Lawmakers taped up signs declaring their offices a "Dental Free Zone"

July 5, 2017 6:33 AM

Q: What group did one Maine legislator describe as having "power right up there with the NRA", saying they "do everything they can to protect their interests — and they have money"?

A: Dentists.

The American Dental Association and its members (64 percent of U.S. dentists, compared to just 25 percent of physicians in the AMA) in particular are defending vociferously against incursions onto their turf by dental therapists, who can perform basic oral exams and pull teeth without the direct involvement of a (more expensive) dentist. A program in Alaska result in multiple (unsuccessful) lawsuits, and a similar program in Maine has been kneecapped by schools and licensing boards, all run by dentists.

posted by Etrigan (59 comments total)

Trying to resist the power of the dental lobby is hard - it's like pulling teeth, man!

Sorry, I had to.
posted by kevinbelt at 6:38 AM on July 5, 2017 [26 favorites]

"You want the tooth? You can't handle the tooth!"
posted by GenjiandProust at 6:42 AM on July 5, 2017 [38 favorites]

The dentists had a unique way to get around the blockade: the regular checkup. While the bill was pending, some lawmakers found themselves getting an earful when they stretched out and opened wide for an oral exam.

“I’m certainly a captive audience when I am in the dental chair,” said Brian Langley (R), a Maine state senator who also got calls from four other dentists in his district and ended up siding with them.

"Is it safe?"
posted by mandolin conspiracy at 6:43 AM on July 5, 2017 [18 favorites]

Man, my hygienist does most of the work when I go to the dentist anyway.
posted by misskaz at 6:46 AM on July 5, 2017 [21 favorites]

misskaz: Man, my hygienist does most of the work when I go to the dentist anyway.

As in the nurse-doctor battle, there is a gender factor: More than 95 percent of dental hygienists are female. ... Currently, hygienists work in small offices with licensed dentists, 70 percent of whom are male.

Wait, wait, lemme guess who gets most of the money.
posted by clawsoon at 6:50 AM on July 5, 2017 [33 favorites]

Anything to knock the dental industry down six or seven notches is a-ok with me. Their services are priced way out of any semblance to reason. Hell, just to add dental coverage to a health insurance policy practicality doubles the premium. Just as NPs have taken-over a good deal of my physician's workload, I fully support the rise of the Dental Therapist (providing, of course, they actually provide a significant cost savings to the patient, seeing as how many (most?) patients still won't have insurance.
posted by Thorzdad at 6:50 AM on July 5, 2017 [18 favorites]

Man, my hygienist does most of the work when I go to the dentist anyway.

Keep that up, if you want to not find out what kind of work dentists really do.....
posted by thelonius at 6:50 AM on July 5, 2017 [6 favorites]

While the bill was pending, some lawmakers found themselves getting an earful when they stretched out and opened wide for an … exam.

This is why the proctologist lobby is so powerful.
posted by Kabanos at 6:51 AM on July 5, 2017 [16 favorites]

Did you just see the budget snafu we had up here?

Do not take anything 'one Maine legislator' says with more than a fraction of a grain of salt
posted by Reasonably Everything Happens at 6:54 AM on July 5, 2017 [1 favorite]

I get it. He's an anti-Dentite!
posted by SansPoint at 6:58 AM on July 5, 2017 [14 favorites]

More on the book mentioned in the WaPo article (Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America), including an interview with the author:

Why Dentistry Is Separate From Medicine: The divide sometimes has devastating consequences

The Tooth Divide: Beauty, Class and the Story of Dentistry
posted by mandolin conspiracy at 6:58 AM on July 5, 2017 [8 favorites]

That Wikipedia article on DTs reeks of that creepy PR-style writing. For such a short article, there are nearly a dozen different mentions of them being a member of a "dental team."
posted by mystyk at 7:03 AM on July 5, 2017 [2 favorites]

Timely, as the temporary crown I had put in to postpone an expensive oral surgery I can't possibly prioritize with a back surgery and nerve damage therapy pending, with a repossessed car and home foreclosure just getting underway, just popped out last night and now I've got a damn exposed nerve back there aching constantly, too.

What the hell is up with how dental care is held off to the side from medical care more generally in the U.S.? Is that all due to the dental lobby's influence or what?
posted by saulgoodman at 7:07 AM on July 5, 2017 [4 favorites]

Man, my hygienist does most of the work when I go to the dentist anyway.

