The great Theater of Oklahama is calling for you! 

Anyone who misses this opportunity shall miss it forever!

Accursed be those who don’t believe us!

Amerika, Kafka

If you had been somewhat like me in your literary tastes as a teenager, you should probably remember the finishing scene of Kafka’s Amerika. The protagonist, Karl, desperately looking for employment opportunities, finds his way to some dodgy and heavily advertised place called the great Theater of Oklahama. According to the offer: “Everyone is welcome.” And, despite the fact that Karl was initially looking for a job as an engineer, he finally agrees to be taken on board as a trumpeter.

Looking at the trends in orthodontic marketing, I can’t help thinking of this particular scene and occasionally wondering – what is the current engineers/trumpeters ratio in our specialty? Surely there is a very thin line between these two demeanors. And surely being a flamboyant trumpeter is not a novel trend – it has been around since Kafka’s times.

One of the first and most notorious pioneers of a grotesque self-promotion in dentistry was a Californian man by the name of Edgar Randolph Parker. He officially changed his name to Painless Parker to overcome the legal boundaries in the dental advertisement policies of the time. Surprisingly, this was probably the least controversial gesture of his. Among other things, he owned a travelling circus which would include an elephant used as a moving billboard, organised street performances during which he would extract teeth, and wore a neckless made of over 350 teeth which he claimed to have pulled in one day. Once a struggling dentist, he owned 28 offices and employed 78 dentists in the end of his career. Showmanship pays the bills.

Today, we have many descendants of the great Parker penetrating the orthodontic landscape. Starting from the most egregious and financially successful, DIY aligners companies, to the individual orthodontists who state they have developed a “secret sauce”. 

Parkerian behaviour has its common patterns. Traditionally one starts with some bold unsubstantial claims. Such claims should be first – very appealing to patients, and second – implicitly throw all the other practitioners under the bus. I am Painless Parker. Meaning: all the other dentists are incompetent sadists. I am a non-extractionist orthodontist. Meaning: all the others are just not brainy enough to figure out how to treat without a help from a surgeon. I am a CBCT airway-friendly guy. Meaning: all the other folks are backward relics who want your children to suffocate.

Another pattern of Parkerianism is an adamant denial of all the conflicting scientific facts and the usage of various catchy anecdotes to support the claims. Undoubtedly, there is a plethora of high-quality research unambiguously telling extractions do no harm, CBCT is not a reliable way to assess the airway, and no brackets are superior to the others. Yes, but let me show you some beautiful pictures from my office to prove that all those scientists are sheer idiots!

A question that always crosses my mind is such – how on earth people are buying into this glaring sophistry?! To the day, I haven’t found a better answer than this quote from Mark Twain: “A lie is halfway down the street, while the truth is still putting on his trousers and getting out of bed”. Simply, the Parkerians are more vocal and talking straight to the public with almost no attempt to legitimise themselves in the peer community.

In politics, such behaviour is known as populism. Populism, as Parkerianism, does not aim to unite the people. Its strategy is to capitalise on division. As a result, we sometimes find our specialty looking more of a flashy junkyard of extremely polarised opinions, rather than a cohesive edifice based on logic, evidence, and mutual respect. This situation sometimes makes it challenging, even for experienced clinicians, to make head or tail of the latest trends, and, the worst of all, may therefore contribute to the impingement on the quality of the results. 

So what could we juxtapose to the insatiable egotism and gargantuan greediness of Parkerians? Being quite a fledgeling orthodontist somewhat about five years ago, I had an undeserved privilege to interview Rolf Behrents in Saint Louis. I then asked him a naive and – how I then thought – reasonable question – what is the main cause of malocclusion? He smiled through his grey beard and bursted half-jokingly: “I wish I knew!” He then, of course, gave me some basic ideas on genetic and environmental factors. But how cool is that first response? Honest and totally disarming. My point here is that the only real advantage a responsible orthodontist has over the Parker’s descendants is an ability to plainly tell the truth. Without a fear to appear less appealing, without being afraid to lose patients, without a necessity to present oneself and the specialty as something different of what it really is. And in the end of the day, whatever you think of the patients, they do sense the difference. Truth is more compelling than showmanship.

I started this blog posts series with a Stoic quote, and, as the rules of composition require, I finish it by going back to Stoicism again. The greatest of all virtues, according to the ancient philosophy, is moderation. And as I see it, moderation is the only way to practice orthodontics. It is applicable both to the treatment and to the marketing. I genuinely believe that marketing should be done with moderation. I am not saying that we have to restrict our advertising or keep quiet. Quite contrary, marketing is good, and should be done as much as possible. But done responsibly – toeing the mark of common sense, without undermining scientific research, treating the patients and colleagues as we ourself want to be treated. Marketing could be educational and salubrious then. If we carry on delivering simple but important truths about our specialty to the public in a responsible manner, we do have a chance to put the divided jigsaws into place.

Raise your voice, my friend! It’s needed to be heard.