Integrating Mental Health in Chronic Disease Management - Episode 303

Found is a new set of clinical protocols for chronic metabolic disease. That's going to turn out to be a brand new subspecialty of medicine, which is how you treat chronic metabolic disease. We actually changed someone's fasting blood glucose by 100 points from one week to the next because they were only eating ice cream and drinking chocolate milk and we changed the flavor of ice cream and that improved their blood glucose fasting seven days later. The big story for us is how do you reverse chronic metabolic disease, which would be type 2 diabetes, hypertension, serious CHF, and how do you then apply that to things like pulmonary disease and even steroid utilization to get people off of steroids more quickly?

Welcome to the Gladden longevity podcast with Dr. Jeffrey Gladden, where our passion is helping you to become an a checker on this show. We want to help you optimize your life energy, longevity, health and human performance with impactful and actionable information by answering four questions. How good can we be? How do we make 100 the new 30? How do we live well beyond 120? And how do we live young for a lifetime? Now here's today's episode of the Gladden Longevity Podcast.

Welcome everybody, to this edition of the Gladden Longevity Podcast. I'm your host, Dr. Jeffrey Gladden, and we're here answering the big questions in life. How good can we be? How do we make 100 the new 30? How do we live well beyond 120? How do we live young for a lifetime? And how do we develop a 300-year-old mind? You know, when you think about answering those questions, one of the biggest issues that people have are the implementation, the recommendations that come out when they do testing or when they start to go down the pathway of understanding things that should change in their lives in order to facilitate their progress. And today I'm going to be joined by a PhD, Dr. John Oberg, who's in Austin, Texas. He's a fascinating guy who's developed systems around actually helping people to implement, looking at it through the lens of both the practice, the medical practice, and also patient, you know, client, if you will. I didn't know what to expect when I went into this podcast, but it becomes really a fascinating conversation. I think you're really going to enjoy hearing what we have to say. It's not a terribly long podcast, but it's incredibly insightful. So enjoy this podcast as much as I did. Welcome everybody, to this edition of the Gladden Longevity Podcast. I'm your host, Dr. Jeffrey Gladden, and I'm here, as you know, with Dr. John Oberg. John is in Austin, Texas. We're in Dallas, Texas. So I guess technically we're doing a Texas podcast today.

It's good, I love it. And I gotta get to Texas. Meet you in person.

Yeah, there you go. We're not that far off. I've got to be in Austin later this month giving a talk anyway. That's great.

Let's find a way to get together.

Yeah. Cool, cool. So tell us a little bit about your journey. I know you have a passion for behavioral change and its impact on health and the healthcare system and people that are in the healthcare system. Tell us a little bit about how you got drawn into that loop.

Yeah, a little bit by accident. So I started early in my career helping with change management in a corporate environment. And then in 2014, I was trying to fix the way that healthcare is paid for. We started a medical cost sharing organization and we're pretty successful with that. But it really hit home a few years ago when my mother in law ended up in the hospital with diabetic ketoacidosis. That was totally kind of unnecessary in the sense that had she just had the right insulin amounts injected for a couple days, we wouldn't have had the problems we had. And you know, I had, I had a really hard time getting a hold of her provider on the phone. And it wasn't really her provider's fault. I have since met her provider, have a ton of respect for the work she does. And it was just the system is really, really tough. And so I went back and I called my friends at USC and I said, hey, I want to come back and I want to get a doctorate and I want to solve this whole type 2 diabetes thing. And they kind of laughed. Yeah, we've been working on that for 60 years as a world. And so we'll take your money, you can come try to get a degree. But type 2 diabetes is going to be here for a minute. And so we did our first clinical study, took 50 patients who were very low income, very low access to care. Their average A1C was 9.6. And in 12 weeks we had their average A1C to 6.4. We kept 83% of the group in control for the next two years with no hospitalizations. And I think everyone's eyebrows kind of raised. They're like, how did you do that? What's just happened here? And it had to do with the medicine and the mental health and the behavioral change and then a number of other kind of non Clinical variables. We felt like we really had something. And we're about to release our second paper, which I'll talk about here in a minute.

