"The hardest technology is behaviour change" - Daniel Kraft

[00:00:00] Dear listeners, welcome to Faces of Digital Health, a podcast about digital health and how healthcare systems around the world adopt technology with me Tjasa Zajc

[00:00:19] In this episode we're going to look at the current state of Digital Health and its potential with Daniel Kraft, a Stanford and Harvard train physician scientist, inventor and entrepreneur focused on accelerating much improved future of health and biomedicine

[00:00:37] at the convergence of accelerating technologies and human innovation.

[00:00:42] Daniel is the founder of next-met-health and digital.health.

[00:00:47] Next-met-health is a conference happening in San Diego this year in early December,

[00:00:54] and Digital.health is a sort of digital health formulary where you can find all the latest and greatest innovations in Digital Health.

[00:01:06] In this discussion, we actually talked about what Daniel is skeptical about when it comes to healthcare digitalization.

[00:01:14] What are the basic help practices that are potentially even more important than technology?

[00:01:21] Why is behaviour change key in improving health span?

[00:01:27] The current state of AI has been taught to home care and other trends that were seen in the industry.

[00:01:35] So enjoy the show and if you haven't yet, make sure to subscribe to the podcast and if you're a regular listener, do leave a rating or a review wherever you get your podcast.

[00:01:47] This really gives us some feedback and also ideas about how to improve and work in the future.

[00:01:54] Now let's dive into this episode.

[00:02:12] Daniel, hi and thank you so much for joining me here on Faces of Digital Health to discuss your view on healthcare innovation.

[00:02:21] You're known as someone who basically has the best overview of healthcare innovation like the craziest new things and ideas that are out there.

[00:02:32] But actually since before we started recording, you mentioned that you didn't have a lot of sleep and I'm quite tired since we've got the time difference and it's 9 p.m. on my side.

[00:02:43] What are your favorite innovations in the sleep space? What do you use to stay optimal?

[00:02:52] According to my ordering with my sleep score 55 today because I had a late flight from New York back to San Francisco.

[00:02:56] It's not often jet lag doesn't help but my favorite low tech innovation is just a good sleep mask. There's only simple things you can do a cooler room, a sleep mask putting your smartphone away from your bed.

[00:03:07] These are not high tech. They're just things we have to know but can be reminded to do and then of course I've got my or a ring multi human ring my apple watch and my loop and they all give me slightly different sleep score.

[00:03:17] I picked the one that gives me the most REM sleep.

[00:03:19] But it's a reminder that you don't need fancy things in health to do the right thing whether it's to work out to eat right exercise to have good social connection.

[00:03:27] Sometimes the digital tools that we can talk about can help you nudge their in those directions to give you virtual elements of those but nothing quite replaces sleep, but we are seeing some digital tools and technologies trying to hack your sleep.

[00:03:38] There's a couple now whereables that try and play music when you sleep. There's a few ones that are putting in not just sound waves, maybe some new forms of neurocimulation electric electricity is medicine.

[00:03:49] So I think it's been to get my six hours being worth eight or ten in the future.

[00:03:53] Oh that would be lovely. I would love to have that to just be able to do more, but I do agree with you that sleep is like the number one thing we need to be mindful of because it has implications in cancer in various diseases and I love the fact that you basically emphasize that many times it's important to just stick to the basics.

[00:04:14] Sleep eat, pre-divers food exercise and I one of the things that kind of fascinated me lately is I'm coming across a lot of articles and books that basically emphasize the importance of exercise as the one of the key things for longevity.

[00:04:36] What else do you see in the longevity space and this balance between being high tech and being just a worry well and actually doing something that are more simple and less expensive to achieve similar results.

[00:04:54] We are in this exponential high tech digital super connected age sometimes that can be a bad for health. We know I've got young kids that your mobile devices and social media for kids or adults can be bad for your brain and your sleep.

[00:05:07] I think there's a new emphasis I think I was always pushing against the term longevity. I'm here in Silicon Valley a lot of people want to live forever and it's a long time, but I think more people want to live to 120 and feel 50 60.

[00:05:20] I'm in this idea now that's in the site guys to being proactive moving and when you're younger and healthier doing the things that are going to maintain your muscle mouth, your bone, your brain, your immune system.

[00:05:31] I think it's a very important thing to do is to get a lot of energy and you can have that health span piece and not wait for the sick care model that we're so used to which pays for disease management.

