Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1229 Sex, Drugs & Oral Cancer with Robert J. Whitman, MSE : Dentistry Uncensored with Howard Farran

1229 Sex, Drugs & Oral Cancer with Robert J. Whitman, MSE : Dentistry Uncensored with Howard Farran

8/15/2019 6:00:00 PM   |   Comments: 0   |   Views: 131
Robert J. Whitman is the Chief Executive Officer and Co-Founder of Forward Science. He received both his bachelor’s and master’s degrees in biomedical engineering from Tulane University and began his career as a Clinical Engineer at M.D. Anderson Cancer Center, where his focus was developing advanced technology for early detection of cervical cancer. Fueled by a passion for early cancer diagnostics, Robert then went on to work in research and development at Remicalm LLC, where he worked on creating cancer-screening products utilizing fluorescence technology licensed from M.D. Anderson Cancer Center.

VIDEO - DUwHF #1229 - Robert J. Whitman

AUDIO - DUwHF #1229 - Robert J. Whitman

Finally, in 2012, Robert launched Forward Science with fellow, former engineer, Brian M. Pikkula with the goal of developing innovative technologies for clinicians to advance oral cancer screening procedures. In addition to his role as CEO, Robert also serves as an adviser to startup medical technology companies on product development strategies at the Texas Medical Center and often speaks nationally on the topic of oral cancer and early discovery.

Howard: It's just a huge honor for me today to be podcast interviewing Robert J. Whitman who's the founder and CEO of Forward Science. He received both his bachelor's and master's degrees in biomedical engineering from Tulane University and began his career as a clinical engineer at MD Anderson Cancer Center where his focus was developing advanced technology for early detection of cervical cancer. Fueled by a passion for early cancer diagnosis Robert then went to work in research and development at Remicalm where he worked on creating cancer screening products utilizing fluorescent technology license from MD Anderson Cancer Center. Finally in 2012 Robert launched Forward Science with fellow former engineer Brian M Pikkula with a goal of developing innovative technologies for clinicians to advanced oral cancer screening procedures. In addition to his role CEO Robert also serves as an advisor to start-up medical technology companies on product development strategies at the Texas Medical Center and often speaks nationally on the topic of oral cancer an early discovery. My gosh I think what Mark s. Chambers the department had neck surgery at the University of Texas MD Anderson Center doing is just mind-boggling and you went to Tulane congratulations on getting a degree while living in New Orleans Houma Bourbon Street where I was at last weekend with three of my four sons and I don't know how why are you not an alcoholic you should you should have never gone to class what happened?

Robert: You know I think discipline early on gets you, you get a good taste at such an early age that you get through that so most people start drinking in college but you know I wont admit this to my parents all the time but we got a much earlier start than the average person.

Howard: and Tulane I mean it's consistently ranked among the top 50 universities in the nation and the reason I asked you to be on the show you did not ask me is because I have never understood the difference between oral cancer and cervical cancer. I mean I turned that patient upside down it's cervical cancer insurance pays have all these tasks have regular screenings it's like duh and then you turn that human over and you look at the mouth the same technology the same fluorescence Delta Dental doesn't pay for the exams the test aren't screen you know I've seen em yelling all the time get your annual screening and it's like 50,000 Americans die from oral cancer each year what what is going on why is this still crazy?

Robert: It's tough I mean we started our career at MD Anderson Cancer Center doing cervical cancer research and early on you know the numbers were exactly where oral cancer numbers are we're at 40 50 thousand cases and in you know the 90s the pap smear came out in these trends assuming the 50s the pap smear came out these trends plummeted so you went from 50,000 cases to 12,000 now but

Howard: For cervical?

Robert: For cervical

Howard: Okay

Robert: So you went from 50,000 down to 12,000 and you know so some people talk about the vaccine playing a role in that and maybe so because times past enough now but he's really because of annual screenings were so regimented for female student annual pap smear and yes the elf in the room is of course females are going to give an annual pap smear the insurance pays for it so I'm going to go to my annual ob gyn and by no means or you and I getting a pap smear so we'll throw that out the window now but for for women that are getting annual pap smear we're finding cervical cancer so early now that's why the rates of plummeted it's not just said it's going away it's the fact that we're finding it so early that it never test sized into cancer and the HPV is being removed and now we're having much longer prognosis for these females.

Howard: and what year was the peak of cervical cancer 50,000 when that's starting to do.

Robert: This is in the mid 50s 1950s is when the CDC came out and said we have to do something about this and this is kind of we educate dentistry on is you know the annual pap smear changed the game on cervical cancer it forced women you don't get every year a preventive screening test so if the CDC payes were an insurance pays for it in theory it's a great test right it's only 50 percent accurate scientifically now we want that test that's 90% accurate 100% accurate and the challenge is we want to test it just test way more advanced then right now back in the day was called scopes and it was looking so the accuracy for pap smears was actually pretty low it was the fact that cervical cancer was getting paid by the insurance and females were getting educated properly to get screenings.

Howard: Okay so you know how many people are dying your world cancer um is it still about fifty thousand?

Robert: So you know we're getting 53,000 cases here in the u.s. diagnosed and we're getting about ten thousand died that's just the u.s. you know you throw in third-world countries in places like India where forty percent of all cancers oral cancer male you're you know a top ten cancer where it's you know it's a third of the deaths or from cancer related to world cancer so to your point I mean the issue is this is the only cancer and and again when you look at statistics the first book that we ever read an engineering school is how to lie with statistics so I challenge every stat that we were ever told oral cancer is the only cancer in the past 16 year is that too risen every single year incidence rate we got to do something right away there's something that we're doing wrong in the United States of America and nobody wants to talk about it. So you know our issue is that incidence is rising but also survival rate hasn't gotten better you put those two things together and now you have no one every our American dies of oral cancer and it hasn't changed in two or three decades.