Yeah, that is impressive. So walk us through. I assume this was part of your PhD. Is that when you ran the trial? Okay, so it was kind of part of your thesis. What was the actual thesis?

Well, so I got a doctorate in social work, so a little different. We had a capstone project instead of a dissertation. And so the whole thesis for my capstone was that people, if they had the right providers in medicine and in mental health, and you understood behavior change and you gave people the right plan that was expertly input with, you know, professionals and you all worked together, that you could actually get a better outcome. But it was this multivariate problem that wasn't any singular variable. And so it was really around, how do you help people make radically small changes?

Okay, well, that's an interesting concept. There's several concepts in there. So, you know, one of the ways in which systems in life in general tend to be broken is that the components are not really communicating with each other effectively. I think another one is that it's difficult for the patient in this situation to actually figure it out for themselves. Right. That's. They kind of have to be guided into it with some.

It's an unreasonable request.

Right.

Like you can't. For a patient. Expected.

Yeah, no, exactly. That's. No, no, that's my point. It doesn't matter, really. You talked about some economic, socioeconomic challenges some of these folks had, and yet it doesn't really matter what socioeconomic strata people are in. They find it challenging to kind of implement these things. So. And then the whole concept of behavioral change, and then the whole concept of radical micro changes. So why don't you start with behavioral change? Because I think, you know, this is always a little bit of the elephant in the room. I mean, we can talk about all the great things we can do and all the great outcomes we can get, but a lot of it really boils down to someone taking the initiative or feeling motivated to take the initiative and then having the tools to do it. So you want to kind of walk us through behavioral change?

Yeah, I think, you know, we. We call. The program I developed in my doctoral work, we've since renamed, is called System for Therapeutic Alignment and Rapid Titration and Start. Right. And that's where you start. And so what we do is we say, okay, let's look at everything the patient has to look at from medically, a clinical perspective, and Then let's look at all the mental health issues that are going on and you know, what are the things that stand in the way of behavior change. Treatment burden is something that we're super sensitive to inside of our medical practice is how much treatment burden does a patient have? And then we evaluate a whole bunch of other, what I'll call non clinical variables. Everything from the social determinants of health that are actionable versus non actionable health belief systems. And what all that does is allows us to measure that vis a vis, or I guess not vis a vis, but we look at across a matrix with readiness for change. So if I have a severity score of 5 with diabetes, for example, and a commitment to change, that's very, very low. We need to actually have that conversation with the patient. And I'll give you some real world examples about that. But at the end of the day, we start with rapid titration of medicine. And once we have rapid titration of medicine, which is a small form of behavior, then we can move into other behaviors around diet and exercise. But we have to start with very, very small changes. Like for one patient it was how do you change your coffee creamer? Like that was the size of the change we had to make.

The acronym start again was something Alignment Rapid titration System.

Yeah, System for Therapeutic Alignment and rapid titration. Not published yet. In fact, this might be the first podcast we've actually shared with that name. You're the first.

Okay, well, wouldn't be the first time with the first on something. So it's good. You know, I like that. I like start. So really what you're doing is you're looking at it through the eyes of the patient, if you will, and you're, you're understanding what is the biggest hurdle to them and starting there. And it could be, it could be coffee creamer, it could be access to alcohol, swipes. I mean it could be anything. That's right, right. It doesn't matter what it is, it just matters that you can identify what are the barriers to the implementation of this. What's interesting about that is it sounds like you're looking at. Because barriers come up in different categories of things. I mean, it could be self sabotaging behavior. Right. It could be depression, it could be, you know, whatever else. So walk us through a little bit of the, the lenses that you're looking through to actually identify the hurdles.

