Kevin O’Brien - Evidence first: Critical thinking and the future of Orthodontics

[Music] Welcome to another episode of the European Orthodontic podcast, where we'll be talking to Professor Kevin O'Brien from Manchester about his life, background and orthodontics, research career, and a little bit about his blogging. My name is Finn Gagan. I'm an orthodontist. I'm on the Council of the European Orthodontic Society. This podcast is brought to you by the European Orthodontic Society. So let's get started. [Music] Kevin O'Brien is an emeritus professor of orthodontics at Manchester. His health posts in the USA was Dean of Manchester Dental School from 2004 to 2007, and was chair of the General Dental Council from 2011 to 2013, having published over a hundred scientific papers and obtained over seven million in external research funding. He currently writes a surprisingly successful orthodontic blog. So welcome, Kevin, and thank you so much for agreeing to coming onto the podcast. It's a great pleasure to have you here. Thanks very much for inviting me. It's very nice to be invited, even though I have been retired for almost five years now. So thank you very much. Retirement means many things to many people, but to start back to front, you've been fairly active orthodontically in your retirement. Yeah, I suppose I have in a way. When I retired, I did intend just to read trash novels like Jack Reacher books and listen to Led Zeppelin and Pink Floyd. But then in many ways, my blog took over my retirement. I'm very busy with other things, like looking after grandchildren, gardening, and just generally messing about. So, yeah, I am quite busy. Some of it involves orthodontics, but most of it is sort of family things, and other things that I think are more enjoyable. Yeah, I think that sounds good. It sounds like a good balance. As with many of the people we've asked onto this, we sort of asked them a little bit about how inert they ended up into orthodontics and why. So, do you mind sharing with us a little bit about where you grew up and how you ended up studying orthodontics? Yeah, so I was brought up in the Westershire countryside, which is in the centre of England, in a very small village of about 3,000 people. As a complete aside, Martin Coburn, who's professor of orthodontics also, was brought up in the same place as I was, and in fact we played on the same swings and slides on the village green, at five years apart. So, there must be something in the water. Yeah, so seems to be a fertile place to grow up if you want to be a professor of orthodontics. Yeah, so I came to Manchester, studied dentistry there. I then went to work in general practice, and I was a general dentist for four years. But I've always been interested in treating children and working with children, and so that's when I started to develop my interest in orthodontics. At that point though, it was very difficult to get onto orthodontic training programmes in the UK, and you had to take a series of examinations, which were very biased towards hospital dentists and people on residence programmes. But one day we were driving home from work, and I was part, we were on a traffic jam on the motorway, and a car hit us from the rear with a closing speed of about 60 miles an hour. Wow. This gave me a severe whiplash injury, which put me off work for three months. I was signed off work. So I had phoned my friend Jonathan Sandler and said, "I'm off work for three months. It's going to be brilliant. I can sit down and do nothing." And about 20 minutes later, there was a knock on my door. And Jonathan was just standing there with a big box of books. And he said, "Here, which was my exam kit?" So he said, "Here you go. Here's the books you need to learn for the exam." I suggest you just get on with it, and that's what I did. I went back into hospital training, and was very fortunate then to get a place on the very first Manchester MSC course in orthodontics in 1984. How did you know Jonathan? We were undergraduate students together. We lived in the same house. So our careers followed very, very closely. We've got, obviously, we've continued to work together for many years. And so I got on the Manchester course and pretty much stayed in Manchester all that time at a year out where I did a sabbatical post in Pittsburgh in the United States in 1991. But most of the rest of my career has been spent in Manchester. And Kevin, what point did research and a career as a researcher start to focus or form or have an idea that you. This might be part of your future? I mean, strangely, it was when I was an undergraduate. I did a final year elective in which we. I didn't know that this is what we were doing, actually. But I did a final year elective where I interviewed child patients and their parents before they went into. have appointments on dental health education. And I randomly allocated them to health education or not. And I interviewed them to see what they'd learnt from their appointment. And that was my final year elective. And I really enjoyed doing that. And I think that was probably the start of my sort of research interest. It was always a little disappointing that the tutor who was marking my work gave me a C for that. I thought it deserved far better. But. But no, and that was it really. When I was on the orthodontic programme, my research project was something that was just looking at bonding and ways of sticking brackets to teeth. And I learnt statistics when I was doing that. And then it just sort of took off from there. I've just always been interested in research, I suppose. Because I was talking to a colleague from the US and he's still working. And he recalls his first few bandups where he made his own bands. Yeah, yeah. And then had to place them like molar bands