Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

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howard

General Dental Practitioner in Private Practice Healthy Smiles since 1996

www.smilenepal.com

Facebook.com/pande.neil

Twitter: @neilpande

Howard: It is a huge honor to see the most gorgeous, smiling face in dentistry. My buddy Neil Pande from Kathmandu, Nepal. You are just an amazing man. Did you know, there's a big song in America, back when I was little, Katmandu?

Neil: Yeah.

Howard: Have you heard of that song? I forgot ... Do you remember who sings that?

Neil: Bob Seger.

Howard: Bob Seger, Katmandu. That was the first time I'd ever heard of that word. I was probably 10 before I realized, it was a real city. You are just amazing. I want to start with, I'm just profoundly sorry about your natural disaster. It was an earthquake of what, 7.8?

Neil: 7.9. 

Howard: 7.9. Then 2 weeks later, it was a 7.4?

Neil: 7.3. 7.3, yeah.

Howard: Explain to listeners around the world. Probably 5000 dentists are going listen to this. They listen to this on, from every country on earth, every episode. Tell them about ... First start with ... Tell them about Nepal and Kathmandu, and why this is an earthquake prone region. I'm in Arizona, and I grew up in Kansas. In Kansas, we had tornadoes, that was our natural disaster. The ground never moved, and we never had tidal waves or anything. Why does the ground move in Nepal?

Neil: Howard, as you know, Nepal is between the 2 giants like India and China. Basically they say, millions of years ago, the Indian plate came in and came on to China. Whatever is being made is, Nepal. Nepal is in that line, where the 2 giants meet. That's why they are supposed to be a millimeter or so, moving every year. This time it was ... We've actually moved 1.5 meters towards the north. We've really gone inside the plate ...

Howard: Is India going under China or is China going under India? Which one's going up?

Neil: India's going under China.

Howard: India's going under China. That's also the highest mountain in the world, is in your backyard.

Neil: Yeah, that's right, Mount Everest. Yeah, that's what you wanted to do once upon a time, right?

Howard: There's the 7 Summits. The highest mountain in all 7 [I've gone 00:02:32] is, I started with the middle one, and I did Kilimanjaro in Tanzania. That was 19,000 feet. The 3 above that will be South America, then North America. Then if those go well, the big one would be Everest. Sorry, before you get to dentistry and go into the talking points, how was the disaster? How was the recovery? What fundraising mechanisms?

The best fundraising mechanism I've seen is, when the TVs are advertising. "If you just dial ... If you pick up your cell phone right now and dial this 5-digit number, you automatically make a 10 or a $20 contribution" or whatever it is. Those campaigns raised gazillions of dollars, because it's just so easy to pick up your cell phone and put in a 5-digit number. How can a dentist help with these relief organizations?

Neil: First of all, how it hit us was, I was in a class. We're doing some orthodontic training. Above my practice, there's a lecture hall. Suddenly, I was just outside, at 8am. It was like a wave coming in, it was like a rafting on a ground, you know? Trying to hold on to something, to hold yourself. After that, the amazing ... That's the beauty of ... Lot of people like you Howard, love this country so much because you've seen it, you've been here, you've seen how hard people get through. They are always smiling and happy about life. You guys have been great, helping. 

All the international media poured in, the major agencies poured in. Then, they started doing things on the ground. Regarding the funds that happened. Usually, the fund was given to these big organizations. One thing I have to say Howard is, whenever you give to big organizations, there's a big overhead as well. If you give, let's say $100, around 60 to $70 goes in their overhead, and 30% goes to the real victim, if it goes there. You have to be very careful, where you give. That's one thing. 

I feel, in today's need is more about giving skills, giving know-how, rather than money itself. Money can ... Earthquake, what I've realized, it doesn't kill people. Earthquake just shakes the ground. What kills is, the man-made structures. If you look at all those buildings that have gone down. In Kathmandu, actually Howard, frankly speaking, it's not as bad as the media shows it. The bad part is outside Kathmandu, the villages where they have these mud houses, with stone mud houses. Those are the things that have gone down. 

They are already in the rebuilding phase. I feel, we got to make them dependent. Not dependent, independent. Empower them, teach them how to do it, rather than just give them then money and make the house. That makes them dependent. Like what happened in Haiti. Still, they are not empowered yet. They are still dependent on all the aids that are coming in. My feeling has been, it's about giving the skills, know-how. Of course, the latest technologies, so that they can move on with their lives. 

Howard: You know Neil, one of the ... You're one of the most interesting dentists I've ever met in my life. No, I'm serious. There's 2 million dentists around the world, and meeting you was amazing. Then, when I flew 15 hours all the way back from Kathmandu to America, I was thinking a couple of things. Buddha was born in your backyard. The other thing I was thinking is, I almost wanted to write a book, and I almost wanted to call it, the Giggle Factor. 

The one thing I noticed is that, when you're in these super rich, advanced countries, whether it be the United States, Germany, Korea, Japan or whatever. People are just wrapped so tight, and you just never see them giggle. Then, when you go to a place like Kathmandu that's technically, well they're poor. I'm like, "I'd never saw so many people laughing and giggling." The girls were in these beautiful, bright purples and oranges. 

I posted a lot of pictures on Dental Town, my Trip to Nepal. I just saw more happiness and giggling. When I climbed Kilimanjaro, it was in Tanzania. My God, I often wondered if, there was anything that would not make an African laugh? These people lived in huts and they had no electricity, in some of the areas I was. No electricity, no running water, no sewage. All it was just, [inaudible 00:07:39]. Everyone's playing and everyone's smiling.

