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Per Ahlberg, CEO of Per Capita AB, discusses Sweden's different approach to dentistry.
Sweden and I am not like others!
First of all, I am not a dentist, dental technician, dental hygienist or dental nurse. I am a Web-entrepreneur that has now worked in 10 years within the dentistry in Sweden. I am now working in my own company Per Capita AB together with some of the most dental skilled people, institutions and companies. 2008 I founded www.Dental24.se. In 2010 I was nominated to The Web Entrepreneur of the year by InternetWorld, a leading Internet magazine in Sweden.
I am born and live in Gothenburg on west coast of Sweden in the same town as professor P-I Brånemark who invented the implant for 50 years ago and where professor Jan Lindhe lives. In 2005-2008 I happened to work with the Brånemark implants, Procera and CAD/CAM solutions as Sales Manager for Nobel Biocare.
Now I share corridor with a Nobel Prize winner in Medicine professor Arvid Carlsson at Sahlgrenska Science Park in Gothenburg.
Before my job at Nobel Biocare I worked 10 years (1989-1999) as Sales & Marketing Manager for Novartis/Ciba Vision, a pharmaceutical and contact lens manufacture and in the IT industry for Oracle as Major Account Manager. In the mid 70th I was a foreign exchange student in San Jose, California.
What I do today is to combine many of my skills in the dental industry. I also try to educate everyone that works professionally with dentistry in using modern technology and “thinking digital” (CAD/CAM incl. scanning, CBCT, digital documentation, communication, content marketing, etc.). Today Dental24 is a leading dental forum in Sweden that most dental people read and visit regular.
I spend my days wondering, why isn’t the digital paradigm shift is going faster in dental health? For me it’s clear not only what will happen in the future but what is already happening right now. I think it might have to do with the mindset of key opinion leaders. Sometime we need use more multidisciplinary knowledge within dentistry.
Howard Farran: It is a huge honor for me today to be interviewing Per Ahlberg all the way from Sweden where Doctor Branemark was born and raised right?
Per Ahlberg: Right.
Howard Farran: You guys grew up in the same city.
Per Ahlberg: Yep.
Howard Farran: Wow, I'm sorry that he passed away, but he lived a good, long life. How old was he when he passed away?
Per Ahlberg: Eighty five.
Howard Farran: Eighty five years old.
Per Ahlberg: He passed away a year ago.
Howard Farran: Yeah. You know when I started podcasting I tried to podcast him and at the time he was actually, I talked to his wife, they were in Brazil. I guess he had a facility training institute in Brazil too. Did you ever go there and visit him?
Per Ahlberg: No, but I know some dentists that have been there and working.
Howard Farran: Yeah, man. What a great life. What would you like to tell our viewers? You're talking about 7,000 dentists in about 206 countries. What would you like to tell the viewers about his long life?
Per Ahlberg: Thank you. He has done a lot for the whole world. It's such a good thing to get fixed teeth and it improves life quality for so many people.
Howard Farran: Historian will say he invented dental implants. Isn't that pretty correct?
Per Ahlberg: Yeah. He invented it or he found out [inaudible 00:01:31] integration. He was actually putting a small camera into the vein and that camera was made in titanium. He wanted to reuse it and he couldn't get it out. That he also integrated. Then he started to do research. Why didn't it come out like the other material? That's how it started. I think that it was in the end of the 1950 something, '57 maybe.
Howard Farran: Yeah, he definitely created the entire space. What an amazing life. I'd like to also say that I was born in Kansas, which is in the very middle of the United States. I grew up Catholic. My mom and dad went to mass every day. Everybody was Catholic, Kansas and republican. The most evil thing in the world when I grew up was Communism, Russia and China, those were the good versus bad. Right in the middle between good and bad were the Socialists, the ones that were headed toward communism. That was always your neck of the woods. It was always Scandinavia. It was Sweden and Denmark and Norway and Finland.
Then when I started lecturing, I started lecturing around the world. I always tell everybody when I would come back to the United States that the greatest societies I have ever seen in my life were Scandinavia and Australia and Canada.
Per Ahlberg: Thank you.
Howard Farran: It just doesn't get any better than that. I mean when you go to Denmark, Sweden, Norway, Finland and Australia, that's just the greatest, advanced, to me it's the most pleasurable, honorable, sophisticated society [inaudible 00:03:31]. When people complain in the United States about health care and whenever they try to move to a single payer system and they say Socialism, Socialism, I just tell them everybody that's against it has never been there and seen their society.
They also complain about taxes. They always say, "Oh their tax rate is so high." Yeah, but their jobs are $40 an hour. Would you rather be an American making $10 an hour and have no health insurance or education and pay small taxes, or make $40 an hour, pay half those to the government and get free college. They just don't get it.
Does your news cover much of American health care, or Obamacare, much of that, or are you up any on that debate?
Per Ahlberg: I follow the American politics and the new election coming up now. I've done so. I think I know more about politics than many Americans, you could say.
Howard Farran: I wouldn't doubt it.
Per Ahlberg: Many are so interested in what President's family is doing but what can kind of politics does he, what does he stand for? What does he want to do? What does he want to achieve? That is second.
Howard Farran: I tell people around the world that aren't Americans that to understand American politics you have to realize that it's just sports. That's all it is. It's no different than soccer or football. You love your team and you hate ... like for instance, my favorite hobby is football, NFL. Of course I'm in Arizona so I like the Arizona Cardinals and I want them to beat every team. Last night our team won in like the last second of the game. I was jumping up and down and [inaudible 00:05:16]. That's the way politics-
Per Ahlberg: In what sport?
Howard Farran: We call it football. But soccer is the number one sport in the world, but you guys call it soccer football right?
Per Ahlberg: Yeah. But you also won against Toronto in hockey yesterday.
Howard Farran: Yes. Three to two. I was at the bar and both big screens were on side by side and it was amazing technology. Whenever a commentator was talking that television would go live. Then whenever it was just the sport and the other commentator ... I was sitting there the whole night wondering how do they do that? There must be some new technology because two big screens and you could just follow the commentators all though. I can't believe you watched the NFL and hockey last night and you're on the other side of the world. Basically yeah, I truly believe that the average American, like probably 85% don't understand the issue at all, they just-
Per Ahlberg: What issue do you mean?