So the easiest ones are probably the clinical medicine, because clinical medicine in most cases has kind of some type of standards of care for Most medical conditions. And so those are fairly easy to understand. And then we look at in the mental health side, we look generally at depression, anxiety and stress. And there are some pretty well validated tests we can use to figure out the severity score for someone there. And if we can intervene inside, we have mental health clinicians inside of our practice. If they can intervene, like cognitive, behaviorally, they'll do. So sometimes we have to refer somebody out for treatment. So we had a woman in our practice who was suffering from depression. And when we dove into it, her husband had died a year earlier. She hadn't gone through the grieving process and so she was referred out for grief counseling. And even after just a couple sessions with her grief counselor, we noticed her behavior improving. She had a lot more commitment to the program because she was working through that, that process. Someone else had grief counseling because they had retired without a retirement plan and they didn't know how they wanted to spend their time other than they wanted to teach young kids how to read who were underserved and they didn't know how to Eng with that population. So we actually got them on a three way call with their librarian and taught her how to get involved with the local library to teach young kids reading skills. And that helped to keep her motivated. So we start with the clinical medicine, getting them on the right medicine. We then look at the mental health issues and then we look at other things that might be getting in the way. And the other things includes anything in their life. So one person refused insulin injections and refused dialysis. And the physician said, look, they're going to pass away. We need to get them, you know, referred over to palliative care. And when I got on the phone to talk to them, to explain to them what was happening, they said, well, I don't want to die. I said, well, that's okay too, but you have to do one of these things. Either you have to take insulin right now or you have to get on dialysis right now or you're going to die. And they said, well, no one's ever taught me how to inject insulin. I'm scared. I said, no problem. How about if I get a provider on video with you right now, we'll have medicine in your house before the end of the day. And they said, well, can you bring my daughter into the conversation? And we got all the right paperwork signed so we could do that. And we had them injecting insulin by the end of the day. But no one had slowed down with them enough to figure out why they didn't want to take insulin. They were just scared of needles.

Yep, got it. Yeah. It's interesting. I think what happens for providers is that they get, they see this, they see the solution. Right? The solution is, let's say in this case, injecting insulin daily or twice daily or whatever it is, and then they feel like their job is done because they're there as a clinician to understand the process the diagnosis and then make the prescription. I don't know what it is. I think professionally it's like that's the end of the road. It's kind of like I've done my job, you know, I've done what I'm trained to do, what I'm paid to do, etc. And I think, I don't know that it's the provider's fault in a sense in that way. However, it's, I think it's a lack of consciousness on the provider's part to. And they know this, they know everything you're talking about. The problem is that in medical practices and hospitals even for that matter, it doesn't get set up with this kind of a system around the patient. Right. So did you figure out a way for people to get paid to do that? I know you're saving money, but did you?

Yeah, we have. Yeah. So, I mean, we get, we get, we have a fee for service medical practice that gets paid the same way that other fee for service medical practices get paid. And I think the good news is it's not, it's not the provider's fault. Like this hasn't been trained in medical school or, you know, postgraduate training of any kind. And so we think that what we found is a new set of clinical protocols for chronic metabolic disease that's going turn out to be a brand new subspecialty of medicine, which is how you treat chronic metabolic disease. And so we're training physicians at the fellowship level and giving them some version of CME every single week. So our providers have to go through 60 to 90 minutes of training per week normally to learn about this. And so the problem you talked about a minute ago, I talk about that as the kale and carrots problem with our providers. Like, I know you need to eat better, so let me get you to eat kale and carrots. Well, the problem is that most people are eating unhealthy, go from where they are to eating kale and carrots. They have to take these small, tiny little steps. And you know, that might mean that you go from, in one case One flavor of ice cream to another. We actually changed someone's fasting blood glucose by 100 points from one week to the next because they were only eating ice cream and drinking chocolate milk. And we changed the flavor of ice cream and that improved their blood glucose fasting seven days later. But like, these are the.

