Magic game: the illusion contest

Those whom the gods wish to destroy, they first make mad.

A proverb

Here is a parable about two ancient Greek painters, Zeuxis and Parrhasius. They once contested to reveal who is the greatest realist painter of the time. Zeuxis painted grapes so life-like that when he turned off the covering from his canvas birds flew down to peck at them. But when it came to Parrhasius to reveal his work, he asked the opponent to open the canvas for him. Zeuxis tried to push aside the cloth covering Parrhasius’s painting but the fabric turned out to be the painting itself.

What has the story to do with orthodontics? I think – a lot. In the modern social media-driven world, we have certainly crossed the point when it was easy to tell what’s real and what is not. Perfect cherry-picked orthodontic cases are being demonstrated to us on a daily basis to advertise some new appliance, promote a popular course, or just out of vanity. Social media doesn’t require of an author to disclose a conflict of interest, indicate an underling science, or even be able to put words into meaningful sentences. Does this create a problem? I guess so.

How many times you have heard from the patient that he or she saw some incredibly appealing treatment modality on social media and now is thrilled to try it? Magical non-extraction brackets? Appliances to grow mandibles? Airway-friendly CBCT? It is fine for an ancient painter to fool his opponent to get a prize, but there is no humility in treating the patient as Pavlov’s dog for financial gain. 

Not only this undermines the clinician’s credibility, this also casts a shadow on the entire specialty of orthodontics. It has been a centuries-long effort for our specialty to pave its way from barber salons to academia. However it seems that today some practitioners are not much opposed to sally back to the hairdresser shops, or perhaps to the circus tents nearby. The social media brouhaha which these individuals broadcast drags many patients away from the reliable treatment options based on unambiguous scientific grounds to the alluring but deceptive realm of fantasies. 

Would we be comfortable if driving licences would be given to candidates based on their social media accounts? Clearly, many patients today are making important decisions regarding their future treatment just based on pretty images seen on the screens of their smartphones. This is a treacherous approach, of course. It could be argued though that if the person is indiscriminate enough to delegate the orthodontic treatment to someone who is unreliable, it is the person’s own problem. Yes, but what about the fact that even orthodontists themselves often fall prey for marketing gimmicks, guru’s advice, and the tempting trends of the day?

The formula I developed for myself over the years is such: what you see on the screen has ABSOLUTELY nothing to do with the real life. Although it still takes a constant effort to remind myself again and again that each and every wonderfully finished orthodontic case belongs nowhere but on the lowest step of the evidence-based medicine pyramid.

We still don’t have better resources to quench our thirst for knowledge than systematic reviews and randomised-controlled clinical trails. And eliciting meaning from these sources takes such unsexy activity as siting alone in a quiet environment building brain muscles – the muscles no one would appreciate when you show up on the beach. Moreover, quite a few would appreciate them in the clinical settings. The only certain fact is that the absence of these muscles would be definitely fast revealed and lead to many unfavourable consequences.  

The pain and misery of not focusing on the right steps of the pyramid is not just the pain and misery we reward our patients with. It is our own pain and misery, and the ugly frustration of not knowing how to get out from the trap. Treat others as you want to be treated is not merely about a responsibility we hold before our patients, it is actually a recipe for our own calmness and serenity.

In our brave new digital world where nothing is real and everything is possible, the ability to discern truth from imitation is one of the most crucial survival skills. We have never be tired of asking ourselves a simple question – are we focusing our attention on the right things? Or are we willingly deceiving ourselves? Maybe taking a few steps up and looking on the issue from a broader perspective might improve the outcomes? Both for ourselves and our patients.

Finally, it is good to remember that Parrhasius succeed in fooling not some random person, but his equally skilled colleague… We have met the enemy and he is us.

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