Born in the UK, Michael Grant underwent a typical British boarding school education and studied business in Munich, Germany, on a scholarship from Siemens AG. After working for Siemens Dental for a number of years, he spent 2 years working for a US company in South Korea and 3 years in Australia for Espe prior to its sale to 3M. Following that, Michael was in charge of Espe Premier, Espe’s US subsidiary in Norristown PA for 10 years. For the past 18 years, Michael Grant has been an independent dental industry consultant working with DMG Hamburg, Henry Schein and Hu-Friedy. He is now based in Bangkok, Thailand, where he also has an organic farm 2 1/2 hours north east of Bangkok which specializes in 100% organic production of most fruits and vegetables, including mushrooms as well as producing numerous Thai FDA-certified health foods, beverages and snacks. He’s also about to open a restaurant and farm shop and cottages for organic farm stays are planned for 2019.
Joel H. Berg is Professor and Lloyd and Kay Chapman Chair for Oral Health at the University of Washington School of Dentistry in Seattle. Dr. Berg is a board-certified pediatric dentist and was President of the American Academy of Pediatric Dentistry for 2012-13. Dr. Berg previously held positions as Chair of Pediatric Dentistry at the University of Washington from 2003-12, as Vice President of Clinical Affairs at Philips Oral Healthcare (Sonicare) from 2000-2003, and as Head of the Scientific Department for ESPE Dental AG (Seefeld, Germany) from 1998-2000. He is the author of the book Early Childhood Oral Health, and of over one hundred manuscripts and book chapters on subjects including dental restorative materials for children and other work related to biomaterials. His current research interests include the development of dental caries prevention programs using risk assessment models and early childhood oral health.
VIDEO - DUwHF #1072 - Michael & Joel
AUDIO - DUwHF #1072 - Michael & Grant
Howard: It is just a huge honor today to be podcast interviewing Michael Grant, Joel Berg that we had on what, a week ago?
Joel: A couple of weeks ago.
Howard: I mean he is centered out of Bangkok, Thailand and if anybody wants to do dental business in Southeast Asia...
Joel: That's right he's the guy to talk to.
Howard: They need to talk to Michael Grant. He was born in the UK. He underwent a typical British boarding school education and studied Business in Munich, Germany on a scholarship from Siemens. And Siemens...
Michael: Big corporation.
Howard: Yeah, and when they were diversifying their [portfolio? 0040], they spun off the dental division.
Michael: Yeah, that's right indeed.
Howard: And called that Sirona and the building didn't move or anything it's just a lot of these big, like Procter and Gamble and Gillette they're redistributing their portfolio.
Joel: You worked for Siemens.
Michael: I worked for Siemens, yeah.
Howard: So really Sirona's really Siemens and it spun off and now it's owned by a Dentsply x-ray on the Nasdaq. After working for Siemens Dental for a number of years he spent two years working for a US company in South Korea and three years in Australia for SP prior to it sold to 3M. Man, it's a global world. Following that, Michael was in charge of SP Premier, SP's US subsidiary in Norristown, Pennsylvania for ten years. For the past eighteen years, Michael Grant has been an independent dental industry consultant working with DMG out of Hamburg, Germany and Henry Schein and you're friends with Stan Bergman, and Hu-Friedy which is Pennsylvania?
Michael: Chicago.
Howard: Oh, Hu-Friedy, Chicago. Okay. I'm sorry about that, brain fart. He is now based in Bangkok, Thailand where he also has an organic farm, two and a half hours northeast of Bangkok, which specializes in 100% organic production of most fruits and vegetables, including mushrooms as well as producing numerous Thai FDA certified health foods, beverages, and snacks. He's also about to open a restaurant and foreign shop and cottages for organic farm stays are planned for 2019. Ryan, who is the female dentist that we had on this show who always does a missionary trip to Bangkok, Thailand every year? She takes care of her husband.
Ryan: She's on Smiles on Wings.
Howard: Smiles on Wings.
Ryan: Yeah, let's see, hold on.
Howard: Are you familiar with her?
Michael: No, but there are a few people that ...
Ryan: Usa Bunnang.
Howard: Can you send me her YouTube?
Michael: There are a few people that come over and do work like that that I help sometimes, but some of them had originally brought the supplies with them and the equipment, which is very difficult. But the dental supply system in Asia is very sophisticated, just like here, they can get anything there.
Howard: So how long have you been in dentistry?
Michael: About two hundred and forty years.
Howard: Two hundred and forty years now. That is a long time.
Michael: The reason I got into dentistry was that I general Siemens training and the smallest group that Siemens had was dentistry and so that's why I chose it. I thought the power stations and airport lighting and household equipment they're huge factories or big companies with thousands of employees and the smallest one at that time were three thousand people was Siemens Dental. That's why I went into dental [inaudible 00:03:24].
Howard: And then they spun that off.
Michael: They spun that off, yeah and then I went to work with SP, SP in Germany.
Howard: So when they spun it off to ...
Joel: Sirona first.
Howard: When they spun it off to Sirona, did you stay with ...?
Michael: No, no that was long, long time.
Howard: Which city was Sirona in, was it Salzburg, Austria or ...
Michael: Yeah, actually Sirona moved their headquarters. Siemens Dental was in a place called Bensheim near Heidelberg in Germany and Sirona, I think for tax purposes moved their headquarters to Austria, but they kept the manufacturing plant and everything else.
Howard: Who just did that out of Japan? Who's the biggest Japanese company?
Joel: GC, they moved to Switzerland.
Howard: GC, they moved that to Switzerland but wasn't that just a tax move. Did they move any management or employees?
Michael: Mr. Nikowli, the owner moved to Switzerland.
Howard: Yeah, and now and it's funny because Connecticut's having a problem where they did a big raise the tax on the wealthiest so guess what's happening. Thousands of millionaires are moving their home.
Joel: Seattle just did that too.
Howard: Who did?
Joel: Seattle's raising taxes like crazy.
Howard: Yeah.
Joel: Phoenix is trying to get them down here all this companies.
