ViziLite Plus
I am extremely tired of advertisements in the dentist's office for cosmetic procedures such as whitening and veneers. I thought that an important tenet of the medical profession (okay, dentist are barely part of the medical profession, especially ambulance-chasing dentists) was to do no harm, and making me think there is something wrong with me because my teeth don't have a certain appearance, IMO, is doing harm. It's one thing if they're so crooked I can't chew properly and I'm having indigestion, or they're jammed together and I can't clean them properly and have periodontal disease as a result. It's another to tell me that my smile might not be white enough.
Now that said, my dentist is not an ambulance-chaser (although there's one guy in the office who is the "TMJ expert" and I won't let him near me). My dentist had, in fact, just returned from Tanzania yesterday where he was doing dentistry as a mission. He's generally a decent guy.
So today I was faced with a choice that I think is on the ethical borderline: whether to be screened for oral cancer using something called ViziLite Plus. This is a rinse that you use, and then they peer into your mouth with ViziLite, a "specially designed light technology." This technology can reveal cancer before it is visible in ordinary light.
I was first shown an "informational video," which was actually a brief Fox "news" story about oral cancer and ViziLite, focusing on a 27-year-old woman who died from oral cancer. The "doctor" narrating the story offered some facts which are also available in the ViziLite brochure:
* 25% of oral cancers occur in people who don't smoke and have no other lifestyle risk factors.
* The American Cancer Society estimates a 5.5% increase in new cases of oral cancer and a 1.5% increase in deaths associated with oral cancer.
* When oral cancer is found early, treatment is 90% successful, otherwise the outlook is grim (I can't remember how grim she said in the "news" story, that info is not in the brochure, 50% five year survival rate?).
* Someone dies from oral cancer every hour.
Finally, the "doctor" shared that the test was some percent effective (90%? 98%?), which meant that you might have to undergo further tests because of a false positive, but "hey, better safe than sorry, right?" She also noted that most insurance won't cover the cost of the test (which is $45 at my dentist's office).
My hygienist came in and asked me if I wanted the screening. My hygienist and her husband have both had cancer, so I didn't want to have a discussion about the screening or cancer in general. I simply asked a question that wasn't answered on the video, "What percentage of the population actually gets oral cancer?"
She had no idea. "But I do know that 25% of the people who get oral cancer have no lifestyle risk factors." (In fact, in the pamphlet I was given, you can fall into three categories: increased risk, high risk, and highest risk. My question is, increased from what? Is there just "risk"?)
I told her that a quarter of an infinitesimal chance was pretty small, and I'd have to research the chances of contracting oral cancer before I made a decision. I've had enough screenings that are paid for by my insurance, such as mammography and colonoscopy, to know that a false positive is no picnic. Three times in my life I've waited for a result that might be cancer, and it never has been. In all three cases, I had actual symptoms. I appreciate that these screenings exist, but in some cases I question the value of "better safe than sorry." I don't like waste, I don't like false positives (which lead to more tests), and the dentist has eroded my trust with his ads for veneers and whitening and his shady cancer-screening scare tactic FOX "news" clip. In fact, many doctors have eroded my trust with their "I have a hammer, you look like a nail" philosophy. Doctors are what they are -- we must be realistic about this fact. You are a matching game to them -- match the symptoms to the prescription or procedure, not a complicated human puzzle to be solved and treated holistically.
So I decided to try to find the chances of contracting oral cancer on my own.
First of all, infection with HPV16/18 is a risk factor, which is why, they're speculating, more young people are contracting oral cancer. Is infection with HPV considered a lifestyle risk factor? The brochure is not clear. My gynecologist just tested me for HPV infection and I've never been exposed. Does that mean that I'm less likely to be one of the 25% of oral cancer sufferers who doesn't have lifestyle risk factors? It's not clear, but I'm definitely not a smoker, drinker, or tobacco chewer.
The oral cancer foundation* says that more than 34,000 Americans will be diagnosed with oral or pharyngeal cancer this year. (Does this test screen for pharyngeal cancer? The pamphlet says the dentist examines your mouth, not your pharynx.)
