Dr. Porter Jones founded and was CEO of Dr. Porto, a chain of medical and dental clinics in Sao Paulo focused on providing high value patient care to the medically underserved. Prior, Dr. Jones spent 4 years at Hospital Albert Einstein where he managed the oncology department as well as the medical practice division. He currently is the CEO of Boka Sciences, an oral health company focused on preventative care through the diagnosis, monitoring and treatment of xerostomia. Dr. Jones is a graduate of the University of Utah School of Medicine and has an MBA from Harvard Business School.
VIDEO - DUwHF #1272 - Porter Jones
AUDIO - DUwHF #1272 - Porter Jones
Howard: It's just a huge honor for me today to be podcast intervening Dr. Porter Jones MD MBA he's the founder of Dr. Porto, a chain of dental clinic medical and dental clinics in San Paulo Brazil focused on providing high value patient care to the medically underserved prior Dr. Jones spent four years at hospital Albert Einstein we manage the oncology department as well as the medical practice division he currently is the CEO of bogus sciences and oral health company focused on preventive care through the diagnosis monitoring treatment of xerostomia which is why he brought him on the show we just need to know more about that. Dr. Jones is a graduate of the University of Utah of Medicine 2009 and has an MBA from Harvard Business School and actually knows the godmother of health care Regina Hurtslinger who we had on the show back in the day amazing to have you on the show today how are you doing?
Porter: I'm well thank you for having me it's a pleasure to be here.
Howard: So when's the last time you've been to brazil?
Porter: About a month and a half ago, I still make it down four to six times a year I love being there i love the culture the people and in business down there.
Howard: So all of your medical dental clinics in brazil or in is what in three cities it's is that right three cities mostly?
Porter: Three cities on the force four separate locations on the outskirts of sound paulo in the medically underserved areas of Sao Paulo where patients don't just don't have adequate access to good medical and dental care, we wanted to give them the opportunity to receive the same type of medical and dental care that everybody else is receiving and in the center and the more robust areas of the city and we took the clinics and the care physicians and dentists to them rather than them having to come into the city to receive proper treatment.
Howard: and where does this come from mean how do you just all the sudden have I mean I mean most every dentist listening to you right now only has one dental office they can barely manage that you know how does your journey go or all of a sudden you own four dental offices in another country on the outskirts of what is the largest city in the Americas isn't is San Paulo bigger than Brazil I mean bigger than a de Mexico City?
Porter: It rivals Mexico City I think I think one or the other is gonna be the biggest but yes it's one of the largest.
Howard: and they're both bigger than the largest city in the United States newer say I mean I and in fact the largest lecture I ever gave in my life was in Sao Paulo to 4,000 dentists in the year 2000 at the Aesthetica Hilton and I said I said did you say 4,000 and you go yeah yeah I mean it's just I mean how many people do you think live in that Metro?
Porter: About 20 million people
Howard: Wow So tell us about your journey how does little boy dr. Porter Jones end up in Brazil with four dental clinics and you're and MD not even at DDS how does this happen?
Porter: It's a good question when I was younger I lived in the southern part of Brazil southern portion of Brazil for a couple years in the state of paraná and I lived in the cities of could achieve ax and iguazu falls I think most people are more familiar with the iguazu falls the large waterfalls in the southern portion of Brazil after medical school and graduating from business school in 2011 that is when Brazil may have been just the hottest country on the planet and I thought it would be an interesting opportunity both career-wise and for my family to go down and rekindle what I had learned and loved about Brazil and and look for and start a career down there. So I landed with Albert Einstein Hospital Albert Einstein Hospital is one of the largest and is considered the best private hospital in all of Brazil and frankly in all of Latin America when I arrived there I oversaw the oncology department along with the medical practice division which focused on the IT and the outcomes of what was going on in the hospital now to give you an idea Albert Einstein Hospital looks like a five-star hotel there's not much to compare it to here in the United States just a different level of care along with that care though is very restricted access of those who can actually go to Albert Einstein afford it whether it be through their insurance or out of pocket a great great place to innovate a great place to treat but at the same time there was something that got me about the restriction of access as you would know Brazil just has somet the divide between the haves and have-nots is huge and most are to have not side and they don't have access to adequate care there is a public system in Brazil but at the same time that is a lot like what we hear it's not always up to par on standard of care and in addition to that it can take months and months to get that type of care so as my as my time at Einstein was coming to an end or as I was mentally preparing to do something else this idea of working in the impoverished and medically underserved areas of Sao Paulo was very interesting and providing them with medical care and and dental care as well so we we got together a small group of individuals for investment and we decided that our plan would be to take medical and dental clinics to the medically underserved to the outskirts of San Paulo and provide care to them where they are living and a price that they can afford. So our business model was take the best graduates from from the most prestigious schools in Sao Paulo the young graduates pay them slightly above market and really push high volume so that we could we could decrease the price for these individuals so for an example we would charge anywhere between eight and ten dollars u.s. dollars to fill a cavity or $14 a month for maintenance on braces for individuals that wanted braces this allowed us to to again like I said provide care to individuals that just were not getting it the dental site came about because the dental portion of the public health care sector in Brazil is much worse than the medical and we started to find very quickly that there was a high demand for dental care bringing new technologies or technologies that they just didn't have access to prior so we utilized them brought down some technologies some basic things from the states implemented a full EMR system which was not overly common down there so that all the patients could be seen in any of the clinics if they happen to be in different areas of the city and we had a great time within the first year had about 5,000 patients going through the dental and medical clinics and we felt like we were you know both profitable and doing good for the community and it being a great project and I learned a lot about dentistry that's where I cut my teeth and dentistry learned about the operations learned about techniques what's important and I also then really begin to understand the importance of prevention if we can prevent more we're leaving the money in the patient's pocket and not having them have to spend their time money and go through procedures if we can do that properly and that became an interesting aspect or something that I noticed very quickly that we seem to do decent in medicine and that we're just not quite up to par in dentistry in regards to prevention became an interesting focus and that has continued on since returning back to the States trying to look at this preventive dentistry side of the market.
