The Saad Truth with Dr. Saad - Dr. Kevin Tracey - Neurosurgeon and Author of The Great Nerve (The Saad Truth with Dr. Saad_890)

00:00:00.000 Hi everybody, this is Scott Saad. Today I have, I think for the first time on this show,

00:00:06.400 a neurosurgeon, Kevin Tracy. How are you doing, sir?

00:00:10.360 Very well. Thanks for having me on.

00:00:12.480 It's a pleasure. Okay, so let me just mention a few things about you. You are a neurosurgeon

00:00:17.260 and inventor. By the way, my 13-year-old son today, who knows if he'll change his mind,

00:00:23.220 today he says that he wants to be a neurosurgeon. So maybe you are the hero that he needs to speak

00:00:29.660 to. So neurosurgeon and inventor, president and CEO of the Feinstein Institute for Medical Research.

00:00:36.000 You're a professor of neurosurgery and molecular medicine at Hofstra University. I could not

00:00:42.780 believe your Google Scholar metrics. What's going on, man? I got to get my act together. 138,000

00:00:49.060 plus citations, which for those of you who don't know, that's a pretty big number. Your latest book,

00:00:54.720 The Great Nerve, the new science of the vagus nerve and how to harness its healing reflexes.

00:01:02.800 So let's start there. What is the vagus nerve? Tell us all about it. Keep it at a layman's term.

00:01:08.400 My audience is very smart, but don't bore us with the specific neurotransmitters and so on.

00:01:14.820 Take it away.

00:01:15.300 The vagus nerve is actually a paired structure. So you have two of them, like two thumbs and two

00:01:25.900 kidneys. You have one on each side. It starts at the level of your, about the level of your ears

00:01:31.180 and your brain and travels down your neck across your chest and abdomen. Along the way, it's the

00:01:38.200 longest of what's called cranial nerve, nerves originating from your brainstem that go into your

00:01:42.900 body. And it's the longest of those, of those 12 pairs. But along the way, the vagus nerve is,

00:01:49.320 it's like a information superhighway. It's like a transatlantic cable connecting your body to your

00:01:54.680 brain and your brain to your body. So I already said, you said vagus nerve. I already said you have

00:02:01.180 two. And now I'll clarify that a little bit more on each side of your neck where the vagus nerve is

00:02:06.920 traveling. Inside of it, you have about a hundred thousand individual nerves. So you really have

00:02:13.080 200,000 vagus nerves. And what, what it's doing is carrying the information about the function of

00:02:21.240 all your organs that you never think about all day long, back and forth between your body and your

00:02:26.100 brain. This information is the basis of reflex circuits, reflexes, like when the doctor taps your

00:02:33.860 knee and your knee pops up and you said, who did that? It's, it's, it's reflexes that are operating

00:02:41.180 to control how your organs are working. And essentially the information your vagus nerve

00:02:47.960 is carrying is, is fundamentally keeping you healthy. So that's why it's so important. And

00:02:52.460 there are now billions of web impressions and social media postings on this. There's a lot of

00:02:58.700 interest in the vagus nerve and its relationship to health. Of the 200,000, let's call them informational

00:03:06.760 processing units. How many of these of the 200,000 have been mapped so that we could say, you know,

00:03:15.160 number one, 132,336 does this. Is it 5% has been mapped? Is it 95% has been mapped? Where are we in that

00:03:24.200 process? Uh, when you go to level of fiber specific mapping, it's zero. Wow. Yeah. So my colleague,

00:03:32.920 I'm sitting today at my lab at the Feinstein Institute and my colleague upstairs, his laboratory

00:03:41.260 is actually leading a consortium, uh, a major NIH funded consortium of several centers. And they're

00:03:49.420 producing the first detailed fiber specific maps of the human vagus nerve. They harvest vagus nerves

00:03:56.120 from cadavers and they, they section, they slice them, um, five microns at a time, and then stain each

00:04:05.120 slice with various, um, dye stains, like, like ancient pathologists and anatomists used to do, but they're

00:04:15.360 also applying technology like single cell RNA sequencing and very sophisticated protein mapping

00:04:22.620 using antibody stains. And then they're reassembling this, uh, and building computer models, almost like

00:04:29.840 a CAT scan, three-dimensional CAT scan of, of the human vagus nerve following where all the individual

00:04:36.860 fibers go, starting from the level of about the neck down to all the organs, the liver, the pancreas,

00:04:44.280 the intestines. So yeah, we're building those maps now with all the interest in the vagus nerve and

00:04:49.800 all the quote unquote vagus nerve experts out there talking about do this, that, or the other thing.

00:04:55.260 The first question you ask, and the answer is zero. Much of what's being talked about today

00:05:00.540 is, is actually pointing to anatomical maps that go back 50 or a hundred or more years.

00:05:06.680 So if we compare that zero to let's say our, our topographical understanding of the actual brain,

00:05:16.600 that number is obviously greater than zero. So what is it, why is it that so much attention has

00:05:23.920 been spent on, you know, trying to understand at least, I mean, not every single neuron and every

00:05:28.760 single synapse, but you know, we do have an idea that, you know, if, if there's a stroke here,

00:05:32.920 you lose your ability to, for language. So there's somewhat of some good mapping. Why has there been

00:05:39.320 so little progress with that particular nerve? It's a really good question. I don't have a great

00:05:44.300 answer for you on that. As a, as a general rule, there's a tremendous interest in mapping the vagus

00:05:52.980 nerve. Now I told you the story of, of what Stavros is doing upstairs for human vagus nerves

00:05:58.260 in animal experiments, in basic neuroscience, basic neuro immunology laboratories. There's a

00:06:04.540 tremendous interest in applying very sophisticated molecular and genetic techniques to draw detailed

00:06:12.240 maps of the vagus nerve in mice, for instance. So there's a lab at Harvard in Boston led by a colleague

00:06:20.820 and friend named Steve Lieberlis. And Steve's lab has done some absolutely brilliant work doing fiber

00:06:27.100 specific mapping in, in mouse vagus nerves. This really surprising results. So let me just give

00:06:31.960 you another, for instance, my, mice vagus nerves are obviously much smaller. Mice are smaller than

00:06:36.800 humans. And say there's 5,000 fibers in a mouse vagus nerve. Steve and his students and his postdocs

00:06:45.100 have, have mapped the fibers that control breathing. And it's like a hundred or 120 fibers. Imagine that.