on all of the teeth. So the idea of we sometimes forget with all the talk of new things, and innovation, et cetera, that the movement from bonding every tooth to bonding a tooth was quite a significant jump forward for orthodontics. Yes, it was. And certainly, I mean, I was in that group that was in that transition away from bands to bonds. I mean, one of our clinical supervisors made his bond. Sorry, would only allow us to bond canine to canine. He expected us to use preformed bands on pre-molers and molars. Because he felt it was good for our souls. And it probably was. I don't think the patients particularly enjoyed it. But no, it was that transition period. And it actually wasn't that long ago, to be honest. Kevin. Just because we're going to talk a bit about some of the time you spent in the States. I want to ask you a question. At the UK, in the UK at that time, where was fixed appliances versus removable appliances in your day-to-day work? Like when you were in the dental school as a postgraduate or as an early orthodontist, what were you using or what was the sort of proportional use of fixed versus removal? I mean, it was a bit of a hybrid. It was a hybrid. We were trained by two really good sort of senior trainees who had qualified out of the Eastman and dental hospital in London. So they were very traditional. And the traditional approach at that point was you'd start a treatment off with a removable appliance. So you'd fit bite planes or you'd retract canines with finger springs and sort of fairly primitive mechanics. And then once you'd made progress, you'd then go through a transition to watch fixed appliances. And our fixed appliances at that point were standard edge wise. So we not only had to learn to bend wire, we had to learn to put torque in the wire. And then I think it was over those few years, I think, as we developed, we did fewer and fewer removable appliances. But it was an interesting time for UK orthodontics, because most UK orthodontics was provided by simple removable appliances. And very few people were using fixed appliances. And it was at that point there was an inquiry into the standard orthodontic treatment in the UK because it was very poor. And that sort of led to the work on the development of the peer assessment rating by Steve Richmond and Bill Short, which they then used in studies of the quality of orthodontic care, which again emphasized that it was poor. And that prompted the funding bodies, I think. to tweak the way that people were paid and so fixed appliances became far more commonly used. And in a way I think the UK caught up with the rest of the world at around that time. So this would be the mid 1980s and that was predominantly the work of Steve Richmond and Bill Shaw. And Kevin, was some of that standard or that low quality, was that related to what part of that was related to training and education in the clinician? Where did that kind of was? You know, because you know in our profession we tend to be very appliance. Sometimes we get into conversation about appliances. So I've sort of a bit firm believer in what stuck between your ears for the three or four years you're doing your post grad. Where does that fall into that void or that quality lag that occurred at that time? I mean at that time UK orthodontics was predominantly based on removable appliances because they were in a way cheap and cheerful. The orthodontists had trained post-war mostly again on removable appliances. But I think the main driving force behind that was that the demand for orthodontic treatment was great and it was consistently increasing and yet there was a tremendous shortage of orthodontists. So the that group of orthodontists had to provide high volume treatment to as low a cost as possible and that's why they were using removable appliances. I think it was only with the realisation that this actually wasn't doing much good coupled with the fact of an increase in training numbers and an increase in specialist orthodontists that we sort of gradually made that transition to fixed appliances. Certainly when I was on the training programme it was absolutely clear and it was ham at home that fixed appliances were the only way to go and that we really didn't do much removable stuff after a year. May I ask, was there some reluctance within the wider British community about using fixed? Was there anyone who felt, oh well it isn't what it says it is, there was there any sense like what a lot of things you hear when a new appliance is brought in that there's a certain guard who feel this is the way I've done it and it begs to be seen or what was, are there any parallels to be drawn between that period and today? Yeah, there was a reluctance because people I think still felt that and in some ways they were potentially right. So I'm just going to take a bit of a side swipe here. They felt that you could get an awful lot of treatment change with spontaneous alignment, taking four pre-molders out and letting the teeth drift and the canines would move back and their incisors would align quite nicely. And so the lot felt that we were potentially over-treating with fixed appliances. I think it was a concerted effort really by many people over several years to try and get people to drop the removal appliance. But of course a lot of the people who were using removal appliances were coming up to retirement anyway. So it was sort of a natural transition I think that occurred because we have to remember there wasn't many of them in a way. There were very few specialist orthodontists. And were those orthodontists, were they have been guys who trained post-war or during the war or pre-war was it a good mix or where was the majority from? It was a mix. Most I think are trained post-war and around the foundation of