The Morning Drill: July 25, 2011

A collection of dentistry and health related links/comments for your day.

Alzheimer's: Early detection, risk factors are crucial

With more than 5 million people suffering from Alzheimer's disease in the United States, a number that's expected to rise to 16 million by 2050, the pressure is on to find better methods of diagnosis, treatment and prevention.

Around the world, Alzheimer's disease is the second most feared disease, behind cancer, according to a recent survey of five countries conducted by the Harvard School of Public Health.

Yet there is still a lot of misinformation: Only 61% of Americans who responded to the survey correctly identified Alzheimer's disease as a fatal illness. Many participants also mistakenly believe there are sure diagnostic methods and effective treatments to slow the disease, but most would seek medical attention if they became aware of their own early signs.

The research that came out of the Alzheimer's Association 2011 International Conference on Alzheimer's Disease, which took place in Paris last week, reflects a growing emphasis on early detection.

Research suggests the best targets for exploring treatments are patients who do not have full-blown Alzheimer's disease, but experience mild symptoms. Scientists have identified biological indicators called biomarkers that seem to be associated with Alzheimer's, although they are not perfect predictors. (...)

At the Paris conference, researchers said 3 million cases of Alzheimer's could be prevented worldwide if lifestyle-based, chronic disease risk factors were reduced by 25%. This estimate is based on a mathematical model.

In the United States, physical inactivity had the biggest association with Alzheimer's out of the risk factors studied, followed by depression and smoking. Midlife hypertension, midlife obesity, low educational attainment and diabetes are other risk factors.

"If we can demonstrate that these risk factors can be modified, and that it will lead to lower rates of Alzheimer's disease, the impact could be huge," Levey said.

People in their 40s and 50s have still got perhaps a couple of decades to modify lifestyle to potentially lower risk, he said.

CDC: Chickenpox deaths plummeted since vaccine

Chickenpox vaccine has dramatically cut deaths from the disease, especially in children, says a new government study proclaiming an important public health victory.

Researchers from the Centers for Disease Control and Prevention found that chickenpox deaths fell from an average of 105 per year to 14 after the vaccine had been available for a dozen years.

Deaths declined in all age groups, but the drop was most significant among children.

"To see the near elimination of chickenpox deaths in this country is very exciting," said Jane Seward, a CDC official who co-authored the paper. She has been involved in the agency's chickenpox vaccine program for 15 years.

The report was released online Monday by the journal Pediatrics.

U.S. budget issues put oral care programs in peril

When the Patient Protection and Affordable Care Act (PPACA) was signed by U.S. President Barack Obama in March 2010, the law authorized the spending of millions of dollars to help Americans take better care of their oral health.

But with Congress locked in a battle to trim trillions from the federal budget and raise the nation's debt ceiling, key provisions designed to promote research, preventive programs, and oral health literacy languish without funding.

"We're talking about our economy collapsing rather than funding some important health initiatives," said Jude McCartin, a spokeswoman for Sen. Jeff Bingaman (D-NM), a leading congressional advocate for the oral healthcare provisions.

Meanwhile, funding for the current fiscal year has been blocked outright for another initiative, a $60 million program to allow states to set up pilot projects to try out alternative workforce models such as dental therapists.

The PPACA places a major focus on expanding the dental workforce, authorizing funds for training traditional dental providers, and exploring the use of new models.

At least 49 million Americans live in more than 4,000 areas lacking adequate oral healthcare services, and the U.S. would need nearly 10,000 additional practitioners to meet the needs of these shortage areas, according to the U.S. Department of Health and Human Services' Health Resources and Services Administration (HRSA). Moreover, 16 million beneficiaries are scheduled to join Medicaid in 2014, and a pediatric dental benefit has been included in essential benefit packages under the PPACA.

Former NFL players: League concealed concussion risks

Seventy-five former professional football players are suing the National Football League, saying the league knew as early as the 1920s of the harmful effects of concussions on players' brains but concealed the information from players, coaches, trainers and others until June 2010.

The players "did not know the long-term effects of concussions" and relied on the NFL to protect them, the suit says.

The lawsuit also names as a defendant the football equipment maker Riddell Inc., which has been the official NFL helmet brand since 1989.