00:06:54.020 And you would have thought something as important as breathing, being controlled by the vagus nerve,

00:06:58.540 it would be a much bigger number of fibers. In our own work, collaborating with other labs as well,

00:07:06.580 we estimate that the fibers that control in the vagus nerve that turn off inflammation,

00:07:11.880 which is where our main interest has been, we estimate that in humans, it's less than a thousand

00:07:17.660 fibers. It may be as few as a few hundred fibers. So if it's a few hundred fibers controlling inflammation

00:07:25.120 and you have 200,000 fibers, the, the, the complexity of, of making these maps is, is really

00:07:33.320 amazing. But we have the tools now in animals and laboratory animals, it's laboratory experiments.

00:07:39.980 We have the tools to go fiber by fiber by fiber to build the maps. And someday when we are able to

00:07:46.860 apply similar kinds of tools to humans, we'll have all the answers to this, but yeah, no, there's,

00:07:52.500 there's a huge opportunity for research there. So does the fact that now you've got an explosion of

00:07:59.340 computational ability and, you know, computational modeling and, you know, computational biology,

00:08:05.120 technology, is that going to, you know, expand the ability of researchers such as yourself to be

00:08:12.740 able to quickly map this? Because in a sense, maybe, so I'm going to answer the question that

00:08:17.980 I originally asked you, maybe at, you couldn't have mapped it. And the reason why it was at zero

00:08:22.820 is because you were computationally limited. You weren't able to, to do the types of things that

00:08:28.660 now you're talking about where they're slicing and so on. Could that, could it be as simple as that

00:08:32.680 in terms of once we get the supercomputers going, the quantum computing going, we might be able to

00:08:38.280 crack the whole mystery? I think that computing is part of the equation. And yes, as the, as we,

00:08:44.780 as we embrace this explosion in AI and then, and then the explosion and the efficiency and the capacity

00:08:53.480 of computing, yes, things will go faster, but you, but that, but biology is complicated and there's

00:09:00.280 things that computers can't do without experimental data and input. And there you get, you get advances,

00:09:07.620 you get staggering advances when the technology advances. And so I'll tell you something that

00:09:14.800 we're really excited about now in, in neuroscience and in neuroimmunology, it's a technology called

00:09:19.880 trapping and what you can do now. And this brings together this whole line of questioning about

00:09:25.620 maps. Cause when you, the kind of maps you're, you and I are talking about, it's not just a picture

00:09:31.940 of the neurons. It's a, it also is a description of what their role is, what they're doing and how

00:09:37.180 they work. And that you can't, you can't predict that from a, from an AI program. You have to measure

00:09:42.760 it. You have to try the experiment. The way you do that now, the way we do that now is with a really

00:09:48.100 cool technology I said called trapping. So imagine through genetic engineering of a mouse, you can,

00:09:55.460 you can rig the neurons in its brain so that when those neurons are activated by a specific task or a

00:10:03.360 specific memory or a specific event, they turn themselves red. I'm, it's almost like a self tattooing

00:10:10.320 neuron. Now we've, we've been doing this and this is started actually the first use of this in

00:10:18.940 immunology, neuro neuroimmunology was by Asha Rolls in Israel and her brilliant paper and cell a few years

00:10:26.260 ago. And what we can do is we can, we can produce inflammation in the mouse through a chemical trick or,

00:10:34.720 or by studying mice that have conditions like colitis or arthritis. And you can say,

00:10:39.440 what are the neurons in the brain that that disease, that condition is activating.

00:10:45.820 And you're going to go back and identify those neurons. You can wait two weeks. You can let the

00:10:51.100 colitis go away or let the inflammation that we caused in the mouse, let it go away. And now you

00:10:57.020 can selectively reactivate those brain neurons without trying to produce any inflammation in the mouse or

00:11:04.720 doing any chemical tricks. And the activity of those brain neurons will cause the colitis to reappear

00:11:11.780 or the arthritis to reappear or the other inflammation that those neurons are associated

00:11:18.380 with. That means having the memory in your brain of the inflammatory state produces the inflammatory

00:11:26.580 state in your body. Wow.

00:11:28.220 Yeah. That's the right answer. Wow. So now we can say, well, where are those signals traveling

00:11:34.860 from the brain to the body and back? Some of them are in the vagus nerve and we can draw maps

00:11:39.300 of those fibers from the, from the neurons in the brain to the fibers in the vagus nerve to the

00:11:45.940 location in the intestine or the, or, or, or wherever else we're studying inflammation. But that's what we're

00:11:51.800 able to do now. You can't, I, I, a computer model, even a very sophisticated AI model can't conjure that

00:11:58.940 up. It has to start with the observations from these kinds of modern technologies.

00:12:05.000 Uh, only because we're on the theme of computers, I'll ask one question about AI, and then we'll go back

00:12:09.920 to how you chose that particular interest in, in, in studying that particular, you know, system. Uh,

00:12:16.740 do you foresee ever a day where, uh, there is no need for Dr. Tracy performing the surgeries because

00:12:24.620 the robots will be so, uh, their, their dexterity will be so, I mean, I saw recently on, I think it

00:12:31.060 was an Instagram reel where these robots were, you know, were peeling like the, some unbelievably small

00:12:38.680 minutia that you could have never imagined that they would have that level of dexterity. Is this

00:12:44.180 something that is way, way in the future science fiction, or are many people in medical fields,

00:12:49.700 whether it be in neurosurgery or certainly like in radiology, for example, where, you know, you have

00:12:54.440 the pattern recognition that, that the AI can come up with that oftentimes beats the ability of the human.

00:13:00.960 How does AI challenge or contribute or help, uh, neurosurgery?

00:13:07.460 In the way that you just described, I think you're going to see, uh, who was it? Ernest Hemingway said

00:13:15.980 change happens slowly and then all at once, something like that. I think that we're living

00:13:21.720 through now the change happening slowly. And, and there's, there's a good reasons for change

00:13:26.980 happening slowly in medicine. You know, even in your own personal case, you don't want your own

00:13:31.380 doctor chasing every shiny new object every five minutes, right? You want, you want careful

00:13:36.360 conservative thinking to be the, the first do no harm to that, to guide, guide the early adopters and

00:13:44.600 the early, the early adopters and the early decision makers. That's all fine. Well, in that, in that

00:13:50.180 scenario, change is already happening, right? As you said, in the, in the medical fields that are,

00:13:57.660 that are highly image oriented, you mentioned radiology. There's also dermatology and pathology,

00:14:04.140 even, even now, um, AI guided and computer assisted, if not computer, um, uh, I'm not gonna say

00:14:16.280 independent, but computer deterministic evaluation of colonoscopies, right? There are products now

00:14:23.560 out on the market where the, the, the camera is, is feeding all the information straight into

00:14:30.940 a, um, a computer that's, that's reading every single image and picking up things, uh, polyps and

00:14:38.780 potential tumors or other problems that the doctor may or may not have picked up. That means we're one

00:14:44.680 step away from colonoscopies being done by swallowing the camera. Why do you need, why do you need the

00:14:49.480 doctor to hold the tube if the, if the images are all being read after the fact by, by a computer?