the health service. And if I remember Kevin a lot of those guys came back didn't they and they might have done a year transition. There was a kind of program for demobbed soldiers and young guys who'd missed that window, wasn't it? Well at that point training in orthodontics was a one year training program. When I did my training program it was only two years and it was a couple of years afterwards that they then became a three year program across the UK. So I suppose when I do think about my career like many people at my age now coming up to retirement we were sort of transitional orthodontists. We were trained in fixed appliances and that was all we could really do which was good. And I think that made that transition and improved the quality of orthodontic treatment. I mean there was research that was done to show that it did improve over that time. You mentioned you did the sabbatical year was that with Professor Vig in Pittsburgh? Yes I was very lucky to be offered at post by Kate Vig. It was quite interesting. I'd done a talk at the Royal College of Surgeons at that point I was just finishing my PhD and she was in the audience and she just came up to me afterwards and gave me her card and said I'll be in touch and I didn't think anything of it. And then it was about three or four weeks later. I got a letter because of course we hadn't got email in those days. I had a letter inviting me to come over and give a week of seminars at Pittsburgh which I did. Had you been to the States prior to that? No, no, the further side of the plane was France. And so at the end of that sort of week period which was brilliant. She then offered me, asked me if I wanted to go and do a sabbatical. Which was great. We had a very young family at that time. Our children were eight, six and four. So it was quite an upheaval for us just to pack everything up and go and live in America for a year. But it was an experience we still look back very fondly. How did the university accommodate you? How did Manchester go? Was that an issue? Was that a difficult change? No, no. I think I'm not sure if they were glad to see the back of me for a year or whether they thought it was a career enhancement. They're incredibly supportive. They just said they'd keep my job open for me. And Kevin, professionally was away? What would you say were the first impressions? What were the big differences? What would you have said, you know, were the good things about what you'd seen in Manchester that were probably something better? What did you see in Pittsburgh that you thought this is better? What were your feelings of being over there when you'd come home and you'd had time to digest the difference? What were your thoughts? I mean, it was very interesting and you have to look at it at sort of two levels. Clinically, I thought they were pretty much the same as we were. However, they treated far fewer cases. Each student on the resident programme only treated 30 patients over a two year period with lots of transfers. I also thought they overanalyzed everything, which was quite interesting. They were very much into sephalometric analysis and space analysis and those sort of things to underpin their planning. The other thing that struck me is that an awful lot of their treatments were cases that we wouldn't even have started in the UK. They were quite minor. And they were certainly quite surprised when I showed them my sort of case reports. I wasn't allowed to train anybody clinically. It was absolutely clear. I hadn't got a US license and I got into a little bit of trouble once because the students asked me to give them some clinical seminar as I did. I was someone's to Kate's office and told that I wasn't really allowed to do that because I hadn't got a US license. But they sort of were quite like that alternative viewpoint, I think. I also learned a lot about research, a tremendous amount of research because my job was mostly research. And somehow that American confidence that they have sort of engenders their society rubbed off a little bit on me. I think I came back quite a different person. I had to tone it down a bit when I came back sort of become more polite again to sort of fit back into UK life. But it gave me an awful lot of self confidence just working in that sort of environment. It was great. Did the research field was a just that institute or could you have sort of extrapolated differences between the research environment in the US at time versus UK or even in Europe? It was pretty much the same as it was here to be honest and in Europe and I did have, it gave me the opportunity which I thought was fantastic was to go down to North Carolina and meet up with Bill Profit and Kitty Tulloch to work on some of their research projects. And at that point you did realise Krike, but no, then I had to do research down here. So I think it was that combination of the two made you realise that we weren't necessarily behind but they were starting to ask different questions. And of course they were starting to do the big class two studies down in North Carolina and at Florida I worked closely with the Florida team. Where clinical trials. You're talking more specifically about clinical trials, am I correct? Have that been a feature of your academic life in the UK up to that point or was this relatively a new, a new line of inquiry from your perspective? I think the first clinical trial I did was when I came back in 1992 I did a trial on aligning archwires. Essentially someone gave us some wires to test and we thought why don't we do a trial. But we didn't add a do that and we so Bill and I had to get a book out on how to do a clinical trial and we did a trial and it's still an often quoted paper. Interestingly we've made every mistake under the sun and sometimes I want