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VIDEO - DUwHF #792 - Dhru Shah
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AUDIO - DUwHF #792 - Dhru Shah
Dhru graduated from the University of Sheffield in 2003. He then went on to complete a year of vocation training in general practice within the North Wales training scheme. He continued as an associate practitioner in the same dental practice for a few years thereafter, and further developing his skills and gaining experience in the general dental care of patients. Following this he completed various hospital posts gaining further training within the various disciplines of dentistry. These included working as a Senior House Office in the department of Restorative dentistry at the Royal London Dental Hospital followed by posts of a Senior House Officer and a specialty doctor in the department of Oral and Maxillofacial surgery at the North West London Hospitals NHS trust to further enhance his surgical skills. During this period, Dhru also completed examinations allowing membership of the Faculty of Dental Surgery of the Royal College of Surgeons of England. Soon after this he embarked on a four-year specialist training program in the field of Periodontics and Implantology at Guy’s Hospital, London. As part of his specialist training, he also completed a Master of Clinical Dentistry degree in Periodontics at King’s College, London whilst also attaining the Membership of Periodontics from the Royal College of Surgeons of Edinburgh. This training now enables him to offer a range of treatments to manage periodontal diseases (gum diseases) as well as the provision of dental implants.
Dhru’s passion however lies in helping people, helping dentists – making them thrive. He believes in Education…empowering people with education, with knowledge and giving them the opportunity, the inspiration to thrive and be the best that they can be. He is the CEO of Dentinal Tubules which has over 30000 members, it is UK’s largest online and offline learning platform, has an international network of study groups of their members (called Tubulites) and has offered learning to so many people.
Howard Farran: It is just a huge, huge honor for me today to be podcasting Dr. Dhru Shah all the way from London, England. He is a registered specialist in periodontics. He graduated from the University of Sheffield in 2003. He then went on to complete a year of vocation training in general practice within the North Wales training scheme. He continued as an associate practitioner in the same dental practice for a few years thereafter, and further developing his skills and gaining experience in the general dental care of patients. Following this, he completed various hospital posts, gaining further training within the various disciplines of dentistry. These included working as a Senior House Office in the department of Restorative dentistry at Royal London Dental Hospital followed by posts of a Senior House Officer and a specialty doctor in the department of Oral and Maxillofacial surgery in North West London Hospitals NHS trust to further enhance his surgical skills. During this period, Dhru also completed examinations allowing membership of the Faculty of Dental Surgery of the Royal College of Surgeons of England.
Soon after this he embarked on four-year specialist training program in the field of Periodontics and Implantology at Guy’s Hospital, London. As part of his special training, he also completed a Master of Clinical Dentistry degree in Periodontics at King’s College, London, while also attaining the Membership of Periodontics from the Royal College of Surgeons of Edinburgh. This training now enables him to offer a range of treatments to manage periodontal diseases, as well as the provision of dental implants.
Dhru's passion, however, lies in helping people. Helping dentists make them thrive. He believes in education and empowering people with education with knowledge, and giving them the opportunity, the inspiration to thrive, and be the best that they can be. He is the CEO of Dentinal Tubules, which has over 30,000 members. It is UK's largest online and offline learning platform; has an international network of study groups of their members called tubulites, and has offered learning to so many people.
My gosh. Last time I was in London, it was so fun meeting you and your adorable wife, who is a pediatrician, and your sister, who's a pharmacist. How's your wife and sister doing?
Dhru Shah: They're well, thanks. They're well. They're keeping themselves busy. They're keeping themselves occupied all day long, so they're keeping very busy.
Howard Farran: Most of all the podcast listeners, about 85% of are commuting to work right now, and they have an hour commute, so so they can find you, I always retweet my last guest tweet. You're ... I'm @HowardFarran. You're @DentinalTubules.
Dhru Shah: Yep.
Howard Farran: Dentinal Tubules. And I just retweeted your tweet "This is a tubules study club. Happening as we speak. On an evening. Hands-on prep roadshow." So what are you more passionate about these days? Is it providing periodontal surgery or educating dentists around the world?
Dhru Shah: Both of them, really. I can't ... Each one fuels the other. You know, when you're educating people, you're making a difference to their lives, and when you're, you know, treating patients, periodontal surgery, you're making a difference to peoples' lives, and that's what I'm passionate about, so realistically both of them working as well as each other.
Howard Farran: And it's yin and yang, 'cause when you're teaching something, it makes you more excited when you're back in the dental office doing something, and whenever you're teaching something, someone comes up and teaches you something, and tells you, so it all just fuels on each other. It's like a cat chasing its tail.
Dhru Shah: Exactly. Exactly, and it's amazing, because what it does, it doesn't just fuel you; it gives you that energy to start fueling others as well, which makes the big ... That's the big difference in what I do.
Howard Farran: I want to start off ask you something about ... Over here on this side of Atlantic, in our 30 years, we've gone from indemnity insurance that paid full fee to all of these PPO plans that are about 40% less, and you guys have had the same issue with the NHS. It's not like they give you more money each year. They've been cutting your fees and cutting your fees. How many dentists are in the UK now, and how many of them are still solely on the NHS, and how many of them have kind of got off the NHS and gone more of a fee for service?
Dhru Shah: I think there's about 30 to 33,000 dentists within the health service register in the UK. Now, difficult to say how many are purely NHS because a lot of the practices could be NHS practices, but they still offer some element of independent, private treatment. So, I have to be honest, I don't know what the breakdown would be, but we do know that more and more practitioners are wanting to move towards the private sector simply because of the issue of funding cuts and the challenges of bureaucracy that the NHS provide.
Howard Farran: Now, as we speak right now, your dentist right across the English channel across the Euro tunnel, the dentists in France are on strike and the last two days, they've had major protests in two different cities and last ... When you google it, they did it back in 2014, too, just three years ago, so they're having issues with their state dental scheme, too.
Dhru Shah: I think it's a global problem. A centrally-funded dental scheme ... Medical schemes are struggling. End of the day, medical ... You'll agree with me. Medical advancements have gone way ahead, and there's so much more available for patients, and it's hard. It's hard for any sort of centralized, you know, government-based scheme to be able to subsidize or support this.
In the NHS system, it's meant to be that what fee structure the government sets, you should be able to provide the best possible treatment on that. Not the easiest thing to do, in all honesty, and we're not supposed to say that the NHS and the private sector are different, or one is worse than the other. So everything available on NHS is as great as the private service treatment.