"For decades, defendants have known that multiple blows to the head can lead to long-term brain injury, including memory loss, dementia, depression and (chronic traumatic encephalopathy) and its related symptoms," says the 86-page lawsuit, filed in Los Angeles County Superior Court on Tuesday.

"This action arises from the defendants' failure to warn and protect NFL players such as plaintiffs against the long-term brain injury risks associated with football-related concussions. This action arises because the NFL defendants committed negligence by failing to exercise its duty to enact league-wide guidelines and mandatory rules regulating post-concussion medical treatment and return-to-play standards for players who suffer a concussion and/or multiple concussions."

NFL spokesman Greg Aiello said Monday night that the league had not seen a copy of the suit but would "vigorously contest any claims of this kind."

Enjoy your day!

The Afternoon Drill: July 11, 2011

A collection of dentistry and health related links/comments for your day.

Shortage of Physicians, APNs, PAs Predicted for 2025

Advanced practice nurses (APNs) and physician assistants (PAs) are frequently touted as the solution to the physician shortage, but there will not be enough of all 3 professionals combined to meet the nation's healthcare needs in 2025, according to a study published in the June issue of the Journal of the American College of Surgeons.

Lead author Michael Sargen, a medical student at the University of Pennsylvania in Philadelphia, and coauthors write that although the United States needs to expand the workforce of these 3 types of "advanced clinicians," healthcare personnel with less training must assume more patient care responsibilities, especially as more Americans gain insurance coverage under the Affordable Care Act.

Right now, the nation fields close to 300 advanced clinicians for every 100,000 Americans. That number is roughly 7% less than needed, based on the demand for services, which the authors extrapolate from healthcare spending. The authors write that if training programs for PAs and APNs — which include nurse practitioners — grow as currently projected while physician residency programs fail to expand, the per capita supply of advanced clinicians in 2025 will resemble the current level.

However, the workforce of 2025 in this scenario will be 20% less than needed because of burgeoning demand for services. The authors cite government studies that forecast a 65% increase in healthcare spending from 2009 to 2025 based on its historic growth rate of 2.5% above the growth of the gross domestic product (GDP).

The healthcare reform law aims to reduce that growth rate to 1% above GDP, the authors write, but even if reformers hit this target, demand for services will still outstrip the supply of advanced clinicians.

Coauthor Richard Cooper, MD, an authority on physician workforce issues and a professor at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, chalks up the continued rise in spending not only to costly technologies but also to the sheer proliferation of new therapies.

"Research is finding ways to treat diseases that were once untreatable," Dr. Cooper told Medscape Medical News. "We once didn't treat lung cancer. Now we do. We don't treat Alzheimer's disease now, but we will in the future."

Quitting Smoking When Newly Pregnant Same as Never Smoking

Women with a newly confirmed pregnancy now have extra incentive to quit smoking, according to the results of the largest study to date looking at the effect of smoking on pregnancy outcomes.

"There's now a second clear message," said senior investigator Nick Macklon, MD, professor of Obstetrics and Gynaecology at the University of Southampton and director of the Complete Fertility Centre, also in Southampton, United Kingdom.

"Not only that smoking is bad for pregnancy, but...women who take the effort to stop even as late as when their pregnancy has been confirmed can achieve birth weights which are the same as if they had never smoked."

Dental worker admits plot to steal customers' personal info to get credit cards

A worker at a dental business faces up to a year in federal prison after she admitted giving customers' personal information to a relative who used it to get credit cards in her name.

The St. Louis Post-Dispatch reports that Claudine Jones of Cahokia pleaded guilty Friday in U.S. District Court in East St. Louis to conspiracy and making a false statement.

As part of her plea, Jones admitted supplying a cousin with personal information about roughly 10 Dental Network of America customers.

Those details, including Social Security numbers and birthdates, then were used by someone to get five credit cards on which $3,700 was charged.

Dental Hygienist named Miss Massachusetts 2011

Molly Whalen, 20, of Middleboro, was selected as Miss Massachusetts 2011 Saturday at the 72nd annual Miss Massachusetts Scholarship Pageant in Worcester.

Competing as Miss Taunton, she was chosen from among 15 contestants at the Hanover Theatre. She will receive more than $8,500 in scholarships, and will compete at the Miss America Pageant in January in Las Vegas.