to go back and write about that paper because a lot of people quoted but it was a very poor piece of research by contemporary standards but that was the first clinical trial that I did when it was when I came back. And again I think at that point sorry to cut across at that point when you talk about Manchester because you've mentioned Bill Shaw a couple of times now. Manchester had a so that year was what 92 93 so the dental school the ordante department had yourself Bill Shaw gumversemp was she involved in the department. Gumver wasn't with us at that point so while I was away in the US Bill was also unsubbatical in Los Angeles I came back a year before Bill came back while I was away Manchester made me see any lecturer. So at that point when Bill came back Bill was on Bill was the chair Steve Richmond was the other senior lecturer and then we appointed Dave Bien as lecturer and also a very fortunate also to work with Nicki Mandel who was on the postgraduate program and she was coming through doing trials. So that period from about the mid 1990s that's in a way Bill was doing trials on Clefner and Palette work. I was doing orthodontic trials we were doing the big class two studies both Dickie and David were also involved in trials is that we just seemed to be doing trials on every patient we were quite happy to say every patient we treat should be in a trial and we did an awful lot of work at that point and it was a very incredibly vibrant time in Manchester. It was it was also coincided with a change around and fortunes with your favourite football club would that be correct to say do you think there's a correlation? There might have been a correlation they were certainly head-e-days for United. So Farrah has arrived in around 86 and he's a couple tricky years and then founded for a while and then it in 1992 that they won the Premiership for the first time because that was my first season back from America and they had brought through some of the Academy players at that point and they like gigs that was true about two or three years later yeah because that was it they called it the class of 92 or they still do when we try and think back to those those those those housey and days and just and just and if you could could you sort of discuss the department or what it was like working with Bilsho and how he was as a colleague or how you saw him and you know a bit like a man united team sometimes you're right people right place right time and did it did it have that sense was it exciting place to work in after you came back and after a bill came back yeah it was incredibly exciting I think it was an accident in a way though but tonight always got on you know you point to me onto this onto his first postgraduate program it was just incredibly vibrant and even you know as the years had gone on and we were very closely together he um we would sort of about continually bounce ideas off each other um about try about studies and the ways we interpret it different things and um so yeah so it's so it was it was a man incredibly vibrant time we just seemed to be doing research all the time um and what was the kind of man trail in your opinion of of a good researcher what was the kind of foundation stone if you were talking hopefully we might have some academic colleagues listening to the podcast what what do you feel are the foundation so what what are the questions someone would need to be asking or in other words why would you be involved in research today well what would if you were selling that career to a younger colleague what are the bits that you'd like the salient bits that you feel are appropriate from your own experience that you'd like to get across to those colleagues I suppose the biggest the biggest thing is is I are you I'm just trying to think of the best way to put this I suppose is are you interested in really stopping and thinking and then trying to make a lasting difference with a piece of research work that will change that will change orthodontics and the way that we think and that people shouldn't really be afraid to ask the question why um and or continually ask people to prove the statements that they're making you've got to have a mind that is questioning but you want to raise questions that are going to make a difference do you use the most important thing do you think dental schools promote that way of thinking for example I have a palimine he'll know who I am talking about who is an engineer and after he worked as an engineer he decided to go back and studied dentistry and he's a successful dentist now with a PhD in material science but he tells a story with much laughing about how he was taken aside at second year and was told if he asked any more questions he might not finish the degree yes I mean it depends who you come across I'd like to think the most serious academics and researchers would never say that to somebody it's been said that those things have been said to me even you know when I became established people took me aside at meetings and said do you really want to be asking this question because it's not going to do you much good that didn't make any difference it just sort of made us think okay well we really are going to ask that question now then um and you said and you said there we do you think that did you feel when someone came to ask you question like that you had the back of your colleague your colleagues had your back that you were kind of feeling well we will ask it because you you mentioned that you just went from i to we you changed him yeah it was that part of that the ability to be able to sort of ask that kind of question yeah I mean I've always worked as a as part of a team all the best researchers work as teams and certainly there's many people that are that I've worked