Howard Farran: Like health care or taxation or energy policy or all that stuff. I think one of the reasons Dentaltown has been successful and my podcast, social media, I always avoid sex, religion, politics, violence and just stick to dentistry. The only reason I brought it up to you is because ... and I didn't want to start here or go there, but your country is very unique from ours in the fact that your government picks up about what, 1/3 of the dental bill?
Per Ahlberg: Yes.
Howard Farran: And about half the dental offices are government owned and operated?
Per Ahlberg: Yes. Right.
Howard Farran: That's why I wanted to touch on this very scary subject of sex, religion, politics and violence and talk about that. Everybody that says that Socialism is horrible, they've never even left Kansas. They haven't even gone to Mexico. You know what I mean? It's like you only know what you know. If you're born in a tribe and your tribe tells you this is good and this is bad and this is good, then they just believe it. As I get older and older and older, I learn so much more and it makes me so much more humble because you realize what you didn't know when you were a kid.
Now I realize at 50 years old ... like in science, I bet in a thousand years from now everything we believe in science is going to look literally ridiculous, like we look back a thousand years ago and we think those people were barbaric. I think in a thousand years from now dental implants there might not even be dental implants. They might just be growing back the tooth.
Let's start there. How many countries have you been in?
Per Ahlberg: Oh I don't know. Most European countries, at least in the west, and United States, Canada, Mexico and then last year we took Asia around the world.
Howard Farran: Going around the world and you're a very intelligent man in the field of dentistry, what do you think are the pros and cons of your government health care system subsidizing dentistry and do you think it's a good model? Do you think the United States should follow that model?
Per Ahlberg: Maybe not exactly, because there is challenges, of course. It's good that people who most need dentist care can get it, no matter if they have enough money or not. That's the good side. We take care of the poor people. We take care of regular people. We take care of older people. There is a safety net in Scandinavia, and in dentistry especially in Sweden. We invest a lot in dentistry in Sweden to let people really needs help, get it. The ones who gets most are those who need it most with the most advanced, most extensive dental care. The one that needs it least, they don't get that much subsidy, and normal people have to pay a little bit. Normal people have to pay 2/3 of their dental care, but they go on check ups and they don't do that much. Most people have pretty good teeth.
Howard Farran: The United States, the year I was born in '62, is when they passed the first Medicare, which people over 65, the old, the over 65 could get health care. Then later states passed their version for the poor, which is called Medicaid. Your country covers what? All dentistry from the young, birth to 20? Then the old 65 and over. Is that pretty much correct?
Per Ahlberg: Yeah.
Howard Farran: Then the poor people in the middle.
Per Ahlberg: Yes. Every one younger than 19 or up to 24, depends a little bit on what [inaudible 00:10:38] you have lived, gets free dental care, totally free.
Howard Farran: When you say gets free dental care, is that just like extractions and fillings and cleanings? Does it also include root canals, crowns, implants, orthodontics?
Per Ahlberg: Yeah, but there's not that many who gets that. This is just when they play hockey, they might need an implant or two.
Howard Farran: That is the moral dilemma if you're a dentist and you like hockey. How can a good dentist like hockey if it leads to [inaudible 00:11:13]. That's one of my favorite jokes. What has 12 teeth and 10 legs? The starters of a hockey match.
Per Ahlberg: Yes, yes. Good. After 25 you get a little bit subsidy from the government for doing check ups, not much. If you really have to do something you get more. If it's more costly you get more pay from the government. Since 2008 your age doesn't care that much, you get a little bit more as a youngster and a little bit more as older people, senior person. Everyone gets a little bit. Everyone has that safety net today. For a couple years ago we had 65 plus for dentistry. That's when we get rid of most endentuless patients. Now we only have .3% that doesn't have any fixed teeth. It's fantastic.
Howard Farran: In the United States at 65, 10% of Americans have zero teeth. 10%.
Per Ahlberg: You have to do something about it.
Howard Farran: Tell me this, back to the specifics, if I'm 15 years old and need braces would the government pay for braces?
Per Ahlberg: They'll pay for that. They don't pay for cosmetic, but they do pay for a lot of orthodontics.
Howard Farran: I do my own cosmetics. Whenever someone comes in the room I just turn the lights off. It really enhances my appearance. What about the dentists? You say about half of them work inside a government dental office building as an employee.
Per Ahlberg: For the state.
Howard Farran: For the state. So you call Sweden the state?
Per Ahlberg: No. There is states like in the States.
Howard Farran: Okay.
Per Ahlberg: It differs a little bit from region to region.
Howard Farran: How many people live in Sweden and how many dentists are there?
Per Ahlberg: There is about 10 million people and about 7,200 dentists, 4,000 hygienists, and about 10,000 nurses and about 1,200 technicians.
Howard Farran: I know you're a numbers guy to be able to answer that question. 10 million divided by 7,000 so that's a dentist for every 1,428 people. The United States has a dentist ... so you're 1 to 1,428. I think the last I saw in America is 1 to 1,850.
These dentists, do they make a good income? Would they make a comparable income as a dentist in the United States?
Per Ahlberg: I don't know what you earn in the States. Some dentists gets pretty good salary and others might not. I hear from you on your other product costs that you have to pay back a lot of your studies, cost for studies-
Howard Farran: Student loans. Now is dental school-
Per Ahlberg: Yeah. They have study loans, but not for going to the University, because that's free.
Howard Farran: So then what wasn't free, the dental school?
Per Ahlberg: No the dental school is free, but not everyone can go there. They don't get in there.
Howard Farran: Oh I see.
Per Ahlberg: They have to pay for their own rent and food during the time they go there so they end up with a little bit of loan anyway.
Howard Farran: All their University and dental school was free, so they have no student loans.
