Note: The I AM GPH podcast is produced by NYU GPH’s Office of Communications and Promotion. It is designed to be heard. If you are able, we encourage you to listen to the audio, which includes emphasis that may not be captured in text on the page. Transcripts are generated using a combination of software and human transcribers, and may contain errors. Please check the corresponding audio before quoting in print. Subscribe now on Apple Podcasts, Spotify, Google Play or Stitcher Radio.
EP53 CariedAway with Richard Niederman, Pratik Dey Sourav and Habib Benzian
Chris Alexander: Welcome to the I AM GPH podcast. I'm Chris Alexander and today we're joined by Dr. Richard Niederman from the NYU College of Dentistry, Pratik Dey Sourav, an MPH alum from the NYU College of Global Public Health, and Dr. Habib Benzian from the NYU College of Dentistry. Their CariedAway venture project was named a finalist in the 2019 300K entrepreneurs challenge at the NYU Stern School of Business. CariedAway is a biannual cavity prevention service that reduces cavities by nearly 80% in school-aged children by providing quick, painless treatments that are performed conveniently in school settings. Their innovative program promotes the importance of oral health to several East Coast States and they plan to expand their services nationally and globally. Let's hear more in our interview. Thanks guys. To start off, can you introduce yourselves and tell us what brought you here to be working on this startup?
Richard Niederman: So my name's Rick Niederman. I'm chairman of Epidemiology and Health Promotion at NYU College of Dentistry, and I also chair the WHO Collaborating Center for Oral Health there and I'm a founder of CariedAway.
Chris Alexander: What brought you to doing this work?
Richard Niederman: I think it was having done this for 20 years within an academic environment, it was just too slow. For example, it took me five years after I got to New York City before we could finally get into schools and provide care to kids and I think as a private enterprise we could have done it in one year.
Chris Alexander: Great. And Pratik about you?
Pratik Dey Sourav: My name is Pratik Dey Sourav. I'm a Senior Management Analyst at NYU Langone hospitals and I've been working with Dr. Niederman for the past two years at the dental school on school-based cavity prevention and while I was there I found out that there's a big gap in cavity prevention financing, to be more precise, at the public financing of cavity prevention and despite the fact that dental caries or cavities, the most common noncommunicable disease among children in this world, it's five times more prevalent than a child with asthma. So it made me realize that maybe private funding or private investment could be a solution to that funding problem that exists right now. So that's what got me involved and that's how I teamed up with Rick.
Habib Benzian: Well my name is Habib Benzian. I'm a public health dentist. I live in Berlin in Germany and in New York and I'm associate professor both at the College of Global Public Health and the College of Dentistry. At the College of Dentistry, we also have a WHO collaborating center, which indicates that we have a global interest in things that are beyond the U.S. only. So we work very closely with the World Health Organization on promoting oral health and I got into this because the Dental College has two large school health programs ongoing that do very similar things as we want to do with CariedAway.
Chris Alexander: Okay so tell us about CariedAway. What is it and what's the origin of this idea and what's the mission behind the company today?
Richard Niederman: So CariedAway, brings care to kids in schools. It started really with the publication of the Surgeon General's report in 2000 indicating that caries and kids cavities in kids is an unexamined, unnoticed epidemic. So I was challenged at that time when I was in Boston to come up with an evidence based method for preventing cavities in kids. I'm trained as a dentist and also have training in evidence-based health care. So I was teaching at Harvard at the time and Forsyth Institute, a Harvard-affiliated research institute, wanted me to start a kids program. So that's what I started doing and at that time, and today there are school based programs. They do exams, they do fluoride varnish, they do sealants, but typically they don't do them all together and none have outcome data. Where people do have outcome data, they cannot demonstrate that they've improved health. So we took everything that we knew worked: sealants, fluoride varnish, toothpaste, what are called interim therapeutic restorations, went into schools twice per year and chronicled the baseline need and we chronicled how well we can improve health. So we reduce cavities by almost two thirds in two years and it took us about 20 minutes twice per year to deliver care and it cost us about $75 to do that. So the parents didn't need to leave work, the kids didn't need to leave school. There's no shots, no drilling, no pain and we could reduce cavities by almost two thirds. So, that's the motivating thing. First, could we control caries, which hadn't been done in 20 years in the U.S. To give you some numbers in the U.S. in 1990, Medicaid spent about 1 billion for kids' oral health. In 2015, they spent about 15 billion. So they went from 1 billion to 15 billion. We trained about 30% more dentists and a similar number of hygienists, and we didn't improve health. The amount of cavities in kids increased. So I looked at that and I said, okay, something's not working and we developed this program and demonstrate that it can work and we now have two federal grants for almost $20 million to provide care to kids in school, in the Bronx, in New York, and in rural New Hampshire.
Chris Alexander: So, you mentioned there's some populations you're currently working with. Is that going to expand in the future?
Richard Niederman: Backing up a step when we started this, we thought about where could we have the maximum impact, what we have at on pregnant women, school age kids, teenagers, adults, disabled, elderly and we picked kids because they're in school for a finite period of time and we could see them routinely. So where we picked to start when I was in Massachusetts, is Massachusetts, New Hampshire, Maine, Kansas, Colorado and Hawaii. Now we're in New York and we're doing the Bronx. So it's a largely Latino urban population and we have another population in New Hampshire, that's largely rural and white. In New Hampshire, there isn't water fluoridation; in New York there is water fluoridation. So we have two very distinct populations. We think it'll work similarly in both. and our plan is to expand in both communities and nationally as well and we have data on national need and globally.
Chris Alexander: So there's a lot of different health issues in the world to conquer and a lot that people are concerned about. Why do you think this one is important and this one is a great opportunity?