What flavor did you go to?

I don't even remember.

Okay.

And it may have been a different brand. I don't remember. But I remember that our team was looking at the backs of these pints of ice cream to figure out like.

What would be the sugar in it. Yeah, right. Yeah, that's pretty funny. Yeah, that's pretty funny. So I think you're right though, is this is always been a little bit of no man's land, right? Like nobody, nobody really takes ownership of it. It sounds like what you're doing is you found a way to take ownership of it and then build that into your practice. We do take ownership of health coaching. We take ownership of prescription of diagnosis. But what you're really talking about is almost bespoke implementation is really what this is, Right. Understanding what is the micro change that needs to occur for this person in this location at this time. And that's, that's a really insightful thing to do. So do you find that you have people that are trained now? Have you been in your fellowship program? I know you're training practitioners to kind of be savvy to this, but I can almost imagine you could have somebody from another that's not a practitioner. It could be a nurse, it could be an ma. It could be a lot of different people, social work. It could be a lot of different people that could fill in to this slot of being almost like the integrator, if you will, with the client. Right. There's got to be an element of psycho emotional understanding. There's got to be the social understanding. There's a lot of little pieces that go together here, but it seems like. It seems like a really fast standing position for somebody and almost very gratifying.

Yeah, we work in pods, right? So we want people to be working at the top of their license. We want physicians to be in that kind of diagnosis and prescription phase. We want, right, you know, APNs to be working at the top of their license. And we use social workers clinically, you know, so clinical social workers who have licensed for therapy to be doing their part of the work. We do think at some point we can do something that is more akin to like non therapeutic social work to help here as well. When we get to scale. But what we also realize is this, this is not the same work that gets done inside of a primary care practice or inside of an endocrinology practice or inside of a functional medicine or an integrative medicine practice. Like these are different skills. And I've had a lot of, you know, providers say, well, can you just teach me how to do this? And you know, I'll take a couple hours of my time. And you know, we really thought about that. It's like the answer would be if we could, we would. But that's the same as you teaching me brain surgery. In a couple of hours I might be able to learn the anatomy if I've been through medical school. But that's not the same as actually having practiced under long term tutelage. And so there's this illusion of simplicity that goes along with what we do. People forget it took us 10 years to figure this out. Now it doesn't take 10 years of training for somebody else, but it certainly can't be given in just a couple of hours.

The textbook, yeah, I can appreciate the complexity of it because you're dealing with, you're dealing with a lot of variables across a lot of different current disciplines. Right. So it's very much of an integrative thought process. And so somebody has to be kind of broad minded in their, in their skill set. I imagine there are certain personality types that actually can gravitate into this and do well, and others that, that might struggle with it that are a little more concrete or a little less able to kind of be abstract and pull a solution from an unseen, you know, spot, so to speak. Like if we just change the elevation of the bread, you know, maybe their GERD gets better, maybe that's the first step. And then they don't blah, blah, blah and blah blah, blah, and they get a good night's sleep and then they can shoot their insulin or whatever. Right.

So there's a lot of learning from each other too. I mean, a lot. I mean there's, it's constant case review and constant learning about the different things that, you know, like our people have to know how to understand how to find someone's library system so they can call the librarian with the patient on the phone and have that three way call if that's what the patient needs.

Right.

And as importantly, we're set up so that if we're working with a payer, a payer may have a nurse navigation line and a care coordination team. And so we're designed to not do the Same work, it's already being done inside their payer group. And so if one payer group has exceptional care management and another payer group has an exceptional nurse hotline, each patient's going to be guided back to the resources they already have in a helpful way so that we're not having the system double pay for a resource.

Yeah, that's a good point too. And yet somebody's got to keep tabs on what they're not doing. Right. Even though they're good at. Right. So what are, what's not being done? And that takes a degree of mental flexibility. Right. So these people are, they're not air traffic controllers, but in a way they're kind of doing some air traffic controlling. Right. All these different things coming at them. Right. So it's.

