. Some years ago, the Harvard Medical School conducted a statistical study that implicated the consumption of coffee in the production of stomach and prostate cancer, saying that more than one cup a day raised the risks significantly.  Five years later, the same Harvard Medical School released a second study about coffee which completely contradicted the original assertions and in fact said that three cups of coffee a day actually seemed to reduce the incidence of colon cancer which is the second leading cause of cancer deaths, actually higher than breast cancer. For over twenty-five years, leading medical and nutritional experts have expressed the opinion that consumption of 'antioxidants' either in capsule form or through a diet rich in these substances significantly reduced the risks of certain cancers.  The three substances which have been most touted are high doses of Vitamin C, Vitamin E and a form of Vitamin A called Beta Carotene. - This triad of vitamins supposedly gives (gave) significant protection against cancers of the lung and stomach.  Further, this combination has been statistically proven to provide excellent protection against heart disease.  Heart disease and cancer are the two leading causes of premature death.  About two years ago, Time Magazine devoted an entire issue to the value of a broad spectrum of vitamin supplements, saying that at last, medicine had recognized the value of these substances that it had resisted as 'snake-oil'.  Indeed, we have long recognized that education in nutrition has been badly neglected in the medical education process, as have been many forms of "alternative medicine". About six months ago, yet another study was released which said that in fact, large amounts of beta carotene (a form of Vitamin A which is stored in body fat) statistically contributed to a higher incidence of lung cancer in smokers and non-smokers alike.  The study was conducted in Finland.  What makes this study "suspect" is the homogeneous nature of the participants....common genetic ancestry.  To be truly representative to the population-at-large a study must be heterogeneous. What does this all mean?  Do not rush out and buy piles of a particular vitamin or herb when they are touted as a miracle preventative for certain diseases.  Be extremely skeptical of any statistical study.  Ask who has underwritten the study.  For example, the Coffee Institute is funding a study to prove the beneficial effects of the beverage.  To be truly valuable, no study should ever begin with an outcome "bias". Human beings are constantly looking for direct cause and effect (i.e. if you do this you won't suffer a particular disease and if you do that you will).  Unfortunately, the problem is not that simple.  For example, it is absolutely clear that smokers have a higher incidence of cancer and heart disease.  Statistical studies from hundreds of credible sources have proved this beyond any reasonable doubt.  However, there have always been a statistically -significant number of individuals who have smoked who do not succumb to these diseases why?  We do not know, but we -can speculate that their genes are not susceptible to the damage inflicted by cancer causing substances, as is the case in the majority of smokers. Yet, there has never been a statistical study to find out why some individuals seem immune to the damaging effects of carcinogens in cigarette- smoke.  What is the bottom line?  A great many so called credible statistical studies belong in the famous collection of Robert Ripley's Believe It Or Not Among its collection is that Stew Leonard's is the largest dairy store in the world probably true, but are we absolutely sure?  I think not.  Perhaps someone will fund a round the world trip to disprove it I think not. THE DEMON AHEAD- Y2K If you haven't heard the term, Y2K yet, you haven't been on this planet.  The YEAR TWO-THOUSAND is fast approaching and with it the potential for widespread computer problems associated with their display of the digits “00".  Suffice it to say, these electronic "geniuses" may interpret those two digits as a "shutdown signal ". Clearly if that occurs, we are in for some difficult times with banks, insurance companies, the Federal Government especially.  Many officials and experts have said that the IRS is so far behind that we can count on large problems relative to tax payments, reimbursements and the like.  The President has assured us, however, that the Y2K problem has been "fixed" relative to the payment of Social Security checks...we'll see. So far as Westwalk Orthodontic Group is concerned, we have eliminated our internal Y2K problems and I stress the word "internal" We, as all other businesses, depend upon communicating with other business computers and if theirs isn't fixed, we too will be a Y2K victim.  Experts in this problem have made the following suggestions: First, before the end of the year, set aside a month's worth of "cash' to protect against inability to write checks for cash or payments.  Second, create a Y2K file that contains your bank statements, insurance records, records of securities transactions, all utility bills, current drug prescriptions, credit card statements, tax and mortgage receipts, etc.  Third, if you are planning to travel by airline, do not plan elective trips in the first two or three weeks of the year 2000.  Several large airline companies have already indicated that they will fly very reduced schedules during that period.  A few have even said that they do not intend to have aircraft in transit on the evening of the arrival of the New Year.  What is our prediction?  Life will go on and problems will occur that can be managed by people talking to people, at least within this country.  However, since we are so very interdependent for trade and economic interaction, I predict substantial worldwide instability that will cause our stock market to react very badly.  That might give our self-destructive Republican Party a better chance of repairing the impeachment fiasco as Bill Clinton finishes his term.  Unquestionably, the New Millennium will start off with things and events that no one can predict.  So, forewarned is forearmed! GEMS ON THE INTERNET For those of you who are fortunate or unfortunate enough to have a personal computer which is linked to the, internet, occasionally some very touching and poignant material is passed from user to user.  This poem was circulated by a physician who is caring for a little girl who is terminally ill.  Whenever such a situation occurs, it is so sad and tragic that we are forced to reflect on the - true meaning of life and how we must imagine on how such an event puts every thing in perspective.  The poem is entitled SLOWDANCE. Have you ever watched kids on a merry-go-round Or listened to the rain slapping on the ground? Ever followed a butterfly's erratic flight or gazed at the sun into the fading night? You'd better slow down, don't dance so fast Time is short and the music won't last Do you run through each day on the fly When you ask, "How are you?' do you hear a reply?  When the day is done, do you lie on your bed With the next hundred chores running through your head? You'd better slow down, don't dance so fast Time is short and the music won't last Ever told your child, we'll do it tomorrow And in your haste, not see his sorrow? Ever lost touch, let a good friendship die 'Cause you never had time to call and say, 'Hi'? You'd better slow down, don't dance so fast Time is short, the music won't last When you run so fast to get somewhere You miss half the fun of getting there When you worry and hurry through your day, It is like an unopened gift .... thrown away... Life is not a race, do take it slower Hear the music before the song is over. THOUGHT FOR THE DAY: Work like you don't need money; Love like you've never been hurt and dance like no one's watching. Coming Soon!  As we approach the Millennium, Westwalk Orthodontic Group is planning on having its own WEBSITE.  We will keep you informed as to its progress and hope that you will find it constantly informative. Spring and Summer will be here before we know it.  The Groundhog, Punxsutawney Phil didn't see his shadow and therefore, he predicts that the remainder of the Winter will be mild.  During the Super Bowl, financial gurus revealed that there is a Super Bowl Index which has correctly predicted Bull and Bear Markets 28 out of the last 32 years.  As we all know, Denver repeated its '98 performance by defeating Atlanta.  According to these experts, when an old American Football Conference team, the Denver Broncos defeats an old AFC team which became a National Conference Team (Atlanta) this signals a severe downturn in the' market.  Hopefully, Punxsutawney Phil is right and the gurus are wrong. As is customary in closing, we at Westwalk are very honored and grateful for your having chosen us as your orthodontists and -even more, so as, genuine friends.  We love our work and our professional family that is dedicated to producing the very best of treatment results in the most patient-friendly of environments.  Our total dedication is to making your stay with us the most positive and rewarding of healthcare experiences.  In so doing, it is our goal to provide a lifetime of excellent dental health and a smile which will light up your world.