Whalen is a 2011 graduate of Massachusetts College of Pharmacy and Health Science, where she earned a Bachelor of Science degree in dental hygiene. A 2008 graduate of Coyle and Cassidy High School in Taunton, she is the daughter of Robert and Maureen Whalen of Middleboro.

During her year of service, she will highlight her platform "Smart Smiles: Promoting the Importance of Oral Health" as well as promoting The Children's Miracle Network Hospitals, the national platform of the Miss America Organization.

Enjoy your afternoon!

The Morning Drill: June 21, 2011

A collection of dentistry and health related links/comments to start your day.

Is the U.S. dental hygienist market saturated?

As the overall job market in the U.S. continues to be sluggish, a few recent reports -- which considered hiring outlook as a criterion -- have ranked dental hygienist among the top 10 professions in the country.

But the reality is that in many parts of the country hygienists are having a hard time finding work, according to many in the field.

What accounts for the discrepancy?

Primarily the U.S. Bureau of Labor Statistics (BLS), according to Caren Barnes, RDH, a professor in the department of dental hygiene at the University of Nebraska Medical Center College of Dentistry.

"They publish statistics that say this is a high growth area, while the job markets are actually saturated," she told DrBicuspid.com.

According to the bureau's Occupational Outlook Handbook for 2010-2011, dental hygienist ranks among the fastest-growing occupations, and job prospects are expected to be favorable in most areas, although competition is likely in some areas.

Todd Jonson, an economist with the BLS, said that they make these projections by looking at both current trends and future labor markets.

"When you have projections looking 10 years ahead, you can't expect to be dead-on," he explained.

While reports of qualified hygienists being unable to find work could be true, he added, these reports are coming from individuals, while the BLS is looking at national trends.

Caryn Solie, RDH, president of the American Dental Hygienists' Association (ADHA), said that the BLS used a census survey for these projections that indicates there is a growing need in the population for the professional services of dental hygienists.

"However, due to a variety of factors -- including the impact of the recession -- we have seen that in some portions of the country traditional clinical practice jobs are in short supply," she added. "This is not an issue that is unique to dental hygienists, and we do feel that growing opportunities in the field will help to alleviate some of these issues."

Experts Issue Guidelines on Safe Weight Loss for Athletes

Gymnasts, wrestlers and boxers often feel pressure to lose weight to boost performance, but the drastic methods they sometimes use -- including strictly limiting calories and intentional dehydration -- can be dangerous to their health, experts warn.

To offer guidance to athletes, coaches and parents, the National Athletic Trainers' Association has issued a new set of guidelines for safe weight loss by athletes.

They include: using body composition assessments to measure lean body mass versus fat; gradually shedding no more than 1.5 percent of body weight a week; eating a balanced diet that includes all food groups; and losing weight under the supervision of nutrition, health and weight management experts.

"In the performance sports -- gymnastics, dance, ballet -- they have this huge responsibility to not only do a performance but to look good while they are doing it. It's a unwritten rule that they have to be a certain weight, and they get a lot of pressure, not just from dance masters but from the public's expectations and themselves," said Paula Sammarone Turocy, lead author of the guidelines and chair of the department of athletic training at Duquesne University in Pittsburgh. "We also see it in traditional sports -- jockeys, wrestlers, boxers. They all have weight requirements. If they don't make the weight, they don't compete."

And the pressure to shed weight cuts across all sports, she added. Many cyclists, swimmers, runners, soccer players and even football players believe that losing weight will mean they can run, swim and jump faster.

Getting down to an ideal body weight to improve performance isn't a problem in and of itself, she said. It's when athletes go to extremes that their drive can backfire. "When it's done improperly or done to extremes it does interfere with performance," she explained.

The new guidelines were to be presented Monday at the annual meeting of the National Athletic Trainers' Association in New Orleans and are published in the June issue of the Journal of Athletic Training.

US Dentists' Amalgam Use Surprises Researchers

Despite improvements in resin-based composite technology, US dentists are placing more amalgam restorations than composites, and amalgam is still emphasized by US dental schools, according to the results of 2 studies published in the June issue of the Journal of the American Dental Association.

"I thought that most people were using composite," researcher Sonia K. Makhija, DDS, MPH, an assistant professor of dentistry at the University of Alabama at Birmingham, told Medscape Medical News. "It was surprising that so many people are using amalgam."

