Henry Peck 0:06
All right, thank you, everybody. So to kick us off at this event earlier in the week, we started our conversation with Dr. Stuart Hart. Mark Jessore. From Integra, we asked a question, you know, are we entering? Or are we in the decade of the brain and I think today, you're going to hear some perspectives some innovation, and some real impact that kind of soundly cements the fact that we we might be in that decade or we might be entering that decade. Before we get going. I'd like to first have the panelists introduce themselves because we have an incredibly esteemed group of accomplished professionals, innovators, neurosurgeons, and I'd like to give them the opportunity to to introduce themselves one by one, starting with Coach Singletary on my left.
Mike Singletary 0:46
Thank you very much. I'm just really excited to be here and and Mike Singletary, former football player, Chicago bear, and entrepreneur, speaker, and really loved the medical side of life right now.
Dr. Hunt Batjer 1:07
Good morning. Thank you, Henry. I'm Hunt Batjer. I am a cerebral vascular neurosurgeon. I got it this year, right. I've been called other things. And I have a strong affiliation to the Mayo Clinic, University of Texas Southwestern and University of Texas at Tyler. And this is a seminar about the underserved and to link head injury with stroke. Stroke is easy. And I also love the athletic part. I love Mike. And I was honored to be for eight years, the NFL, head, neck and spine co chair, as we put together a new paradigm to try to combat lifelong injuries and athletes. And then I'm even more empathetic, that I've had a fall of my own and a spinal cord injury. That, unfortunately, is been a challenge for the last several years. But I'm honored to be here with you today.
Geoffery Klass 2:12
I'm Jeff class and the CEO at since diagnostics. And we've developed technology that detects measures, monitor stroke and traumatic brain injury patients. Because we know if they got it, they're gonna get a chance that time matters. You know, it can't be an hour to treatment. It has to be measured in minutes and seconds. So it's very applicable to the discussion that we're going to have here today. And I'm really honored to be here with all of you. And thank you.
Bernard Bendok 2:40
Thank you for having me on bring up and Doc from the Mayo. I'm an ambassador, neurosurgeon at Mayo Clinic. And I'm interested in tele robotics, new technology to improve outcomes and for neurovascular and patients with cranial neurosurgical diseases, artificial intelligence and ways to improve how we practice medicine.
Henry Peck 2:59
Fantastic, thank you. So let's start in the world of athletics as a way to kind of contextualize this conversation when we talk about stroke, traumatic injury and injuries to the brain. Coach Singletary I'm sure as a legend of the game, a coach, a player, and more over than that a father and a family member. Many people approach you and ask questions like should I allow my child to play this game? Given the work that we've seen the research that's come out and a lot of what's been in the media around head injuries in football? How do you respond to a question like that from a parent asking should their child be able to play this game?
Mike Singletary 3:37
Well, I think when I retired from the game, never really thinking about traumatic brain injury and concussion and CTIA. All those things never really occurred to me. Until after I retired, and I started hearing about traumatic brain injury and things like that. And, and I just began to do a lot of research and study, obviously, it was of concern to me. And when I begin to look at young people, look, kids playing the game and starting tackle football at six years old and and I really begin to research and ask people, medical doctors about about that issue. Should Should I let my kids play? I believe we have a couple of sons and I wanted them to hear today and I wanted to make sure that I was doing the right thing. And so the consensus was, you know, let your kid grow until maybe you're around 12 years old, and by that time, the their their physiological structure, their brain and ligaments and bones have basically grown on. And now you can allow them the opportunity to play the game. And that's what we did. We waited till our kids were 12 years old, our son was 12 years old before we let them play contact sports. And because we didn't want them to have premature injuries, that their bone structure, we're gonna have a difficult time continuing to grow. And so that that was very important for us.
Dr. Hunt Batjer 5:29
Guys, because you have a follow up question, Mike. You're you're at a at a meeting of community meeting. And a woman comes to the microphone. And she's asking you a question about her son, and she lives in a, an affluent suburb and North Dallas. And she said, Mr. Secretary, my son's a ninth grader, and he really wants to play football. What? And I'm going to go see the coach, what should I ask the coach? What's important to know? Wow.
