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Jackson Hole Preview: “Do We Receive Another Hawkish Surprise?”

Jackson Hole Preview: "Do We Receive Another Hawkish Surprise?"

With the most important earning report of the week, and probably quarter,…

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7 months ago

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Jackson Hole Preview: "Do We Receive Another Hawkish Surprise?"

With the most important earning report of the week, and probably quarter, out of the way, when NVDA reported blowout earnings and guidance only to see a bout of selling the news which nearly pushed the stock to red on the day, because as JPM's Stuart Humphrey said "now we can be happ... until we get pessimistic into the next earnings print because THERE IS NO WAY THEY CAN GUIDE LIKE THIS AGAIN....or can they", attention now turns to the last main event of August, and the summer, when Jerome Powell speaks tomorrow just after 10am ET, at Jackson Hole.

Before we go deeper, here is quick FAQ courtesy of BofA economist Aditya Bhave:

  • When is it & what is topic? August24-26, “Structural Shifts in the Global Economy”
  • Why does market care? Fed Chairs often speak, and other officials attend. Major policy changes have been signaled, and it is often during a long intermeeting period.
  • What do we expect at JH? Fed to reiterate 2% objective, stress more inflation work to do, sound less balanced vs July presser or FOMC minutes due to recent strong data.
  • What is market JH reaction? Rates = less balanced Fed guidance will be hawkish; stay underweight front end. FX = no strong signal likely, neutral rate focus likely hawkish.
  • What is historic JH reaction? Rates = sell off into JH, sideways week after, sell off into Sept; curve flatter (Exhibit 1); FX = sideways, 2022 was outlier

With memories still fresh how Powell crushed markets exactly one year ago, when his last-minute revised, and at just 8 minutes, sharply abbreviated speech sent stocks tumbling more than 3% and accelerated the global bear market, while the prevailing rhetorical question is "do we receive another hawkish surprise", the consensus view around Powell is that this time we will receive no new information, because, as JPM's Market Intel desk writes, "the Fed is strictly data dependent, and that all pause will be characterized as a “hawkish skip” to maintain optionality."

Of course, blindly hoping that Powell will not rock the boat may be the fastest way to being stopped out of a career in finance, as today's post-Nvidia reversal selloff in both bonds and stocks demonstrates, as markets start to freak out about the return of a much more hawkish Powell.

That's why we previously published not one but two J-Hole previews: in the first one we analyzed what the Fed chair may say...

Powell will i) present a modestly hawkish medium-term baseline policy stance, ii) allow for risk that the Fed is done hiking but not shut down the possibility of more tightening, iii) while damping expectations of early cuts.

Powell may also raise the prospect of future pre-emptive strikes to limit inflation surges, arguing that the difficulty in slowing inflation and its disproportionate impact on low-income families justify an asymmetric policy.

Market-moving comments would likely relate to the rising term premium at the long end in fixed-income markets and any indication whether the Fed sees it as either desirable or likely to persist. The Fed doesn’t control long-term rates actively, despite buying and selling for the Federal Reserve System portfolio.

... and the second one warned that "Equities Are At Greater Risk Of Jackson Hole Shock Than Is Priced In", and which looked at the market's growing complacency as volatility on major macro "events" and releases has been surprisingly muted vs other trading days unlike previous years.

While we urge readers to refresh on both of the above notes, we wanted to point out that JPM's rates strategist Jay Barry did a good job breaking down recent Treasury behavior and what is likely on/off the table to be discussed by Powell. For the TL/DR crowd, JPM's conclusion is that with the 10Y around 4.25%, yields are likely too high, and Jackson Hole could be the catalyst for a near-term rally, which would aid risk-assets. Some more details from Barry's note below:

To the extent that the title of this year’s conference is “Structural Shifts in the Global Economy” and that Chair Powell pushed back against market pricing in a more hawkish fashion in this venue last year, market participants have been speculating about whether this year’s edition will be another market-moving event. Indeed, a well-respected Fed reporter over the weekend wrote on how stronger productivity gains and a wider budget deficit might raise the neutral interest rate , (r*).

Indeed our own economics team argued earlier this year that low neutral rate estimates are a result of GFC reverberations which depressed demand and inflation, and that the cyclical backdrop points towards higher neutral rates. Moreover, resilience in the face of a large policy shift would reinforce the case for revising neutral higher (see When you wish upon r*, Bruce Kasman, 2/15/23). Notably, individual FOMC estimates of the longer-run Fed funds rate, which markets view as a proxy for r*, have been gradually moving up in recent SEP, but have yet to affect the median rate. While the article made the case on why the neutral rate of interest might be rising, the article concluded by saying Fed leadership had not yet been convinced about this. Nonetheless, in an environment in which long-term yields have been climbing for the last month driven by increased growth and inflation expectations, and perhaps exaggerated by a less supportive monetary policy backdrop globally and fears of increased duration supply, this has only added pressure to yields ahead of Chair Powell’s comments at Jackson Hole on Friday morning. We think it’s somewhat unlikely the Chair’s comments will foreshadow a larger change to the longer-run dot at the September FOMC meeting, as Chair Powell has repeatedly discussed policy as being restrictive. Moreover, if history is a guide, this could be a slow process: Figure 2 shows the median longer-run dot declined 175bp over the last expansion, but this was spread over a decade. Thus, we think it would be difficult to conclude with certainty the Chair would make an aggressive statement on this topic on Friday, even though the risk may lean in this direction.

Another way of putting this: the Fed is increasingly contemplating how to break it to the public that it will have to raise the inflation target from 2% to 3%, something we said over a year ago is coming...

... and which a Jason Furman weekend op-ed reinforced.