Yeah, we have a great system of communication where, you know, I would say a lot of primary care physicians, when they first hear about what we're doing, might feel like we're stepping on toes. And then when they actually get into the, the actual details of what we do and how we do it, they say, well, gosh, you're actually helping me. And then we say, well, wait till you see our continuation of care note, because we're going to go to all the providers, all the pharmacies, we're going to do the entire medicine reconciliation, and we're going to give all of that to you in the way that helps you the best. And so, like, one great example of that is when we have patients that come out of the hospital and get referred to us. We don't actually do what's called a transitional, transitional care management visit. We get all the paperwork together, hand that off to the primary care physician and say, you do that TCM visit because that's your role now. We're going to do all the heavy lifting. We're going to take all the paperwork to be successful at tcm and we're going to have done that for you so that you have light lifting, you go spend your time with the patient. Here's all the paperwork you bill for that visit. We don't need to. That's not our business model. And they, I mean, tears of joy when they hear that, Right?

Absolutely. Well, you're, you're actually, I mean, the biggest worry that a clinician has is that they're doing the good work of making a diagnosis in the prescription, and yet their clients or patients aren't getting better because it's not being implemented. Right. That's their greatest. And so if you're, if you're helping with that integration execution. Oh, yeah. I mean, it's high five all day long, right? So yeah, that's cool.

There's a cardiologist here in Austin that was having trouble with one of the. One of the. The patient's not making the adjustments they had to make and they're an exceptional cardiologist. I mean, we work with them regularly. They said, hey, I've got this one patient that I want you to see if you'll take them on. We know that your stuff works for type 2 diabetes. We've also seen it works with CHF and, you know, other cardiovascular disease. And there's some early evidence that pulmonary disease will be treated similarly. They said, would you mind taking this patient on too? And we did. And it was, you know, again, successful. It's great to be able to support specialists where they want the support, knowing that they're still a specialist and they're still driving, you know, driving the treatment plan for the conditions they specialize in.

Do you have any hybrid models or you're working with functional medicine physicians or longevity medicine physicians that are working in a cash based world and do you have any overlap with them where the individual's insurance can pay for some of the implementation things that they're finding might need to be done? Is there any kind of hybrid kind of scenario like that?

Yeah, I would say we're working on that right now. There's three different functional medicine practices that we're talking to right now that want to engage us in that way. And so we haven't kind of got all the finishing details on all of that. We think there's a lot of there there. I think in most functional medicine practices though, you get patients who are generally more healthy, generally more motivated to change, maybe need a little bit less of the type of help that we provide. And so I think we're going to find that a lot of functional medicine physicians are pretty well suited to do a lot of the work we're doing. Maybe just a little extra nudge here and there for a few patients.

Yeah, I think that can be true. I think one of the recurring themes here from a patient's perspective that I'm hearing is a sense of overwhelm when they, when they feel overwhelmed by either a circumstance or complexity or, you know, whatever it is, you're kind of coming in to simplify and remove the sense of being overwhelmed. And I think feeling overwhelmed can happen in any practice. Right. So particularly depending on how in depth people are going and how much they're trying to do at once. And their own appetite for change can also lead them to a place of being overwhelmed, even though they're eager to change. Right. So many things that can contribute. And I don't think that's, I think that's, you know, that's as possible in a functional medicine practice as it is a traditional one. I'm trying to think maybe even in, maybe even in a psychology practice potentially of some sort, people could feel overwhelmed with what's being asked of them. So anyway, I think it's, it's a really, really intriguing, interesting thing. What's the bigger strategy here? Is this something you're trying to scale, something you're trying to prove out, something you're trying to turn into a local Austin business? Or what's, what's, what are you trying to do here?