Howard: Yeah, people don't realize that if you don't pay your taxes at the end of the day it's forced. I mean if you don't pay your taxes, they're going to come and arrest you and put you in jail. It's not a voluntary thing, you have to do that and it's so easy for so many people. Well, when people say free healthcare, I would say, well, what does that mean? Are you going to arrest me and take me to a dental office and chain me to a chair? Why do I have to work free? And they go, "Oh no, no, no, we'll pay you." "With what?" "Oh, other people's money." "Well, did you ask those people?" It's crazy how people just feel entitled to the rights of other people's work and break to be. But let's start back at macroeconomics. Do you think it was smart for Siemens to spin off Sirona and do you think it was smart for Sirona to marry Dentsply?
Michael: Siemens was a very good, very high-quality product company and it was sad actually that they spun it off. But it was so tiny, it was such a tiny part of their multi-billion dollar business. Many people that I used to speak to from other Siemens group didn't even know they had dental.
Joel: If I can pitch in, if you don't mind, there was a story that I heard about Siemens Dental, which I don't know if it's true, but I heard it many places, that about twenty-five years ago when Siemens still had the dental division, the CEO of Siemens was flying in a plane to the US in first class. And the two beds next to each other and he turned to his seatmate and said, "Hi, I'm so and so, what do you do?" And he said, "I'm an artist." And the other guy said, "Oh okay, what are you?" And he said, "I'm the CEO of Siemens." And the artist said, "Oh, I use some of your dental products for my artwork. I use some of the materials where I work." And he said, "We have dental products?" And then a month later it was spun off. I've heard that story many.... but it's a believable story.
Howard: Yeah, you can't make this up. When I was a little kid in Wichita, Kansas, there was a company in Maze, Kansas, and they made side balers. But through all the mergers and acquisitions it was eventually owned by the parent company Fiat and the CEO said, "What do we have in Maze, Kansas?" And nobody knew in Fiat headquarters so they just shut it down. Like if nobody even knows what this thing is.
Joel: Yeah, which probably a hundred million in sales or something.
Howard: Yeah, it was crazy. Do you think it was good that he married Dentsply and ...
Michael: I think it's a pity because I think.
Howard: You think it's, what?
Michael: A pity, I think it's not good that these good, healthy reasonably sized companies are then just spun off because it was very unique. It was very good, very high quality and people like it. It's the same with SP, SP was bought by 3M.
Howard: And where was SP out in Germany?
Michael: SP was in a place called [ Seifeld? 07:00], which is south of Munich. It's a beautiful, beautiful area and Joel also worked with me at SP and that's how we met about thirty years ago. And that was a great pity because they get swallowed up by a corporation and then the saddest thing is, is that the customer service level always drops I think because a smaller company is much more closely connected to the customers and the customer's desires and wishes and I think it's nicer if they can stay, but it's ...
Howard: Ryan, send me a stat on the S&P 500's from 2000 to 2018, their survival rate. And I want you guys to, [inaudible 07:55] she podcast eight thirty-one. Smiles on Wings with Dr. Usa Bunnang, I think she's out of Pennsylvania or somewhere. But she runs a charity out of Bangkok, Thailand and I told her ...
Michael: She must be Thai then.
Howard: Yeah, and I told her that I would go there with her, but I don't like to fly fifteen hours without killing ... like when Cambodia asked me to speak at their dental association. They said we got to get a neighboring country, so they called Malaysia so ...
Joel: He can hook up any lectures you want.
Howard: Yeah, yeah.
Michael: I can hook you up with [inaudible 08:29] Schein or whatever.
Howard: When we lecture in Cambodia, Ryan and I, we went to the airport, flew to LA, flew to Tokyo, flew to Kuala Lumpur, flew to Cambodia and from the minute we left our house till we got to our hotel room is thirty-six hours. So you don't go thirty-six hours, lecture, turn around and come back.
Michael: But I can hook you up. There's a great group called T32.
Howard: T32.
Michael: Yeah.
Howard: Can you find that Ryan?
Ryan: What is it?
Joel: Thirty-two teeth.
Howard: T32.
Michael: In Singapore, they have offices about twelve in Singapore. They have ten in Philippines, they have one big one in Shanghai and they have one in Hong Kong and they're looking also to buy some in Thailand.
Howard: It's a DSO, dental office.
Michael: Yeah.
Joel: But it's high-end practices.
Michael: Very high-end.
Howard: T32, in Singapore.
Joel: The principle guy is a prosthodontist, graduated [Udoug? 09:16].
Joel: Yeah.
Howard: What's his name?
Michael: Kengmun Wong.
Howard: Can you find that?
Ryan: Kengmun Wong?
Michael: K-E-N-G M-U-N W-O-N-G, family name Wong. W-O-N-G, T32, and the same guy. So they are very innovative. Their main aim is to educate people about products and even though they educate their own people obviously, but they also educate any other dentist. They're very happy to educate people and they have very close connections in Asia to America especially. So a lot of people do postgrad courses here and things like that so one of the advantages that Asia also has, is that it jumped in at the top level. I mean we've taken two hundred years to get where we are now and they come in and they have all the innovations and everything else that we have in America, and America is still the leading, in my opinion, country with new products, new techniques of operations and dentistry in general. Pediatrics with Joel, they're far ahead of most countries with pediatric dentistry and...
Howard: I still don't know why it's a specialty because all pediatric dentistry is just a small human.
Joel: Right, but nobody wants to treat.
Howard: What is your specialty? Small people.
Joel: Small, animal veterinarian dentistry.
Howard: So this is Dentistry Uncensored, I like talking about the most controversial things. But one of the most controversial things in these multinational companies is there is three-degree types of price discrimination. First-degree price discrimination is I sell Bill Gates a Coca-Cola for $1000 and I sell you one for $1 and Supreme Court says that's illegal. Number two is volume and Supreme Court says it's legal. If I buy one Barbie doll, I pay ten bucks, but if Walmart buys a hundred thousand they can pay five bucks. Supreme Court says it's cool. Just show your math, so that we know there really is volume, but number three is geographical and it is illegal in the United States by the Supreme Court, but it's done all over the world, especially in dental supplies. For instance, if you go to Scottsdale, the richest area, and you go to West Phoenix, the poorest area, and you go buy a basket of goods, you go buy a gallon of gas, a gallon of milk, a Big Mac, a pack of cigarettes, all the prices are the same. But then the insurance companies will ensure a population of people, say at Intel, and those employees come from all over the city and Intel pays a fixed amount, but then when you go to the dentist in Scottsdale, they'll value a crown at a thousand and you go to South Phoenix and it'll be five hundred.