Per Ahlberg: Yep. More or less. It depends on, you know. If you study and that takes all your time and you can't work at the same time, and I don't think most can work at the same time as the study to get this-
Howard Farran: I don't buy that argument. Not to be rude, but it seemed to me when I was in dental school 1/3 of the class, their dad was a dentist and was just paying for everything. Those kids were all too busy to have a job and all they did was have fun and party and have nice vacations. The poor barn trash like me, who went to school and studied and worked 40 hours a week, all the poor kids worked 40 hours a week. I know tons of poor kids who worked 40 hours a week all through their college degree. I think not being able to work in dental school is a rich kid phenomenon. You know what I mean?
Per Ahlberg: Yeah.
Howard Farran: When you go to China they work sun up to sun down six days a week and then they'll tell you their day off, Sunday, is their hardest day because that's when they've got to get their whole house in order, laundry, cleaning, shopping and everything. They like to come back to work on Monday for a rest day from working so hard Sunday. Would you say that dentists make a good income in Sweden?
Per Ahlberg: Yeah. I would say so.
Howard Farran: Half work for a state run clinic, so they're an employee?
Per Ahlberg: Yeah. They can probably make even more if they're private and run their own business. [crosstalk 00:16:44]. They get almost as a doctor, most of the doctors work for the state, the regular or bed doctors.
Howard Farran: You call them bed doctors?
Per Ahlberg: Med.
Howard Farran: Oh medical.
Per Ahlberg: Medical.
Howard Farran: Medical doctors all work for the state of Sweden?
Per Ahlberg: Most of them. There is private. I don't know the ratio, but there is private clinics too.
Howard Farran: Dentists half work for the government of Sweden and half are private.
Per Ahlberg: Yes.
Howard Farran: If you worked for the state then you would have less stress because then you wouldn't have to run a business. Correct?
Per Ahlberg: I think you have more stress because you have five days full, the schedule is from 8 to 5 or something like that. They hardly get any time off for continuous education. That's pretty bad. The private ones, many of them, they work like four days a week with dentistry and the fifth day they work with their staff and their company, and maybe talk to sales people, and maybe they even play golf, I don't know.
Howard Farran: Today is Tuesday here in the States and yesterday I worked all day at the dental office, and at 53, I came home and the first thing I had to do is lay down. The next thing I knew I had taken a two hour nap. It's just exhausting checking three hygiene and running and emergencies.
Per Ahlberg: I think the people who work for the state, they're pretty busy. They have a tight schedule.
Howard Farran: I also want to ask you a question, your part of the world is, it seems to me but maybe I could be completely wrong, but it seems like your part of the world is very anti-mercury amalgam. That mercury is not-
Per Ahlberg: It's forbidden.
Howard Farran: It's against the law in Sweden?
Per Ahlberg: It's against the law since 2009. There is some, you can go to some exceptions, if you really have a good reason, but normally it's forbidden.
Howard Farran: You know what's silly about that ... okay so Sweden's banned it since 2009. Does Sweden when you die, do they offer conditional burial versus cremation?
Per Ahlberg: Yeah.
Howard Farran: Cremating humans with silver fillings in their teeth is responsible for 6% of the atmospheric mercury contamination around the planet. A lot of these countries like Sweden who have banned it, continue to do cremation. A lot of countries, like United States who have not banned it, shouldn't [crosstalk 00:19:30]
Per Ahlberg: They must take care of that don't they? They take out the amalgam.
Howard Farran: They do in Sweden?
Per Ahlberg: Then they clean the fume that comes when they burn. I'm sure.
Howard Farran: I don't know, are you just assuming this or do you know this?
Per Ahlberg: I assume this.
Howard Farran: I assumed it too and it's not the case. You go to a crematory and it's just a mortician which I believe is-
Per Ahlberg: And they don't have any cleaning?
Howard Farran: I believe it's a one year of education program. In fact, I looked into it. In Arizona I think you can get mortuary cremation licenses in as little as nine months.
Per Ahlberg: I'd check it out.
Howard Farran: They just, they just-
Per Ahlberg: That's bad.
Howard Farran: They just put the whole body into a deal, they shut the door and they turn a deal like a submarine missile chamber and turn her on and it vents out the roof. I would think that while the world is discussing amalgam, the whole work could at least pass a law and say that dentists have to come examine the mouth before it's cremated and extract the amalgam. You wouldn't haven't to dig out the roots. Obviously-
Per Ahlberg: But you have cleaning on your units, don't you, when you work? You have separation for amalgam?
Howard Farran: Right. When we're drilling out amalgam we have to do that. The dentists complained a lot about it in the '70s and '80s but I went down to the water department and they said, "Look it's a lot easier for you to take out the amalgam when it's all chunky and right there. What's really expensive is when you dump that into hundreds of millions of gallons of water, then we have to filter it out." I believe in user fees, I mean if we're creating the mercury going down the drain, if we're creating it we should clean it up. I think it makes sense all the way around that the dental office should have a mercury cleaner.
That's not what I'm talking about. I'm talking about when Grandpa dies and he's 70 years old and he's got 15 big amalgams in his teeth and you stick him in a container and turn it on to 350 for the afternoon, that mercury is venting out there and plus I think it would be a hazard for the mortician. I think one of the first things they should do is start passing laws that says the dentist needs to come by Grandpa before you cremate him and look at his mouth. Like I say, you don't have to dig out the roots, you can just reach in there with forceps to snap off the crown [crosstalk 00:21:57]
Per Ahlberg: I'd check that out. That's interesting. I don't believe that it's not cleaned, that it's not filtered. I wouldn't think so, but I'd check it out.
Howard Farran: Well I have checked it out-
Per Ahlberg: It should be.
Howard Farran: And my information is that that's what they do. At any rate I'll meet you at the United Nations and we'll call it the Per Ahlberg Dental Amendment. Maybe you can get a grant from Nobel Biocare. Now you started out working for Nobel Biocare didn't you?
Per Ahlberg: Yeah. 2005.
Howard Farran: What did you do with Nobel Biocare?
Per Ahlberg: I was a sales manager in Sweden. I was sitting on the Headquarter of Nobel Biocare at the time.
Howard Farran: You were sitting on the what?
Per Ahlberg: I was sitting on the headquarter, but I was in the same building as the headquarter. I was working Nordic and particular Sweden. I had all the international people next door.
