Art and Science Meets Moral Relativism: Guest Editorial

Guest Editorial
Art and science meets moral relativism

Robert H. Kazmierski
It has been accurately said that there are often of higher priority. Art is only to fill in the gaps between
many different ways to treat a patient properly. How- the scientific points and is of lower priority.
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ever, just because there are multiple ways of treating Herein lays the explanation as to how multiple differ-
a patient well does not mean that every way of treating ent treatments may be proper. If we plot the points of
a patient is correct. While this seems simple and self- science on our graph, there are potentially an infinite
evident when stated this way, in practicality this con- number of different lines of treatment that cross all of
cept is currently very much in question in orthodontics. the appropriate points of science and still share the
Examples that quickly come to mind are orthodontic same end point. All of these roads lead to Rome: ethi-
treatment for obstructive sleep apnea (OSA), expand- cal treatment. As such, treatments that are different
ers on 3-year-old children, and cone beam computed from our own yet still account for and cross over the
tomography on children of similarly young ages. points of science deserve our respect. They also
I believe that some consideration of the art and sci- deserve our attention, as we may find a better treat-
ence of our profession and how this relates to the con- ment line than our own.
cept of moral relativism will help to shed light on when a Also in this analogy is the explanation as to why cer-
treatment is ethical, when we should be respectful of a tain treatments are improper or even unethical. Lines
treatment that is different than our own, and when a treat- that represent these treatments do not cross over valid
ment is unethical and should be pointed out as such. scientific points when appropriate. Worse, those sup-
To start, the course we go through in the diagnosis porting these treatments will sometimes create false
and treatment of a patient can be analogous to a line on scientific points along their line and then claim to have
a graph. This line may be straight or take many twists crossed them. As an example, orthodontic articles lack-
and turns as may be needed to properly treat a patient. ing legitimate scientific research methodology have
Also, the line is continuous just as a patient’s treatment been published in nonorthodontic sleep medicine jour-
is continuous between the start and ending points. nals. These are presented in lectures as valid scientific
Within this same analogy, the facts established by research. This false evidence is then used to justify
valid scientific research might be thought of as points improper and sometimes unethical treatments.
on this graph. These points of valid scientific research Examples of points of valid scientific evidence
have gaps between them and are unfortunately not would be the American Association of Orthodontists
continuous. The problem here is that we must continu- (AAO) white paper and scientific articles published in
ously treat a patient from start to finish or by analogy nonpredatory peer-reviewed orthodontic journals show-
draw a line on the graph, yet science can only provide ing that expansion is not a legitimate technique for
individual points on the graph. So continuously treat- treating OSA outside of the very rare direct recommen-
ing a patient with only completely known scientifically dation of a physician board certified in sleep medicine,
proven principles or points is not possible. that we cannot prevent OSA with any known early
As might be obvious by now in this analogy, while the childhood orthodontic treatment, and that extractions
points on our graph are the “science” in our treatment, do not cause OSA. The logical conclusion of this is
the line between those points is the “art,” filling in where that, with the possible exception of severe craniofacial
needed to allow continuous treatment to take place. anomalies or syndromes, expansion should almost
Importantly, however, proper treatment demands that never be done on children under 7, expansion for treat-
the line of our treatment crosses the points of science ment or prevention of OSA is nearly never indicated,
whenever this is possible. The science is mandatory and and extractions do not cause OSA.
When those who do lecture on and practice these
nonscientifically based treatments are questioned, the
retort invariably becomes that all treatments and all
beliefs are legitimate, and we need to be respectful of
Robert H. Kazmierski, Private Practice, Moorestown, New
Jersey, 110 Marter Ave., Suite 404, Moorestown, NJ 08057, those treatments, those who treat that way, and those
DrKaz@ThinkStraightTeeth.com, MoorestownOrthodontics.com who teach others to treat that way. In their minds,
Ó 2023 by The EH Angle Education and Research Foundation, Inc. every treatment deserves equal consideration and
747 Angle Orthodontist, Vol 93, No 6, 2023

748 KAZMIERSKI
respect. This seems especially so if the treatment is As ridiculous and extreme as that example sounds,
one that they are doing or lecture on. it is not completely unlike what is currently occurring in
This is where the concept of moral relativism comes orthodontics. We would do well to remember that
in. Moral relativism holds that no one opinion is objec- rather than being a fringe practice, bloodletting per-
tively right, wrong, or superior to another. The philoso- sisted as a legitimate means of medical treatment for
phy has a natural appeal and was popular in the 1960s over 2000 years. Doctors practiced it their entire
hippie culture in the form of “I’m okay. You’re okay.” careers, were convinced of its efficacy, and had many
While this superficially appeared to work in the peace success stories. The practice lasted well into the late
and love culture of the ’60s, Moral relativism has a fatal 19th century, when scientific studies were finally used
flaw and a dirty underbelly. In fact, there are bad things to discredit it.
Our patients will be better treated, and we will be bet-
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and opinions in the world along with people who would
willingly and intentionally harm others. These harmful ter clinicians if, instead of repeating medicine’s mistake,
things, opinions, and people cannot and should not we learn from this example and accept what science
have equal standing in a moral world. This gives us as has already taught us. The AAO white paper and the
orthodontists a moral obligation to point out the deficits best science we have say that these treatments do not
help patients, sometimes hurt patients, and, worse, are
of these harmful treatments and suppress the advo-
sometimes being done on 3-year-old children.
cates for them as much as we are able.
For those representing us, knowingly hosting a lec-
As an extreme example, imagine if bloodletting
turer who uses poor science and teaches improper
were advocated by lecturing orthodontists as a means
treatment is not just “hearing both sides.” It is a de
of treating and preventing OSA, advantageous to 3-
facto endorsement of that treatment and lecturer. It
year-olds, and facilitated achieving harmonious devel- helps the spread of these teachings elsewhere. This
opment of the jaws. Just as is happening with current encourages even more improper treatment. As a
improper treatments, these lecturing orthodontists would result, allowing lecturers of this nature at AAO and
tell us how they have successfully treated patients this regional orthodontic meetings should stop.
way for decades. Many case studies and slides of suc- For the rest of us, we should not let improper treatment
cessful results would doubtless be presented. Were we to and those promoting improper treatment hide behind the
consider all treatments, opinions, and teachers as being false cover of moral relativism. We might help by profes-
equal, we would have to accept bloodletting as a legiti- sionally pointing out, or at least supporting those who pro-
mate orthodontic treatment. Moreover, we might even fessionally point out, these improper treatments and
have to listen to them at AAO-endorsed lectures as a part those lecturing for them. In this situation, we are not being
of “hearing all sides of an issue.” Once having lectured disrespectful of another opinion. Rather we are actually
there and placed this on their resume, they may easily acting morally by attempting to prevent improper treat-
use this experience to gain more speaking engagements ment and promoting what is best for our patients. That
lecturing on the many benefits of bloodletting. seems very respectful, moral, and worthwhile.
Angle Orthodontist, Vol 93, No 6, 2023

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Art and science meets moral relativism

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747 Angle Orthodontist, Vol 93, No 6, 2023

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Angle Orthodontist, Vol 93, No 6, 2023

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