[00:05:38] So back to the simple stuff, so exercise mindfulness social connection diet. The challenges we often know what we're supposed to do there's lots of studies. You can get presented with all the charts but it's really hard the hardest technology is often behavior change.

[00:05:49] And I think what's emerging in this new field of digital health is AI enabled, etc. I like to call it an AI or generative AI but generative health. This idea that if you're in Europe or California, if you're 16 or 67, if you like the color blue and you have a personality type that's an extra bird or introvert your health coach will know that it will know your.

[00:06:13] Your genome from when you've been sequenced, it will know your social and where you've been. I know that I'm jet lag from last night. My Apple Watch won't tell me what I'm sitting on a plane and the I'll window seat that's time to take a walk. It'll have context and it'll be most of this idea of your personal avatar. It might show up with the right music, the right nudges, the gamification that works for you to help you do those basic things and small changes a little more exercise, a little more steps a little better diet reminding me the right way without nagging you.

[00:06:40] Aligning you, you like points I like badges someone else wants social credit. I think that's going to be exciting part of this new age and we're seeing I think open AI with thrive and out some new platform that's going to be I think that next generation human coach meets digital health meets doing the basics. That's staying away from the metformans and the drugs in the gene therapy and those things that are sometimes still early sometimes snake or Lee in the mix that will if you stay healthy for next 10 20 years. I think some really amazing things will be that it will help stop and even reverse aging.

[00:07:10] AI we are moving away from the hype that was caused with open AI. So what's your currently favorite thing in AI applications? What do you think is not going to turn into reality anytime soon?

[00:07:27] You're also a physician so even from that perspective where do you see the most potential and also even with AI at the moment we focus on generative AI.

[00:07:38] And in the past we had this challenge of companies calling every algorithm AI or any computation AI. So where do you see the clarity in the space around AI in healthcare at the moment?

[00:07:52] As you mentioned there's often a lot of hype right and we all know more is law the power of exponentials are super computers getting faster cheaper fitting into our rings and wearables and inside of balls.

[00:08:03] But those my other favorite laws called Amara's law which in a nutshell is that we tend to over estimate what will happen in a couple years we over hype where AI is going to be in two years.

[00:08:11] Or another technology but we underestimate where it will be in a decade. If we go back at decade earlier 2011 or so we had IBM Watson and we thought we'd have Dr Watson in two years in a VR AI agent for medicine.

[00:08:24] So that was over-hyped over marketed. But now at decade later we know have multiple FDA clear products for radiology for example seeing all the evolutions of AI and drug discovery that are getting super exciting.

[00:08:35] So I think what's most relevant now it's still early days. There's the low hanging fruit of helping the doctor and nurse and clinician if we burn out with taking our conversations and making them easier to process when doing all this the grunt work.

[00:08:48] But the biggest gaps are where we can close the gap. I just invested in a company called Jeeve Health at India along with Andrew Aang and his AI fund where they're building really the ultimate AI doctor for the poorest India. Everyone at India has a smartphone even though one of the living slums or rural villages.

[00:09:03] And now they have no access to primary care. They could use smart tree eyes. They can speak in India. They can upload their labs or x-rays. They can tree eyes them to tell health or a real clinician when they need it.

[00:09:13] So there's big gaps and places outside of the US or Europe around where these things can happen. There's no lobby is the doctor.

[00:09:33] There's a lot of things to do with the research and health coaches in our pockets.

[00:09:36] So there's a couple of areas I think of converges.

[00:09:37] Just remember that we get excited about the one or two year view or only a chat GPT 40. It'll be 6.0.

[00:09:43] We'll make 4.0. It'll look slow. What might we see in a decade? How do you design your startup, your platform, your hospital system, your clinic,

[00:09:49] to be a little future-proofed to remember the exponential and Amara's law. And I just more is law.

[00:09:55] So you're designing a little bit ahead of where the puck is today.

[00:09:59] Which piece of technology is currently the most interesting to you?

[00:10:06] And I also, I mentioned that when you have presentations, you usually present a very broad and detailed overview of all the fancy interesting and unusual tech even.

[00:10:20] So how do you do that? How do you find and keep track of all these crazy things?

[00:10:26] Well, 10, 12 years ago I gave my second TED talk. It was called in the future medicine. There's an app for that.