Howard: Okay so what why what is the difference between a female cervical cancer in viewed in society versus oral cancer and I always felt that some of it has to do with if you got your cancer from being a bad boy there's less money like lung cancer lung cancer is the biggest biggest one drawers everybody but it doesn't get the most money the most research because ever he's like well you should have not smoked.

Robert: So true you know one of the biggest hurdles that we face is that stigma you know and you look at you look at Susan Coleman's done for breast cancer awareness it's remarkable that you look at you see the color pink and you associated with breast cancer and you have walks and events the problem is you know with oral cancer almost every major cauase is self-induce whether it's tobacco and alcohol related or HPV everybody looks at this I did it to myself so if I do you know for one we're not living long enough to share our story and there's some way we are nobody shares it you know tony wind is one of the best hitters ever played baseball and he died at 56 years old from excessive tobacco use nobody in the major league baseball is talking about it, why I mean you had the option the opportunity to educate and screen patients regularly better at the highest risk it's just taboo right I mean that's why we do marketing a little differently we have sex drugs and oral cancer everywhere you can find because if we're not addressing the HPV issue then who is and know we're not gonna change these trends.

Howard: Well Kyle we just got the name of this podcast it's sex drugs and oral cancer by Robert Wittman I mean who's not gonna click into sex drugs and oral cancer I mean they'll see that in thankful I hope they left the number is there some website I can go too. So let's start with that what is well latest statistic on oral cancer you're so you're going just to summarize it's one death per hour in the US or world

Robert: That's just the u.s. so you know we're getting the incidence rate is 53,000 cases this year alone we're getting about...

Howard:  Diagnosed or dead

Robert: That's diagnosed, 53,000 diagnosed we're gonna get about 10,000 of that dying every year here in the US you know 60, 70 percent of those patients that are diagnosed are found in late stages because traditionally when you see or feel the tumor it's a secondary tumor that we find.

Howard: So it's one death in the US per hour.

Robert: Correct

Howard: Per hour 53,000 cases diagnosed annually and 10,000 will die

Robert: Yep and then worldwide you get a hundred twenty-seven thousand deaths and that's a lot.

Howard: Worldwide how many?

Robert: 127 thousand oral cancer deaths every year and that's with two hundred seventy four thousand cases so you're seeing I have the population that's diagnosed with oral cancer died within five years.

Howard: How many worldwide how many

Robert: 274,000 so the five-year survival rate worldwide is less than 30 percent and that's tough.

Howard: Worldwide survival rate is what?

Robert: Less than 30 percent so you know we spend half of our time educating because the dental  industry does a very good job with education but oral cancer is not one that you know it's a mandatory 12-hour credit every year and you know we struggle with educating on the new trends and new factors because there is new technology that we can help change lives and just getting people to incorporate it into their everyday practice.

Howard: So let's talk about your you have a famous lecture called sex drugs and oral cancer what does that mean why did you add sex and drugs and oral cancer those three things normally don't go together?

Robert Yeah I mean I think most of the time we think of it's marketing right so we throw the word sex in there and drugs and people want to listen which is partially why we did it realistically it's because world cancer is caused from two major risk factors tobacco and alcohol for a longest time but now the sex comes in from sexually transmitted HPV and you know you've talked about it of us and all your your podcast so you've had a ton of educated people getting on and talking about oral pharyngeal cancer or HPV relationship and you know its tough we're not we're not fully comprehending right now where this is gonna be within the next 10 years because this is just a start to what HPV is gonna do for the world cavity and oral pharynx specifically. So we got a long way ahead of us and I think education and early discovery is really the key to helping change these trends.

Howard: Well that's another one I mean um um well first of all on the HPV in it's not just from kissing now I mean it's not just from sex it's from kissing and well just kissing in general I mean I don't want to just say oral sex but can you transmit HPV obviously by kissing.

Robert: Yeah I mean you saw the recent deadly little article that came out that said well there's like whenever it's you French kissed someone there's so many bacteria and things getting swapped you mainly from sexually transmitted so it's typically rule sex so we're seeing it's imp on the cervix to the mouth so we don't have to draw stick figures on how it gets from a cervix to the mouth but that is how we're traditionally seeing it but it also could be fun sharing a drink after a loved one now there's a reason that that every time a woman's about to have a child they get an annual paps but they get pap smears regularly it's because if the mother has HPV then the child is likely to get HPV too and you gotta be able to defend against that early on so it can be more than childbirth sharing a drink and then the highest incidence is from sexy transmission.

Howard: So do you think Michael Douglas played a big role in getting us out when he came out and he said I got oral cancer and it was from oral sex and when the newspapers heard Michael Douglas say oral sex I mean they jumped on that to know tomorrow what did you think of that the whole Michael?

Robert: I'm in New York walking down you know Broadway and there's a huge tabloid on the side that says sex gave me cancer and of course we gotta grab that I don't know what that means but we're in the cancer world so I grabbed the article if it's Michael Douglas telling the world that you know cunnilingus gave him oral cancer and for the next month cunnilingus was the most ruled word I tell everybody you're gonna google it don't google it on a work computer or don't Google the next two kids it's cunnilingus his rule sex he just tried to pretty up the way he got a little cancer from not just saying it blatantly he did a good job for a year about educating about oral cancer and how HPV relationship but then no he's a PR team told them to stop talking about it and look unfortunately that's where we're at of oral cancer you don't come to your point earlier people aren't getting above and people like Michael Douglas have a great opportunity to share the world about a little cancer and he did it for a year but he makes him look bad you got more questions any wanted.

Howard: It made me not want to kiss him anymore I absolutely stopped that dream but but you know it's funny we started this about you know okay you turn someone stand on their hands and you look at the cervix and the whole world's behind you the health insurance everything on the vaccine for HPV that we should our patient we getting is Gardasil and you open up the Gardasil website and it's vaccine a for cervix and vaccine B for Gardasil so I mean we're supposed to be a Doctor of Dental Surgery a physician of the mouth and all my MD friends there they're totally on top of cervical and all my dentists homies and they don't talk about this to patients they don't give the vaccine. I'm in Arizona I'm not even allowed to give a flu shot let alone a vaccine for HPV but I can go into Walgreens and have a pharmacy tech give me a flu shot it's like okay my nine years of college I can't do it but a farm tech he looks like he's younger than any of my four children I mean so what would it why what do you think a Gardasil9 and again it has to be some cultural taboo?