Howard Farran: Imagine if the government was in charge of cell phones. Smart phones. We'd probably be on a 1985 Nokia flip phone.
Dhru Shah: We'd still be dialing. Remember those things?
Howard Farran: We'd still be dialing? Why do you think it is that people in America and Britain and France buy their own house and car and cell phone and go out to eat on their own dime, but when it comes to their body, they expect it to be free? Even this last election in America ... Here's America, $19 trillion in debt, and the party that almost one, their rockstar Bernie Sanders was saying, "Oh, and we'll give you free health care and free college."
Dhru Shah: I think it-
Howard Farran: It's like, do they not understand a $19 trillion deficit, and how's it going to be free? Are they going to go arrest all the teachers and chain them up in a building and say, "You will teach for free the rest of your life." You know, someone's gonna, you know ... I mean, what-
Dhru Shah: I think you know what it is. And this is my view is that generally politics is based around gathering votes, and gathering votes is about how much can you give away. The more you give to the public, the more votes you get, right? Now, people have become used to this. They've become used to a government, who have all these years, the American, the European economies have been the strongest in the world. There's been a central bank of money, right? And they've been able to give this, but as we realized, like you talk about in the 19,000,000,000,000 debt in America, these numbers are shrinking. These numbers are shrinking, and therefore the ability of central governments to be able to pay for a lot of these benefits is going to reduce, but it's not going to be easy, because, like a baby, when you take the toy away, they're not going to be happy, are they? So it's one of these sort of things.
Now, we should actually, as people, be encouraging responsibility. That's important. Responsibility. Now my personal story was, when I went through education, I paid through my fees because I was a foreign student, and I was paying something like £20-£22,000 a year, plus, you know, all of my living expenses, and halfway through my education, we ran out of money. My dad had a difficult situation back home and we ran out of money, and I had to make a choice, Howard. Do I quit and go back home, or do I find a way? And I worked like crazy. I worked in shoe shops. I worked in burger bars. I slept for two hours a night. I saved and crunched money. I lived in a little room where you could just about fit a mattress. The room's roof was so low you couldn't get up full standing. All the sacrifices, and it made me value it more. So I have more responsibility.
I mean, this is what drives my education. I don't want anyone else to go through that, but when you talk about health care, it's the same thing that goes through. The population needs to take responsibility. They need to be learning to save money for a bad rainy day in the future. Everyone's too reliant on governments, and every time when somebody says, "What will the government do for me?" And who was the famous man who said, "Ask not what the country can do for you; ask what you can do for the country?" I think we're in that stage. Ask people what responsibility will they take for their own life, their own existence, for their own priorities. That's my view in all these sort of things.
And the more responsibility we'll take, I just believe, automatically everything will go through. Health care is very expensive. It is very expensive, and there's no denying that. And if somebody else is going to pay for something that's very expensive for you, you're not going to say, "No." You're always going to accept it with both hands, and people have to realize politicians are not there to just help you. They have their own agenda, and you have to take all these things in a balanced viewpoint. I come from that angle.
Howard Farran: You know, the thing I love the most about London is, you know, when you go to Japan, they're all Japanese.
Dhru Shah: Yeah.
Howard Farran: When you go to Vietnam, they're all Vietnamese. When you go to Poland, it's 98% Polish. There's very few countries like the United States and Canada and the UK where it is, I mean, the British empire ... The sun used to never set on the British empire. What I love the most about London is every block you walk down, there's restaurants and bars and people. Every corner you stand on, there's people from a different country. It is the most cultural epicenter on Earth. Nothing compares to London. In the United States, you can get London light only in Manhattan. You really can't get it too much anywhere else.
So since you're sitting at the epicenter ... I mean, even the time zone: zero. Is dentistry practiced very differently than, say, the US and Canada versus the UK? Or is it pretty homogenous?
Dhru Shah: The techniques are all homogenous and, in fact, I'm realizing, as we've progressed on through my exposure, Dentinal Tubules' exposure to dentists around the world, that actually the dental knowledge, the dental applications, the dental learning, as in America, as and in the UK, are very very parallel and the same.
We talked about the NHS, and because the NHS has held a big shadow over the industry for a long time, I think the UK dentistry used to be a lot more conservative. While the American system is more insurance-based, from what I gather, so it was much more proactive, but I think that sort of small distinction is beginning to level itself out now. And don't forget, Howard, you know, Dental Town, Dentinal Tubules, whatever we're look at it, globally, we're all getting the same learning platforms now, and therefore our philosophies are going and merging in the same direction, as far as I can see.
So what London was and what it is in terms of provision of dental care has completely changed, and it's amazing to see. Some of the cases, some of the results, some of the knowledge coming out of some of the top dentists around the London city, it's respectable. It's actually something you can consider to be globally acceptable. There's still-
Howard Farran: I want to ask you a couple of the controversial periodontal issues of the United States and see what you guys are thinking about on the other side of the pond.
Dhru Shah: Yeah.
Howard Farran: The biggest one being LANAP, or lasers being used in dentistry.
Dhru Shah: Yeah.
Howard Farran: I remember when LANAP started, it was very controversial, and just one periodontist out here used it, Allen Honigman. How does a periodontist like yourself and your periodontal colleagues in London and all of the periodontists on Dentinal Tubules, what do they think of this new technology?
Dhru Shah: I think lasers is interesting. It's being accepted with cynicism, is a good way to put it. Now, you know, look at the ... You look, you know, even few years ago, people used to think, "What's going on here?" And various dentists ... In fact, you look at the work of Anton Sculean and I think he showed something like 230 odd consecutive cases and phenomenal results, and in Dentinal Tubules, we've had a couple of lecturers who've done some Tubules livestreams for us and shown amazing results, so more and more people are understanding that lasers do have an implication and a practical sort of application in periodontal work.
To really try and convince the more hardcore cynics is going to take some time. They're more interested in getting science, and science meaning real, randomized double-blinded, controlled trials and things long those lines.
The other barrier to lasers is the cost. The big Biolase machine, you're still looking at, maybe, 60, £80,000. People need to be really convinced before they will take this on board. There are other laser machines, and the smaller machines, which can help you do the basic elements, because the big Biolase EPIC machine lets you do everything: hard tissue, soft tissue, everything. And I think it'll slowly come on board. It's still early adopters in the UK who are using these more often. Do you use lasers yourself?