with when I was coming through the system and learning and there's many people who actually worked with me on trials I mean we've carried out many multi-centre studies and I don't know how many people have actually worked with in terms of the trials that I've done but this is a lot and I think that you're right it is way sort of working in a clinical area such as ours I don't think any one person can do it themselves or should do it themselves they should always do it in collaboration with people you learn a lot I mean when we started off for example on our trust to studies I was going around asking people to take part and they were saying well you're asking the wrong questions here you need to be using twimlock appliances we need to be doing herbs to appliances for example and it was all part of that sort of combination between me as a as a neophyte academic and very experienced clinicians and so I suppose that's why I always say we because it's got to be a combination of I would say a good academic but also excellent clinicians to run a trial and I think that's something that's perhaps missing nowadays what in your opinion constitutes a good orthodontist or if you were talking to a young dentist who said I don't know if I want to be an academic but I know I want to be an orthodontist what in your opinion would constitute how to become a good orthodontist? I suppose you have to be or it's essential that you're clinically sound that you're very analytical and of course you've got to be have those those critical skills I think in terms of their overall development with time because we all have to to move with time is that you should try and practice you know I mean it sounds a bit corny really as you've got a practice in that evidence-based way but appreciate that a lot of our treatment is underpinned not solely by research but it's underpinned by clinical experience and patient wishes so you have to practice according to those but also when research is available you the research should outweigh the influences of clinical experience but what you should also do is not fall for the claims that are made by people and by the sort of the industry about different types of treatment that they're developing and that you shouldn't take a one size fit. it's all approach, you've got to be fluid and flexible according to your patience needs, but also be critical about research and research findings. And you need to be able to interpret research findings and not take them at face value because if we can't analyse papers properly, then of course we are at the in a way we sort of pushed to accept anic dot and case report, which is what we shouldn't be doing. We should be able to analyse research that is published. And from the other side of the chair as an academic and teacher, when you look across, given your experience at the UK, in the states and Europe, how do you feel training and standards have gone or are going or what are your thoughts on the type of graduate that's coming out of practice and do you see any differences or do you see any areas of concern? I don't think I see too many areas of concern and it's often been pointed out to me that actually the vast majority of orthodontists still sort of practice in that evidence-based way and they do read the literature. I think my only big concern at the moment is the effect of social media and the poor quality case report on social media and of course that sort of fear of missing out on something. That's always been there in the past, I remember when there was an awful lot of pressure for people to mount every set of studycasts because of TMD problems or potential TMD problems. We're still getting that and plus many other things such as expand, you know, what seems to be wild expansion claims and airway coming through on social media, but I'm not sure how much that is influencing people and we must be very careful that we don't base in our sort of impressions of societies or orthodontists on what we read on the internet, which of course is mostly inaccurate. So I think everything's all right. There's just a lot of white noise going on at the moment, particularly about things like breathing in the airway. So as part of your retirement, you've sort of positioned yourself right in the middle of that white noise. So what was the story with the blog? How did that come about? Yeah, I mean that came about, I first started this about 10 or 11 years ago. I think it was as I finished being chair of the Journal of Dental Council and I was a bit of a loose end one day. And I thought I'd write a blog so I had the next day off and I just sort of, so I got onto WordPress, downloaded WordPress software and by the end of the day I'd finished the basic structure of a blog. And I just, I think my first blog post, so I just simply reported the presentations that I'd seen at the British orthodontic conference and they were read about 30 times at the end of that week and I thought, "Oh, that's nice." So I slowly developed it really as to discuss research papers and a bit of the stuff that was bothering me. And then about a year later it suddenly took off to the extent that it is now. So you say it took off. How did you recognise that it took off? What did that mean to you? What were the things that made you realise that it wasn't just you speaking into the ether or 30 people from the University of Manchester or, you know, what was there? How did you know? Well, the blog itself connects readership figures and Google Analytics collects that for you. So most blog writers are obsessive about how many people they've got reading their posts. So I think it was pretty much on the second year. The number of reads for the year hit 200,000 and so I thought, "Well, that's something's obviously happening at this point." And