I am blown away. I just read this editorial in the AJODO (see article here) and I am stunned and nearly speechless… nearly. I only know Grubb and Greco by reputation but Vaden was my program director at UT Memphis and I know his attitude, philosophy and ability intimately. A more antiquated, paternal minded, indifferent to patient wants and comfort, self assured, ideological Tweeter the world has never seen. Vaden thinks nothing of:
  1. Putting a gazillion separators in a patient
  2. Causing patients incredible pain
  3. Banding all teeth but the incisors because he “doesn’t believe in stick on braces”
  4. Removing 4 premolars on practically every case and sometimes U6s on top of that
  5. Forcing stainless steel wires into band slots using 012 steel ties on the initial appointment while the patient’s eyes cross in pain 
  6. Prescribing double J-hook headgear

and that’s just naming a few things… but now he sees fit to talk $h!t in general about others and how they practice based on some unrealistic hypothetical where a patient must have been tricked into choosing to get braces and pay (because she had no free will)?? REALLY??? Wow. Wow! WOW!!!!

To say that another orthodontist is doing wrong simply because they don’t do it the way you do without ever setting foot in their office is the height of arrogance. To say that others who do more or do things faster or do things that patients like better than what you do is wrong and pure closed minded egotism. OF COURSE the doctors who are faster and provide services that are more attractive to patients are hacks and running mills – what other possible explanation can there be? They certainly can’t be better than the great Jim Vaden!!! To practice an antiquated, dogmatic, unchanging methodology that ignores any and all advances in technology or treatment such as Jimmy and the Tweeters preach just so they can feel important and lord over a bunch of Brazilian and Korean students and the ortho residents unfortunate enough to attend the programs where Jimmy’s cronies are in charge is laughable and narcissistic. If Jimmy and the Tweeters lived the rest of life like they practice orthodontics, then they would drive a Studebaker and live without AC or microwaves.
The funniest part is that these pro-establishment Tweeters worship THE ORIGINAL orthodontic rebel. That’s right, Charlie Tweed rebelled against the Angle establishment and was banned for it. Dr. Tweed is surely rolling over in his grave watching these Tweeters and their concrete, unchanging Dogma served up in his name. If he were alive today, Charles Tweed is much more likely to be friends with Dwight Damon, David Sarver, Terry Discharger, Marc Ackerman, David Butler, Derek Bock, Jason Tam, Jeff Kozlowski or even me than the Tweeter elite. Dr. Tweed believed in utilizing new technology and techniques to achieve better results – that’s what his system was initially based on – and he would be horrified at how his system has been frozen in time. That’s the core of who he was but the Tweeters have corrupted Tweed’s memory for their own purposes. It’s despicable, as is this editorial.
These guys talk like anyone who does anything faster or better than them are shameful and harming patients but if you want to see shameful cases and harm to patients then all you need to do is travel to Memphis, TN and look through the thousands of cases that were miss-treated by residents under Jim Vaden’s direct supervision. Don’t take my word for it, see it for yourself.
Shame on you Drs. Vaden, Grubb and Greco. You obviously believe that respect for you, your authority and your position are the most important ingredients in an effective orthodontic new patient visit. You seem to believe that “properly done and properly evaluated” records, not the result or the patient’s happiness, are of primary importance. I know for a fact that you believe strongly in the Paternal Model for healthcare delivery but you take the position that others are forcing patients into treatment they don’t want? You are what is wrong with the orthodontic profession and you are the obstacle that stands in the way of improving it. Sermons like these from the pulpits of “I am older than you so I know more” or “I associate with has-beens and suck up to them so I’ll get my turn in the big chair when they die so  I know more than you do” will carry less and less weight as the rest of us wake up to reality and the motives of those who seek power in the AAO and ABO. Thanks for this editorial. It makes me positive that leaving the AAO was the right move.

19 thoughts on “The Height of Arrogance On Display

  1. Hey Ben, well done. It creates a problem when the Orthodontist does not appreciate what is “possible”, and so is critical of anyone doing it differently.

    I have to say I don’t always agree with you postings, but on this one “I’m in”.

    1. Thanks Duncan. I’m glad you like this one. I’m also glad you don’t agree with all I have to say because that would be weird! Have a great week.

  2. While I don’t always agree with your stance on all things orthodontics, in this case, I think there are parts to both of the above commentaries that are correct. Our office is one of the “young ones” so perhaps that is why?? The authors’ viewpoint is closed minded and antiquated, however there are A LOT of orthodontic offices (and let’s not even get started on dental/ped offices that are practicing ortho) these days that are not properly diagnosing and just trying not to let the patient leave to get a second opinion. Agree:: You MUST be up on technology and see what is best for the patient in all technologies in our ever changing profession in order to be a critically thinking & current doctor. That said, we have received patients in our office who have left competitors after only a few visits stating exactly what was stated here in the original article – that they didn’t even know what was happening and spacers were in and they were being asked for payment -“It was a whirlwind” – so after a few visits, they left & came to us… they like that we explain everything thoroughly and give them time to think it over. Taking thorough records (even with implementing every single newest technology available in our office, literally) and analyzing them thoroughly/ reaching out to other dental professionals/ having an interdisciplinary approach (especially in the case of adults – which is over 20% of our practice) prior to starting treatment is honestly also good practice. So, agree on some not all, but thanks for the viewpoint! On a side note: That “removing 4 premolars” line is making me cringe – Not necessary and can be completely prevented in over 99% of cases if you get them early enough….