Howard Farran: I have my toys. I've never done ... I'm not doing LANAP.
Dhru Shah: No.
Howard Farran: But yeah, I think ... My first laser I bought 1987 was a diode for 48 grand. The Nd:YAG. The Nd:YAG laser for 48 grand.
I want to ask you another question.
Dhru Shah: Yeah.
Howard Farran: You know they say just had 6,000 dental students graduate from 56 dental schools last week, and they have this stress in their life. You know, 30 years ago, we did all these periodontal surgeries and tried to save the teeth. Now, the oral surgeons are always like, "Forget all that crap. Pull that tooth out. We'll fix that gum disease with titanium," and they get mixed signals. Some people say, you know, "You can cure all that periodontal disease with titanium." Other people are saying ... But I've noticed this. This is what I've noticed in my backyard: 30 years ago it was all periodontal surgeries to try and save the teeth. Then implants started coming along, and implants just kind of took over.
Dhru Shah: Yeah.
Howard Farran: But now I see that pendulum coming back because, when an oral surgeon tells some young dentist, "Well, these implants have a 98.5% success rate. What is the periodontist success rate?" Well, the oral surgeon doesn't have a 98.5% success rate. What I see is that implants that are five years old in the United States, 20% have peri-implantitis, so I know this is an unfair question to ask you 'cause you're not seeing the x-rays, you're not seeing the page, but how are these young kids supposed to navigate between periodontal surgeries and therapies to save a tooth, whether just to extract that silly tooth and fix it with titanium. And in light of the fact that in five years, 20% have peri-implantitis.
Dhru Shah: [crosstalk 00:16:45]. Well, I think the thing we're now realizing is we've got to ... You talk about a young dentist, and young dentists have got to look at two things, and those two important things are, especially in UK and Europe, one is the evidence. As much as the evidence is never perfect, it's worth looking at the evidence, because if you consider these sort of factors, look at the [inaudible 00:17:12] and paper. They've followed these periodontally-treated patients for 30 to 40 years, and on average these patients lost maybe two teeth, after 30 to 40 years. So, if you look at the bigger picture, periodontal treatment and saving teeth really works well.
You then move to the next stage of thinking. Periodontitis, and it's being shown in a fair amount of bases now, periodontal disease is actually one of the risk factors for periodontitis. So therefore, if you're going to take the teeth out and stick some titanium in there, there's already a risk factor, and that's periodontal disease itself, so try and keep the teeth going for as long as possible, because you'll be surprised how long these teeth go for, and I have a patient, she was 38-years-old 10 years ago when she visited me, and some oral surgeon had suggested to have all her teeth out and put titanium in. She came to me saying, "I don't want that 'cause the cost is too much and I can't go through that." She was really nervous. She was very very anxious patient.
I said, "Listen. Come and see me. Let's deal with your periodontitis teeth. Let's do some non-surgical treatment." I hadn't even reached surgery yet, Howard. And guess what? Ten years now. Ten years. Every single tooth is in the mouth. So, you know, my view is I'm going back towards saving teeth as best as possible, and the other factor to look at is the patient factors. You know, there are local and systemic risk factors. Patients could be smokers. Patients could be diabetics. Where is the periodontal disease? How extensive it is. What's the tissue biotype? What's the motivation levels of your patients? Some of these guys have periodontal disease because they're not cleaning their teeth well, and if you're going to stick it out and put titanium there, you might be fighting a challenge of will they be able to clean that well?
Howard Farran: So-
Dhru Shah: All these big factors have to be put into account, and the young dentist has to realize that dentistry is a long-term profession, and the better things you do for your patient, you will develop long term trust, so maybe if those periodontal teeth then don't survive in the future, that patient will come back to you, and in the UK you-
Howard Farran: Dhru-
Dhru Shah: Yeah, go on.
Howard Farran: Dhru, when you're talking to Americans, you can't say "smoking," 'cause now half the states legalized marijuana, so are you talking about tobacco or marijuana? You can't just say "smoking" anymore.
Dhru Shah: That's very true, and we're looking at tobacco smokers for some, but marijuana rolled up has some tobacco within that if I'm not wrong, in some areas, but it's the tobacco smoke we're looking at. Or even possibly the electronic cigarettes, 'cause we're looking at a lot ... I don't know if it's that big in the States now-
Howard Farran: Yes.
Dhru Shah: But in the UK, it definitely is. They come with vapors with all sorts of different chemicals in those. They're all probably as problematic as it is, but that's interesting. I think it'll be interesting to see what this legalization in the States, and Canada I think now as well, is going to do to peoples' oral health in the future.
Howard Farran: Well, one of the most interesting books I ever read was by a British sailor when they arrived in Hong Kong for the first time, and they ... Man, I ... The book is also on audio cassette. It's like 20 hours long on audio cassette, but basically at the height of the opium trade, he basically said that half of China was just laying around getting stoned, and so I think this legalization of marijuana, I think history might be repeating itself, but you know ...
You said that having periodontal disease was a higher risk factor for peri-implantitis, so, if 20% of the implants had peri-implantitis, at five years-
Dhru Shah: Yes.
Howard Farran: That's only 60 months. I mean, it's still hard to get the dentists to even talk about peri-implantitis because ... But you go into American dental offices every single day, and they've seen the mom every three months for periodontal therapy, and they've never seen her husband for 10 years, and he comes in and he's got [inaudible 00:21:18] out teeth. He's got gum disease. Now if she came in every 3 months for gonorrhea, the doctor would say, "I think I need to see your husband," but for periodontal disease, the dentist just, I mean, so many dentists just say, "No, it's not contagious." It's like, well if you were in your backyard and there was a giraffe there, it had to come from somewhere. I mean, how ... Are humans born with periodontal P. gingivalis in their mouth? And can you really treat a woman for periodontal disease who's kissing her husband every day and he's never been treated?
Dhru Shah: I don't think there is ... Again, I will say there is ... I don't think there's any element of contagiousness like that, because there are various things to think, and think about this: it's not just the bacteria. Yes, everyone's born with P. gingivalis or, you know, the red spectrum antibiotics, the A.a, etc., but there is a susceptible patient underneath. Some patients, you've seen them, they haven't seen the right side of a toothbrush, but they don't seem to get periodontal disease. Some do. So there is obviously an inherent susceptibility, but then there is a third factor, and which is lifestyle factors, because people have such a lifestyle that they maybe don't look after their teeth.