Mike Singletary 6:06
These days, I think it's really important. When you talk to a coach, particularly that age young football players, does that coach really care about the health of the kids? And before my Son, or whomever I'm always looking at? How would I answer that question? If, if it were my son, and if I'm talking to a coach, and he said, Hey, you know, we're about winning, we have a winning tradition here, we want to go out and, and that's what we're going to do. That's what we're here for. And I'm thinking to myself, You know what, this is not the coach for my kid. I really believe that. In America, we've gotten, we've gotten away from what's really important as a coach for young kids. I think for young kids, we need to allow our kids to go from one level to the next healthy, we need to make sure that they're healthy. First, we need to make sure that they're they love the game, they're positive, we're teaching them about the game. And it's not so much about winning, we'd like to win. But that shouldn't be the driving force. As they get older, and you know, we have a chance to get a scholarship have a chance to make money. Now we should focus more on winning, but when the kids are young man, let them grow, let them have fun, teach them how to play the game. And then hopefully, later on, they have a chance to win a game.
Henry Peck 7:41
And as we talk about, you know what that parent might want to learn from that coaches. Dr. Baker said, you know, maybe you're talking to somebody in a community like Dallas, how might the perspective change or what kind of data exists that shows disparities and what you might hear from that coach if say, the child or the child's school, they're playing in a suburb 30 miles east of Tyler, Texas, for example. We'll meet after you can give it a shot.
Mike Singletary 8:08
I thought that debate you know, I think that first of all, is the question lends itself to when I think of myself playing football, The Sandlot game, man, I love sandlot football. And I love sports where there were no referees, there were no parents at the game. There were no fan that the game booed against nine years old man, let the kids you know, have a chance to learn how to play the game. And so I just think that these days, what we know now about the game is so important to have someone a trainer, someone who has some kind of health background, in case there is an injury on the field in case there is a head injury of any sort. Someone that is there in likelihood in in an area where there's an affluent area, middle class, what have you, they're more likely to have someone there that can understand and can detect a concussion. Whereas kind of where I grew up there you're just out there with the kids. And if a kid has a concussion you go on the sideline. Can you see this? Can you see that? Okay, good. Let's go back in the game. Big difference. So that that really is the biggest difference in in the game coming from a an affluent area, middle class area basic versus a poor area.
Henry Peck 9:56
And we'll use that as a as a nice launchpad to Talk about kind of access and global disparities. But one last point kind of on this perspective, Dr. Batjer, when we talked about bringing this conversation to the event, one thing that you made sure that we knew is that coach Singletary thinks very differently than a lot of the other contemporaries in this field. And I want you to add a little bit of perspective to that for the audience. What did you see kind of working with the league, and what is so different about his perspective compared to the others that you interact with?
Dr. Hunt Batjer 10:26
It is it is night and day, when the winner for early in my experience was Mike, he, he came to me we were we were at a Hall of Fame event, where he was hosting a medical meeting. And one of the things that was was distressing him was that some of his idols from childhood, were coming up up to him at the Hall of Fame events and, and not able to, they're asking the same question over and over. And then they would have trouble finding their chair for dinner. And that was really distressing to him and it. And I've noticed that in the way he reacts to parents, to kids, to the whole concept of what, what an athletic leader needs to be focused on. And that's you, that is who you are, and you can't help it. And God bless you for it. But that's not the rule. And I think it's important for everybody to remember that that is not the rule. And it's about it's more like the coachee described, we're here to win any questions. And so that's what I encountered when I started out with the league. Thank you.
Henry Peck 11:41
Thank you. Let's go over to Jeff and Dr. Ben doc, as we start to kind of look at the technology and the solutions in this space. Jeff, can you get us current on Sense Neuro Diagnostics, what's happening here and the Dr. Pandoc, a little bit of the work that you're exploring the technologies that you're looking at from the Mayo Clinic side?