Howard Farran: Walk all of us Americans through the name of Nobel Biocare. I thought it started out with Dr. Branemark and then it was the Branemark implant. Then of course Sweden, where is the Nobel Prize out of?
Per Ahlberg: Sweden. All of them except for the Peace Prize which is in Norway.
Howard Farran: I assume that's where they got the word Nobel, from the Nobel Peace Prize, it was Sweden. So it went from Branemark to Nobel Biocare. How did it go from Branemark, the founder's name, to Nobel Biocare?
Per Ahlberg: Well [Per-Ingvar Branemark 00:23:31] needed some money and he asked the guy who had bought the Nobel Industries that had more industries than just this industry or they might not have even this industry to be in, but Per-Ingvar Branemark needed money and he got it from this Penser, Erik Penser. He still lives in London. He gave him some money to start up. It ended up with instead of making chems or nobel things from [Kosgoga 00:24:09] in Sweden, they started to make implants instead. Small industry, instead of big industry, or small pieces instead of big pieces.
I don't know if you know what a howitzer is. It's a pretty bad thing. It's a cannon. That's what I did in the past.
Howard Farran: What do you call it? How do you call it? A Howlowitz? Spell it.
Per Ahlberg: Hobbits. Hobbits. I don't know how-
Howard Farran: It's a cannon?
Per Ahlberg: Yeah it's a cannon.
Howard Farran: For the Navy or the Army?
Per Ahlberg: Army.
Howard Farran: Army cannon.
Per Ahlberg: Yeah, mostly Army. That probably comes from the dynamite, because that was really the [inaudible 00:24:57] that you mention. Then they started up the company called Nobel Pharma, but it wasn't really Pharma so they changed name to Biocare. Then it got on his own and he was introduced to the stock exchange in Stockholm, later on in Zurich, and now it sold to United States.
Howard Farran: Wow. Then you started in 2008, I don't want to say this arrogantly, but you started Dental24.se which is kind of like a Dentaltown, isn't it?
Per Ahlberg: Yes, it is similar.
Howard Farran: It's similar. We started Dentaltown in '98 so I hope you borrowed some ideas. Do I get any credit for any ideas you borrowed from Dentaltown?
Per Ahlberg: I checked with you and see what you had. I didn't take everything. It confirmed that my thought was right, this is something we needed. We needed a community for the Swedish dentists' business, not only for dentists but for hygienists, technicians, nurses and the industry. The suppliers. I bundled that into a whole and we work with a team. You have to work together. You know how important it is to work together with the technicians and the nurses and the hygienists.
Howard Farran: Dentists were so crazy in their early days Dentaltown. They'd get mad when any non-dentist would come on. They go, "That guys coming in and he's just trying to sell something." I said, "It's named Dentaltown, not Dentisttown." So he's trying to sell something and you're what, a volunteer? What do you free crowns in your office? I'm pretty sure you do half a million a year and take home 150,000 and you're pure and innocent and good, but anybody selling dental supplies or a dental lab or dental technology is evil because you were born in Kansas and you're a Republican.
I still have not got this through on Orthotown, the orthodontists still say no. Only orthodontists come on there. I always run into people who only sell to orthodontists, they so desperately want to know what they're saying and what they're thinking so they can serve them better and they want to be orthodontists. The orthodontists say, "Out, out. Only us."
Per Ahlberg: But you know what?
Howard Farran: I'm glad you saw the vision of that. It takes more than dentists to do dentistry and if you took away about 560 dental companies, we wouldn't be great dentists. We'd be sitting on a rug on a sidewalk with a hammer.
Per Ahlberg: We need each other, it's a teamwork.
Howard Farran: Right.
Per Ahlberg: Very much so. We have a little bit of that in Sweden also, the dentists and then their association. You have to be a dentist to be into them and they can't sell to dental24. You know? I don't exist. But we are largest. According to what we see from them and hear from them we don't exist.
Howard Farran: Yeah. I mean even here in the American Dental Association, for years, when you go to a convention, you couldn't buy anything from a vendor there. There was no transactions on the floor. You could just see these Christians thinking of Jesus and kicking over the money changers in the Temple, 2,000 years ago. What a joke. The American Dental Association is all about money. They collect $100 million in dues, you have to go to the meeting. The vendors pay thousands. There's just cash flying everywhere, but you couldn't make a transaction. It's like people are just silly. People can just be so silly. The older I get, the more I wish everybody could be just like me.
Per Ahlberg: You have your own party.
Howard Farran: When I say that my boys start laughing, they think I'm the craziest monkey in the village.
Per Ahlberg: Maybe you're running for President one day.
Howard Farran: You know, I can't because I just think ... I've lived half a century, I've lived 53 years and they just all lie, cheat and steal. In fact it's funny, when someone wants you to vote for their team instead of the other team it's like, look they're all liars, they're all cheaters, they're all sociopaths. How could you like your lying sociopath more than the other lying sociopath? It was funny.
We had an election, the last time, you could take one of the candidates, his name was Romney, and you could go to YouTube and you can take Romney is for that, and you'd find a YouTube video where he's for it. Then you could Google YouTube the same way, Romney is against this, and find another speech where he's absolutely against it. It was just comical. It was literally comical.
Per Ahlberg: [inaudible 00:29:45]
Howard Farran: Again I don't like to talk religion, sex, politics or violence, unless I'm on the comedy stage. I love to do stand up comedy. I'm doing it in town next week and that's where I let it all hang out. That's when I have no filters and go crazy. Tell us more about dental24. You know what I wish you would do? Since you're in Sweden, is it mostly just for Sweden? Is the language all in Swedish?
Per Ahlberg: Yeah. I don't like any competition from you, so I do it in Swedish.
Howard Farran: Yeah?
Per Ahlberg: No. No. In order to make it very accessible we write everything in Swedish. Then you can go deeper. Everyone speaks English here.
Howard Farran: On the website are they talking in English or talking in Swedish?
Per Ahlberg: Swedish. Everything, more of less everything is in Swedish.
Howard Farran: Here's what I understand about language. I've talked to a lot of language specialists, because all these people say, "Well these people speak English who are reading us." This is what they tell me. They tell me if you're born in a country, you're born and you learn a language, and you have more than 50 million people to talk to, then you don't have any incentive to learn another language.
