Diversity: Our Source of Strength

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IF YOU THINK about it, you’ll realize that diversity is what bails us out of many problematic situations. When a virus attacks a field that has been planted with several varieties of corn, it will take out one individual crop, but not another because the genetic makeups of the corn crops are as different as the original seeds that were planted. Perhaps each of the varied corn crops is not as productive as a single superseed crop might have been, perhaps it is not as resistant to other viruses, perhaps more water or a greater amount of pesticides is required to protect it, but no one virus is likely to wipe out the entire crop. Diversity reduces efficiency, but it provides a built-in insurance policy against that rare but calamitous event of a single virus’s destroying all the seed corn. We should think twice and perhaps three times before adopting the genetically modified crops that some of the major agricultural companies are developing. The more uniform our food supply the more likely it is that at some point in the future, a calamitous event will occur and the diversity that protects us will not be available.

Diversity is the natural order of things. It is only when man intervenes that diversity’s built-in security is threatened. Take banking: we now have a concentration of financial power in the hands of about ten banks that have played fast and loose with leveraging the assets of their investors as well as the many who bank with them. They all play by the same rules, namely a major lack of regulations. There was a time when there was a vast array of banks to choose from with so much diversity that no small group of banks could bring down our financial system if their investments soured. Today that is not the case, and when push comes to shove the result leads to a public bailout that costs us and not the perpetrators. Greed changed the rules, so there is much less effective diversity in the banking system and when an unexpected negative event hits these few but powerful banks, they must be publicly supported lest they bring the system down with themselves. So powerful are they, that they maintain their power in the face of their own dastardly deeds. What occurred in the financial realm goes against nature. We created a system that destroys the protections that diversity offers, all in the name of excessive profits in good times and no protection when it hits the fan.

Much the same problem occurs in the beef industry. A more uniform product that leads to rapid weight gain is the industry’s goal. Antibiotics and corn feed instead of grass produce a weaker but more rapidly maturing animal that is ready for slaughter that much quicker. The animals are bred for uniformity. If and when a deadly virus attacks these animals, diversity will not be present to ward off extremely high death rates.

I think you get the idea. Uniformity often produces short-term benefits, but leaves us open to what is called a “black swan” event, a negative so bad that it wipes out all the profits that may have accumulated throughout the years when the uniform product acted more efficiently. So what does this have to do with endodontics?

When I think of diversity, I also believe it should hold true for academics. If we learn one system and that system proves to have defects severe enough that they must be addressed years after it was first taught, the price paid for such a limited education will have impacted very heavily on all the graduates from those years. Diverse techniques would make themselves known if the schools sponsored an open forum for learning. Unfortunately, diversity is exactly what too many schools take active steps to minimize if not eliminate altogether. This state of affairs exists because the major manufacturers are in collusion with cooperative schools; the manufacturers trade “grant money” for access to the schools’ students. For the major companies, this is a giant coup because they understand well that what a student learns to use in his clinical educational years is likely to be continued after graduation. The schools will make the case that they can’t teach everything and they must make the student body competent with at least one technique while they do not have the time to teach a variety of techniques. This is purely a rationalization to deliver access, their side of the bargain, in exchange for significant amounts of grant money. To further the agreement, policies are put in place to eliminate the access to competitive products and techniques that the students might find advantageous, if not in school then certainly after graduation. The denial of access to information on alternative techniques is part of the original deal. This point was driven home to me when I visited the major military dental hospital in Xian, China. Among the first-rate educational facilities, an entire lecture hall is set aside for all manufacturers to introduce their concepts to the students. While the students must become proficient in at least one technique, there is a conscious effort to expose these students to other methods so they become better informed by the time they graduate. Not only does this effort not exist in many American schools, but steps are taken to limit knowledge to exactly what is being taught in the programs, programs too often created by a cooperation between the school administrators and the major companies that give them grants that they have ultimately become dependent on.

Inevitably, policies that favor one particular technique and the instruments included in those techniques over others lead to uniformity, the exact opposite of diversity. More specifically, in endodontics those policies have generally led to the adoption of one rotary NiTi system or another, or, more recently, to the adoption of a NiTi reciprocating system, the choices determined by factors that have more to do with a university’s endowment than with any scientific principles. Combined with a gatekeeping effort to deny students access to alternative viewpoints, the result is that class after class of graduating dental students is never made aware of the potential shortcomings of NiTi, whether used in rotation or asymmetric reciprocation. As long as the research demonstrates a superiority of these techniques over alternative methods, the schools can with some justification say that they made the right decision in teaching a uniform technique. Greater efficiencies are attained when students learn one technique that produces superior results. The limited education they receive is at least directed to producing graduates who will do safe, effective procedures. However, as research accumulates on the techniques now being predominantly taught, we are becoming ever more aware that these techniques are fraught with mechanical limitations, including a significant potential for instrument separation, ineffective cleansing of oval canals, and the production of microfractures. Yet, how many classes have graduated with an education limited to the techniques that produce these problems? In effect, the universities backed the wrong techniques and it is the graduates and the patients they subsequently treat who suffer. The lack of diversity that seemed so unimportant over all these years has done its damage. In fact, these students who were taught in an atmosphere of forced uniformity have not been trained to seek out a broad range of options. They were taught to accept uniformity rather than the less efficient, but safer, state of diversity, and they are not likely to pursue alternatives outside the narrow range of their education. Of course, the human spirit is a difficult thing to stifle and there will be many dentists who will explore alternative means as they become more aware of the present restraints, but these independent individuals will be seeking answers despite the training they had in their professional education and not because of it.

I hope that more papers such as this one will be written and that the long-term disadvantages of an artificially narrowed education will be discussed as the serious problem it is.

October - December 2012

Diversity reduces efficiency, but it provides a built-in insurance policy against that rare but calamitous event.