Now, the woman who walks into your office and has periodontal disease. Maybe it's not contagious, but the husband is living possibly in the same environment and the same lifestyle, and so my suggestion always is, look, if this motivation and this element has to work on you, what is the motivation, the lifestyle, the plaque control of the people around you? That's the important part to look at really. That's what I would balance against.
Howard Farran: Well see, in America, they just want to take a pill. They don't want to change their lifestyle or brush or floss or-
Dhru Shah: No.
Howard Farran: They just want to take a pill. When is the periodontal disease pill going to come out?
Dhru Shah: In the UK, they just want to take mouthwash. They don't even want to swallow the pill. You can't take the pill out. I mean, I wish we could change patients ... And in fact, it's moving more towards that. We're trying to put patients into a risk profile. We're getting more and more into that. We have to be looking at risk profiles of patients. In fact, there was some guy who was telling us about some work where he said the bacteria in your mouth are self-selected based on you as a profile, as a person.
So that's interesting, isn't it? I don't know if that's going to change, but we're still a long way from finding these things.
Howard Farran: I think the most interesting thing I'm reading about is how your gut biome affects your oral biome, and I've always noticed some people who have a lot of gum disease don't have cavities. People that have full mouth decay who really don't have that much gum disease. You never really see full mouth cavities and gum disease in the same mouth, but how the human is made of one trillion cells, but the gut is filled with ten trillion microorganisms, parasites, fungi, bacteria, and what you eat in your diet changes that, and some day, some people who have never seen a toothbrush and don't have decay, we might find out they have a different gut biome. We might be trying to change gut biomes in the next 10, 20, 30 years, so that streptococcus mutans is over and up in the mouth.
I want to ask you another thing. Back to these graduates. You're an elite periodontist. You're the CEO and founder of Dentinal Tubules. You've been at the forefront of dental education for 30 years. She just walked out of dental school, and she goes to the ADA convention and they're selling 175 different types of implants, and she's got a lot of student loans, the government ... The insurance doesn't want to pay you any money hardly. How does she make sense of 175 different implant systems? And I know what she's thinking. She's wondering, "What system do you use?"
Dhru Shah: Well, look. We know most systems work very well, and my considerations about the implant systems I use are based on what my mentors, my peers, the people I looked up to used, therefore I've had their guidance as I've approached through time, and the second thing is I look at all the signs. I look at all the bits that go around it. I try and study the biology, the mechanics of implants, and I find a system that fits those mechanics in my favorite ways.
So as a young graduate, you're going to be, 175 ... If I'm not wrong, somewhere in Italy, for example, there are about 463 implant systems, and we know titanium, also integration, is predictable. It works. It's about finding ... The third thing about finding it is not just the system my mentors used to use, not just the system that fits the biology and mechanics of what I understand, but the third thing is support. The company's support. You know, today, if a component broke down or if I had some issue with components, I need to be on the case to call the company and say, "I've just had an issue. Can you get me a new component?" And I don't want to be waiting seven days for it, and that sort of thing. That's the practice I work in, and that's how I work. So the implant systems and the practices I'm in, the mentors used to use them used it for quite many years is the Neoss system. I carried on using that. I-
Howard Farran: The which system?
Dhru Shah: The Neoss. Neoss is the system. It's-
Howard Farran: Spell it.
Dhru Shah: It's similar to Nobel Biocare, from what I gather.
Howard Farran: N-E-O-S-S?
Dhru Shah: N-E-O-S-S system.
Howard Farran: N-E-O-S-S system. Where are they out of?
Dhru Shah: They're actually based out of the UK. Their head office is in the UK.
Howard Farran: Does Italy really have, what did you say? 430? Were just joking or is that-
Dhru Shah: It's something like 463 implant systems out there. Crazy. You know, people everywhere is making them. They're local suppliers, and, I mean the other system I've used recently is the Medegen implant system because I love their restorative platform. You've heard of the Medegen system, with their SS platform, their S-shaped abutments for my soft-tissue profile and it's a bit more of an aggressive implant. It works more via cutting, while the Neoss system is a more a compressive implant system.
So I've got two variations I can use, and I choose what I feel best in the patient's mouth based upon my own decision-making. Now, a young graduate coming out needs to understand all this, needs to see how other people have worked. It's very ... And this is where I think Dentinal Tubules steps in, or even your platform, Dental Town, steps in, they're to see what others have been using, asking them why they use these implants, and what was the thinking behind it, biologically, mechanically? And we know Nobel Biocare, Straumann, Dentsply Sirona, or Astra are some, you know, 3i, BioHorizons, those are the implants that have been on the market for a long time. All of those implants work really well, and I've had experience with most of them.
I've settled on these two because of a lot of factors. My referring dentists ... What do my referring dentists prefer to restore? And they all like Neoss as their system, so I use Neoss to help them as well, so there's all these factors I put into place, and hopefully this kind of thing helps young dentists, too.
Howard Farran: Do you know the CEO of Neoss?
Dhru Shah: Well, no. I know his name. I've never met him.
Howard Farran: Well, tell him that ... What I do is whenever my guest mentions another company or whatever, I always forward their twitter so that my homies can find them easily, and this people does not have Twitter. They have LinkedIn, YouTube, and Google+. Tell them that Google+ is only used by Google employees, so-
Dhru Shah: Neoss is not owned by Google.
Howard Farran: So since ... Now, Google+, the joke is that you know, the consumers on Facebook, the only people using Google+ are the 40,000 employees at Google, so tell them they need to get a Twitter deal.
Dhru Shah: Twitter account.
Howard Farran: So, tell us about your journey. What was going on in your life? Tell us the Dentinal Tubules story. Where were you at in your journey ... Because we both ... What year did you launch Dentinal Tubules?
Dhru Shah: It was 2009. 2009.
Howard Farran: Oh my god. I'm old. I was 1998, so I'm ... God, I'm old. But anyway, so what was going on in your journey where you started the Dentinal Tubules?