Joel: Not much difference.
Howard: 50%.
Joel: Wow.
Howard: There's a lady that posted on Dentaltown today and she says there's this article in the Washington post about poor rural dentistry and what's wrong with the rural area, and this lady said, "Well, I was in a small town in rural and I moved just a half hour to Memphis and my insurance usual and customary fee is now twice to what it was. If they had paid me twice of what it was in the rural, I would've stayed there." I think Delta is the largest abuser of geographic price discrimination, but the pharmaceutical companies, we know they sell Viagra for $10 a pill. I didn't know that. Joel just told me; That's his thing. But they sell the same pill for $0.25 in Shanghai because it might cost them a nickel to buy it. And then so Walmart started to say, "Well, gosh, if you're going to sell this stuff for dirt cheap in Asia, we're going to go put up a buying store in Hong Kong."
And they were buying up all the pharmaceuticals, shipping them back. But then when George Bush was elected, I think the pharmaceutical industry raised about $6,000,000 so the first thing he did is pass the law to ban the re-importation of drugs. I'm sitting there thinking, okay so all these mom, pops, senior citizens voted you in office and the first thing you did is throw them under a bridge for a $6,000,000 donation? Couldn't you just have said, "Hey, if six million seniors each give me $1, I'll let you buy Viagra for $0.25 a pill instead of $10." But sorry, this is the end of the question, I know I rant too much. But what they call in dentistry gray market...
Michael: Right.
Joel: Yes.
Howard: And they say that obviously, they sell bonding agents for $250 a bottle in America that they sell for $50 in New Delhi. And then when a dentist who’s from Indian descent in Phoenix calls his dentist father in India and says, "Buy it all up and ship it back UPS." It's all good, but we're supposed to say that that's bad, it's dirty, it's a gray market. So talk about that.
Michael: There are specific problems with gray market and the biggest problem is that you don't know when it's re-imported whether it's the real thing or not. It could easily be a copy and it could be very dangerous. There are some things in China that happened when they put melatonin in children's milk and things like that. So you cannot guarantee that it's going to be the original product if you...
Howard: Can I just stop you there? In a large B to C market like Melatonin and Viagra, Vitamin C, I totally get that. But in a small B to B market, would anybody really go into the B to B business of making dental bonding agents?
Michael: People that do it in a small way makes enough money for them and they'll do it.
Howard: I'll give you another example. I had several friends that knew that Patterson had an exclusive distributorship with the cad cam CEREC machine so they just flew to Germany, bought it from there and then shipped it back here, and so they got it for sixty grand back in the day and all their friends were paying a hundred grand because Patterson, marked it up 40% and that is illegal. But then the Patterson reps like, "Well I don't want to lose my $5,000 a month supply account over enforcing this illegal activity." So do you think the gray market is a bad end, do you think it's very...
Michael: I think it’s problematic, but I work with the MG and Henry Schein and Hu-Friedy, but Henry Schein for example, bring a big assortment of products in a one-stop shop area or a system in Asia that a small dealer couldn't do. And also because registration products are getting more complicated and more expensive in Asia, many of the original small dealers that were importers, they can't afford it anymore.
Howard: Because why?
Michael: Because they can't afford it anymore. They can't afford the registration because just take Singapore for example, there are about two thousand dentists and if you have a...
Joel: Like Seattle.
Michael: You have an exciting product coming out and the local importer says, you know maybe I've got a thousand of those two thousand customers and it's not worth it for me to register it, but somebody like Schein can afford to do it. If the local dealer doesn't register it, it means the dentist can't use this amazing product that's new and innovative and exciting. So there are pros and cons with all those sorts of things like that.
Howard: Now I noticed one thing that would concern me, I'm in Phoenix, so one of the problems with buying supplies in Phoenix is that when you throw them in the back of a UPS truck, it's a hundred and forty-five degrees. So back in the day when I opened up in '87, we used to complain all the time and you would get polyvinyl siloxane pressure gel that wouldn't even set. It would just be this permanent goo and then you call and they go, "Is there any chance you're in Phoenix?" I'd say, "Yeah, I'm exactly in Phoenix." So I know heat and so if somebody bought something legit, but then it wasn't stored or refrigerated or the right conditions.
Michael: But the major manufacturers that I deal with they have strict guidelines of how you can store it, how you can deliver it. For example, local anesthetic has to be delivered and cooled, which is more expensive obviously, but in cooled containers and things like that. And also the impression materials can't get too hot and they have storage recommendations for the dealers and delivery dept, because in Asia it can be on the back of a motorbike and these cities Hong Kong or Singapore, they deliver the motorbike and it's boiling hot like it is, and so they have to have special containers then to deliver them. It's getting more complicated. It makes it more expensive also for the [inaudible 18:12]
Howard: That anesthesia thing though I always think that anesthesia thing it's not all quite whatever anything says because Stan Bergman, who's a friend of both of ours, several times I've been out in the middle of Timbuktu jungle, whatever, on some missionary dental trip and all of a sudden you come up to something that looks like my house with ten operatories and it's like, "Who the hell built that?" It's always, Stan Bergman. It's always Henry Schein, but the funniest one was we were at an orphanage in Tanzania and I told these kids, I said, "The guy that built all this is my friend and I'm going to take out my phone and I want you to thank my friend, his name's Stan." So I'm telling them all and they're all listening, but you don't know what they're hearing. And I said, "Okay so when I say three everybody say thank you, Stan." And I go, "One, two, three," and they go, "Happy birthday to Stan." It was so adorable, these little kids and...
Michael: Schein is a very benevolent company. They do a lot of good work all over the world.
Howard: So what do you thinks going to happen with Stan and Schein with your neighbor in Seattle, Amazon? I noticed that the last two greater New York dental meetings Amazon had a booth, but I've been seeing them stalking meetings for four or five years. What's the corporate DMF? I spoke there one time in San Diego, the dental manufacturers...
Joel: Oh the DMA.
Michael: DMA.
Howard: Dental manufacture. [Inaudible 19:48] San Diego and there were two men in black and everybody knew they were with Amazon. What is your prediction?
