6. Engineering work : Encounter with Fukuo and Dr Miyata

Mr. Fukuo Morita who was the president of a Japanese company that made dental equipment had stopped in Alaska on his way to Sweden where I gave him rough sketches on dental equipment that unified patient, dentist and assistant bodies with instrument, light and other devices in the position where dentists had best control of their fingers and mouth views. He showed the drawings to the chief engineer who immediately wanted to test it for production. My main interest was a model clinic for Japan that a wealthy person named Dr. Miyata wanted in one of his new big buildings. I was suddenly in a mixed situation among a major dental company, the school with its plans for a new building and Dr. Miyata’s building plans. I met Dr. Miyata because of a bunch of epileptic barking dogs in a research lab. I spent early mornings in an office adjacent to the dean and Dr. Sato in the school research building. The dean (Dr. Suzuki) asked me why I was spending less time in the office. I told him I could not tolerate the noisy dogs above. He told me to check with the research project director Dr. Miyata. I went up to complain about the dogs and Dr. Miyata stopped working in a surgery team removing various tissue samples from the dogs to check effects of a drug that arrested epileptic spasms. He asked me to join him that evening for dinner. He picked me up in his chauffer driven limousine. He asked me to accompany him on a trip to the US where I was first exposed to how the very rich find ways to spend their money. Before the 2nd war the emperor granted monopolies to families. Miyata held the monopoly on all silver and carbide steel in Japan. His stock of silver was confiscated by the US Army but at a later date he was paid many millions of dollars for it. He wanted to go to the US with me to find ways to use the money so on the long pre-jet plane ride we discussed ideas. I proposed coop apartment buildings and super markets that did not exist in Japan at that time.

We met with owners of big apartment buildings and supermarkets that he easily arranged in his own way, Dr Florey who won a Nobel prize for use of penicillin picked us up at the Seattle airport, a 4-star General picked us up at the San Francisco airport and Miyata wanted to take a taxi from San Francisco to Los Angeles so he could see California!! My cost report from an amazed taxi company did not phase him, so I told him that riding down the San Fernando Valley was pretty boring. Dr Florey mentioned that Dr. Miyata was awarded the annual prize from an international association of physiologists for his report on Jacksonian epilepsy.

On his return to Japan, Dr. Miyata promptly made the first 3 coop apartments in Japan and Japan’s first supermarket in his big Tokyo buildings. It was very successful business, so he donated generous space to me for a ‘model clinic’ in a large building for the ideas. The building with the clinic was replaced in 2008 with a new building after more than 40 years.

In the meantime a team of Morita Corporation engineers was coming to Tokyo from Kyoto on weekends with drawings on the dental equipment that was planned for my model clinic. I kept adjusting the drawings and the engineers were confused because there was no dental equipment that compared with it and parts had to be packed into a small space. At the end of 3 months the company president came with the engineers to say that these weekly reviews could not continue and asked me to come to the factory full-time to direct the engineering project. I was in a dilemma because in the new building with a large clinic, graduate students and international patient base I would be well set.

I finally decided to work with the engineers full time for one year with the understanding that all mechanical and electrical engineers in the factory were assigned to the project. This meant that the special order for my clinic became a production plan for the factory which was a risk and I was then told the company with hundreds of employees would go bankrupt if we failed. The decision turned out to be a good one for 2 reasons- 1) I learned a lot about engineering and the management in factories, I concluded that engineering schools provide much better education than medical and dental schools! 2) Shortly thereafter student riots on university campuses and classrooms flared up along with strong anti-American feelings from the developing Vietnam War.

Invention of dental equipment at Morita factory –
Morita had to offer something for the one year stay, I had no idea what to negotiate when they mentioned patents etc. So I asked Dr Miyata to negotiate for me. His first offer in negotiations was to buy the company which Morita rejected along with negotiating no further with him. Dr Miyata became my advisor when he also found about the high company risk in the project, The final result was that I would be an engineering consultant and receive 5% of the wholesale price. I had saved enough money from Alaska so I proposed no compensation to me for the 1 year knowing the company risk centered on the young new president. We worked 6 days a week until nearly midnight. Shortly we had a first prototype surrounded by a ring of engineers with drawing stands and backed up with excellent technicians. I treated patients with the developing prototypes since many patients were available in the factory. I had to sign approval on every one of hundreds of drawings after the stamps of approval by the project engineer and the chief engineer. Many patents were identified and soon a narrow extension to the project area was added with a guard at the door. The project team needed ID cards to get in. Even in Japan they worried about industrial spies. I did not have an ID card since it was easy to recognize me. My experience in a machine shop with turret lathes, grinders etc while a dental student and making plastic molds in dental school saved a lot of time for engineering drawings on some parts.