[00:10:32] And back in 2011 there was maybe 10,000 or less health related apps. Now there's a 100,000 back in 2011.

[00:10:39] There were a couple of wearables that fit bit and only come up in 2009. Now we have hundreds of not thousands.

[00:10:44] So I built a platform to help me keep track and others called digital.health. You go to digital.health. That's the website.

[00:10:49] We have over 3,500 companies and solutions. So if you put it in depression, diabetes, a fib, practice management, robotics, you'll find solutions out there that you might want to use as a patient as a clinician.

[00:11:01] So I use that as a bit of a, if I see something new, I'll put it in the database and other folks are adding their solutions as well. That's one way I keep up.

[00:11:07] I still like you use social media, Twitter, read nature, New England Journal. I'm here at the Stanford campus today. I just met 15 companies, digital health companies from Canada who are visiting.

[00:11:15] So it's hard to have any one path. I think when medicine now is clinicians and as innovators, you can't stay in one little silo.

[00:11:23] And as I share this conference called next mental health, just be called exponential medicine.

[00:11:27] The magic has always been bringing people together and ideas from different fields from AI and wearables and robotics to send bio to psychedelics to chat about us to drones to nanotech

[00:11:34] and sparking the cross conversion. So I never have one favorite technology. It's often where you blend them together.

[00:11:40] And I can talk about some favorites that are blending them together as well.

[00:11:44] Yeah, talk about your favorites.

[00:11:46] I was always, I've been an early adopter of augmented virtual reality. I found all the Oculus's and I still have my Google Glass in my backpack and it's broken.

[00:11:53] But now it's getting magical. Apple vision pro is still a little heavy.

[00:11:56] But when I put on Apple vision pro and I sit with sent by my friend to see their sign. There's a platform called Ziya.

[00:12:02] It's a mental health platform. My wife is actually getting a master's in psychology right now. She tried it as well.

[00:12:05] So you go into that set. It's like you're in your living room or house. And then this smart robot pops up and it speaks to you.

[00:12:11] Remember, your name. Remember, it's your medical issues. You have a stress anxiety or clinical anything.

[00:12:18] It'll talk to you. It'll give you recommendations when you come back two days later,

[00:12:21] a real member can be homework. You can put you in a home meditative environment.

[00:12:24] So it's the first time I've had that experience of being in a very high resolution.

[00:12:27] Having another being, this case in AI enabled virtual robot that I had a clinical interaction with that felt very smart.

[00:12:34] It felt intuitive. It put a beautiful environment. You talk about sleep or flowers and you're being in a meditative room.

[00:12:40] And these will be tools not for a place or psychologists, but to maybe be the homework. They can help monitor you if you have a patient with that for a bit suicidal ideation.

[00:12:47] It might help report that to the clinical team. And that's not just going to be for mental health.

[00:12:51] I like to talk about that in the metaverse, but the mediverse where clinical interactions will be well beyond the zoom screen.

[00:12:57] And we'll start to blend the dallities and be more multi-modal. So that's one example where things are coming together.

[00:13:03] It's an example of AI for shoreality, smart systems, smart design thinking, and a platform built on real clinical evidence.

[00:13:09] What we saw after the pandemic wasn't that everything suddenly was managed through telemedicine.

[00:13:15] That was a little bit of a disappointment because it was expected that this is going to be the new reality.

[00:13:21] But what this shift is the increased interest into how we can provide more care at home and improve the experience through that end.

[00:13:31] Last year, next meta, Rassu Shresta basically talked a lot about the partnership between HM Health and Best Buy, which was really interesting.

[00:13:42] And I remember he might think or somebody else explaining to me that when because of COVID and burnout and everything, a lot of nurses went into stores because the jobs there are so much less psychologically exhaustive.

[00:14:00] Best Buy realized that actually they have a lot of medical force that can already learn or share a lot of their existing knowledge to expand this health care area.

[00:14:11] I actually wonder which parts of health care do you think are still going to stay in strict brick and mortar, in all the hospitals and facilities.

[00:14:23] You can't just, you can break down silos, you can introduce technology but you're not just gonna abandon the buildings that are already there, you just don't demolish those.

[00:14:32] So how do you see this change to the home at the one hand and basically the existing infrastructure that's not going to go away anytime soon?

[00:14:43] Yeah, quick question. We are moving a bit from hospital to home hospital like all it.