Michael: I think that people like Schein have a customer service level that you need when you're treating a patient and you got something that's not working, but you can call up and then find out exactly what's going on and if you're making any mistakes and what you can do to avoid a mistake. You can't do that with Amazon, so I think that the direct contact with the customer that Schein and other companies like that have are beneficial and I don't think Amazon will be able to provide that.
Howard: I think the most interesting feedback is we had on the president of the 3M of the dental division, which does over a billion a year in sales, and he was sitting right in your chair and I asked him what he thought and he says, "You know what's funny?" he says, "so many people ask me about that, but you know who's never asked me about that is the dentist." He goes, "I've never had a dentist say, will you sell your stuff through Amazon or Amazon Prime?" And I think what it is is the dentist, they always think their number one cost is labor, but their number one cost is the PPO reduction fee. They charge a thousand for a crown, the insurance pays six hundred. So 42% is PPO fee, the dentist is 35%, the staff is 25%, the lab bills 10%, supply is 6%. So on the feeding chain, they're mostly concerned about PPO's, they're mostly concerned about labor. They've got their eyes on their lab bill...
Michael: But they worry most about...
Howard: By the time they get to supplies and the electric bill...
Joel: They spend a lot of time worrying about that though.
Michael: Yeah, they do.
Joel: The amount of interest on the part of dentists isn't related to that percentage?
Howard: You think the interest is not related to that?
Joel: I mean I think they don't spend enough time talking about, as you just said, which is correct.
Michael: They didn't realize it often, they're all so low.
Howard: And the weirdest thing is ... so the PPO reduction is their number one cost at 42%. That dentist pay for dock is 35%, staff 25%, lab 10%, supply is 10%. But here's where it gets just creepy, marketing is 3% and they won't do it. They don't blink. I'll say to you, "Hey, will you do all your dentistry 42% off?" "Sure, where do I sign, okay." Hey, instead of 3% you want to spend 5% marketing to the half of America that over a hundred and fifty million people that don't even have dental insurance and will campaign for your $1000. "No, I don't like selling dentistry, I like marketing."
Joel: I know I’m not supposed to ask questions for you, but it's [inaudible 22:34] if I could ask you that.
Howard: Absolutely, pretend we're at a barn having a beer and a cheeseburger.
Joel: Good, because the first thing you said, the PPO reduction, which is interesting and I think dentists they don't like it of course and they talk about it a lot, but it's a reality. So I'm hearing your advice to dentists would not to fight that because you can't change that, is to do more marketing. Is to recognize that is true and to spend more in marketing. In response specifically to the biggest expense and to say, "Look, I can't get by with this $600 a crown, it's not going to work for me." So complaining about it doesn't change it.
Howard: There's two trains on the PPO discussion and I'll talk about the first one. All three of us have to agree that when we got into dentistry the biggest brands in dentistry, Colgate, Crest, and Listerine they were already there. The biggest brand built in our lifetime was Invisalign. And Invisalign is sixty-five hundred bucks and there are a thousand dentists who spend 5% of collection doing all this Invisalign advertising and they get five to ten, some of them fifteen and in places like Cambodia and Indonesia. I'm not talking about New York City, that are coming in and dropping sixty-five hundred for Invisalign. So I mean half of America does not have any form of dental insurance and most dental insurance doesn't cover orthodontics. And I mean when you get a high ticket item like Invisalign, I mean it's just crazy. I know one dental office that spends 15% on just digital marketing.
He's an Orthodontist. He's doing five million a year in Invisalign. And also when we were little, the big old families, no birth control, just the really worst child got braces. Now they come in at forty and they're just post divorced or getting fixed up again and they're like, "This ones rotated and this one's chipped," so people are buying $6,500 Ortho when no one in their friends and families, even knows they have a crooked tooth. So...
Joel: So marketing is the answer.
Howard: Yeah, so I think Invisalign is just going to... I think that stock will do well because orthodontics is no longer treating malocclusions and crossbites and that. It's forty-year-old women saying, [inaudible 24:48]. It's almost gone into the mani-pedi, hair, fashion, personal grooming market. But the thing about the PPO, which is abuse and I wish dentists will lay the line is that I've always said that the reason the people have never trusted help from governments around the world is because they're never really trying to help, they're always trying to control. They don't sit there and say, "Hey, here's $500 a month to help you with your apartment or condo or trailer or whatever." They said, "No, you have to live in government housing."
The same thing with the insurance. Delta's not helping anybody because they're saying, "Oh no, here's the fee. You can only sell a Ford Taurus and there will not be a Buick, a Cadillac, a Ferrari." It’s like why is Delta killing off the Ferrari, Mercedes Benz? Why don't they just really try to be a benefit and say, "Hey, you need a crown? Well, our fee schedule a crown will only be, say seven hundred and we only pay half. That’s three fifty. If you want to go to a dentist that charges a thousand, knock yourself out. Here's a list of all the dentists in Seattle. Here's the ones that take our fee schedule and here's the ones that you'll have to pay a higher fee." Because people value stuff differently and so what happens then...
Joel: That's indemnity insurance then basically, is what you're saying. Indemnity insurance.
Howard: Or when they set their fee schedules. They set their fee schedule and it's great when they want to benefit and help, but when they sit there and say, "Oh no, we want to control. We want to go into a price market segment of a Chevy, a Taurus, an Olds, a Buick, a Cadillac, a Rolls Royce and say, there will be nothing above a Ford Taurus. There will be no Buicks, Cadillacs, Chevys." And then when some girl really values this and says, "Well I live in a poor part of town and I want to go to this fancy cosmetic dentist in Scottsdale," but she's not a member, well, why is she not a member? Because Delta says, "Well, you have to accept our fee." Well, why can't that little girl who's getting a benefit from her employer — this isn't some federal government deal; the employer bought this — why can't she apply her subsidy, her benefit? Same thing in public housing, there's all this crime in all these areas. If you just sit there and said, "Well, we're not going to provide your government housing, we're going to give you a benefit. We're giving you five hundred a month." How many would go rural? How many would go buy their own trailer park or their own condo? But see, it's never about helping. It's always about controlling and then it always does not end well.
Joel: Totally agree with you there.
Howard: It never ends well.
Joel: You should ask Michael because I think the dental insurance doesn't exist in Southeast Asia, right? And this T32 which is doing well…
Howard: So name the countries that you understand well. Is it basically all of Southeast Asia?