I went to the AAL conference and lots of people were congratulating me on my blog and things like that. And shortly after that I think it was 2019 which, no 2020 which was the Covid, the start of the Covid crisis. Readership went up to nearly five and a half million, not five and half million, so half a million, just over half a million. And it sort of stayed fairly stable at about 450,000 hits a year and it's not changed for the past five years. I have created a bit of a monster. As I say, I'm now in the 11th year. I begin to fear that I'm more well known for my blog than my research work which I was particularly proud of. We did some great research and I'm wondering if it is getting lost in the noise around my blog. Well, it could be a, um, Roy Keen kind of situation really, isn't it? Because for those who don't know who Roy Keen is, um, Google, CYPAN, 2010, I think, wasn't it? It was one of the big captains of Manu who was quite Irish guy, quite well spoken, but well outspoken perhaps, well, maybe the best way to describe it. But he has a second career as a pond at 10. And a kind of like, our writer of where the game is today, with that be as a man you support or with that be a fairer appraisal of where Roy is? Yes, absolutely, absolutely. I don't think I'd ever compare myself with Roy Keen. You haven't been doing any two-fodded tackles to anyone. I suppose the thing about the blog now is that I'm trying to strike that balance between the occasional post which actually has a pop at people. And I know in the past I've overdone it and it's the social media world is a horrible world if you're not careful. And I'm also trying to to emphasise good research, but also to point out research that's been often quoted, but in fact it's not very good and that people need to sort of look and read between the lines of research papers. And I think I think I've succeeded in that. I mean we are getting to the point now, I'm not tiring of it, but I'm wondering what to do with it. And I think it's, I honestly don't know what to do. And so when I'm going to stop, I've still got plenty of energy and I still enjoy doing it. It's sort of a hobby really. But it does promote a conversation that wasn't there before. You know, you'd meet hearted artists and people and say, "Have you just seen Kevin O'Brien's blog today?" And one of the interesting things about it is, and I think you talk about it, and perhaps, you know, it's for another day, but for people to be able to accurately appraise things, it's nice for them to be able to listen to what you're saying and then access the journal. How do you feel the big publishing companies? Because for a lot of reasons, the work you've done has, you publish it in a journal, but the journal then, traditionally, the open access hasn't been there for people then to benefit from that, which for a lot of cases was government-funded research. And I know, for example, in the UK, people have talked about this for a long time, like Ben Goldaker, you know, in the wider sphere of science. But how do you feel that access to people? You know, with social media, where people have been pretty much able to say what they want on a costed, yet when you look at your research that somebody access to that work is hindered by gatekeepers, how do you feel about where that is right now? I've always thought that research should be free. The results of research should be free to access for everybody. And so the open access has been a big development. It's been abused with the rise of predatory journals. So predatory journals tend to be a low-quality journal that accepts a fee from somebody submitting a paper for publication. So they call themselves open access, but really what they're doing is they're just accepting fees for the publication. A lot of the research is very poor. It's very poorly refereed. And it's very difficult to tell the difference between a paper and a predatory journal and a journal that has been properly refereed and works to good standards. You can look journals up. You just, you know, you just Google predatory journals and you get a list of the predatory journals. But a large amount of orthodontic research now is appearing in these journals. And now Parry has been doing quite a lot of work on this and is writing some papers on it, sort of highlighting the dangers. And it is a danger because this research really is very, very poor. So in a way I always suggest to students and people that they sort of confine their reading to the main journals and not incorporate predatory journals in their reading. But it is a problem. So in my blog really, I avoid the predatory journals. If someone's made claims that have got traction somewhere, I will review a predatory journal. But it's it's quite rare that I do that because I try to be constructive even though I'm being critical to a journal article that's published in the main journals because I know it's taken a lot of work. work and in a way I try and emphasize that it's up to people to interpret the paper in their own way. I'm just providing some guidance sort of based on my experience. You've invited Porek and Martin to host a couple of the blogs and is that where you think the future might be that you can sort of share amongst peers who might provide a balance to kind of continue what you're doing but again you know from a similar standpoint to yourself academically. I mean I've got to stop one day I'm sorry, it's absolutely inevitable that I'm going to become in Kairan at some point if I haven't achieved that aim already. But yeah I did ask Martin and Porek to come on board and they've taken on a fair load of posts so they write them and I sort of put them into blog form for them because that can take it that can take a time. I'd quite like to include more