What about JPM's trading desk? Here, we look to the latest note from Market Intel head Andrew Tyler who reminds us of what he wrote after the latest CPI release: “The CPI, hourly earnings, and jobless claims combined to create a dovish signal for the markets. The disinflation story continues but this print is not enough to remove the ambiguity surrounding the Fed’s future behavior meaning we are likely to get a data-dependent message at Jackson Hole before seeing a “hawkish skip” at the Sept meeting. While today sets up as a relief rally of sorts, I do not think this is a dovish enough print to push markets back to near-term highs given the dearth of market-moving information and the seasonal weakness of Aug/Sept. That said, I do think Q4 will be a strong quarter for stocks as the economy continues to exhibit growth without inflation and the prospect of improving earnings and lower yields will also be positive for indices.”

As Tyler concludes, while there has not been enough of break in macro data to warrant a change in this view, given the market turmoil surrounding China, let’s see if Powell addresses potential risks or look at the recent surge in yields as additive to their mission, or say nothing.

* * *

Turning to Bank of America's view, here is what the bank expects from Fed communications?

We expect Powell to reiterate the Fed’s commitment to its 2 percent inflation target. He will likely note that although there has been progress on the inflation front, there is still a lot more work to be done. Therefore, policy will remain restrictive for an extended period.

At the July press conference, Powell noted that risks around the impact of Fed policy were becoming more balanced and, given the lagged effect of monetary policy on the economy, the Fed would likely start cutting rates before inflation reaches 2%. We think the tone could be less balanced at Jackson Hole given the robust data flow since the July FOMC meeting. In particular, 2Q GDP came in well above expectations at 2.4%, and July retail sales ex-autos surged by 1.0%. While the Fed would prefer not to short-circuit the business cycle, policymakers are probably becoming increasingly concerned about a re-acceleration in inflation, driven by strong aggregate demand. Therefore, we expect Powell to push back— implicitly or explicitly— against the degree of rate hikes that markets are pricing for next year.

Meanwhile, in terms of the extent and timing of additional hikes, Powell is likely to emphasize that the Fed is data-dependent and every meeting is live. If Powell were to comment that he is comfortable with the current pace of hikes for now, markets would view that as guidance towards a pause in September and a possible hike in November.

Market participants have recently speculated that Jackson Hole will be used as a venue to highlight upcoming shifts in Fed communication around the neutral rate. Market focus has recently increased on the neutral rate due to underlying economic resilience in the face of elevated policy rates & re-pricing of global 3y1y rates.

We would be surprised to see any large shift in Fed communications around the neutral rate at Jackson Hole, given that there is significant uncertainty around estimates of this rate. If the Fed were to signal expectations for a higher neutral rate it would likely be interpreted by the market as hawkish since it implies higher overnight rates to slow the economy.

Next, BofA looks at what is expected rates & FX market reaction around Jackson Hole?

US rates: Fed communications that sound less balanced vs the July FOMC minutes risk being interpreted as hawkish by the market. This could result in greater pricing of hikes at the Sept & Nov meetings, which cumulatively price 11.5bps of further tightening. We would not be surprised to see this pricing shift to 15bps if more balanced Fed rhetoric is adjusted due to recent strong data in favor of a clearer tightening bias.

Hawkish Fed rhetoric risks & increased hikes will reinforce our core view for clients to remain underweight the UST front end. We have recommended clients position in Dec ’23 – Mar ’24 FOMC steepeners, which should benefit from a more hawkish Fed message and / or reiteration of higher for longer message. We also expect a further reduction in the extent of rate cuts priced in ’24. Cuts in ’24 have been reduced by 25bps since last Monday; we see risks these cuts are reduced further (Exhibit 2). A further reduction of rate cuts will likely result in a bear flattening of the UST curve.

FX: This year’s Jackson Hole conference occurs amid a relatively choppy and rangy FX market. The dollar has been rallying over the past month mainly on relative U.S. growth outperformance and the rise in both nominal and real yields. (FX Watch: The USD’s road trip 16 August 2023) However, this has been occurring amid a broader disinflationary trend in the U.S., as well as expectations that several other major central banks could keep rates higher-for-longer than the Fed to bring core inflation down. While we do not anticipate any overtly strong policy signals from Jackson Hole this year (as noted above), any overt suggestion of a higher-than-expected neutral policy rate could serve as a fresh catalyst for another leg of dollar appreciation. Conversely, should the topic of eventual rate cuts receive prominence, the dollar could move back into the lower-half of the year’s range.

Finally, what are the historic rates & FX reaction around Jackson Hole?

Rates: US rates have recently sold off into Jackson Hole, held the moves during the week after, and sold off more meaningfully into September. Since 2010 the US 10Y has declined 2+bps in the symposium aftermath but increased 3+bps in the 10D after. Over recent years the yield declines have been smaller & sell-off larger. The largest sell-off in recent years was 2022 due to Powell’s hawkish remarks on inflation.

The UST curve has tended to flatten modestly in immediate response to Jackson Hole (Exhibit 3). However, the curve has historically steepened in the 10D after the event. Powell’s 2022 Jackson Hole speech resulted in a curve steepening in the 10D after the event despite the more hawkish message & large rate sell-off at the front end.

Overall, recent years have seen the UST curve bear steepen in response to Jackson Hole.

FX: The dollar has traded within a modest +/- 0.5% range in the 10 days before and after Jackson Hole on average (Exhibit 4). FX volatility has similarly been subdued around the event (Exhibit 5). However, 2022 was a bit of an aberration. Last year, the USD appreciated about 3% in the 2 weeks leading up to Jackson Hole and continued another 1% in the weeks after.

While Chair Powell’s hawkish remarks added to the dollar’s ascent in 2022, it’s uptrend was well entrenched prior to the event. Indeed, 2022 was a noteworthy year for the dollar, as the DXY index reached a new 20-year high that September. Drivers for the dollar’s appreciation at the time included: the Fed’s aggressive tightening campaign, recession fears across the globe, energy shocks in Europe and elsewhere, and China’s zero-covid policies.