[00:14:48] And a lot of the dots are here now that trick is putting the systems and the incentives and the workflows together.

[00:14:53] At next mental health this December will have Jared Connelly who will share the hospital home platform at mass general hospital. So where I train a mass general now has hospital home program. They also have an emergency room at home program. How many emergency and urgent care visits could be managed with smart telehealth and right diagnostic and then right home triage kit for example.

[00:15:12] And of course health care is a continuum when I train at mass general. I don't know how many times we wait one extra day for that patient to get one more lab or wait one more temperature and of course hospital care is super expensive.

[00:15:24] And it's also not the best not the best place to get on some cases it's loud, etc. So can you just start to patient a date earlier that's an early model right now with patches from vital connect to bio intelligence.

[00:15:37] In some cases you never need to admit the patient the first place is many of the reasons we admit someone is to watch their vital signs.

[00:15:44] And the trick though is to get the clinician, the nurse that order flows the data to flow in a way that isn't overly taxing right no one wants to look at all the patients data and needs to be filtered and AI needs to be trusted for the right levels of alerts.

[00:16:00] So there's lots of things involved a lot of is more culture, payment models, regulatory and getting the clinician culture moving into this.

[00:16:08] Of course we still need hospital centers triage and right down the street from Stanford tertiary care but there'll be sicker and sicker patients there.

[00:16:15] And the ability to manage a simple pneumonia or already just charging folks from home from their or the big procedures which you stay there for a week.

[00:16:23] And as the money goes and the incentives flow and we get better outcomes at home without infections and demonstrate the ability for your smart phone camera to look at that wound and track the care you don't need to drive in and have your appendectomy scar looked at those will all show value and benefit.

[00:16:38] And it also means we need to train our clinicians differently who's going to go to medical school how do we train them in virtual versus physical care got fidgetal cared you need not just good bedside manner you need good website manner.

[00:16:47] We might need a whole new generation of workforce to smartly use these tools and often there's a lot of folks who're stuck in the old models that don't want to change because the dollars come to heads and beds.

[00:16:58] We need to change what will happen in some places in HS Kaiser geistinger where it's a pay viter rather than the ones who get paid for more hospital missions.

[00:17:08] One of the speakers in the recent episodes from Canada said a very interesting thing we were talking about business continuity and how when we talk about digitalization.

[00:17:17] We always focus on digital data gathering but many people are really not aware that systems go down in hospitals and for the business continuity sake for that hour half an hour.

[00:17:33] In some cases if there's a cyber attack that's even more days the processes go back on paper and what she mentioned is that she said now we have junior doctors that are trained with digital systems and they don't know how to chart on paper.

[00:17:51] So I think we have a very interesting mix of challenges when it comes to healthcare but definitely the increased need to for digital literacy is the number one I think priority in speeding up the adoption and affinity to using tech.

[00:18:09] But there's I want to raise the point that there can be a downside in digitization and AI enhancement so what I was a medical student and resident we used to handwrite our notes you'd think you had penned and brain to pencil you.

[00:18:25] You're still having time to use your cognitive brain to think to do a differential diagnosis now we're in the force in the era of chat GPT.

[00:18:34] And there's a quote from Sam Altman the founder of open AI said GPT is like an e-bike for the brain and now you see all these kids in my neighborhood writing e-bikes up the hill they're not.

[00:19:00] But we're not trying to find out the line on GPS or the doctor who trains with chat GPT never gets to develop a differential diagnosis by themselves and use their brain muscle so.

[00:19:09] And where is the convergence of where technology and our human abilities merge and how do we maintain our human abilities knowledge sets and blend those because usually AI with the clinician is better than one by themselves.

[00:19:21] So I think that's an open question and also how we get a trainer is the doctor's medical students of the future to integrate these tools when we don't need to memorize things like we used to.

[00:19:31] That might free up our brains for not just IQ but EQ better patient doctor relationship more even digital empathy whether we're talking virtually or in person it hopefully open up the ability for clinicians of all types to be more with their patients, but there are some downsize to technology as well.

[00:19:48] Definitely and I think I didn't mention before but it's important to emphasize that when we are moving to at home care a lot of that is happening because we are going into a bigger shortage of clinicians.

[00:20:04] And the system being overburdened so it's not that home care is ever going not ever but not it's not going to soon replace hospital care, but it is helping alleviate the pressure on healthcare systems and enabling that people who need care can receive it.