Habib Benzian: I think it's both, exactly. There's a need and it's an opportunity. The need is dramatic and it's an unmet need and an undiscovered need. Some people have called it a silent tsunami. Tooth decay, cavities is the most common disease of mankind. 3.5 billion people around the world suffer from tooth decay and the majority of that remains untreated and you can imagine the huge amount of toothache or pain, suffering in daily life, social interaction, working, going to school and that comes from toothache. We all know toothache is among the most horrible pains that you can have. Most everyone has had the experience of a toothache. The opportunity is that toothache and cavities and tooth decay are largely preventable. There are very simple measures that can be done on a daily basis. One as an individual can do and health systems and society can do, and schools are great places to start with such prevention early on in life and bringing kids on a healthy pathway for their future. So seeing that this concept that we are promoting through CariedAway such as simple and cost effective way of addressing problems before they occur, it makes it universally applicable to many countries and in particular to countries with a poorer health care system or with no dentists around. So we are aiming ultimately to bring CariedAway to other places than the U.S.
Chris Alexander: So you talked a little bit about the attraction and the progress that you've had so far and you currently are funded. You talked a little bit about the funding. So what's going to happen when that ends? How do you continue taking this around the country and around the world?
Richard Niederman: Well we bill Medicaid for what we do and Medicaid fees will support prevention. So that's how we would expand the program. Like I said, there are programs all over the country that do school-based prevention, but they're not optimized. They do one thing, they do another, but they are not organized to efficiently deliver a comprehensive program of care and to monitor outcomes.
Chris Alexander: What's the unique angle that you're taking that's differentiating you from other competing startups in this space?
Richard Niederman: I would say three words: better, faster, cheaper. I think our economy of scale and our knowledge, process knowledge, and we have proprietary software for electronic health records. So we know for each and every student how they're doing and also for the clinicians, how we're doing. So it's process, knowledge, experience, negotiating with the different state agencies. It's all of that.
Chris Alexander: So shifting gears to talk about the public. I know a big part of your work with CariedAway is building awareness in health in general, but specifically oral health. If you could spread a message to the people out there listening, what would you say? What do you want the public to know that they currently don't know?
Habib Benzian: Well one of the key messages that oral health is important in the first place and for many different reasons and just the fact that dental care is not perhaps covered by your insurance doesn't mean it's not important. It's actually the opposite. Oral health matters a lot for your general health, for your wellbeing, for your productivity, for concentration in school and there are very simple things that everyone can do and it starts with twice-a-day tooth brushing with a fluoride toothpaste. This is the most basic self care that everyone can do, and the next level would then be go to a checkup regularly to have a dentist or someone with special knowledge, it can also be a hygienist, check your teeth and see if there are any problems that you are not aware of yet, and one of the main risk factors for tooth decay and for cavities is high sugar intake and that is something that we are all culprits of or suffering from because sugar is everywhere. So if we have any way of reducing our daily consumption of sugar, sugary food, that will also go a long way in improving oral health and sugar is hidden in drinks in many processed foods. So start cutting, for example, avoiding sugary drinks, go for water, go for the light versions.
Chris Alexander: What drives you to put in the hours to do this work? You're juggling multiple roles, multiple types of work and yet you're pushing to accomplish something that sounds really big. Where does that motivation come from for you?
Pratik Dey Sourav: In my case, using school as a platform to deliver care. This is something that I've been working on for quite some time now. Parallel to working at dental school, I was also working for the World Food Program on their school feeding program and school-based deworming program. So I basically see CariedAway as our venture as an entry point to the schools. Not just to deliver oral care but also other kinds of care such as deworming or noncommunicable disease prevention, injury prevention, vaccination and such and such. So when we eventually plan to disseminate that, that our experience and our practice with other parts of the country as well as with other parts of the world, primarily to the low and middle income countries. So that's what I see ourself in the future and that's a passion that I always had and that's what drives me day to day.
Chris Alexander: Awesome. How about for you? What keeps you going?
Richard Niederman: I think the same thing. I came to dental school recognizing that there's a huge gap in what we know and what we do. So caries, cavities had been treated with drilling and filling for a hundred years and yet we know it's a preventable infection, but dentists aren't trained to treat it as a preventable infection. I see that as a huge gap in care. Furthermore, the Brookings Institute in one of their studies indicated that probably only 30 to 40% of the U.S. population, let alone the world population, can afford the care that dentists are trained to provide and we're not incented to do prevention. We're incented to intervene. What Atul Gawande calls rescue care rather than preventative care, we have a method that's efficient and we can thrive on Medicaid fees delivering prevention. So we have a huge untapped market, a huge need and it's global. So it seems like a great opportunity to make a contribution.
Habib Benzian: Well it's different. Several motivations I guess. One is, as you mentioned is impact. I started off as a dentist working in practice and in that situation I can only work with one person, one individual at a time and that is what brought me to public health because I can improve the situation of a larger group of people, of populations and that brought me to working internationally with governments, with international organizations that do it on a nationwide level or even global level by influencing policies and guidelines and recommendations and overall, I think what matters for me is that I'm engaging in something that has broader public and social benefits. I would have difficulty engaging in the same way for a commercial product that has no social value apart from the commodity maybe that it has but I think we want in public health, ultimately, we all want to make the world a better place.
Chris Alexander: So lastly, how can listeners get in touch with you, follow your progress? How can they learn about what you're doing?
Richard Niederman: Well, we're CariedAway. C-A-R-I-E-D, that's a play on words. So caries is what the profession calls cavities, so CariedAway is a play on that name. We want to get rid of cavities, so cariedaway.com is our website.
Chris Alexander: Excellent. Well thank you guys so much and best of luck to you.
Richard Niederman: Thank you very much for having us.