According to the National Cancer Institute, there will be 22,900 new cases diagnosed this year and 5,390 deaths. That's not one an hour, so I'm not sure what the discrepancy is. Perhaps one includes the pharyngeal and the other doesn't, but since the screening doesn't seem to screen for pharyngeal cancer, it doesn't seem right to use those statistics in the pamphlet. Clicking on a statistics link, the National Cancer Institute estimates 35,310 people will contract oral or pharyngeal cancer, with 7,590 deaths. (Still not one per hour. I can't shake the image of the ViziLite Plus people conking a few oral cancer victims on the head to round out the numbers to a nice neat one per hour.)
The statistics page also offers this: 0.74% of men will develop cancer of the oral cavity and pharynx between their 50th and 70th birthdays compared to 0.25% for women.
Now a quarter of that .25% will have no lifestyle risk factors, so that's .0625% of women contracting this cancer between the ages of 50 and 70. (I assume the risk is lower for women younger than that.) And what about women who have no lifestyle risk factors and don't have HPV? Not clear.
.58% of all women will develop ovarian cancer during that same age range,
5.62% of all women will develop breast cancer,
1.58% colorectal,
2.33% lung,
just for some similar statistics on other cancers. I read on one of these sites that it's the sixth-most prevalent cancer, but again, that includes the 75% of diagnosed sufferers with lifestyle risk factors.
So is it worth the screening? That depends on how much $45 means to you (or whatever your dentist charges) vs. how you will react to a positive result (false or otherwise) and what kind of further tests will be done (I'm guessing biospy). If the false positive rate is 2% (I have no idea what it is), I'm more likely to have a false positive than a true positive, and you most likely are getting a piece of your mouth sliced off for nothing.
I don't object to the screening, just the general lack of information and the scare tactics used to push it.
*Oh, say, guess who one of the corporate partners/sponsors for this ".org" is? Zila Pharmaceuticals, Inc., the makers of ViziLite Plus.
Now that said, my dentist is not an ambulance-chaser (although there's one guy in the office who is the "TMJ expert" and I won't let him near me). My dentist had, in fact, just returned from Tanzania yesterday where he was doing dentistry as a mission. He's generally a decent guy.
So today I was faced with a choice that I think is on the ethical borderline: whether to be screened for oral cancer using something called ViziLite Plus. This is a rinse that you use, and then they peer into your mouth with ViziLite, a "specially designed light technology." This technology can reveal cancer before it is visible in ordinary light.
I was first shown an "informational video," which was actually a brief Fox "news" story about oral cancer and ViziLite, focusing on a 27-year-old woman who died from oral cancer. The "doctor" narrating the story offered some facts which are also available in the ViziLite brochure:
* 25% of oral cancers occur in people who don't smoke and have no other lifestyle risk factors.
* The American Cancer Society estimates a 5.5% increase in new cases of oral cancer and a 1.5% increase in deaths associated with oral cancer.
* When oral cancer is found early, treatment is 90% successful, otherwise the outlook is grim (I can't remember how grim she said in the "news" story, that info is not in the brochure, 50% five year survival rate?).
* Someone dies from oral cancer every hour.
Finally, the "doctor" shared that the test was some percent effective (90%? 98%?), which meant that you might have to undergo further tests because of a false positive, but "hey, better safe than sorry, right?" She also noted that most insurance won't cover the cost of the test (which is $45 at my dentist's office).
My hygienist came in and asked me if I wanted the screening. My hygienist and her husband have both had cancer, so I didn't want to have a discussion about the screening or cancer in general. I simply asked a question that wasn't answered on the video, "What percentage of the population actually gets oral cancer?"
She had no idea. "But I do know that 25% of the people who get oral cancer have no lifestyle risk factors." (In fact, in the pamphlet I was given, you can fall into three categories: increased risk, high risk, and highest risk. My question is, increased from what? Is there just "risk"?)