[00:20:23] If we look to the future of home care people want to age in place they don't want to go to the nursing home or the hospital.

[00:20:29] If you can imagine the art of the possible all these things are already somewhat here today the title cares of the world now the home.

[00:20:35] The home of a tester becoming home diabetes test or becoming home cancer test 10 years from now where could we be we should all have some blue to the component from our smart phone and medical to record.

[00:20:45] I actually helped to develop an exprisor in that we can all have a pretty low cost diagnostic device that does all our vitals tracks them over continuity of time including those from your wearable devices and their cameras and environments the trackland.

[00:20:56] We can have a smart dispensary right I vell.

[00:21:00] Technology you can watch my TED talk and tell them innocent 3D printing your pills at home so dispensing medications can be done with either the actual pill and maybe blending the medication you need.

[00:21:09] The voice as an interface you don't need you could be 99 or 9 and still talk to the AI health agent that could help you through things and then care still is humans we're not going to replace with robots quite yet the human or robots are getting there.

[00:21:20] How do we up skill the mother the home health aid it's not a nurse to use the AI to help make the early diagnosis or help triage or manage the therapy so this is interesting blend and I think those of us intervening and digital health and beyond need to be thinking about how to connect those dots and maybe creating some of those visions of the not so distant future to help the technology's merge.

[00:21:44] Here's a maybe tricky or specific question for you because you like to focus on the positives and like the positive aspect and vision of what health care could be and how technology could improve the situation what are you most skeptical about.

[00:22:03] You can still be every start by seeing an AI startups you could still be a little skeptical about where are the insights coming from of course bad data in bad insights out there's still in need to diversify our insights whether it's the genome or the metabolome or the digit so sometimes the claims are still a little bit ahead of the skis I'm still skeptical about.

[00:22:23] Or sometimes it's disappointing to see some amazing digital health companies for example digital therapeutics perhaps challenges if whether it's in diga or companies that never got adopted properly in the states because no one wants to know how to prescribe them or smartly pay for them.

[00:22:37] So it's often the business model sort of the challenge and here especially the United States we have so many misaligned incentives so many different scattered health systems.

[00:22:43] The harder part is getting your amazing technology innovation into the right hands and utilize to create the value so sometimes it's it's easy to get excited about the new.

[00:22:53] I think it's a very cool technology idea startup but how do you really plug it in and integrate it is often something not to be skeptical of but to be mindful of.

[00:23:00] I'm a stem cell biol stem cell biologist for more transplanted clinician think there's still a lot of hype around stem cell therapy and people going to.

[00:23:07] Care being countries to get stem cell therapy of all sorts for things that aren't well proven so while our folks are trying this longevity approach I think we need to be open minded and now allow people to crowdsource trials if you're going to try something new on the edge.

[00:23:19] Maybe that data could be collected in a virtual way and we can measure the impact and we can all learn.

[00:23:25] With x prize we just received a lunch to 101 million dollar health spent x prize to see about stopping and helping reverse aging and measuring that in the metabolic sort of muscle immune system and rain those are all challenging to measure how do you measure aging.

[00:23:38] So those are a couple things up something ahead that are still always challenging how do you integrate into actual solutions given the diversity of platforms.

[00:23:46] How do you prove it things work have the right data and insight especially an AI and then how do you not have too much snake oil in there that can sometimes be harmful and at the same time.

[00:23:55] Bring and now everyone to be a data donor so we can build these virtual smarter learning engines and not waiting 17 years from something being published in the general to being something that you and I can use or we can start to prescribe and bring to the impact at the bedside or the website.

[00:24:10] You just got me thinking how with very distinct this we discussed how convenience is such a top priority and important part of new technologies and delivering care but at the same time it's exactly what's also.

[00:24:30] I don't want to say making us more sick but it's definitely making.

[00:24:36] Staying healthy more difficult and I'm talking about process foods I'm talking about electric buys that you mentioned instead of biking to work if you are in a place such as in European cities in a lot of places you can actually do that in the US like when the distances are much larger it's not that practical to do that because then you would need.

[00:24:58] I don't know too much time spent on the road or using stairs instead of elevators so there's so many things that you can seamlessly embed in your life instead of sitting all day and then going for a half an hour run.

[00:25:17] And food as medicine was also one of the topics at next met last year so how do you see that the kind of relationship between how we design our policies, how we shape our society.