So in Austin we've got kind of a medical practice that has, so we have a little primary care practice and concierge, functional medicine practice that is kind of like our laboratory. That's not the big deal. The big story for us is how do you reverse chronic metabolic disease, which would be type 2 diabetes, hypertension, you know, CHF, and how do you then apply that to things like, you know, pulmonary disease and even steroid utilization to get people off of steroids more quickly? And so we know that three and a half billion people in the world have some type of chronic disease. About a billion of them fit into the work we're doing. And so we want to go work with, you know, large scale employers to help them reduce the cost of healthcare with employer groups and help them reduce the cost of care by, you know, we think every dollar that gets spent on this type of work, we're seeing about a five dollar savings for an employer. So that would be helpful. And then all of the financial success we have at our practice, we're taking to try to then take this to even lower income populations. Like how do you go deploy this in sub Saharan Africa and how, you know, we've, we've cut a huge amount of the cost out of the process. But how do we then cut the cost by 90% again and increase the quality to, again and how do you really make just this type of clinical help more successful? We think we've already got a line on a way to like reduce the cost of mental health care by 95% using a number of different kind of clinical innovations, including artificial intelligence to listen in to peer counselors for kind of therapeutic markers that would say now you need a therapist, because that's gone out of the bounds of, you know, peer counseling and into the bounds of, you know, clinical therapy. And so we think there's ways to use AI to be much, much more successful. And we're really excited. We're using AI in 13 different places in our practice. But none of those things get in the way of the relationship between the patient and the provider. So we don't need a patient using AI for medical care, but we do use AI to give patients better information, more information, by lowering the overhead for our providers.

Yeah, yeah, no, that makes sense. You know, there is. Speaking of mental health and AI, there's a lot going on in trying to democratize mental health by utilizing AI practitioners, if you will. And looking at that, it's interesting. I've played with that a little bit just to look at the emotional intelligence of AI at this point in time. It's, it's a little bit not there yet, but yeah, it sort of tries to be there, but it's not there. It's. You can see that it's. I mean, it's not going to get worse than it is today. Right? So, yeah, yeah.

I mean, I tell people all the time, I talk about this on podcasts and we talk about, like, how does an AI, you know, function as a computer and how does the brain work? And, you know, we have, we've written some internal AI to emulate some of the emotional stuff that goes on in conversations, but it's only an emulator. You know, a computer, broadly speaking, processes things like the cerebral cortex, but it doesn't process things like your limbic system or your amygdala. And we don't have computers that will do that today. And even like, quantum computing would allow for more bandwidth, but not a change in terms of how we actually process the information. And so in the absence of that, we've had to put some emulators together internally for our practice to solve that very problem. But very few people that I've talked to know how to do that. Like, it's been a two year process just to set up that one piece of the engine. And then when you put the whole conversation through that, you've got to deal with latency problems and, and, but we're doing that today and with, with pretty good success so far.

Yeah, no, that's really intriguing. Yeah, it's a, it's a nice way to democratize right when you can. Or scale right when you, when you can get something that can help. And it sounds like what you're doing is you're scaling by allowing lower trained people to carry on these peer conversations until it becomes clear that they do need somebody else.

So there's not enough mental health workers in the world. And so we want them working again at the top of their license where it's most important, important. And so, and, and I think you've also got this idea that, you know, people in their, as they retire are getting kind of sidelined by society as being, you know, less important to society. And from a sociological point of view, that couldn't be, you know, more untrue. Like, you know, there's so much wisdom that's being sidelined. And so there's a. I have a personal notion that I want to kind of bring all that wisdom off the sidelines and back into society where we have this mental health crisis and this isolation crisis where people feel lonely. And it could solve all of this with just a few of the right conversations. And so that's one of the byproducts of the way that we're engaging in the conversations. We're engaging in.