Geoffery Klass 11:56
Sure. It's since we've been working hard to get ourselves to market. And we will be clear to the FDA this year, and going commercial sometime early next year. But the technology we're bringing, you know, to the field is so needed, because patients you know, people that suffer a TBI errs suffer a stroke, you have to measure the time to treatment in a matter of minutes, it can't be in a matter of hours. So where you live, shouldn't have any impedance on your access to the right kind of treatment. And that's what we want to bring to the market, we were bringing them technology, that when an ambulance comes up in, you know, the rural part of Texas, that patient is going to get detected for exactly what's going on. So they get right to the right facility to treat them as quickly as possible. But the same as in the inner city, you know, they should have access to the exact same treatment that everybody else does. But an ambulance comes up, they pick people up and they just bring them to the nearest hospital. And these hospitals aren't really equipped to handle that condition these people have. So you know, you're some of you may have heard about mobile stroke units, you know, and they're around and a lot of the urban centers, and they're great, nothing wrong with them, they cost a million dollars, and they cost 2 million a year to outfit them and operate them the device that we have, which is going to really detect stroke by subtype and bleeding. The headset only cost $200. So for 2 million bucks, you can really buy a lot of $200 headsets. And why should you not be able to turn every ambulance into a stroke unit by using such technology. Because for us, it's all about getting this patient from where they are into the hands of Dr. Ben doc and the great things that they can do.
Bernard Bendok 14:01
Thank you, you know, Henry and I were reflecting earlier this morning about how we're now in the decade of the brain. And I will take it a step further further in that we're in the decade of cognition. Because humanity is moving away humanity made its living for the last since forever. In manual labor, that's how most human beings are in there, keep going forward, robotics, AI, that's all going away. And so we need to reinvent ourselves as a species. So when we look at outcomes in the hospital, back in the 50s and 60s, if our predecessors had somebody walking and talking that was good enough. They could move their arms legs, they could say some words, that's good enough. That's not good enough anymore. But we've got to get people back to being able to use their the mind part of the brain, not just the arm and leg movement, not just speech. So our bar has gone way up. So what does that mean? We have 12 million strokes worldwide per year at least Since a conservative estimate, we're not really measuring in Africa. So it's, we're probably missing several million of those 10%, or one to 2 million involve occlusion of a major brain artery, just like you do in the heart. So clot travels up, lodges in a brain vessel and you are out of luck, you are not going to go back to a cognitive job after that, you'll probably be in a nursing home if you're or you're probably going to pass away. But if you can get to a hospital within an hour, so if you happen to live by the Mayo Clinic, or, or Northwestern or one of these are UT Southwestern, and you are close, and you get to the right team, you got that clot removed. Now with the beautiful technology, many companies in the room here are are involved in this, you can patients gonna wake up and start moving again and you preserve their cognition, the brain is about a trillion billion 100 billion neurons, trillion connections, and you're losing several million neurons a minute. So your operating system has been degraded from Windows 12, Windows 11, Windows 10, back down to, you know, Windows 95, and so on to Henry. And so 1/3 of them. So let's forget Africa for a moment where you basically have nothing in terms of resources and manpower, human power, United States, first world country 100 million American 1/3 of the population cannot access a stroke center within 60 minutes. That means they're going to have a bad outcome. So when I'm gonna call it Mayo Clinic in Arizona, if I get called an ambulance is coming from downtown Scottsdale, they're going to do well, I get a call, they're up in the Flagstaff the mountains of Arizona, we're gonna go through the motions, you still got to treat them got to cross the t's not the eyes, they are not going to do well. So we've been involved Dr. Baker and I and others on this panel been involved with technologies with neuroscience to try to make that as it because currently today in the United States, your ambulance, your wonderful EMS team, they're doing wonderful work, are obliged by law to go to the closest hospital, but that may not be the right hospital. So you wind up at the wrong hospital, and it's game over. Because by time you transfer to Mayo Clinic, it's four or five hours and we're gonna be able to help in most cases, the window starts to close rapidly, you're losing millions of neurons a minute. And so now with better devices and ambulances to tell us what kind of care does this patient need, maybe using AI to make smart decisions on the fly telemedicine in the ambulance. And if that can't happen, maybe we extend our capabilities across Arizona across the country, maybe even to other countries with tele robotics. And we've been involved with some really cool research. This is very recent, where we can now navigate these devices into the brain. And we did the longest distance experiment in December. And about a month ago, we navigated wires and catheters from Scottsdale all the way to Zurich. And we were able in 20 models 20 simulations, extract clock, and to me it was almost faster than being in person. And as I tried the apple immersive heads up display a couple of weeks ago, there's going to be very little distinction very soon. You all know this between reality and remote presence. And I think I'm very excited about what I've seen what our lab has been involved with what I've been working with Dr. Baker on. And I think that for the first time in human history, since Hippocrates, we've been we have not been able to scale healthcare, it's still a history and physical patient has to wind up to you by chance, if they're lucky that so people sometimes retire in these remote areas. I always tell people, you got to retire near a good hospital, you can't be retiring. And and and so for the first time in human history due to AI and robotics, we're going to be able to scale healthcare skilled neurosurgeon. I'll end with this comment that you'd be surprised at 70% of my time is spent doing things that I didn't need 17 years of education to do, charting, documenting, seeing patients who don't really I'm happy to see them. I'm cordial. And I'm delighted to see everyone but I don't they probably didn't need to be in my clinic. So what if we could with AI and robotics? Have me see the right patient at the right time? And now I've got half my week available to do tele medicine tele robotics, to be able to scale our capabilities to we'll get to Africa for sure. But what about rural America where the outcomes are pretty much on par with developing countries in terms of lack of access to you know, cutting edge health care? So thank you for allowing me of the comments.
