The Monday Morning Quote #359

“If a writer is so cautious that he never writes anything that cannot be criticized, he will never be able to write anything that can be read.

If you want to help other people, you have got to make up your mind to write things that some men will condemn.”

Thomas Merton


On award winning pies…

cmlxhemgydwew4gcgwkhI was listening to Simon Mayo’s programme on Radio 2 a few minutes ago and I heard him interviewing John Nicholl from A.F.Huddlestons Butchers in Windermere. Last Wednesday they won “the national title of supreme champion at the British Pie Awards” for their beef and vegetable pasty known as “The Grafter”. Their butcher’s business employs three people John, his wife, Elspeth, and another man.

Here’s a report from the local paper.

Last year was the first time they entered The British Pie Awards and they won the “meat and potato category”. John told the paper that, “We have entered competitions for years but winning at the British Pie Awards is just phenomenal”.

I think we can all congratulate John and his team on their success, especially as John took a break to speak to Radio 2 whilst making the 48 Grafters for tomorrow’s sale. In view of the publicity they will probably sell out in short time, but as they have no more space on the premises they can’t make any more pies and pasties.


So what’s the point of writing about this? I wonder if through the length and breadth of Cumbria and the North West there are loads of grumpy butchers and associated pie makers chuntering to each other on social media, the Great British Pie bulletin board or at local BPA (British Pie Association) section meetings, “it’s all a fix”, “you only win if you buy tickets for a table”, “won’t catch me going to London for one of those fancy affairs”, “I could win if I entered”, “a mate of mine ate one once, nothing to write home about”, “I’m reporting him to the GPC (General Pie Council) for unfair advertising”, “my clients love my pies that’s why they come back for them” etc etc….

You have to admire John & Elsbeth for being prepared to step up to be judged and above all being ready to lose.

Nothing ventured. Nothing gained. We all do what we can to earn a crust.


The Monday Morning Quote #358

“The only thing you have power over is to get good at what you do.

That’s all there is; there ain’t no more!”

 Sally Field,


via Box of Crayons

50 years ago….

A piece of my childhood disappeared…

Every summer my mother, my brother and I went to Dublin to stay with my mother’s parents. We flew from Rhoose airport with Aer Lingus on one of their Focker Friendships. Then, like now, the flight used to take just under an hour though air travel was far less than the routine that is has become.

1038103758_031a216610Amongst the highlights of the stay in Drumcondra. a suburb a couple of miles to the north of the Capital were a trip to the zoo in Phoenix Park or a chance to climb the 168 steps of Nelson’s Pillar in O’Connell Street. The view of the city centre and the countryside beyond from the wire cage at the top was spectacular.

In 1966 everything changed. Nelson and his plinth had survived unscathed during the fighting and bombardment of the adjacent 3756743_origGPO during the Easter Rising nearly a century ago; but on this day, March 8th, an IRA off shoot placed a bomb on the pillar which detonated just after 1.30 in the morning. The charge destroyed Nelson’s statue and most of the pillar, the army finished the job a week later.

So there would be no more 3d climbs to the top.

In fact there were to be no more trips to my grandparents as both of them passed away that year.

The start of the end of my childhood.

A couple of Orthodontic posts from Kevin O’Brien

Orthodontics can be a hidden art and it’s often perceived by non-orthodontists as a secret language. Most undergraduates know a something about it, but not much, similar to knowing a few key phrases. “good morning”, “where is the bus stop?” and “two beers please”. That’s where it ends. After graduation it used to be kept (mostly) to the confines of those who had been through, what the New Scientist once called, “the years of crawling subservience under the gaze of the white coated moguls that control our great teaching hospitals”. Then, when deemed to be fluent in the language, the specialists with their M.Orths, headed off to their own planet in the Orthodontic universe to fiercely guard their patch and occasionally share a few simple phrases of ortho speak with their referring dentists.

Times have changed and with the relentless march of a thousand aligner systems everyone has a phrase book – or at least they think they do. Or could it be that they have the dodgy Hungarian Phrase Books?

I am not looking to fan the flames of the GDP v Specialist debate, there’s way too much of that about, rather to present Professor O’Brien’s last two blog posts for your consideration because I think they are both worth a read. I find him to be readable, thought provoking and that sometimes rare thing someone constantly questions what he does and WHY he does it.

First up:

A thinking about Orthodontics blogpost. In its entirety.

This is a short blog post to read just before the weekend, or just after if you are in Australia!  I have just attended a major symposium in the UK and I was asked to give a major lecture.  The preparation of this took some thought. During the meeting I listened to some great presentations and this got me thinking about orthodontics.  I have been working as an academic orthodontist and research since 1986, spent a large amount of time researching clinical matters, I have trained too many people for me to remember and spoken at many major orthodontic conferences.  But what do I know about orthodontics?  Here is a list of my academic knowledge and opinion.