Robert: Yeah I think the part about health care that we're all trying to figure out is you know how do we have this integrated medicine from dentistry is doing blood pressure is and you're doing so many things in the dental office well let's be real I'm gonna go to my dentist every six months and I don't know I don't know my PCP is I haven't been to a primary care position in years because you typically don't do your annuals as much as people would like because people go in and they get sick but dentistry should be to be able to step up and everybody's got their own rules and regulations they got to take care of which puts a hurdle in it I think if you look at the vaccines some people were pro or against vaccines or it's it's everybody's personal choice but you got a look at the risk versus reward and right now the risk of oral cancer has been rising and you know the word for being able to get vaccinated from a disease that's been affecting a lot more patients is there so it goes back to education and your point it's its ease of use and we can give people that you be able to give these vaccines like a dental office then yeah I think what people would give it you probably give it.

Howard: but there's several threads on dentaltown discussing you is it a personal choice is it a is a vaccine and you know and what I what I can't stand the most is them when somebody ask an honest question than society marginalize them just stop doing that quit be you know you're not getting change someone's mind by bullying them and making them feel bad you have to engage them and there's no such thing as a stupid question. The dentists are upfront that I'm that they're concerned that you're right not to vaccine and then you bring your kid into my pediatric dental office and expose 30 kids and that makes the evening news so is this vaccine really a personal choice?

Robert: Yeah I mean I think early on in Texas it was creating texas by md anderson and one of their affiliates and the governor at the time tried to mandate it and you know here in the united states if you get anything mandated people get turned off whether the vaccine was beneficial or not when it comes out of the gates mandated people fought back winning way too hard and he started on the bed foot so you know mandating vaccines yeah the challenge is if you you know now with vaccinations in the schools they're mandatory because all it takes is one kid not to be vaccinated to be in a school and they're much sick so no it's tough I don't have a ton of experience with it but as far as my kids I have four and a half year old and it almost two year old so we haven't had the conversations yet but my wife is an ER nurse and we believe in Science we believe the medical industry these vaccines work you know they're they're out there for a reason.

Howard: What I have found here in Phoenix what if I'm able to change someone's mind is that I'm they say well if you're vaccinated you're not gonna get it what are you worried about it used to be wearing my kid so they don't and I said well that's a great thought but my kid or myself will still get the virus and my body will have to go to war and it's gonna be in a full front war before this vaccine kicks and builds up my immune system and yeah I won't die for me because I got vaccinated but I'll be coming home from war and I don't want to go to war and they're like oh so because they just think well if you get a vaccine you have this magic shield the virus can't come in so they don't understand biology and so on so let's just go through it why is dentistry not screening for oral cancer?

Robert: You know I think there's a lot of factors that play a role with that you know for one anything insurance pays for I think people are more likely to do so if you want to talk about the elephant in the room if we can get insurance companies on board the issue with that and again I have no political issue with insurance companies but I also they don't take care of us and our screenings so the reason that insurance companies don't cover our screenings or screenings with any injunctive device is mainly because and I'm asked somebody high law from one of the insurance companies and he swore to me I'll deny this if I put them on the stand so I won't do names but today why don't you guys cover oral cancer screening you know for for us cervical cancer gets covered because every dollar you spend you save five dollars long term dynamaxx the hope or purpose of prevention for them for every dollar you spend an old cancer screening you save the medical insurance company money so why would the dental insurance pay two to five million dollars in their premiums but it doesn't save them a dime it saves the guy down the street the money and unfortunately that's the world we're in and insurance dictates a lot of stuff and you and I will probably agree that we shouldn't let it dictate things but it does for patients so a lot of our patients that get educated that insurance may or may not cover it's a simple fee for service they do go ahead and get the screening but for the offices that are insurance driven insurance we don't expect to cover this in the near future because it's not saving that insurance company money they run a for-profit business and they're saving their counterpart down the street the medical insurance company that money. So that's the biggest reason the other reasons are people don't talk about cancer you know I've heard a million times I'd rather not talk about cancer I got in dentistry to be cosmetic and to make patients feel better you know unfortunately I think we have a responsibility to our patients that you guys are the educating factor you're the you're their clinicians now you have to talk about everything that they need to know about and oral cancer's been on the rise for a long time I think the third and final challenge is technology you know it's not something that people learn about in dental school it's not something that has been out there for 50 60 years we have advanced technology now that's not diagnostic but we have to embrace it that it's just one of the tools that we have in our office and part of what we try to offer his unlimited education so that when you do have a patient in the chair and you have a lesion you're concerned about call us let us help you you're not on an island on your own you're not gonna call the world mythology that's going to give you his or her thoughts without even seeing the lesion let's have a discussion let's say some pictures let's do some diagnostics and let's figure out what's the game plan for this patient and I think knowing that you have somebody in you on your side to help you through that process we have offices that are onboard a lot more frequently and we're seeing patients every day because unfortunately it's not the 40 year old smoker anymore it's the 16 year old that walks in the door that doesn't have any risk factors whatsoever.