Per Ahlberg: No.
Howard Farran: America is 300 million, so they all speak English. Then you go to Brazil and they've got 200 million so they all speak Portuguese. But if you're born in a country of like 10 million, you might know up to five language because you want to talk to more people. They say that humans basically want a pool of about 50 million people to have access, the scales of economy of people.
Per Ahlberg: If you should learn any language [inaudible 00:31:33] you should learn Chinese. That's hard. We learn English as a second language. We understand Norwegian and Finnish, not Finnish, but Danish.
Howard Farran: Here's what the dentists tell me around the world. Say their native language is German. I'll say, "Can you read English?" They say, "Yeah." Well I say, "Do you go to Dentaltown?" They said, "Well here's the deal, my native language is German and if I have to just pick up fun reading like fiction, I'll read German, but when I have to read English, after about an hour my mind is just exhausted."
It seems to me that reading as a second language is never fun, it's never natural. I don't know, I don't speak another language.
Per Ahlberg: Right. Right. That's right, you're right.
Howard Farran: Google Chrome will translate anything into 64 different languages, but it's kind of like going from shaking the hand of a person to shaking the hand of a manikin. It's translated, but it's just not right, there's something ... when you look at a manikin you say okay, it should look like a human, but it's not just quite really a human, you know?
Per Ahlberg: Right. But it's pretty good though.
Howard Farran: You know what I wish we would do, I wish, since none of us know Swedish and you know English, I wish you and your four or five smartest people would compare dental24.se to Dentaltown.com and see if we came up with the same innovations or if any of us could learn from the other, that something that you did that worked, that I should do at Dentaltown or you might find something we did with Dentaltown and whatever.
Per Ahlberg: Yeah. We should. We should.
Howard Farran: If there's anything we can ever network together. You know a lot of dentists, a lot of people ask me, "Why did you have this guest on, because he's with another dental magazine." Or, "Why would he talk to Per, when he's with a competitor dental24?" I just think that's so silly. I never think in fear and [inaudible 00:33:33] I always think in hope for the [inaudible 00:33:34]. I noticed this, the 20 years I've been here, dentists in my little city, [inaudible 00:33:39], the ones that would go out to eat and hang out regularly with the other dentists in [inaudible 00:33:45] we had the most fun and rewarding career. The ones across the street that saw us as competitors and they were competing against us and they were never to be found, it just seems like they were never happy. In fact one of them retired and no one even knew it for like a year.
I've never met a dentist who only reads one dental magazine. I'm not in competition with another dental magazine or another website.
Per Ahlberg: Exactly.
Howard Farran: Dentaltown, in fact, if you had to say whose Dentaltown's in competition with, it's not even another dental website, it'd probably just be Facebook and Twitter like the rest of the world. You know what I mean?
Per Ahlberg: Yes.
Howard Farran: Anything we can do, like if you saw something we had and your programmers wanted our code, or whatever the hell I mean, I don't think in [inaudible 00:34:28] I just literally have fun, that's all I try to do everyday, is get up and play.
Per Ahlberg: I'm open to that. I think you have a lot of things to contribute with. I think you are ahead in many areas, in many areas. Sales and marketing for sure, you are much better. On IT you are more mature in IT. You use the web better than we do here.
Howard Farran: On Dentaltown?
Per Ahlberg: Americans, and Dentaltown too.
Howard Farran: You're talking about Americans.
Per Ahlberg: When I started up, I got a recommendation, check it out what they're doing in the States and that's how I found you. Then I already decided to go for dental24 and then I just checked on you and I check a little bit on XP, is that what's it's called Dental XP?
Howard Farran: Yeah. Dental XP out of Atlanta, Georgia.
Per Ahlberg: I checked a little bit on Dental Advise and I checked on Dental Compare. I visited Dental Compare once in California, to share knowledge about how can you share, how can you share knowledge, information. It's important. I think you are doing it well. You have Facebook, you have Twitter, you have all those social media, it comes from the States.
Howard Farran: Yeah, Silicon Valley. Facebook. Google Plus. Twitter. All in one little city, between San Francisco and San Jose is Google and Facebook and Twitter and Pinterest. They're all there. Did you ever meet the woman dentist who started [Euginal 00:36:11] in France? A French dental website?
Per Ahlberg: No.
Howard Farran: I was so impressed with her. That sweetheart of a woman flew all the way from Paris, France to Phoenix, Arizona just to network and shake my hand. I thought you know what, if you're that ambitious to do that, I already can assure you, you're going to conquer all your dreams, and she did. She was an amazing person. I was so proud of her.
My job is to guesstimate what everybody is wondering. Probably what they're wondering is anybody who has been to Scandinavia, or Australia for that matter, agrees that's about as advanced of a ... when you fly over countries at 30,000 and you look down at cities, it kind of looks like an anthill. It looks like a mouse. It looks like a way ants and termites and bees would colonize. It looks like little human colonies. Of all the human colonies I've seen of little bumbling bee humans, I think Scandinavia is the best. I wish it had better weather. I wish they could pick it up and move it down and set it in the middle of the Mediterranean.
How is dental technology used in your Scandinavian region versus other parts of the world or of Europe or in the United States?
Per Ahlberg: What do you mean?
Howard Farran: I mean are you doing rubber impressions with Polygonal Siloxane or are you [crosstalk 00:37:42], CAD/CAM, lasers?
Per Ahlberg: Yeah, we're doing it. I sold [Presaira 00:37:50] for ten years before the other came on board on CAD/CAM. You know the Presaira?
Howard Farran: Yes. Sure.
Per Ahlberg: Nobel back there had it ten years before everyone else.
Howard Farran: How is that going now?