I thought to myself, "Man, the price people pay for" ... Then I look at America, which is technically or supposedly, the richest country in the world. Even though on some economic measurements, China passed it this year. I think the experts at the IMF are saying that, "The American economy was 17 trillion, 400 billion. The Chinese economy was 17 trillion, 600 billion, but they have a billion more people than in the United States." You would expect, that's probably right. 

It just seems like, the happiest people in America, and to the ones I would say, are the most, Nepalese are, kids in grammar school and high school. They don't have a lover, they're not married, they don't have a career, they don't have a job, and they're still playing and make-believing. Going in the backyard. It was still amazing sometimes, to go watch kids still make-believing in the backyard. You're thinking, "Dude, that dude's 14 years old, and he's still in this make-believe playing world." 

Then they do everything society tells them to. They go to school and they become a dentist, they get married, and they dump out a bunch of kids. They think they're doing everything right. Then all of a sudden, then they got migraine headaches, they're grinding TMJ in their teeth, their lower back's always going out, and they're at the chiropractor. They have Irritable Bowel Syndrome. Every time they turn around, they have a [jide 00:08:59] in their heart. It doesn't seem to go away, and so they unwind all that. Their career's gone, the kids moved out, they're finally retired. It's almost like, they lost their whole life doing what they were supposed to do.

I want you to address this. Dentistry in the States. 18% of dentists during their career, will need outpatient or inpatient substance abuse issues. They've had a high suicide rate, probably 10 years out of the last 30 that I've been in it. They say, "It's a high-stress job." I don't want to really give credence to that, because look at what the high-stress will be, if you were a soldier in war or Afghanistan or a police officer getting shot at. A fireman in, a house on fire. 

If someone said to me, "Who's the most spiritual dentist you know?" I'm a big fan of your Facebook posts. I'd say "Well, damn, it's Neil." If you took the second through 10, and added them up, they'd still be less spiritual than you. Was Buddha a big impact on that? Buddha was born in your backyard. Explain my perceptions of the Giggle Factor. Why are you always smiling? Why are you always so damn happy?

Neil: I don't know. I think I was born smiling, I don't know. Yeah, one thing I've realized over the years is, I've also gone through that stressful life. All the wants and desires and the world of materialism, where nothing ... It doesn't seem to end. You want this much and that much, and that. That guy has that. There's an ad there. You want that, another car, another house, bigger. That never ends, and it's the same here as well. I think Buddha has been a big influence in my life. 

I got to know Buddha, not through the natural way, which is through the Gurus and all that. Buddha basically talked about "Everybody can be like me. Everybody's God. You are God within yourself. Try to do the things right, and you are God yourself." What I've done over the years is, I limit my wants. My wants, my desires. It's not that I have forced myself into limiting those things. Just being happy with everything we do. A sip of water, you just sip. We sip with full, whole-heartedly. That gives you satisfaction.

Everything you do, every breath you take, every beat of your heart, you take it from the deep within. I think, that's what has helped me. That's exactly what Buddha tried to say. It is all about awareness within ourselves. Awareness of impermanence and trying to live that life, every second of it, to the fullest. That's something I've been trying to do, and lot more to do there.

Howard: I apologize for my ignorance on this because the United States, everybody's pretty familiar with Judaism, Christianity, Islam. The eastern religions, we don't hear as much as, about. Was Buddha's father, a Hindu? Was Buddha ...

Neil: I think he was a ... Hinduism basically, what I feel about Hinduism. It's not a religion, it's a way of life. If you look at Gods in Hindu, they are millions and billions of Gods that, are of different variety of Gods. I feel in Hinduism it was, everybody was God. Every human being, everybody was God, at that time. Hinduism was very confused at that time, when Buddha was born. Buddha's father ...

Howard: What year was that, 500?

Neil: 2500 years ago. 

Howard: 500 B.C., okay. 

Neil: Yeah, 500 B.C. He was a king, and he was a son of a king. He would never saw anything bad. He was protected from all that, that is bad. Suddenly one day, he sees people dying and people having problems. He realized, "Oh my God, this is something serious." That's where he goes in to find out, what life is all about. He comes back with a message like, "We are God ourselves, our awareness, our sense of impermanence. That's what keeps us Godly. Doing good things in everyday life." That's what his message was. 

Howard: Now, one of the things I learned ... Where was Buddha born, in Nepal?

Neil: It was towards ... From here, from Kathmandu, it's around western side of Kathmandu. Towards the Indian border. It's a place called Kapilavastu. 

Howard: Now, is Hinduism the first religion? I've heard some people say, Judaism was the first. When I was in India they said, "Hinduism was first." Do you know, which one dates back their earliest?

Neil: No idea, I'm totally clueless on that.

Howard: Oh, okay. Then, what advice would you give? Right now, there's this Dentist driving to work. He's in a lot of debt. He's at $250,000 student loans, he bought a practice for 500,000. His wife Muffy bought a house for [inaudible 00:14:27] 100,000. She stays home and has 3 kids, 4 kids. She's burning up 5, 6, 7000 a month. The economy, it's up, it's down, it's up, it's down. Maybe, they're in a small town and the Bain factory's gone. He's just grinding his teeth with a migraine, wearing a Night Guard, with a irritable bowel. His lower back's going out. What advice would you give that dentist?

Neil: First of all, if he's already taken loan. That's a different thing, he's got to work it out somehow. At the same time, be within himselves. Do a bit of self-reflection, just trying to find out peace within himselves, wherever he finds. If he's a new dentist, he's planning to do that. One should, I feel, know a limit. If you are just putting everything in, and you want to do everything here, what others are doing. The way you were being conditioned to do it, from dental schools. From the schools, to the world of materialism, just getting you in that shackles. Just tying you in that shackles. 