Dr. Makhija and colleagues in the Dental Practice-Based Research Network, a collaboration of practicing dentists who participate in research, analyzed reports from 182 US dentists on 5599 restorations of carious lesions in posterior teeth.

Overall, the dentists used amalgam for 3028 of these restorations, and composite in 2571 others. (The researchers collected no data on the 930 restorations these dentists made out of gold, glass ionomer, or anything else other than composite and amalgam.)

Although the dentists were not a statistical sample, previous studies have suggested that they are generally representative of what dentists are doing in the United States, Dr. Makhija said.

More Evidence Vitamin D Boosts Immune Response

Laboratory-grown gingival cells treated with vitamin D boosted their production of an endogenous antibiotic, and killed more bacteria than untreated cells, according to a paper in the June 2011 issue of the journal Infection and Immunity. The research suggests that vitamin D can help protect the gums from bacterial infections that lead to gingivitis and periodontitis. Periodontitis affects up to 50 percent of the US population, is a major cause of tooth loss, and can also contribute to heart disease. Most Americans are deficient in vitamin D.

Vitamin D has become a hot area of research in recent years. In addition to infectious diseases, studies suggest that it has protective effects against autoimmune diseases, and certain cancers.

Diamond says that after he began conducting research on vitamin D, he began taking it as a supplement. Since then, "I have had only one cold in four years, and that one lasted only three days," he says. "Other people I've met who have done the same have seen similar results. We are trying to figure out how it's working, and what other infectious diseases can be mitigated by it."

Enjoy your morning drill!

The Morning Drill: June 17, 2011

A collection of dentistry and health related links/comments to start your day.

Adriana Sklenarikova 'Saved' by Bulgarian Dentist

World renown supermodel Adriana Karembeu nee Sklenarikova had to undergo an emergency dentist appointment during her visit to Bulgaria.

While on a working lunch at the Bulgarian Velingrad spa resort, the supermodel suddenly felt her tooth aches. Sklenarikova had to go to a local dentist, who immediately solved her problem, according to the 24 chasa daily.

The model was vary grateful and even took a picture with the dentist. Adriana Sklenarikova is in Bulgaria to get acquainted with the country's spa business opportunities.

On Tuesday, she was present at the official opening of a new spa center in the northern Bulgarian city of Veliko Tarnovo.

Her visit to the Balkan country also has to do with the launch of her own cosmetics brand, which is stepping on the Bulgarian market.

Healing Times for Dental Implants Could Be Cut

The technology used to replace lost teeth with titanium dental implants could be improved. By studying the surface structure of dental implants not only at micro level but also at nano level, researchers at the University of Gothenburg; Sweden, have come up with a method that could shorten the healing time for patients.

"Increasing the active surface at nano level and changing the conductivity of the implant allows us to affect the body's own biomechanics and speed up the healing of the implant," says Johanna Löberg at the University of Gothenburg's Department of Chemistry. "This would reduce the discomfort for patients and makes for a better quality of life during the healing process."

Dental implants have been used to replace lost teeth for more than 40 years now. Per-Ingvar Brånemark, who was recently awarded the European Inventor Award, was the first person to realise that titanium was very body-friendly and could be implanted into bone without being rejected. Titanium is covered with a thin layer of naturally formed oxide and it is this oxide's properties that determine how well an implant fuses with the bone.

It became clear at an early point that a rough surface was better than a smooth one, and the surface of today's implants is often characterised by different levels of roughness, from the thread to the superimposed nanostructures. Anchoring the implant in the bone exerts a mechanical influence on the bone tissue known as biomechanical stimulation, and this facilitates the formation of new bone. As the topography (roughness) of the surface is important for the formation of new bone, it is essential to be able to measure and describe the surface appearance in detail. But roughness is not the only property that affects healing.

College of San Mateo's dental program is in decay

A locked, darkened room sits on the third floor of a sparkling new building at the College of San Mateo. Pipes poke out of its walls and floors, gathering dust.

The room was supposed to be the center of a new dental hygienist training program, and was built at considerable expense using voter-approved bond funding. 

But by the time the building was completed last year, the community college had lost so much state funding that it was forced to put the hygienist training program on indefinite hold. Until the state bounces back financially, the expensive room will likely remain locked and darkened, college President Michael Claire said.

“When we’re cutting English classes and mathematics classes and there’s waiting lists for those, you have to make some decisions about what you can and can’t do,” Claire said. “You have to make really tough decisions about the have-to-haves versus the nice-to-haves.”