Michael: Yeah.
Howard: And which one of those have dental insurance?
Michael: Singapore has some sort of dental insurance I think.
Joel: Not much.
Michael: But most of them don't.
Howard: Japan does.
Michael: I have to correct myself. Thailand has dental insurance, but unfortunately, the level of the care is...
Joel: Most people work outside the system; it's like UK.
Michael: Yeah, but the level of care, I mean they can get it for very little money.
Howard: So do you consider Japan Southeast Asia or not I really?
Michael: It's different altogether. Australia, New Zealand, Japan, Korea, they're...
Howard: Alright, I'll give you another example in Japan, and not just Japan, one of the greatest civilization ever lived, but in France, Paris, and London. London, Paris, and Tokyo has got to be top ten list of the three greatest civilization that ever lived and when I podcasted live from there, when I was lecturing there and podcasting live, no one would go on the podcast and say, but they all tell me the reason implants are booming is because in all three of those great civilizations, the government insurance will only pay $100 for a molar endo. But it's not a $100 benefit towards your molar endo, you can only charge $100. So when you need a molar root canal, and Tokyo has got a higher cost structure than Phoenix and we're over here getting a $1000, so what do they do? What do they do?
Michael: Go private.
Howard: They extract the tooth because an implant is not on the deal. So they say, "Yeah, that tooth's got to come out." So they're pulling a human tooth that [inaudible 29:11] root canal and crown and place an implant because they can charge $1,500 for the implant because it's out of the government. So if those three great civilizations would say, “We only give $100 benefits or root canal,” then the dentist in Tokyo would say, “Well a root canal costs $1000. Insurance will pay a hundred. Do you want to pay nine hundred just like you bought a Honda Accord, and a Lexus, and a Toyota and a Sony, or what do you want to do?”
Joel: Do an implant for more money.
Howard: And that's where dentists and physicians need to wise up because I think there's a general consensus that people need help in healthcare. But once the help crosses into control, then the pros and cons...
Joel: But how do dentists change that though because they don't have the decision power to change that fee structure, the fee schedules thing?
Howard: Well, I know I'm not a lawyer, I'm not an insurance person. I'm just a short fat, bald, dumb dentist from Kansas, born in a barn. But that's...
Joel: I didn't know the barn part.
Howard: Well I know I was born in a barn because my mom told me a million times, every time I left the door open she said, "Howie, were you born in a barn?" And I thought I must have been because I always leave the door.
Michael: But you know that group I was telling you about in Singapore, T32, they are endeavoring to make implants more accessible to the people who don't have so much money. They're working hard on it. They do the top of the line stuff, but they're definitely making an attempt to make it feasible for a person with less money to get one if they need one.
Howard: So explain to my homies here in the United States, Canada, Australia, country by country tell them what's dentistry like in Thailand and...
Michael: It's like anywhere else. I mean even in America you have very high level dentistry and you have poor dentistry and in Thailand, it's exactly the same. But you can get, for example, I'm quite close to the number of universities in Bangkok, you can get very good dentistry for a little money. But you can also go to one of the top of the line dentist to treat a lot of tourist dentists. In Thailand, in general, there's a lot of tourist medical care and dental care.
Howard: See why can't interns also do that, I mean what a concept. Why is it $100,000 for a bypass here and you can get the same bypass done in New Delhi and the Indian doctors I think have to be better because if you look at how many people applied to get into med school or dental school in America versus India, you have to be a freak unicorn to get in. I mean you have to have a resume that basically says I'm Batman. If Batman and Wonder Woman had a child this is the freak that would come out because they're either straight A...
Michael: Half the medical community in England are from India and they're very good. They're highly trained, very good, very successful, and very able.
Howard: So is dental tourism a thing in Thailand?
Michael: Yeah, definitely.
Howard: And where are they mostly coming from?
Michael: All over. From the Middle East, from Europe. Thailand itself gets about twenty million tourists a year.
Howard: And what are the main reasons of tourism? What's the number one attraction? This is Dentistry Uncensored so just go ahead.
Michael: They have in high season weather, like Phoenix, not quite as hot but dry during the three or four months of the year. It is inexpensive in comparison with many other countries. They have beautiful islands with clear water and fish and unspoiled things like that as well. But they also have to be careful because the more and more tourists come, the more likely it is to ruin the [inaudible 32:58]
Howard: But what about safety?
Michael: It's very safe.
Howard: Most Americans number one concern is, is it going to be safe.
Michael: The funny thing is that most American cities are much more dangerous than any other city in Asia, much more dangerous. I would be much more concerned about going through certain areas in Philadelphia where I used to live than I would walking around Bangkok at night.
Howard: Yeah, but that's a problem because in America you know where not to go and...
Michael: Yeah, but now the tourists don't know.
Howard: Right, right.
Michael: But it's very safe. Most...
Howard: Yeah, I quit going to Cabo. Me and a dentist in New Mexico, Craig [inaudible 033:29], we always used to go down there and go deep sea fishing. But the last time I was down there, the policeman robbed me. I was walking back to the resort and it was only like a mile and I hear these sirens so I kind of go to the side of the road and they pull up right behind me. So I kind of get more on the grass because obviously, it's not me. No, no, it was me and they threw me up against the truck, frisked me, took all the cash, credit cards in my wallet, threw the rest on the ground. Jumped in the police car and rode off.
Michael: Amazing.
Joel: Unbelievable.
Howard: And then I walked in there and I complained to the hotel manager and he actually started crying. He goes, "They're ruining our business."
Joel: I'm sure.
Howard: He goes, "I've been here forever," and he goes, "most of all my good clients aren't coming back." But they say ten thousand people get killed. Oh and then we did a charity dental thing where we flew to Acapulco. Here's how Howie likes to do charity because I'm too old for living in the jungle and all that stuff. But there was this one where we could stay in five-star resort in Acapulco and then every morning it was an hour drive up the dirt road and we do charity dentistry all day. But at the end of the day you're back in a five star resort and all that stuff like that, but we were there for a week and Zach was there, it was Zach and it was like the fourth or fifth day there, there was like three people gunned down in front of the hotel.
Joel: Yeah, I know. Indonesia might be a little bit right in the southern part of Thailand on the border.
Michael: No, but the southern part is Malaysia, no.