It's time that you realize that "Hey, this is not the" ... If you are of that sort. Try to figure out, "What's my limit? I'll go step-by-step." If you go step-by-step, I'm sure ... We all have gone through that. I look at myself. I started with 1 dental chair. Then I slowly got into ... It's all about patience, at the end of the day. Once they have trust in you, they do not have any ... That trust is just amazing, between dentist and the patient, that trust. 

You go, as you go. Not everything, you put in a basket at one time and try to do everything. Then you're unhappy and you're grinding. You're worried about all your loans. Somehow, it doesn't work. Then you are crammed by the world of that materialism, and it just doesn't get you out, until you are 50 or something. Then your life is already gone. The beautiful part of your life, the present is gone. If the present is gone, what's there in future? We don't know. It's actually ... We do not know what's there in future for any one of us. 

Howard: Neil, I want to ask you some of the questions that I found most stunning, when I was in your amazingly beautiful, gorgeous country. In United States, Coca-Cola was invented in 1890, and Pepsi was 12 years behind it. We've had a century of Coca-Cola. We were having dinner at that restaurant. There were about 8 dentists. There was an older dentist, and he made a statement that, he practiced dentistry, before soda drinks were so common in Nepal, and now. In his 1 unit career, he has seen disease [missing in pill 00:17:29] teeth, skyrocket that, he's associating with soda. 

Whereas an American, they couldn't see that difference because this dates back to their great grandparents. Have you ... I take it, you're ... What are you? I'm 52. What are you, 40?

Neil: 42, 43.

Howard: 43. I'm 10 years older than you. Have you seen in your career, have you seen pediatric decay or decay in general, go up in Nepal? Do you think there's dietary changes in your country?

Neil: Definitely, Howard. The way we're seeing ... The pain problem in urban Nepal, I would say, it was almost same. If we are really seeing rural, where they did not have access to all these sweets or any soda and all that. The main problem was, periodontal disease at that time. Now, we are seeing kids, small kid, just 4 years old, 5 years old, with complete rampant caries, abscess, name it. There is no care. To tell you frankly, there is no care available there. They just go on, as they have. They just go on with that. 

Yes, I feel sodas are the ... I was in a village, just 3 days ago, doing some  relief work. I was talking to these mothers. "Hey, what do you give your kids to school? What do you send them, snacks?" She was like, "Biscuits and all the instant noodles and all that." I said, "You always talk about chocolates and all that. Do you realize, there's so much sugar in them?" She was like, "Wow." I said, "Later on you'll realize, you're giving them poison. Would you like to give your child, a poison?" She was like, "Oh." She was really taken back.

Yeah, you're absolutely right. There is a study, where in a mountain trail, around Mount Everest region, where the kids never used to have any cavities. Their diet was very healthy, natural food. You know Howard, what I tell the parents? "Give your kids live food, food that are alive. That'll make them alive. Give them dead food, like packed food." I call them dead food, "And you don't even know who made them, how it's made, and all sugar, all the good taste that is in there. They get used to it, and then they're dead." Dead food gets us nearer to death. That's a pretty strong statement, but it works. 

In a village scenario, we got to give them that kind of message. That's what I try to do in the ... Okay, just coming back to the trail. After the tour, the trekkers started coming in. They started bringing in chocolates and all that, and giving it to the kids. There was rampant decay, all over the village. This is documented stuff. Now we try to tell trekkers and everybody, "Do not take chocolates and all that. If you want to give something, give pencil, books, whatever, but do not take these chocolates and all that. Do not encourage that. Once they get into the habit, they're not eat their normal food after that." It's human behavior, you know?

Howard: Yeah, and you also see that in houses that raise kids with substance abuse. Every time there's a celebration, the parents got to break out alcohol. Why do you need alcohol, because it's someone's birthday? It's like, every time we're supposed to say yay, we're supposed to open a Budweiser. The same thing with a kid. When you did something good, why do you associate that with, you have to eat something? You're not a dog. You give a dog, a treat, after it does a trick, and not your kid. 

I got to tell you, probably the greatest education I got was, not 9 years of college. I don't think, it might be 1000 books I've read. Where I gained the most knowledge is, just going around the world and visiting countries. You don't know what your biases are, until you get there. I always thought, India ... I thought, because they were Hindu, they didn't eat meat, they were more likely to be vegan and vegetarian. That, these would be the most unbelievably healthy people in the world. My God, they eat more sweets. I don't want to offend any of my Indian listeners. I've never been to a country. You walk into a dentist's house, immediately they're out with a tray of sweets and cakes and cookies. Every dental office I walked into, I was treated with more sweets in India. Yeah, it's the added sugar, it's not natural sugar in a banana or an orange or anything. It's the added sugar in sweets, that's really making a change.

The other stereotype that I thought was the funniest one is, when you're born and raised in America, you just hear how evil, socialized medicine is, and socialized countries. They almost let you think that, the word socialism should come with a Swastika. Then you go visit these countries like Denmark and Sweden, and Norway and Finland, who were like the ... This was supposed to be the bottom of the barrel, socialist countries. My god, those are the greatest societies, minus the weather that, I've ever seen in my life. It was just, lowest crime rate, highest education, highest health. Oh, and it's a socialist country.

An excellent teaching point for you, and I want to ask, how you got it. When we talk about business, there's different business strategies. You could be the low-cost provider like Walmart, Costco, Southwest Airlines. You can do a target market like, you're just a cosmetic dentist or this or that. The big one is usually, price segmentation, market differentiation, differentiating yourself at the market. I found it in Kathmandu, there are offices like yours, with digital X-rays and the high, high, high-end. Then there were dentists that were treating the poor, with hardly any technology. 