I had specified a fixed flat support for patient bodies designed for patients to self-position their mouths to the 0 point for my best finger control -in other words no dental chair that tilts patient bodies. That offered another advantage. Instrument supports, switches, regulators and lights could be in fixed positions for best finger control and views of operating points. Error in positioning these items leads to adjustments in body positions that leads to error in treatment method and undue tension in the bodies of dentists and coworkers. Many dentists give up patient care from body disorders from position error in equipment parts. Medical clinics have tables to lie on for exams and treatment and patient seats for consultation so patients experience in my designed dental clinics became close to their experience in most medical clinics.

However Morita is a company wanting to make money from their factory products and the directors decided we must first adapt my concept to a dental chair that tilts patient bodies because all schools in Japan were standardized with teachers and students standing in front of upright or slightly reclined patients. Horizontal patients did not exist. We had gone a long way with fixation of parts to mouths of horizontal patients  when I was faced with what I wanted and what the company wanted. Morita promised to make what I wanted for the model clinic later so I loosened up with helping to make many parts that do not belong in dental clinics. The first 5 chair-type units with instruments integrated into the patient support were installed in my Tokyo clinic about 1 year after my work started at the factory.

Dr. Miyata who had degrees in engineering, physiology, dentistry and political science had given me good advice about payments and how to negotiate. I was to accept payment as an engineering consultant but tax authorities converted this to royalty payments as inventions because Morita had registered me as the inventor for many international patents with patents rights assigned to them. I later learned why the government preferred this. Royalty payments are unearned income where tax rates were very high while engineering consultation is earned income with lower tax rates. The high tax rates encouraged me to spend money in my interest on standards for health care rather than pay high taxes with much spent on military weapons. This became significant when my income rose through the 1970s, 80s and 90s to 1.5 millions of dollars annually. I now favor high taxes for high income people to spend much of their income on socially useful projects other than questionable nation protection or a related family dynasty through inheritance. Knowing this I have never owned a house, car, stock or property for personal use or speculation during my years of wealth. In fact I lived for most of those years in one room with a small window, This is not compatible with living with a wife who spends much time at home and it resulted in a divorce with a wife who felt a rich family gains respect from a show of property.

It was no fun living alone but in the late 1970s I fortunately met someone who had decided at the age of thirteen that no woman can rely on a man so that a woman must support herself. She is a simultaneous Japanese-English interpreter who I needed for special meetings. We remain married today. At our first meeting she interpreted for my meeting with five deans of dental schools. The subject was the effect of school terminology on student accuracy in treatment outcomes. Dental school teachers were accepting my basic change of patient-dentist positions but many students could still not demonstrate accuracy of treatment outcomes. We now live in a simple apartment as low level consumers with skin covers and no car. The millions of dollars from dental treatment technology was spent on efforts to set standards for electronic health records and procedure manuals in clinic LANs.

Let’s go back to the 60s after the 1963 year that I spent fortunately in a factory instead of a university where students increasingly objected to the US involvement in Vietnam. If I had stayed at the university with their anti-US riots perhaps I would have been forced to go back home to the US.

Morita company had hired a market research company to determine the market for their huge expenditure in Japan. The research conclusion was there was no market in Japan because all school students and all dentists stood in front of upright patients while the factory outcome placed the dentist behind a horizontal patient’s head. However such data is never 100% because they found a female dentist who treated patients on her kitchen table because her father told her to reject all habits she acquired in dental school. In her age of 60s she was one of the first to adopt the position reversal and later became well respected from being a screwball.