Turning to equities, it's worth noting that while stocks usually move up by 40 bps in the following week, investors vividly recall the -3.2% move after last year’s hawkish surprise. This year, with 3 of 4 financial stability indicators having deteriorated from “moderate” levels, JPM's trading desk writes that we may see a more neutral Powell allowing for another week of calm before we kick off the quarter’s finishing kick post-Labor Day.

Goldman had a preview note too, and we summarize the key parts below:

Q: What do we expect policymakers’ message to be?

A: We are not expecting to get a strong monetary policy signal out of Jackson Hole. Although we do expect the FOMC to skip a hike in September, key data including the PCE inflation and employment data come out shortly after the Jackson Hole symposium. The Fed will likely wait to be informed by these new data before changing their current posture.

We expect Powell’s speech will touch on similar themes to last year’s. Bringing inflation back down to target remains the Fed’s key concern, though the current backdrop is much more reassuring. Last year, the Fed was on the verge of making a big upward revision to both its inflation and unemployment rate forecasts; Powell warned that reducing inflation would ‘bring some pain’ – a statement that induced a significant market correction. This time around, a soft landing looks more plausible than at any point over the last year, and we expect that Powell’s message will be that they’re going to see the job through.

We also expect the sideline interviews to be close to what we have been hearing over the past few weeks – adamant that they will ‘see the job through’, but no rush to hike again either. We suspect the debate will turn to whether the Fed should turn to a ‘higher for longer’ policy or will follow New York Fed President Williams on the idea that they might need to cut to keep the real funds rate from rising too much.

Given the conference topic, President Lagarde’s speech could touch on some of the same topics she spoke about earlier at the Council on Foreign Relations. She argued that a more fragmented economy could lead to more instability and less resilient supply chains. Her speech at Sintra argued that there was a risk of more persistent inflation risks, and that monetary policy should break this chain by holding down demand. That is a very different type of inflation persistence than the ECB had to combat for most of the last decade, so this could also fit the theme of the Jackson Hole symposium, to some extent.

Q: What is the conference topic and how does that dictate the discussion?

A: This year’s conference topic is “Structural Shifts in the Global Economy,” which will set the direction for the research that gets presented, but much less so for the sideline interviews.

Although the conference organizers have not yet given any guidance as to what the discussions will cover, a few possible topics include deglobalization and the green transition, the neutral rate, artificial intelligence, larger fiscal deficits, and remote work. We will be watching particularly closely for any discussion of the neutral rate.

Typically, the conference topic will feature prominently in the keynote address (though it does not preclude a separate policy discussion) and dictate the papers being presented. While the academic part of the symposium has the potential to impact the long-run direction of policy, the side interviews should shed more light on immediate policy questions. And we should note that this particular conference is one of many such events held throughout the year, with no particular extra relevance in this regard.

* * *

Still not enough? We conclude with some excerpts from the just published J-Hole preview from Fed whisperer Nick Timiraos:

  • As with previous years, Powell is unlikely to use his speech to preview the Fed’s very near-term policy deliberations. Rather, he is more likely to review what the central bank has done and provide a broader framing of where policy might be headed. Such remarks would likely underscore that the Fed’s inflation-fighting job isn’t done.
  • “The theme I would be emphasizing is trying to get people off the binary view that once inflation starts coming down, it’s mission accomplished,” said former Fed Vice Chair Richard Clarida, who served with Powell from 2018 until early 2022. “What they want to avoid is” declaring an end to rate rises “and then find themselves next spring with underlying inflation not really having edged down in a very tight labor market.”
  • It may be too soon for Powell to publicly discuss how Fed officials might manage the proverbial last mile of the inflation fight—in which inflation gets much closer but not all the way to their 2% target. But the issue is likely to be a topic for lively debate on the sidelines of the conference.
  • “It’s too early to declare victory. It’s too early to foreclose the possibility of another hike down the road,” said Ellen Meade, an economist at Duke University who is a former senior adviser at the Fed. “Powell will need at some point to talk about that last mile, but right now he’s navigating the end of tightening and the how-long-to-hold conversation. The last mile comes after that.”
  • The theme of this year’s conference, “Structural Shifts in the Global Economy,” will delve into whether and how the Covid pandemic and the policy response permanently altered the economy, including trade networks and global financial flows. Papers will examine the potential ramifications of rapid shifts in monetary policy and the large increases in public debt. Christine Lagarde, president of the European Central Bank, is set to speak Friday at 3 p.m. ET.
  • One overarching question is whether the economy is exiting a period of low inflation and low interest rates that occurred between the 2008 financial crisis and the 2020 pandemic, and which some economists then dubbed the “new normal.” Policy makers concluded over the past decade that the neutral rate of interest, or the level that should prevail when the economy is growing steadily with low inflation, had declined.
  • Clarida said he expects the neutral rate will return to the lower levels that likely existed before the pandemic, even if Treasury yields remain modestly higher because of the premium investors demand on longer-term debt.

More available to pro subs in the usual place.

Tyler Durden Thu, 08/24/2023 - 14:40

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‘I couldn’t stand the pain’: the Turkish holiday resort that’s become an emergency dental centre for Britons who can’t get treated at home

The crisis in NHS dentistry is driving increasing numbers abroad for treatment. Here are some of their stories.

Published

4 hours ago

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March 10, 2024

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This clinic in the Turkish resort of Antalya is the official 'dental sponsor' of the Miss England competition. Diana Ibanez-Tirado, Author provided

It’s a hot summer day in the Turkish city of Antalya, a Mediterranean resort with golden beaches, deep blue sea and vibrant nightlife. The pool area of the all-inclusive resort is crammed with British people on sun loungers – but they aren’t here for a holiday. This hotel is linked to a dental clinic that organises treatment packages, and most of these guests are here to see a dentist.

From Norwich, two women talk about gums and injections. A man from Wales holds a tissue close to his mouth and spits blood – he has just had two molars extracted.