00:14:55.480 So these things are happening as we speak. I mean, if you, even in psychiatry, right, where you have,

00:15:01.840 this goes back decades where psychiatrists have been scanning, uh, web searches, search engines

00:15:09.460 to, to, to pick up diagnosis of early depression, anxiety, or even schizophrenia from, from kids as they,

00:15:18.420 as they do their Google searches. And certain combination of, of words have been, are being

00:15:24.280 studied as possibly being warning signs that this, this person should, should be helped, should seek

00:15:29.900 help. These things are all happening and have already happened in some cases. So when you, when you

00:15:35.180 look at the power of robot assisted surgery today, whether it's for endoscopic surgery with GI surgery

00:15:42.860 or, or, or urology, uh, procedures in, uh, in, in another gynecological procedures or neurosurgery,

00:15:50.280 as you said, I think absolutely robots are going to be, are going to be more and more capable of doing

00:15:56.560 more and more of the, of the surgical intervention with less and less of the human intervention.

00:16:01.780 Yeah. I'm, I'm just brainstorming here. And so I'm thinking back of some of the research that I had

00:16:07.260 studied when I was a doctoral student, where if you show people that the likelihood of you being

00:16:14.020 accepted into a program, if you use an actuarial model, just a mathematical model actually results

00:16:21.740 in better outcomes than if you use a human decision maker, because the human decision maker,

00:16:26.840 maybe their blood sugar is low because they're hungry and now they're pissed off. So the exact same

00:16:31.720 file that I might've said, yes, okay, get him into Princeton. Now I say, screw this guy. He's not going to get 0.98

00:16:36.720 into Princeton. So even when you tell people, Kevin, that it would be in their best interest to use an

00:16:43.560 actuarial model, they don't feel comfortable in giving their future away to a cold mathematical model.

00:16:53.560 Might it also be the case that even if we ran studies showing that the likelihood of a neurosurgical

00:17:00.800 robot of making an error is lesser than a human one, do you think that it would be the case that

00:17:08.060 people would have reticence? I want a real human being working on my brain, not some cold algorithm.

00:17:15.500 Does that seem reasonable for me to expect that they would have that bias?

00:17:18.960 I'm not a psychologist. I'm not an expert in this space, but I will tell you first,

00:17:26.880 I saw a statistic recently. And like I said, I don't know if it's true, but it was from a reputable,

00:17:32.440 it was from a reputable journalistic source that a significant percentage of job applications

00:17:38.940 to major corporations today are already being screened by AI. So in one way, you can say there's

00:17:46.080 already been an abdication to that model, the actuarial model. And I think the same thing

00:17:51.020 happens in colleges, where a large number of the college applications are already being screened

00:17:57.640 by AI. And as far as what people will prefer when they seek their healthcare, I mean, there's the old

00:18:06.560 neurosurgery joke, right? If you ask a neurosurgeon who the three best neurosurgeons in the world are to

00:18:12.580 solve that patient's particular problem, they have a very difficult time thinking of the names of the

00:18:17.520 other two. So it's complicated. You know, I think medicine is, I think as doctors, and I no longer

00:18:29.880 treat patients, I'm not practicing now. I retired from my clinical practice. I run my research lab now

00:18:35.800 full time. But when you think about what we're going through, and maybe this is an important

00:18:41.740 punctuation point on this whole conversation. AI is here, AI is not going away, AI is going to be

00:18:48.000 more and more involved in all aspects of our lives. That's, and it will replace some, the way we do some

00:18:55.440 things. Our obligation now as healthcare leaders, and providers, is to make sure that we insert the

00:19:04.300 humanity, the humanity, the humanness, the human touch into healthcare, because AI can't do that. And it needs to

00:19:15.380 be sort of constantly reiterated, discussed, and, and reminded that patients with the highest trust in their, in their

00:19:27.600 physicians, or in their healthcare providers, have better outcomes. This has been studied, improved 10 ways to Sunday. If you have a high, those

00:19:37.880 patients with the highest confidence, the most belief in their caregivers have better outcomes. There's something about the human

00:19:44.820 touch and the interaction of compassion and caring, especially when, frankly, medicine runs out of options, you still have that

00:19:56.000 compassion and caring, that we cannot lose sight of it has to remain on the critical path of what we do in all of medicine and

00:20:03.340 surgery.

00:20:04.420 Beautiful. I'll come back to your book, and one particular term, which I'm sure you'd be happy to talk about, bioelectronic medicine. So let's, let's

00:20:13.020 table that for a second. But since we're talking about neurosurgery, do you mind if I ask why you decided to, to leave your

00:20:20.140 clinical practice? Because I was got one of the questions I was going to ask you is that you wear many hats, which one do you

00:20:26.080 prefer? And why? And has that preference shifted across your career? And it would seem to me that maybe now, perhaps you're more

00:20:34.100 excited about your research than you are about the clinical. So walk us through all those decisions. And again, I ask these

00:20:39.280 questions, first, because I'm interested in people that I talked to. But as a psychologist who studied psychology of

00:20:44.960 decision making, these types of decisions always fascinate me.

00:20:49.200 Well, I mean, it's a it's a long story. But but to tell it in brief, my mother died of a brain tumor when I was five. And it came as a

00:21:00.340 very sudden surprise to all of us. My my father, her father was a PD, a professor of pediatrics at Yale and New

00:21:09.120 Haven, Connecticut, came as a surprise to him, my, my infant baby sister and my younger brother, all of us were

00:21:18.040 obviously devastated by this. And so all my life, I've been very sensitized to what is neurosurgery and what is the

00:21:25.400 impact it can have. By the time I was a teenager, I had really decided I wanted to be a scientist.