Dhru Shah: I was at a stage where I didn't feel inspired in dentistry. I did not feel enjoying the profession. I think I was at a stage where the people teaching me were not encouraging me, and I felt I needed to connect with people who were passionate about learning in the way I was. Learning out of the box in a different way, and I started Dentinal Tubules with that approach. A complete share, learn, and connect approach. Everyone shares together. That's how we learn together. That's how we connect, but in that I think I found my big passion. Coming back from my roots in Africa we were talking about, I've seen people who do not have access to education. People who can't afford five cents a day to go to school, and I believe we're at a phase of technology now. Technology can deliver solutions to communities of the world that would never have had these sort of things, and the whole Tubules project has now become education to the world. Education and accessibility. Giving education to areas where it would not be available. Empowering people through education and connecting the world through education, through learning.
And Dentinal Tubules is my journey, because when I lost inspiration, it's given me the education to really become a great periodontist. It's given me the power to move forward, and not only that. Setting up these study clubs around the world, in fact, we've just been to India and back last week, and setting up these study clubs around the world and providing this education to dentists, we're raising the profile to another level, and that's exactly what we want to achieve overall: changing peoples' lives. That's what we aim to do, and in fact, I'll read something interesting to you.
When somebody once said that, "Dhru," this is, the person messaged me and said, "This is an out of the blue message to say 'Thank you.' To say we feel very grateful and privileged for my husband's association with Dentinal Tubules." Says, "You are an immense inspiration to us, and we couldn't be grateful enough for introducing us to a world of dentistry we had forgotten existed, or, to be truthful, didn't even know existed in England. Our entry into England, and introducing us to this NHS dentistry, curtailed our growth, not just in dentistry, but in all dimensions. It destroyed our passion for our jobs, and what you're doing is motivating beyond words. You've given us passion back. You've given us desire, and we thank you for the desire to share and spread education." That is what Dentinal Tubules is about.
Howard Farran: And you have a romantic leap through spreading education because you grew up Kenyan-
Dhru Shah: Yes.
Howard Farran: But your parents were Indian descent, right?
Dhru Shah: Yes, that's correct.
Howard Farran: And what ... I love history, and basically the silk route, went all the way from Japan to the Korean peninsula, all the way to India, all the way up to the Roman empire, and for the logistics of that, on that silk route, every 20 miles had to be an Indian family because that was about one day's journey back in the route, and then you would hand off the exchange goods coming and going and now here you are in London, back in India, I mean Dentinal Tubules ... Did you almost think about calling it the Dentinal Tubules silk route? Exchanging-
Dhru Shah: That would have been nice. I would have-
Howard Farran: A network exchanging ... But I love that and most of my friends and [inaudible 00:33:24] from Kenya are Indian descent, and it all steps back and just a very, very rich history. So what has got you ... So you've had Dentinal Tubules for 2009-2017 so-
Dhru Shah: Eight years?
Howard Farran: Eight years?
Dhru Shah: Nine years?
Howard Farran: So has it changed much in the last eight years from when you started to now? Has it changed?
Dhru Shah: Absolutely. It's innovated itself every year. You know, when you think about 2009, it was a basic forum for people to learn and study, and every year something new has come in.
Howard Farran: That was right after the crash. I'm surprised you could even start after the crash. 2009 in America, just in Phoenix, we had 87 dental offices went bankrupt.
Dhru Shah: Well, it was at the peak of the crash and that's the best time to start businesses, isn't it? And it's probably the time when the world needs the most inspiration, Howard, so we did it. We did it at that point, you know. We started as a simple forum. We then introduced articles. We then started ... We've got a mega media team that goes all around the world filming conferences, filming surgeries. We have so much stuff coming into our edit studio. It's changed.
We started livestreaming. You've got a green screen behind you, and we're doing livestreaming, and we livestream to our study groups around the world. We could get thousands of viewers in a moment. Now we've set up study groups. We've got a lot of technology at the back and doing things. I'm a bit of an IT geek. I must say periodontist is one part of my hat, but the other part is IT, and so we're doing all this. It's always innovating. Always doing new things. We've literally virtually run a crown preparation hands-on course over the next month and half where everyone's getting hands-on training, and there'll be 200 people in a month and a half just had it through one tutor who's virtually doing this.
Lots of little things setting up which is completely changing the way people learn dentistry. So it's quite cool [crosstalk 00:35:30] Dentinal Tubules [crosstalk 00:35:32] never sit on the edge.
Howard Farran: Do they have an IMAX theater in London?
Dhru Shah: Yep. Absolutely. Have you been to one?
Howard Farran: Well that's the next thing. You said this green screen ... What we're doing is we're switching to an IMAX because I'm so fat, they'll only be able to fit me on an IMAX. That's our new upgrade.
But you know, these dental students, when they walk out of school, they think, "Okay, I learned the dentistry. Now it's time to go get a job," and the bottom line is, if you're a doctor, your education never stops at dental school, and if I look back at the 30 years I've practiced, and I had to pick one variable that separated the ones who are happy and fulfilled and successful and loved it and made a great living for their family, and those that were burned out, depressed, and miserable, I think the number one thing I can link to is hours of continuing education.
Dhru Shah: Yeah.
Howard Farran: And I always put that number at 100. Whenever you meet a dentist who is complaining that he had to go to this course because he's trying to get his license renewed, and he had to have his 17 hours or whatever to renew his dental license for another three years, they were miserable.
Dhru Shah: Yes.
Howard Farran: But the ones who always took 100+ hours a year ... Because humans need daily ... Sure, they need daily brushing and flossing and deodorant, but they need daily motivation, and what I found the most exciting thing about Dentinal Tubules or the AGD or anything, and that is you're a summary of the five people you hang around with the most, so when you go to dental continuing education, you're around people who are excited and intellectually curious and hungry and humble and want to learn, but back home are your dental school classmates that they might be burned out of dentistry. They just do it for a job. They just do it because they don't know another job they could get that would make as much money as a dentist, and you hang around those people, and they're energy vampires. They just suck all your happiness and motivation out.
Dhru Shah: Yes.
Howard Farran: So I think, when you get on the forums like Dentinal Tubules and go to study clubs and hang out with people that have positive energy and karma, they're sharing it with everyone. It just fuels you, feeds you.
Dhru Shah: Completely. That's what it is, and also think about it: the people who go on these course, 100 hours a year, do it because they love it, and it's all about, as I've said, connecting. Share, learn, connect. When you're connecting, you're actually raising your levels to another level, and that's important. The more you share, the more you find people with the same thought processes and you elevate the entire love of what you do, and if you do dentistry with passion and purpose, you just find a real different angle to it, and you've probably seen these.
Those dentists who do 30 hours just to keep their license, they don't have a passion for it. They're just doing it to pay the bills.