How did you differentiate yourself? Did you specifically try to say, "I want to be a high-tech dentist, high-end?" Many dental offices we went to, yours was like the Taj Mahal. There were other ones that would just be doing basic dentistry. Would you agree with that?

Neil: Howard, all that ...

Howard: Especially some of the dental offices, where the streets were only, maybe 2 meters wide or something.

Neil: Yeah, yeah. I think Howard, I think my basically, principle of practice has been based on your teaching. I've been with Dental Town for a long time, somewhere in early 2000. That's when I started my practice. Whenever Dental Town used to arrive at Kathmandu, and going through that. Those are the things ... I always wanted to say "Hey, why should we downgrade ourselves?" Actually if you look at it, dentistry doesn't cost too much. Am I right? Let's say, a digital X-ray for example. I got it in 2006. It costed me something like, current $5000 or something. Just an X-ray. That has given me so much advantage, over the years. I have not had to use films, my processors, my time is saved. It's been now, 2006 to now, 9 years. That guy is working beautifully. Of course, taking your Phosphor plates now, and all that. 

You are the inspiration Howard, actually. You've actually, staying there at Phoenix, you may think you just impacting few. You have impacted a lot of dentist, who are forward-thinking in the world. Thank you for that. That's amazing. The access to knowing what's available there, and just trying to getting there, that's ... Thank you, thank you. You are the crux of all that.

Howard: Thank you. All I did was, just threw the dental boat in the internet. When I saw the internet coming out, I said, "This is the way I can connect to guys like you, at the speed of light." I just thought, that was going to be so cool. It turned out to be very, very cool. 

What type of mix of dentistry, do you find yourself doing? Do you place implants? I know you do Endo. Tell me your mix of dentistry. 

Neil: Mine is more of Endo. I've been doing Endo for a long time. Yes, I do a bit of implant, but not that, too much of implant. When there's good bone and a straightforward case, I try to do that. When I have a little difficulty, then I work with my Periodontist, to do some of those work. She's also just come back from a lot of training in Atlanta, stuff like that. We do have a mix of restorating ...

Howard: Was that Atlanta, was that ... Who'd she get training in Atlanta? Was that Goldstein Garber & Maurice or?

Neil: I'm not too sure, Howard. She just told me, yeah. Anyway, and lot of restoratives and most of restoration. Guess what Howard, this has really been intriguing me all this while, after the earthquake actually. I've been trying to link the earthquake with the teeth. I say, "Whenever there is ... Our mouth is going through earthquake, all the time, all the time. Whenever man-made structure, it does fail, one time or the other, whereas the nature stays. That's exactly whatever we've seen. A single tree hasn't fallen in this huge earthquakes we've gone through. Still today itself, there were 3 of them. A single tree hadn't fallen, but the houses have fallen, where the foundation was not right. 

I had an architect friend the other day in the chair, and he just sent me SMS saying, "Hey, my crown has fallen." I was like "Hey, how many root to scale?" Retrofitting, how is the soil down there?" Guess what? Dentistry is so much with that Physics, the architectural part of dentistry. If you do it well, if you treat the soil well, if you treat your pillars well, it will not fall. That's another thing I just wanted to share with you. Earthquake dentistry, actually I'm writing an article on that. It's so many things that have happened, the man-made structures going down. It's all related to exactly the same thing dentistry has gone through, you know?

Yeah, my basic thing is restorative dentistry. I didn't do much of extractions. I have a friend who does that for me. Dentures and all that, I have another friend. It's a group practice, as such. We do everything actually. 

Howard: Yeah. My best friend would be a pediatric dentist. That's the one I want to refer the most. You know know? That's an interesting ... Yeah, there's a big dental lesson there, that's profound observation. I've never heard that, during the earthquake, a tree never fell. That was because the tree can give. They were building buildings that don't give ...

Neil: Modulus of Elasticity.

Howard: Yeah.

Neil: Modulus of Elasticity, yeah. 

Howard: No, no, no. We had to learn at dental school that, there were basically 3 choices. There were tensile. If you take a wire, you can't pull it apart with tensile strength. If you bend it back and forth, it'll shear off. Then, what is strong? Porcelain, you could put a porcelain plate, and have an elephant stand on it. You say, "Well, that's really strong because if it stands on Plastic Tupperware, it'll deform." If I drop the porcelain plate, it'll shatter. I drop Tupperware and it'll bounce. That's why in my mouth Neil, I have 7 inlays, onlays, and they're all gold. They're all, high noble gold, because it gives. They actually ... The only dentistry I did 28 years ago, that's still there and looks better now, than when I first placed it is, the gold work. 

At first when you put in that gold, it's like you're trying to smooth it out and you're trying to make the margin nice. God, after 28 years, it looks like it was welded in there. There's soft malleable gold, and its changing shape as the tooth dehydrates and ... Yeah, gold is amazing. It's so frustrating that, even when you go to Asia and Nepal, where the girls wear gold pins in their nose and their earrings, and their jewelry and their fingers and everything. Then, you try to tell an American, "Let's go with a gold tooth. Oh my God, are you crazy?" You have 5 gold things in your ear, a gold bar in your nose. Your whole body is decorated with gold. You have a gold thing hanging in your belly button, a gold chain in your ankle. Then I try to tell them, "Let's do a gold molar," and they just, like I'm crazy. Is that the same in Nepal and India?