00:21:31.780 All my life, I knew pretty much as long as I can remember, I wanted to have a laboratory, I wanted to

00:21:37.400 invent things. And I wanted to understand how to invent things that could lead to cures. I just thought it was

00:21:44.040 such a fascinating path. And so I was on that path as a chemistry major in college at Boston College, and then

00:21:52.900 making a career decision of getting a PhD in chemistry, where I could then go learn to make

00:21:58.140 pharmaceutical drugs, or getting an MD, and learning how the diseases actually work. And that's the path

00:22:07.300 I chose, obviously. And then in medical school, you have to pick surgical versus non surgical

00:22:11.640 specialties. The decision to become a neurosurgeon, you know, it's certainly an interesting story now

00:22:18.440 looking back, but I didn't become a neurosurgeon, because my mother died of a brain tumor when I was

00:22:24.200 five, I became a neurosurgeon, because when I finished my training in the early 1990s, so as a

00:22:33.500 fully trained neurosurgeon, the neurosurgery departments had a lot of resources. And this was a

00:22:41.340 time when the departments, whether it was neurosurgery, or medicine, or general surgery, the departments

00:22:46.260 with the most resources had the biggest opportunities to support research laboratories.

00:22:51.540 And so I could combine a career doing neurosurgery one day a week, and then running a big laboratory

00:22:58.020 for the other, you know, six days a week, which is what we all did. We worked, we worked in the clinic

00:23:04.420 a day a week, and then we became obsessed with our laboratory projects. So I always had a career that

00:23:11.280 combined these interests of doing research to discover ways of trying to help people and

00:23:17.280 understanding how diseases worked. And in neurosurgery, I wouldn't, I wouldn't trade a minute of it away. I

00:23:23.920 loved learning how to do neurosurgery. I loved interacting with the patients. I love doing

00:23:28.400 neurosurgery. But I wouldn't trade away a minute of, of the years I spent in the laboratory working with

00:23:34.900 brilliant graduate students and brilliant postdocs trying to unravel how, how, how, how the universe

00:23:44.580 is assembled, you know, take it apart piece by piece, and then build it back together again,

00:23:49.700 so that you can, you can invent new therapies. And we've been fortunate because we've, we've had a

00:23:54.900 couple of, of, of wins in that, in those stories. And, and it wouldn't have happened, I think, if I wasn't

00:24:00.500 acutely aware from my training of, of, of how, how disease affects people, and, and how the importance

00:24:10.500 of the brain and the nervous system in those connections and those responses, but it also

00:24:14.980 wouldn't have happened if I hadn't taken the time to spend years in the laboratory and learn the basic

00:24:19.140 science principles of how to, how do you do an experiment to take apart a complex molecular

00:24:24.660 interaction and break it down to the simplest, the simplest assemblage, and then reconfigure

00:24:31.460 it in a way so what's broken is now fixed. Beautiful. When I was deciding after my undergrad

00:24:37.860 what to, to go into, one of the things that I thought of doing was to do an MD, PhD, I was very

00:24:45.460 much interested in potentially psychiatry, just because I was interested in behavioral sciences and so on.

00:24:51.620 And the reason why I would have been interested in doing an MD, PhD is exactly what you intimated,

00:24:56.020 which is, I would have liked to, once in a while, you know, be doing the helping others. But I was,

00:25:02.260 at heart, I was somebody who wanted to solve puzzles. And so I thought that the MD, PhD would work out.

00:25:08.180 Later, I ended up not pursuing that goal, because I was quite disheartened, and you'll, you'll tell me if,

00:25:13.620 if I'm right or wrong, by the amount of what seemed to be quackery in the mental health professions in

00:25:22.420 general, right? So it went from all the Freudian stuff, where it was all environmental, mommy didn't

00:25:28.340 hug you enough, or maybe she hugged you too much, that's why you're schizophrenic, to completely the

00:25:32.900 opposite, where everything became pharmacological. And like most things in life, the sweet spot is

00:25:38.340 somewhere in the middle, a bit of listening to the patient, and maybe being empathetic.

00:25:43.620 And when need be, giving that pill is probably the right. So I could have followed you in that MD,

00:25:49.140 PhD, I know you didn't, you didn't pursue a PhD, right? You got you got your right. All right,

00:25:54.420 let's go back, go back to the book. And let me mention it again. I don't have the physical copy.

00:25:59.060 And I think your your assistant sent it to me, to my university address here, where I'm on leave from

00:26:05.060 my university. But let me read it, the great nerve, the new science of the vagus nerve and how to

00:26:10.660 harness its healing reflexes. Tell us all about bioelectronic medicine.

00:26:17.300 The book tells the story of something I mentioned briefly earlier, which is that signals in the vagus

00:26:23.780 nerve can turn off inflammation. And we made this discovery quite by accident, you asked about the

00:26:30.980 origin story in my own career case, the origin story of this accident is that we were studying

00:26:38.100 animals that had a stroke, cerebral infarction. And the idea was, the stroke causes inflammation

00:26:46.100 in the brain, which it does do. And we put a molecule into the brains of these animals to turn

00:26:51.460 off the inflammation, which it did do. And we were very happy with that. And that was what we expected

00:26:57.540 to see. What we didn't expect to see was when we put these molecules in the brains of these mice,

00:27:05.140 this is back in the 1990s, that the inflammation in the body of the animals was also turned off.

00:27:11.780 So this was a real head, a real head scratcher. This is a real WTF moment. Because there was no way

00:27:18.420 to understand how a molecule in the brain of a mouse would turn off inflammation in the body of the mouse.

00:27:24.020 And the key experiment came when we cut the vagus nerves that were carrying the signal from the

00:27:31.620 brain to the immune system in the body. And that was a real sort of, as I said in the book,

00:27:39.460 we don't say Eureka in the lab anymore. We say, holy shit. Because once we realized there were signals 0.99

00:27:46.340 in the vagus nerve that were acting like the brakes on your car to stop inflammation, then we realized we

00:27:53.860 should be able to make a nerve stimulating device, a small battery powered electrode, and implant it in

00:28:02.100 the vagus nerve of humans, because we already knew that could be safely done. As a neurosurgeon,

00:28:08.100 it was being done to treat epilepsy patients back in the 1990s, so it's safe. And if we could do in humans

00:28:16.020 what we were doing in the mice, then we should be able to treat conditions like rheumatoid arthritis and

00:28:21.460 inflammatory bowel disease. So back in 2007, I started a company called Setpoint Medical with a colleague from

00:28:28.020 Harvard named Shaw Warren. And now 18 years later, literally just a couple weeks ago here at my center, we

00:28:38.020 implanted two patients, because the FDA approved this idea as a therapy for rheumatoid arthritis around the

00:28:47.940 first of August. That whole story made the front page of the New York Times about three weeks ago.

00:28:54.500 Wow. And the reason is that this now is a therapy that will be available to people with a very

00:29:03.460 serious condition, rheumatoid arthritis, that's currently treated with very dangerous, expensive

00:29:08.660 drugs called biologics, things with names like anti-TNF and anti-IL-1. And these drugs, right now,

00:29:16.420 we're trading off the treatment of inflammation with these drugs with the side effects of immunosuppression.