Howard: Now when you say your four years at Albert Einstein was that in Philadelphia?
Porter: No that was so Paulo so it's a Jewish founded hospital much like some of the other Albert Einstein hospitals they're all Jewish founded so the Albert Einstein hospitals fully owned independently down in Sao Paulo by local local individuals.
Howard: Wow
Porter: So I ended up spending seven years in Brazil during my time after graduating Business School.
Howard: and so when you went what made you go down there the first time was that a mission church mission for yourself?
Porter: Yes that was that was a Mormon mission when I was 19 and was sent down to the southern portion of Brazil to spend two years there learning the language culture and obviously spreading what I was down there to do.
Howard: Yeah I mean did you feel like you won the lottery getting to go to Brazil I mean I've had patients who almost cried when they found out you know they were gonna go to you know Kansas or Oklahoma there and their other buddy gets to see another continent or country did you feel like you won the lottery?
Porter: I was super excited and and you've been Brazil is just a wonderful country so much going on there's so much to learn wonderful people great culture so I was extremely excited and it didn't disappoint the two years were were fantastic and I was more than happy and excited to go back.
Howard: So you're an MD you're a dentist you you've worked in the top echelon of you know the most care that's the nice the mercedes-benz care that's a poor visit as it question your beliefs and foundations and what system to deliver health care I know it's a huge debate if the government gets too involved its socialism if free enterprise gets too involved it's it's a market price segmentation which a lot of people don't cities how was your evolution how long ago did you graduate from med school what years that?
Porter: I graduated in 2009
Howard: So a decade yeah you're a really smart guy so what how was your views changed in the decade of graduation to today?
Porter: That's a great question at the beginning I felt like we had a wonderful system I still do think there are many aspects of the u.s. system that are great my perspective was completely changed down in Brazil down in Brazil the onus has put much more on the patient the patient needs to go shop around for what type of care and treatment they want patient needs to understand what type of physicians and dentists they are seeing a lot of the payment is out-of-pocket for those that have insurance even then they need to pay out-of-pocket and then they get reimbursed directly from the insurance company and it's an interesting dichotomy when you are putting up the money when you're fronting a good chunk of the money you sure sure want to make sure that you're going to be reimbursed you do the legwork to make sure that everything is pre-approved that it's accepted now in my dental and medical clinics in in the outskirts of San Paulo these individuals don't have access to private health insurance they either go to the public system or they pay out of pocket and again it's interesting how market dynamics work when you're paying out of pocket it really becomes a battle of who can give the best care and who can do it in the most inexpensive manner and the patients are very involved in pricing what they're gonna get done how they're gonna get done or how they're gonna get it done of when they're gonna get it done and I've really moved to the side of we need to put more onus on the patients on both the medical and dental side to be part of the decision making part of the shopping process and in deciding what is going to be to be done I think here in the States as we know it's just easy when insurance is covering everything to see do any any sort of procedure any sort of radial radiological exam and it'll just be covered and down there that's just not quite the case you want to be more diligent on what's getting done and if it really needs to be done or not.
Howard: Well when you hear people talk about health care it's just not a clear they don't think logically like they do with their smartphones yeah I mean there's no federal government agency that monitors a smartphone but we have a Department of Agriculture for wheat farmers and all the wheat farmers I knew back in Kansas didn't have anything kind to say about you know the government regulation but it just becomes a very emotional lately they talk about fraud for Medicare it's like well they well no one ever looks at the bill because they have no payment I mean if you just made a standard 5% copayment your fraud I'd be gone and everybody would start shopping for price but when you say that the people who they just think you're crazy because they point to this poor person who they don't want to have any involvement in this decision and and so for so are you gonna kill economics I mean is economics a joke to you because you feel sorry for this poor individual so it's just so emotionally complicated, what would what advice would you give for the American system after a decade of this?
Porter: I would say again put more onus on the patient make them be much more involved financially in what is being decided and the care that is being given I know this was started and tried through copay but when you're talking about a $30 copay for a $2,000 procedure I don't think most people care about that $30 going back to the Brazil system you may pay out $1,800 upfront out of your own money for that $2,000 procedure in hopes that you then will be reimbursed directly from your insurance company you're gonna be much more diligent in making sure that insurance company is going to reimburse you and that you really need that procedure because you are putting that money upfront and having that capital outlay at the beginning and it's just interesting when you see bills and when you're passing credit cards before you're getting anything done you think twice and you want to make sure that you aren't getting exactly what you what you believe should be done in conjunction with the recommendations from your health care professionals.
Howard: Yeah and I know doctors right here in the valley of our own hospitals you say yeah my patient had emergency went there the first thing you did is took something by three thousand dollar MRI cat scan whatever and it had nothing to do with anything and but if that Hospital would have said well you give us three thousand dollars right now and then it'll pay you back they would they would start thinking well why do I need this and you know it's just an ended when other I always hear Canadian saying well my dad had this major operation and his only bill was for a Netflix movie it's like you're are you bragging that your father had zero feedback about the price the cost the system really I mean I mean who is telling you that this is a good idea I mean it violates every it's like economics is a joke ever everything is a joke when you take away these most basic things but I do have to say that in America like I've learned from doing the water fluoridation thing from Phoenix twice because it expired after 20 years and I go do it again that a quarter of Americans will never be in a frame of mind to analyze the water fluoridation issue so you just have to give up and right now I don't think there is a I think between the one to see more government involvement socialist versus more free enterprise movement I think it's gonna be a stalemate for my whole lifetime do you see anything breaking in this in this debate I mean it's been going on for over a century if you read read the book the Pulitzer Prize winning book the rise of healthcare by Paul Starr which i think is the greatest summary of US healthcare system ever I mean how it was just it was I think came out in 1984 with a few books where I read it and then like six months later I just had to read it again I mean this is amazing going on for a century.