Howard Farran: Your secret sauce might be your wife and sister, though, because they were pretty gosh-darn fun, high energy ... They were exuding as many smiles as you are, so you've got a good team behind you.
And another thing I want to point out is this: if you thought in fear cause you know and everything and, "Howard, why are you promoting Dhru Shah and Dentinal Tubules? Isn't that a competitor to Dental Town?" Let me address that: I've never met a dentist who reads one magazine.
Dhru Shah: No.
Howard Farran: I've never met a human who only has one app on their phone. Even the people that have Facebook, they also have Twitter, and LinkedIn, and Pinterest, and Dental Town, and thinking in abundance is so different than thinking in fear, and so many of these little kids will go back to the community and the dentist across the street from them don't want anything to do with them because they think you're a competitor. Those guys live in fear. Your competitor is iPhones, trips to Disneyland, eating out at restaurants, and you need to find the dentists in your area who think in abundance.
Dhru Shah: Yes.
Howard Farran: Like there are some orthodontists who will try to make you feel bad if you start learning Invisalign. Well, you don't need that orthodontist. He's not going to be at your funeral. He's just thinks the pie is small. He needs to be thinking, "Let's double the size of the pie. Let's grow the pie. Let's think in abundance," and that's what I like about local study clubs, finding out which dentists ...
If I was a young dentist and I was going to a small town and there were ten dentists, the first thing I'd want to go do is knock on the door of every one of them and think, "Okay. Who's on my team, thinking in hope growth and abundancy, and who's a negative Nelly Annie, who thinks in fear and scarcity?" And in America, one of the best clubs is the Academy of General Dentistry.
Dhru Shah: Right.
Howard Farran: 'Cause those people are all trying to get 500 hours of continuing education to get their fellowship, and then another 600 hours to get their mastership, so you're already meeting people who have a goal of taking 1,000 hours of continuing education. Those people don't think in fear.
Dhru Shah: No.
Howard Farran: I mean, it's just getting on the right mindset. I think what you're doing for the profession of dentistry is amazing, and it's ... I've been watching you for a decade and it's amazing to have you on your show. If you had to give that commencement speech to those 6,000 kids who just walked out of school, since most podcasters are young, they're mostly under 30, old guys like me, hand me my [inaudible 00:40:49]. Here's my advice to the dental students. Here's my advice, but they won't listen to an old, fat, bald guy. I mean-
Dhru Shah: "Pathways of the Pulp."
Howard Farran: I mean ... "Pathways of the Pulp." You couldn't buy a book like this for like $200 and, I mean, you can learn everything, but the millennials have to hop on an airplane for $300, fly across the country, stay in a resort, drop $3,000 on a weekend root canal course, and then fly home, and what percent of that book will that weekend course cover compared to this textbook?
Dhru Shah: Oh, completely. This textbook has so much information. [crosstalk 00:41:26]
Howard Farran: Oh, a hundred times. And then when you talk about implants, look at this. Carl ... This is Randolph Resnik, Carl Misch, "Avoiding Complications of Oral Implant Surgery." I mean, it's 1,000 pages of complications. They won't buy this book for 200. They'll buy a $300 airline ticket, fly across the country, drop $3,000 on a weekend implant deal, get a certificate, come home, and that weekend course, what percent of this book will it cover?
Dhru Shah: 1%.
Howard Farran: I know. So let me set it up. They just graduated from school. They're $350,000 in debt, what would that be in British pounds?
Dhru Shah: Probably about the same at the moment. Probably a bit more. It's not a huge difference. 400,000?
Howard Farran: And she wants to be a good dentist someday. What advice would you give her?
Dhru Shah: My advice to dentists, and this is the mind part, is find your passion. That's what I would say. Don't go into ... Yes, you're in big debt, and yes, you've got to earn a living, but put that money aside for a day, close your eyes, and think, "How am I going to best serve the human being called a patient walking through my door? What am I going to do for that human being to make their life the best possible thing as they walk out through my door?" That's the passion that will help you because when you find your passion, I'll tell you what, you will suddenly find a rocket up your fuel, because you'll find similar passionate people. You will find similar persistence people, and you will find ways to gain that knowledge of your passion.
You just told me two books, and there was a gentleman, Carl Misch, who, bless his soul, left us earlier on, but he was amazing. His passion was implants, and how much knowledge did he impart across to people? Find their passion to a young dentist because your level of dentistry, your level of exudance, your level of confidence will rise to another level, and before you know it, you'll be like me, watching videos all day long. Hey Howard, I sit on the treadmill and watch these tubules. I sit on the treadmill and listen to your podcasts because I know that's how I'm getting fit in the body, fit in the mind at the same time.
Passion is what drives me there because I love what I do, and when you love what you do, suddenly every day just becomes a simple flow, and every day becomes one, which is results-oriented, and when you find your passion, at the end of the day, you ask yourself one question, and that one question is, "What are the five good things that I achieved because of my passion today?" A positive mindset will develop and carry on delivering that. That's what I would tell the 6,000 young graduates sitting in front of me.
Howard Farran: That was amazing. That should have been a commencement speech. I want to ask you another question where the historical macro economics is in direct collision to modern-day reality. So in 1900 in America, healthcare was 1% of the GDP, and there were no specialties. At the end of the century, healthcare was 14% of the GDP, and the physicians, MD's like your wife, who's a pediatrician, there were 58 specialties and there were nine for the mouth, and now you see the recurrence of the belief of the super doctor, like we're going back to 1900.
The kids come out and they say, "I'm going to master implants and orthodontics, Invisalign, and cosmetic dentistry, and sleep apnea, and bone grafting, and ..." And it's like whoa, whoa, whoa, whoa, whoa, whoa. Really? I mean, you can almost not master just placing implants. You could almost not just master ortho. You could almost just not even master sleep apnea. You can't master anything and whenever a dentist comes up to me and says, "You know, I'm going to learn sleep apnea." I'm like, "Well that's a shitload of information. What are you going to give up? Are you going to start referring out of endo? Or what are you going to give up?" So what do you think about this noise and belief that's spread at all these conventions that you should just be a super dentist and master every single thing on earth and you'll be the best.
Dhru Shah: My view is stick to what you know best, and look, I could not master the white stuff in the mouth, the composites and the crowns and the things like that, and so I became a periodontist 'cause I enjoyed my surgery. It takes ... I'm still young in periodontics. I still haven't mastered it. It'll probably take me another 20 years to achieve the super result, so I don't know when I'll get time to do the next bit.