00:29:22.420 And with the side effects of potentially going bankrupt, some people have to spend $50,000 to

00:29:28.660 $100,000 a year on these drugs in the United States. And they only work half the time. So now the question

00:29:35.140 is, will some of these patients who are not gaining benefit from these expensive, dangerous drugs, will

00:29:41.060 some of them have a immunoregulator, it's called, implanted in their neck as their primary therapy for

00:29:48.980 rheumatoid arthritis. And the early data are very, very promising. That's what's happening as we speak.

00:29:55.060 So how big is that device?

00:29:58.740 It's about the size of a multivitamin. It's less than an inch big. I mean, you could swallow it.

00:30:06.740 What's the energy? I mean, do you have to change the battery? How does that, is it like a pacemaker?

00:30:11.780 It is a, it's a fully self-contained device. It has a battery, which is fully rechargeable. So

00:30:19.620 it's implanted once for at least 10 years, maybe for life, you recharge it by putting a collar around

00:30:24.980 your neck and then charges right through the skin once a week. There's a motherboard that controls

00:30:37.300 the electrodes. There's an antenna that communicates to the doctor's tablet or iPad. And the electrode

00:30:43.620 sits right on the, on the vagus nerve. And the little device about the size of a multivitamin is

00:30:49.700 wrapped in a, it looks like a peapod, a silastic peapod. And the neurosurgeon puts one stitch through

00:30:55.540 the top of this peapod that closes over the device and holds it in place on the vagus nerve at about

00:31:01.380 the level of your Adam's apple through an incision that's an inch or an inch and a half long. Once

00:31:06.100 the incision heals, well, with your beard, no one would ever, would ever see it on you anyways.

00:31:10.500 But even if you don't have a beard, it, the incision travels in the skin creases and it's,

00:31:15.460 you won't notice it. You won't know anything's there. Wow. So in the ecosystem of bio electronic

00:31:22.340 medicine. So I mentioned, I guess pacemakers would have been an early manifestation of that,

00:31:27.060 the stuff that you're doing and to link it back to, we were mentioning briefly earlier psychiatry.

00:31:32.580 So I'm thinking, let's say about transcranial magnetic stimulation are all of these things that

00:31:38.340 I just mentioned under the general rubric of bio electronic medicine. Yes and no.

00:31:45.540 I would say that let's do pacemakers, cardiac pacemakers first, because they're historically,

00:31:50.340 they go back to the 1950s or so and that they're not really medicine, right? They're really a

00:31:56.260 structural thing that inner or an artificial hip, for instance, it's very structural. And in the case

00:32:02.820 of a, of a, of a pacemaker, you've got electric sparks, electric pulses that activate nerves that

00:32:11.060 activate the heart to beat, right? So that's not very drug-like. It's very mechanical.

00:32:18.980 What bio electronic medicine captures in its definition and what it delivers in its promise

00:32:24.980 is the idea of using devices to target nerves as drugs. So in the case of rheumatoid arthritis and

00:32:35.140 the immunoregulator stimulating the vagus nerve that we just talked about,

00:32:38.740 what you have is actually a drug target. So let's, let's pick a cytokine. Cytokines are inflammatory

00:32:46.420 molecules. They were much talked about during COVID. They have names, they're proteins,

00:32:51.780 they're made by white blood cells, and they have names like TNF and IL-1 and IL-6. So right now,

00:32:58.740 if you're a drug company, you might pick TNF as your drug target. And you say, I want to make

00:33:03.620 molecules that suppress TNF or neutralize it. You make your molecules, you screen them,

00:33:10.340 and then you prove they're safe and effective. And then you sell them and the patients inject them.

00:33:15.620 Bio electronic medicine is different. Bio electronic medicine says,

00:33:19.860 we're going to start with our same drug target, TNF, but we're not going to make drugs against TNF.

00:33:24.500 We're going to identify nerves that produce molecules, neurotransmitters that turn down TNF

00:33:32.660 in situ, in place. Then we're going to say, those nerves can turn off TNF. Now I can make a device to

00:33:40.420 control the nerve to turn off the TNF. And the device becomes the therapy. And that's what

00:33:46.900 bio electronic medicine is. So we've done this now to treat inflammation, as I said, in rheumatoid

00:33:52.500 arthritis, it also seems to work in inflammatory bowel disease. In animal experiments, it works in

00:33:59.220 multiple sclerosis, there's evidence from diabetes, there's evidence from other inflammatory conditions.

00:34:04.580 So we understand the basic principle for stimulating the vagus nerve circuits that

00:34:10.180 regulate inflammation. And there's a lot of work going on in laboratories around the world,

00:34:15.300 replicating all this, as well as in replicating and new clinical trials. But that's the tip of the

00:34:21.060 iceberg because there's so many other nerves in your body that are controlling the activity of

00:34:29.620 other immune responses in other tissues and other organs. It should be possible to work our way

00:34:36.420 through other diseases and conditions and target other nerves with other devices. So that's the field

00:34:43.300 we call bio electronic medicine. Okay, is it and forgive me if this is a dumb question. In much of the 0.97

00:34:50.820 responses you give the the I word always comes up inflammation. It should one presume then that the

00:34:59.300 the the bio electronic approach that is replacing in this case, the pharmacological approach is one

00:35:08.100 that is largely working with the cluster of inflammation diseases, or it could be pancreatic

00:35:16.900 cancer or whatever, something that doesn't necessarily involve, you know, an inflammatory response. Oh,

00:35:23.700 but bio electronics can also go down that pathway.

00:35:27.540 So, you know what I'm gonna say, right? I'm a scientist, and I don't I don't like to predict the

00:35:32.100 future. So we try not to presume anything, we try to form hypotheses, do experiments, and look at the

00:35:39.940 data. Now, the data for today are in inflammation, and many clinical trials have now been done. And as I

00:35:50.900 said, rheumatoid arthritis has has received FDA approval as an indication. But the laboratory data for

00:35:58.980 many other inflammatory conditions is very promising. And when you, when you approach the problem of

00:36:06.420 inflammation in a reductionist way, you go down the funnel, to look at the simplest, first principle

00:36:13.700 mechanisms, we know a lot about the first principle mechanisms of what causes inflammation and what

00:36:19.940 drives it. And that gives us the opportunity to connect those back to nerves that we can then connect to

00:36:25.460 devices. So that's a huge research opportunity. But about a two more important points.