Across the state, public entities have faced a similar problem, as voters approve funding for new facilities but there is no money to run them once they’re constructed.

Dental care called a health care crisis

Sepulveda is part of what local officials are calling a growing North Coast health care crisis that only now is being assessed in Sonoma County. According to a study by the Sonoma County Task Force on Oral Health, yet to be formally released to the public:

-- In 2010, there were only 15 dentists for 109,000 low-income residents in Sonoma County — a fraction of the pool available to those with private insurance.

-- In 2009, 52 percent of the county's third-graders had a history of tooth decay, exceeding the state average.

-- The county's impoverished third-graders are more than twice as likely to suffer from untreated tooth decay as children from more affluent families.

The report is expected to be reviewed by the county Board of Supervisors next month.

Enjoy your morning drill!

The Saturday Drill: June 11, 2011

A collection of dentistry and health related links/comments for your day.

Government lists formaldehyde as cancer causer

The strong-smelling chemical formaldehyde causes cancer, while styrene, a second industrial chemical that's used worldwide in the manufacture of fiberglass and food containers, may cause cancer, the National Institutes of Health says.

The NIH said Friday that people with higher measures of exposure to formaldehyde are at increased risk for certain types of rare cancers, including those affecting the upper part of the throat behind the nose.

The chemical is widely used to make resins for household items, including paper product coatings, plastics and textile finishes. It also is commonly used as a preservative in medical laboratories, mortuaries and consumer products including some hair straightening products.

The government says styrene is a component of tobacco smoke, and NIH says the greatest exposure to the chemical is through cigarette smoking.

The two chemicals were among eight added to the government's list submitted to Congress of chemicals and biological agents that may put people at increased risk of for cancer.

Drilling Away at Dental Costs

If you lack dental insurance or have a skimpy policy, your options for scoring a better dentistry deal are growing.

More insurers are offering individual dental coverage. Others, such as Aetna and Cigna, are stepping up their efforts to help members with certain medical conditions prevent tooth and gum problems that can wreak havoc on their overall health -- and lead to costly dental and other health-care bills. Meanwhile, a new website called Brighter.com offers members discounts at participating dentists.

About 10 million Americans have lost their dental insurance in the last few years as the recession weakened the reach of employer plans, the dominant source of coverage. Fifty-four percent of people had some form of dental benefit in 2009, down from 57% between 2006 and 2008, says Evelyn Ireland, executive director of the National Association of Dental Plans, a Dallas-based trade group.

Exercise Reduces Silent Brain Infarcts

Older people who exercise regularly may be less likely to develop silent brain infarcts, considered hallmarks of subclinical cerebrovascular disease.

"Encouraging older people to take part in moderate to intense exercise may be an important strategy for keeping their brains healthy," lead investigator Joshua Willey, MD, from Columbia University in New York, said in a news release.

His team's new study was published online June 8 in Neurology.

"These silent strokes are more significant than the name implies because they have been associated with an increased risk of falls and impaired mobility, memory problems, and even dementia as well as stroke," Dr. Willey said

Dental Pilot Program Bill Passes Budget Committee After Three Contentious Votes

Sen. Laurie Monnes Anderson (D-Gresham) and fellow legislators think that Senate Bill 738 will address, for the first time in years, an “extreme need” to provide better access to dental care throughout Oregon, particularly in rural areas.

That bill would fund pilot projects across the state, offering dental services to people whose incomes fall below the federal poverty level, by expanding the scope of practice of dental hygienists.

The bill passed out of the Joint Ways and Means Committee this morning after almost failing on Wednesday and being the subject of three contentious votes today.

When the Joint Ways and Means Committee voted on Wednesday, the bill received a split 12-12 vote, with Rep. Mary Nolan (D-Portland) absent. Nine Republicans, as well as three Democrats representing rural areas, voted against the bill.

Typically bills that receive a split vote do not survive, but Rep. Tina Kotek (D-Portland) changed her vote from “yes” to “no,” a procedure allowing for the bill to be reconsidered.

Kotek made a motion to reconsider the bill, but Republicans tried to stop it by objecting to the motion on parliamentary grounds.