I used to go to a two-person dental practice (one dentist, one office manager, no hygienist - apparently that's relatively common for early-career dentists like him) and honestly it was one of the best cleanings I ever got. No shade to hygienists but if I knew how to find another practice like that, I would 100% go there. Would hate to go to a practice like that as a lawmaker, though!

I also learned that a urologist acquaintance of mine has formed close friendships with a few longtime patients. It's amazing to me because I'd be WAY too awkward to ever hang out with someone that I had that relationship with, but good for them.
posted by R a c h e l at 7:07 AM on July 5, 2017 [1 favorite]

Going to school to do that stuff can be expensive. The loans... it's like in-dentured servitude.
posted by parliboy at 7:10 AM on July 5, 2017 [9 favorites]

Well dentists can be very incisive. Like a canine once they get their teeth into something. They have their own wisdom.

Molar.
posted by quinndexter at 7:10 AM on July 5, 2017 [16 favorites]

I need a about 40k in dental care because of lupus complications. Does my $1000 dollar a month medical insurance cover it? Of course not. If I paid another $300 a month for dental insurance, would that cover it? Not after the $1500 maximum treatment cap, but hey, I can get two free cleanings.

Medical care in this country is already pretty sad, but dental care here is obscene in both cost and availability.
posted by SecretAgentSockpuppet at 7:15 AM on July 5, 2017 [19 favorites]

This is why the proctologist lobby is so powerful.
When my brother-in-law was in private practice, the state rep was a patient, getting a routine exam.
During the prostate probing, he casually asked "I forget, are you a Republican or a Democrat".
posted by MtDewd at 7:17 AM on July 5, 2017 [7 favorites]

What the hell is up with how dental care is held off to the side from medical care more generally in the U.S.?

Probably we're lucky that you don't have to buy seperate insurance for each bodily organ or system. "Sorry sir, but your insurance doesn't cover the pancreas".
posted by thelonius at 7:25 AM on July 5, 2017 [16 favorites]

"I forget, are you a Republican or a Democrat"

Moderate Centrist, Doc. Straight up the middle for me!
posted by quinndexter at 7:33 AM on July 5, 2017 [8 favorites]

Dental insurance basically covers only routine dentistry, for people who don't have any serious dental problems. I guess it pays some of root canal, crowns, that kind of thing, but it's mostly for cleanings and fillings and (when that stops holding the line) extractions.
posted by thelonius at 7:36 AM on July 5, 2017

Probably we're lucky that you don't have to buy seperate insurance for each bodily organ or system.

Don't give the insurance lobby any ideas.
posted by tobascodagama at 7:36 AM on July 5, 2017 [15 favorites]

If I paid another $300 a month for dental insurance, would that cover it? Not after the $1500 maximum treatment cap, but hey, I can get two free cleanings.

Let me get this straight. You can pay $3600/year, for a maximum payout of $1500/year? Sounds like a gret deal!
posted by thelonius at 7:41 AM on July 5, 2017 [6 favorites]

I used to go to a two-person dental practice (one dentist, one office manager, no hygienist - apparently that's relatively common for early-career dentists like him) and honestly it was one of the best cleanings I ever got

I had the opposite experience. I was going to a younger dentist that only had a hygienist in the office part time, and you always wanted to schedule your cleaning on a day she was there.
posted by COD at 7:47 AM on July 5, 2017 [2 favorites]

tl;dr, the Maine legislature tried to go a bridge too far, allowing the ADA to gum up the works, and in the end were only able to pass a toothless law.
posted by mubba at 7:53 AM on July 5, 2017 [5 favorites]

Going to school to do that stuff can be expensive. The loans... it's like in-dentured servitude.

So?
In almost any other field, if someone was trying to justify their high rates because of the cost of schooling, the hard libertarian response would be "No one forced you to become a whatever." Yet, we think nothing of letting the medical field (as well as the legal profession) beg forgiveness for their high fees because schooling.
posted by Thorzdad at 7:53 AM on July 5, 2017 [2 favorites]

Back when I had dental coverage, it was much less than $300 a month (about an order of magnitude less, actually), but was otherwise mostly the same coverage. Crowns and root canals were reimbursed 50%, most other stuff was paid at 80%, and braces/whatever had their own special thing. Total yearly cap was around $3000 a year actually paid out.

