Ben is a family dentist, and the founder of the Brush DJ app. Inspired in his early career, he created an app bringing together music and the simplicity of brushing teeth for two minutes into an app downloaded almost half a million times.
In the latest episode of 15 Minutes With The Doctor: Brush DJ, the smartphone app helping to beat dental cavities, Ben and Vinay go in-depth about this simple but effective app. They cover how he created it from mockups using a ruler and compass, how he has hundreds of 5-star reviews with almost no marketing spend, and his ongoing passion for improving oral health. In this unique article, Ben unravels an analogy comparing the healthtech startup scene to a game of snakes and ladders, something many of us played growing up. He also shares his insights on securing grant funding and how the app has been a part of research trials with little input from Ben.
Research on a digital health app
Vinay: I read about a randomised control trial (RCT), which is obviously the gold standard in research. I liked that because it shows how helpful your product is and the increasingly common thinking towards an app being a medical intervention. This app is a preventive tool, and the trial showed its effectiveness. So it’s very good for you because it validates the product.
Ben: One of my hats for many years was researching drug and alcohol use. So I understand research and appreciate that sometimes an RCT is not always appropriate. They take a lot of time, and doing them well is very difficult. Often, you do them in a healthcare setting that isn’t the ‘real world.’ So it’s got to work.
By the time you’ve set up the trial, got ethical approval, and collected the data, it could be two or three years, and the app could have changed. That was my worry about doing some research, but someone else did it, which was great, and it makes it more robust. We’ve had trials done in India and Iran, which show the app is better than the traditional method of a dental professional guiding people on how to clean their teeth – Which is cheaper and saves time.
Vinay: These institutions just did this on their own after discovering the app?
Ben: Yeah, they did it off their own backs. The one in India was the most recent, and they said, “Well, we’d like to carry out research,” and I said, “Well, yeah, OK.” So I just kind of forgot about it, and they came back and said, “We’ve found great results.”
It does strengthen the argument for the use of the app, but it’s not the be-all and end-all. Some healthtech innovators say, “well, have you got a randomised control trial to show this is effective? And the response is like, “Well, no, I haven’t”. And then you’re another three or four years into it…and you need to finance and keep the startup going before you get the answer. But some interventions are no-brainers! What’s the harm? I would be worried about specific innovations that could cause harm, but something like this app doesn’t cause any damage. We did the risk analysis. There are low risks.
Vinay: There is a lot more thinking out there about having research and evidence of apps. I’m sure there are probably many people, fellow app developers, who are a bit envious, that you’ve had an RCT undertaken without the need for enormous input from yourself?
Ben: Yes, all I can say is that it was independent of me. It’s really awesome that they were carried out without in-house intelligence.
I’m a very cynical dentist.
We have lots of people who come to tell us that their latest product is the best product, and you look at the research, it can be dubious at times. However, the Brush DJ research was outside of my control, and it gave an authentic result.
How to secure grant funding in digital health?
Vinay: Could you share any tips on how you managed to get some of that grant funding? I guess it helps because there is a lot of evidence around brushing for two minutes or was it something that you did specifically that secured the grants for you?
Ben: I think it was more that people could see it was such a good idea.
That’s the thing about oral health; it applies to everyone.
Everyone brushes or hopefully brushes their teeth, so it wasn’t a complicated niche area of healthcare. It was something that everybody understood. And also, there’s often a headline saying how terrible NHS dentistry is, so everyone started thinking…this is something that would help. You didn’t have to be a specialist in oral health or dentistry to understand the concept.
And the other thing, people loved it because of the music, everyone loves music. It’s an excellent hook to get that kind of product engagement and people thinking, “well, yeah, I’ll try that because I do like music.” It would be really difficult to find somebody who doesn’t like music. I believe it’s about 0.1% of the population.
By the time I got into grants, we already had a product that had been out there for a few years, and we already had great feedback from users saying how much they loved it. So I could use that if we had an interview for funding, we could say, “well, we’ve got this evidence, we’ve got a product you can actually use tonight, or you can use it now because it’s only two minutes and people can grasp it quite easily.”
Also, it was very low cost.
The NHS loves low cost, and it was something that could be deployed so easily. It wasn’t something that was a prototype; it was there ready to go. The other thing about innovation in the NHS or healthcare is that it is like a game of snakes and ladders. You played it as a child. You roll the dice, go up the board, hit a ladder, and it takes you up. Those ladders are like grants and meeting the right person. But then you also have the snakes, which we get in healthcare innovation too. There are many snakes, including regulation and resistance to change and the various layers within the NHS.
The other main concern for me is the long-term funding of these projects and these products. Brush DJ is free. I keep it very low cost. I don’t employ anyone; watching your cash flow is a big one, and you need to think like a business person. Go to as many courses as you can on running small businesses, understand that cash flow, and understand what you can and can’t claim for tax purposes. R&D credits is something to look into if you’re developing something novel. Don’t think you can do it on your own. I’m at the stage where I’m looking for a partner to work with, someone who has got that money to invest. Ideally, someone who has health apps in their portfolio and understands the sector.
Link: 15 Minutes With The Doctor: 45: Brush DJ, the smartphone app helping to beat dental cavities with Ben Underwood