This is a precursor to a more thoughtful blog post that I am going to post next week, so here we go. You may not agree with me..

  • Malocclusion is caused by a combination of genetic and environmental factors
  • There are many ways to treat particular malocclusions.
  • Evidence based orthodontics is a combination of clinical experience, patient opinion and scientific research.  The proportions of influence of these factors varies according to our level of scientific evidence.
  • Arch form and dimensions should generally be accepted
  • Functional appliances and other bits of plastic, pistons and springs do not change or influence facial growth. They tip teeth.
  • To my knowledge there is no high quality scientific proof that orthodontics, extractions, appliances, expansion, myofunctional orthodontics influence breathing, posture, academic attainment, sleep disordered breathing etc
  • Class I molar non extraction treatment is very easy
  • I wish that I knew how to intercept malocclusion…
  • Extraction of permanent teeth is required for the treatment of some malocclusion..but treatment mechanics are as important as the extraction decision
  • You can only “drive” upper molars 2 mm distally
  • Temporary Anchorage devices are better than other anchorage reinforcement method by about 2mm
  • Wire and bracket properties do not influence the efficiency of alignment
  • None of the new developments that are supposed to speed up orthodontic treatment seem to work; according to new trials..
  • There is no such thing as non-compliance treatment
  • I simply do not understand clear aligner systems
  • Self Ligating brackets do not have any advantages over conventional brackets.  The self ligating practitioner should explain this to their patients.
  • The alternative orthodontist should explain to their patients that there treatment is not mainstream.
  • The General Dental Practitioner who has been on a short  course to learn speedy orthodontics should explain to their patients the limitations of their training and knowledge
  • There has been and there continues to be great high quality research being done in orthodontics and don’t tell me that our evidence base is weak!
  • Nearly all orthodontic treatment relapses to a degree and this is probably caused by ageing and we cannot stop time…………….

That’s about it, does anyone want to add to the list?

Now here’s the second one:

Evidence based orthodontics is not as straightforward as it seems…

Should we practice evidence-based orthodontics?

This is a basic point and a good place to start.  It has been pointed out to me several times that orthodontics is different to other part of dentistry because it is more of an art than a science. Furthermore, it is difficult for us to do harm because the harms that we may cause are usually minor, for example, decalcification and root resorption. It is, therefore, not necessary for us to practice evidence based care.

I must disagree with this sentiment.  This is because we need to practice ethically by ensuring that our treatment is based on evidence, when it is available.  We also need to inform our patients of all the potential risks and benefits of treatment.  To this end we should be particularly careful of making statements that are not based on good research evidence.  I can think of the following examples, the proposed benefits of non-extraction treatment, methods of speeding up treatment and orthodontics that is provided to reduce sleep disordered breathing in children.

Continues here

The Monday Morning Quote #357

“Humankind seems to teeter between hubris and paranoia: the hubris of our ever-growing power contrasts with the paranoia that we’re permanently and increasingly under threat.

At the zenith we realise we have to come down again…we know that we have more than we deserve or can defend, so we become nervous.

Somebody, something is going to take it all from us: that is the dread of the wealthy.

Paranoia leads to defensiveness, and we all end up in the trenches facing each other across the mud.”

– Brian Eno


A warning for TCO consents?

Lady Blindfolded Holding Scales Justice Front RetroFrom Pennington Manches LLP via Lexology

How landmark Montgomery ruling may influence aesthetic practice

The Montgomery v Lanarkshire case has been seen as a landmark case for consent. The wording in this case may well have an implication for Treatment Coordinators. I am aware that most practices use treatment coordinators well, they are highly trained and good ethical communicators. However some are not and they are used to save time in getting appropriate consent and if they are not qualified DCPs (or perhaps even if they are) could well be viewed as “sales advisers”.

Don’t shoot the messenger, I know it’s about “surgery” but I think this applies across the board for any procedure or process that could be deemed to be cosmetic.

Here’s the opening paragraph.

Although a decision to undergo cosmetic surgery is rarely taken lightly, Penningtons Manches often hears from clients who with hindsight feel that they were not advised fully prior to their procedure. Investigations may establish that the consenting process has not been as thorough as it needed to have been. Patients may believe that they understand the pros and cons of any planned procedure and that they have ‘consented’ purely because they have signed a consent form. This is not necessarily so. It has been well established for some time that consent should not be obtained by just any doctor, regardless of grade or specialty, let alone by a sales adviser, but by a doctor of appropriate seniority and experience to understand the procedure, its risks and benefits. Ideally consent should be obtained sufficiently in advance of the procedure and certainly more than 24 hours beforehand.

The full article is here:

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