On 6 November 2024, The General Dental Council (GDC) struck me, Dr Mike Mew, off the dental register, ending over 100 years in which me, my father and grandfather have practiced orthodontics.
There was no finding of dishonesty or meaningful harm, only of misconduct, which was entirely philosophical, concerned with potential risks and reason for treatment. The core argument was focused on the cause, if there is a significant environmental influence on malocclusion, or not.
The following two statements from the Public Determination ended my career;
32 However, the Committee did consider that the core belief which underpins Orthotropics was unique in that its premise is that environmental factors are the major cause of malocclusion....
Neither the defence or prosecution argued this point, and at no point in any communication to patients did we ever argue that environmental factors were anything over and above a ‘significant’ cause. Although I do believe that it is indeed a ‘major’, this is my personal opinion. The treatment approach does not require the environment to be a major cause of malocclusion, only significant.
33 After taking account of all the evidence in this case, the Committee did not consider that environmental factors are the primary cause of malocclusion....
In other words, in order to support their finding of philosophical misconduct the committee made a finding of fact It is exceptionally unusual to do so, and did so without proper scientific debate on the issue. Their statement of fact was that to do orthotropics requires the environment to be a major cause. Then they go on to make a further finding of fact that the environment is not the primary cause of malocclusion.
Effectively the GDC’s Professional Conduct Committee (PCC) is arbitrating on treatment modalities and making decisions of fact. They are not allowed to do the first, it’s not the remit of the GDC. And the second comes entirely from the committee as neither of the prosecution experts argued either of these points, which leads us to question the validity of and the evidence upon which these conclusions were drawn.
However, given how our argument of significance has been legally interpreted, orthotropist and all practitioners within the UK who consider the environment to be a significant cause of malocclusions will have to anxiously consider whether they can continue to practice. This decision has potentially very far-reaching ramifications in respect of many registered practitioners within the UK whose treatment philosophies are based on the same premise. It certainly means that Orthotropics cannot be offered to any patients within the UK and will now therefore only be available in other jurisdictions such as the United States. We thus presented the following statement, which was transcribed into the written records without objection.
To the Members of the Professional Conduct Committee,
It was with profound sadness that I received the précis of your decision via my lawyers earlier in the week. I am grateful to note however that no findings of dishonesty have been made against me nor have you found that the Orthotropic treatment provided by me caused harm that was in any way different from the type of minor and transient harm caused by mainstream Orthodontics.
I have spent many anxious hours with the assistance of my legal team deciding how to react to your decision. I have considered whether I could present some middle ground that may have allowed me to continue to do the work that I love and have dedicated my professional life to as my father and grandfather did before me, seeking better answers for patients.
As you know I have always questioned whether a disciplinary hearing was the correct or even appropriate forum for the weighing of complex scientific evidence as to the aetiology of malocclusion which is so crucial to our profession. After all, if I am right, we as a profession are treating an illness without any understanding of the causes, and many may conclude that if you do not understand the cause then you do not really understand the problem.
The aetiology of malocclusion is a controversial issue and there are firm and at times entrenched views on both sides. I note that you found Professor G, the defense Orthodontist expert, to have given a balanced and unbiased opinion on Orthotropics. You were not able, in your decision, to say the same of the GDC experts although you have preferred their opinions.
What has caused me great disappointment is that rather than acknowledge that there are two reasonable schools of thought on this topic, you the PCC, the disciplinary panel of a regulatory body, have made a scientific finding of fact that there is no adequate objective evidence to support the premise which underpins Orthotropics and many other treatments, namely that the environment is a significant cause of malocclusion.
You describe the premise that the environment is a significant cause of malocclusion as a core belief which it is. You also say that it is a belief that is unique to Orthotropics. It is not. You heard evidence that world-leading professors from other disciplines including evolutionary biology at Stanford University hold the view that the environmental impact on the development of our jaws has reached epidemic proportions.
Given your finding on this issue I cannot in good faith suggest any conditions that could allow me to continue clinical practice with integrity. That is because to do so would be to break with all that I believe and know. I have always striven to work in the best interests of my patients, something which I think you accept, and I would not be able to tell patients that the environment was anything less than significant in respect of all aspects of their health including their dental health when providing treatment.
In light of your decision on the aetiology of malocclusion, all practitioners within the UK who consider the environment to be a significant cause of malocclusions will have to anxiously consider whether they can continue to practice. Your decision has potentially very far-reaching ramifications in respect of many registered practitioners within the UK whose treatment philosophies are based on the same premise. It certainly means that Orthotropics cannot be offered to any patients within the UK and will therefore only be available in other jurisdictions such as the United States.
In the near future I believe science will be able to provide evidence that will convince the mainstream that my father has been correct all along as to the aetiology of malocclusion. When that day comes I hope to able to practice again but accept that under the current regime and in light of your decision I will not be able to do so at present.
This process has taken an extraordinary 7 ½ years to get to this stage and the toll on me and my family has been a high one, reputationally, emotionally and financially. It has also had an extreme effect on my health.
If one positive were to come from this marathon litigation I hope it will be an open and genuine debate on the aetiology of malocclusion. Not for the benefit of any individual’s ego or to present one school of thought a victory over the other, but for the benefit of the millions of children seen each year by practitioners treating symptoms the causes of which they do not understand. This means that any attempt at a cure or indeed prevention is impossible. That is a situation that must change and I have and will continue to dedicate my working life to finding the truth upon which all can agree.
Yours sincerely,
Dr Michael Mew BDS (Lon) MSc (Orth)
Contents of the case
The case involved 2 patients and 1 video.