Neil: Yeah, same, same. Actually, whenever you talk about gold, they're like, "Well, gold." You know what I tell them? I tell them, "You know what's the biggest ornament that is your own? Your own ornament are your teeth. You cannot get better ornament than that. When you're going to cover the ornament when it goes wrong, you got to find the best thing that does it. Gold is so much similar to your tooth structure." Usually, they don't buy it. 

Howard: Maybe we should try to bribe one of the biggest models out there, like maybe Madonna or Britney Spears, or the newest one in America is Caitlyn, which is Bruce Jenner. Maybe we should get them to have all their fillings replaced with gold. Maybe if they're on television or not, they young Americans think, "I want to have a gold crown like Caitlyn and Madonna and Britney Spears, and all these people." Yeah, that's amazing. 

Neil, you sit in the middle of some of the biggest empires in the world. You have China on the right, that's the biggest country in the world. India on the left, that's the second biggest country in the world. You obviously have friends all over the world. Sitting in your position, how would you compare and contrast European dentistry, Chinese, India, America, versus lessons people could learn from each other. I'll give you some examples. Japan and Australia and New Zealand use more glass ionomer. Americans, you hardly can't find glass ionomer. What have you noticed, sitting in the middle?

The reason I ask you that question. It comes from the smartest Endodontist I ever met in my life, was Bambi [Du Rogentubi 00:32:35]. I asked her one day. I said, "Why are you so smart?" He said "Well, I'm from Nigeria. In America, you learn Endo and you just drink your Endo Kool-Aid. If you're in Germany, you drink their Kool-Aid. You're in Japan, you drink their Kool-Aid. In my country Nigeria, we were taught, well, the Americans do this and the Europeans do this. Japan does this. We learned to compare." He thought, we were given a recipe and said, "Just do this." Whereas he thought, people like in Nigeria were taught, "Well, let me tell you how the exact same people with the exact same teeth, eating the exact same sugar, how they fix it 3 different ways from around the world." What do you think is, the best way?" 

You're sitting in Nepal. You got India on the right, China on the left. What have you seen, international dentistry? What lessons do you think are going around that, could be shared?

Neil: I think over the years, seeing dentistry from all around. Especially, I was trained in India. Then, I was trained in UK after that. What I found is, there is too much of dentistry, and there is too little dentistry. There is a dentistry which is in the mid-part. Of course, non-invasive, invasive, all those things come forward. American dentistry, just don't mind, but majority we see there's little too much dentistry there. For a small tooth ... It's like an insurance I call it, buying an insurance. For a tooth that is supposed to be okay, it can go in for a fracture or something, you will crown it right away. Whereas, if you look at the other, European dentistry, they may try to do something else, before crowning it. 

At the same time, Australians do it in a mid-way. I've found actually, the Australian way are kind of a mid-path. Not right or left, but the mid-path. Personally, that's what I've been trying to practice. That's what I feel. Chinese and Indian ... Chinese dentistry, I really, actually don't understand because they have their own system, they have their own thing. Yes, we do have seen lot of Chinese dentistry being done. Japanese dentistry, so much of gold again. That is beautiful. I think that's one of the reasons that they've great bonding strength and things like that. 

Indian dentistry's more influenced by, I think American dentistry right now. It's in a mix. Some are amazing, but some of the work you see, you're like, "Where is the thinking there?" Sitting here in the middle. Sometimes I look at it, Nepal being the center of everywhere. I feel that we should be a good judge at ... Sometimes I see people saying, "Hey, you need a crown there right away," without judging the tooth properly. 

We cannot play God, I feel, without understanding the forces and all that. Just taking in more in the monetary terms, and just going with a crown. That crown also does fail after some time. Of course, it all depends on the age as well. If it's a old guy, maybe that would be a good thing to do. In a younger age, if you start doing too much of dentistry, it gets back to us. That's what I feel.

Howard: I have to agree with everything you said. I think Germany has the best labs because number 1, they educate them. America has a lab industry, where almost there are 56 dental schools. Probably 50 of them don't even have a program for laboratory tech. How could we have good dentists and engineers and architects, if you didn't have good schools in dentistry, engineering. I think the United States could learn the most from Germany. It's like Educate your lab people, or you're not going to educate the lab people. The best lab techs I've ever seen in Canada, Germany, even in Hong Kong, were all educated in Germany. 

You're right, I do think the Australians are far more conservative. I would call the American ... A lot of the Americans are aggressive, and they're quick to stick their tooth in a pencil sharpener and make a crown. I think a lot of that is from reimbursement because their insurance will give them 1000 bucks for a crown, only 250 bucks for a filling. A lot of these filling materials, by the time you numb them up for bonding and place a rubber dam, and try to get tights contacts, and do the whole thing. Some of these fillings would take you half an hour to an hour. The dentist is thinking, "Okay, I didn't even make a penny on that. I'm not going to work that hard for an hour, for free. I'm just going to stick in a pencil sharpener and do a crown." 

I think that was a big driver of this CAD/CAM revolution because people basically, it wasn't a crown machine. "I was going to do an MOD filling. Now I'm going to scan it and make it outside of the mouth, and do an MOD inlay or onlay or partial crown. Then, bill 1000." I think a lot of that was economically driven. 

I also think that, the Americans are the most ... The average dentist in America is basically, an engineer. They're a Civil Engineer. They build houses, bridges and crowns. Everything fails, from biology, from decay. I think the Australians get that, the most. They're always trying to do everything with bioactive, glass ionomer, something to try to fight it. I always give the analogy that, "What the dentists in America do is, they build this amazing barn out of wood. Then they beg you to brush it and floss it, and use a tongue scraper and Listerine and all this stuff. When it fails from the termites eating it, it's always the patient's fault." 