Very cool, really, really cool stuff that you're working on. I can see how you got intrigued by this. And it sounds like actually the further you've gone down the road, the more possibilities you've seen as you keep building out into them. Right. I mean, that's kind of what I'm sensing here. So that's always.

Yeah. I mean, our, our second study, we're going to release the data here, we're going to try to get it published. But, but the high levels, we had a larger cohort of patients who had an average A1C of 11.06. And within 12 weeks, we had them down to 7.8 at 180 days. So 24 weeks, we had them down to seven point two. And 30% of them off of insulin entirely.

Yeah, that's remarkable. I mean, if you're listening to this, it's not only remarkable from the standpoint of the, let's call it the health cost savings in the immediate, but it changes the trajectory of these people's lives. The compounding impact of having high glucose and high insulin levels. I mean, if they still are able to make insulin. But the point is that those are really aging accelerants. And so everything in terms of vascular disease, brain dysfunction, kidney failure, on and on and on, immobility, bone density loss, muscle mass loss, all these things. If you're changing that whole trajectory, it's making a massive difference, not just in the, you know. Well, we got a few people off insulin so we're saving a couple of bucks. That's. That's the tip of the iceberg of what you're actually doing. So that's very cool.

It's not sexy work. That's the thing we've learned is it's. It's very much in the weeds, getting muddy, and our providers love it. You know, they say that we used to have a success story before they worked at our company Pursina. They're like, once every six months, one of the 25 of my team would have a success story, and now they're having multiple success stories a week, every single provider. And so they just. They love getting up and coming to work every day.

Yeah, no, that's. That makes sense. Well, mud wrestling is kind of sexy. You know, that's.

I'm going to tell them. I'm going to. I'm going to steal that. I'm going to tell.

Exactly. Yeah. So there you go. Well, cool. Very cool. What else would you like to chat about? Anything else that you want to bring forward?

Yeah, I mean, we're excited. So I think that if you're. I don't know when you'll be sending this out, but we're trying to write a book for our patients right now that people want to read about this. We hope to have that book out by the end of the year. And then I do a podcast for just stories of hope called Tales of Abundance, where we just have cool stories about anything in life that is going to, you know, describe abundance and give people hope. Hope is such a powerful tool when we're talking about some of these problems. And so we literally talk about anything from Bitcoin to good eating. And really, anyone that has a story of hope, and so you should go check it out. We just had a guy that was allowed to talk about being a CIA spy for a few years, and so just weird, hopeful stories. That it?

Yeah.

Yeah. So.

No, that's awesome. Yeah. So talesofabundance.com I think, is the link for that. If you're listening to this. T A L es of abundance dot com. All one word there. And what's. What's pracna. That's another.

Yeah, Prisina is the. Yeah, Prisina is the. Is the medical practice. That's the place where we're doing all this research, all this medicine. We're a medical practice that has therapists, mental health therapists, but that's what we are. We talk a lot about the technology and the protocols, but the reality is we're a medical practice. We have paying patients who come in every day, and this is just where we're really focusing our time and energy on.

Yeah, I love it. I love it. Yeah. Well, you're making. You're making the real difference, right? It's one thing to make a recommendation, it's another thing to allow somebody to be able to implement it. And that's. Yeah, that's. That's when change is actually happening. So, yeah, kudos to you. Really, really strong work. Awesome.

Thanks. I appreciate that.

Thank you for listening to this week's episode of the Gladden Longevity Podcast. If you would like more information on what we've discussed or other topics, please reference the show notes or go to gladdenlongevitypodcast.com youm can also find us on Instagram, Facebook and Twitter by searching Gladn Longevity. If you've enjoyed this podcast, please subscribe to get future episodes delivered to you and share our podcast or this episode with someone in your life that you may find benefit. Thank you for listening. We'll be back next week with another exciting episode. The Collide and Longevity Podcast is provided for informational purposes only. It does not constitute medical advice. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding your medical condition. The use of any information and materials linked to this podcast is at the listener's own risk.