Given all the work that had to be done, it saved me a lot of money. My dentist at the time spent considerable time and effort running the numbers with me to figure out exactly how to get the insurance company to cover the most possible. (And he didn't even get benefit of the really expensive root canals!)
posted by wierdo at 7:54 AM on July 5, 2017

Keep that up, if you want to not find out what kind of work dentists really do.....

I am very lucky, I'll admit: still have my wisdom teeth (get nagged about it sometimes but they aren't bothering me save for a little crowding), and only one teeny cavity ever. Hygienist does all the work, then the dentist comes in, puts on some gloves, pokes around in my mouth for ~45 seconds, looks at the x-rays, says "looks good! when you gonna get those wisdom teeth out?" and leaves.
posted by misskaz at 8:24 AM on July 5, 2017 [1 favorite]

Ya'll that are putting off expensive dental work, might consider a trip to Mexico.

It's wrong that you'd have to, but it would probably be better than letting untreated problems make you sicker :(
posted by emjaybee at 8:25 AM on July 5, 2017 [5 favorites]

Thorzdad, I think you failed to notice a pun.
posted by Nancy Lebovitz at 8:32 AM on July 5, 2017 [2 favorites]

I put off going to the dentist for nearly a decade because I was terrified of how much it would cost. I was lucky, but if it hadn't turned out that way I was definitely researching going to Mexico to get it worked on.

It is ridiculous that something that has such a critical impact on systemic health isn't covered with all the other medical insurance but I'm sure that someone has a financial interest in the inefficiency because America.
posted by winna at 8:38 AM on July 5, 2017 [4 favorites]

I will recommend this article to my patients who chew gum.
posted by jonmc at 8:40 AM on July 5, 2017 [2 favorites]

I love how the ADA's general response is that the solution to lack of dental care is that people should be encouraged to brush more often -- as if the real issue here is the lack of moral fiber of those with dental problems.

It's almost as if a group whose (well paid) livelihood is dependent on the status quo lacks the ability to understand how the status quo is failing the rest of the population.
posted by tocts at 8:53 AM on July 5, 2017 [6 favorites]

They have a talent for causing things pain!
People will pay them to be inhumane!
posted by justsomebodythatyouusedtoknow at 9:41 AM on July 5, 2017 [4 favorites]

the idea that the extraction of wisdom teeth may be unnecessary, but continues to be performed on patients who can pay

From the NYT article linked above.

My mother-in-law is a former dental hygienist. She was very good at what she did and she has kept up on the literature after her retirement. We have always gone with her advice with our children w/r/t dental procedures: no fluoride treatments because our water is fluoridated and they use toothpaste with fluoride added, keep the number of x-rays limited (they don't get them every six months or year, generally only once every two years or if there's been a major change [braces just came off, wisdom teeth seem to be emerging]), and, based on her advice, we aren't having their wisdom teeth removed unless and until they start causing problems. Why in the world would I put my kids under anesthesia for a procedure that they probably don't need?? It makes zero sense to me and if I talk about it with other parents, they inevitably say that they had no idea that wisdom tooth removal is probably unnecessary.
posted by cooker girl at 9:48 AM on July 5, 2017

More on Alaska's dental therapist program.

It's not that folks in the rural villages are choosing not to go to the dentist---it's that there are no dentists to go to.
posted by leahwrenn at 9:50 AM on July 5, 2017 [4 favorites]

the idea that the extraction of wisdom teeth may be unnecessary, but continues to be performed on patients who can pay

(Decent) Dentists don't extract wisdom teeth for shits and giggles. It's usually because they're in bad shape and they won't be getting any better. Wisdom teeth are the hardest to brush, the most difficult to clean, and the least necessary teeth in the mouth. If you've ever had a wisdom tooth with an exposed nerve you'll want them out of your mouth ASAP. The post-operative pain from wisdom tooth removal is sheer relief compared to the agony of a bad cavity in a wisdom tooth.