Per Ahlberg: It's pretty good, I guess. The business has changed, of course. The others are caught up in many areas, but what I understand they are doing okay. We were early. I was working close to [inaudible 00:38:23]. They were in the building, it was developed in the building where I work. CAD/CAM, we went early on CAD/CAM. Now CAD/CAM goes into the dentist office and there it's a little bit tougher because the dentists is not that advanced in IT. Many of them. It is getting so technical for some of them that they wait for their retirement and they don't invest in the new technology that is obvious that will come. There is a big change. There is also a big change, I know you have the same change over in the States that clinics are betting bigger, they are maybe 10 dentists, 30 dentists at the same building, in the same office, to share the big investments that we see the CT and CAD/CAM and oral scanning and so on. It is coming. It's coming.
Howard Farran: I always take opinions from people who live inside their world with a grain of salt because they always have the human emotional bias. When I looked into government ran businesses, health care business models, I like to go to health care MBAs and economists who have no emotional baggage in the debate. They think that what drove the consolidation of pharmacists was that for pharmacists, 70% of their cost was buying the prescription pills. From economics, it made massive sense for all of them to roll up into one big unit to be able to compete and leverage Merck and Pfizer and Johnson & Johnson. You needed a big 400 pound bullet, where as in dentistry, it's only 6% of costs. Leaving pharmacists and going to physicians what drove the big consolidation was a lot of this high-tech, expensive equipment like CT scans and MRI's and all these massive pieces of equipment.
Physicians realized if we're going to buy that piece of machine we should share it with a bunch of other providers. When I went to my urologist, because I had a kidney stone for the third time in my life, there was like 12 urologists in one building, when you go in and take the X-ray or whatever. What's funny is that dentists in America, I don't even think 1% of the dentists work for the government in the Indian Public Health Service or the National [crosstalk 00:41:07].
Per Ahlberg: Some are working for the military, right?
Howard Farran: Yeah, a few in the military. I guess if you included the military the Indian Public Health Service and the social clinics, maybe 4%, maybe 5%, it's really a [inaudible 00:41:23] there. It's one of the specialties, Dental Public Health, but it's really a [inaudible 00:41:26]. What's really consolidating fast is these corporations that have 500 to 2,000 dental offices. I do think the big driver of this is twofold. I'm going to get in trouble for saying this because you never should talk about sex, religion, politics, violence, but I believe that half the graduates being women, the women all married male dentists, doctors, bankers, lawyers, and a lot of them just wanted jobs, they don't want to deal with owning their own business. I have lots of women dentist friends that work for these clinics and love it because they're a single mom and they got a kid they've got to take care of, a 10-year-old kid and they just want to come in, do their work and leave.
The other thing is these high technology things like Sirona Dent Supplies, [Sirack 00:42:17] CVCT, 3D, X-ray machines, lasers, all this stuff. It's funny, it's kind of a perfect storm. I believe it's going to end up like Sweden. I think about, with the lawyers, half the lawyers work for a big group and then half are individual private. In your country, half work for the government, the state, and half are private practice. I think in our country 10, 15, 20 years from now, half will probably end up working for corporate and then half will be individual boutique. It just depends on if you're highly motivated and you [crosstalk 00:42:52]
Per Ahlberg: That could be.
Howard Farran: Motivated, and you-
Per Ahlberg: That's fine.
Howard Farran: You love your [inaudible 00:42:51] and you have a niche market and you're all gung ho, you'll be the half that has your own place. If you just want to go in without any business or worries and drill, fill and bill, you'll work in corporate.
Per Ahlberg: What we see here now is change coming up. Like 10, 15 clinics in an area or it might not be in the area, it could be spread out too, but it's becoming more and more dental chains owned by investors. It might not be owned by a private owner, it could be a fund or investment fund, you know?
Howard Farran: Mm-hmm (affirmative)
Per Ahlberg: So that is coming more and more. Half in Sweden is owned by the state. About 1/4 is a cooperative. It's dentists who have gone together and share all the things that they don't want to do like economy, like education, they get together with that and having a simple organization for that. Even for buying things they can get together and get a better deal.
Howard Farran: I think the most interesting thing is everything in history that goes around comes around. Like it just always comes back. America, a lot of people that came to America were indentured servants. They only got a free ride because when they got here they had to work on somebody's farm for seven years. Now I feel like with all these dental schools dumping these kids out at $300,000 or $400,000 a year, financially they can't move. They can't do anything and they're indentured servants. Basically what they did is now they have to go work for me, or a chain, an old dentist like me or some corporate industry and they've got to work for seven, eight years to pay that back. Basically it's indentured servants.
I want to ask ... go ahead ... I want to change subjects-
Per Ahlberg: What most people do here, I think most of them when they leave school they go to the public dentistry. They start it and then they continue after five, ten years, they start their own private practice.
Howard Farran: Right. Talk about your toothpaste. You buys believe, or you believe that in 1959 Professor, I'm not even going to try to, [Ingved Erikson 00:45:40] from Sweden with naturuoimmunofluorostat toothpaste, NA2PO3F in tooth paste and that you feel that's a better toothpaste than the international Colgate?
Per Ahlberg: No. What he did was he got a patent, he wasn't the only one who got the patent, but he got one patent on mixing charcoal with fluoride. That was the first toothpaste in '59. Even Colgate Palmolive and I believe Proctor & Gamble might have had a patent on that. That was the first generation toothpaste including fluoride.
Howard Farran: Now the first toothpaste really in America, Pepsodent, by Ipana, which most people drove the six month cleaning, because in the '50s when they came out, they'd say brush your teeth with Ipana and see your dentist twice a year. They said that on television back when that was really the only media, mostly television and there's only three stations and they just had so many commercials that everybody believed you should just see your dentist twice a year. Then when the dental insurance companies started in about 1959 the North Sherman Dental Insurance in New Jersey they said, "We'll pay for a check up and a cleaning every six months." The patients all thought we should see you every six months. It's amazing how that is still held all the way to 2015. When you tell someone with gum disease you need to be seen every three months but their insurance is saying we only take care of every six months, it's amazing the power of advertising.
It's amazing how a toothpaste company ... then when the dental historians tried to figure out where they got that, it came from a marketing department. Some kid writing the ad decided twice a year. There was nothing behind that. Isn't that interesting?
Per Ahlberg: You know there is an expression, "He's that type of guy who believes his own press releases."
Howard Farran: Well I just want to say for the record-
Per Ahlberg: That's a marketing guy.