Dr. Hunt Batjer 19:44
Just went on to come at Barnard the for us a major event occurred in 2015. And that is for randomized trials showed that endovascular interventions, surgical interventions and After an immediate stroke, made a big difference in outcome. And what what we know now is that the data over the next four years after that seminal event showed that in the United States, that impact has been very, very modest. And in fact, in roughly a third of the areas of a map of the United States, the incidence of either thrombolysis, or thrombectomy, that Bernard was referring to, has is either the same or worse than it was before. And that means one of two things need to happen, we need to fundamentally reorganize the way our health system works in the accreditation of stroke centers. Or, or if we don't think we can move the Rock of Gibraltar in three years, new technologies, and that's what this work, they'll say, the NanoFlex activities with the robotic remote treatment that can be done on the space station, with a patient on the space station and the surgeon in feedings. That's not a problem. The end and with this technology that Jeff referred to, you've got a monitor that can be put on at the moment of pickup, and that would go with the patient to wrap their critical care, regardless of the country they lived in. And I just think this is really an amazing opportunity that the new technology that we have now, that is ready, in a shocking period of time, is going to be a fundamental one affecting the world of the underserved.
Geoffery Klass 21:52
I think it's, you know, it's important to note that the cost of Miss treatment of stroke and traumatic brain injury, you know, the poor outcomes, it has an economic impact on the US healthcare system of over $300 billion a year. That's a tremendous number, and the population is aging. So the incidence of stroke and traumatic brain injury is only going to keep going up. So we've got to absolutely do something to improve these outcomes. So speed is the answer. We're speaking with people in Australia, they have a feeling that if they don't fix the problem now that it could, in effect, bankrupt the country, you know, in the near future. So you know, it's, it's a problem in the US, it's a problem in, you know, Australia, but Canada, India, the continent of Africa, they're no different than each other, you have technology and urban centers, but you have a massive landmass that has absolutely nothing to treat these people with, to diagnose them to understand who needs to get flown in, who needs to stay home, you know, and we have, we have a big challenge here. And we have to get at it and address it now. Because really, speed is of the essence, not only, you know, for the patient, but also for what the cost this is going to have on our, you know, on our income our systems.
Henry Peck 23:18
So, Dr. Bayesian, I know I'm working with the windows 95, Microsoft Clippy operating system here, but from what you guys are describing, to me, it sounds like you're putting together a really rich continuum of technologies and of care here in the US and abroad. You know, as we talk about AI, robotics, digital, some of these advanced technologies, I think a lot of us often hear kind of questions around the adoption of cloud, you know, what will clinicians adopt here in the US and what may fit into the existing infrastructures and business models? And I'm curious, too, I'll go to you first. And I know return joke is definitely coming. And then we'll go to Dr. Ben, Doc. But tell me kind of how you see your colleagues responding to this and how, you know, some commentary may be on how the global clinician audience may think differently than the clinicians that are, you know, blessed to work at Mayo and UT and in some of these more well resourced high infrastructure areas.