[00:25:31] Texas on sugary drinks and things like that to actually prevent us from needing patch solutions for the problems that you created for ourselves.

[00:25:42] Great question I think this is just a bit of an 80% of our chronic disease and our costs and morbidity and mortality is driven up by our genetics but by our bad behaviors not enough sleep.

[00:26:00] And we can start to measure these things for the digital tools but the behavior change part is hard and you mentioned that we're how do we do it's a lot of that design right food as medicine.

[00:26:09] I don't need to be medicine, but if you think there's been these studies where I think they did this at Google a lot of folks who've gained weight because they would go to the snack bar when they it's free food at Google and they started to put the sugary stuff behind.

[00:26:22] Hidden not out in the open there still there and that reduced calorie intake by several hundred calories a day or.

[00:26:29] And a cafeteria if you put your your salads up front in the beginning of the line it changes your salad intake versus at the end when you're played as already full so some smart design designing cities is adding schools do you have to walk is a way to walk across the park.

[00:26:43] Thomas gets spoke at next bed last year about his building age project which is also around designing your healthy communities whether it's your home your place of worship the parks so you make the smart decision.

[00:26:55] You don't have to take the bus because it's easy walking path so some of it is making it easier to design integrate those healthy behaviors into our daily practice.

[00:27:04] The blue the blue zones there often in villages where they walk every day till their 90 plus and so if you design social connection you design your cafeteria work to make sure people mix and mingle that sit neat and a cubicle.

[00:27:17] All those can be really impactful how do you provide meditation spaces all those things are design elements and even how you design the clinic and hospital future often.

[00:27:24] Lowed in noisy and you can make them with windows and quieter elements and ways to let people heal visit that all end up I think impacting health in subtle ways over the long periods of time so that's part of it.

[00:27:38] Yeah I think one of the interesting areas that still needs a little bit more exploration is the whole impact of the hospital experience on patient outcomes because we know that hospitals are scary and that creates stress and there's a lot of research done mostly on the challenges in ice use because of all the beeping and noises and some innovators have already tried to mitigate that with giving patients music so they can.

[00:28:08] Avoid all those sounds but yeah that's definitely still a lot of things to do research on when it comes to behavioral and kind of environmental changes.

[00:28:18] We are like close to wrapping up but I do want to pick into the program of what next met is going to bring to the audience this year in December.

[00:28:30] So if I just mentioned a few things that were presented last year there was a presentation on non-invasive deep range stimulation based on sound waves.

[00:28:39] It was mentioned that one of the wearables is developing a new digital sleeping pill meditation program specifically designed for cancer, menopause or cardiovascular disease, meriloo, japsen, the CO and founder of open water shared findings on the use of face of waves via interference to basically impact the global storm ourselves without damaging the healthy tissue and much much more.

[00:29:06] So can you be specific in sharing some of the things that many will probably hear about for the first time and we'll be able to learn more about in December in a San Diego.

[00:29:19] Sure for those of you who don't know I've been running since 2011 a program now called next met health where the theme is to bring people from all these different fields together to look at where things are going.

[00:29:28] It was called exponential medicine in 2019 and for every year we bring about 600 people from 30 countries together to see the art of the possible it's now near next and what's needed.

[00:29:37] This year is an amazing faculty coming that have never been going to have Larry Brilliant who's a famous epidemiologist help cure small proxies now working on precision health span engine called Evity and the epidemiology of aging among Jevity.

[00:29:49] He's an amazing spirit and soul. Dean came in this coming one of my heroes he's known for inventing the segue but he really started and is a medical device engineer expert and he's going to share some of the work they're doing in patches and medical devices but also his work on regenerative medicine.

[00:30:05] He shares the advanced regenerative medicine institute so that's exciting.

[00:30:09] Ed Boyd and will be there who's leading neurobiological engineering at MIT one of the co-inventors of after genetics and he's doing work across amazing neurotech including aware of what device it helps sleep.

[00:31:52] We have some other folks coming and look like Eric Topel is going to join us.

[00:31:56] I'm working on a few other surprises and we'll have our scientists go or beach bonfires some of those other magic elements and you got the next med.health and we'd love to see many of you there.

[00:32:20] Linked in. Additionally check out our newsletter you can find it at fodh.substeck.com that's fodh.substeck.com. Stay tuned!