Howard Farran: I just want to say for the record that I'm a legend in my own mind. That's all that matters. I love that joke. I've only got you for ten more minutes. What do you think listeners from 200 countries around the world, what could you tell them about that they might not know?
Per Ahlberg: They have to fight for getting better financing on dentistry. There is a movement going on, even here, where we have 1/3 paid by the government, but to include the mouth into the, say that the mouth is part of the body and shouldn't cost more to go to a dentist than it costs to go to a medical doctor. That's going to happen. We have to go in that direction. We have to make more health checks. We have to work more on preservative, no, with good things, instead of-
Howard Farran: Preventative. Preventative.
Per Ahlberg: Preventative. Thank you.
Howard Farran: Preventive. I just think it's a amazing you can do this interview in English. If you told me I have to interview you in Swedish, I don't even know one word. In fact when I first saw your name Per Ahlberg, P-E-R, I just assumed Per was Doctor, Dr. In American it's Dr. In Portugal or Brazil it's Dru. So it's only three letters, it ended in r, I just assumed Per was doctor. I just thought you were Doctor Ahlberg. Then I found out you're not even a dentist so I shouldn't even be talking to you because you're not a dentist. How dare I speak to a non-dentist. I want you to know I'm really going out of my way to speak to a human whose not a doctor.
Per Ahlberg: I think you got a point here. I think dentists have to talk to more people that know other things than they know themselves. They should talk to technicians. They should talk to people who know marketing, who know finance. They should talk to more people that know other things.
Howard Farran: I've always thought that dentists could double their income if on the weekend they could become a bartender. It would force them to just talk to strangers. Maybe since all the strangers are drinking, and I've never seen a bartender not nursing a drink behind the bar, almost all my bartender patients are alcoholics. Maybe Fridays and Saturdays you should just go drink behind the bar and talk to drunks to learn how to talk.
Yesterday, I was swamped and this guy came in for a second opinion and you can just tell that after talking to him that he just couldn't have a normal conversation with his dentist. It was like my god. When I was done I got up and went to my office and called the dentist and said, "Buddy, what's going on?" He's a friend. This is what he told me, "Well I was kind of rushed for time and uh, uh, uh." I'm like, "God just talk to him like a drunk at a bar." He didn't know the basics of what you were talking about. He didn't know the simple things.
Per Ahlberg: That's a little bit what I have done with dental24. I'm checking up with what is being written in the newspapers about accidents, about in politics that will change, and what the patients who talk to them and know about, because I hear it on the radio and the TV. I bring that up on dental24 so you can be updated on, so you don't have to hear it from the patient. You can read it on dental24.
Howard Farran: The government, I find it very interesting how people are against the inequality of income in the United States. All the billionaires have a lot of money and they have more money than the bottom 90%. Everybody has a problem with that, but they have no problems with these government agencies with all their money. As a businessman, I try to look at which CEO is managing their people, time and money better, these 1,860 billionaires around the world or all these government agencies.
The United States Post Office, they had all the money. They didn't end up in the next day package, that was FedEx.
Per Ahlberg: You're right.
Howard Farran: They didn't end up delivering a package, that was UPS. I look at the government stewardship of assets to be very lame. I look at these free enterprise people as being very ... and when they die the money is all going to be circled back into the monkey pit anyway. I have no problem with this inequality of these guys managing a lot of people, time and money in their very short 40 year work span. Just let them run and they'll innovate faster than the post office.
One thing about the insurance that I am worried about, if all health insurance and dental insurance is free, that will violate every economic fact, principle that we know. There should be some consequence. There has to be co-payments. There shouldn't even be a free bypass. Then why would grandpa want to quit smoking and going on walks and lose some weight? If they said, "Dude you're going to need a bypass in five years and it's $100,000 and your portion of that is 10%" and you're going to come up with 10 Grand because you come up with 30 Grand for your car, you came up with 100 Grand for your house, and you're going to come up with $10,000 for a bypass, that is probably the most clarity in his walnut brain to say, you know, I gotta quit smoking, lose some weight, join a gym and get this fat off.
Free dental care, are you kidding me? Have you ever been in a dental office in America. They bring cans of Coca Cola into the office. They come in the chair, I had a mother holding a 3 year old, screaming from an abscess from [inaudible 00:54:00] and she's [pie patting 00:54:02] Mountain Dew into the babies mouth from a 64 ounce Styrofoam cup. She's pie patting Mountain Dew into the mouth in my chair. If all dentistry is free, I believe that if you want more of something, incentivize it. If you want less of something, tax it or make it more expensive. I think health care around the world, unless you're a victim like a six year old kid had, there's nothing there could do to prevent leukemia. Things that are just bad luck, that should be covered, but anything that has behavior attached to it, if they don't have a co-payment they're not going to change their behavior. I really believe that. Especially dentistry.
What percent of dental disease is from diet and not brushing and flossing? What would you guess?
Per Ahlberg: A lot.
Howard Farran: Yeah. All the monkeys in the zoo don't have cavities, none of the gorillas, chimpanzee, orangutan, [inaudible 00:55:06] they're all eating leaves, while we're all drinking Coca Cola.
Per Ahlberg: I don't think the dentists can save the world, but they can help.
Howard Farran: We save the world one tooth at a time.
Per Ahlberg: Yeah. Someone else has to educate the people. That's what we have seen with the toothpaste and brushing teeth-
Howard Farran: Free enterprise. That was free enterprise not government. I believe that waiting for the American Dental Association, they have $100 million of dues every year, they're not going to advertise on TV, they're not going to advertise during the World Cup and the government, they're not going to. I think the reason I'm so active on social media is because I'm hoping that-
Per Ahlberg: There you can get it.
Howard Farran: I'm hoping that all these dentists are sharing ... I post on Facebook and Dentaltown and Twitter and Google Plus ten times a day, of the best memes I'm being sent or I see. I got up this morning and people have already sent me 20 things to post. I share this because I think the worlds' 2,000,000 dentists cutting and pasting and sharing stuff with my Facebook.com/Howard Farran or @Howard Farran on Twitter, to their people. I think we can educate the 7 billion people ourselves with social media faster than at any time in the world.