The dental clinic organises everything for these dental “tourists” throughout their treatment, which typically lasts from three to 15 days. The stories I hear of what has caused them to travel to Turkey are strikingly similar: all have struggled to secure dental treatment at home on the NHS.

“The hotel is nice and some days I go to the beach,” says Susan*, a hairdresser in her mid-30s from Norwich. “But really, we aren’t tourists like in a proper holiday. We come here because we have no choice. I couldn’t stand the pain.”

Seaside beach resort with mountains in the distance
The Turkish Mediterranean resort of Antalya. Akimov Konstantin/Shutterstock

This is Susan’s second visit to Antalya. She explains that her ordeal started two years earlier:

I went to an NHS dentist who told me I had gum disease … She did some cleaning to my teeth and gums but it got worse. When I ate, my teeth were moving … the gums were bleeding and it was very painful. I called to say I was in pain but the clinic was not accepting NHS patients any more.

The only option the dentist offered Susan was to register as a private patient:

I asked how much. They said £50 for x-rays and then if the gum disease got worse, £300 or so for extraction. Four of them were moving – imagine: £1,200 for losing your teeth! Without teeth I’d lose my clients, but I didn’t have the money. I’m a single mum. I called my mum and cried.

Susan’s mother told her about a friend of hers who had been to Turkey for treatment, then together they found a suitable clinic:

The prices are so much cheaper! Tooth extraction, x-rays, consultations – it all comes included. The flight and hotel for seven days cost the same as losing four teeth in Norwich … I had my lower teeth removed here six months ago, now I’ve got implants … £2,800 for everything – hotel, transfer, treatments. I only paid the flights separately.

In the UK, roughly half the adult population suffers from periodontitis – inflammation of the gums caused by plaque bacteria that can lead to irreversible loss of gums, teeth, and bone. Regular reviews by a dentist or hygienist are required to manage this condition. But nine out of ten dental practices cannot offer NHS appointments to new adult patients, while eight in ten are not accepting new child patients.

Some UK dentists argue that Britons who travel abroad for treatment do so mainly for cosmetic procedures. They warn that dental tourism is dangerous, and that if their treatment goes wrong, dentists in the UK will be unable to help because they don’t want to be responsible for further damage. Susan shrugs this off:

Dentists in England say: ‘If you go to Turkey, we won’t touch you [afterwards].’ But I don’t worry because there are no appointments at home anyway. They couldn’t help in the first place, and this is why we are in Turkey.

‘How can we pay all this money?’

As a social anthropologist, I travelled to Turkey a number of times in 2023 to investigate the crisis of NHS dentistry, and the journeys abroad that UK patients are increasingly making as a result. I have relatives in Istanbul and have been researching migration and trading patterns in Turkey’s largest city since 2016.

In August 2023, I visited the resort in Antalya, nearly 400 miles south of Istanbul. As well as Susan, I met a group from a village in Wales who said there was no provision of NHS dentistry back home. They had organised a two-week trip to Turkey: the 12-strong group included a middle-aged couple with two sons in their early 20s, and two couples who were pensioners. By going together, Anya tells me, they could support each other through their different treatments:

I’ve had many cavities since I was little … Before, you could see a dentist regularly – you didn’t even think about it. If you had pain or wanted a regular visit, you phoned and you went … That was in the 1990s, when I went to the dentist maybe every year.

Anya says that once she had children, her family and work commitments meant she had no time to go to the dentist. Then, years later, she started having serious toothache:

Every time I chewed something, it hurt. I ate soups and soft food, and I also lost weight … Even drinking was painful – tea: pain, cold water: pain. I was taking paracetamol all the time! I went to the dentist to fix all this, but there were no appointments.

Anya was told she would have to wait months, or find a dentist elsewhere:

A private clinic gave me a list of things I needed done. Oh my God, almost £6,000. My husband went too – same story. How can we pay all this money? So we decided to come to Turkey. Some people we know had been here, and others in the village wanted to come too. We’ve brought our sons too – they also need to be checked and fixed. Our whole family could be fixed for less than £6,000.

By the time they travelled, Anya’s dental problems had turned into a dental emergency. She says she could not live with the pain anymore, and was relying on paracetamol.

In 2023, about 6 million adults in the UK experienced protracted pain (lasting more than two weeks) caused by toothache. Unintentional paracetamol overdose due to dental pain is a significant cause of admissions to acute medical units. If left untreated, tooth infections can spread to other parts of the body and cause life-threatening complications – and on rare occasions, death.

In February 2024, police were called to manage hundreds of people queuing outside a newly opened dental clinic in Bristol, all hoping to be registered or seen by an NHS dentist. One in ten Britons have admitted to performing “DIY dentistry”, of which 20% did so because they could not find a timely appointment. This includes people pulling out their teeth with pliers and using superglue to repair their teeth.

In the 1990s, dentistry was almost entirely provided through NHS services, with only around 500 solely private dentists registered. Today, NHS dentist numbers in England are at their lowest level in a decade, with 23,577 dentists registered to perform NHS work in 2022-23, down 695 on the previous year. Furthermore, the precise division of NHS and private work that each dentist provides is not measured.

The COVID pandemic created longer waiting lists for NHS treatment in an already stretched public service. In Bridlington, Yorkshire, people are now reportedly having to wait eight-to-nine years to get an NHS dental appointment with the only remaining NHS dentist in the town.

In his book Patients of the State (2012), Argentine sociologist Javier Auyero describes the “indignities of waiting”. It is the poor who are mostly forced to wait, he writes. Queues for state benefits and public services constitute a tangible form of power over the marginalised. There is an ethnic dimension to this story, too. Data suggests that in the UK, patients less likely to be effective in booking an NHS dental appointment are non-white ethnic groups and Gypsy or Irish travellers, and that it is particularly challenging for refugees and asylum-seekers to access dental care.