Porter: Yeah yeah I don't see in the near future anything changing there's too much money too many corporations involved that don't want it to change in a lot of aspects I mean going back to the same idea prescription medications there there's nothing covered in Brazil you get prescribed a medication you go to the pharmacy you pay a hundred percent out-of-pocket I can't imagine the pharmaceutical industry here in the United States ever giving up what they currently have in regards to reimbursement and how things are paid out and as you can imagine the prescription medications are 10% of the cost down there then they are up here because you are all paying out-of-pocket there's just too many factors of play too much money changing hands and healthcare in the United States for what I see something changing in the immediate future.
Howard: Yes so you got the long-term economic issue where big business always colludes with the lawyers in the government to pass all types of anti competition all types of regulatory environments which is only created to drive up their their profit earnings but as I notice in and on water fluoridation and medicine but then you have a whole nother group where they just they dislike the government so much like I had people say yeah doc I believe you and you all this so that's all cool but I don't want the government doing anything for me you know and by water fluoridation so there's such a strong you grew up in Utah there's a huge anti-government contingency up there when you say so a lot of conservative people I mean Utah Kansas Texas I mean there's just a lot of people who do not want to get in bed with the government even if it's for a good reason so talk about your journey the reason I am brought you on was none of that it's a xerostomia it just keeps getting to be a bigger bigger problem which I believe is driven only moment mostly from polyphagia I mean you started having all these I mean I'm in Phoenix and a lot of retirees and my god they're on five six seven different prescription medications and so talk about your journey how did you after all your journey end up in xerostomia?
Porter: Yeah you bet so the company was founded by a brilliant man named Grant Donovan he has an engineering degree from Vermont and an MBA from Stanford and he came up with this as he was investigating further and further the ability to measure dehydration well as you can imagine dehydration is very difficult to measure as we've got so many factors that do affect dehydration or the ability to measure that in the system and as he was moving along this path he realized an interesting market would be measuring salivary flow and being able to diagnose xerostomia Grant took this company from California as he's a Utah resident they've ever...
Howard: You said Grant Donovan was the was the pioneer of this?
Porter: He's that he's the pioneer in the family I read the founder and the in the inventor of the system when I moved to Utah Grant was working on this alone pushing it forward FDA approval etc etc and I met him we hit it off and with the background that I have operating dental clinics understanding dentistry along with with having a medical degree it just seemed like a great fit putting Grant and I together to push this company along so for the past year and a half we spent time perfecting the device getting it through FDA regulations going through through pilots and testing in numerous dental clinics talking with industry talking with key opinion leaders and working to really hone what we want to provide to the to the dental clinics and provide to the patient and here we are we're still at the very beginning of the journey but we're having a really good feedback and we're working on this entire preventative care platform we really believe that this device can be the center or the base of preventive dentistry and we hope that other people will pile on and be part of this movement and continue to work in this area of prevention and do as much as we can preventing issues rather than just treating them.
Howard: So your for your first say business model is more in the Diagnostics of xerostomia not a pharmacological treatment?
Porter: We do not have the treatment but we have been working with great companies that do provide the treatment so groups like Forward Science that has the supersaturated calcium phosphate rinse and when chatting and discussing with groups like Elevate Oral Care and these other these other groups that do have treatment options working together with them we can test and screen all patients and once that is done we can give recommendations or at least allow the dentist to understand what's out there on the market for treatment or for prevention in regards to this and if we can have these unique partnerships alongside of us it allows us to create that complete package or at least allow the healthcare professional to understand what needs to be done after the diagnosis is made and what are the care protocols to go through when working with a patient that has xerostomia or high post elevation.
Howard: Okay so I am podcasting as a young kids behavior so I always tell the kids I shoot me an email Howard@dentaltown.com I love the comments on the YouTube channel but a quarter of are still in school and the rest are all under 30 so I'm gonna start with just basic first of all why does a kid in dental school and he's probably sitting here trying to learn how to do a filling or a crown or a root canal why does he need why does he need to know about xerostomia and what are you actually how are you measuring it and how does your measurement measure xerostomia and why is that a problem you just start with the basics?
Porter: Sure that's a great question saliva has so many protective factors in the mouth that is your natural barrier against periodontal disease against cavities against gingivitis we've been told by numerous Dean's of dental schools that with good saliva you really should never have cavities so we want to be able to provide or look at this in a pragmatic way of let's make sure that we are doing as much as we can on the protective factors which is saliva to basically give care on a year-round basis or promoting good salivary flow and and that starts with going ahead and monitoring it and I think your question is great yeah you're learning how to do root canals you're learning how to do the procedures in the end as a healthcare professional you don't only want to react you want to be proactive and we saw this in medicine 15 to 20 years ago people didn't quite understand or believe in the preventive aspect and want to invest in it and now it's starting to prove that this is a very hot market and very interesting to patients and patients are getting more involved and more attune to prevention rather than simply treatment of the problem and we want to be part of that allow a platform where young dentists and all dentists alike are promoting preventative measures so that they are helping helping promote good oral health rather than just treating the sequelae that could come from low saliva poor oral hygiene etc.
Howard: So what is your device how does your mission is describe your quantum mechanics machine what how is it made what is it measuring?
Porter: You bet so it's measuring just as the literature shows it measures how much saliva a patient is making in milliliters per minute so the test can be done at chair side in the in the office it has two disposable sponges that are that are placed in the patient's mouth and it takes about sixty five seconds to run the entire test now there's an LCD screen a five inch LCD screen that walks the healthcare professional through every step of testing the patient so right at the beginning the first disposable swab is placed in the patient's mouth to zero out the mouth then the patient rests or allows Sal the saliva to pool under the tongue for 60 seconds as this saliva pools at the end of 60 seconds you take the other applicator place it in the patient's mouth for three seconds place the applicator then back on the on the reader or the device and at that point in time you immediately get a digital readout which is in milliliters per minute we provide the healthcare professional with the ranges of what these these readings mean so anything about 0.3 milliliters per minute is considered normal and anything below point 1 milliliters per minute on this read is considered xerostomic.
Howard: Okay so say those two numbers again.