Dr. Hunt Batjer 24:13
Don't hurt me? No. That's, you know, there's, there's, it's easy to be a naysayer, because there are regulatory issues. There's good samaritan laws would if somebody's going to put a catheter in an artery in a rural area in America or in Nigeria, or in Afghanistan, for example, would they be protected under? If if an inadvertent event happens and the patient passes away? Are they liable? We've got to get that sorted out until COVID helped us a lot in telehealth because telehealth offers us the opportunity that Dr. Ben dock when he's doing a procedure on a phantom patient in Zurich, Switzerland. He's in the room. He's one watching every bit and talking to the physician or the technician in that room and Zurich, in the same way that we did with COVID, when patients from all over the country were being seen remotely, and that's, and that's something that could actually work. And Mike's situation for the, for the child in an underserved area, where a an athletic trainer could be by telehealth, seeing the game interfacing with with the child, and monitoring and taking care of him or her during that injury recovery, so that we have the technology to cope with those matters that you appropriately bring up.
Bernard Bendok 25:45
Yeah, you know, I have a colleague in Phoenix, who spends part of her time in Africa helping her. She she grew up there, and she became a neurosurgeon. And, and she mentioned she made a comment that I think has stuck with, you know, was very insightful in that here in the US, we're always trying to debate, are these technologies actually dangerous? Are they good for us? What will it do to my job, you know, so if you're a radiologist, last thing you want to hear is that there's a new paper showing that AI can read a scan better. On the other hand, in some of those countries, what they'll tell you is we can't wait because we know we can Africa right now to do to even meet their minimum needs in neurosurgery, for example, they need another 9000 neurosurgeons, that's not happening anytime soon. And that's maybe just to cover basic trauma. So you're not even counting all the things that actually need attention. So in countries with limited resources, and again, we can go to rural America is another area of need, you need the technology, you're never going to be able to have comprehensive stroke centers at every of the 5000 hospitals in North America, you wouldn't be able to train enough people, there wouldn't be the economics to support it. And so I personally am very optimistic that I'm very excited about how this is going to transform healthcare and a good way. We're, you know, as I think about it, me and Dr. Baker in our careers, I did some rough numbers, we each probably, I suspect he did about 10,000 surgeries in his career, somewhere in that ballpark. And that's probably what I'll wind up doing. That's a small village. But if you can train other people, if you can extend your abilities with AI and robotics, you can start to affect hundreds of 1000s of patients. As they say, if you want to be a millionaire, you have to change change a million lives, if you want to be a billionaire, you have to change a billion lives. So you think about that in terms of impact, it's in a spiritual sense. If you really want to change the world, as a doctor, you you've got to embrace these technologies, that's my view.
Henry Peck 27:42
Kathlyn be thinking about your technology, as you prepare to go commercial, get it in the hands of more people, what's going to be needed to get it, you know, into these into these underserved areas that Dr. Ben doc and Dr. Batjer are referencing both domestically in rural America and abroad in some of these underserved countries and be saying more about kind of the the plan to get it there.
Geoffery Klass 27:59
So the plan is, you know, we're engaging ourselves with the thought leaders, you know, like Dr. Ben doc and Vasia. But the thought leaders in Canada, the thought leaders in Germany, and thought leaders in Australia, because they're the ones who really understand, you know, the problem and the magnitude of that problem, but understand that the solutions have to be extremely innovative. And they're the ones that are going to push these technologies out into the field. And without their support, you know, it wasn't gonna work. But they're gonna be able to help make the argument to help really promote those kinds of things that people need, you know, ultimately, everybody deserves a chance. And where you live, shouldn't dictate whether you're going to have a good outcome or not. Right. And so the thought leaders that we've been speaking with, they understand that, and they really support what we're coming to market with. And that's what we need. We need two people to understand what the problem is. But those people don't understand what the solution is to take what we've got what we're all working with here on the whole continuum of stroke, and traumatic brain injury, and they push the solution for us. So we're engaging the thought leaders to really make it happen globally.