That's why I love Titanium, that's why I love bioactive materials. I think, "If we made all those barns out of aluminium, now the patient doesn't have to do a damn thing." The termites come back, and they can't eat the aluminium. I think, that's the most exciting thing about the internet is, its taken 220 diverse countries, put them all in 1 cell phone. People, through Facebook and Twitter, are all talking to each other and realizing, there's other great people with great minds and hearts, doing something very different. Yeah, that was neat.

I want you to talk about implants. I want you to specially talk about implants. What would you say, the Koreans have 20,000 dentists. 15,000 out of 20,000 placed an implant last month, surgically placed it? In America, 95% of the 120,000 general dentists have never placed a single implant in their life? Brazil, Brazilians. If American dentists place implants at the rate Koreans did, our implant market would grow 700%. The Brazilians, you go down to Brazil, and they don't think twice about placing implant. An American still file down 2 teeth and do a bridge. Why do you think that is?

Neil: I guess you know, one thing is to ... The suing culture, there's lot of suing happening. The lawyers after all, I think that's one thing. Another maybe, very hard to say. Maybe the training, as you said. There's always a taboo. Even now I see things like Perio association websites and all. All that saying, "Implants should be placed by Periodontists or something or." General dentists are usually kept aside. That's exactly what is happening. 

If you look at this part of the world also. Somebody invented a department on implant, where nowhere in the world you have, in a college, where you don't do much implants, you create a Implant department. It's lot of this specialists versus the GP, that thing. That in sense, what has killed implant, I feel. I feel, after all the good training. It's just like in college I remember, even a crown. I went to do a crown, they would not teach you well because they would want to sell their Master's program, so that they sell them, only the Master's guys. Who suffered at the end? It's the patient because the guy who's been trained out of dental school, does not even know how to do a good crown. Now, who suffers at the end is, the patient. That's why we see bad dentistry. 

I feel, it's training, it's that ego. I don't know why dentists at times say, "I want to treat the world." We can't. We have a limitation of that 4, 5, 6 hours, whatever we work. We can treat certain patients. There are patients ... Thankfully, I have a cardiac surgeon who's a friend. He said "Hey, we have just 5 to 6% of people have cardiac issues. You have 1 heart. You guys have 97% of the population, one time or the other, suffers from some dental disease. You have 32 of them. You guys have enough work. It's not that, you have to fight among yourselves, trying to buy on "Hey, that's my case." Come on, it's about education. Educating the public in the right manner, and doing the right work. There is enough work.

Implants being killed by this kind of thing, about lack of training because again, training guys want to sell their training. That's another thing. That's why they don't want to teach implant in college, too well. I think, that's where the whole thing comes in. I hope you agree with me.

Howard: Yeah. You go around the world, and most problems could be summed up as, money is the answer, what's the question. I want to also ask you, in Kathmandu. I remember one time, I was in Hong Kong. A dentist told me that he read my book, The Business of Dentistry. After he read my book, he lost his dental license because he got all excited about marketing. He did some marketing. He didn't realize in Hong Kong, it was just completely illegal. They immediately, they saw his sign. He was doing everything I was doing. He lost his licence, and did get it back for 90 days. I almost bankrupted the guy. 

What is marketing like, in Nepal? When I was there, it looked like Coca-Cola was the master marketer. I don't think you could drive in Nepal for 5 minutes, and not see a Coca-Cola sign. What is marketing like, in Nepal, for dentistry?

Neil: When we were driving together, I loved what you said. "Dentistry cannot marketed. In Nepal, dentistry cannot be marketed." We cannot have advertisements, we cannot have any kind of boards saying ... It's illegal basically, just doing all those things. We're just supposed to be in the corner, just waiting for a patient, without telling them the good things that we should be telling. 

You're right, Coca-Cola has no problem sending their ... All the health issues that it creates. The health guys, even doctors, we cannot market, we cannot advertise. Some guys are doing it, but that's against the law. People like us, we want to be with mainstream. It's sad that, there's absolutely no marketing. Marketing could be of course, awareness that more dental schools, dental clinics are there. Giving people that feel of "Hey, I can have a better teeth like that. How can I" ... There is absolutely ... They don't allow any marketing in this part of the world, and that's sad. We've taken that from India. India has taken it from the United Kingdom. Now in United Kingdom, I think it's allowed, but still we are a long way to go, yeah. 

Howard: It'd be like, getting in a boxing match. If you and me got in a boxing match, and I was Coca-Cola and you were dentistry. You were handcuffed behind your back and blindfolded and gagged. How can dentistry fight decay, when Coca-Cola's on every corner? How can diabetes, obese ... How can any of these people fight back, when these guys just dominate the message that, you drink water?

Then, when I was in Africa, the thing that I got really reeducated on is, I didn't realize that the doctors were telling them to drink Coca-Cola because it was clean. They said, "You tell this kid to drink out of a creek or a well, and he may get cholera and die." I want him drinking bottled soda, and I want him drinking Coca-Cola." The trade-off is, a cavity on every teeth and a big belly and obesity and all that, but he's not dead, he's not dead from cholera." Do you see those issues in Asia?

Neil: Yeah, I think over the days, I've been seeing a lot of patients coming in with, all they drink is Coke, all the time. Not that much, Howard. I guess, it's the water. People are a little more aware, I feel. They're getting more aware. One thing that has really worked in Nepal is this, small, small health workers, NGOs, working and trying to put in messages. Yeah, it's not that I don't see that kind of patients, but not as much. I don't see much of that, yeah. 