00:36:32.500 When you look at the conditions that kill two thirds of the people on the planet Earth every year. So

00:36:44.180 every year, 60 million people die, according to the WHO, 40 million of those people die of conditions

00:36:51.060 which are related to inflammation, which is, you said sort of the big eye that is inflammation a unifying

00:36:58.500 thing. It is right now, because we can do the reductionist work, we can do the clinical trials,

00:37:03.220 and we can ask the important questions that affect two thirds of the deaths on the planet,

00:37:08.900 on the planet Earth. But maybe the most important answer is about the future is that

00:37:19.140 I don't have a crystal ball, and I'm a scientist, and I don't like to make wild guesses.

00:37:24.180 But if you know, besides the area of a pond, and you know what percentage of the pond is covered in

00:37:31.380 pond lilies, and you know that the doubling time of the lily pads appearing on the pond,

00:37:37.140 you can make an accurate prediction about when the pond will be covered in pond lilies. That's not

00:37:42.900 really predicting the future that's dealing with today, and knowing what the reality of the facts of the

00:37:48.820 matter are. So in that light, I'm actually quite confident that millions of people with conditions

00:37:57.300 related to inflammation are going to be treated with an implant, a small device the size of a

00:38:05.940 multivitamin to simulate their vagus nerve, or some other nerve in the coming years. I think this is going

00:38:11.220 to be a new way of thinking about how to treat inflammation. I think that process has started,

00:38:18.980 and I don't think it's going to stop. I think it's going to accelerate.

00:38:21.540 Nice. I saw you before we started our conversation. I tried to this morning listen to a chat you held,

00:38:30.580 I think with a fellow neurosurgeon. I can't remember his name, a gentleman from University of Miami.

00:38:34.580 And you, he asked you a question, which I'm going to ask again, maybe hoping for a different answer.

00:38:41.700 Uh, he had asked you, have you faced a lot of resistance that actually, I perked up when I heard

00:38:48.660 that because, uh, in my current book, so I'm writing a book right now called suicidal empathy.

00:38:55.220 What happens when you have a noble virtue, like empathy that becomes this regulated, you end up with

00:39:00.740 all sorts of, you know, foreign policy and domestic policy problems due to suicidal empathy. So I have

00:39:06.980 a chapter where I talk about things like what I, you know, settled science, right? As a form of

00:39:14.020 epistemological empathy, right? It's settled, shut up. And so therefore, you know, the orthodoxy says it's 0.99

00:39:20.500 this. And then if you're, uh, you know, a heretic, then, you know, we're going to ostracize you. And I give 0.96

00:39:28.180 a whole bunch of examples, many of which are from medicine. One, which of course you're undoubtedly

00:39:32.900 familiar with, Semmelweis, right? With the hand-washing probably saved more people than, uh,

00:39:39.380 most other working physicians, uh, in, uh, recorded memory. Uh, and yet of course it didn't turn out

00:39:46.500 well for him in terms of his lifetime. Now, the reason why I said, you know, because when that gentleman

00:39:52.660 asked you, you said, Oh, I haven't really faced any, any blowback. Do you still hang on to that?

00:39:58.260 And if so, isn't that surprising? Isn't it the case that whenever you have someone that's doing

00:40:03.060 something that is non-orthodox, you should be expecting blowback?

00:40:08.500 So I don't remember exactly the answer I gave before, and I'll try to give a, a different answer

00:40:15.380 this time or a similar one, but different. I think when I referred to not a lot of blowback,

00:40:20.820 I think that really was in the context of, uh, from the side of immunology.

00:40:25.140 Okay. So a lot of the work that I did, uh, and with my colleagues, uh, here at the Feinstein

00:40:31.460 Institute and before that at Rockefeller university in New York city, we were interested in unraveling

00:40:37.300 the basic building blocks of inflammation at the level of individual molecules. And I, so I spent years,

00:40:42.820 uh, identifying the, the, the activity of a molecule that I said before is called TNF.

00:40:50.260 TNF and, and how, if you block TNF with monoclonal antibodies, you can use these as drugs to treat

00:40:57.060 inflammation. And so when I migrated in with my colleagues into studying, uh, TNF as the target

00:41:04.740 of a monoclonal antibody to, uh, controlling TNF using electrical signals in the vagus nerve,

00:41:12.340 the immunologists were very surprised, uh, because the nervous system and the immune system were viewed

00:41:19.380 as sort of separate entities. They were firewalled from each other, but they, but they didn't have any

00:41:24.900 reason to not believe me because of the background I came out of from studying TNF for many, many years.

00:41:31.300 And I was a neurosurgeon where, what was interesting was I would say the, those that resisted this, uh,

00:41:41.220 idea, and there were many, they didn't come after attacking me. They, they just, they just didn't talk about it.

00:41:48.500 But, you know, if you, one way to, one way to, to, to, um, well, if, if, if your child is acting out,

00:41:56.340 not that any of my children ever acted out, but one way, one way to obviously to get, to get back at

00:42:02.580 someone who's acting out, doesn't have to be a child can be an adult at a cocktail party is to just ignore

00:42:07.460 them. And so there was a lot of people that did that. And, and frankly, most of them were in neuroscience.

00:42:15.620 The immunologists, the immunologists in their own way, they thought, wow, I think the immunologists thought, wow,

00:42:21.580 it's interesting. It's kind of cool. Um, have no idea if it's going to work and maybe, you know, maybe it'll work

00:42:27.380 and we'll hear about it someday. Well, that took 18 years or 20 years, um, to, to prove to everybody that, that it could

00:42:33.940 work on the neuroscience side. I, they, they didn't, I would say they didn't really embrace this until

00:42:41.540 the last five, five years or so, but now this space called neuro immunology, these relationships

00:42:48.980 between the brain, the nervous system and the immune system. It's one of the hottest fields in all of

00:42:53.460 science. I participated in a meeting just a couple of weeks ago here in New York city, hosted by, by, uh,

00:43:00.100 chaired by Brian Kim and David artists, two of my colleagues across town here in New York. And, uh, that meeting

00:43:07.920 was attended by like 300 people in person and hundreds more online. And that's a big scientific meeting for a new

00:43:15.440 field. So neuro immunology is now exploding and there's very little resistance to the idea that we're going to be

00:43:23.860 making lots of new therapies that are going to help lots of patients. But the obstacle now is the

00:43:29.640 classic barriers to adoption. You've got the early adopters, you've got the middle, the middle two

00:43:36.040 thirds, and you've got, uh, and you've got the late adopters or the laggards. And the reason I wrote the 0.79