Porter: Yeah point three are above 0.3 milliliters per minute or above is considered normal salivary flow so at least on the quantity of saliva you have the protective factors that you need to prevent oral health issues as we do know there's quantity or there's also quality so we can look at pH and some other issues but this is at least the quantity or the amount of saliva and the patient is making point 1 milliliters per minute or below is considered very dry or xerostomic these patients need immediate treatment and we can talk about treatments it's in your discretion but these are the patients that need immediate treatment there is then that middle range between point 1 and point 3 you're not normal you're also not xerosomic but you are low and you won't you will also require some sort of treatment a less robust treatment than if your xerostomic but you will require some treatment in that range. Now some interesting numbers through our populational studies we're finding around 20% of the population has xerostomia or they're below that point 1 range and then we're finding an additional 40 to 45 percent is in that gray area or that area that is below normal and slightly above xerostomia but still does require some sort of treatment so when you're looking at the adult population 65 percent of the entire population is is somewhat low on the salivary flow they're producing on a day-to-day basis.
Howard: and is that age is age very dependent on atomy is this an elderly thing mostly I mean they always talk about the over 500 medications that cause xerostomia and Orsini health histories on patients all day long the kids aren't almost nothing and the old timers are on lots of pills.
Porter: Yeah and that's a great question and we do see the older individuals get the higher the incidence of hyposalivation they tend to have and we believe and we know through looking at these these patients that most of that is correlated with the amount of medications are using so you're exactly right over 500 medications that cause a decrease in salivary flow and naturally as we get older we tend to be on more medications we tend to be on more blood-pressure medications anxiety medications, medications that treat depression and the more we have this polypharmacy as the as the population ages the more we're gonna start to see or we are seeing a lack of healthy saliva.
Howard: and so here's another way to look at the healthcare - I mean you know when when you're a dentist you really understand polyphagia so you're looking at these prescription pills and you're knowing you're noticing how they're affecting oral health very upfront personal and close but when you look at the data on how many people are killed in the u.s. hospital system I mean the low ranges are a hundred and eighty thousand a year all the way up to four hundred thousand ear I mean it's like cancer heart disease and hospitals so going back like okay why would you want to make this machine that kills 300 thousand people a year free I mean so I'm very very frightened of a system that encourages that they always have a cure or a treatment and people want to believe so they want to go to the hospital they have a problem they give them pills it's like but are you being transparent of how many people this is killing and so now I mean you know so it's very it's a very complex nuanced issue because I look at all these people and when you say to him are you sure you should be on all these medications and they look at you like my you know my doctor gave them to me and it's like they want to believe and it's just I it's frightening but I picked up very early back in that I got at school in 87 and I figured out by 90 that all the men in my practice that were 90 to 100 and parked in their car and walking in they weren't on any prescriptions it was it was like it was like why should I even take your blood pressure or temperature on I just wanna know if you're taking any pharmaceuticals if you're not you're probably really healthy so polyphagia is just say it's gonna get worse and worse and worse isn't it?
Porter: Oh it is we we look just like you said we look at all treatment just based on pharmaceuticals you can live the wife the life the way you want to live and there will be some sort of drug that will fix it and it's been shown and proven that food causes a lot of these issues and can also cure a lot of these issues depending on diet and we've unfortunately gotten to the point where we eat what we want to eat we're sedentary as we want to be and we just take pills to try to mask a lack of healthy living and then we take more pills to counteract the side effects of the original pill you were taking and it just compounds then so on and so forth.
Howard: Well man follow up that you're talking about diet causing it and diet curing it and talk about that for the people who want to do all things naturally.
Porter: Yeah I think I think these vegan diets are amazing when you see what it does to your overall health I mean you can see diabetes drastically decreasing obviously there's weight issues arthritis you can see drastically decreases overall inflammation from the lack of meat and protein products it's quite amazing what we can do as a human to actually counter balance negative things going on in our organism through the cutting out of meats and proteins and really looking at plants and nuts and then really focusing on what we call today a vegan based diet I think there's a lot that we can all do and unfortunately it's just not part of the culture it is difficult to eat that way because there's so much around us it's quite accessible cheap and easy to get a could get access to but we can do a lot with diet that we don't need to rely on medications for.
Howard: So are so what are you doing are you vegan or your are you married kids and all that you know is that working in the real world family home.
Porter: I'll tell ya so I've got a 10 year old and a 7 year old they do not enjoy the vegan diet as you can imagine kids don't love a lot of vegetables and I would say we we Teeter back and forth between going plant-based and then going back to what we consider just a healthy diet that does include protein we try to eat as healthy as we can promote or limiting protein that comes in and then trying to really promote plant-based with the kids not as easy it is is it not overly easy with kids as it is as an adult to make those decisions and move forward.
Howard: Oh, it's so hard and and then the worst part about it is when you do go vegan and you start doing your daily yoga and you get into it even if you just do it for like ten days then when you fall off the wagon and go eat your meat lovers supreme pizza delivered to your house you just feel horrible I mean you don't know that it's like you love the taste you love the food and you're just sitting there feeling like you know just just feel horrible so yeah it's so obvious and it's so hard that's that what is what I am so how do you see that moving forward plant-based diets?
Porter: Honestly I don't I don't think a lot of it is gonna move for it I think it's getting maintained on the continue to be on the fringes you know it'd be amazing if you could take everybody who's teetering on type 2 diabetes and get them on plant-based diets and if they would they would move forward and actually be good stewards of that type of diet but I don't see that and I think going back to the discussion on pharmaceuticals I believe that pharmaceuticals is a big part of that issue why would you want to eat a plant-based diet when you can take your insulin on a daily basis and eat whatever you would like not understanding that there's so much other things that are going on downstream from the insulin from the excess weight from the diabetes but you know when you when you can be treated through a pill or an injection that's really not much work on your behalf and you can just continue your life the way it's going.
Howard: Yeah and another reason I think people don't like government involvement with health care is because it comes out of just weird judgmental stuff like they just released a big study that showed that globally diet kills more people than tobacco and but tobacco it's really easy to say oh it's bad right now everybody's freaking out on vaping and they'll say like one guy died over here so yeah one guy probably got hit by lightning too but how could you don't take that ferocity at something like salt where were you you look at the Centers for Disease Control studies like my gosh you look at the biggest number and you never talk about that hardly ever and then they shift down 3 or 4 smaller diseases and you're like obsessed with that but I mean like when people are discussing well I don't know if I want to be vegan we'll forget vegan and being just just start looking at salt that's still a people don't even really focus on that what are your thoughts on that?