This article is part of Conversation Insights
The Insights team generates long-form journalism derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.

In 2022, I experienced my own dental emergency. An infected tooth was causing me debilitating pain, and needed root canal treatment. I was advised this would cost £71 on the NHS, plus £307 for a follow-up crown – but that I would have to wait months for an appointment. The pain became excruciating – I could not sleep, let alone wait for months. In the same clinic, privately, I was quoted £1,300 for the treatment (more than half my monthly income at the time), or £295 for a tooth extraction.

I did not want to lose my tooth because of lack of money. So I bought a flight to Istanbul immediately for the price of the extraction in the UK, and my tooth was treated with root canal therapy by a private dentist there for £80. Including the costs of travelling, the total was a third of what I was quoted to be treated privately in the UK. Two years on, my treated tooth hasn’t given me any more problems.

A better quality of life

Not everyone is in Antalya for emergency procedures. The pensioners from Wales had contacted numerous clinics they found on the internet, comparing prices, treatments and hotel packages at least a year in advance, in a carefully planned trip to get dental implants – artificial replacements for tooth roots that help support dentures, crowns and bridges.

Street view of a dental clinic in Antalya, Turkey
Dental clinic in Antalya, Turkey. Diana Ibanez-Tirado, CC BY-NC-ND

In Turkey, all the dentists I speak to (most of whom cater mainly for foreigners, including UK nationals) consider implants not a cosmetic or luxurious treatment, but a development in dentistry that gives patients who are able to have the procedure a much better quality of life. This procedure is not available on the NHS for most of the UK population, and the patients I meet in Turkey could not afford implants in private clinics back home.

Paul is in Antalya to replace his dentures, which have become uncomfortable and irritating to his gums, with implants. He says he couldn’t find an appointment to see an NHS dentist. His wife Sonia went through a similar procedure the year before and is very satisfied with the results, telling me: “Why have dentures that you need to put in a glass overnight, in the old style? If you can have implants, I say, you’re better off having them.”

Most of the dental tourists I meet in Antalya are white British: this city, known as the Turkish Riviera, has developed an entire economy catering to English-speaking tourists. In 2023, more than 1.3 million people visited the city from the UK, up almost 15% on the previous year.

Read more: NHS dentistry is in crisis – are overseas dentists the answer?

In contrast, the Britons I meet in Istanbul are predominantly from a non-white ethnic background. Omar, a pensioner of Pakistani origin in his early 70s, has come here after waiting “half a year” for an NHS appointment to fix the dental bridge that is causing him pain. Omar’s son had been previously for a hair transplant, and was offered a free dental checkup by the same clinic, so he suggested it to his father. Having worked as a driver for a manufacturing company for two decades in Birmingham, Omar says he feels disappointed to have contributed to the British economy for so long, only to be “let down” by the NHS:

At home, I must wait and wait and wait to get a bridge – and then I had many problems with it. I couldn’t eat because the bridge was uncomfortable and I was in pain, but there were no appointments on the NHS. I asked a private dentist and they recommended implants, but they are far too expensive [in the UK]. I started losing weight, which is not a bad thing at the beginning, but then I was worrying because I couldn’t chew and eat well and was losing more weight … Here in Istanbul, I got dental implants – US$500 each, problem solved! In England, each implant is maybe £2,000 or £3,000.

In the waiting area of another clinic in Istanbul, I meet Mariam, a British woman of Iraqi background in her late 40s, who is making her second visit to the dentist here. Initially, she needed root canal therapy after experiencing severe pain for weeks. Having been quoted £1,200 in a private clinic in outer London, Mariam decided to fly to Istanbul instead, where she was quoted £150 by a dentist she knew through her large family. Even considering the cost of the flight, Mariam says the decision was obvious:

Dentists in England are so expensive and NHS appointments so difficult to find. It’s awful there, isn’t it? Dentists there blamed me for my rotten teeth. They say it’s my fault: I don’t clean or I ate sugar, or this or that. I grew up in a village in Iraq and didn’t go to the dentist – we were very poor. Then we left because of war, so we didn’t go to a dentist … When I arrived in London more than 20 years ago, I didn’t speak English, so I still didn’t go to the dentist … I think when you move from one place to another, you don’t go to the dentist unless you are in real, real pain.

In Istanbul, Mariam has opted not only for the urgent root canal treatment but also a longer and more complex treatment suggested by her consultant, who she says is a renowned doctor from Syria. This will include several extractions and implants of back and front teeth, and when I ask what she thinks of achieving a “Hollywood smile”, Mariam says:

Who doesn’t want a nice smile? I didn’t come here to be a model. I came because I was in pain, but I know this doctor is the best for implants, and my front teeth were rotten anyway.

Dentists in the UK warn about the risks of “overtreatment” abroad, but Mariam appears confident that this is her opportunity to solve all her oral health problems. Two of her sisters have already been through a similar treatment, so they all trust this doctor.

Alt text
An Istanbul clinic founded by Afghan dentists has a message for its UK customers. Diana Ibanez-Tirado, CC BY-NC-ND

The UK’s ‘dental deserts’

To get a fuller understanding of the NHS dental crisis, I’ve also conducted 20 interviews in the UK with people who have travelled or were considering travelling abroad for dental treatment.

Joan, a 50-year-old woman from Exeter, tells me she considered going to Turkey and could have afforded it, but that her back and knee problems meant she could not brave the trip. She has lost all her lower front teeth due to gum disease and, when I meet her, has been waiting 13 months for an NHS dental appointment. Joan tells me she is living in “shame”, unable to smile.

In the UK, areas with extremely limited provision of NHS dental services – known as as “dental deserts” – include densely populated urban areas such as Portsmouth and Greater Manchester, as well as many rural and coastal areas.