These younger dentists, maybe they want to get good at everything or maybe they're scared that if they're not good at everything, the patient will walk away, but hey, it goes back to what we said. There is no competition. Find dentists who complement your skills and develop a great collaboration network. You become good at one thing, let the other dentists or the other specialists become good at their thing, let the other person be good at that. Between the five of you, you'll be sending patients to each other and working as a team. That's my viewpoint. It's all about collaboration. It's all about working together.
Howard Farran: If my homies listening today, if they went to DentinalTubules.com, what would they find at DentinalTubules.com?
Dhru Shah: At DentinalTubules.com, they will find a community of tens of thousands of dentists ready to help and support them, pretty much like Dental Town. At Dentinal Tubules, they'll find well over 30,000 minutes of video-based content on anything in dentistry they want, from non-clinical business to clinical business, clinical topics of basic dentistry to advanced dentistry. They will find the study groups around the world and they can form their own study groups who are more than welcome to bring people on board.
They will find speakers, livestreams, where they can log on and happily enjoy a conversation like we and I are having, and they will just find inspiration to become the better dentist who loves what they do everyday, and that is what they will get: a bit of everything.
So we have, like you, we've worked hard to bring some of the best and biggest speakers in the world to come along. I mean, Pat Allen, Edward P. Allen, came the other day and did a livestream for us. He was phenomenally amazed at what a livestream entails, and we hope to tubulize the world. "Tubulize" is our term. It means you've been inspired to teach or learn and share.
Howard Farran: So is ... British words are just slightly different than English words, so when you're looking ... So clubs and study clubs is ... What is "speakers" under? Is that under "community?" "Partners?"
Dhru Shah: "Videos." You'll see it under videos.
Howard Farran: Oh is it [crosstalk 00:48:31]. Okay, so let's see-
Dhru Shah: Yeah. You'll see "Tubules Talks."
Howard Farran: "Tubules Talks." "Tubules Live." "Playlists." "Tubules Casts." Where was the list of the speakers? Because I saw it earlier. I don't know what I-
Dhru Shah: You can go on the homepage. You can go on the homepage and you'll see industry leading speakers, and you'll see on the homepage we've got some of them. We're updating this list as you and I speak.
Howard Farran: Okay, there you go. Edward Allen.
Dhru Shah: Yep.
Howard Farran: Alessandro Conti. Howard Gluckan, from ... I love that guy from South Africa. Lincoln Harris from Australia. Sam Lee, an amazing periodontist. He's from, what? Boston?
Dhru Shah: Now Sam Lee is now in San Diego. From Boston originally, yes.
Howard Farran: Okay. He moved to San Diego. That was smart. Boston is as cold as London in the winter. The one thing I have to tell my homies is that, you know, it's sad that the Chicago mid-winter meet. Chicago is one of the greatest cities in the world, but they always have their annual meeting in February. That would be-
Dhru Shah: Why's that?
Howard Farran: Because I've asked them for 30 years, they say, "Well, we've had it this time of the year since 1985." And it's like, all right, whatever. And then Boston, another great city, and their seminar, their big Yankee dental congress is in January. It's like, and London, I've got to tell you, London is the coolest city on Earth, but you don't want to go to London in January. I mean, it's up in the middle of the North Sea. I think Boston, Manhattan, Chicago, London, I like the spring and the fall, but I've got to tell you the first funny story about London.
I have four boys, and whenever I go on overseas trips I take at least one of them with me. Sometimes I take two or three or four. First time I went to London, I took Greg with me and we checked in the stop and he saw this big Ferris wheel. The London Eye, and he said, "Let's go ride that." So we're all excited. We set out across London. It was so deceiving. I think the thing was like 20 miles away from the hotel, because after we were walking like four or five hours, it didn't even get any bigger. We finally got to it. I think we got to our room at like, I don't know, I think like 9 or 10 or 11. I think we got to that thing at like midnight, and it was the coolest time ever. I mean, every city block was just another amazing smell from a restaurant, the sound of music, I mean, it was just ... But when we got home, the only thing he told all of his brothers and sisters and family, the only thing he would mention is he only wanted to eat the fish and chips. And every time it was time to eat, I don't care if it was breakfast, lunch, or dinner-
Dhru Shah: Fish and chips.
Howard Farran: He still thinks London has the best fish and chips in the entire world.
Dhru Shah: That's amazing. Now, London probably does actually, because it's amazing, but London is cosmopolitan. If you sit on the London metro, the London underground, you could probably hear about 50 or 60 languages within a very short while. The world comes together in London and I've got to say, the events of the last few weeks, a few things that have happened across London have been very, you know, they've been sad, actually, people having lost lives, but I still believe it's a city that holds its own and people really ... London has a life of its own and people do look after each other.
Howard Farran: Well, how old are you, Dhru?
Dhru Shah: 37.
Howard Farran: 37. So I'm 54, so it's the same story every day, because when I was growing up, the IRA was doing that all the time.
Dhru Shah: Yeah.
Howard Farran: So now it just ... And then yesterday, we had a bad event here where some senators and congressmen were playing baseball and someone went down there shooting people, but everybody always thinks the sky is falling, but I want to tell you real quick ... So we had a congressman shot the other day. Well, actually, if you go back through history, that's the 17th time it's happened and that stuff's always going on. It will always go on. Hell, we had one of the congressmen that died, when was that? In 1859, senator David Broderick died because he called for a duel with the California chief justice so they actually walked out front, paced off three steps, turned around, and shot at each other and one of them was killed, so the crazy stuff has always been around.
I still think this is Europe's finest. I mean, think about the last century, had World War I and World War II.
Dhru Shah: Yeah.
Howard Farran: So the Europeans that thing, "Ah, it's so bad right now." Bad compared to what? Compared to World War I? I don't think so. World War II?
Dhru Shah: Hopefully we don't get there.
Howard Farran: It-
Dhru Shah: Hopefully we don't get there.
Howard Farran: I don't think it will. I think that every generation thinks they've got it the hardest, but if you go look at the last 100 years, just the last 100 years, we've got it so much better. You know what I'm most excited about? This is 2017, and if we go back to the last century, 17 years into the first century, what did you have?