Porter: I think that's a great point and I think it all boils down to acute versus chronic conditions going back to your vaping we can immediately see in the moment poor reaction to vaping and someone's going to the hospital it takes years and years and years of excess salt to finally start manifesting itself however at that point in time you may not have much going back and I just think the human condition is is programmed to what is immediate and what do I need to really focus on if it's gonna affect me within the next day or a week and if things are not going to affect you for the next 20 years it just doesn't seem like it's a top priority in change and and making adjustments and lifestyle.
Howard: Yeah you know the the bail clinic studies going back to the 80s where you know when you have a sodium ion in there remember the book the k-factor written by an MD with the PhD and he says it takes more potassium ions to pump out one sodium ion you're only gonna get the potassium from plant so if you got a so if you live in a country where all the processed food you know as several grams of sodium a day gets to the point where there's not enough bananas to eat to get this stuff out of there so how much does this technology cost?
Porter: Good question so we've tried to make it affordable we do not want the barrier to entry to prevention being cost so we have an opening package of 169 dollars per month which gives you 25 tests and the use of the machine for high-volume clinics that goes as high as 600 dollars per month this is very much like a blood pressure test in a physician's office you're getting a baseline read of your oral health through this machine just like in a physician's office a baseline read of your systemic health when we can correlate to blood pressure and we want to be able to monitor that in perpetuity in a longitudinal way so that patients can see how their salivary flow is changing over a certain amount of time so we do promote the testing of everybody but we do understand that not all dental clinics can can adapt to that and put that into process flow so we do offer packages as little as 169 per month.
Howard: Okay so your most basic intro package is 169 a month.
Porter: Correct
Howard: and what would that include?
Porter: That includes the use of the device better
Howard: Do they own the device are they leasing it?
Porter: We don't like to use the word lease but yes they are leasing it.
Howard: and what do you call the device?
Porter: The Boca flow device
Howard: The Boca flow okay
Porter: So they are leasing the device for that price and the mayor shipped 25 tests per month so it's much like the razor razor blade model you have the device and then every patient you test you need a new set of disposables to test each individual patient.
Howard: For 25 tests?
Porter: Yep
Howard: So 169 a month you to use the Boca flow device plus 25 tests?
Porter: Yeah 169 to use the Boca flow device and 25 tests per month
Howard: and when did you start selling the doing this program would it Boca Flow start releasing the Boca flow device?
Porter: Just in 2019 we've just slowly been releasing as of this year we're probably only about four months in.
Howard: Okay and then what is so I'm early bird you heard it first on Dentistry Uncensored I try to stay on top every time so early what's the next level up the 169 a month what's next up?
Porter: So for 349 per month you get the device the Boca flow device on a on a month-to-month basis and 100 tests and those are shipped directly to your office on a rolling basis every month.
Howard: So that's a Boca Flow device plus a hundred tests?
Porter: That's correct and then the one up from that is $599 per month and that gives you the Boca flow device plus 200 tests shipped to your office per month.
Howard: Okay so um I know all the DSO King pens which I'm in Arizona which is ground zero for DSOs 18% of Denis in Arizona or affiliated with the DSO and in some states that's you know Isen 1% so this is ground zero by far and they're the ones that always if it doesn't make sense in the business model dead on arrival. So I always tell people if you've got something that makes sense on a business deal well go talk to the DSOs first cuz they'll get it long before my homies in private practice well who don't even care can't tell you any of their numbers so if I was a DSO kingpin and I had a hundred offices they're gonna ask things like okay so how do I get my money back.
Porter: Yeah that's a great question we're seeing numerous models that are being used some clinics are charging for the tests the average price that they're charging is about ten dollars and they're baking that into the to the fee that they're charging for that cleaning or the biannual visit there is codes there are codes that can be utilized to submit for reimbursement DO417 and DO418 could possibly fit.
Howard: Say that again...
Porter: DO 417
Howard: Okay
Porter: and DO418 could be coded for the use of our device and in 2020 there's already projected or already been we've already been told to the ADA that there will be a code that is specifically just for measuring salivary flow. As you can imagine you can submit it doesn't mean all insurance companies are going to reimburse because this is new and this is the first device of this kind on the market we're not finding currently that a lot of insurance companies are reimbursing. So moving on to what else is going on when you're preventing Howard as you know you're also keeping up some revenue on the back end if you're preventing five cavities over the next two years in a particular patient five cavities that you're not charging for in revenue that is not coming in however on the preventative care side there is revenue to be made so the ADA recommends anyone that has dry mouth or low salivary flow receive their 5% fluoride varnish in the dental office and on top of that they return in three months for a follow-up which can be charged to the patient to receive an additional fluoride varnish we're seeing an uptick of anywhere between 50 and 100 percent acceptance rate of fluoride varnish use in the office for patients that have dry mouth so this is providing a different revenue stream that they weren't previously receiving. There's also prescription strength fluoride gels think like Prevident 5000 that if the office wants to hold in cell two the patient could have a small uptick in revenue from that in addition to professional strength oral health rinses that clinics can can hold in stock and also offer. There are some prescription options for treatment which one that we like is supersaturated calcium phosphate rinse obviously there is no economic benefit for the for the dentist on that but there is a benefit to the patient and what we're feeling and what we hope is that you're swapping out a small upfront additional charge to the patients for the preventative care for the follow-up for some of these products in exchange for the long-term sequelae that occurs with with poor saliva flow and by doing so we also hope that patients are happier with the care they're more well they're willing to come in more often they're willing to take the dentist's recommendations and they're willing to be more sticky as patient through this type of care and treatment rather than just fitting x-rays getting cavities filled and washing and repeating this process over and over.