In Felixstowe, the last dentist taking NHS patients went private in 2023, despite the efforts of the activist group Toothless in Suffolk to secure better access to NHS dentists in the area. It’s a similar story in Ripon, Yorkshire, and in Dumfries & Galloway, Scotland, where nearly 25,000 patients have been de-registered from NHS dentists since 2021.

Data shows that 2 million adults must travel at least 40 miles within the UK to access dental care. Branding travel for dental care as “tourism” carries the risk of disguising the elements of duress under which patients move to restore their oral health – nationally and internationally. It also hides the immobility of those who cannot undertake such journeys.

The 90-year-old woman in Dumfries & Galloway who now faces travelling for hours by bus to see an NHS dentist can hardly be considered “tourism” – nor the Ukrainian war refugees who travelled back from West Sussex and Norwich to Ukraine, rather than face the long wait to see an NHS dentist.

Many people I have spoken to cannot afford the cost of transport to attend dental appointments two hours away – or they have care responsibilities that make it impossible. Instead, they are forced to wait in pain, in the hope of one day securing an appointment closer to home.

Billboard advertising a dental clinic in Turkey
Dental clinics have mushroomed in recent years in Turkey, thanks to the influx of foreign patients seeking a wide range of treatments. Diana Ibanez-Tirado, CC BY-NC-ND

‘Your crisis is our business’

The indignities of waiting in the UK are having a big impact on the lives of some local and foreign dentists in Turkey. Some neighbourhoods are rapidly changing as dental and other health clinics, usually in luxurious multi-storey glass buildings, mushroom. In the office of one large Istanbul medical complex with sections for hair transplants and dentistry (plus one linked to a hospital for more extensive cosmetic surgery), its Turkish owner and main investor tells me:

Your crisis is our business, but this is a bazaar. There are good clinics and bad clinics, and unfortunately sometimes foreign patients do not know which one to choose. But for us, the business is very good.

This clinic only caters to foreign patients. The owner, an architect by profession who also developed medical clinics in Brazil, describes how COVID had a major impact on his business:

When in Europe you had COVID lockdowns, Turkey allowed foreigners to come. Many people came for ‘medical tourism’ – we had many patients for cosmetic surgery and hair transplants. And that was when the dental business started, because our patients couldn’t see a dentist in Germany or England. Then more and more patients started to come for dental treatments, especially from the UK and Ireland. For them, it’s very, very cheap here.

The reasons include the value of the Turkish lira relative to the British pound, the low cost of labour, the increasing competition among Turkish clinics, and the sheer motivation of dentists here. While most dentists catering to foreign patients are from Turkey, others have arrived seeking refuge from war and violence in Syria, Iraq, Afghanistan, Iran and beyond. They work diligently to rebuild their lives, careers and lost wealth.

Regardless of their origin, all dentists in Turkey must be registered and certified. Hamed, a Syrian dentist and co-owner of a new clinic in Istanbul catering to European and North American patients, tells me:

I know that you say ‘Syrian’ and people think ‘migrant’, ‘refugee’, and maybe think ‘how can this dentist be good?’ – but Syria, before the war, had very good doctors and dentists. Many of us came to Turkey and now I have a Turkish passport. I had to pass the exams to practise dentistry here – I study hard. The exams are in Turkish and they are difficult, so you cannot say that Syrian doctors are stupid.

Hamed talks excitedly about the latest technology that is coming to his profession: “There are always new materials and techniques, and we cannot stop learning.” He is about to travel to Paris to an international conference:

I can say my techniques are very advanced … I bet I put more implants and do more bone grafting and surgeries every week than any dentist you know in England. A good dentist is about practice and hand skills and experience. I work hard, very hard, because more and more patients are arriving to my clinic, because in England they don’t find dentists.

Dental equipment in a Turkish treatment room
Dentists in Turkey boast of using the latest technology. Diana Ibanez-Tirado, CC BY-NC-ND

While there is no official data about the number of people travelling from the UK to Turkey for dental treatment, investors and dentists I speak to consider that numbers are rocketing. From all over the world, Turkey received 1.2 million visitors for “medical tourism” in 2022, an increase of 308% on the previous year. Of these, about 250,000 patients went for dentistry. One of the most renowned dental clinics in Istanbul had only 15 British patients in 2019, but that number increased to 2,200 in 2023 and is expected to reach 5,500 in 2024.

Like all forms of medical care, dental treatments carry risks. Most clinics in Turkey offer a ten-year guarantee for treatments and a printed clinical history of procedures carried out, so patients can show this to their local dentists and continue their regular annual care in the UK. Dental treatments, checkups and maintaining a good oral health is a life-time process, not a one-off event.

Many UK patients, however, are caught between a rock and a hard place – criticised for going abroad, yet unable to get affordable dental care in the UK before and after their return. The British Dental Association has called for more action to inform these patients about the risks of getting treated overseas – and has warned UK dentists about the legal implications of treating these patients on their return. But this does not address the difficulties faced by British patients who are being forced to go abroad in search of affordable, often urgent dental care.

A global emergency

The World Health Organization states that the explosion of oral disease around the world is a result of the “negligent attitude” that governments, policymakers and insurance companies have towards including oral healthcare under the umbrella of universal healthcare. It as if the health of our teeth and mouth is optional; somehow less important than treatment to the rest of our body. Yet complications from untreated tooth decay can lead to hospitalisation.

The main causes of oral health diseases are untreated tooth decay, severe gum disease, toothlessness, and cancers of the lip and oral cavity. Cases grew during the pandemic, when little or no attention was paid to oral health. Meanwhile, the global cosmetic dentistry market is predicted to continue growing at an annual rate of 13% for the rest of this decade, confirming the strong relationship between socioeconomic status and access to oral healthcare.

In the UK since 2018, there have been more than 218,000 admissions to hospital for rotting teeth, of which more than 100,000 were children. Some 40% of children in the UK have not seen a dentist in the past 12 months. The role of dentists in prevention of tooth decay and its complications, and in the early detection of mouth cancer, is vital. While there is a 90% survival rate for mouth cancer if spotted early, the lack of access to dental appointments is causing cases to go undetected.