    1. There will always be those who skirt the rules and even the law. They are in the vast minority. There will also always be those who think that what they do is correct and anyone who does less (or does more in this case) is incorrect. They are in the vast majority. You cannot control what others do any more than they can control what you do. If patients leave another office and seek a second opinion because they don’t like how things are done or because they fall behind on payments or because they can’t afford the cost of treatment there, of course they are not going to have nice things to say about that office when they come to you. Do you really think that you don’t have patients leave your office and say they didn’t like you or it? If that never happens then why don’t you start 100 percent of patients who walk in the door. Dr. Anonymous, I appreciate that you also think you are correct in how you do things but you must understand that you cannot please all the people all the time. Your patients agree with you as surely as those who don’t start with you do not. Stop worrying about what others do. That’s a problem for the state board.
      Here’s a related article. http://orthopundit.com/your-patients-agree-with-you/

      1. Nice spin. “Stop worrying about what others do.” Isn’t that your whole platform?!? You are constantly telling other orthodontists how they should practice! Honestly, I’m not worried what others do… Let them keep it up, it is literally driving more patients to my door every single day. And my closing rate with recalls is about 90%.. I am certain that you assumed it was much less. I’m certain I can always do better and I continue to work at it daily. You are correct though, you can’t please everyone! I offer the best of what I have been trained to do and personally see each and every patient at each one of their visits. This is my business philosophy, what I want for my patients, so that’s my choice. I don’t “worry” about how others practice. That’s their choice. There are plenty of different types of offices out there. To each, their own. That said, I don’t have to agree with it just because it exists. I would imagine that you feel the same about how a lot of orthodontists practice, for different reasons, as you are very vocal about many of them. Back to the topic at hand: I believe that stating that orthodontists should use diagnostic tools to diagnose is not the height of arrogance. Just because something is an old philosophy doesn’t mean it can’t work in a modern age. I have every advancement out there, but there are still some older techniques that have value. This is my opinion. I don’t have the intimate knowledge with the one author that you do, but I do know very well one of the others, which is why I chose to remain anonymous. That said, I think both sides have points, as I stated earlier. I enjoy reading your posts as they often offer a different perspective. However, just because I don’t fully agree with you doesn’t mean I am 100% incorrect either. I am certain we all have things we can take from each other.

        1. I certainly offer my opinion as to how to improve in practice and many benefit from it but many also reject it. I don’t care how anyone practices as I’ve said many times but if you are dissatisfied with your results and unwilling to change then I’ve got no time for that. I do find it odd how many orthodontists wish to remain anonymous while speaking authoritatively. You’re welcome to do so but its hard to weigh your advice as we can’t tell anything about you. Thanks for taking time to comment

    1. Sour grapes about what exactly? Please elaborate. Thanks so much.

  3. Thanks Ben, that made me chuckle. I remember telling Vaden during my board case presentations that I wanted to open a practice next to his when he told me I should have used a J pull headgear instead of the “forsus” springs that I used.

    1. Sounds about right. I spent three years listening to him talk about how everyone else did things wrong.

  4. I have read the article after having read your blog.
    I fully agree with the Ajodo paper and I think that your writing is dictated by bad personal past experiences.
    Maybe Dr. Vaden is the worst and most arrogant orthodontist on earth. I don’t know him, and I have no personal opinion about this, but I can’t see any sign of arrogance in the article, while I feel a lot of personal hate in your comments for reasons that are unknown to me.
    As total disclosure. I can only say that I met once Dr. Greco and found him a very agreable colleague.
    Regards
    Giorgio Fiorelli
    Italy

    1. If calling someone out for being duplicitous based on personal knowledge is a sign of personal angst then I’ll just have to cop to that. I’ve listened to what Vaden says publicly while knowing what he said and did privately and have not said a ton about it in the past but this article was the straw. Guys like him and the other “academic elite” and AAO brass go unchecked and say whatever they want and we orthodontists are too polite to speak up. No more. I’m calling it as I see it. They should expect it for taking such positions publicly.
      I have the same done to me all the time. I expect it. I embrace it. Detractors constantly try to find fault or hypocrisy in what I do and say (and sometimes they are correct and I appreciate them pointing it out) and I dismiss or listen to them as appropriate. It’s part of life. If we don’t stop being polite about how the leadership of our profession talks and acts and spends money we will politely end up in the dust bin of history. Thanks for taking the time to comment.