Howard: So let's finish the point on the dental insurance I mean history repeats itself because the more things change the more you're still a homo sapien and as the homo sapien goes from smoke signals to the telegraph to the telephone and the internet is only the telegraph 2.0 or 3.0 but 1895 x-rays were discovered and it was in 1896 the next year the Charles Edmond Kel's took the first dental x-ray and there was no but nobody was using dental x-rays until 1954 when the first dental insurance company started in California and then when they came out with their dental insurance for the long shores and club they were the shipping industry every container that came in and out of America with his Longshoremen's Club and it covered a hundred percent for cleanings exams and x-rays and America like a domino of the whole everybody bought an x-ray machine so the fact is that what it should it could it doesn't matter someone's got to pay for this the patient has got to pay for it and or the dental insurance so is the patient coming in and asking you for a flu shot they'll pay you ten bucks like video Walgreens or they asked you for Gardasil mine by merging company and pay for that upon you know it's it's a crazy mess so so tell me specifically what are you doing what what is Forward Science I mean you've been on this for a long time what are you doing to help this today like so I'm a dentist I saw patients couple days last week you see some something you're suspicious about what how are you changing that?

Robert: yYeah I mean I think the first step that we want to do is we wanted to take current technology that's being used at the top Cancer Center the nation and get it out to every single person in the world that can use it. So obviously the dental industry is do we need to focus on you guys are seeing patients across the board so for us we took technology fluorescence technology that we utilize for both cervical cancer and oral cancer along with over lower endoscopy fees in the lung so any of you coastal cells in the body we took that technology we incorporated into an easy user-friendly simple device with no per patient costs and we want every dentist and specifically every hygienist to have a device and every time you see a patient's you screen them it takes two minutes it is not diagnostic it's not gonna just throw a red flag and say cancer it's there but it's just like you're loops if you see a lesion of interest it's gonna help you see it better that's the purpose of it so our device will ID it's been on the market since 2013 you know we even save the lives ever since we have patients that are lesions that are found early that aren't even cancer yet.

Howard: What's this one called?

Robert: Oral ID

Howard: Okay oral ID.

Robert: So Oral IDs been on the market since 2013 it's a simple easy device I mean you can see how it's simple it easy is it's a simple light and you shine Oh shine a light on the patient's tissue you wear a pair of glasses the glasses block out all the light coming out of the device we only want to see the fluorescence from the tissue and then you're able to see lesions much earlier so here's one of our laminated sheets that we give to the dental office and you can see lesions that are white light compared to fluorescence technology it gives us the ability to see these lesions when they're stage one stage zero and that's the difference from a patient having eighty percent survival rate to a forty percent survival rate so that's our first step we launched the Oral ID we thought that the device itself was going to change the market but we then shortly realized you can't just launch the device and hope everybody uses it you know things things happen you guys are busy you're running a practice there's new technology every year so what we did was we said hey let us do a program let's give you marketing material to market your practice let's give you unlimited support continuing education let's have a doctor on staff when you have a lesion you take a filter so you put this on your smartphone you snap a picture of the patient's mouth send us the lesion you know let's help you through it. So now we're we have a monthly program that we support our offices from marketing efforts all the way to saving lives and our offices are making money their marketing their practice better and ultimately what our goal is and hopefully everybody's goal is we're able to change some lives by finding cancer early that's really what our goals been for the longevity of forward Science.

Howard: So then you're really at teledentistry?

Robert: I mean diagnosis always goes to you guys so yeah we're we're the unlimited support if they have a question if you need anything we're gonna walk you through and it's not that we're clinicians he said we're science-based and we've seen every case possibly you know we've worked with the top cancer center religiously on a lot of different research and studies we know what people are looking at we know the tissue is challenging to look under a new type of light so let us help you find a lesion take a picture send it to us let's walk you through what the thought process should be and over time...

Howard: Let's go back to the oral ID and your we're going through a lot of your prices so it's um how much is that cost how much is a starter kid to tell me tell me you since insurance not paying in is definitely money's the answer what's the question, so my homies listening right now what is the what is this cost what are you people charging for it, how does this work financially cents at the end of the month my staffs gonna want to get paid I'm gonna have to pay my rent mortgage build a computer insurance malpractice so how does this economically work talk MBA.

Robert: So typically in the past these devices costs between two and five thousand dollars upfront and then every time you seen a patient there's a 2.57 sheet so the average office screens about a hundred patients a month that's $250 a month so that's an upfront cost and an ongoing cost and that's why I dentistry wasn't going after a lot you know it's not cheap so we said hey our goal is not just to sell a bunch of widgets in to ride off in the sunset we want to change lives and we want to truly make an impact on Dentistry so we said hey what if we just say no upfront costs and instead of charging every time you screen a patient what do we have a device that just charges you a little monthly fee so that now you don't have to worry about 250 bucks a month and then you screen 200 patients now it's 500 bucks a month so we now offer our device in a complete program it's nothing upfront two hundred dollars a month and that's it you get a limited warranty unlimited CE credits you get a lot of different social media signs so when you're marketing this to your practice you want to hold up a sign that says fifty Shades of oral cancer put it on Facebook put it on social media and let let your patients be your marketing. So typically our offices if you look at the economics they charge between 20 and 35 dollars per screening again it cost you zero dollars so that's 20 $35 profit after the first day of hygiene we typically see about a seventy-five percent acceptance you've paid your monthly you paid your monthly feed and you have a hundred percent profit after that so our offices are making between two and three thousand dollars per device in their office every hygienist you know puts it in their comp plan if that's something that offices do you can still - the bottom line for the office.

Howard: Its 250 a month?

Robert: It's $200 a month

Howard:$200 a month

Robert: Yeah most other devices are 250 a month because the Sheik is 250 and then the screen hunter patients.

Howard: Wow and how what year did this come out?

Robert: We launched in 2013 March 2013 we've switched to our monthly program we call it the ID for life program from the market demand you know market wanted more support more marketing more literature and as a small business you can't just give stuff out for free...

Howard: Started in what year?