Prior to one of the wisdom teeth in my mouth going nuclear my dentist warned me I would need to get them removed. I thought he was being overly dramatic and I was shit scared about the possible pain that would happen afterwards. Then one of my wisdom teeth thought otherwise and I was rapidly and dramatically taught a very important lesson about cynicism towards health providers.
posted by Talez at 9:55 AM on July 5, 2017 [9 favorites]

It's frustrating but not surprising that the ADA puts its members' finances ahead of patients' interests. See also--the AMA's support of Tom Price. I suspect that more dentists belong to the ADA than doctors to the AMA because doctors all have robust specialty orgs and also don't have unified positions on all that much.

I *am* shocked that someone would talk to a politician about an issue while they're being treated (and then refuse them care based on their vote)--that seems utterly beyond the pale, and so coercive.

[FWIW, I *love* working with PAs & NPs--they make everything run more smoothly, save me a ton of time (which ultimately is great for patient care), and are great point people for many patients/families. But, as a surgeon, I suppose I don't feel threatened by their encroaching into my field--all they can do is help me.]
posted by n. moon at 10:02 AM on July 5, 2017 [1 favorite]

Commenting about three comments so far (that I'm not going to quote) - Dental insurance is the one insurance that I regularly make claims to (mostly for preventive care) and even If there's no emergent work I still come out ahead. I'm in my sixth decade of life and still have all my wisdom teeth, but it took a significant change of my self-performed oral hygiene a while back in order to keep them; and that's all it took (really just getting a SonicCare and regular use). I was faced with the choice - take better care of your teeth or they are going to need to come out. It wasn't (to me) a question of my morals. For me at least, there's a strong correlation between how well I take care of my teeth and how much other-than-regular-cleaning dental care I'm going to need.
posted by achrise at 10:03 AM on July 5, 2017

Why in the world would I put my kids under anesthesia for a procedure that they probably don't need?? It makes zero sense to me and if I talk about it with other parents, they inevitably say that they had no idea that wisdom tooth removal is probably unnecessary.

This seems to be begging the question - of course it's unnecessary if it's unnecessary but you don't know without doing some sort of analysis. A lot of people are going to have serious problems if their wisdom teeth come in. My kids got x-rays and their wisdom teeth were coming in at a ridiculous angle that it didn't take a dental surgery degree to diagnose. But to say you're blanket not getting it done is as foolish as saying you'll get it done without any analysis.
posted by GuyZero at 10:33 AM on July 5, 2017 [10 favorites]

This seems to be begging the question - of course it's unnecessary if it's unnecessary but you don't know without doing some sort of analysis.

I believe cooker girl is talking about routine prophylactic extraction, which is very much a thing.
posted by Etrigan at 10:43 AM on July 5, 2017 [5 favorites]

Yeah, the nagging I get from my dentists about my wisdom teeth is 100% prophylactic: They're all erupted, and although one's pointed a bit sideways, they aren't causing me any issues. They even admit it's just because it's so hard to keep them clean; despite demonstrated evidence that as of age 41, I am doing a good job of keeping them clean. One dentist said I should do it now because recovery from the surgery is easier when you're younger. But both my parents still have theirs, so why would everyone assume I'm gonna ever need them out?

It was actually my older, now retired, dentist who used to say "if they're not bothering you, keep 'em," so now when his replacement at the same practice gives me a hard time I just tell him Dr. Marks said they're fine.

Ironically the only thing that might persuade me to get them out is purely elective and cosmetic: they crowd my small mouth and my crooked teeth are getting worse as I get older. I suspect if I were to do invisalign or similar, part of the plan would include removing my wisdom teeth. Otherwise? Bah, leave me and my teeth alone.
posted by misskaz at 10:56 AM on July 5, 2017 [3 favorites]

ANGINA DENTATA
posted by It's Raining Florence Henderson at 10:58 AM on July 5, 2017 [1 favorite]

they crowd my small mouth

I asked my dentist why wisdom teeth are such a problem, and she said that basically there's not enough room for them.
posted by thelonius at 10:58 AM on July 5, 2017

Among the general public, dentists tend to have a Norman Rockwell appeal

Well, it's true I also find Normal Rockwell cringe-worthy and worth avoiding at all costs. . . so, fair point.

Would spending half as much time in school and earning half as much money actually increase the number of practitioners? I assume since the ADA is fighting the idea, the answer must be yes. But, it seems like an empirical question that should be answered. The more general question would seem to be, why do dentists earn so much more than locksmiths, or translators, or machinists? Is it really a shortage of applicants willing to spend four years in school, or is something else limiting their number?