Per Ahlberg: Yeah. And it costs less. It's free. It's not really free because you have to spend your time there.
Howard Farran: That's where marketing has changed. It used to be when I got out of school 28 years ago, you could buy marketing. You could just pay for marketing and all work. Now everything you pay for, even if it doesn't work.
Per Ahlberg: You have to earn it.
Howard Farran: The new currency is not money, it's time.
Per Ahlberg: That's right.
Howard Farran: Now if you spend an hour every week blogging or updating your website or social media, or have your dental assistant do it for you. That's what I tell dentists today, go in your office, which person works for you that checks their Facebook before they get out of bed, and checks it in their bed before they go to bed, have that person do all your social media. Now I think the world's 2,000,000 dentists are bringing up the dental IQ of the planet faster than insurance companies or toothpaste companies or government agencies can do.
Per Ahlberg: I think that social media is good on distributing, sharing, but what's most important is you have to have your own website and keep that updated. That's where everything should be written and saved. Every office, every clinic and every supplier should have a really good home page. That's the hub. Now it looks like, I think that Facebook is for free and it's your homepage, no it's not it's just for distribution because you can only write a few things there, but you can spread the word.
Howard Farran: Did you know the founder of Facebook, do you know his dad was a dentist?
Per Ahlberg: No.
Howard Farran: Yeah. Mark Zuckerberg is one of four kids who to a dentist named Ed Zuckerberg.
Per Ahlberg: Okay, I didn't know that.
Howard Farran: He's the nicest guy in the world, so I always say that Facebook is number one because he was the son of a dentist. I tell my four boys that all the time. I say see what a good, nice, solid, middle class dental background upbringing. A great guy.
Well hey I really would love to lecture in Sweden. If you ever see-
Per Ahlberg: You can do that through Skype, you know.
Howard Farran: I do this, in fact I'm tempted not to ... I'm doubled my honorarium in the United States because I can lecture more dentists around the world from my home than getting in an airplane and flying to some city [crosstalk 00:59:20]
Per Ahlberg: Sometimes you have to do a little bit of both.
Howard Farran: But I love the international lecturing because that's a vacation. I don't want to do any more lecturing in the United States and Canada because there's so much work getting to and from the lecture. The lecture is fun. I'd lecture for free. I get paid to travel. When you, like last month lectured three cities in Australia and it's just a blast. I got to go to Melbourne, Sydney and Brisbane.
I love Sweden. What are the best months to see Scandinavia?
Per Ahlberg: It's probably in the summer time.
Howard Farran: What months?
Per Ahlberg: July.
Howard Farran: July is the best month.
Per Ahlberg: Even though most Swedes take vacation in July but Stockholm is empty, Copenhagen is empty in July.
Howard Farran: I think it's the wildest dilemma that I tried to figure out how to solve this and the only thing that I can see is immigrant workers because in Sweden the one month where the weather is perfect where every tourist would want to go, all the Swedish people say I'm not working in a restaurant [inaudible 01:00:21]. When I went there and I took my four boys there, it was in the summer and everybody was laying our on lawns and parks and sun tanning and bathing and you could go to ten bars in a row, or restaurants or whatever and almost everything was closed.
Per Ahlberg: Otherwise, the summertime from May, mid May, May is beautiful, everything is blooming. It's green. Until mid August, fine, very good. All this could be-
Howard Farran: We could just go there and the Swedish people are still working all the hotels, restaurants and bars?
Per Ahlberg: We are back in August you know, and then the Germans come. They take a little bit later vacation.
Howard Farran: Okay.
Per Ahlberg: It could be quite empty in the towns in mid July, but the weather is probably the best. Probably.
Howard Farran: Well hey, Per-
Per Ahlberg: Yes.
Howard Farran: Thank you so much for spending an hour with me. It's 10:00 in the morning here. What time is it in Gothenburg Sweden?
Per Ahlberg: It's 6:00 and it's dark outside.
Howard Farran: 6pm. Is it Gothenburg?
Per Ahlberg: Yes.
Howard Farran: What's the capital of Sweden?
Per Ahlberg: Stockholm.
Howard Farran: Stockholm. Okay, that's where me and the boys went, Stockholm. Hey, thank you so much for spending an hour with me-
Per Ahlberg: Thank you.
Howard Farran: Thank you for all you've done for dentistry. I hope you check out Dentaltown.com and compare it to dental24.se. If someone goes to www.dental24.com does it forward to dental.se?
Per Ahlberg: No it doesn't. They can go to www.dental24.se and get that into Google translate and they can get the most out of it.
Howard Farran: Right on.
Per Ahlberg: Just push the world wide web.
Howard Farran: Will you do me a favor, a big favor? If you know any great dentists for me to podcast interview on that side of the pond, living over here on the other side of the world, I might not be aware of, someone who wants to talk for an hour about root canals, fillings, crowns, if you find someone who is passionate about something on your side of the pond, it doesn't have to be Sweden, it could be Norway, Finland, Germany, whatever, tell him Americans love in advertising, you run an ad and the person has an Australian accent I mean that's just [inaudible 01:02:45].
Per Ahlberg: Or French.
Howard Farran: French, yeah exactly, especially if it is a French woman, but I'm telling you Americans love, they tell me all the time, and I say what do you like the most about Dentaltown? "Oh I love [inaudible 01:02:57] that I met dentists. I have six friends from around the world and here they are in Parsons, Kansas talking to dentists around the world in Australia and London and Sweden. So if you know any big names out there that would like to do an hour about any subject in dentistry-
Per Ahlberg: I do.
Howard Farran: Tell them email me Howard@Dentaltown.com. If you're a guest listening to this, you could really help me a lot by going to iTunes and writing a review because the reviews on iTunes really helps your search engine optimization. There's 2,000,000 dentists around the world and my mission is to collect all the best information I can and spread it around the world into every continent.
Per Ahlberg: You'll do it.
Howard Farran: Per, thank you so much.
Per Ahlberg: Thank you very much Howard. Let's keep in touch.
Howard Farran: All right, have a great day.
Per Ahlberg: Thank you. Bye.