Interview with Dr. Jay W. Friedman
by: Michael Davis DDS
December 17, 2013
Dr. Jay W. Friedman has had a significant impact on the oral health of the public. His commitment to public health has spanned seven decades from the 1950s to the present. He pioneered in the development of quality standards for dental care, group practice, and dental insurance. An accomplished clinician, he has been a consultant to a number of state and national organizations. Notable are Dr. Friedman's remarkable contributions in leading the challenge against the prophylactic extraction of third molars, as well as advocating for adding dental therapists to the oral health work force.
Dr. Friedman earned his Doctor of Dental Surgery degree from Columbia University in 1948. Subsequently, he practiced general dentistry in Farmingdale, New York from 1948-1954, including two years in the U.S. Air Force Dental Corps. In 1955, Dr. Friedman became the director of an innovative group practice dental cooperative in Seattle, Washington, which served as a prelude to his pursuit of a life in public health. He received his MPH in 1962 at the University of Michigan, followed by an NIH Fellowship. Friedman then moved to Los Angeles, California, becoming actively engaged in research, writing, consulting, and clinical practice. Between 1964 and 1977, he served as a researcher at the UCLA School of Public Health. His 1972 Guide for the Evaluation of Dental Care was distributed widely by the U.S. Public Health Service; it set the standard for monitoring dental practice. In 1974, he co-edited, with Jerge, Marshall and Schoen, Group Practice and the Future of Dental Care. In 2002, he reissued a revised edition of his Consumer Reports Book, “The Intelligent Consumer’s Complete Guide to Dental Health.” In 2012, he received the John W. Knutson Distinguished Service Award in Dental Public Health from the Oral Health Section of the American Public Health Association.
Introduction
Dr. Davis: Dr. Friedman I’m honored to interview you, both because of your work to advance public health dentistry over the years, but very specifically your efforts to reduce the routine removal of asymptomatic third molars (wisdom teeth). Extraction of these asymptomatic teeth most often generated no patient benefits. All the while, patient risks of morbidity and mortality were elevated, especially injury to the jaw nerves causing numbness of the lip and tongue, jaw fractures, post-operative infections, and the potential risks from sedation. A number of young adults faced serious clinical injury, inclusive of untimely death. Dr. Friedman, I’m not overstating, that your work to educate our dental profession actually saved many lives. In the face of your work, you were highly criticized by elements of the oral surgery community, whose potential income was threatened. Regardless, you took the high road, in advancing the dental profession, in service of the public welfare.
Interview Questions
Dr. Davis: Dr. Friedman, in recent years we’ve seen advancement of corporate owned and managed dental clinics. These private equity backed dental clinics have a fiduciary responsibility, to place the interests of shareholders to the fore, and generate profits. By contrast, doctors have both an ethical and legal responsibility, to place the patient’s interests to the fore. The conflict of interest seems obvious. Would you like to elaborate?
Dr. Friedman: It is not only excessive third molar extractions that should concern us. They are just one part of a pattern of what I call FUN (Functionally Unnecessary) treatment, which may be physically and fiscally harmful to the individual and exploitive of public funds. It applies to the whole gamut of dentistry, including unnecessary x-rays, cleanings, fillings, crowns, replacement of missing teeth, and the array of “cosmetic dentistry.” Nonetheless, I believe the majority of dentists are well-intentioned and provide care they believe is in the best interest of their patients. That they―we―are not immune to FUN treatment is due in part to deficiencies in our education and the need to generate money to pay rent, utilities, supplies, salaries, and our own income.
Corporate owned dental clinics and private dental practices share the same objective, which is the generation of profits. In a capitalistic system, corporate shareholders benefit as if their investment produces the profit rather than the workers who perform the service. In a private practice, at least the dentist is part of the workforce. He or she may share some of the “profits” by awarding bonuses to auxiliary staff. In many private practices, the staff is given incentives to generate income and a bonus in the same manner as the corporate practice. So in that respect, I do not see a big difference between the two systems.