Joel: Oh Malaysia, on the border of Malaysia, yeah.
Michael: But, yeah there are some problems in that area there between Malaysia, but otherwise it's very safe, very safe and inexpensive and they are very friendly.
Joel: Service orientated
Michael: Very service orientated.
Howard: In the twenty richest countries the dentist are always in the top 1% in years of education and they're usually in the top 5% in income.
Michael: Right, same.
Howard: Is that about the same?
Michael: That's about the same in Asia, yeah.
Howard: About the same.
Michael: Yeah, definitely. I mean in the countryside they're perhaps not as well paid, but it is about the same, yeah.
Howard: So tell us what do you do? What is your job? What is your business?
Michael: I work mainly as I said before with a company called DMG and Johnny, which is a manufacturer of lots of privately owned company. It manufactures, many types of...
Howard: Out of Germany?
Michael: Yeah, out of Hamburg, Germany. I work with Henry Schein and Henry Schein are establishing themselves in Asia. They already have a place in Hong Kong, they have something in China and they have they bought the biggest deal about five years ago in Thailand and they're also looking at other places.
Joel: Australia the only dealership.
Michael: Australia and New Zealand, they also have. And I also work with Hu-Friedy and Hu-Friedy is well known for high-quality instruments all over the world and I help promote their product, I have a lot of connections. For me, me personally it's not what I know it's who I know more because I have a lot of connections. Having been in the dental industry for very long, I know a lot of Deans of the universities. I've been friendly with Joel who's famous as well for about thirty years and we worked together when I was with SP. So that is mainly what I do and I try where I can to help students if I can do that. I work quite closely with the university called [Shazer? 36:54] University in the Middle East and a group of their student's association I tried to bring to DMG, to Schein to whoever, to let them see other parts of the world and let them introduce them to the dental manufacturing world, which they would never normally see. And also, for example, I'm trying to get somebody to do a postgrad course, I'm trying to help somebody do a post-grad course in Thailand which will be based on English study.
Howard: You're trying to get someone to do it?
Michael: No, I'm trying to help them to get there because one sad problem is that with the states the cost of post-grad courses here is very expensive. And now a lot of them are concerned because they don't want too many foreigners here. And so there are other areas opening up in Asia, Australia, New Zealand, South Africa to cater for this group of young dentists that don't have so much money but still want an advanced, post-grad education.
Howard: So you're looking at putting lower cost post-grad education centers in Southeast Asia.
Michael: Yes.
Howard: Would you do much of it online?
Michael: Well, no, at the moment I have contacts with various universities. I have Thammasat University just outside Bangkok for example.
Joel: T32's going to do that, right? They're trying to do what you just said.
Michael: T32 this group and DSO group in Singapore they center on education, education for young dentists, for existing dentists and that's what I like. And I'd like you to do a podcast there sometime because...
Howard: Where?
Michael: In Singapore.
Howard: Last summer I lectured in Singapore, we did four or five podcasts there.
Michael: Yeah, but this particular group are already dedicated to education.
Howard: Absolutely, and what's the name of the group?
Michael: T32.
Howard: Let's see if Ryan found.
Michael: But there are other groups like that too, but they are specifically dedicated to educating competitors and their own people and young dentists and students.
Howard: Ryan, found it.
Michael: Good on Ryan.
Howard: Ryan, good job. Detective Ryan.
Ryan: Which was that?
Howard: T32.
Ryan: Oh yeah we got that.
Howard: He wants us to lecture there.
Michael: Yeah.
Ryan: Oh right.
Howard: Well, another thing we used to talk about Stan and those guys is Dentaltown has four hundred and fifty online CE courses. They're all ADA approved, AGM approved. The vetting process is enormous and I argue with five, six dentists every day on the email that we won't approve his course. We just tell him you're saying this stuff, but it's your feelings. It's a belief model. We can't be a belief model, we don't want to lose our- But anyway-
Michael: But my two heroes in the dental industry are Stan Bergmann and Gordon Christensen. Also with Dr. Christensen, he has these podcasts and training seminars and he also reaches out to the poor people in Asia. I'm allowed to try and get people connected to the CRA at a much lower price, for example, than they would have to do it here, so that's very important.
Howard: Yeah, he's my dental dad. Anyway, when I came out of school, one of the first things I signed up for was going up to Provo once a month for a year for his twelve PCC courses.
Michael: Amazing.
Howard: And he was the first role model that when you come out of school dentistry, you got it. I got it. I remember telling a guy when I was out of school, we were talking about crowns and bridges, and he can’t prep a crown. He can’t prep a tooth for a crown. A monkey could do it. And Gordon was the first one that made me understand, “Howard, you will never, ever, ever understand dentistry. You'd have to live a thousand years.” And you know what you know, you don't know what you don't and he was the first guy that took me from dentistry was a craft to dentistry is a science that you and him and me will never- I mean, last time I was talking to [inaudible 41:06] she was telling me, you hear all these one-liners like, "Well, cavities are caused by streptococcus mutans." And I was like, "You know, by the time you're four millimeters deep into a cavity, not only is there no streptococcus mutans, we're discovering a new species of bacteria every three months, four a year!” So when these little simple one-liners like, "Hey, cavities are caused by streptococcus mutans,” well, they're not.
Michael: But also comparing dental products for a dentist, I think what CRA does is comparing the dental products because everybody who makes a product comes and says ours is the best product and everything else, and he will tell you it's too expensive, it's no good, if they need more studies on it. I mean that's a wonderful thing that he started, Dr. Christensen. Amazing.
Howard: So let's go to more controversial stuff. Amalgam. One of the things I don't like is people, they don't realize when they're saying stuff on Dentaltown and Facebook that there's two million dentists around the world reading this and I remember going to a dental office in, it was either Tanzania or Ethiopia or Somali, it was one of those villages, and the dentist, great guy, had his chair, but anyway, so he puts on the acid etch and then he rinses, but he doesn't have an assistant with a high-speed suction. And then the lady puts her hand out and she takes a Dixie cap, rinses, spits the water. Then he puts the bonding agent on and cures. And then the lady puts her... She's a Muslim girl and it was very difficult and she swishes again. Then he puts on the composite and he cures it and he’s doing all this stuff and I'm okay, this was just... So in order to have an adhesive dentistry practice, you need high-speed suction. You need four-handed dentistry, you need all this stuff, but when you go around the world it seems to me gross numbers, five hundred thousand dentists practice like they do in Germany and Japan and a million five don't have that facility. So how does composite work? So tell me do you see amalgam in Southeast Asia?