I told her that a quarter of an infinitesimal chance was pretty small, and I'd have to research the chances of contracting oral cancer before I made a decision. I've had enough screenings that are paid for by my insurance, such as mammography and colonoscopy, to know that a false positive is no picnic. Three times in my life I've waited for a result that might be cancer, and it never has been. In all three cases, I had actual symptoms. I appreciate that these screenings exist, but in some cases I question the value of "better safe than sorry." I don't like waste, I don't like false positives (which lead to more tests), and the dentist has eroded my trust with his ads for veneers and whitening and his shady cancer-screening scare tactic FOX "news" clip. In fact, many doctors have eroded my trust with their "I have a hammer, you look like a nail" philosophy. Doctors are what they are -- we must be realistic about this fact. You are a matching game to them -- match the symptoms to the prescription or procedure, not a complicated human puzzle to be solved and treated holistically.
So I decided to try to find the chances of contracting oral cancer on my own.
First of all, infection with HPV16/18 is a risk factor, which is why, they're speculating, more young people are contracting oral cancer. Is infection with HPV considered a lifestyle risk factor? The brochure is not clear. My gynecologist just tested me for HPV infection and I've never been exposed. Does that mean that I'm less likely to be one of the 25% of oral cancer sufferers who doesn't have lifestyle risk factors? It's not clear, but I'm definitely not a smoker, drinker, or tobacco chewer.
The oral cancer foundation* says that more than 34,000 Americans will be diagnosed with oral or pharyngeal cancer this year. (Does this test screen for pharyngeal cancer? The pamphlet says the dentist examines your mouth, not your pharynx.)
According to the National Cancer Institute, there will be 22,900 new cases diagnosed this year and 5,390 deaths. That's not one an hour, so I'm not sure what the discrepancy is. Perhaps one includes the pharyngeal and the other doesn't, but since the screening doesn't seem to screen for pharyngeal cancer, it doesn't seem right to use those statistics in the pamphlet. Clicking on a statistics link, the National Cancer Institute estimates 35,310 people will contract oral or pharyngeal cancer, with 7,590 deaths. (Still not one per hour. I can't shake the image of the ViziLite Plus people conking a few oral cancer victims on the head to round out the numbers to a nice neat one per hour.)
The statistics page also offers this: 0.74% of men will develop cancer of the oral cavity and pharynx between their 50th and 70th birthdays compared to 0.25% for women.
Now a quarter of that .25% will have no lifestyle risk factors, so that's .0625% of women contracting this cancer between the ages of 50 and 70. (I assume the risk is lower for women younger than that.) And what about women who have no lifestyle risk factors and don't have HPV? Not clear.
.58% of all women will develop ovarian cancer during that same age range,
5.62% of all women will develop breast cancer,
1.58% colorectal,
2.33% lung,
just for some similar statistics on other cancers. I read on one of these sites that it's the sixth-most prevalent cancer, but again, that includes the 75% of diagnosed sufferers with lifestyle risk factors.
So is it worth the screening? That depends on how much $45 means to you (or whatever your dentist charges) vs. how you will react to a positive result (false or otherwise) and what kind of further tests will be done (I'm guessing biospy). If the false positive rate is 2% (I have no idea what it is), I'm more likely to have a false positive than a true positive, and you most likely are getting a piece of your mouth sliced off for nothing.
I don't object to the screening, just the general lack of information and the scare tactics used to push it.
*Oh, say, guess who one of the corporate partners/sponsors for this ".org" is? Zila Pharmaceuticals, Inc., the makers of ViziLite Plus.
posted by Maggie at 7/03/2008 12:15:00 PM
7 Comments:
I once had a dentist who was a "TMJ specialist," and a lot of patients came to him specifically because they had TMJ problems. But he never pushed TMJ stuff on me, which I appreciated. Then my insurance changed and I had to dump him, which was ironic since eventually I developed a TMJ problem and couldn't go to him.
I dumped another dentist because it seemed he'd rather whiten and cap my teeth than clean and care for them.