Howard: So do you you being a physician and now being in the world of dentistry do you think physicians have a bigger discount with dentistry than say physicians versus a dermatologist ear nose and throat you know all the other specialties did you do you believe that?
Porter: Sorry I didn't quite understand do I believe what?
Howard: That we're kind of disconnected with health care more then say a dermatologist and ophthalmologist I mean I still you know yo EC charging to two of my pet peeves is that they'll give a statistic about you know certain how people do this but I might just assume those were just American people or the whole population and when they say the most trusted profession they say doctors but you look at a whole list of twenty dentists aren't on there is that's maybe what is so what do you think of the current relationship between dentists and physicians and in the minds of the patients? You know if your physician told you any advice on any body part you'd listen but when so how is this gonna be perceived when the dentists are talking about things other than the oral cavity?
Porter: Yeah why I think this is an interesting point I do not think there's much correlation or or or continuity between denison physicians in the United States one thing that I loved about my clinics down in Brazil was we almost always had physicians and dentists on staff at the same time and Howard is very interesting to see the interaction between the physicians and dentists and it went both ways it was not just the dentist going and asking the physicians to look at that issues that may have been going on it was the the physicians also asking for a lot of recommendations and help from the dentists and working in that multidisciplinary care just created a seamless transition and in those clinics you didn't see much of a divide between a dentist and a physician regarding help another example is at Albert Einstein in our oncology department as you would know chemotherapy is one of the largest Wreckers of teeth that you can find you just knock out all salivary flow and many chemotherapy patients once they're done with their chemotherapy treatment have no teeth. Well at Albert Einstein we had dentists full time on staff seeing those patients every time they came in for treatment in the indian ecology department we loved that interaction you don't want to treat someone's cancer and then leave them with an additional $20,000 worth of dental care that needs to be done because none of their oral health was monitored during their treatment. Coming back to this we believe that through this type of preventive care through the dennis being more interactive with what type of medications the patient is on what is going on with their salivary flow looking and monitoring for things like Sjogren's and lupus these are autoimmune diseases that we feel the dentist should be the frontline screener for it shouldn't be the rheumatologist or the or the or the family practitioner if the dentist is testing everybody you know the type of patient you know if it's a female and in early to mid 30s and has extremely low salivary flow without medications we need to start thinking this could be an autoimmune disease we need to be referring to the to the medical side. We hope that this can bridge that gap a little bit and then the patient when they go see the dentist isn't only feeling like they're just looking at my teeth but they are looking at my entire system of my entire organism.
Howard: So is that the lion's share of them starting with this as Sjogren's syndrome which attacks the glands that make tears of saliva and lupus is that is that the is that the 82 you know if you talk about the 80/20 rule is that 80% were the main focus?
Porter: With our with our platform and device?
Howard: For xerostomia I mean when so there's dentist concerns patients concerns and so when it looks like what is the dentist measuring what is he most weighted concern for would it be Schroeder syndrome and lupus?
Porter: For the dentist no for the dentist this would be polypharmacy hypersalivation due to excessive medication that is gonna be the lion's share what the dentist sees someone is dry because of the medication that they are on on the fringes so the smaller portion in the population you may see people that are dry because of Sjogren's and lupus and then also chemotherapy patients that are undergoing chemotherapy but the lion share of everybody they're gonna see is the normal everyday person walking around in the population that is on three to five medications and because of that their saliva is low and now because of low saliva they're going into the dentist and every six months they have three or four additional cavities it's interesting when we hear about these patients saying every time I go in it's another three cavities it's another four cavities and the first time our device gets implemented into a clinic and they get tested and they're below point one below that threshold it's very quick to realize what's going on and why even when they come in and say I brush my teeth and I've got good oral hygiene but I still keep getting cavities well if you don't have saliva protecting your teeth 23 and a half hours a day taking out when you're rinsing your mouth and eating and brushing you're gonna begin to have problems and that's what the patients or the dentists are focusing on helping those patients getting them on a treatment protocol and increasing their saliva or also providing protective factors so that every time they come in every six months they don't have three to four additional cavities.
Howard: yeah and the polypharmacy everybody cases you say it takes to be considered polypharmacy are you going with five?
Porter: Well we're looking at five is the first row where we start thinking this is gonna be serious you're gonna have extremely low saliva flow.
Howard: and remember to stop prescriptions prescription is just a regulatory deal these people would go to nutrition places I mean I get people that he eat a thousand milligrams of vitamin C every day just because they that's what they believe so it's just five really concentrate things and it's so what I'm reading it's 40 percent of the older adults of elderly but for adults it's usually those was some type of intellectual disability so they all this psychiatric ADD their danger I mean they they start pumping on them with all these filsoofs so it's elderly 40% intellectual disability 21% those are doctor physician dentist concerns what is the patient usually have focused on when they're asking for help of xerostomia what would you what would is their discomfort why are they not liking it and talking about it?
Porter: Yeah know that's the great point we're really trying to get out part of our platform is we need to educate the patient generally the patient doesn't notice that they have low salivary flow or dry mouth until about 50% of the flow has been has been reduced it's a slow process then they start noticing and they start noticing things where it's hard to eat it can be hard to talk difficult more difficult to swallow so these are kind of the mechanical things that they're noticing what we're finding is most patients don't understand that there is a direct link between this dryness that you're feeling and oral help the disease they don't they're not we're not able to fill in that gap to where they understand yes there's some mechanical issues and discomfort that you're having but what's really occurring is increase in cavities increase of periodontal disease increase in all these additional items that they're going to need to be treated for so as you can imagine not many patients go in complaining of this because they don't quite understand the severity of what's going on in their mouth when they have dry mouth.
Howard: So in dentaltown in February we had an article on electro-stimulation and xerostomia what what are your thoughts on going into okay so when you get a measurement at senator 0.1 milliliters flow so now you want to treat that what are you what are you doing?