More public funding to provide access to existing dentists is a great idea. But, "why is your job worth 10X more than someone else's equally demanding job, and why aren't more people doing it," isnt' a crazy question to ask.
posted by eotvos at 11:01 AM on July 5, 2017

More public funding to provide access to existing dentists is a great idea. But, "why is your job worth 10X more than someone else's equally demanding job, and why aren't more people doing it," isnt' a crazy question to ask.

Part of the answer is that dental care isn't a take-the-lowest-bidder kind of job. And because of wide-spread use of dental insurance most people aren't even making any price comparisons at all. Dental insurance companies are somewhat indifferent to the rates they pay dentists - they can't pay any amount but as long as people are willing to buy dental insurance at whatever price point, dental insurance companies are willing to pay what dentists charge. It's just not a very price-sensitive market.
posted by GuyZero at 11:12 AM on July 5, 2017 [1 favorite]

two data points:

1. I had to have 8 teeth pulled (including the wisdom teeth) in order for orthodontia, to fix my opossum-like jaw.

2. New Zealand has had nearly a century of practice with this terrifying profession. They're doing very well, notably by having in-school access to dental therapists, which ensures nearly universal access for low-income children.
posted by ivan ivanych samovar at 11:16 AM on July 5, 2017 [1 favorite]

If I had gotten my wisdom teeth out immediately I wouldn't be looking at orthodontics in my forties to correct my mouth back to the state it was in after I had braces at thirteen.

Just a thought on that one.
posted by winna at 11:18 AM on July 5, 2017 [4 favorites]

See also, the AMA. Chamber of commerce, API, etc. Or really any other group of professional laborers using guild politics. Their tyranny over their workplace trains them to think that that is how all polities should function.

ER docs and lawyers are more likely to be forced to sympathize with their clients, or they d be the same. If I m too broke to see the dentist, I don t go.
posted by eustatic at 11:45 AM on July 5, 2017

I don't know any dentists personally, but it strikes me as one of those professions that nobody goes into, except for the money. My own dentist always has that resigned fake smile, and seems to spend a lot of time sighing and staring off into the middle distance...

But if you have a profession entirely composed of people who are only in it for the money -- supposing that's true -- it's not surprising that they lobby so hard against the public good. They did the same in Canada and won.
posted by klanawa at 11:47 AM on July 5, 2017 [1 favorite]

eotvos: Would spending half as much time in school and earning half as much money actually increase the number of practitioners?

It seems to for Physician's Assistants (PAs), which is a good analogue. My employer recently launched a PA program, and the demand is super-high. The students want to get out and start working with people, instead of spending most of a decade in school.

When I or one of my kids is treated by a PA I always ask where they went, and mention our program, and every single one is excited about the field. My niece is in college now and plans to be a PA because she doesn't want to owe a mint but does want to start helping people.

I would be happy to go to a practice where a dental tech works on me and a dentist checks in once in a while. Heck, that's all my dentist does now: he peeks in when the hygienist is finished, harumphs, and then shakes my hand while mispronouncing my name.
posted by wenestvedt at 12:09 PM on July 5, 2017 [5 favorites]

My dentist at the time spent considerable time and effort running the numbers with me to figure out exactly how to get the insurance company to cover the most possible.

Whereas today they just hand you a CareCredit brochure and expect you to take on more debt.
posted by Thorzdad at 12:54 PM on July 5, 2017 [2 favorites]

Whereas today they just hand you a CareCredit brochure and expect you to take on more debt.

*eyes $11k treatment plan for bridge work and some crowns*
posted by thelonius at 1:53 PM on July 5, 2017 [1 favorite]

My employer recently launched a PA program, and the demand is super-high. The students want to get out and start working with people, instead of spending most of a decade in school.

And just like with all the people who don't see the point of paying for a dentist when their hygienist does all the work because they've never had any actual dental problems, that will be absolutely terrific for all the people who need nothing from a first-point-of-contact urgent care or primary care provider except their vitals taken, their blood drawn, and their existing prescriptions renewed. it sure would be frustrating to have to go through a lot of schooling just to learn how to do that. good thing patients definitely know if they'll need any more than low-level basic care before the fact, when they're choosing between an M.D./DO and a PA.

in their favor, some PAs are happy to let you push them around a bit if you come in knowing the procedures you want and the referrals you need and the drugs you prefer. but you are not supposed to have to know that, in order to be a patient. that is what doctors are for.