The reasons for the crisis in NHS dentistry are complex, but include: the real-term cuts in funding to NHS dentistry; the challenges of recruitment and retention of dentists in rural and coastal areas; pay inequalities facing dental nurses, most of them women, who are being badly hit by the cost of living crisis; and, in England, the 2006 Dental Contract that does not remunerate dentists in a way that encourages them to continue seeing NHS patients.

The UK is suffering a mass exodus of the public dentistry workforce, with workers leaving the profession entirely or shifting to the private sector, where payments and life-work balance are better, bureaucracy is reduced, and prospects for career development look much better. A survey of general dental practitioners found that around half have reduced their NHS work since the pandemic – with 43% saying they were likely to go fully private, and 42% considering a career change or taking early retirement.

Reversing the UK’s dental crisis requires more commitment to substantial reform and funding than the “recovery plan” announced by Victoria Atkins, the secretary of state for health and social care, on February 7.

The stories I have gathered show that people travelling abroad for dental treatment don’t see themselves as “tourists” or vanity-driven consumers of the “Hollywood smile”. Rather, they have been forced by the crisis in NHS dentistry to seek out a service 1,500 miles away in Turkey that should be a basic, affordable right for all, on their own doorstep.

*Names in this article have been changed to protect the anonymity of the interviewees.

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Diana Ibanez Tirado receives funding from the School of Global Studies, University of Sussex.

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The Coming Of The Police State In America

The Coming Of The Police State In America

Authored by Jeffrey Tucker via The Epoch Times,

The National Guard and the State Police are now…

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March 9, 2024

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The Coming Of The Police State In America

Authored by Jeffrey Tucker via The Epoch Times,

The National Guard and the State Police are now patrolling the New York City subway system in an attempt to do something about the explosion of crime. As part of this, there are bag checks and new surveillance of all passengers. No legislation, no debate, just an edict from the mayor.

Many citizens who rely on this system for transportation might welcome this. It’s a city of strict gun control, and no one knows for sure if they have the right to defend themselves. Merchants have been harassed and even arrested for trying to stop looting and pillaging in their own shops.

The message has been sent: Only the police can do this job. Whether they do it or not is another matter.

Things on the subway system have gotten crazy. If you know it well, you can manage to travel safely, but visitors to the city who take the wrong train at the wrong time are taking grave risks.

In actual fact, it’s guaranteed that this will only end in confiscating knives and other things that people carry in order to protect themselves while leaving the actual criminals even more free to prey on citizens.

The law-abiding will suffer and the criminals will grow more numerous. It will not end well.

When you step back from the details, what we have is the dawning of a genuine police state in the United States. It only starts in New York City. Where is the Guard going to be deployed next? Anywhere is possible.

If the crime is bad enough, citizens will welcome it. It must have been this way in most times and places that when the police state arrives, the people cheer.

We will all have our own stories of how this came to be. Some might begin with the passage of the Patriot Act and the establishment of the Department of Homeland Security in 2001. Some will focus on gun control and the taking away of citizens’ rights to defend themselves.

My own version of events is closer in time. It began four years ago this month with lockdowns. That’s what shattered the capacity of civil society to function in the United States. Everything that has happened since follows like one domino tumbling after another.

It goes like this:

1) lockdown,

2) loss of moral compass and spreading of loneliness and nihilism,

3) rioting resulting from citizen frustration, 4) police absent because of ideological hectoring,

5) a rise in uncontrolled immigration/refugees,

6) an epidemic of ill health from substance abuse and otherwise,

7) businesses flee the city

8) cities fall into decay, and that results in

9) more surveillance and police state.

The 10th stage is the sacking of liberty and civilization itself.

It doesn’t fall out this way at every point in history, but this seems like a solid outline of what happened in this case. Four years is a very short period of time to see all of this unfold. But it is a fact that New York City was more-or-less civilized only four years ago. No one could have predicted that it would come to this so quickly.

But once the lockdowns happened, all bets were off. Here we had a policy that most directly trampled on all freedoms that we had taken for granted. Schools, businesses, and churches were slammed shut, with various levels of enforcement. The entire workforce was divided between essential and nonessential, and there was widespread confusion about who precisely was in charge of designating and enforcing this.

It felt like martial law at the time, as if all normal civilian law had been displaced by something else. That something had to do with public health, but there was clearly more going on, because suddenly our social media posts were censored and we were being asked to do things that made no sense, such as mask up for a virus that evaded mask protection and walk in only one direction in grocery aisles.

Vast amounts of the white-collar workforce stayed home—and their kids, too—until it became too much to bear. The city became a ghost town. Most U.S. cities were the same.

As the months of disaster rolled on, the captives were let out of their houses for the summer in order to protest racism but no other reason. As a way of excusing this, the same public health authorities said that racism was a virus as bad as COVID-19, so therefore it was permitted.

The protests had turned to riots in many cities, and the police were being defunded and discouraged to do anything about the problem. Citizens watched in horror as downtowns burned and drug-crazed freaks took over whole sections of cities. It was like every standard of decency had been zapped out of an entire swath of the population.

Meanwhile, large checks were arriving in people’s bank accounts, defying every normal economic expectation. How could people not be working and get their bank accounts more flush with cash than ever? There was a new law that didn’t even require that people pay rent. How weird was that? Even student loans didn’t need to be paid.

By the fall, recess from lockdown was over and everyone was told to go home again. But this time they had a job to do: They were supposed to vote. Not at the polling places, because going there would only spread germs, or so the media said. When the voting results finally came in, it was the absentee ballots that swung the election in favor of the opposition party that actually wanted more lockdowns and eventually pushed vaccine mandates on the whole population.