Robert: 2013

Howard: and instead of having you know the I I think one of the biggest problems is you know you know there's a statement of income a statement cash flow a balance sheet the business model of a monthly recurring revenue, a recurring revenue model like Netflix is why Netflix almost had a valuation of Disney because Disney was that you know I see in 30 years were you know company would a laser for 50,000 and they sell a thousand of them and then they'd go bankrupt because they had no recurring revenue and I saw it in dental software that the best dental software companies are ones it just charges those to say okay we just want a hundred bucks a month because if all you guys are paying $100 a month we can plan our payroll or expansion or bills but if we sell you something really big one time we're panicking because we don't know how to budget because we can't predict the future so congratulations on converting to a recurring revenue model it's the obvious no-brainer business model. So it's so you started this in 2013 it's 200 a month how popular a successful is that it's now 2019 so six years how many how many dentists are doing this now?

Robert: So in 2013 we sold out right and we went that route and then in 2015 we switched to the monthly model so as far as worldwide we do have a lot of offices worldwide that are using this third world countries obviously have a big opportunity to save some lives but here in the US you probably have four or five thousand offices that have a device we got our footprint in with some large groups that we work with and you know DSOs are probably a whole another topic of conversation that we can go over but for them they wanted to motivate their team differentiate themselves but also make some money so you know if DSO's are doing it then there's an opportunity for the revenue driving aspect to be there and so we...

Howard: Which DSOs are doing it?

Robert: So Smile Brands came on board with

Howard: Who?

Robert: Smile Brands

Howard: Okay

Robert: So they're bright now small brands monarch castle or wherever you are there's a different office and then now we're working with you know some of the biggest groups in the nation whether it's Aspen, Heartland you know we're working from office to office and then trying to work with corporate to figure out how we can impact their entire system so no for them there they're always looking at their initiatives and typically their initiatives are a year or two out but from our end we want to work with every single practice that's trying to do the right thing all the way up into big groups and we don't you know we're agnostic to who we go for we want patients get screened and wherever whoever screening patients that's what we want to be.

Howard: and Smile Brands he was on a Steve Built he's a CEO co-founder he was episode 787 and I always told these young dentists you know those at the end of the day they want to most I want to work for themselves and they'll work for these guys with these and they'll come out after a couple years I'll say well tell me this guy is running several hundred offices what did you learn from the business they didn't you know they just did fillings and crowns so when Steve Built is doing something like this he figured out how to charge money pay their overhead and and that income because if you don't make profit you're no longer alive so congratulations on Steve Built and but you haven't got an have you got Heartland or Aspen or...

Robert: Yeah we're working a lot of regionally so typically for them you know it's a two to three year process we have some regional rollouts so we're working with you know for them they have a lot of initiatives whether it's laser is whether it's another hygiene initiative so the fact that this can be put in the hygiene and grow it up and it's something that we're doing trials with and we are working with all three of the ones you mentioned so again I mean it for us it's bandwidth and we need to be I could be able to go as many offices we can service everybody the same that's been our focus and say one.

Howard: and they want to do a pilot I mean so it's called the the BB gun the rifle the cannon and you know my favorite business book who wrote that built to last good to great...

Robert: Drop link somebody it's a high reading but somewhere around here

Howard: Built to last oh my god Jim Collins I'm sorry JIm I'm sure you're not seeing this but I'm my four favorite business books of all time were all written by him I mean it was built to last good to great how and how the mighty fall all that I kind of stuff but what he talks about successful companies when they have an idea like say your Aspen in you got five hundred offices or nine hundred offices Hartland you so say oh we're gonna do this and do it because then you might go bankrupt so what you do is you start with the BB gun you say well see if we can hit this and you'll take one office one region and you'll hit it and you'll shoot at it and you hit it say wow that work so now we're gonna load up and we're gonna go to a rifle so now I'm gonna try to shoot you with a rifle and if that also works then we're gonna go ahead and load up and take a cannonball and hit everyone and when you don't follow that recipe you run out of cash and when you study the forty to sixty thousand bankruptcies that happening every year in the United States a lot of them were profitable they just ran out of cash because I just sold you something and you're not gonna pay me for ninety days well my bills are a dollar a month I don't have three dollars in savings to wait for you to give me three dollars and ninety days so you got a business and it was profitable so the collection policy what insurance you know collecting half down when you start in half before you see to a crown I mean if you don't have your financial house on order you should just call yourself doctor what is shoulda coulda and prepare for bankruptcy today. So I love I love the fact that these guys are doing it in a way that would make Jim Collins proud and they're testing it out regionally so oral ID is that your would you say that's your flagship product because I always think of you a smile max too but what is your what is Forward Science flagship base product?

Robert: We made our name from Oral IDs so early on we would go to trade shows and we only had one product so we would have Oral ID branded everywhere and that's where we were known for so when we launched saliva max which is a prescription range for dry mouth we had you know we had we brand a little bit you had to put Forward Science really big on everything and then our products underneath and that's just par for the course of business and we're fine with that so Forward Science has been you know what the company's been named since 2012 but we had to focus back to Forward Science in 2015 when we launched saliva max to say look we have a Oral IV which is an award-winning oral cancer screening device that's been on the market since 2013 we're also looking for an oral health rinse and saliva max that we're launching. So we have these two opportunities we have some diagnostic tests but you know saliva max was our first introduction to the pharmaceutical world and there's nothing on the market that actually treats both xerostomia mucositis no typically the way that we come up with a product does we listen to a dentist and then a hygienist and then another dentists and by the eighth time we hear something we try to figure out how to make it so people kept complaining about dry mouth and how biotene doesn't work and how it's acetic and all those things that we hear but nobody had a solution for that problem so you know my partner and I got to the lab and we said hey what can we do and a year and a half later we launched saliva Max and it's been it's been dentistry it's biggest kept secret because people don't always understand how the prescription world works in dentistry but it's one of the only products that actually treats both xerostomia and mucositis and the fact that you can treat both of those I mean it's it's a game changer for an oncology patient for medication induced xerostomia patient and anybody else that just has minor xerostomia which unfortunately is population nowadays.

Howard: So yeah xerostomia is so huge because we had the fastest growing population as the over 65 and by the time they're on five different medications they have polyphagia going on and they're they're miserable and it's hard for a young dentist to realize how painful that can be I mean even when you eat food it doesn't even taste right if you don't have saliva. So if oral I if Oral ID is your flagship product and I'm what would be your second I mean you got site ID path ID HPV ID pH ie D bio-rad slide the max lidocaine what would be your next...