Dhru Shah: The first-
Howard Farran: You had the Spanish influenza the killed five percent of the population. What do we have this century? Vaccines.
Dhru Shah: We are living in one of the best times. I'll never deny that. We're living in one of the best times on the planet.
Howard Farran: This is gonna be our finest century.
Dhru Shah: We have the best standard of living. We have a roof over our head and we're actually living ... And we have everybody's got a car. Everybody's got a brilliant life. It's comfortable.
Howard Farran: Yeah.
Dhru Shah: And there's no doubt about that.
Howard Farran: In fact, the next generation will be so lazy, they won't even have to drive the car. It'll be all driverless cars.
Dhru Shah: They'll be flying in it.
Howard Farran: Well we'll be sitting there in the nursing home saying, "When we were little, we had to drive our own car." I still think, in my lifetime, the greatest technological advancement I experienced as a child was when we got an automatic garage door opener because I had five sisters, so every time we pulled up to the house, mom kicked me out of the car, and the garage door was made of wood, and I was just a little boy. I mean, it almost broke my back every time I let that thing ...
When we installed an automatic garage door opener, I don't think I ever remember having anything that exciting before in my entire life, where you would just push a button and the damn door would go up. That was amazing.
Dhru Shah: [crosstalk 00:54:59]
Howard Farran: I've only got you for three minutes left. Take it away for the close. Three minutes.
Dhru Shah: Look, all I want to say, Howard, is you have done an amazing job and the amount of people who I walk around and listen and say, "The first time I heard this guy," "The first time I saw the speaker," "The first time I saw this procedure was on Dental Town," and whatever idea you came up with, you have touched and changed the lives of many people in this profession, so you know, if you were gonna give me three minutes, I would say in those three minutes, congratulations to you because you've done something of great, amazing importance, which not many people, especially when you started, had the nerve to do it.
I'm hoping that Dentinal Tubules also does the same thing and collaboration and all of these things are important, but what you've done is ... Pat yourself on the back for that.
Howard Farran: Well-
Dhru Shah: I just wish that whatever you do for the next five years, continue delivering that passion to dentists. That's what I would say and as long as we can keep people energized, inspired and passionate, I think that job is happily done.
Howard Farran: Well I can say the exact same thing to you, and I'll tell you what. I love dentists and I have been in so many dental schools in Africa and Asia where they told me that their entire family saved up, sent them to dental school in Somalia and it was in the capital and it's the finest dental school and the only thing that they really enjoyed about the whole dental school experience is finding the online resources of Dentinal Tubules, YouTube, Dental Town, and I was just in Soweto like six months ago and these dentists would tell me that they can go home and get on your site, YouTube, Dental Town, and they would say, you know, "It would take me three months' income to fly to London and take a course."
Dhru Shah: Exactly.
Howard Farran: Or to fly to America to take a course, and now you can get online and become the best damn dentist you can in the entire world the resources are there. You've just got to be hungry enough to realize ... Humble enough to realize that somebody knows something more than you do. You've got to be humble.
Dhru Shah: Yes.
Howard Farran: And then you've got to be hungry. You've got to have the work ethic. I mean, think of the work that you ... You slept two hours a night because of your drive to want to be a periodontist and-
Dhru Shah: Yes.
Howard Farran: So they can sit there and I've seen them in Somalia, Ethiopia, Tanzania, and they're just young, passionate. This one girl, she was full [inaudible 00:57:45]. All I could see was her eyes. She held her smartphone like it was a holy book and she just said, "I can learn every dental procedure known to man for free on my Samsung." And she was just so excited. She was giddy, and it's so interesting that in 1880, 80% of the planet could not read or write, and now over half the planet is on the internet through their cellphone, making it a smartphone, and in just five more years, they're adding another billion earthlings to the internet via their smartphone and that's why it's going to be our finest century.
Dhru Shah: That's our vision. The Tubules project is about education to the world, and the technology we're developing in three years, when Tubules turns a profit, I'm going to put that money into building a school in Africa and teaching them math, science, English, etc., using the Tubules technology, via their smartphone or their device. Nobody in this world should never ever have no access to education. They should always have access. That, my friends, is the Tubules vision and the Tubules project and I'm going to go for that.
Howard Farran: And can I give you one little tip on that?
Dhru Shah: Yep.
Howard Farran: If you have that center by the Serengeti, or by mount Kilimanjaro, or halfway between mount Kili, and the Serengeti, so many dentists would go and visit and teach for free and do everything because it's so cool when you can go do missionary dentistry and then climb Mount Kilimanjaro or go see the Serengeti because the Serengeti is still the only place I've ever gone in the world where I just thought, "Oh my god. I didn't realize this still exists."
Dhru Shah: Heaven on earth.
Howard Farran: What's that?
Dhru Shah: Heaven on earth.
Howard Farran: I mean, you go to a zoo and you see two hippos. You go to the Serengeti and there might be 150 hippos in one pond. I mean, it was just so ... You always knew where the lions were because all the animals were staring at it. And you always knew how fast the animals were because those little gazelles, they'd get within 20 feet of those lions because they knew they could outrun them, but the wildebeest, they'd stay back 100 years, so you could ... The guides could pinpoint where the lions were laying down in the grass just by the speed and the distance. I mean, oh my god that is so cool.
But hey, love you to death. Please tell your wife and your sister it was great seeing them. Can't wait to see all you guys again, and if you're ever coming to America, if you ever want to do anything in America, just let us know. We'll help you do whatever you want to do.
Dhru Shah: Thank you, and same here. Come around to England soon. We haven't ... Well, you were here last year but we missed you. Next time. You interviewed one of my friends, Neel Jaiswal when you came here.
Howard Farran: Yes I need to come back with Greg. He needs some more fish and chips.
Dhru Shah: Yeah. That's right. I'll take you some good places. Thank you very much, Howard.
Howard Farran: I've got tell you. This funniest picture. I've still got it. I should hang that up. We were coming out of this restaurant. This guy had a red Ferrari. He was this little kid and he just spoke out, "Oh, I wish I could sit in that car and have my picture taken!" And the guy ... He was telling that to me, and the guy that owned the car was just like, the other side, and he goes, "Hey, little boy. That's my car. Go sit in there so your dad can take a picture of you." And he was like "Oh, really? He had so much fun with that. It was a red Ferrari.
Alright, Dhru. Have a rocking hot day.
Dhru Shah: Have a good day. Enjoy. Thank you very much.