Porter: Yes I think that electro-stimulation is interesting because I think there's some treatment options that are to increase the salivary flow and then there's other treatment options that are gonna act as a protection to your teeth and they don't necessarily increase salivary flow so electro-stimulation is an interesting one because that has been shown to increase salivary flow another item would be something like pilocarpine which can be given again we're going back to the pharmaceutical but that can increase your salivary flow in hopes I'm Just having more saliva in the mouth so these are interesting mechanisms and a patient can look at to to just increase the amount of flow the other items like the fluoride the oral health rinses calcium phosphate rinses to an extent or more protective so even if you do have the low saliva these protective mechanisms should help and will help your oral health.
Howard: and which companies products did you mention an earlier that you like the most?
Porter: Yes so we've worked with forward science and they're they're supersaturated calcium phosphate rinses called saliva max that was original originally came out to treat mucositis in cancer patients but it's also been shown to help in remineralization and increase baseline salivary flow things like pilocarpine a systemic drug that will increase production of saliva those are generic very cheap a lot of dentists can also offer that in lollipops or tic-tac size so it's more more localized and then we've got some some other items like or a care on the oral threats I think closest is an interesting one because it also helps out with pH and then you have the prescription strength fluoride gels and and we've got interesting companies like elevate oral care that has a whole suite of items that you can you can utilize for dry mouth when you're looking at xylitol mints the fluoride gels etc that can be used at home.
Howard: Do talked about there might be a lot of kids with pilocarpine and flew over their head is that uh is that getting more common did you see that is that a popular treatment?
Porter: It is not and I think it should be used more widely the issue with pilot carping is it it not only activates your salivary glands but any gland that secretes a serous fluid most most often your sheer sweat glands it also activates so one of the big problems is people complain that their hands and their back and their feet to become extremely sweaty so the dentist needs to recognize that there needs to be a titration period and a little bit of hand-holding with the patient and when I when I say titration period we don't want to give the patient the the immediate full 5 milligram dose slowly work up to the dose where you can feel like the salivary flow has increased but your sweat gland and the rest of the glands in your body have not increased in their production as well so there needs to be a more interaction on that but once you get to that baseline that is something that you can take the well will activate your salivary glands. I also think the dentist should look at and think a lot about the the local pilocarpine usage so the lollipops little tic tacs that you can get at specialized pharmacies as you know they're they're not commercially ready readily available so you do need to go through a specialized pharmacy and request that formulary but a small tic-tac just used in the mouth not to be swallowed five milligrams a pilocarpine patient pops it in it generally work on the local level so they don't get a lot of the systemic effects of pilocarpine and they're doing so that will increase salivary flow for people that are in the the xerostomia range that are gonna have real issues I believe they need some of these stimulating factors whether it be pilocarpine whether it be saliva max or whether it be electro-stimulation they need something to get that stimulated rather than simply relying on fluoride to to provide the protection.
Howard: and rank those in order of how you would do it for yourself pilocarpine electro-stimulation put them in order if it was I you order would you put that in for yourself?
Porter: If I was extremely low I would I would be using pilocarpine and the supersaturated calcium phosphate rinse is my first defense in regards to getting my saliva up and getting immediate protection on the back end I would also be using some sort of oral health rinse like oral care or something that's focused on dry mouth in addition to at home use of the fluoride gel president 5000 or anything that's 5,000 parts per million I would be attacking it with all four of those but the front line of increasing saliva would be very important to me.
Howard: Okay so sitting in pilocarpine be number one
Porter: I would use pilocarpine in conjunction with the supersaturated calcium phosphate rinse.
Howard: Made by Forward science?
Porter: I like their product I think they have a great product.
Howard: So that's a mouthwash
Porter: It is comes in a sachet a powdered sachet that you can carry around in your purse you add a milliliter of water to it throw it in your mouth for a couple minutes spit it out it's got a lot of the ions in it that can add to the minerals that you need for your teeth and it has been clinically proven to increase salivary flow so the pilocarpine and the saliva max can both increase your baseline saliva flow and then we want the patient to go in and continue to be tested so they can monitor how this is going in a longitudinal basis to figure out where they are now at on their baseline with the pilocarpine in the saliva Max.
Howard: and what percent of my homies probably don't even know what pilocarpine is and have never used looked pilocarpine is never used it and how big is the knowledge gap you thing because I mean dentists I mean even when they just do something they really really know like a denture or a particle but if they only do it once or twice a year it's so hard to keep right on top of something whereas you're doing fillings every day.
Porter: Yes no it's a great question we're seeing that most dentists I would probably say anywhere between 70 and 80 want to be walked through and understand the treatment options I don't think this is this is the fault of the dentists or the education at all I think it's an issue of we just have never had a diagnostic device to measure saliva flow before and it's just natural that if you don't have something to measure you don't really look a lot at treatment and if that's just not top of mind it's just not part of your of your clinic I really do believe that once this begins to be part of the overall treatment part of the gold standard of your care when you're going in the treatment is going to be much more top of mind much easier to get access to I also think that because of Boka sciences and the bulk of flow device that there's gonna be in more innovations coming from big companies that weren't to attack the xerostomia and dry mouth market with a diagnostic there's bound to be innovations in how to better treat patients that have xerostomia.
Howard: So are you on who is your product champion in dentistry and who's gonna be your the guy you know you need outside man you need a product champion have you started isolating dentist to be your product champion for this to talk about it lecture make online CE what are your thoughts on that?
Porter: A good question we've done a lot of research with the University of Utah my saliva specialist there named Dr. melody Weller has been great and her colleague Brian Trump we've also published with West Coast University and the individuals they're looking at populational data how many people have dry mouth etc and then we've been working with people like Brian Novi who was wonderful and very well-respected in the field Tina Pappas I think she is she's great she has the device and speaks about it she's been working on saliva and saliva flow and xerostomia for most of her career she's at Tufts University as you know Brian Novi used to be at at Zdenek West and part of their preventive dentistry program and is now working in Massachusetts with some with some other clinics. Stephen Powell at Loma Linda is a great champion we've got a lot of really wonderful people and I can't leave off Rory Hume who's the Dean of the University of Utah School of Dentistry he's wonderful he understands the issue has been very helpful in in both educating us and helping us understand how we need to position this and how we can create a preventative platform.