Sen. Fred Girod (R-Stayton) objected on the grounds that a member of the House--Kotek--filed the motion to reconsider a bill that is a Senate bill. He argued that because the motion was not served from a Senator, Kotek's motion was invalid.

"We need to allow bad bills to die and not have someone drop a vote so they can move it to the floor," he said. "I would ask my colleagues on the House side who are Republicans to stick with me on this procedure."

Girod's motion to reject the motion failed, only receiving seven votes. Kotek's motion for reconsideration passed, and received votes from two Republicans.

Then there was a third vote to pass the bill out of the committee so it can proceed to the Senate and House floors. The bill passed out of the committee 17-8.

The bill was not expected to hit the rocky road that it did in the committee, but it was the subject of a short but passionate debate about scope of practice issues on Wednesday.

Girod, who filed a potential conflict of interest because he is a dentist, spoke passionately against the bill when it first came up for a vote on Wednesday.

He believes it will expand a dental hygienists’ scope of practice so much that it will fundamentally change his profession for the worse, by allowing “people who are not allowed to practice dentistry to practice dentistry.”

“For some reason, this committee thinks that any moron can do dentistry,” Girod told his colleagues. “I dare someone to look in the mirror work backwards in a mouth that has saliva, a tongue that won’t sit still, and try to cut [in the mouth]. It is not that easy.”

He argued that it’s just as inappropriate to expand a dental hygienists’ scope of practice as it would be to expand a nurse’s scope of practice to practice medicine.

Enjoy your Saturday drill!

American Association of Public Health Dentistry Publishes Dental Therapist Curriculum Guidelines

Actually it is a special edition of their journal, Journal of Public Health Dentistry.

A renewed interest in finding ways to improve access to oral health care has emerged in the United States since the publication of the Surgeon General's report on the oral health of the nation in the year 2000. This special issue of the Journal of Public Health Dentistry calls upon the reader to consider several pertinent matters in developing educational programs for dental therapists, a well-established provider of oral health care in many countries used to reach underserved populations. While the addition of dental therapists is controversial in the field of dentistry, other types of mid-level providers have been used in providing medical care. For example, currently, there are mid-level nurse practitioners, physician assistants, and certified registered nurse anesthetists. Emergency medical technicians are sometimes included in this classification as well. Mid-level providers can examine patients, diagnose them, and provide some treatments, all of which must be signed off by a supervising licensed physician.

While debate continues in the field of dentistry about the benefits of adding a mid-level provider to the workforce to reach the underserved, dental therapists are being trained and deployed in two states. The Alaska Native Tribal Health Consortium has educated and deployed dental health aide therapists (dental therapists) in several communities in remote areas of Alaska. Legislation in Minnesota permits the education of dental therapists, and models of training have emerged, one at the bachelor's degree level and the other at the master's degree level. Some of the students enrolled in the Minnesota programs will soon graduate and become part of the workforce in that state. In addition, several states have indicated interest in adding dental therapists to the workforce.

It all sounds good, just like ObamaCare does/did and I will review some of the contents of the AAPHD report over the weeks and months ahead.

But, many questions remain.

In the meantime, who is going to hire or who is going to pay dental therapists to practice?

The federal or state governments, who are broke? Or ,will the dental therapists compete directly with better and more comprehensively trained dentists and offer their services for less?

As, I said, many questions remain and organized dentistry will be opposed all along the way in this dental turf war.

Legalize Self-Employed Dental Hygienists?

A few of my dental hygiene students from West Los Angeles College last year in front of the Simi Valley Free Clinic

This fellow over at the left wing Think Progress does not even have a clue.

Despite the dental cartel’s effort to silence me with hired goons it remains the case that one of the craziest policy practices common in the United States of America is widespread rules against self-employed dental hygenists. The way this works is that both dental hygenists and dentists are licensed occupations. And they perform distinct functions. Given the nature of the work, it’s quite natural that some dental hygenists would be employed by dentists. But it’s also natural that some dental hygenists wouldn’t be so employed. After all, there’s a lot of demand for teeth cleaning as such. But in many states, it’s illegal for a hygenist to work unless she works for a dentist.

How about education and training which varies in each state. Plus, professional licensing laws which are not national in scope, but the province of each state and their state legislature. Some states, including California permit and license independent dental hygiene practice.

It is easy to ridicule and bitch and moan, but to what end?

And,what is really the goal here?

Probably just bitching and moaning, it seems.