people. I think I've got to move it away from me doing the lion's share or I just stop it one day and say right that's it and kill it off. Which I think would be a great shame. As I say I sort of I think I've created a monster but it's a monster that's quite good and people find very useful. No I agree with that and I do think it's a it was good to see you know Martin's take or Porek's take on things as well because there is that appetite obviously amongst those guys and I'm sure amongst others to maybe share the load so perhaps that could be something if we have academic peers and colleagues who might raise their hand or might know you or might want to be involved could do because I think it does help and I think it's a great thing and you have to be congratulated for what you've achieved. It's also good to bring other people on board because they're considerably more polite than I am from time to time and as I say I've made mistakes in the last ten years that I do regret but they you know in a way that's just social media I think unfortunately. That's the nature of the evolution of social media as well isn't it? Yeah yeah yeah yeah so well done and you have to by putting yourself out there into something that's completely new and you are exposing yourself to the potential of that that you you don't know walking in the door so I think that's that's quite brave and it's you know it's part of the gig. Some people have said some terrible things to me on social media and things like that and you just have to put up with the keyboard warriors because you know if I have met them at a conference that they wouldn't say anything to you to your face and that's just a fact of that's just an unfortunate fact of life with social media. I sort of I sort of put it I sometimes relate to the equivalent of being in a very busy temple bar a pub at about twelve o'clock at night and you've just walked in but everyone else has been there for about four hours and yeah you can sort of feel like that a wee bit and you know that losing your temper is the last thing you should do. Yeah I mean this is one of the reason this is this is one of the reason I know people one have come to conferences and things like that people have said to me why do you never come to the banquet or the major social events or why do you leave at nine o'clock and one of those reasons is that there's always somebody who wants to come to sit to tell you exactly what they think of you around about around about ten o'clock. Yeah they've brought they brought our triginous with them as backup. I always I always leave before the witching hour starts. Yeah well that's when my dad used to say about work parties Kevin. He said arrive late and leave early and because they're the occasions where things get a little bit fruity so yeah I sort of I took that advice early on I think you'll probably rise to some extent. I mean my my wife agrees with that she also says when you leave early no one notices that you've got any way so it makes no difference. Yeah yeah really it. Listen Kevin that's been super 40 minutes and thank you so much I could have like this is a problem for me because I would love to chat. Yeah yeah and keep going on but we're not doing the Joe Rogan show where we'll sit and talk for three hours on random topics unfortunately but it's been a great sort of idea for people to know you in your background as a researcher and as a blogger or one and the other just to see how it's been so I really appreciate you taking the time to share your sort of experience and your own career and your journey with us so thank you so much. Okay thank you very much. We said at the start we weren't going to we weren't sure whether to say it or not but I'm delighted I'm going to say it. I'm delighted that you've accepted the invitation to be the speaker for the Sheldon Freel Memorial Lecture in Dublin in 2026 that's just fantastic. Yes yes no I'm looking forward to that I mean I always like speaking at the EOS conference actually I've only spoken a few times and really enjoyed it but I also always like coming to Dublin. Well we're going to advertise it with your Irish name so for all those listeners you won't see Kevin or Brian it'll be Quivine, Yvren and then he gives you 12 months to give the lecture in Irish so that would be fantastic. Yeah that would be interesting I've got to make sure I'm still here and as I say in 12 months so let's keep our fingers crossed. Well we really look forward to it and thanks again on both fronts. Before we sign off I just wanted to give a quick reminder to our listeners. Please be sure to subscribe to the podcast to receive a notification when each new episode has arrived and we'll hope you continue to join us for our next episodes. More pressingly we are coming into the middle of April and the next 100th annual Congress of the EOS will take place in Crackle in Poland from the 2nd to the 6th of June and it's going to be an incredible event. We've been out to the venue we've seen Crackle in amazing town with an amazing history. The venue is fabulous the speakers I think will make it worth the visit to come both as an orthodontist from a clinical, from scientific and from those who are studying orthodonties I think there's a lot to learn so we hope to see you there. This podcast was brought to you by the European Orthodontic Society, a membership organisation with over 3,000 members from all branches of the orthodontic profession working in private practice, hospitals and universities throughout Europe. To find out more visit www.eosEurope.org and follow the EOS on Instagram, LinkedIn, Facebook and X. All views expressed on this podcast are solely those of the host and guest speakers and do not reflect the opinions and beliefs of the European Orthodontic Society.