Howard: I always gt mad when I hear these arrogant Americans saying that, "We need to go to Mars, we need to go to Mars." It's like $1 trillion. I always think, "You know what? 7 billion people, 3 billion live off $3 a day, and don't have running water, electricity and sewage in their house, and we need to go to Mars?" It's just not noble to say "Well, why don't we just get clean, chlorinated water and a toilet to 3 billion people?" That just seems like a million times more noble than, going and getting a red rock from Mars. We got moon rocks, and those are completely useless. Now we're going to spend $1 trillion, to go get a Mars rock?

Neil: Yeah. I'd like to add on that, Howard. Basically, if you look at the earthquake itself. We haven't been able to map our own planet. We don't even know so much, these plates. The mapping has not been done. There are so many places in this planet of ours, that's completely unexplored. We're trying to get out and collect rocks. Yeah, just because that fascinates us. Ground reality check needs to be done, I think. 

Howard: What is it? I forgot, how many men have stood on the moon. Is it 16 or 23, something like that. No one has stood on the bottom of the ocean. 

Neil: I was named after Neil Armstrong, so. That's, yeah.

Howard: My favorite business lesson for Neil Armstrong. You were named after Neil Armstrong. Name the second person who landed on the moon?

Neil: Buzz Aldrin, right?

Howard: Most people can't. I think an interesting business lesson's that, whenever you hear the best, at least half the time, you can just substitute best for first. Yes, "What's the best University in America?" They say Harvard. That was the first. You say, "What's better, Pepsi or Coke?" They'll say Coke. That was 12 years before Pepsi. Americans still say, "Hand me a Kleenex, and they're just using a tissue made by a knock off company. Being first is so huge, whether you're the first dentist in the area to do sleep medicine, laser dentistry, cosmetic, Botox. First to market, it's hard to beat, a first to market.

Let me ask you another thing. I'm sorry it's non-dental, but we just had one of our biggest media deals. It's called HBO, and they have this show that's been going for 20 years.

Neil: Yeah. [crosstalk 00:49:29] 

Howard: Yeah, they had this show called Real Sports with Bryant Gumbel or whatever. They did a piece on Everest. Basically the spin was that, these Sherpas wouldn't be putting their life in danger, if rich people weren't going there, from Germany and Japan and the United States, and dumping 100 grand because they wanted to get to the top. That, it was actually the rich people's fault that, any Sherpa died on the way up to Everest. I just wondered, that's weird because people die on a motorcycle, people die snow skiing. Everyone's going to die. No one gets off earth, alive. You live in the country of Mount Everest. Do you think that, industry in unethical?

The other thing they were talking about was, the litter of these bottles and everything. Having gone and flown over Everest. It's not like Kilimanjaro, where it's a single volcano on a prairie, where the 19,000 feet starts at a grassland. Where you start with baboons and lions and tiger and gazelles, in order to climb 19,000 feet. Everest is just 1 little point of a range that goes forever. For instance, see from eye to eye, when you're at 30,000 feet. Okay, so 1 trail has a bunch of [option 00:50:50] bottles. 2 questions there, is it unethical for a guy like me to have a goal that, someday I want to go drop a lot of money and hire a bunch of Sherpas, and go to the top of Everest? Is that a unethical goal or ambition?

Neil: No, not at all, no at all. What you're doing is, you're giving them jobs, you're giving them a means to live. These guys are doing really well. What is the problem here. The twist here is, the companies that ... Let's say, Howard wants to go to Everest. You contact a company. A company charges $100,000 for that. The guy who carries your thing on his back, actually gets $10 a day or let's say ... Yeah, $10 a day. That's where it's wrong. It's not, you were doing something wrong, it's those companies. 

In selecting that, just finding out "Hey, how much is my porter getting?" Would be a good idea. It's not ethical. If you guys don't come here, then what'll the Sherpas do? 

Howard: That's funny, you just interchanged porter and Sherpa, in the same conversation. When you go around the whole world, there are porters. When you go to Everest, there's Sherpas because that's actually the most common last name for the people that live in that village?

Neil: Exactly, exactly. They are the very strong, very amazing guys. Some friends are also there. There are some dentists also, who've actually been to the highest point, we have a clinic as well. He's a very good friend of mine. Sherpa is a clan, it's a kind of a clan in Nepal, who have been known for their ... They're used to living in that kind of altitude. For them, climbing these mountains, it's just like running through the backyard kind of thing. 

They have promoted that place, they have created jobs with that and all that. It's great. Only thing is, there are some companies which suck in, on their behalf, and hardly give these guys anything. That's where it's wrong. The wealth distribution, whatever comes in, has to be distributed well with the guy who actually carries on his back as well. That's where the ethical part comes in. 

About the litter. Yeah, now the rule is like, a lot of them are doing ... I've got few friends who I just actually placed an implant, 2, 3 days ago, on a mountaineer. She's climbed almost 7 mountains. She's German, but she's climbed around 7 mountains all around the world, highest. She's done Everest, couple of times. She carries her own waste. Whatever she uses, she carries it back. That's what has to be promoted. It's about monitoring it. Of course, poop, remains a poop there. Poop, you cannot carry back I guess, in those so many days. If there is some managements. There are so many companies. The government takes so much money on these permission granted for climbing the Everest, almost $50,000 or so. They should be doing something from that money too. Cleaning up ... You can't expect a trekker to carry his poop back.

Litter, I don't see is a big issue, and it's very much manageable. It's a media hype, a lot of times. As I said, when the earthquake shook, the picture that was shown to you, was disastrous and Kathmandu's gone. In reality, it's not. It's similar, it's the media hype. Media gets a picture, and doesn't do much research, and just puts in on your plate because it's sellable. I guess, that's the thing. 