Bernard Bendok 29:18
Can I give an example. So 10 years ago, as we were trying to make decisions on which stroke patient to treat, you can use time as a measure. We can also use brain perfusion much like you do with a heart you get a stress test and see what part of the muscle is being supplied. And we knew we've known for 20 years that if you if you have good quantitative perfusion data blood flow data from a scan a CAT scan, you can make good decisions and recognize what part of the brain is dead irreversible. What part is just stunned by living on the margin. But to do that, you need your that one out of 20 radiologists is only available on between Monday and Wednesday between 10 and noon. So how do you get a 24/7 stroke doesn't know time of day or night. So there are companies out there now I want just to avoid bias, you know who they are who now, right to my smartphone patient comes here with a stroke or, and I can see their exact perfusion map, this is my son actually. But you can see the perfusion map and make quantitative decision, this patient will benefit, this mission will not benefit. No human being this, you couldn't hire enough radiologists to cover 24/7 to be able to do that. This isn't Mayo Clinic, let alone you know your other hospitals out there who are more resource limited. And then forget about countries that are just developing and trying to feed their poor and take care of, you know, immunizations. So with with this kind of technology now and you bypass the human being completely it goes from scan right to my phone, there's no human in between. Usually the I got a call the next day saying hey, did you see that scan? Yeah, it's patients already out of the hospitals. And so I think it's an exciting time to embrace new technology. And I think what you're doing is bringing it, I have it in the hospital now with with these technologies, you're bringing it to the ambulance. And so the future of healthcare is no longer the concrete building. It's the ambulance, it starts in the home. So there's a physical environment. And then there's the virtual Hospital, which is worldwide potentially. And that's where making this ambulance, a smart ambulance, rather than just a flip phone ambulance is really where it's gonna go.
Henry Peck 31:33
Coach Singletary I want to come to you to kind of bring us home and in summation a little bit on this session. So we're talking about tele robotics, AI, telepresence in surgery and in care, talking about advanced diagnostics. And where we started was with the family member, the actual people affected by this technology and the people that you interact with and the communities that you think about. This is your second year joining us here at the event. And we're thrilled to have you and the community in the discipline that you represent. Can you maybe bring it home and tell us a little bit about how in hearing all this innovation that we're talking about in these bold ideas from doctors, Min doc in Asia and Jeff, how you think about that translating to the real world and what you leave with and carry back out as you wind down the event.
Mike Singletary 32:19
I think first and foremost, being here. You gives me such tremendous hope for our future. And I got back to my room last night. And you know, even last night, it was a lot of a lot of excitement, a lot of chatter, a lot of conversation. And I'm looking at this and thinking about this, and I get back to my room and I What does that remind me of Matt is and this you know, this morning, I thought that's the locker room. It's the locker room, you know, football players, you know, being a football player, you can't wait to get to the locker room. Because that's the safe place. I'm in a place for everybody that does what I do that that that is a part of the same thing. You understand my world you understand what I'm trying to do. And so twice I've been here, and there's such a buzz and there's such a excitement. And for me, I'm sitting back and talking to Dr. Bader, I have no idea what he's talking about half the time. I'm just gonna I'm just going to do okay. Oh, wow. That's amazing. And but at the same time, when I'm leaving, I'm thinking, wow, I can't wait to get back in contact some of the connections that I have to figure out a way to try and make this happen figure out a way to try and take this to the next level. But I'm just very encouraged. And I've always been intrigued by medicine because I played a game. And that game, you know, made a lot of difference. You know, those fans screaming and what have you but what everybody here is doing if you have any success at all, you're changing lives, you're saving lives. And to me, that makes all the difference in the world and that makes it worth my time makes it worth my while to be involved in what everybody here is doing. And my buddy here, Dr. Bajur he the piece of work but but making a tremendous difference one day at a time.
Henry Peck 34:49
Thank you and Dr. Basil, we'll go to you to share any closing thoughts and bring us home?
Dr. Hunt Batjer 34:55
Yeah, I think it's I think the thing that differ MGH people that come to places like this from, from the rest of the folks in the world is is something intangible, you know, there's, we all are required to put bread on the table to feed our family. But the people that go into these fields have something else, there's some deeper force driving them. And it's and it's doesn't have, there's no dollar value on it. Nor are they there for $1 for it, as Mike, very nicely articulated, it's there because it's possible. And it is a way to truly make a contribution that will live on. And maybe I'm more sensitive to that at my advanced age of 72. But the the idea that we are creating a momentum behind great minds that we're all experiencing at this at these sessions that could catch that infection and carry it on and impact a pyramidal number of people and humans worldwide.
Henry Peck 36:15
Well, thank you all so much for joining us again for the second year of this conversation and hopefully to many more and to the innovators out there to want to get in touch and continue to to work in this space and leave that lasting legacy that you guys talk about. Thank you so much everyone for joining us and enjoy the rest of the event.
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