Patient A, parents very happy with the treatment, great outcome, no problems
Patient B, while I did the treatment plan, I did not actually treat the patient. This was done by another registrant.
We will upload the video in due course to be openly assessed.
Orthotropics has been practiced in the UK for over 50 years, including on me and all of my siblings, and there has not been a single issue of harm or other problems reported in this time.
Thus, the issue can only be philosophical, if the treatment was in the best interests of the patient and if it posed any risks. Due to the complexity of the case the committee decided;
34 Given the volume of information and evidence in this case, the Committee found it beneficial to outline its thinking on the expert opinion, both generally and individually.
While favoring the GDC’s expert witnesses, the PCC chose to dismiss the opinion of both defense experts:
38 On balance, the Committee found Mr P and Mr S to be the more persuasive experts. That is not to say that it did not accept in part, and in relation to some of the issues in the case, the evidence of Professors G and S.
If you accept the PPC’s finding of fact, and the opinions of the GDC experts rather than the defense experts, then it was inevitable that all charges would be proven against me as it would be improper to suggest a treatment to a child that has no adequate objective evidence underpinning it - in essence Orthotropics is not a valid treatment protocol however well it is executed. Conversely, if you do not accept it’s finding of fact, then hardly any of the charges against me would have been proven, which shows how philosophical this is.
This raises the biggest issue in the trail, during the process, we clearly demonstrated that the GDC experts had been biased, that they were advocating for the prosecution, which was admitted in part by the committee.
35 The Committee has carefully weighed and considered the expert evidence before it. It had some criticisms of both Mr Powell and Mr Smith in the way that they presented their evidence. However, it felt that this was outweighed by their skill, experience and expertise as detailed below.
40 .... “Mr S made some unfortunate comments ”.....which he then had to apologies for, effectively caught red handed.
The law states that assessing the validity of experts advocating for the prosecution is binary, either they demonstrated bias or they did not, but if there is any evidence that they did then this taints
their evidence meaning that their opinions must be disregarded in their entirety, as it’s very likely they the bias run far deeper. The best analogy is if you find a clear example that a friend or partner lied to you, you would be suspicious that it runs far deeper, and in my opinion (hearing them in full) this went considerably further, as we have the transcripts, will be highlighting this in time.
Also, from 2009 until 2015 I engaged in a letter writing campaign (see this link https://orthotropics.com/timeline/) asking for an open debate on the aetiology of malocclusion. Writing to the GDC (to 4 separate chairs, Mr Rudkin, Dr Mathewson, Dr Lockyer and Prof O’Brien), the BOS (a significant number of times), Sir Paul Beresford MP (the chair of all party dental committee multiple times), my MP Jane Ellison, Earl Howe DOH, Council for Healthcare Regulatory Excellence, Royal Society, had a question asked in the House of Lords and multiple letters in the pages of the BDJ. It seems unusual that this debate never happened, however in full knowledge of this campaign the GDC has made a statement of fact on exactly this subject, “Committee did not consider that environmental factors are the primary cause of malocclusion.”
Finaly the law covering non-mainstream treatment approaches is usually covered by the Bolam/Bolitho Test, meaning that if your treatment approach is supported by a responsible body of dental opinion, then treatment decisions consistent with this body would not be malpractice, however “62 On this issue, the Committee has been guided by and preferred the evidence of Mr Powell and Mr Smith.” Thus, I was guilty of malpractice.
In summary, normally in advance of any finding of fact there would be a scientific debate, the existence of adequate objective evidence to support each argument would be assessed and even if the popular opinion favored one side, the other side would still be allowed to continue practicing as long as there was a significant body of opinion in its favour. Either way there would be no immediate sanction unless evidence of harm had been clear. In this instance:
There was no scientific debate ahead of the finding of fact.
The finding of fact itself was inconsistent as the ruling stated that the aetiology of malocclusion is either multi-factorial or inconclusive, neither of which would rule out the significance of environmental factors.
While the GDC’s expert witnesses failed to provide objective evidence that could be seen as conclusive and while their testimony was found to have been tainted with bias, they were believed.
While the defence provided adequate objective evidence in the form of research from a group of Stanford University professors and testimony from defence witnesses (ones that the GDC acknowledged had given a balanced and unbiased opinion on Orthotropics), they were not believed.
While a significant body of opinion exists that is in favour of the significance of environmental factors (including the Stanford University professors, the others that they cite in their paper and the many other professionals worldwide practicing Orthotropics,myotherapy or any other treatments that addresses environmental factors) this was also ignored.
And while the tribunal found that I had not caused any significant harm, nor has harm resulted from Orthotropics in the last 50 years, after a 7.5 year process, it concluded that the risk of harm was so great that I needed to be struck off with immediate effect – without actually specifying what the exact harm was or how it might suddenly be such a great risk.
Indeed, there has always been two schools of thought about the aetiology (or cause) of malocclusion – that it is either genetic or environmental -– and each of these has fallen in and out of favour over the decades. Numerous tribunals have been held over this period and never before has any of them made a finding of fact about the science in favour of either school of thought. Had any of the earlier tribunals made such a far-reaching finding of fact during any period when the environmental school was in ascendence, then the vast majority of orthodontists in the UK (all of whom practice a conventional form of orthodontics which is based on the genetic assumption) would have been prevented from practicing, including both of the GDC’s expert witnesses.
While protecting lucrative professional vested interests, this ruling if applied widely and evenly would not only prevent a large body of the profession from practicing any longer (and make it impossible for them to get insurance), but it would also prevent patients gaining access to a large collection of treatments that address environmental issues as well as hampering all public health efforts that focus on prevention – something that is essential in addressing the current epidemic as outlined by the Standford Professors, which we have been attempting to highlight for decades.
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