Odontologists--remember we need basic, foundational research in all areas of our discipline. Are our procedures scientifically valid and reliable?
Critically examine everything we've been taught. Question the scientific basis of every standard, guideline, best practice, or principle followed.
Keep in mind the quote often attributed to W. Edwards Deming: "Without data you are just another person with an opinion." I would add, if you use incorrect data, you are commit forensic malpractice, because, after all: "First, do no harm."
We insist on evidence-based treatment in health care, why not in forensics?
Merely saying "we're following the science" without verifying that the "science" being followed is actually true is the same thing religions and cults do.
Roger D Metcalf DDS, JD
PO Box 137442
Fort Worth, TX 76136-1442
ph: +1-817-371-3312
fax: +1-817-378-4882
metcalfd
Because of my resignations from the ABFO and the AAFS I have lost most of my professional colleagues and friends. That's very unfortunate, but so be it. I meant no harm to those organizations, I just could not support them any longer.
So, in order to burn any bridges that might be left…
I came to realize that, IMHO, most dentists simply are not actual scientists. This is not a criticism--we are by and large trained to be clinicians, not researchers. Admit it--we are not usually in a lab performing controlled experiments. Most of us do not take courses in experimental design and experimental methods and advanced statistics—that's simply just not in the undergraduate dental curriculum for those training to be "wet fingered" dentists. We usually do not perform scientific research projects under the close guidance of an IRB committee. The folks going on in dental specialties will get a smattering of that training, but, even so, they most often wind up being practicing clinicians and not actual researchers in a lab. Again, not a criticism, an observation of the way things are.
But the Dunning-Kruger effect takes over. We think--certainly I include myself here--that because we are very competent in one area, surely we must be just as competent in other areas. We think that because once in dental school 50 years ago we placed a beautiful Class IV gold foil, that makes us competent to critique scientific studies. We think because we have a lot of experience doing extractions, that makes us forensic odontology oracles. That's not the case, I find.
I worked full-time in a busy county morgue for 16 1/2 years, *in*the*morgue* every working day. Our facility handled three major MFI occurrences and many smaller ones. I have been president/chair of the three major forensic odontology organizations in the US. I have about as much experience as anyone in forensic odontology. I've seen a lot of horrendous cases. So I thought whatever I believed about odontology was obviously the correct view.
But I had an epiphany after reviewing some extraordinarily dismal papers submitted to peer-reviewed journals, and as I took a long hard look at myself in the mirror, I realized that the things I had believed had no real foundation, either. I had opinions, but no data. I realized I was not infallible. Ipse dixit doesn't work if we're talking about taking folks' freedom away and sending them to prison.
So I started grad school and quickly found out that I didn't really know much about experimental design and methods and statistics--certainly not as much as I *thought* I knew. As they say "I didn't even know what I didn't know." I had to admit that the anthropologists have the advantage on us here--they go to great lengths to ground their methods in actual science.
All-in-all, this is my round-about way of saying: I'm not advocating abandonment of forensic odontology by any means...but it has to be implemented based on methods that can be scientifically shown to be valid and reliable.
As a forensic odontologist concerned with human rights, I think it is important to remember--although it is not always a popular viewpoint--the accused have rights, too, in most of our societies, and that includes the right to a fair trial. Using unproven methods is fundamentally unfair.
© Copyright 2013, 2019 Roger D Metcalf. All worldwide rights reserved. No reproduction without permission. Neither the Tarrant County Medical Examiner's District, Tarrant County, the American Board of Forensic Odontolgy, the American Society of Forensic Odontology, the Royal College of Physicians, Oklahoma State University, nor any other organizaion mentioned here necessarily supports or endorses any information on this website. Any opinions, errors, or omissions are my responsibility, and mine alone. This site DOES NOT REPRESENT the official views of any of these--or any other-- organizations. Similarly, those other organizations may not fully represent my views, either.
Roger D Metcalf DDS, JD
PO Box 137442
Fort Worth, TX 76136-1442
ph: +1-817-371-3312
fax: +1-817-378-4882
metcalfd