I have in fact had a PA as my primary provider (at one of those chain concierge places where you pay an extra fee for 24-hour email access to your "doctor," except you don't actually have a doctor, you have a PA, who is extremely nice and responsive and provides very nice customer service and bedside manner along with sub-par medical care because they're not a doctor and didn't spend nearly a decade in school learning about medicine.) If you want someone who makes eye contact and smiles at you because you are sick of doctors being dicks to you and charging a lot of money, you're set. if you want someone who knows more out of their own head than you can find out on your own with a good understanding of medical terminology and the internet, you have just wasted several hundred dollars. many PAs may be much smarter and more extensively trained than mine was but the thing is, they don't have to be. nobody requires them to be.

I have had enough bad doctor experiences to make me start hating them before I meet them, like cops. so nobody call me a doctor fan. but doctors can decide to stop being dicks and start paying attention to underserved populations in the blink of an eye, just by deciding to. Some of them already do. PAs and NPs can't likewise just decide to have the full range of doctor training and knowledge unless they want to go back to school. you learn things in those long years of school and doctors and doctor-equivalents fucking well ought to know all of them.
posted by queenofbithynia at 2:05 PM on July 5, 2017 [1 favorite]

I believe cooker girl is talking about routine prophylactic extraction, which is very much a thing.

Yes, that is exactly what I was talking about. Suggesting that I was going to stick my fingers in my ears and not get any sort of testing (x ray or visual or whatever) done for my kids before we make the wisdom tooth decision isn't a very generous reading of what I wrote. They've both had x rays and the dentist admits that it looks like there is going to be plenty of room for them but we should have them taken out anyway, just because it's easier that way (oh, also, we pay out of pocket. So there's that). Ridiculous. And my parent friends who have agreed to the phrophylactic removal of their children's wisdom teeth are aghast that they had any other choice.

I'm not talking about wisdom teeth that will come in sideways or with nerves exposed or that will crowd the other teeth into movement. That's not prophylactic removal. And, for the record, I had two of my wisdom teeth taken out because they were going to come in sideways but my dentist back in the day thought that taking all four out would be overkill.
posted by cooker girl at 3:34 PM on July 5, 2017 [2 favorites]

Growing up, my family didn't have any medical insurance so we never had a lot of (at the time) "routine" medical/dental proceedures (things like having your tonsils or your wisdom teeth taken out). I stll have 3 of my wisdom teeth and they have never csused me any problems (the fourth one was pulled after I broke it crunching down on a pebble hidden in my salad greens).
posted by WalkerWestridge at 5:16 PM on July 5, 2017

If we're going for individual anecdotes, my orthodontist told my custodial insurance-having parent there was no pressing need to deal with my wisdom teeth unless they started giving me pain. At 22 (just before I aged off said parent's dental coverage) I had all four extracted because they looked iffy. As a result of waiting that long, despite having endured roughly a decade of orthodontic treatment and pain my front lower teeth are now misaligned, to a point that sometimes causes me discomfort.

A colleague who's now dealing with the Invisalign thing tells me that apparently current recommendations are that if you've ever had orthodontia you should plan to wear a retainer as an adult.
posted by Lexica at 8:10 PM on July 5, 2017 [1 favorite]

Ya'll that are putting off expensive dental work, might consider a trip to Mexico.

It's wrong that you'd have to, but it would probably be better than letting untreated problems make you sicker :(

I've seriously considered that, but I let my passport expire, and now, apparently, Homeland Defense won't let me renew my driver's license or my passport until I show up, in person, at a federal office, with my divorce papers from the teenage marriage in the 80s, my marriage license for my second marriage in the 90s, my original social security card from the 60s, a birth certificate, and fuck knows what else.

You know why? Voter ID laws. They totally fuck women who change their names when they marry. If I had kept my maiden name the whole time, I wouldn't be caught in American Brazil and could seriously investigate medical tourism possibilities.
posted by SecretAgentSockpuppet at 6:05 PM on July 6, 2017 [2 favorites]

Is this where I chime in that Periodontics is the Chiropractics of oral health? 'Oh my, I see you have gums, and they have a disease!' Pretty much like, 'I see you have a spinal column. This is a problem.'
posted by breadbox at 3:54 AM on July 7, 2017