Morita became desperate, so they convinced me to go back to the US where they thought my countrymen must better understand my way of thinking. The US companies in the meantime had been changing from standing dentists and near upright patient positions with an emphasis on seated patient care with more ‘reclined’ patients. However their x,y,z 0 point for positioning patients remained under the patient’s pelvis. I had located the patient-dentist positioning 0 point between the front upper teeth for the dimensions and positions of everything in the treatment area in the patient mouth for best finger control. So habits from the industry-school-dentist merry-go-round resulted in nobody agreeing with me. However my demonstrations of patient treatment caught attention in dental meetings so more than 100 US dentists adopted it before my return to Japan in 1964. During my stay in the US a man crowded up to me during a demonstration for dentists in San Francisco. He kept repeating ‘When can you come to Australia?’ To get him out of the way I finally said ‘It would be nice to see Australia’. That was enough for him so he took my name card and started making repeated phone calls from Australia. The dean of Loma Linda U. dental school handed his phone to me during a meeting in his office. He said ‘It’s a call from Australia’. Martin Halas had traced me to the dean’s office. He said ‘Tell me when you are coming to Australia or I keep calling back’ I mentioned next spring which was a year away in the US. I forgot that spring in Australia was 6 months away so shortly I received a letter of invitation from the president of the Australia Dental Association. Martin Halas was a PROMOTER who gave me the first taste of being a celebrity. My arrival was announced in the newspapers and I started the tour with an interview in the 6 o’clock news of the major nationwide TV news. During my later tour I was surprised at the number of strangers who recognized me. The TV interviewer first commented that I had invented a ‘revolutionary” system for treating patients so please explain it. I gave him a plastic model of a mouth with lips and cheeks then asked ‘How would you want to place your fingers into the mouth as a dentist’? He turned the simulated mouth with one hand while feeling the teeth with the fingers of his other hand and concluded that the mouth would face upward and the upright dentist’s body is in near contact with the top of the patient’s head. He was holding the mouth at stomach level so I reminded him that dentists must look closely at what at what they are doing so he raised the mouth to his heart level instead of bending down to the mouth to see mouth detail. I then asked him to compare his conclusions with his position relations to his dentist. I then mentioned that everything a dentist uses should be designed for his conclusions as a human being. He could derive the answers in a few minutes but dentists need to reset decades of habits. This was the beginning of a series of worldwide demonstrations on patients that later developed into continuing education courses with many course conductors and precise data collection that continue today. The data links treatment positions and treatment method with treatment outcomes. My early courses in Japan focused on treatment planning and time management introduced by 4 dental treatment objectives but the worldwide courses focused on best body conditions for use of fingers with precise views of instrument-tissue contacts. I started with standardizing use of dentist fingers and eyes worldwide with the Latin-English terms learned in dental school. I could go a long way with well trained instructors adjacent to learners in the expensive ratio of 1 instructor for every 2 students. I began writing manuals in English that covered all procedures in dental clinics. I soon gave up on English because medical and dental school terms are long and based in 1 and 2 dimension imagery. I needed names of planes, lines and points on human bodies that linked with instruments and surroundings in 4 space-time dimensions. I finally concluded that 8 numeric scales and xyz-time could cover the needs of patient-clinic records and procedure manuals. The facilities, interpreters and instructors for the courses were arranged by the distributors of products from Japanese, US and German factories.

The US factory (Ritter-Sybron) was the world’s largest dental equipment factory in the 1960s. It was linked with the German Ritter factory. I was giving a course in Southern Japan when I received a call from the president of the Japanese company (Morita) to come to Kyoto to meet the president of the US Ritter and Vice president of Sybron company. Morita was excited because Morita was the Asia maker for Ritter equipment. Ritter had come to renew the contract with their newly designed equipment. Morita directors had decided to commit to my concept so Fukuo Morita wanted me to explain it with everything the company had made.

I proposed to meet the US president and vice president in Ritter’s hotel suite with a well designed simulated head, some instruments with tubes, a scissors and cardboard for 1 day. I first clarified one condition from asking to whom the president was most responsible. He answered ‘the stockholders’. I reminded him that he had significant impact in the field of health care therefore could he agree that patients were primary, health providers were secondary and the stockholders were tertiary in his priorities? He finally agreed. His agreement later ended With the simulated head, instruments, tubes and cardboard cutouts he simulated what he would want as a dentist and as a patient. At lunchtime the Ritter directors said they were convinced and wanted to meet Morita to reverse the contract from Ritter equipment to Morita equipment. It included a clause that I must work several weeks in the engineering department of the US factory and several weeks in their German factory. On arrival in the US factory the president told me that 80 dentists were coming that included American Dental Association directors, school deans etc. He wanted to see whether they could be convinced in the same way I convinced him. Their reports to him would determine further moves if any. The favorable reports excited the company but one problem kept returning in the directors’ meetings.  Their market depended on a worldwide dealers’ network who offered many varieties of dental equipment and instruments in their showrooms. Dental dealers felt their interest in survival was more important than better control of dentist fingers. My concept would decimate the need for such variety. Finally Ritterconcluded that the logic of my concept in the interest of end users outweighed the risk of dealer reactions. This conclusion ended in company bankruptcy when they offered the system components outside of dealer products. Many people lost their jobs including the many engineers and others I worked with in the US and German factories. This raises the question of jobs versus elimination of waste in random health care. During my early years a job would be more important than reliable and waste-free health care. This is a contradiction in the industrial age economy.

I got a taste of how a collaboration of companies can lead to worldwide recognition in fields such as dentistry. On the other hand company competitors can convert this into a notorious image. Rumors spread on why a  dentist from a rich country settled in a poor country.

In general top level decision makers in universities, engineering, and large health care facilities were warm to my ideas but many climbing company, academic or other ladders could not see a future on their ladder with adoption of my concepts. The top people with interest in their organization environment needed the ladder climbers which often led to frustration.

I spent the remaining 1960s with continuing education courses centered on treatment planning and demonstrating patient treatment set up in hotels throughout Japan that later evolved to 3-day courses. Hundreds -or thousands- of dentists watched me treat patients 8 hours a day with checks on accuracy of outcomes. One thing I had to prove was that patients did not drown when treated on flat surfaces. The confidence I built up at that time with a principle for precise finger control with precise views that covered the full range of all dental and surgical procedure prepared me to later deal with top administrators in worldwide schools, national standards organizations, professional groups and WHO.