Howard: and so are these, your in Utah have you talked to Gordon about this he's considered by everyone who's at least over 50 the god of Dentistry have you ran this by Gordon and Rella?
Porter: Gordon has it and this has become an integral part of Rella and her research staffs process they're doing incredible research on the type of bacteria and the depth of that goes into cavitus lesions what bacteria what depths and what is actually causing the issues and they have woven in with this research protocol full dry mouth screening for these in these patients to now begin to correlate is there a correlation between dry mouth lack of saliva and the type of bacteria that's in the mouth in the depths that those bacteria go so they've been working with us very carefully and have been again wonderful champions and we love that they're using our device for research we found that this is end up being an interesting foray into the research field. Rella always says I'm so glad I don't have to have my patients drooling in a cup for 10 minutes not only is it uncomfortable to them it's not overly accurate and it takes a long time now they can they can test and measure salivary flow for these patients you know along the course of the day these patients often spend 10 hours in the chair they can see the longitudinal data in conjunction so they've been wonderful and we will continue to work with them.
Howard: but saliva max is still your on your your top pick for treatment this?
Porter: I think saliva Max is is wonderful when you're the very low ends remembering though that saliva max doesn't have the fluoride component so we need to remember every patient that is dry or hypo salivation needs to receive their 5% fluoride varnish in the office and they need to follow up with the dentist and receive another three months fluoride varnish. So there needs to be compounding I wouldn't say there's one silver bullet right now that you can just say this is this is what it is it's the only thing you need to use I think each of them have a different mechanism and they should be used in conjunction and that's where the dentist need to create that care protocol and we're trying to work with them to do so and find the best options but yes I think saliva max is a wonderful start for people that are low it often can be covered by medical insurance so it's not an out of pocket expense going back to our insurance discussion and some of these others are an out-of-pocket expense but they're needed as well on top of that.
Howard: You know like even yesterday I mean I mean you were trying earlier about how we started this conversation that your dental clinics all had physicians as denticles clinic and like yeah dental office the question is oh well her blood pressure is high, I don't think we should work on her today and you're going to send her on her way whereas I mean I didn't solve anything you know if a physician was there we just kept kept going I wonder how technology and tella dentistry and telemedicine will start making this all work closer together for the individual who doesn't want to drive all around town seeing a different doctor in a different corner of Phoenix every other day you know.
Porter: You know I think the universities are gonna push this just this year the University of Utah here in my backyard and where I went to medical school has integrated their EMR so now the dentists and the physicians utilize the same EMR so it's very easy...
Howard: EMR?
Porter: Electronic medical record
Howard: Okay
Porter: Yes so they're using the epic the platform is what the EMR is is called and it has a dentistry platform so now if you're getting treated at the University of Utah by your dentist the dentist has full access to your to your healthcare records on the medical side and the physician vice versa has full access to your dental care what this is allowing is you don't have to do a tedious medication reconciliation with your patient because you can see it right on the computer as they come in you can see what their past blood Sugar we're when their when their exams were done their past past blood pressures it's allowing it to seamlessly integrate this is gonna be icing the first step and the future of of combining the two professions is having one single electronic platform that his is is curating all of your data so the dentist and the physician can see what one or the other doing.
Howard: Well yeah and what you just said is is really being the entire problem I mean like go into a dental office they're their practice manager software doesn't talk to their accounting software yeah you look at research around the world they're all on different platforms you look at a lot of the research it's all duplicate I mean a team is doing this in China India and Brazil and that's already been done and if they were all synchronized together they'd be onto something else last and final question just to the kids out there you're seeing that back when I was just getting out of school they would sell a device like this and it was Feaster Sam's family you sell a device like a $50,000 laser and after you sold a thousand if you didn't sell any for several months you're out of business so they're always trying to get revenue streams they he said he didn't want to use the term lease but whenever you make your relation with a company like say Netflix where you say you're getting gonna give them ten dollars every month into perpetuity well now they can budget a bunch of big movies and blockbusters so if you want your company that you're working with to be healthy they pay their bills monthly just like you pay your bills monthly so a revenue stream you know if you're coming out with the business where you sell at one time there's no revenue stream there's there's no disposables there's nothing to work with I'm you kind of got a dead platform that's why some businesses are so challenging that so when you sit there and you're leasing a machine so they can count on subscribers and then you'll have this data coming in which would give you bigger and bigger data so it eventually AI can come in and cert machine learning and and then combining that with the medical records and I mean we start doing this God just think what it look like for the next generation.
Porter: Yeah well I think that's a great point we need to constantly be innovating of providing value not just being stagnant and in our next phase to your point we're working on finalizing a software form whereas the patient leaves the office they immediately get a text saying what was your salivary flow rate and where do you why in the in the risk profile this machine bot that we're developing and creating and it should be up and going in a couple weeks we'll then walk the patient through what is xerostomia why do you have it now what can you do for it and it's very interactive on treatment options education what can you do at home to alleviate the discomfort and we want to have that constant interaction with the patient and this can come and the guys from the clinic and also interacting with the dental clinic but we want to make sure that we reading properly part of part of this is diagnosis treatment and education and we need to fill all those three buckets so that we continue to provide the maximum benefit to the patient as they're they're trying to prevent and be as healthy as they possibly can.
Howard: and this is why a dentaltown just we just came up on our 250,000 registry remember we're still signing a thousand new dentists month it's because of the message board format it's not like Facebook Twitter and LinkedIn last in first out you're just scrolling in just endlessly so that when you have a specific question like if you just take the word xerostomia or pilocarpine or just something specific you would pull up every single thread and posts had ever mentioned this since day one and it's just such a organized matter that's why when you go to go to the Jet Propulsion Laboratory and ask him if they're studying Mars on Facebook it's all message board format or they'll call it bulletin board format but you can go in and type in one word so I hope you joined the discussion and illuminate in this area for dentists because it's gonna be a growing concern and it was an honor for you to come on the show today thank you so much for coming on the show and I tell us everything you know about xerostomia.
Porter: Well thank you for having me it's been a pleasure and I really appreciate it.