Michael: So Asia is reasonably sophisticated, so they're highly trained and they have access to all the equipment and so usually they have all that, they can do adhesive dentistry. There was a very famous dentist called Dr. Graham Mount who was very big in Australia in the development of glass ionomers an...
Howard: Dr. Graham?
Michael: Graham Mount, yeah. He was very famous.
Howard: Graham Mels?
Joel: Mount.
Michael: M-O-U-N-T.
Howard: Can you find him?
Joel: He was like the main clinician involved in the study of glass ionomer when it first came out.
Michael: Yeah, with Wilson and who else [inaudible 43:57].
Joel: McClain.
Michael: McClain in England, but...
Howard: Does he still practice?
Michael: No, he passed away two years ago.
Howard: It is so hard to podcast someone since they passed away.
Michael: It's true, but he did amalgams. He had amalgams in patients that were thirty years old. They were done very well. Perfect. No secondary caries.
Joel: That's what I find interesting about him. He was a master of gold. He was like the Tucker Study Club guys, he was quality of gold stuff. He was a master of amalgams. The most beautiful amalgams you ever saw and with glass ionomers, he did them beautifully too. As you just said, Howard, they bastardized the technique and they started seeing it as sort of sloppy stuff instead of if you do it the right way, you can have really high-quality dentistry.
Howard: Well, that's a great geographical question. Why do you see glass ionomers used more in Australia, New Zealand, Southeast Asia, than in the United States?
Michael: Because of people like Graham Mount. Graham Mount was in Vietnam a lot because one of his disciples, Professor Hien Ngo who went on to do a lot more with...
Howard: Who is now the Dean in the dental school in Kuwait.
Michael: Right in...
Joel: In Sharjah, United Arab Emirates.
Michael: It's next to Dubai, yeah. So because of him and because of Professor Hien Ngo, Vietnam has a high usage of glass ionomer because it releases fluoride. If you seal it well, it’s easy to use.
Howard: I brought Hien Ngo, flew him all the way — back when he was in Adelaide — to Ahwatukee when I was in charge of the Ahwatukee Study Club thinking, man, are you in for a treat? And like forty people showed up. Just an amazing guy.
Joel: He's a great speaker. I love listening to him.
Michael: He is a close friend of ours. I know him very well. He also has a small farm and he's been to my organic farm.
Howard: I know you guys got to run, you got to catch a plane. Talk about your organic farm.
Michael: Well, in America they say you can take the boy out of the country, but you can't take the country out of the boy. And so I was brought up in the countryside in England, in the Hereford area which is a beautiful area between England and Wales, beautiful rivers, mountains, wild ponies and I was brought up with horses and animals and lots of dogs and hunting and things like that. So I always wanted to have a farm and in America, I have my place in Pennsylvania, five acres in the countryside, but I couldn't afford to employ anybody and I was too busy to do it myself.
So when I go to Thailand it was affordable in comparison with other countries so I started the farm and it turned out to be an organic farm and I have a Thai partner who runs most of the farm because I'm away most of the time, but I love it. I love the animal part of it. We don't kill any animals. We use the animals for their poo for fertilizer. We have cows and we have pigs and...
Howard: So are you vegan, a vegetarian?
Michael: No, I'm not, but I'm a flexitarian. I would like to be a vegetarian, but it's complicated and sometimes impolite when I go to dinners and invited to things. So when I'm in Thailand for example, I hardly eat any meat at all. Here with Joel, I have to eat meat every day because that's all he gives me. And...
Joel: I'm an [overlapto, bovo, porso, avo? 47:09] vegetarian.
Howard: I am a vegetarian, I’m a 100% vegetarian.
Michael: Well, that's right.
Howard: I only eat animals that only eat grass.
Michael: I have a friend in New Zealand and he says I eat everything that moves.
Howard: Well, I call it the scream factor, a vegetarian, because if you kill an animal and it cries like a human, like a dog, it's illegal. But when you cut a fish head off doesn't make a sound. So many people who save the cows, chickens, and pigs, they don't care about fish and you cut a tomato, you're killing tomato. It doesn't scream. So I just line up in the scream factor. If it has a face that makes you say, "Ooh, aah and it cries when you kill it...
Michael: Anyway on our farm, we kill no animals. Even the chickens when they stop laying they go into retirement and they just cost us money because we feed them. But we use all their fertilizer, it's very strict. Believe it or not, even though it's in Asia, they're very strict on using any pesticides or insecticides or artificial fertilizer and so...
Joel: Things like the guinea fowl you have ticks, you choose animals that eat animals.
Michael: You also grow plants that help with other plants. Marigolds, for example, support tomatoes and guinea fowl they eat the ticks.
Howard: So are you going to tie this into dentistry somehow? Are you going to use it for a source of continued education?
Michael: Well, yes we're just about to open, what do they call it?
Joel: Breakfast kind of...
Michael: No, the office, what they call it? Remote office for people who want to come. So we're just preparing a room in the countryside at our farm where we have Wi-Fi and printers and everything else and people can come and work there, eat organic if they want to. If they don't want to, they can eat...
Howard: Ryan, you want to go visit and podcast again on his farm.
Michael: It's beautiful.
Ryan: I would love that, that be awesome.
Joel: I’ll go with you. It's beautiful there, beautiful.
Howard: Joel and I we will continue this conversation from Thailand.
Michael: We'll do the Singapore one. We'll do Thailand. I'll take you to the universities and introduce you to the deans of the universities there. There you can also hear from them, how involved they are with the west and how it's working there and then we can have a podcast from the farm and anyway you want that we can do it.
Howard: I am so bullish on humanity because a lot of people they lose their senses they think today's very bad times, politics in the United States. Did they forget the Civil War when one in every thirty Americans were killed?
Joel: Right, right.
Michael: No.
Howard: They're all upset about all these things, but did they forget the last century we had World War I and World War II? When they're complaining about the deficit, did they forget about the Great Depression from '32 to '36 where we lost a third of the banks and had 25% of them [inaudible 50:07]. But I think this smartphone that came out in 2007, I think that's going to be the world's finest century because after everybody had a smartphone and it killed nationalism because there's people in Thailand talking to Americans, Canadians, and Germans and it's just this whole ... I am so optimistic on this.