Howard: I want to ask you ... I only got you for 5 more minutes. By the way, it's 11:30am in the morning here, on a Wednesday. What time is it in Kathmandu?

Neil: Oh well, it's 12:10am in the night. 

Howard: 12:10am in the night. I want to ask you this question. The inconvenience in America, the average divorce, 50% of average marriage fails. Half the marriages fail. In America, the highest success rate is, if a doctor, whether it be a dentist, a physician, or a lawyer, marries another dentist or physician or lawyer. Their divorce rate is 9%. You're a dentist and you married a dentist. 

When you go to India, where they have arranged marriages, they have a 9% divorce rate. When I was over there, a lot of Indians were telling me. They said, they look at Americans as really different because we have, what they call, Love Marriages. Where you got little, young kids in heat, make irrational, emotional decisions, and half their marriages fall. They would rather have parents help you in your selection. When they help you with the selection, 90% of the time, it works. They call their marriages love ... American marriages, love marriages, Indian marriages, arranged marriages. What is it like, in Kathmandu? Is it more love marriages, is it more arranged marriages? You're married to a dentist. Do you think ... You've been married to her, you're not divorced, correct?

Neil: Yeah, not divorced. 

Howard: Do you think, a big part of that is because you both were highly educated dentists, and that's why you intellectually can get to your, or ... Just comment on that. What's it like, being married to a dentist? You guys work together in the same office.

Neil: Yeah, that's right. 

Howard: I adore your wife, she's just a lovey woman. What are your thoughts on that, comparing India versus United States, love marriages, nuclear family, et cetera?

Neil: Yeah, marriages in these days, India or Nepal. Love marriages. Here, it's more of arranged as well. Lot of marriages happen arranged, but now young people are getting wiser and they're selecting their own partners. Sometimes it works great, sometimes it doesn't. Arranged marriage seem to work better because they are forced to make it work better. That's what I've seen in the ... There's too much sacrifice in them. Even though it's not working out, they'll try to please the family because it's a family thing. Family have united. There's lot of struggle, but they do try to make it up.

Howard: Now, was your marriage arranged or was yours a love marriage?

Neil: Love marriage, yeah.

Howard: Yours was a love marriage. 

Neil: Yeah.

Howard: I hope that wasn't rude, of asking. 

Neil: No, not at all. At the same time, love marriage you know, what you're getting into. Actually, it tends to work quite well here. As you're asking, same profession marriage. I see, there are 2 sides of that. I think it's great because you carry the same burden, you understand each other's problem well. At the same time, you're talking to the same boring dentistry over the dinner table, all the time, which is good again. It enlightens you in many ways, but ... In the office, if you're working in the same office, you're just meeting the same person 24/7. That could be a little unhealthy. 

Overall, to do a service, understanding each other. I think it's great. For me, it's been great, yeah. I have been blessed with that. 

Howard: I love data, I love statistics because numbers and math are like gravity. They can force you. You can't deny gravity. I think the one thing, when you look at the 50 states divorce rate and line up the divorce rate, it correlates with age of marriage. The highest divorce rate would be Oklahoma, where they're the youngest when they get married. The lowest divorce rate's Connecticut, where they're the oldest. 

I think 1 advantage of why dentist, physician, lawyers when they marry each other, have such a low divorce rate is because they were usually 24, 25 when they got married. They weren't 16 years old. They weren't in Oklahoma city, dating, marrying a 16-year old. I think a big part of that could be explained just by, "Why don't you just wait till you're 25, to get married?" What percentages of the marriages in Nepal, are arranged? What is the average age of an arranged marriage?

Neil: I would say, arranged marriage will be at least ... I don't know, there's no data as such, actually. Usually what's happening nowadays is, the family likes a girl and a boy, and they just try to make them meet each other. Few days, they just go dating and all that. If they like everything, then they get married. It's like a half arranged, half love, arranged, hybrid let's say. Just like Hybrid Composites. 

Yeah, that's where it's going. I don't have the data on that. If you look at it, the divorce rate on arranged marriage seems to be much lesser because of the social pressure, than the love marriage. I'm not an expert on this issue ...

Howard: Yeah, but that's interesting, where you feel that, there's more pressure to stay together in arranged marriage. Neil, I am out of time. That is our hour. I just want to tell you seriously dude, I think you're one of the coolest guys I've ever met. I think you're just amazing, you're so intellectual. You're the only person I know, who on Facebook, you don't post what you're eating for dinner. It's always a profound thought. Every time you post on Dental Town or Facebook, you always take my mind out for a run. Your face is just, always smiling. The karma you exude. You should be the spokesperson for Buddhism and Nepal, and Dentistry.

Thank you for an hour of your time. I'm sorry I kept you up till, in the middle of the night. 

Neil: No way, it's a pleasure Howard. I would say, it's a privilege to be talking to you, after all these years. Guess what? Where did I meet you? If you remember, it was Twitter. We met on twitter, and that's how everything happened. Amazing, you know? Today, we're here. Thank you for all the concerns. You've been such a ... When you came in here and gave all that lecture, you gave it all free, gave all that. I see the changes that's happening right now, in Nepalese. Whenever a new dentist is opening a clinic and all that, he's putting your mantra in there. I can see that happening. 

Your first thing was location, the ground floor. These things, I see it working. That actually helped lot of dentists, save their practices in earthquake. Ground floors were pretty much, okay. I thank you from the entire Nepalese dental community as well as Nepal. Thank you very much, and you're now the Buddha. 

Howard: Namaste buddy, namaste. 

Neil: Namaste, Howard.

Howard: Have a great day. Thank you.

Neil: Thank you, thank you, pleasure.