00:43:42.140 book, I wrote the great nerve was to tell these kinds of stories because at the end of the day, with all due

00:43:48.920 respect, doctors don't drive big changes, patients and patient demand and patient activists. That's

00:43:56.020 how that's, that's what really drive change in medicine. And so I, I wrote the great nerve as a

00:44:01.820 way to be a resource for people who wanted to know what is the science of this great nerve? What, what

00:44:09.940 is the medical and therapeutic implications of this science? And where are we now with the FDA approval

00:44:16.340 for rheumatoid arthritis? And then third or the third part of the book, what, what can we do about

00:44:22.260 this at home? What about all the billions of web impressions that say, do this, that, or the other

00:44:27.440 thing for your vagus nerve? What's true, what's false and what needs more research? Yeah. I mean,

00:44:32.280 earlier when you mentioned, I can't remember in what context you said, oh, there are all sorts of

00:44:37.380 experts. And I took, and I think you might've even used air quotes. I take that to mean that,

00:44:43.160 so there's kind of a bro science where everybody is not a neurosurgeon and with your, you know,

00:44:50.060 scientific, uh, imprimatur that offers all sorts of advice. Is that what's happening in this

00:44:56.440 particular ecosystem? Right? Yes, that is what's happening. So there's reason why people point to

00:45:04.760 the vagus nerve as a way of, of, of, of, of maximizing and optimizing good health. And people

00:45:13.660 will come up to me after one of my lectures or, or write me an email and say, you know, I want to

00:45:18.660 stimulate my vagus nerve because that'll make me happier or make my heart healthier or stop my

00:45:25.260 inflammation. And I say, that's great. You have 200,000 vagus nerves, which one do you want to

00:45:29.840 stimulate and how are you going to do that? Because that's where it breaks down. So one thing

00:45:34.700 that's talked about is very, very popular, uh, is humming or chanting. Okay, fine. There's a vagus

00:45:41.840 nerve goes through your neck, sends off a few hundred fibers to your voice box, your Adam's apple, your

00:45:46.720 larynx. And when I'm talking to you right now, I'm exercising my vagus nerve. Does that mean I'm

00:45:54.800 turning off the inflammation in my immune system? Well, I don't know. Those are separate fibers.

00:46:00.260 Does that mean I'm regulating the glucose in my liver? Well, I don't know. Those, those are separate

00:46:06.500 fibers in the vagus nerve. I can walk and chew gum at the same time. And presumably you can too. And

00:46:12.100 that's because some fibers have some jobs and other fibers have other jobs. So at the end of the day,

00:46:21.360 when you chant, are you exercising your vagus nerve? Technically you're exercising the fibers

00:46:27.180 in your vagus nerve that go to your larynx. As I said, say it's 500 fibers. What are the other

00:46:34.460 199,500 fibers doing all the same thing? I don't think so. And that's the, that's the opportunity

00:46:41.700 we have now back to the analogy of how many fibers you need. If you're a mouse to control your lungs,

00:46:48.580 112, 120, it's, it's a very complicated system. And, you know, the first thing we talked about in

00:46:56.500 this, in this podcast was, can we, can we identify each and every fiber and what its function is and

00:47:03.080 what its path is? And today in humans, we cannot, but someday we will be able to, at which point when

00:47:09.200 we know all the maps and all the functions and all the origins and insertions of all the individual

00:47:15.100 fibers, we'll be able to, I think, do some very powerful things on the side of therapy.

00:47:20.400 Okay. One more question, because I want to be mindful of your time. We're coming up to the one

00:47:24.740 hour mark. One question that might be a bit out of your wheelhouse, but I hope you'll indulge me.

00:47:30.740 I'm going to try to tie in some of my scientific interests and see if it could connect with some of

00:47:36.420 yours. So I'm, and the reason I asked the question about the resistance, you know, from the

00:47:41.480 orthodoxy and so on. It's because, so I apply Kevin evolutionary biology principles and evolutionary

00:47:47.880 psychology to study human behavior. The idea being that you can't simply assume that human

00:47:53.060 beings are cultural animals. Our biology does matter. Now to you, someone steeped in biology,

00:47:59.220 it might seem like, well, no kidding. No, no. Who doesn't think that? Well, if you're called a social

00:48:04.860 scientist, you actually think that that's the most heretical thing that anybody could ever say

00:48:09.400 for, because for most social scientists, what makes us human is that we transcend our biology.

00:48:14.240 We are cultural animals. And so I spent my whole career fighting against social scientists because

00:48:19.260 I want to talk about evolutionary biology and how it helps us shape our behavior. Okay. So having said

00:48:26.060 that, having set that up, there is a field called evolutionary medicine that seeks to incorporate

00:48:33.460 evolutionary principles in the practice of medicine. Now it may or may not surprise you,

00:48:40.300 Kevin, that most physicians, including I suspect neurosurgeons are not trained in evolutionary theory

00:48:45.740 because they operate at the proximate level. Pretty much every single word you said, and when you're

00:48:50.920 offering some scientific explanation today, operated the proximate. The proximate means the how and the

00:48:57.020 what of a mechanism, how this works, which is perfectly fine. 99.9% of science operates at the

00:49:02.660 proximate. The ultimate explanation though, is the one that answers the Darwinian why, which is why

00:49:09.500 would it have evolved to be of this form? So having given you sort of this background as a neurosurgeon,

00:49:17.160 has there ever been an infusion of ultimate level thinking, whether it be when you're practicing

00:49:24.120 as a neurosurgeon or when you're tackling your research?

00:49:28.060 I think tackling the research, this has happened many times. This perspective has happened many

00:49:33.720 times. Well, look, Plato said it, right? Heal the soul, heal the body. Sick to the soul is sick,

00:49:38.640 the body is sick. I think what I've come to appreciate is you can have it both ways, if you will.