Robert: We classify I mean we kind of classify what we're doing here in kind of two categories when we have the devices which is what might be initially for early screening we have a Diagnostics and that's an entire category so part of our program that we talked about earlier with Oral ID you get all of those Diagnostics for free so whether it's site ID which is a liquid base cytology path IV which is a biopsy kid HPV IVs and HPV tests and pH IVs pH strips for to test them out for their acidity level all of those come for free with our program because we know if you find the lesion you're going to need to diagnose it however you want to diagnose if we have the option for you. So that kind of all lumps together and then we have our therapeutics and our therapeutic source alivamax city big and we're lunching and you know another one hopefully here in the next six months for another therapeutic so that's our therapeutics it's our prescription rinse line that we have dentistry has the option to you know prescribe something that's been clinically proven and it's more of the therapeutic description world.

Howard: Okay let me get that screen so oral ID is screening and then what did you call the the next

Robert: Diagnostic

 Howard: Diagnostic what?

Robert: Diagnostic tests

Howard: Diagnostic test

Robert: Screening, diagnostics and therapeutics.

Howard: Therapeutics okay I'm sorry my walnut brain works and so your therapeutics are going to be...

Robert: Saliva Max

Howard: Well BioRed would Saliva Max be the first one you talked about there?

Robert: Yes Saliva Max and Slidocaine. Saliva Max is a prescription rinse for dry mouth, Slidocaine helps patients it's a five percent Ben's game rinse it helps the patients that are going through oncology treatment thinking through that first week of mucositis pain while they're using Saliva Max to treat it instead of big is a one and done costal medication that we launched about a year ago it's a time-released cycle so it's been clinically proven and now you don't have to worry about the systemic issues that for the cycle your bio red is just kind of a third a liar that we have our booth outlier that we have which is a mail back medical waste service because I'm sure everybody loves that stare cycles got them in a contract so bio red was something that we launched for the dental industry just for a mail order service for sharps in medical waste.

Howard: I gotta tell you my him you know dentistry really started getting you know it's probably first big technology was addressing pain with novocaine but I don't think I'm people remember the history started out with cocaine and and then you had the obvious problems of cocaine do you realize when I was in dental school and you had oral cancer and you couldn't eat or anything like that they had aerosol cans 99.999% cocaine and it was just a lifesaver I mean these patients they can swallow that radiation burns they wanted to kill themselves and they get other doctors saying well you can't give him that they might get addicted its like do they want to kill themselves so and you're worried about something less than killing themselves you know um and my gosh it was it was the most stolen can in Missouri that's all I'm gonna say I'll end it there but so yeah so it was crazy so that's Salivacaine and then you also have Sitavig.

Robert: Yeah Sitavig it's a time-release acyclovir tablet so you put it above me reducer to have you put it on put in your mouth and once you feel the tingling it prevents the telecoil towards it delays the onset of the next cold sore it's been a product that was launched in the dermatology world for a long time and dentistry is you know typically looking at over-the-counter medication or appointment for after the fact treatment this you can shoot in the prodrome face a third of the time it doesn't even erupted so it's truly something that dentistry you can benefit from but you know it goes back to education to keep or everything we do and we just need to get in front of more people that you can do.

Howard: Okay let's talk about that there's a lot of them a lot of young kids that just got out of dental school or maybe they're in dental school they're seeing their first patient and they sit down and Robert Wittman is in for a cleaning or a filling and he's got a big cold sore and they know that cold sore is herpes, do you think that talk about that is do you think the dentist already has that is a contagious talk about that.

Robert: Yeah I mean I think a lot of times people don't know how to have the conversation right HP you know people don't know how to sit down and I'm big on facts do you guys do and say facts and it's not a I feel you feel conversation it's a here's the facts about what you have I mean herpes is not something that's crazy uncommon it's induced from some factor in whether it's stress or whatever they have going on but Sitavig is something that can help and it's not just after it's a rough it's you need this product for next time that you feel the tingling you don't have time to call me and go get it filled you need the prescription right now with you at all times so that if you do start feel the tingling use the tablet and then now a third of the time I won't even erupted if it doesn't rub its way less severe than typically what you're seeing so you know again I think prevention is what we're all about at Forward Science and we want to prevent these bigger issues and Sitavigfit perfectly in our portfolio with preventing these massive cold sores that people are so embarrassed about it.

Howard: Well back to her question though she's wondering should I reschedule this patient I mean so like I'll be 57 in two weeks I've never had a cold sore I was never afraid to work on a patient with a cold sore I was never afraid to you know kiss someone in my family that had a cold sore so it says prevalence of herpes simplex virus type 1 hsv-1 was 47.8% and herpes simplex type 2 11.9% from the CDC do you like those numbers from the CDC?

Robert: Yeah where do we go forward with the data no offense to the ADA but the CDC is a little more up-to-date.

Howard: So if you've never had a cold sore and Robert shows up for a cleaning and he's sporting a big ol cold sore would you do it anyway would you reschedule what what would you do I mean you know this stuff at a different level than any my homies listening.

Robert: Yeah I mean I think that goes back to the clinician themselves and how they practice I think a lot of clinicians are gonna treat the patient and look at convenience and then they go ahead and do whatever they need to do today and then you have the other half of them that are gonna say you know what can you please reschedule so that's always the clinician a clinician I'm you know I'm not a clinician so I never had to make that decision but if you've never had a cold sore before the odds of you having a cold sore at later on in your life it's not common you know I've never suffered from a cold sore so the odds of me getting a cold sore someone that has one it's pretty slim but if I am a cold sore carrier and then somebody else does have it yeah I ask maybe people are more likely to get it but there's a lot of other factors that go in and just looking you're practicing on someone with a cold sore just like HPV we ship people think that now I do I treat this patient with HPV lesion or we were a good example here is we work with an HIV clinic here in Houston and you know the HIV patient has something that people are worried about a lot in there you don't treat these patients any differently you see the same patient and you make sure you treat them the same way and things are going to be fine so I think just simple precaution measures.