  5. Ben,
    I am disappointed in your vitriolic demonizing of Vaden. Shame on you! Talk is cheap. Produce your long term results to disprove the “Tweed Philosopy”. Why are you so angry?
    Doctah McKinley

    1. Dr. McKinley, Thanks for taking the time to comment. Call it vitriolic demonizing if you want but let’s get real here and think back to all the negative vitriolic and demonizing things that Vaden said about anyone and everyone who didn’t agree with him or tried to voice an opinion that was not Tweeter centric. Don’t act like you did not hear him, day in and day out, talk very badly about other orthodontists to anyone who would listen to his griping. He even talked crap about doctors who thought they were Vaden’s friends so he has no right to expect anything but unvarnished honesty from others. Everything I said was and is 100% true and is what I saw and heard with my own eyes and ears. I know you heard and saw it too and there are plenty of others who did as well. I said what I said publicly to counteract Vaden’s ludicrous article that demonizes what he doesn’t understand and even fears – PROGRESS. I am happy to discuss this in more detail with specific examples of what was said and done in my presence if you so desire or have trouble remembering. Dr. McKinley, I like you and appreciate all you did in residency to teach us. You didn’t gripe and complain about being there or whine about the “sacrifices” you were making to “give back to the speciality” constantly as Vaden did. That being said, I’m no longer a resident and I won’t be backed down on this. I don’t respect elders, I respect results. Vaden has no problem demonizing others so it’s time he got a taste of his own medicine – medicine he brewed himself.

      PS I’m angry because the specialty I love is dying a slow death while the profession’s elites cry about the loss of good ole days and how the youngsters don’t respect them any longer instead of getting off their asses and making changes and the rest of us are too timid to do anything about it.

      1. Thanks for your reply. Will talk personally next time we meet. No doubt AAO needs improving & getting in touch with the future, especially the AAOF! Join in to make changes not run away, please.

  6. Ben—-I have ,a long time ago ,realised that most ortho.programs are really a very informative walk down memory lane and a deep dive into the historical origins and “progress ” of our calling.
    I see little being taught to residents that reflects the quality of care that encompasses the total and contemporary
    clinical and inter personal care required and expected by and for for our pts.
    To put it simply—-the residency programs are way out of date .
    On another note,something I told my kids{along with never trust the govmnt.} if anyone starts to talk about ethics they mean yours[ not theirs] and grab a tight hold on your wallet!

  7. Dear Dr. Burris,
    Help! I am a little confused. I read with interest your scathing opinion of Dr. Jim Vaden. I went back and re-read “Well begun,half done” in the AJODO, and unless I received a different copy, nowhere in the article do the authors state “…it is (sic) wrong simply because they don’t do it that way …” It , at least in my humble interpretation, doesn’t demean, condemn or personalize any aspect of current day therapies. It seems the authors are merely pointing out that in order to provide a more complete service to the patient a thorough diagnosis should be made prior to the initiation of any treatment. When we all graduated and a “Dr.” was put before our names our moms and significant others cried! I think (again my interpretation) the authors were merely pointing out the fact that if we still consider ourselves ‘health care providers”, we should honor that. For the record I have known Jim for over 30 years, and yes he has strong opinions and values. Right or wrong he stays true to himself and has never been anything less than honest. Over the years, I have come to appreciate a lot of what you have said. I may disagree with the way you choose to conduct your business, but I do appreciate and admire your willingness to speak your mind. Your editorial seems more to be a personal attack on Dr. Vaden, then a responsible response to the content of the article. I think when we write and post personal diatribes as you did it demeans you. Rise above it.
    Respectfully,
    Dennis M. Ward

    1. Dennis, you’re entitled to your opinion and I’m entitled to mine. Jim Vaden is entitled to his opinion as well. If you think that I shouldn’t call it as I see it in this case because you’re a personal friend with Dr Vaden then I’m sorry to disappoint. If you think that stating what I personally witnessed of Dr Vaden’s behavior during my three years of direct contact is inappropriate because it doesn’t align with your perception of him or align with the persona he projects in public then, again, I’m sorry but you’re going to be disappointed. Vaden and others in the orthodontic elite have log run roughshod over anyone and everyone they dislike or disagre with. No one ever disagrees because we are too polite and because of fear of recrimination. I’m not afraid to call it like I see it. I’m happy to have this conversation face to face with Dr Vaden if he so chooses. I would love for it to be in public and recorded for posterity. I think it would be an eye opening event. There is a disconnect between Dr Vaden’s actions and words and has been for as long as I’ve been around him enough to see it (and longer I’m sure). This article from people in positions of authority in our profession is a “statement of facts” through an incredibly unrealistic hypothetical. It’s an unequivocal condemnation of practice management issues with which they disagree, disguised as an ethics paper. As I stated before, if you want to see real ethical violations and patient abuse then go to UT Memphis and pull case after case after case where teeth were extracted unnecessarily just to allow The Chairman and most of the like minded professors to adhere to an antiquated philosophy that they derive accolades and profit from championing.
      Thanks for taking time to comment. I approved your comment because I think it’s an important topic of discussion and I welcome further commentary. Have a great day.

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