Evidence-Based Ethics Malala Yousafzai Makes Inspirational

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Evidence-based ethics

Shaun Sellars continues this exciting and essential series on ethical dilemmas in dentistry which appears in every second issue of the BDJ

We’re all aware of the Hippocratic oath, the rate with this treatment at ten years’ would be concept of ‘frst do no harm,’ but in our day to immensely benefcial to both practitioner and © hofred/iStock/Getty Images Plus day work, we routinely remove teeth and carry patient. out other surgeries which could, in isolation, Evidence-based dentistry can still be con- which could give us real-world data that is be considered harmful. Perhaps a better rule sidered to be in its infancy, with signifcant likely to be of real use in everyday dentistry. to live by would be to ‘provide the greatest evidence gaps both in amount and quality of Eforts should be made to increase the beneft to patients.’ But how do we know that evidence available on which to make judge- quality of research produced, as large the treatments and preventative measures ments. Tere is also a degree of scepticism amounts of the available research is of poor we apply are benefcial to patients, and aren’t towards evidence-based dentistry, and a quality or outdated. Finally, we should con- causing them issues in the long term? viewpoint of ‘I know what works best in my stantly be on the lookout for ways to improve You can only have a truly beneficent hands’ from a degree of the profession. Tis dis- our practice, taking the whole of the evidence profession, if you have an evidence-based regards both the fact that our views are afected base into consideration. By taking a Bayesian- profession. If you have a variety of treatment by a myriad of cognitive biases, and that true style approach to adaptation of techniques options available to present to your patient, evidence-based dentistry takes personal and procedures, our best practice treatments and you’re trying to do the best you can experience into account. Unsurprisingly, this would take into consideration the full extent for a patient, then unless you know which response mirrors that from doctors when evi- of the evidence base, appropriately weighted treatment is likely to produce the best result dence-based medicine was frst conceptualised in relation to the quality of evidence available, for that particular patient, by whichever in the early 1970s. rather than the current approach of diferent measure of ‘best’ you choose to use, then To help with this we should be encouraging camps playing research paper ping-pong to you will always have a degree of uncertainty. open access publishing of research as well justify their treatment methods. If, however, you have high quality research as increasing the amount of research done Evidence-based dentistry is ethical dentistry. to back up these options, you can pass that in practice, which we should all consider If we move to a more evidence-based profes- information on to the patient. Being able to contributing to. Tere’s a huge opportunity sion, we move to a more ethical profession, to say ‘I know that my team has a 95% success for primary care research to be undertaken the beneft of our patients, and to ourselves. Malala Yousafzai makes inspirational address in Birmingham

Nobel Prize winner Malala Yousafzai opened be able to fulfl myself – only known as this year’s British Association of Oral and someone’s sister or wife. Tat’s why I decided Maxillofacial Surgeons (BAOMS) conference to speak out. I could have stayed silent but it in Birmingham with an address aimed at would have had worse consequences’. inspiring women maxillofacial surgeons. She said that her school uniform became In 2012, Malala Yousafzai was shot in the a symbol of her resilience and also for all head by a Taliban gunman in an assassina- those young women who have a right to an tion attempt because of her activism, writing education. a blog under a pseudonym describing her Sat Parmar asked her why women don’t life during the Taliban occupation of Swat, progress in surgery when ‘60% of admissions Pakistan. Malala was brought to the Queen to medical school are women…do you have Elizabeth Hospital in Birmingham for any advice?’ treatment under the care of Maxillofacial Malala Yousafzai said: ‘It is an issue Consultant and BAOMS President Sat globally. It is surprising that women do lack

Parmar. that representation. Tis is a global topic that Malala Yousafzai In a question and answer session with we need to talk about.’ Sat Parmar and Consultant Maxillofacial Malala called on women and girls to be out there, and we need to break that glass Surgeon Daljit Dhariwal, Malala explained themselves: ‘It’s about inspiring the younger ceiling and fght that inner feeling that it’s not ‘a life without an education I would never generations. Tere are invisible challenges for them.’