Howard: So what is it what does the take away what would should my homeis be doing with Forward Science I mean what do you think the first step I think the first step is I think you should do that section what is it sex drugs and rock and roll did I get there right?

Robert: Sex, Drugs, and Oral Cancer.

Howard: Oh I thought I was always doing sex drugs and rock and roll yeah that's where I messed up I wish you'd make it online CE Course on that on dentaltown.

Robert: Let me know I'm happy to do it.

Howarad: I'm Howard I was the first Howard I'm so i'm shoot me an email if you have any thoughts or shows or leave comments under the YouTube section and but who does all the online CE is Howard Goldstein so he's Hogo and sex drugs and oral cancer by Robert Wittman MSC founder of Forward Science that would be so in a recap how would you how would you what does it take away summaries.

Robert: Yeah I mean I think one thing is educated you know whether it's from us whether it's from whoever else we do have some online courses on our own and I'd love to put them on your platform so learn more about oral cancer who's at risk who's the people you use scream unfortunate everyone and then on top of that you know make sure that you use a jump to technology we'd love everybody to try OralID it's you know I get a no upfront costs it's simple easy to use and if you don't like it send it back and the fact that people can try and device a see how they like it clinically it be make some money while you do it I mean this that's the perfect scenario for a dental provider to make money while they're saving lives and if you don't see the benefit in that then we probably have other issues and then have the conversation with your patients you know I think a lot of people are afraid of having an open conversation but in today's world they want transparency you know your patients want to know about HPV and oral cancer and they're reading about it somewhere else and it's probably incorrect you have to be the bearer of information and you know some of our assures that we give out to our offices or we say blatantly sex drugs and oral cancer.

Howard: Okay but I mean today on the news even very conservative Christian evangelicals they're they're mad at Trump on his last deal not for any policy thing he said but because he took the Lord's name in vain three times during the show and it's exploding and when I when I when you go to dentaltown and you just drop in the key word on HPV or oral cancer all the threads are talking about these dentists are saying and it's they're not gonna talk about it's not gonna happen so this is our country and it's a very very conservative country so how are you gonna get?

Robert: Let us talk for you is well you know part of the reason we switched to this elaborate program is let us market for you let us give you these social signs that you're putting up that says you know if oral cancer so that you put it on social media they call you for that or you know last April we launched a lips campaign so it's called kiss a little cancer goodbye people are taking pictures of these lips put it on social media nobody knows what the lips mean but when they show up in your office and you say that men kiss a little cancer goodbye now all...

Howard: Hold those lips up again, now if you watch this on youtube if those lips had a cold sore would you kiss them I'm going with yes no problem

Robert: I'd ask you Howard which color is your favorite color you got you know painting purple and we have a million other colors that we choose from.

Howard: Well mine's purple and when I told my granddaughter it was paint she said it couldn't be pink cuz I was a boy and so we agreed that hers was pink and mine is purple but there's a thread on dentaltown HPV vaccine discussion with dentist and somebody of the first post hell to the no to the no no no and I mean this is they're not gonna do it so so you're gonna help them and you know Elvis press yeah I really admired him because I was born in 62 in Kansas and my mom my gosh she loved she had everything Elvis did the Beatles did and the Glenn Miller Orchestra and that's what I grew up on it in 1956 Elvis Presley got a polio vaccination live on national TV the one of that was partly responsible for raising mu nation levels United States from point six percent to 80 percent in six months that's how big Elvis is. I mean Elvis is in the house and where are you know the this deal were who's gonna be the HPV Gardasil who's gonna be the Elvis in the house with HIV was a Michael Douglas is even running for was wasn't there rumors about some quarterback for the Buffalo Bills?

Robert: Yeah so Jim Kelly's had oral cancer and he's on his third spot now and he moved part of his jaw and you know I mean for him it was tobacco use so I think the challenge is who's gonna be the next Elvis nobody because everybody's ashamed about it so we have to beat it to the punch and say like you know let's not wait for you to be the poster child let's make sure that we're doing everything we can for our patients and that's screaming it's a two minute exam you some offices want to talk about HPV some don't call it a normal health assessment don't say the word HPV or oral cancer. I'm a transparent person and I'm probably gonna ask them questions about you know if you're six or for all sexual partners you're eight point six times more likely to get oral cancer some people ask the question of how many oral sex partners have you had so don't to each his own but however you do it in your office we'll help you with that questionnaire the risk assessment survey the verbage let us be your guidance on that but do something know when Ulysses S Grant died a long time ago form oral cancer and the same way Ulysses S Grant was being screened is the same worse we're screening today and for me that's just not that's not acceptable and in a disease that is very very easily treated if we find it early but we're just not finding it early enough.

Howard: That is amazing and what I really enjoyed this study a while back it was showing that you know a lot of these countries they just started back stating women first and then they the first days thinking about long as the boys were benefiting from it because they didn't get the vaccine but now the girls are kissing don't have it and it's all her disease and no one wants to talk about her disease every time some child is taking to the Oh are to be put down to have a bunch of pulpotomies and chrome steel crowns they and they don't come out of the procedure and the horrible thing happens the media never addresses why did that two-year-old need eight root canals talk about her disease she's living in a barn with a bunch of people that have blown out decay everywhere and they're all sharing spoons and kissing and hugging and playing and and so so the first week significant data we really have on HPV vaccines is when you gave it to all the girls the boys didn't get it so why have you seen Margaret every three months for periodontal disease for the last five years and you don't even know who her husband is do they have a plutonic marriage with three kids where their children conceived at Tulane University in a petri dish I mean it's a herd disease so you're you're the smartest man I know on this subject you have two children two of how many, what's the plan on this?