The new party in control took note of the large population movements out of cities and states that they controlled. This would have a large effect on voting patterns in the future. But they had a plan. They would open the borders to millions of people in the guise of caring for refugees. These new warm bodies would become voters in time and certainly count on the census when it came time to reapportion political power.

Meanwhile, the native population had begun to swim in ill health from substance abuse, widespread depression, and demoralization, plus vaccine injury. This increased dependency on the very institutions that had caused the problem in the first place: the medical/scientific establishment.

The rise of crime drove the small businesses out of the city. They had barely survived the lockdowns, but they certainly could not survive the crime epidemic. This undermined the tax base of the city and allowed the criminals to take further control.

The same cities became sanctuaries for the waves of migrants sacking the country, and partisan mayors actually used tax dollars to house these invaders in high-end hotels in the name of having compassion for the stranger. Citizens were pushed out to make way for rampaging migrant hordes, as incredible as this seems.

But with that, of course, crime rose ever further, inciting citizen anger and providing a pretext to bring in the police state in the form of the National Guard, now tasked with cracking down on crime in the transportation system.

What’s the next step? It’s probably already here: mass surveillance and censorship, plus ever-expanding police power. This will be accompanied by further population movements, as those with the means to do so flee the city and even the country and leave it for everyone else to suffer.

As I tell the story, all of this seems inevitable. It is not. It could have been stopped at any point. A wise and prudent political leadership could have admitted the error from the beginning and called on the country to rediscover freedom, decency, and the difference between right and wrong. But ego and pride stopped that from happening, and we are left with the consequences.

The government grows ever bigger and civil society ever less capable of managing itself in large urban centers. Disaster is unfolding in real time, mitigated only by a rising stock market and a financial system that has yet to fall apart completely.

Are we at the middle stages of total collapse, or at the point where the population and people in leadership positions wise up and decide to put an end to the downward slide? It’s hard to know. But this much we do know: There is a growing pocket of resistance out there that is fed up and refuses to sit by and watch this great country be sacked and taken over by everything it was set up to prevent.

Tyler Durden Sat, 03/09/2024 - 16:20

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Another beloved brewery files Chapter 11 bankruptcy

The beer industry has been devastated by covid, changing tastes, and maybe fallout from the Bud Light scandal.

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March 9, 2024

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Before the covid pandemic, craft beer was having a moment. Most cities had multiple breweries and taprooms with some having so many that people put together the brewery version of a pub crawl.

It was a period where beer snobbery ruled the day and it was not uncommon to hear bar patrons discuss the makeup of the beer the beer they were drinking. This boom period always seemed destined for failure, or at least a retraction as many markets seemed to have more craft breweries than they could support.

Related: Fast-food chain closes more stores after Chapter 11 bankruptcy

The pandemic, however, hastened that downfall. Many of these local and regional craft breweries counted on in-person sales to drive their business. 

And while many had local and regional distribution, selling through a third party comes with much lower margins. Direct sales drove their business and the pandemic forced many breweries to shut down their taprooms during the period where social distancing rules were in effect.

During those months the breweries still had rent and employees to pay while little money was coming in. That led to a number of popular beermakers including San Francisco's nationally-known Anchor Brewing as well as many regional favorites including Chicago’s Metropolitan Brewing, New Jersey’s Flying Fish, Denver’s Joyride Brewing, Tampa’s Zydeco Brew Werks, and Cleveland’s Terrestrial Brewing filing bankruptcy.

Some of these brands hope to survive, but others, including Anchor Brewing, fell into Chapter 7 liquidation. Now, another domino has fallen as a popular regional brewery has filed for Chapter 11 bankruptcy protection.

Overall beer sales have fallen.

Image source: Shutterstock

Covid is not the only reason for brewery bankruptcies

While covid deserves some of the blame for brewery failures, it's not the only reason why so many have filed for bankruptcy protection. Overall beer sales have fallen driven by younger people embracing non-alcoholic cocktails, and the rise in popularity of non-beer alcoholic offerings,

Beer sales have fallen to their lowest levels since 1999 and some industry analysts

"Sales declined by more than 5% in the first nine months of the year, dragged down not only by the backlash and boycotts against Anheuser-Busch-owned Bud Light but the changing habits of younger drinkers," according to data from Beer Marketer’s Insights published by the New York Post.

Bud Light parent Anheuser Busch InBev (BUD) faced massive boycotts after it partnered with transgender social media influencer Dylan Mulvaney. It was a very small partnership but it led to a right-wing backlash spurred on by Kid Rock, who posted a video on social media where he chastised the company before shooting up cases of Bud Light with an automatic weapon.

Another brewery files Chapter 11 bankruptcy

Gizmo Brew Works, which does business under the name Roth Brewing Company LLC, filed for Chapter 11 bankruptcy protection on March 8. In its filing, the company checked the box that indicates that its debts are less than $7.5 million and it chooses to proceed under Subchapter V of Chapter 11. 

"Both small business and subchapter V cases are treated differently than a traditional chapter 11 case primarily due to accelerated deadlines and the speed with which the plan is confirmed," USCourts.gov explained. 

Roth Brewing/Gizmo Brew Works shared that it has 50-99 creditors and assets $100,000 and $500,000. The filing noted that the company does expect to have funds available for unsecured creditors. 

The popular brewery operates three taprooms and sells its beer to go at those locations.

"Join us at Gizmo Brew Works Craft Brewery and Taprooms located in Raleigh, Durham, and Chapel Hill, North Carolina. Find us for entertainment, live music, food trucks, beer specials, and most importantly, great-tasting craft beer by Gizmo Brew Works," the company shared on its website.

The company estimates that it has between $1 and $10 million in liabilities (a broad range as the bankruptcy form does not provide a space to be more specific).

Gizmo Brew Works/Roth Brewing did not share a reorganization or funding plan in its bankruptcy filing. An email request for comment sent through the company's contact page was not immediately returned.

 

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