Michael: That's true, but that's why I like to bring dental students together or take them to some other countries so that they can see and meet because American and English people they have a certain mindset about what people are like in Saudi Arabia or what they're like in Asia. And then they go and see and they think, my gosh, they're normal nice people. One of the plans is we don't make any money unfortunately yet with the organic farm, had it for about five years, but it takes a while until you can make money out of it. But what my plan is, first of all, that we treat the people well that work with us. We have a lot of Burmese people working on the farm and some Thai people, but our plan is when I start making money is to get orphans and train them, send them to agricultural school, train them in organic farming so they can also get involved an opportunity that they would never have normally. So that's the sort of thing, that's the aim.
Howard: And that's kind of the PPO versus the fee for service. The stock agriculture people are willing to pay a lot more. Like when we were little, all coffee was free at every gas station in America, they had a pot, a little Styrofoam cup, and now people are saying, "Okay, I don't want free. I want to pay five bucks a cup." If you had asked me when I was ten do you think someday you could sell coffee for $5?
Michael: Exactly, you're right.
Howard: I would have laughed.
Joel: You see the Jackie Mason skid about Starbucks?
Howard: No.
Joel: I'll send it to you. It's the funniest thing ever.
Howard: But I know that when I buy cage-free chicken eggs, people are just paying more. To say it's one thing to steal their eggs, but I mean you shouldn't have to live in horrible conditions and then steal their egg.
Michael: But in Asia, it's not as widespread yet.
Howard: What's not?
Michael: Organic farming or treating animals better and things like that, but it's growing. That's why dentistry is growing because the middle class is growing and the awareness of oral hygiene and things like that are growing tremendously. So it's a big growth area.
Howard: And then I just want to say one thing on the international travel, when I hear Americans say that America is the greatest country ever lived. Okay, I already know they've never left the country. When people talk about other religious radicals around the world, how many religious radicals can you name? I mean you go to any family, you go to half these churches, there's crazy old men saying crazy stuff in every religion. But the one thing on my intellectual journey that made me the smartest, was not nine years of college, it's visiting fifty countries. And that's why I always try to convince my boys, I always took at least two, three, sometimes four to all these countries and I think my boys are wiser from seeing all these countries. So let's do this, you plan any trip and when you fly that far, you want to stay at least ten days and then go around.
Michael: We actually are planning a trip already in October.
Joel: That's a different one for pediatric, we're doing this one with Howard.
Howard: But I got to tell you my last story. One day I got off work at 5:00, went to Phoenix Sky Harbor, flew to LA had a layover. Flew sixteen and a half hours to Sydney, landed at 6:00 in the morning, got to the convention, lectured for the Australian Dental Association from 8:00 to 5:00. And then they took me back to the airport and then like 9:00 that night caught a sixteen and a half hour flight back to LA. Then I had a layover and then back to Phoenix. Got home just in time to change into my uniform and see my first patient Monday morning at 7:00 am. That's something you can do when you're in your twenties, but at fifty-five...
Joel: You don't want to do it.
Howard: Oh my gosh.
Michael: But you can relax at the farm.
Howard: Absolutely.
Michael: We'll go to Singapore, we'll go to Hong Kong.
Joel: Best food you've ever had.
Michael: I'll introduce you to Schein in...
Howard: So of all the countries you lived in if you had to stay in one place and never leave again, where would you stay?
Michael: Well, I think America is amazing. I lived in America for sixteen years. There are all sorts of things in America. It's a beautiful, wonderful country with lots of very nice people here. Australia is probably the choice I would make because it's a little bit more English and there are fewer people and they have everything. They have snow, they have sun, they have desert, they have rivers and lakes.
Howard: That's where my brother moved to permanently.
Michael: Yeah, but Asia's nice too. You know it's difficult because like yourself if you traveled a lot there are nice things in various places.
Howard: I know that's why I'll never buy an [inaudible 54:57]. People are saying, "Why don't you buy a condo?" Dude, I don't want to go to a condo every week. I'd rather go to Thailand and the next time go to Vietnam.
Joel: What you said about Americans and not being cosmopolitan I think I heard a statistic, I think it's still accurate that 70% of Americans don't have a passport, which is the highest number of even developing countries. Most of them have passports.
Howard: And the funniest thing is when they say things like, "Well, that's socialized medicine." I say, "Well, what does that mean, socialized medicine?" "You know like in them socialist country." And I'll say, "Like what?" They'll say, "Like Scandinavia." Well dude, have you been to Denmark, Finland, Sweden, Norway. Pretty sure those are the four nicest countries on earth and you're using that as a swear word.
Michael: I think Sweden is the highest rated for people who are happy.
Joel: Satisfaction, Denmark's number one.
Michael: Satisfaction, yeah.
Howard: Oh my God. I remember one time I was in Sydney, Australia, and on the front page of the Sydney newspaper, they were talking about some ladies trunk up broken into. I'm like in Phoenix, they can find a dead person in an alley and it wouldn't make the newspaper. But hey, you should get on Dentaltown talk about what you're doing and that organic stuff and you plan a trip, we love...
Michael: I promise you I'll plan the trip for you.
Howard: It's my number one hobby is talking to dentists.
Michael: I’m happy to do that for you.
Howard: It's so funny because some people go to these deals and they want to check out all these restaurants and all that. My genuinely coolest funniest deal is to go to those countries I just walk into dental offices and I just hang out in dental offices and check it out. It is so interesting.
Michael: I can take her to many dental offices. I can take you to the universities. I’ll take you to Henry Schein, which is a big corporation in Thailand.
Howard: Should we get Stan to go with us?
Michael: I'm not sure, he's a busy man so we'll go see.
Joel: But you can coincide it.
Michael: Yeah, yeah, but it'll be very interesting for you I'm sure because I can give you a good inside view of what's happening in dentistry...
Howard: Well, this show will be continued. Part two will be filmed from Bangkok, Thailand.
Michael: That's it.
Howard: Thanks so much for coming in today.
Michael: Lovely, thank you so much. [Inaudible 57:14]
Howard: Thank you so much.