Next dentist was mum on TMJ, whitening, and capping, but did let me know he could make my teeth EVEN STRAIGHTER if I was interested.
I guess the problem with cosmetic and TMJ stuff is that people can figure out on their own if they're hideous, or in pain. But cancer screenings - that's a stroke of genius. You might have it right now, and you'll ¡¡¡i¡¡DIE!!1!!!
Thanks for the warning. I'll be sure and ask my dentist if he offers this test. ;-)
Yeesh.
I had a horrible experience with a dentist back in CT. I even had a difficult time getting my records from that dentist because he wrote nasty and inaccurate notes about me in the chart. I had to argue with the receptionist in front of a client to get them -After each of her excuses I just kept asking if she was refusing to provide me with my own medical records...finally I got them. But my image of dentists is forever changed. And this screening just supports my opinion.
hpv diseases are passed from one to another from skin contact.
If you are sexually active you are at risk of getting oral cancer or cervical cancer. Oral sex to be more specific will put you at risk to get oral cancer, due to HPV.
IF you have sex you are at risk. hope this helps...
I have always been bothered by the cosmetic push by dentists. But they're clearly reacting to society's vain obsessions.
Our corporate dental insurance provider now offers to pay for ViziLite every two years in 40+ year old patients. Wasn't sure if it was a worthwhile benefit, but your insight helped me decide it is probably not.
Thank you to Patti M. for providing this Boston Globe article on ViziLite:
Oral Cancer Tests Value Unproven
Maggie
I would ask zila for their clinical trials..they do not have any...SPECIFICALLY THE FDA TRIALS. The FDA trials were tested on cells from the cervix and not even the oral cavity. Ask to see studies about vizilite plus. not case studies that they give out which do not have materials and methods..results..discussion... Also look at zila stock and also the ceo has gone to over 40 banks and no bank wants to extend a loan to them..zila is going under....ASK FOR CLINICAL SCIENCE!!!!!!!!!!!!!!!!!!!
I recently went to a new dentist for a routine check-up. The Dentist insisted that I undergo Vizilite Oral Cancer Screening. I was already in the chair and the cancer screening was beginning as I was being told the importance of the test and the $65 cost. I confess that I did not immediately complain. I subsequently found out that the American Dental Association denied its coveted “Seal of Approval” for Vizilite in 2005. I might be a little picky but personally, I think that it is reasonable to demand that my oral cancer screening procedure carry at least the same seal of approval as my store bought toothbrush and toothpaste. The pharmaceutical company that owns Vizilite has apparently never made an effort to resubmit for approval from the American Dental Association. http://www.dentalblogs.com/archives/hedge/vizilite-denied-ada-seal-of-approval/.
Dental insurance does not routinely cover this “test” so the dentist simply charges the patient directly. This is great "additional revenue and margin" for the dentist to improve the revenue stream for the practice. The math is pretty easy if you assume that 15 patients per week are paying $65 each. That is close to $50,000 per year in additional revenue.
"Certification" by Vizilite is available to dentists who (a) have purchased at least 60 test kits, (b) have used the test for at least one year, (c) have done at least 40 tests, (d) have reviewed the ViziLite Training CD, and (e) use the ViziLite's patient brochure, consent form, and mouth map. Dental hygienists who satisfy these requirements (except for the minimum purchase) are also eligible for certification. Proven competence in doing the examinations does not appear to be a requirement. http://www.dentalwatch.org/questionable/vizilite/overview.html.
The pharmaceutical company that owns Vizilite is Zila. Zila is not doing so well financially. Today they were trading at .22 per share. I wonder if it has something to do with their lack of credibility. I can almost imagine the "weekend cruise or golf seminar" where dentist learn how to exploit their patients. This is no different than the oil lube shops that "soak" their customers through scare tactics. In the case of Dentist who partner with Vizilite, this behavior is even more despicable since the tactics prey on the trusting and vulnerable dentist / patient relationship.
The facts make me feel more like I got a prostate exam instead of an oral exam. Southern Dental has refused my reasonable request to remove the $65 charge.
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