00:49:44.560 If you view the organized responding organisms as having sort of three components, you have the

00:49:52.960 reflexive components in the body that are reacting to changes in the environment. You have the emotional

00:50:00.220 component in the brain responding to those body changes, as well as responding to the thoughts from

00:50:09.700 the thinking part of the brain that can be generated. And it's a funny thing, but I tend to build an operating

00:50:18.920 model around the separation and integration of those three components, the reflexive components, the emotional

00:50:27.100 components, and the thinking planning component. But here's the key. And Charles Sherrington, one of the two fathers

00:50:34.380 of neuroscience, said it best back in the 19-teens in his classic book, The Integrative Action of the

00:50:40.800 Nervous System. He said the following. He said, you have to understand a simple reflex circuit. Reflexes all

00:50:47.120 begin with a change in the environment, with a sensory input. Second, the reflex sends a, the input signal

00:50:56.020 activates an output signal. It tends to converge back to the place of the input signal. Third, he said, you can

00:51:03.660 assemble reflexes together and build a complex nervous system, which means at the end of the day, there's no such thing

00:51:12.580 as a simple reflex, because all the nerves in the nervous system are connected, ultimately. Now, in the context of this

00:51:21.460 model, this behavioral model, or this reflex model, the part that's overlooked most frequently, I think, by everybody, not

00:51:31.500 not, not, not, not either extreme in your, in your, in your audiences, is that everything starts with a change

00:51:41.460 in input. So you've seen that you probably know this work better than me, but you put the professional

00:51:47.380 baseball player in a simulator, and you throw the fastball at him, and the muscles swing before he decides

00:51:55.680 to swing the bat. So in other words, consciousness, the conscious explanation of what's happening in

00:52:01.760 the body, and probably in emotions too, to some degree, is 400 milliseconds late to the party.

00:52:08.680 So once you understand that, it changes everything about how you approach behavior, you know, even complex

00:52:15.880 behavior. The, the, the, the inputs in the body can influence your emotional state, in a way in which you

00:52:24.920 are not conscious of. That's called interoception. And this is, this is one, again, one of the hottest

00:52:30.880 areas of science. It's part of neuroimmunology. Because right now, you could be sitting there,

00:52:36.480 you and I just met today, you seem like a very happy, optimistic guy. I'm a happy, optimistic guy.

00:52:42.060 But if we had a little inflammation simmering away in our liver, even if it didn't hurt, even if it didn't

00:52:48.040 have a conscious symptom, might that inflammation make you depressed or me depressed? Well, the,

00:52:53.720 the, the, the experimental evidence is absolutely yes. Wow. The presence of inflammation in the body

00:53:00.520 of an animal or a human can, can, by sending inflammatory signals into the system, into the

00:53:07.260 vagus nerve and other nerves, produces a state which is indistinguishable from depression and sickness

00:53:13.180 behavior. So is it fair then to say depression has to be treated in the brain with serotonin,

00:53:21.260 SSRIs, or with talk therapy or whatever? Maybe, maybe in some patients it's a top-down problem.

00:53:27.700 But the evidence is clear that in other patients it can be a bottoms-up problem. And I don't think

00:53:32.640 these, some of the models that, that, that we use today accommodate that in a cohesive way like,

00:53:40.100 like, like, like, like I'm, like I'm, like I'm answering.

00:53:43.620 Very nice. Last question. And then we'll say goodbye offline. Uh, you've written this book,

00:53:49.760 The Great Nerve. Could we ever hope to expect like Henry March, which by the way, I recently read his

00:53:56.120 book. I don't know if you know, do you know what that is? Yes. Yes, I do. Yes. A great writer and a

00:54:00.400 neurosurgeon. Exactly. And so I just read his book, maybe in honor of my son who, who was interested in

00:54:06.340 neurosurgeon as a 13 year old, but you know, in his case, he's talking about his clinical

00:54:11.080 tales, right? Uh, Oliver Sachs, who was a neurologist, not a neurosurgeon also became very

00:54:17.440 famous as an author, just talking about all these unbelievable cases that he, that he'd face in his

00:54:23.880 rounds. Can we ever expect Dr. Tracy to come up with a book where he blows us away with some of his

00:54:29.600 clinical tales, or are we going to stick to the hardcore science? So the Great Nerve has clinical

00:54:36.040 tales. And I tell them, I tell the story of patients that I've had the good fortune of meeting.

00:54:43.300 Uh, for instance, um, Kelly Owens, who famously, um, monitored and, and, and posted her whole,

00:54:52.220 whole life story in, in blog posts and in, in her own writing online and in private,

00:54:57.620 her story of, of, of, of facing the challenge of inflammation from inflammatory biology is Crohn's

00:55:04.100 disease that complicated, was complicated by serious inflammation in her, in her joints,

00:55:09.880 which looked like rheumatoid arthritis to make a long story short. Kelly was one of the first

00:55:15.780 patients treated in a clinical trial for a vagus nerve stimulation by the company I started Setpoint

00:55:21.600 Medical and she's in complete remission. And so despite having spent more than a million dollars

00:55:28.180 on various drugs that failed to help her, despite having spent years in and out of hospitals from New

00:55:33.740 Jersey to New York, to the, to Minnesota, to Hawaii and back, uh, what helped her was a vagus nerve

00:55:39.840 stimulator. And so her story, you know, I wrote it and it still makes me cry when I reread it. Uh,

00:55:46.180 it's a, it's a happy ending. What we hope from these stories is that the word gets out so that we

00:55:53.420 can shorten the adoption barriers, number one, and number two, so that people have access to, um,

00:56:01.060 calls to action and messages of hope. And number three, and, and, and, and perhaps very importantly,

00:56:08.200 that, that we can take all this, uh, in light of what, what we know today and what we still have

00:56:15.640 more work to do. Look, Kelly's story is a dramatic, I've met many patients with dramatic outcomes. It

00:56:20.440 doesn't mean these ideas or these therapies are going to help everybody. They won't. We know from

00:56:25.260 all therapies and medicine, some people have great responses. Some people have no responses to the

00:56:30.240 therapy and some people have okay responses, but we're early days. I'm very, very excited. And yeah,

00:56:36.200 at the end of the day, like you, the reason we all get to do what we do is, is not just for the

00:56:43.800 science or just for the medicine. It's, it's all about the patients. And you meet a couple of patients

00:56:49.280 along the way who, who feel better. And, uh, it's all about them. Well, you're a hero. Thank you for

00:56:56.840 all of your great work. Pleasure meeting you. Stay on the line so we could say goodbye. People get out

00:57:01.340 there and buy the great nerve. Uh, I'll, I'll be sure to read it. I haven't read it. I only

00:57:05.940 peruse quickly through it, uh, but I'll check it out. Thank you so much for coming on, Kevin

00:57:09.840 and come back anytime. Cheers.

00:57:11.380 Cheers.

00:57:11.500 Cheers.

00:57:11.540 Cheers.

00:57:11.580 Cheers.

00:57:11.600 Cheers.

00:57:11.660 Cheers.

00:57:11.720 Cheers.

00:57:11.800 Cheers.

00:57:11.860 Cheers.

The Saad Truth with Dr. Saad - September 30, 2025

Dr. Kevin Tracey - Neurosurgeon and Author of The Great Nerve (The Saad Truth with Dr. Saad_890)

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