Robert: Oh man we're in Houston Texas our families in New Orleans so we're gonna stick with two right now for our sanity but well we're figuring out here shortly.

Howard: and when will you give them the HPV vaccine and have you and your wife had it and would it still just be only Gardasil 9 by merck?

Robert: So no I mean there's more Gardasil shots now there's a few other companies that have it the good thing is the the vaccines advanced enough where it doesn't protect just against 16 and 18 which cause the majority of server oral cancer it's way more than that so it's about six or seven types down I didn't have the luxury of having it more than my wife because it didn't come out in time you have to get it before you've been infected with HPV so the Gardasil team actually approves it approves it for nine year old boys and girls because if you're good before you become sexually active then more likely you haven't had HPV yet but if you get the vaccine when you're 18 and you've already been infected with HPV then the vaccine doesn't work so that's why they recommend nine-year-old boys and girls and yeah my wife again she's an ER nurse she's very well medically trained way more than me and unfortunately from the world that we live in knowing too much information isn't good we're most likely gonna vaccinate our kids when the time comes.

Howard: and when do you think well basically I know I want to say something else it's called the value chain, when I grew up with my dad I mean you know when he had Sonic drive-ins he was on he was on equal footing with his value chains the meat man that you know the produce everything and and everybody worked together to serve a hamburger to their common customer and dentists have been so abusive and holier-than-thou that the dental societies on you know the that I mean like the California Dental societies would have lectures by Bill dickerson called Delta insurance or the devil and Delta's like really you're bringing in a speaker that's referring to me as a devil and we sold a billion dollars of dental insurance in your state you cretin morons and that and I mean so the we're paying the price for the arrogance that we've treated Delta Dental and then and then you wonder why they snap back at you. Your state dental societies and the American Dental Society and they got a bunch of relationship repair they got to do and then Delta Dental I mean that the average Delta Dental guy in a state will probably give some dentists a hundred grand a year and that dentist could even pick that guy out of a police lineup never sent him a gift never sent him cookies never to you know because I'm a dentist and you're not and then the State Board of Dental Examiners I mean you want to get permission to give a flu shot or or any of this new technology but you know they've only met you twice and both times you walk in there with a lawyer cussing and screaming I mean when when is dentist you're gonna figure out that they're part of this very complex dental value chain.

Robert: Yeah I think it's the fight the fight-or-flight mentality you know I mean you're most dentists are under their own practice and you gotta spray for every dollar and it's tough to your point earlier about why Forward Science is looking at a long haul picture because we want to do the right thing today and we could probably do more financially today but I wanted you don't want to be here in ten years I want to make sure that we can service the products that we're offering with our offices so I think a lot of times people look at the small picture not the big picture you know run a value proposition the taking insurance versus not if you offer this screening yeah 20 30 percent up do get covered so try that but if it doesn't get covered then tell your patient hey your insurance didn't cover this it's going to be twenty dollars out-of-pocket you charge for a copay for a pap smear or mammogram twenty thirty dollars patients are willing to pay for services that they understand it for me personally I pay my dentist sixty five dollars for a screening and he educates me everything that I told him to say he says and he pretty much guilts me into paying it because I have to because I can't say no. So if you educate properly I think it goes a long way but no depending on insurances it's tough these days but to your point they're not the devil it's just understand what their value is use that value and then go elsewhere you need more value.

Howard: Well I think you know I'm the reason dentaltown online CE has been you know such a huge hit we have four hundred courses they've been viewed a million times because it's suscint to an hour it's perfect for a staff meeting instead of flying your staff and put them in hotels and closing down business for a day you can just keep them on the payroll order a pizza for lunch and watch one of these courses I'd love for you to do a one-hour lunch course on sex drugs rock and roll and what the hell is oral cancer and I want to finish this the last question with how do you metrics successful for OralID I mean if you're you know how what is your metric how do you metrics success for this?

Robert: I mean so ultimately for one I'll say this having having your kid have a device in the bathtub and seeing the whole tub light up blue is always a success but you know I think typically people look at success as how much money you're making or how many offices that are using your device we look at it from the patient standpoint how many lives can be truly affected how many lives can we change because we didn't just sell a device we had an office use our device of every patient that walked in the door and those stories that we back from offices that say hey without your device without your CE course without this technology I would have missed this lesion and who knows what happened to Miss Smith I mean that's the ultimate pinnacle for us you know whether it's five devices or a hundred million devices I don't I don't care nobody uses it what the point I'm making the straight technology so we metric our success in life saying and the fact that we can actually do that is pretty grounding.

Howard: and you know to my young homies out there I look that what excites me the most about this podcast well I'm not gonna stop doing it and while you guys are so consuming it is the fact that but my gosh you're the next generation I mean we're about to fade away you guys are gonna replace us and when I was your age look how marginalized gay people were and now now they legally get married they're not they're no longer marginalized. So you young dentists you're gonna go take a job for some conservative dentist and he's not gonna talk about any of these things and real people are going to die and you're a millennial you have to man up woman up homo sapien up and education is the key and if you young dentists and hygienists out there can't look a patient in the eye and talk about sex drugs and oral cancer then that means your decision of what was culturally appropriate will end with this person going to die I mean I already know people who got their teeth clean every six months went to ASU got oral pharyngeal cancer and they're no longer here and I always think to myself that little girl saw a dentist every six months in the same office and she was two years old and he was a board-certified pediatric dentist I mean and she's dead we didn't do her job I mean what would you do if the firemen said well you know what I just don't really want to go to a house on fire I don't find people are running out of the house naked and they were slow it's just not appropriate come on whales man up talk about sex drugs and oral cancer and Robert it was just an honor for you to come on the show today thanks so much for coming on and hopefully in your career you can see us finally make the corner and start being physicians of the oral mouth and not molar mechanics thank you so much for coming on today.

Robert: Thanks for having me we appreciate you keep doing great work.

Howard: All right buddy bye-bye 

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